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SOUTHERN

MEDICAL AND SURGICAL JOURNAL.

EDITED BY

L. A. DUGAS, M. D.,

PROFESSOR OF SURGERY IN THE MEDICAL COLLEGE OF GEORGIA.
AND

HENRY ROSSIGNOL, M. D.

MEDICAL COLLEGE OP GEORGIA.

C 4 1 Q X ;: - ,

v* -jfc -c'^ifl1 prcnds le men ov. je ic trouvi

VOL. XII. 1856. NEW SERIES.

AUGUSTA, GA:

McCAFFERTT'S OFFICE-J. MORRIS, PRINTER.

1856.

V

Oo SOUTHERN

MEDICAL AND SURGICAL JOURNAL.

Vol. XII.] NEW SERIES. JANUARY, 1856. [No. 1.

ORIGINAL MJ) ECLECTIC.

ARTICLE I.

On Scarlatina. By Columbus W. Smith, M. D., of Jonesborough,
Georgia.

In attempting to write upon this subject, I am fully aware bow
difficult a task it is. Many learned and experienced men bave
endeavored to present it in its true ligbt, and yet scarcely any two
agree. It is my design to present tbe disease as it bas recently
appeared under my own observation.

Tbe simple form of tbis disease, termed Scarlatina Simplex, was
generally usbered in witb chill, pain in tbe bead and back, follow-
ed by fever; some slight stiffness about tbe neck and lower jaw.
Tbe tongue was very variable in its appearance: it was generally
furred white, with papillae; of a red cast showing themselves through
the fur, more or less numerous ; in a few cases it was a bilious or
brown fur, with red edges and without the pimples ; but when it
bad this appearance it was always attended with vomiting of a
bilious character, and it assumed more of a general redness after
the vomiting bad subsided. In some cases tbe patients were at-
tacked witb vomiting and diarrhoea, one or both at tbe same time.
The fauces were invariably red, inflamed and tender, and at times
pain was experienced during deglutition," but by no means very
acute. No catarrhal symptoms were present ; the pulse was gen-
erally full and frequent, and the skin hot and diy, although a
perspiration would come on once in 24 hours, and last a longer or
shorter time ; frequentlythis would occur in the night, after which

N. S. VOL. XII. NO. I. 1

Smith, on Scarlatina. [January,

the fever would be somewhat moderated. The appetite was occa-
sionally impaired ; at other times it seemed as good as in health.

In some individuals an eruption would make its appearance,
of a red or scarlet color, with innumerable pimples or small eleva-
tions over the skin. This took place usually within the first
forty-eight hours : it commenced on the thighs and body, and ex-
tended over the whole trunk. By rubbing the finger over the
eruption it would feel rough, and by depressing the skin with the
finger, a white spot would appear and the red would immediately
return. The face was somewhat swollen. This eruption is very
irregular in its duration; it generally continues growing thicker
and redder until the fourth day, and then gradually declines until
the seventh or eighth, when it entirely disappears with desquam-
mation of the cuticle. About the fourth day the fever and inflam-
matory symptoms begin to decline ; but the eruption did not show
itself in half the cases we saw, and when there was no eruption
there was no desquammation ; the fauces would at times be red
and tumid previous to the attack in either variety of the disease.

Scarlatina Anginosa.' This variety of the disease might be
described in a very concise manner, for in truth it seems to be
nothing more than an increased or aggravated degree or form of
the preceding; but we will try and lay it down more particularly.
It was most frequently brought on with chill, high fever, head-
ache, pain in the back, loins, &c. The pulse was rapid, and much
more feeble than in the preceding variety ; the temperature of the
surface was much higher ; fauces and adjacent parts were much
more inflamed and tumid. There was also considerable difficulty
in deglutition ; hoarse voice ; a tough mucus was secreted or
thrown off by the tissues, which appeared to impede respiration
more or less in fact, where the tonsils were much swollen and
prostration very great, some seemed to sink from suffocation.

The prostration in this variety was much greater than in the
preceding. The tongue was generally furred white, and the pa-
pillae were very manifest upon it The fur soon left the tongue,
and at once it became red and dry, and continued so until an
abatement of the symptoms supervened ; it then grew moist and
paler until it lost its florid hue. Ulcers were formed on the ton-
sils, on the tongue, inside and at the corners of the mouth ; in a
few instances, two-thirds of the tongue were covered with a scurf

1856.] Smith, on Scarlatina. 6

or scab which yielded to mild astringent gargles. The catarrhal
symptoms were absent in every case occasionally vomiting and
diarrhoea were present in the beginning; in others the diarrhoea
did not set in until the latter stage. It was then beyond the reach
of remedies, and dissolution soon took place. In the latter part of
the disease, when fatal, the patients became very restless, rolling
and tossing about on the bed ; in many of the cases which recov-
ered, the cervical and other glands about the lower jaw became
enlarged, suppurated and discharged a large quantity of pus. In
those who died, the glands did not become swollen, from which cir-
cumstance we were at first led to think it a favorable symptom.
It was always six days before any abatement took place, and more
frequently not until the eighth, but always on the tenth an abate-
ment was manifest, perspiration came on, and a subsidence of the
more distressing symptoms was obvious. One of the most re-
markable things connected with it was, in several cases, no loss of
appetite occurred through the course of the attack.

The eruption was more irregular and uncertain than in S. sim-
plex ; some recovered with the eruption, others recovered without,
while others died, with their skin as red as flannel. Delirium was
present in a majority of the cases.

Scarlatina Maligna. This grade of the disease differs from
the others, and is indeed what its name indicates, malignant, in eve-
ty respect. It usually appears with chill, followed by fever, head-
ache, pain in the back, loins and extremities, with stiffness in the
neck and lower jaw; the pulse is feeble ; the reaction is not very
j great ; the heat of the skin is not very high it is lower than in
j S. simplex or in S. anginosa. The tongue was red from the be-
i ginning, and also the fauces and adjacent parts were highly
i inflamed and swollen ; a mucus was secreted which interfered
with respiration, and the parts were so tender and tumid, that
deglutition was performed with difficulty. Ulcers were early
j formed on the tonsils, of rather white appearance, which soon
I gave way to others of a dark brown color, and altogether more
i malignant. The tongue and roof of the mouth became very dark
and extremely dry ; the lips also put on a very dark, dry, parched
appearance. The nose ran a watery mucus, and the breath bore a
very offensive odor. The rash or efflorescence was so variable
that it is unnecessary to speak of it : it was frequently absent, and

6 Smith, on Scarlatina. [January,

so uncertain that it was of no practical importance -whatever. In
a few hours from the commencement, delirium occurred, the vital
powers gave way, the patient fell into a state of collapse, and
death ensued.

Death took place in one case in twenty-four hours, and none
survived through the sixth day.

Sequela?. The diseaseT in the epidemic of which we speak, was
followed by anasarca, and in one case rheumatism of the joints of
the upper extremities. These were the only diseases that suc-
ceeded it.

Prognosis. In this epidemic the prognosis was not very difficult.
In S. simplex all recovered, and many did not take their beds
from it. In S. anginosa, when delirium supervened and continu-
ed without intermission, with a high grade of inflammation about
the throat, pulse quick and feeble, at times the surface would get
cool, great restlessness, often turning in bed and attempting to rise
or get out of it, cold sweat, diarrhoea, &c, death was the result.

In the cases that recovered, about the eighth or tenth day a
general abatement of the symptoms was obvious ; less fever, with
perspiration ; delirium began to moderate; appetite improved, and
countenance brighter ; the tongue was moist on the edges, which
gradually increased until it covered the whole mouth : the florid
hue at the same time was disappearing, convalescence was fully
under way, and by the fifteenth day they were able to sit up at
short intervals.

The prognosis in S. maligna is generally easy. In twenty-four
or forty -eight hours the delirium was complete ; the prostration
great, the pulse feeble, respiration hurried, great restlessness ; the
skin was under the ordinary temperature, with dark, congested
spots about on the body and below the eyes; the countenance was
of a peculiar ghastly appearance, indicative of great distress and
anxiety. We saw no case without a majority of these symptoms,
and they all died.

Those who died were from one to thirteen years of age, and
none died who was over that age.

Treatment. Most authors teach us that scarlatina is a disease of
the skin, and their treatment is predicated upon this belief. We
are decidedly of the opinion that it is not exclusively a disease of
the skin, and that the eruption should be taken into very little ac-
count in determining our practice. Our attention should dwell

1856.] Smith, on Scarlatina.

xrpon the particular symptoms attending the case, and our treat-
ment should be directed accordingly.

In the simple variety it was hardly necessary to do any thing
all recovered ; but when a treatment was adopted it was the mild-
est and least irritating. In the beginning, a light laxative of
sulph. magnes., Seidlitz powder, or oleum ricini; during the day,
small doses spirits nitre every two hours, or spiritus mendereri, or
any mild diaphoretic; at bed-time a warm pediluvium; a dose of
paregoric to a child, or of Dover's powders to adults, if the fever
is not too high, and all will be well.

Treatment of S. Anginosa. If any variety of scarlatina demands
close attention and careful treatment, it is this. S. simplex will
get well if let alone, and S. maligna almost as certainly kills; and
if any good can be done, it is in S. anginosa.

In the incipient stage, an emetic of ipecacuanha was given, and
followed by warm infusions, until full emesis was produced. This
was done to remove, if possible, the tendency to visceral conges-
tion, after which the stomach was quieted with an opiate, and then
a gentle saline laxative, or oleum ricini or any mild aperient was
administered, being careful not to induce active purging; after
which diaphoretics were given as vinum ipecac, one-third, and
spts. nitre, two-thirds every two hours, in warm, weak infusions
of balm, sage, &c. ; or nitrate potash, three grains ; ipecac, one
grain, intimately mixed, and given as above, and in doses sufficient
to nauseate. Spts. mendereri may also be used, or any mild dia-
phoretic, with the exception of antimonials; at night, warm pedi-
luvium. If the fever was not too high, and the sensorial functions
too much disturbed, a Dover's powder was administered ; when
the skin became cool and pale and the pulse feeble, the mustard
foot-bath was used three or four times per diem, and also a sinapism
to the spine. If a reaction did not come on, carb. ammonia was
given in doses sufficient to raise the pulse as often as the case de-
manded it When this did not answer, brandy and water, or
other stimulants, were substituted. An application of sinapisms
was made to the stomach and bowels if they were disturbed.

Much has been said and done respecting the use of cold water.
In the epidemic of which we speak, no good was effected by it :
in some instances injury followed its use, and it was altogether
improper to use it in either variety.

Gargles were wholly useless in the early stages, and with chil-

8 Smith, on Scarlatina. [January,

dren they did barm ; but in the latter stages, when ulcers were
present, they were of great benefit. The mild astringent gargles
were best, such as alum, infusion of sage, honey and borate of soda;
a strong infusion of cinchona, with or without tinct. myrrbae.
Strong and irritating gargles, such as salt and capsicum, &c., &c,
were injurious, and cannot be too strongly condemned.

Blisters were used to the throat and nape of the neck in the
incipiency, if inflammation ran high in those parts, but their use
was not attended with much apparent good. They should be
used with great caution.

Treatment of S. Maligna. This variety of the disease ran its
course so rapidly that scarcely anything could be done. When
time was given, it was treated in the same way asS. anginosa. If
the reaction was high, an emetic was given, followed by gentle
aperients; in the sinking state, counter-irritants and stimulants,
carb. ammonia, wine, brandy, elixir vitriol, &c., always selecting
such as seemed best adapted to the case.

During the stage of excitement, in each variety, cold water was
allowed in small quantity, and acidulated if desired. The diet
was mild and nutritious; the rooms were ventillated, and the
clothing and beds were kept clean.

From our observations in this affection, we have been led to the
following conclusions : That scarlatina is not strictly a disease of
the skin, the eruption being merely an effect or an occasional
symptom. We could with as much propriety call typhoid fever a
disease of the skin, because an eruption accompanies this affection.
We think that scarlatina is a modification of the blood, producing
great prostration of the nervous system, followed by inflammation
of one or more of the internal organs, occasioned by some occult
effluvium in the atmosphere, of which we know nothing.

These facts considered, it is but reasonable to conclude that the
treatment should be mild and unirritating, as the attack sets in with
so much violence as to prostrate the patient at once. We there-
fore deprecate calomel purges, antimonials in any form, blisters,
venesection, &c. They cannot, in our humble opinion, be too
strongly condemned. As respects the application of cold water,
we have ever been taught that in no disease of the throat or tho-
racic viscera should it be used, and we know the throat and fauces
are invariably sore, inflamed, tumid, &c. This reason, of itself, is

1856.] Holt's Letters upon General Pathology. 9

sufficient to proscribe it. We therefore place all of the last named
articles in the same category. Those strong and burning gargles
never do good, and often do harm, especially with children.

ARTICLE II.

LETTERS FROM SAUL. D. HOLT, II. D., UPOX S01IE POIXTS OF GEXERAL PATHOLOGY.

LETTER NO. 7.

Montgomery, Ala., Nov. 25th, 1855.
Messrs. Editors Notwithstanding the advancement which has
been made in the science of medicine, and especially in physiolo-
gy, pathological anatomy, and animal and vegetable chemistry,
there has been nothing like a proportionate advancement made in
the art of curing diseases; and one of the principal reasons for it,
I think, is to be found in the fact, that most of our young physi-
cians set out upon their professional career without having been
sufficiently indoctrinated in the principles of general 'pathology.
They may have been well instructed in the causes, symptoms,
diagnosis, prognosis, treatment, &c, of diseases, as they are taught
in the medical schools, and from their text-books, according to the
most approved and correct nosological arrangement and classifica-
tion, and they go forth into the world impressed with the idea, and
confident belief, that they are fully prepared for every emergency,
and that nothing remains to ensure their success, but to apply
those rules to practice. But they often find themselves doomed to
disappointment and defeat, and sooner or later discover that the
systems of practice founded upon the nosological classification of
diseases which they had regarded as the standards of excellence
and perfection, are unsatisfactory, unreliable, and often inappro-
priate to the man3r changes and modifications which diseases are
constantly undergoing, from the influence of climate, seasons, at-
mospheric changes, conditions, &c, which can be met and provided
for only by a correct knowledge of general pathology. Now, I
am not opposed to the nosology and classification of diseases, as
taught in the schools, and by systematic writers generally ; but I
am opposed to the systems of practice founded upon the simple de-
tail and enumeration, in their order, of the symptoms which char-
acterize the diseases to which they respectively belong, according
to their most approved nosology and classification, and I fear that

10 Holt's Letters upon General Pathology. [January,

it will be a long time before we shall see much advancement made,
or have any thing like a uniform and reliable system of practice
established, unless the present system is changed, and diseases
come to be treated, not according to their name, or the class to
which they may belong, but according to the condition which they
present, and the symptoms upon the merits of their real pathology.
If proof is wanted in support of the truth of the assertion, that the
practice of medicine has not advanced in proportion to other
branches of medical science, it is only necessary to examine the
history of some of the most common diseases, as described by the
systematic writers of the present day, and compare them with
those diseases as described by the old systematic writers who
named and classified them. Take Pneumonia, for example, and
what neiu features of the disease do we find, which they did not
notice, what new indications of treatment have we to fulfil, which
they did not recommend, and what new remedial agents have we
which they did not possess. We have the lancet, emetics, cathar-
tics, diaphoretics, expectorants, blisters ; so had they. We have
calomel, tart, emetic, opium, quinine, &c. they had calomel, tart,
emetic, opium and cinchona. We have phosphorus, bryonia, bel-
ladonna and aconite ! Alas, they died before the days of Hahne-
mann and Homoeopathy. We have steam, lobelia, composition
and number six ! but to them, the powers of steam and Doctor
Thompson were alike unknown. Yet, with all the improvements
suggested by these two great luminaries, it cannot be perceived
that the disciples of either have made any great advancement in
the healing art, or that they have improved much upon the old
method of treating pneumonia, and other diseases. What success
those old practitioners had in the use of the lancet, calomel, and
other time-honored remedies, we have no exact means of ascer-
taining, unless we take as evidence the fact, that the testimony
which the}- have given of their value and efficacy m the treatment
of certain diseases and conditions, has had the endorsement of each
age and generation through which it has passed; and it cannot be
considered uncharitable in us to suppose, that they were as suc-
cessful in the treatment of pneumonia, with those remedies, before
the time of Hahnemann, as his disciples claim to be with phospho-
rus and aconite. Now, my idea is, that these old pioneers and
fathers in physic, who named and classified our diseases, under-
stood pretty well their special patholog}', and also the power,

1856.] Holt's Letters upon General Pathology. 11

efficacy, and value of the remedial agents which they placed in
our hands to be used, with a sound judgment and discretion, (in
which manner, no doubt, they used them,) each one in its proper
time and place, according to the symptoms indicating its use. But
there is one great desideratum which they could not supply, name-
ly, a quick perception, and a sound and discriminating judgment,
to make the proper use and application of those remedies, the want
of which has not only brought some of the most valuable of them
into disrepute, and led to their rejection, or discard such, for in-
stance, as calomel and the lancet but has rendered these two arti-
cles if not the ivorst used, at least the best abused, of any other two
in the materia medica. It is true, that diseases are subject to such
changes and modifications, in their general character, as to require a
corresponding change or modification of treatment, for which our
old authors made ample provision for supplying us with the means
and remedial agents best suited to those changes and modifications
not supposing, I dare say, that they were to be used after the
manner of the backwoodsman, who sat down to dinner at a fashion-
able hotel, and finding a bill of fare before him, thought it incum-
bent upon him to eat through it in regular order ; or, perhaps, like
a certain disciple of Hahnemann, not a hundred miles from this,
who being called upon by a lady for something to ease an aching
tooth, after palling often, and prescribing a great quantity of reme-
dies, it finally became easy. Upon his next visit, finding such to
be the case, he exultingly exclaimed, "Ah, ha, dat ish goot dat
ish it." But, said the lady, why did you not give me your last
remedy at first, and spare me from so much pain ? " Oh no, ma-
dam, dat ish not goot, dat will not do, it ish not goot; it will not
do to skip." And so it is, I have no doubt, with many who essay
to practice the healing art, according to the most approved nosolo-
gical arrangement and classification of diseases. They find a bill
of fare before 'them which they feel bound to go through with,
believing that "it will not do to skip." And it is often a long
time, and not until they have had a regular surfeit, before they find
out how to make a proper selection, or discover that it will not do
to slcip. Now, I do not wish to impeach or impugn the character
of the medical profession : on the contrary, I wish to defend it ;
and I would ask, in all sincerity and candor, of those members of
the profession who have raised their voices in denunciation of cer-
tain remedial agents namely, calomel and the lancet whether

12 Holt's Letters upon General Pathology, [January,

their opposition is of a negative sort, not founded so much upon
experience, or observation of their use, as upon the fashionable

sentiment of the profession. Whether their opposition is founded
upon a conscientious belief of their inefficiency, their inappropri-
ateness, and their dangerous or destructive tendency, after oft-
repeated and unsuccessful efforts to apply them to those diseases
in which they have been most highly recommended; or whether
it is founded upon a reckless use and consequent abuse of those
remedies, which by their indiscretion and want of judgment they
have aided in bringing into disrepute, and from mercenary motives,
or a desire to shield themselves from just and well- deserved cen-
sure, and maintain their place in popular favour, that they have
joined the general crusade against these remedies? This maj^ be
considered a harsh criticism, but it is, nevertheless, a true one, and
will apply to every practitioner in the South, who has publicly
denounced the use of these remedies, and especially calomel, as be-
ing unsuited to the treatment of bilious diseases ; and I care not
which horn of the dilemma he may take. If it is to follow fashion,
his opinion is worth nothing; if it is from a want of confidence,
from the want of success, or the apprehension of danger, from the
lack of a knowledge of its proper uses, he is to be pitied ; and if it
is to foster popular prejudice, from selfish and mercenary motives,
he should be despised. For no physician, however well founded
may appear to be his objections, can be justified in publicly de-
nouncing a well-known remedy, because he may have been unfor-
tunate or unsuccessful in its use ; for, by so doing, he is only
exciting and fostering a popular prejudice against a remedy which,
in more skilful hands, would prove most efficacious and useful.
And until some course of experiments and observations are insti-
tuted, to show that the liver has no material agency in the pro-
duction and aggravation of the malignant forms of diseases in hot
climates, and a set of arguments adduced to' prove that calomel is
not the most certain and reliable remedy known to the profession
for regulating and controlling the functions of that organ, I shall
be compelled to continue in the belief, that the sins charged to the
account of this remedy belong not to the remedy itself, but to those
who have misused and abused it.

But let us go back awhile and see how matters stand with our
bill of fare friends. Well, some get through with it, though they
find it generally, " a hard road to trabble, I b'lieve," and find out,

1856.] Holt's Letters upon General Pathology. 13

after awhile, that they have consumed a vast amount more than
was necessary and proper ; because they did not know when, or
where, or even that it was proper for them to "&ikp" but finding
out that they are at liberty to make selections, and becoming better
acquainted with its contents and arrangement, they are satisfied
to let it remain as it has been furnished to them, and are opposed
to rejecting or discarding any article from the bill, because it may
not, under circumstances, have agreed so well with their powers of
digestion. It is among this class that we must expect to find, and
do find, our most scientific and best practical physicians men
who are soundest in judgment, freest from prejudice, most liberal
in sentiment, and who take a common view always, as the best
view of things. Such men find the lancet as efficient for good,
and as potent for evil, to-day, as it was ten, twenty, or fifty years
ago, and the same of calomel, tart, emetic, &c, and if in their use,
they should fail to accomplish the objects and purposes intended,
the failure will be attributed to the true cause the want of a pro-
per application and use of the remedy. There are others, again,
who, by the time and even before they have gotten through with
the bill, either from fastidiousness of taste, from feebleness of diges-
tion, the loss of appetite, or a surfeit from the too free and liberal
use of certain articles in the bill which they desire to have changed
by striking them out and substituting something better suited to
their appetites and tastes. They have gone out among the foreign
restaurats and cook-shops, and found a few fancy articles in the
establishments of Hahnemann, Doctor Thompson and Graeffenburg
(institutions which appear to be under the peculiar fostering care
and protection of the legislature of Alabama) which they wish to
have inserted in the bill of fare, in lieu of the rejected ones.
Now, I do not wish you to consider me as belonging to the
"Hard-shells," or so "old Fogyish," as to be opposed to all pro-
gress and reform, especially as I am willing to adopt the sentiment
of your journal, " Je prends le bein oil je le trouve," provided we
confine our researches to the legitimate domain, and do not have
to descend too low to get the good; nor do I consider all move-
ments as a sign of progress, as we may discover in the motions of
a sea-crab, whose progress is generally backwards. And so it is
with most of the ph}*sicians of this class ; having neither con-
ceived or adopted any well digested and reliable opinions, as their
own, and having no fixed rule or principle of action, and as little

14 Holt's Letters upon General Pathology. [January,

confidence in their own judgment and the efficacy of the remedies
which they use, they are perpetually shifting their ground, advo-
cating a doctrine or a theory one day which they combat the next,
extolling a remedy at one time and denouncing it at another, but
always u aufa.it" and well posted in all new inventions and dis-
coveries, but never make any themselves. These are they who
have endeavored to bring into discredit the lancet, calomel, and
other valuable remedies, and attempted to foist upon the profession,
as their substitutes, such articles as aconite, phosphorus, and bry-
onia. No, no ! call me Fogy call me Hard-shell ; but let me not
progress in that direction. Give us what you please, gentlemen,
but do not compel or ask us to discard or strike from the bill, our
first principles, as our "backwoods" friend termed his bacon and
greens. There are yet others who have labored to get through the
bill of fare as it has been served up for us by the old fathers in
physic, but have not succeeded, for the reason that they have
seized with too much avidity upon a single article, which they
could not be induced to relinquish until they had gorged them-
selves beyond satiety. To this class belonged the famous Doctor
Sangrado, who, though he may have but few disciples, so far as
blood-letting is concerned, in the present day; yet there are plenty
of Sangrados in many other respects besides that of blood-letting,
and if their work is to be judged of by the same rule, namely, the
number of widows and orphans in Valladolid, it might be a difficult
matter to determine which had been the most successful, the ancient
or the modern Sangrados. The means used by each, though some-
what different in character, in principle have been about the same ;
for while the Sangrados proper effected every thing with the lan-
cet, others have been about as successful with emetics and cathart-
ics, upon the principle that man, like a gun-barrel, only required
to be kept well washed out, to keep him in good shooting order;
and if one washing was not sufficient, it was only necessary to give
him another, and so on, to the end of the chapter. Others, again,
have gone upon the principle, that man had no room in him for
more than one disease at a time, and straightway they commenced
crowding in one, which they thought they understood, for the
purpose of crowding out one which they knew little about; and
so calomel has had its day, and so things have gone on, up to the
time of the discovery and introduction of quinine into practice,
when all the little Sangrados, acting upon the advice which the

1856.] Holt's Letters upon General Pathology. 15

immortal Gil-Bias gave to his illustrious prototype, resolved to
" change their method" and " prescribe chemical preparations, what-
ever might be the consequences" have united in one grand league,
constituting the present Sangrado family, who see every thing
through the medium of periodic spectacles, and who have such
strong faith and confidence in the anti-periodic and - proper-

ties of the article that it would not be surprising if we were to hear
that they had offered to stop the oscillations, and to depress and
keep down the sawyers in the Alabama and Mississippi rivers
one effect, however, has evidently resulted from the change, name-
ly, a positive reduction of the number of widows and orphans in
Valladolid. But what is to become of those Sangrados who have
" written a book " ? They must either acknowledge themselves
" disabused," or fight it out, as Gil-Bias did ; and let nobles, clergy
and people perish, but not their reputation.

Now, if it is seriously charged and maintained, that the intro-
duction of quinine into practice constitutes an era of improvement
and progress in the healing art, I would reply, that it is but a tri-
umph of chemistry, and that its active and valuable properties
were known and appreciated by the profession long before its dis-
covery, (in the substance of bark) which they liberally used, and
that its discovery has developed no new principle of general or
special pathology ; and that while its introduction has had the
effect of facilitating the cure of malarial and periodic diseases gen-
erally, and of drawing the attention of the profession from the use
of other valuable and powerful remedies and diminishing the
chances for their abuse, and of substituting a less evil for greater
ones, if not a positive good for those somewhat doubtful,, there
is danger that the very facilities which it affords will lead, if it
has not alread}^ done so, to repeated, if not general abuse ; for so
general and indiscriminate has beeomeits application, that the pa-
thological condition is seldom considered in connection with its
use. Indeed, all that appears to be necessary now in the treatment
of disease, is to know that it is periodic, and pathology may go to
the dogs. Well, if you call this progress, improvement and re-
form, just write me down Old FogyT and let Young America have
the field.

But if you ask me, where a remedy is to be found, and how it
is to be applied, for all the evils of which I complain, I will answer,
that it is to be found in the medical schools and colleges through-

16 Holt's Letters upon General Patlioloyy. [January,

out the country, and especially those of the South, in which the
principles of pathology should be thoroughly taught, both general
and special, but more particularly the former, for the reason, that
the perpetually changing character of our diseases require it, and
nothing short of a long course of observation and experience Avill
serve to supply the want or deficienc}r of it, as every practitioner
who has been long engaged in the profession is able to testify.
And being a comparatively new branch of medical science, and
necessarily imperfect in its infancy, it becomes every physician,
who desires or expects to see any advance and improvement made
in the healing art, to throw the weight of his talents and influence
in aid of its development and perfection, which will eventually
raise the standard of the profession high above the reach of every
species of low and vulgar charlatanism.

But would not this "consummation, so devoutly to be wished
for," be sooner attained by the establishment of something like a
National College of Physicians and Surgeons, which would bring
together and combine the best talent from all parts of our land,
and which would serve as a sort of regulator to all the other schools
and colleges, and finally furnish us with a s}'stem of practice
founded upon the most- correct principles of pathology, both gen-
eral and special, which would answer for every latitude and
climate throughout our widely extended country? But I fear
that the sectional prejudice and animosity the rivalship and jeal-
ousjr, existing among the medical schools, (which are becoming
very numerous in the land, and creating a greater necessity for
such an establishment, or institution,) whose province it should be
to take the lead in such an enterprise, will prevent them from ever
doing so. Until such a work is undertaken and accomplished, I
shall never expect to see a much better state of things existing in
the profession than I have described, and must remain content
with being run over ''roughshod,'1'' by Thompsonians, Homceopath-
ists, Graeffenburgers, &c, &c, for whom I entertain a more sincere
respect, than for those physicians who try to rob them of their
thunder.

llaving thus given expression to my opinions, as to the causes
which have prevented the proportional advancement of practical
medicine with the advance of other branches of the science, but
which have tended rather to produce a retrograde movement in
the healing art and having ventured to suggest a remedy, or

1856.] DrJGAS. ATon-Cb?igenital Talipes. 17

corrective, for the evils complained of, which many, no doubt, will
be disposed to regard as imaginary, and having no real existence,
and that my criticism upon the present state of the profession, is
but the effervescence of a morbid sensibility or of disappointed
ambition, I will leave the subject, and proceed with an examina-
tion of some of those much abused and rejected remedies already
spoken of, the first of which will be the Laved; for the reason
that it very naturally comes first in the order, of remedies, accord-
ing to the classification which I have adopted, namely, the "In-
flammatory" and Irritant, the Congestive, the Congesto- inflamma-
tory, and Congesto-irritant forms of disease. But as this subject
must be reserved for my next letter, which I hope to make more
interesting and instructive than the present one,

I must subscribe myself, as usual, your friend, &c.

Saml. D. Holt.

article III.
Non- Congenital Talipes. By L. A. Dugas, M. D., Sue.

The subject of the present case is a daughter of Mr. B., of Li-
thonia, in this State : she was born in March 1851, and in Novem-
ber 1853 was attacked with Erysipelas, with which she was very
ill, and remained feeble for some length of time. I am informed
that she had no spasmodic affection during or subsequently to her
illness ; but it was observed, when she began to run about again,
that she was lame. This lameness gradually increasing, its cause
Avas observed to be in the foot, whose distortion grew more and
more obvious until I saw her, in August, 1851. The case then
presented all the peculiarities of a well-marked Talipes varus, the
weight of the body resting upon the external margin of the foot ;
one only being effected.

By a sub-cutaneous incision the tendo-achilles was divided in
the usual way, and a few days after, Dr. Chase's very simple and
useful apparatus was applied for the purpose of gradually bringing
the toes upwards and outwards. This succeeded admirably, and
in a few weeks she was enabled to walk flat-footed.

It is difficult to account for the production of such a deformity
by an attack of erysipelas ; yet, as the cause of these distortions,
whether congenital or otherwise, is still involved in obscurity, it is

18 Observations on the Hoot of the Cotton Plant. [January,

well to accumulate facts on the subject. This is the fourth case of
non-congenital talipes I have met in private practice. The others
have been reported in this Journal for 1853, p. 112, and 1854, p.
210.

Observations on the Root of Cossypium Herbaceum, or, Cotton Plant.
By Thomas J. Shaw, M. D., of Robertson County, Tenn.

Cotton Boot Its Ce., ral Characters. It is fusiform in shape,
giviDg off small radicles throughout its length. The size of the
root varies, according to the soil from which it is produced. Its
length varies from a lew inches to that of a foot. When the root
is cut or broken, it displays a white color ; the bark is of a reddish
brown ; the taste is pleasant, somewhat sweet and astringent ; it
contains more of the latter principle than the root from which it
is procured ; it is very mucilaginous in its properties. The root
is easily broken when dry, but the bark is quite tenacious, pulling
off in strings.

This root is too well known in this country to require a lengthy
description ; therefore I will pass to the chemical analysis, as pre-
pared and furnished to me by my esteemed friend, Mr. H. B. Orr,
of Nashville, Tenn.

Chemical Examinations of the Root. The result of which, as
accurately as might be determined, is as follows, to wit:

Gum, Albumen, Sugar, Starch, Tannic Acid, Gallic Acid,
Chlorophyle, Iodine, Caoutchouc, Black Resin, Red Extractive
Matter, Black and White Oleaginous-like Matter. The latter two
abound in this plant.

Proximate Principles. Experiments were made with a view to
the isolation of the active principle of the root, which were not
altogether satisfactory ; for though there was no crj^stalline princi-
ple obtained, as was desired, making the existeuce of it palpable
and distinct to all ; still there is evidence in favor of a principle
existing in it. Time did not admit of an extended experiment in
this department of the analysis. The author indulges a hope of
having time to examine the active principle more minutely than
he has yet done. What he has seen suffices to convince him that
the medical properties attributed to it are not fallacious.

The attention of the medical profession was called to the medical
properties of this root, first by Drs. McGown and Bonchell, of
Mississippi; the latter gentleman by an article written in the Wes-
tern Journal of Medicine and Surgery, about the year 1812, as well
as I recollect. For a want of confirmation, it passed unnoticed
by the profession, until the year 1852, when it was again brought
into notice in an article written by Dr. John Travis, of Marlbo-
rough, Tennessee, in the Nashville Journal of Medicine and

1856.] Observations on the Root of the Cotton Plant. 19

Surgery. He reported but one case in which he tried it, and it
was with entire success, restoring the menstrual flow in a short
time, after 'an absence of about ten months.

I consider this root one of the very best emmenagogues of the
materia medica, and I think it should be so classed. My reasons
for considering it such, are grounded upon the different experi-
ments which 1 have made with it, within the last twelve months.
I sometimes use a decoction, and at others an infusion, but most
generally a decoction, prepared thus :

$. Cotton Root, ?iv. ; Water, lbs. ij.
boil down to one pint. S. A vine glass full every hour. This
produces the most salutary effect in dysmenorrhea ; it acts as an
anodyne in allaying the pain, and as an emmenagogue in aiding or
augmenting menstruation ; its action is very speedy ; after its ex-
hibition, in this case it produces an effect which, indeed, appears
almost natural, that is, almost without pain; the patient, after its
exhibition, feels but little inconvenience from pain, which soon
subsides, and menstruation is immediately augmented, without
acceleration of the pulse or gastric uneasiness. There are few
other emmenaa;o"'ues that can claim this feature.

DO

Its action in amenorrhcea I think superior to any other emmen-
agogue belonging to the materia medica, though it would be
proper to pay some attention to the general health of the patient
before its exhibition. It is superior to any thing that I have tried
in the way of emmenagogues. I have had cases in which I first
tried the usual emmenagogues, with but little effect, (or success,)
when I would determine on trying the decoction of this root,
which would far surpass my expectations by acting with the most
marked effect ; menstruation being produced on the following day
after its exhibition. All of the symptoms disappeared on exhibi-
tion of this medicine. I believe this to be the best emmenagogue
that we can employ in mere suppressio mensium, where there is
no other disturbance in the general health.

With the usual emmenagogues, I was enabled to produce the
catamenia on a }roung lady, which continued for about twentv-
four hours, then suddenly becoming very sparse and painful ; and
in a few days after this period had passed, I employed the infusion
of the cotton root as a means of exciting this function, which it did
on the following day, a plentiful discharge being produced, which
continued for live or six days. She has been regular at every
period since that time, and has enjoyed good health, with the ex-
ception of a few simple attacks, which caused no derangement of
the menstrual function. For about twelve months previous to
the exhibition of this medicine, her health was very much impair-
ed, but she commenced improving, and soon recovered her health.
I could detail other cases similar, in which I have tried the decoc-
tion with the same effect, but I deem it unnecessary to mention its
action in each individual case.

N. s. VOL. xn. no. i. 2

20 Observations on the Boot of the Cotton Plant. [January,.

As a 'parturient Agent, I think it superior to ergot in one sense
of the word, and in another about its equal, its action being about
as prompt as that of ergot, and attended with much less danger,
I have tried both in parturition, and found the cotton root decoc-
tion to act with fully as much efficacy as ergot. In some cases in
which I have tried it, the pain was to some extent allayed, and
labor promoted with as much speed as when ergot was administer-
ed. It appears to be perfectly harmless, from the fact that its ac-
tion is almost unattended with pain. It causes neither gastric
distress, or acceleration of the pulse; if it does, it is not perceptible ;
both of which are occasioned by ergot, to some extent.

I have witnessed its action in retained placenta with good effect,
which was an expulsion of the mass in about twenty minutes after
the exhibition of the first dose. It may be proper to sayr that I
gave two doses before the placenta was thrown off. I believe it
to be safer as a parturient agent, or an emmenagogue, or at least
as safe, as any other article of the materia medica.

It should have a fair and impartial trial by the profession gen-
erally, because it will prove itself worthy of the time and labor
spent in its investigation. It is handy to all, and free of expense..
A few trials by the profession will confirm the truth of this short
essay. Give it a trial, and it will prove itself in some case of
amenorrhcea, dysmenorrhoea, or probably in some lingering case
of labor, which may require the assistance of medicine, to produce
contraction of the uterus for the expulsion of the child. I think it
worthy of the attention of the profession, in the above cases.

Tincture of the Cotton Root oa a Tonic. There is a condition of
the system in which this tincture acts as a valuable restorative.
These cases are of a leuco- phlegmatic temperament of both sexes,
but it is to the female sex that I wish to draw the attention of the
reader. Where there is general bad health, accompanied with
tardy menstruation, I have used it with the happiest effect ; in a
few cases of emansio mensium, caused by anemia, where the pa-
tient was troubled with pains in the loins and giddiness of the head,
with a derangement of the digestive organs,, such as anorexia,
accompanied with an uneasy, depressed feeling at the scrobiculus
cordis, every month, which was promptly relieved by the tincture,
but not with the effect of producing the menstrual flux, which
was afterwards produced by the decoction, I find it necessary to
continue the tincture from' two to four weeks. The strength of
the tincture that I have been in the habit of using, is prepared
thus:.

Bark of the Root, (dry,) 3 viij. ; Diluted Alcohol, lb. ij.

Digest fourteen days, then filter and give it in 3j. doses, three
or four times a day. The tincture which I used was prepared by
myself;, and as I have seen no account of its use, I claim the first
preparation of it, as well as the first experiment with it. My

1856.] Peculiarities of the Negro Race. 21

: brother, Dr. H. J. Shaw, has since tried it, with the same good
effect ; in fact, his experience coincides with mine throughout.
In closing this short and imperfect essay, I indulge a hope that it

! will prove of some service to the profession. [Nashville Journal
of Medicine and Surgery.

An Essay on some of the Distinctive Peculiarities of the Negro Race.
By A. P. Merrill, M. D.

It will scarcely be deemed necessary, in treating of peculiarities,
anatomical, physiological, pathological, and therapeutical, of the
negro race, that we should enter upon the discussion of the science
of ethnology, which has latterly engaged so much attention from
learned men. It cannot be denied, however, that it involves to
some extent the questions of physical and mental peculiarities,
which are found to differ in different races of men, and to exercise
a modifying influence over the animal and moral functions, both
in health and disease ; but whether these differences and peculi-
arities have arisen from a pleurality of original creations, from
the influences of accidental circumstances, or from special provi-
dences, it matters little to our present purpose. The subjects
which we have undertaken to discuss, have reference merely to
the existence of certain facts, in connection with the negro con-
stitution, which so influence and control his health, and the
diseases to which he is subject, as to constitute distinctive peculi-
arities, requiring the adoption of habits of life in health, and the
application of remedial measures in sickness, differing, either in
kind or degree, from those which are applicable to the white race.
And these inquiries are supposed to have reference, especially, to
these two races, as we find them existing in our own country at
the present time, and principally in the Southern states, in the
relations of master and slave.

Anatomical Peculiarities are conceded to exercise an important
influence over physiological functions ; and may, therefore, be
briefly referred to here, as almost necessarily connected with the
other branches of our subject. These, although sufficient in the
negro, to be readily distinguished and palpable, even to the casual
observer, can scarcely be considered of such a decided character,
and so widely differing from other races, as to justify the broad
distinction which has been drawn between different races by a
certain class of ethnologists ; or such as will properly authorize, of
themselves, independent of other considerations, the grave conclu-
sion that God did not malce of one blood all nations of men, to dwell
on all the face of the earth. Nor do these anatomical peculiarities
lead us to expect, from any influences which they may be sup-
posed to exert over the functions of the body, a wider difference
in the character of the diseases affecting the different races, than

22 Peculiarities of the Negro Race. [January,

we actually meet with in practice. The color of the skin, and the
peculiarities of the hair of the negro, however they may have been
originally produced, undoubtedly serve important purposes of
protection and comfort, in the climate where he is found in the
enjoyment of the fullest health. They are such as are favorable
to a high degree of radiation of caloric from the body, which pre-
sents to the air a constantly evaporating surface, and afford to the
brain the most efficient protection from the influence of the rays
of a vertical sun. The scantiness or entire destitution of clothiug,
which is the natural result of that improvidence engendered by a
hot climate, where little other t^ m vegetable food is desired, and
where this is mostly supplied by the spontaneous productions of
the soil, renders these provisions of nature essential to healthful
functions, and even a comfortable existence, in his native country.
In regard to the brain, the peculiarity of the negro consists more
in its conformation than in its volume ; the latter being scarcely
below the average of some other races of greater acknowledged
intellectual endowments, although decidedly below that of the
Teutonic and Anglo-Saxon races. The phrenological characteris-
tics of the negro, are said to indicate a large preponderance of the
animal over the intellectual functions; and such is the inference
to be drawn, also, from an acquaintance with the mental constitu-
tion of the negro. A remarkable fact, in this connection, not
generally noticed by writers, but hinted at by Agassiz, may, we
think, be considered as one of his distinctive traits. Negro chil-
dren are not, in general, deficient in mental quickness, and acu-
men ; and are not unfivquently found to be precocious, and sus-
ceptible of successful instruction 'r while the intellect is not only
not developed subsequently, as in white children, but appears in
truth to retrograde, so as actually to fall below, in many cases, the
developments which have taken place in the white race, even in
childhood. It is not uncommon, on southern plantations, to meet
with children of nearly the same ages, of both sngaging

together in childish sports and pastimes; and to notice that the
ne^ro children are equal, and sometimes superior, to their young
masters and mistresses, in the quickness of their perceptions, and
aptness to learn whatever is attempted to be taught them. Negro-
children often succeed in learning to talk in advance of the chil-
dren of their master, with which they are associated; and we have
found, upon a personal experiment, that they can most readily be
taught, by a system of oral instruction, simple religious truths,
hymns, and forms of prayer, so as to make a very creditable dis-
play of proficiency, as catechumens. The children of family ser-
vants, which are kept in close association with the older members
of the white family, by whom they are apt to be much caressed,
frequently exhibit such evidences of smartness, and such readiness
of wit, as to afford great promise of future usefulness, in spheres of
"action requiring undue intelligence and judgment. With few

i 1856.] Peculiarities of the Negro Race. 23

and rare exceptions, however, they lose all signs of -uncommon
talents, as they advance in years, and sometimes even become
noted for their dullness. No advantage of position or instruction
will, so far as we have been able to observe, obviate or retard this
tendency to deterioration.

The thorax of the negro is less expanded, and his vital capacity
for respiration is said to be somewhat less than that of the white
man. Indeed it is said to have been proved* that such is the fact,
and that a less volume of air is respired in consequence ; but this
apparent defect may be compensated for, in some degree, by the
greater curvature of the ribs, giving scope for greater mobility of
the chest, and consequently a more perfect exhaustion and expan-
sion of the air-cells, iu respiration. This curvature causes a deeper
depression of the spine, which is a constant peculiarity in the for-
mation of the negro skeleton. The scapulas are said to be shorter
and broader, and the pelvis somewhat narrower, particularly in
the male. The legs are apt to be bowed, and the heels projecting
backwards. The muscles of the limbs are short and protuberant,
with proportionally longer tendons. The genital organs of both
sexes are more largely developed, and the breasts of the females
are more conical, with a less extent of base. The nerves have
been represented as being larger, and containing a greater aggre-
gate of substance, in proportion to the amount of brain and spinal
marrow ; but this, perhaps, requires further proof. The liver is
said, also, to be larger in proportion to other organs.

Tlie Physiological Peculiarities are, in part, such as naturally
result from the anatomical. Reason, judgment, forecast, and in-
dependence of character, could scarcely be the accompaniments of
a brain however large its volume, in which the animal organs
maintain a great preponderance over the intellectual and moral.
Consequently we find, what might reasonably be expected from
the anatomical conformation, that the negro is essentially a degra-
ded being, vastly inferior to the Caucasian race, in all the attri-
butes of spiritual existence; and only capable of improvement by
many ages of contact and association with civilized nations. How
far such influences may tend to the improvement of his physical
constitution, and to the relief of his mental deterioration, can at

\ present be only a matter of conjecture ; but admitting that all his
peculiarities of deterioration are the result of forty or more centu-
ries of constant decline, while the interval between him and the
white man, has been widened by as constant an improvement and
elevation of the latter, and it must be admitted as probable, that

! however much may be done by mankind, toward the promotion

| of the civilization and christianization of the former, many thous-
and years must necessarily elapse, before he can be brought up to

; the present position of the white man. No one who has had proper

* Dr. Cart-wright, New Orleans Journal, Vol 1, IX, 196.

24 Peculiarities of the Negro Race. [January,

opportunities of observation, and taken the trouble to improve
them, can for a moment entertain a doubt, that, of all the provi-
dential occurrences, tending to the improvement and elevation in
the scale of being, of this degraded race, none could be better suit-
ed to the purpose, than the existence of American slavery. It
must not be denied, that it is a system which leads to egregious
abuses. Of these we are not the apologist. To his own master
let every slave-holder render up his account.

No fact in psychology is better established, than the inaptitude
of the negro mind to improvement. In his native country lie ex-
hibits no signs of progression. The rising generation does not
aim to improve upon the past, or to profit by a knowledge of its
errors ; but taking the place of their predecessors, they are content
with doing precisely as has been done by their progenitors for
ages. If his forefathers have been accustomed to plow with the
rough branch of a tree, the negro has no conception of any other
method, and works on with the branch of a tree from generation
to generation forever. Nor does he seem inclined to follow the
example of the white man. The latter may settle near him, and
ploAV his grounds according to the most approved modern plan,
and the negro may look on and wonder; but he is not any the
less willing, still, to pursue the example of his fathers, and no im-
provement is attempted, however promising may be its results.
Such has been the stationary condition of the race from the earli-
est times, tending more, perhaps, to deterioration than to improve-
ment ; and there can be little hope of progression in future, while
the negro is left to follow the bent of his own inclinations. Ilis
condition and history promise nothing but the extreme of savage
ignorance and degradation.

By the institution of southern slavery, the negro is brought
under a system of tutelage, in contact with a race vastly his supe-
rior, and of whose habits of thought and action he is constantly
compelled to take notice. By every humane and judicious master
he is cared for, as he requires to be, as a child in leading strings;
and although he has not yet attained a degree of improvement
which would seem to be commensurate with his advantages, it
must be considered, that his pupilage has as yet only been a short
one, and not sufficient tc test his capabilities of ultimate advance-
ment. Time may so far develop these, as to enable him to recover
his lost position in the scale of being, and to carry back to his na-
tive shores the germs of civilization, and the christian religion,
both to be successfully cultivated, to the enlightenment and regen-
eration of benighted Africa. Human research and ingenuity have
not been able to devise any other available means, by Avhich these
blessed results can be secured to an ignorant and degraded people,
than by the influence of long association with a superior and
dominant race. History affords examples in illustratiou of this
position, and our own experience, as well as our reason, confirm3

1856.] Peculiarities of the Negro Race. 25

it. It is an interesting problem, to be solved in the long and tedi-
ous future, whether the negro will, even by these means, ever be
elevated in the scale of being, to a degree which will realize the
anxious hopes of the christian and the philanthropist.

Other physiological peculiarities result from, or appear to be
intimately connected with, the native climate of the negro. Whe-
ther so formed by a separate creation, as some contend, or adapted
by long habituation, the negro race is physiologically constituted
for the enjoyment of a hot climate. Living mainly, in their na-
tive wilds, upon a meagre and vegetable diet, their systems are
less abundantly supplied with carbonaceous material, and have
less adaptation to the generation of animal heat, than the white
race in more northern latitudes. The air which surrounds them
within the tropics, being much of the time of an equal or higher
temperature than their bodies, and never at any time much below
it, there is no necessity for an active reproduction of warmth, to
replenish the moderate waste from external radiation. If it be
true, therefore, that less air is respired by the negro, and a less
amount of oxygen consumed, which appears to be altogether pro-
bable, it is because there is less occasion for physiological combus-
tion ; and this may be further reduced by the more rapid elimina-
tion of carbon by the liver and skin, while the copious supply of
perspirable matter and proportionate evaporation from the sur-
face, tend to prevent an undue accumulation of animal heat, from
the moderate exercise of the functions whence it is derived

The negro constitution being thus eminently adapted to the
torrid region, it follows that the climate in which we find him in
our country, is much too far north for him. Being exposed for a
large portion of the .year, to a temperature to which he is ill adapt-
ed, and liable to suffer all the while from the operation of those
causes, above alluded to, which constantly tend to the reduction
of the heat of his body, so sparingly supplied, he can only be pro-
tected from the evil influences upon his animal functions, and ren-
dered effective as a laborer, by being better fed, and better clothed,
and lodged, than in his native country. The changes which take
place in his physiological functions, as a consequence of his sud-
den transfer to a colder climate, must be counteracted b}' corres-
ponding changes in his mode of living, or disease and an abridg-
ment of the duration of life, must be the natural result. This
remark is, perhaps, scarcely less applicable to the white man of
temperate latitudes, when suddenly transferred to the polar re-
gions. If he neglected to conform, to some extent, to Esquimaux
habits, and indulge in the use of oleaginous food, to furnish addi-
tional supplies of hydro-carbon for an increased production of
animal heat, he will scarcely be able to endure a succession of cold
winters, without a loss of health. The converse of this proposi-
tion is equally true. Emigrants from hyperborean to tropical re-
gions, require, equally, that their habits of life should be charged,

26 Peculiarities of the Negro Race. [January,

and made to conform, in some degree, to those of the fruit-eating
people among whom they go.

Of these physiological requirements there can be no doubt ; and
probabty it will be found upon further and closer observation of
the matter, that they are of a more urgent character with the black
than the white race; for the reason, that the former is possessed
of less resiliency of constitution, and self adaptation to change, than
the latter; resulting partly from difference in actual idiosyncrasy,
and partly from the greater reason and judgment with which habits
of life are controlled. However this may be, it can hardly be
matter of dispute, that southern planters Avho study their own in-
terests, whether they understand the physiological reason for it or
not, have found from long experience and observation, that it is
good economy for them to give their slaves a full allowance of fat
pork, and also of Indian corn, which abounds in oleaginous prin-
ciples wherever it is grown, although to a somewhat less extent
rn hot than in cold climates. Every slave in the southern states,
who has had opportunities forjudging, is aware of the greater
strength of diet afforded by northern, than by southern grown
corn ; and of the certainty with which the former will degenerate
into the latter by a few years of southern cultivation. Southern
corn is always prefered by them, however, on account of its greater
palatableness, and lighter color. And it seems to be a providen-
tial circumstance, that the whole region of country in which slave
labor is profitable, is particularly suited to the production of the
two main articles of diet upon which they subsist, corn and pork.
The former alone would afford them a stronger diet, yielding them
larger supplies of hydro-carbon, than most of the tribes of Africa
can command in their native country ; and perhaps it may have
been a knowledge of this fact, added to the cheapness of the food,
which tempted the original planters of Louisiana, to rely almost
exclusively upon Indian corn in feeding their slaves; while they
were content to clothe them in the coarse linen goods of tint period,
as affording a much better protection from the weather, than they
had been accustomed to in their barbarous homes. Cut when
some of the large sugar estates fell into the hands of North
men who had been accustomed to see the white laborers of the
north much better clothed and fed, and performing m* tive

labor in consequence, the natural result was a trial of the experi-
ment upon negroes; and the large increase of the product of their
labors, consequent upon this change, soon caused a complete revo-
lution in the system of plantation supplies, leading to a better
provision for the slaves from year to year, until, at the present
time, they are probably better fed, and better clothed, than are the
white laborers in any part of Europe.

Still, certain errors arc committed by planters, for the want of
*a proper understanding of these physiological peculiarities of ne-
groes, adapting them to hot climates. The winter being the season

1856.] Peculiarities of the Negro Race. 27

of comparative rest, as the crops are not then growing, to require
extraordinary efforts at tillage, it is the custom of some, to afford
their slaves less liberal supplies of meat at this season than at any
other ; when, if the views above given are correct, they require
more of fatty and hydro-carbonaceous food in cold weather than
in warm. On sugar estates, during the sugar making season, this
want is in part supplied by the free access which the slaves have
to the juice of the cane, and its products. Its physiological effects
become apparent in the high degree of health and vigor which is
maintained, in spite of the extreme labor imposed by this perpetual
day and night process of sugar-making, out of which the slaves
come with an increase of embonpoint and buoyancy of spirits.
These invigorating and fattening effects of saccharine food, are said
to be more perceptible upon the constitution of the negro than the
white man. The amount of hydro-carbon furnished by it may, in
many cases, be greater than can be obtained by the use of cod-liver
and other oils, which cannot always, on account of their indigesti-
ble and cathartic qualities, be taken in sufficient quantity to pro-
duce these legitimate effects. As a remedial agent, therefore, in
phthisis, scrofula, and cachexies of various kinds, saccharine mat-
ter is of no mean importance.

The inability of the negro constitution to generate heat, com-
mensurate with the increased want of it, consequent upon the
drain imposed by exposure to unusual cold, is manifest in its
effects upon the respiratory organs ; which, from exposure to cold
air, without sufficient covering for the body, suffer from a constric-
tion and chilliness, which are frequently quite painful. This it is
which induces the negro, contrary to the common practice of the
white man, to turn his head towards the fire, or to cover his face
with a blanket, in preference to his feet, that the air inhaled may
first be partially warmed, and thus save him the inconvenience of
its chilling effects upon his lungs. Place him in a warm room,
with plenty of warm bedding, and he will soon learn to omit this
injurious habit, which deprives him of the fresh and uninspired
air, so much required by him as a source of vitality, and of vital
warmth. The same want of due supplies of animal heat is evin-
ced, when negroes are required to sleep in the open air. Upon a
hunting excursion, or a military campaign, white men will often
inure themselves to the rapidly sinking temperature of the surface
of the earth, and sleep with impunity without the interposition of
anything to prevent the rapid radiation of heat toward the clear
canopy of heaven ; but if their negro servants who may accompany
them, partake of the same exposure, they not only show signs of
greater suffering, but the effects are apt to tell upon them, in the
development of fevers, and of thoracic congestions and inflamma-
tions, not unfrequently laying the foundation for permanent ill-
health. It is only in our hottest summer weather, or in inter-tro-
pical climates, that negroes can undergo these exposures with

28 Peculiarities of the Negro Race. [January,

impunity. Indeed, we have but few nights in the southern states,
which would not prove injurious to the negro sleeping in the open
air, and particularly by the chilling effects of terrestrial radiation
of heat upon the temperature of the atmosphere, toward morning.

Many of the diseases to which slaves are peculiarly liable, and
which form the principal outlets of life among them, are caused by
a want of proper attention to this high requisition of their organ-
isms for heat, and by the want of proper supplies of fresh air, con-
sequent upon the efforts which they are called upon to make, to
relieve their bodies, and particularly their lungs, from the painful
influences of cold. It is a great mistake, we apprehend, to sup-
pose, that because negroes are often found sleeping with their
cabins closed, and their heads covered, they do not require fresh
air. It is not animal instinct which impels them to forego its use,
but want of comfort. Let them be rendered comfortable, by due
supplies of warmth, or the means of preserving the warmth of their
bodies, and they will be found to enjoy the full respiration of
fresh and wholesome air, not less than white persons. And it has
seemsd to us, that it is mistaking effects for causes to contend, that
the elimination of an undue proportion of carbonic acid, by means
of the skin and liver, is certain proof that nature has intended
these organs to act as greater depurators of the blood in blacks
than in whites. Whenever they do thus act, as is no doubt often
the case, it is compensatory for defective action by the lungs, just
as an increased action of the kidneys, in all persons exposed to the
chilling influences of a cold and damp atmosphere, is compensato-
ry for partially suppressed perspiration ; and it remains to be
proved, that the decarbonizing power of the skin and liver of the
white man, is not just as active and efficient, under the same influ-
ences, or smy other influences retarding the action of the lungs to
the same extent.

To guard against disease from this cause, it is necessary that, in
providing lodgings for slaves, great care should be taken to sup-
ply them with both ventilation and warmth. It is important that
in winter the two should be furnished in combination; and pro-
bably there is no better way of doing it, than by constructing their
lodgings so as to be warmed by hot-air furnaces, through which
air both warm and pure may be supplied in abundance. Upon
large plantations, where the saving of fuel is an object, this might
be clone, were the dwellings properly arranged for it, at less ex-
pense than the same advantages could be secured upon any other
plan ; and there are few nights in the year, that the planter Avould
not find it his interest to kindle fires in such furnaces. The time
lost by negroes in unnecessary sickness, and the cost of medicines
and medical aid saved by such arrangement, not to mention the
increased average duration of life, would amply repay the expense.

Many slave-owners, deeming it important to give their negroes
a-" full supply of fresh air, without considering the importance of

1856.] Peculiarities of the Negro Race. 29

warmth, construct their dwellings with openings in the loosely
laid floor, and with crevices between the logs or planks which
form the walls of the buildings, so that whether the room contain
few or many, there is no possibility of any one individual occupy-
ing a position, which will not subject him to the constant action
of a current of cold air. This induces him to sleep with his head
covered, to avoid the painful constrictions caused by cold inhala-
tions, and thus subjecting himself to the injury resulting from
breathing impure air, even though his room be ever so well sup-
plied with it. Full one half of every inspiration is made up of air
which has been respired before, and the fresh air with which the
dwelling is so liberally supplied, answers \\o other purpose, than to
chill the surface of the body, and the extremities, turning in upon
the vital organs that mass of fluids, and vigor of circulation, which
are required for the healthful action of the cutaneous vessels. The
fluids and vascular action thus repelled, lay the foundation of a
large portion of those diseases which prove fatal to slaves.

But it is not impracticable to secure warmth and ventilation, to
a healthful extent, by building close and warm houses, with glazed
windows which can be opened at the top, near the ceiling of the
rooms, while the lower portion is closed ; and by wanning the
rooms by means of large, open fire-places. A plentiful supply of
warm blankets, and the enforcement of a wholesome rule, to un-
dress on retiring to bed, and lay aside the clothing worn during
the da}r, will secure the occupant of such an apartment a free res-
piration of pure and warm air, a free action of the skin and viscera,
and a great degree of comfort and health. The negroes will be
enabled to warm and dry themselves immediately on their return
from their daily labors, and thus avoid being chilled after exercise
and exhaustion from fatigue. They will lay aside the clothing
worn during the day, to be aired and dried in readiness for the
morning. They will sleep without tight bands about them, and
"without obstruction to cutaneous exhalation. They will have no
motive for covering their heads in their blankets. They will en-
joy the benefit of tolerably fresh air, without danger of being
chilled by its impinging directly upon their bodies. They will
enjoy unbroken slumber, and be invigorated for the labors of the
ensuing day ; and when they rise and go forth, into the cool air of
early morning, it will not be with bodies chilled by cold, or reek-
ing with moisture.

The selection of a healthful locality for negro quarters, is a mat-
ter of not less importance than their proper construction. It is a
common practice, upon the highlands, to give preference to some
worn-out or barren hill, or ridge of ground, which produces .little
or no vegetation, and is, therefore, of little value for purposes of
cultivation. And upon the low -lands, where there is no want of
fertility and productiveness, the plan often pursued is, to keep the
earth around the quarter nearly bare of vegetation. These prac-

30 Peculiarities of the Negro Race. [January,

tiees are followed without reference to, or in accordance with,
what we consider false views of the causation of d i telluric

influences. From long observation and experience in this matter,
we are forced to the conclusion, that it is from the bare and naked
earth that we have most to fear in this respect. Nature appears to
have intended that the earth, or at least the habitable portions of
it, should be coated over with vegetation. Accordingly we find,
that when it is thus coated by the forests, by the luxuriant grasses
of prairie grounds, by cultivated crops, &c, a healthful influence
over the inhabitants is exerted. But whenever these natural coat-
ings are removed, from any cause, bringing the bare surface to the
long continued action of the sun and winds, sickness is nearly the
invariable; consequence. Fortius reason ut>gro quarters should be
established upon a fertile soil, or one which can be rendered so by
cultivation, which should be sedulously shielded, as in a state of
nature, by a luxuriant growth of vegetation of some kind. This
is in accordance with common experience. In some parts of
Mississippi, where the virgin soil has disappeared from the sub-
stratum of yellow clay, upon which it reposed, and the fields have
been abandoned, and become washed in gullies, and bared of
vegetation, sickness, and particularly malarial diseases, prevail to
a much greater extent than formerly when these grounds were
exceedingly rich in vegetable mold. The same necessity for a
coating of vegetation exists when the bare surface of the earth has
been exposed, inconsequence of the subsidence of stagnant water,
the drainage of swamps, &c, which very generally exert a delete-
terious influence until covered by a dense vegetable growth.

The health of negroes is scarcely less dependent upon proper
clothing, than suitably arranged dwellings. The color of the skin
is favorable to the radiation of heat, while the head is protected
from the influence of the direct rays of the sun, by the non-con-
ducting character of its woolly covering. While these and other
constitutional peculiarities serve to qualify him for enduring the
heat of a tropical climate, and a vertical sun, they disqualify him
proportionally, for a cold climate, and for great and sudden tran-
sitions of temperature from heat to cold. They are, moreover,
from a want of resiliency and native vigor of constitution, less
able to adapt themselves to changes of climate, than white men.
These truths are so universally acknowledged, as to require neither
argument nor illustration in their support. Consequently the
slave population of the United States, occupy a region by many
degrees too far north, for the enjoyment of health and long life,
without having their bodies specially protected from the depres-
sing influences of cold, and from the influence of vicissitudes of
the weather, in our capricious climate. The winter season is par-
ticularly trying to them, and apt to be productive of the most
common and fatal class of diseases to which they are subject. It
must be evident, therefore, that the selection of proper clothing is

1856.] Peculiarities of the Negro Race. 31

among the most important considerations in connection with,
plantation hygiene. And such is now the cheapness of the
coarse kinds of goods most suitable for this purpose, that no good
reason can be given for neglecting to clothe them in a manner
most conducive to the preservation of health. The danger of the
loss of health and life, the loss of time, and the expense of medical
aid, and of medicines, arising from a want of proper protection by
warm clothing, is much more detrimental to the interests of plant-
ers, than the most expensive arrangements, in reference to this
matter, which are adopted by the most considerate and liberal
slave-holders.

Since cotton goods have become cheaper than those made of
flax and tow, the materials used for negro clothing are almost
exclusively composed of cotton or woolen, or a combination of the
two. The coarse cottons commonly used, are well adapted to this
purpose for summer, and, with the exception of old and infirm
persons, negroes do very well with an exclusive use of such cotton
goods for about seven months in the year from April to Novem-
ber but for the other five mouths it is safer, and good economy,
to provide all who labor in the open air, and are subject to the
vicissitudes of the weather, with woolen shirts. The old and feeble
should wear them the whole year, and with the addition of woolen
drawers in the winter. In all sickly localities, indeed, it is better
that this aarangement should obtain with all ; for it has been well
ascertained, that the use of flannel next the skin all the year,
affords the most certain protection against malarial diseases, of any
means known, excepting, perhaps, the daily use of quinine; and
it is reasonable to conclude, that its prophylactic agency is more
decided with negroes, than white people, on account of physiolo-
gical peculiarities to which we have referred, and particularly with
negroes living in a climate of unnatural coldness. It is, indeed, a
rare thing, according to our experience, to meet with a violent
case of fover, cholera, or other malarial affection, so called, in a
negro Avho habitually wears tiannel next the person, and particu-
lar^ if he sleep with a woolen covering at night, and in a cabin
properly warmed and ventilated. Contrary to the common prac-
tice of planters, children and youths, for obvious reasons, require
suitable clothing, and nightly protection, much more than grown
persons.

There is no one article of clothing, perhaps, which is more ne-
cessary to the health and comfort of field negroes, than the over-
coat. This is made of various coarse materials, and sometimes of
thick blanket cloth, with a hood to be worn over the head at will,
which is a necessary appendage for those who are not supplied
with hats or caps. These over-coats cr capots, are useful in the
cool of the moruing when starting ^out to work. The negro is
roused from his slumbers at early dawn. Perhaps he has been
sleeping in a close room, with his head enveloped in his blanket,

32 Peculiarities of the Negro Race. [January,

and he goes directly into the cold morning air with his skin reek'
ing with moisture. His stomach is empty, and the general languor
which prevails predisposes him to chilliness, and a repulsion of
fluids from the surface upon the internal organs, to an extent well
calculated to excite disease. In point of fact, we believe it is true,
that a large proportion of the attacks of diseases in the autumn,
and winter, come on, or become developed into notice, at this
time. In cotton -picking and some other kinds of labor, a thorough
wetting of the clothing takes place, and is kept up for some hours,
until the time for breakfast, when that meal is taken in the open
air, and sufficient rest allowed, to produce a pretty general chilli-
ness of the surface of the body. In view of these physiological
peculiarities of the negro, which tend to unfit him lor the endur-
ance of cold, no one can doubt, that this exposure is a trying
ordeal for him, and that he requires all the protection that clothing
can give. At no time, except while sleeping, does a negro re-
quire warmth and dryness more, than when resting and eating his
meals in the open air, and after active labor. While in the fall ex-
citement of exercise, the wetting he receives from the dew, or from
the rain, is of little consequence; but the moment he ceases to act,
he is in danger of suffering constitutional injury, and unless par-
ticular care be taken to guard him against it, disease, and often
fatal disease, will result from it.

We have already alluded to the fortunate, if not providential,
fact, that the two articles of diet upon which our slave population
are mainly subsisted, and which are the best adapted to their
physiological condition, of all the long list of eatables known to
man, are produced in high perfection, and with moderate labor,
in all that region of country where slaves are owned and worked.
Indian corn may be cultivated upon both sugar and cotton plan-
tations, in sufficient quantity for plantation use, without interfer-
ing, in any material degree, with the amount of cotton or sugar
produced. This article is easily preserved, and affords food for
slaves, not only of the most nutritious and wholesome character,
but requiring little labor and skill in the preparation. In general
it is furnished to all the negroes on the plantations, ad libitum.
There are two points in connection with its preparation, however,
which, perhaps, are not sufficiently attended to. One is in refer-
ence to the grinding. It should not be ground to an impalpable
powder, which makes heavy, moist, and soggy bread ; and this
it is which constitutes the principal difference between the corn
bread of cities and plantations. Steam and Avater power are
brought into requisition for the former, and corn meal is met with
in their markets in a state of levigation equal to that of wheaten
flour ; but plantation grinding is more commonly done by horse
power, with less perfect machinery, and the meal is of much
greater coarseness. The other matter of importance is the cook-
ing. Corn meal requires to be very much cooked, and with &

1856.] Peculiarities of the Negro Race. 33

high degree of heat : the more, of course, when not finely powder-
ed. Water and salt are the only admixtures required.

Pork, the other article of diet alluded to, is easily and abund-
antly produced, under skillful management, in all that region of
country in which Indian corn best nourishes ; and the best quali-
ties are fattened on southern grown corn. The large amount of
pure fatty matter which it contains, is an abundant source of
animal heat, so much required by the negro in a climate of lower
range of temperature than he is s\iited to. In his native tropics
it would be injurious, but when removed into- what is to him a
cold climate, such oleaginous food becomes as essential to his
health, as is the blubber diet to the Esquimaux and the Lapland-
er. The unsuitableness of oily j>ork to people of hot climates in
their native region'?, may be the true physiological explanation of
its interdiction to the Israelites by divine authority. The consti-
tution of the ancient Jews was very unlike that of the negro.
His temperament being more sanguine, and ended with a higher
degree of nervous excitability, and a greater exuberance of vital-
ity, the generation of animal heat was proportionally more rapid.
Of course, the leaner meats of the goat and the sheep, with the
fruits, the milk and the honey, which abounded in Palestine, were
better suited to his physiological condition.

But whether this be true or not, true it certainly is, that the
fattest pork suits the negro in our country better than any other
meat. Upon no other can he be subsisted, with any hope of
returning to his owner such large profits of labor. The farther
north you go with him, and the colder the climate to which he is
exposed, the greater is the necessity for this oily diet ; and with-
out a full abundance of it, the negro not only cannot become an
effective laborer in cold climates, but must necessarily suffer in
his bodily and mental health, become short-lived, imbecile, and
unprolific. Too feeble-minded to compete with white men in his
struggle for a livelihood, and too improvident to provide, in the
heat of summer, for the requirements of winter, he is reduced to
the necessity of subsisting upon unsuitable food, and often com-
pelled to wear insufficient clothing ; and disease of body and
mind, leading to early dissolution, and to deterioration in the
bodily and mental vigor of his descendants, are the natural conse-
quences.

In addition to meat and bread, slaves require milk, garden
vegetable, ripe fruits, and sugar or molasses. For adults, sour
milk or clabber is most digestible. Garden vegetables, are liber-
ally supplied on all well conducted plantations. Figs are the
most valuable fruit, not only on account of their easy digestion,
but of the abundant saccharine matter they contain, and not less
because of the fact, that they cannot be eaten in an unripe state..
Sugar or molasses should be looked upon as essential, to the im-
provement of digestion, and on account of their anti-scorbutic

34 Peculiarities of the Negro Race. [January,

tendency ; and liberal supplies of good vinegar should be furnish-
ed, for like reasons.

The negro is, from nature and habit, an uncleanly being. From
early infancy to old age, his skin is rarely cleansed of accretions of
perspirable matter and dirt, which accumulate so readily upon it,
aided by petty copious sebaceous secretions of an odious character.
The injurious effects of this habit might easily be prevented, by
the construction of artificial ponds or tanks, for the special pur-
pose of bathing. The moderate warmth of water thus confined,
would afford an inducement for them to practise ablutions at night.
Even the habitual application of oily substances to the skin, would
be an improvement upon the present neglect of the cutaneous
surface. It would, perhaps, be a poor substitute for bathing ; but
the cuticle would be softened by it, facilitating excretory action,
and preserving a free capillary circulation.

In a state of health, with proper food and clothing, and with
suitable lodgings and means of rest at night, the negro is very
enduring of labor, and will work at a certain slow and regular
pace, with few and short intervals of rest, from early dawn until
night, in the long days of summer. But he cannot be driven, for
any length of time, beyond his natural or habitual movements;
and any attempt to do it must always result in ultimate loss to the
master. Up to his natural capacity he is not unwilling to work.
Beyond it he cannot go without injury. When he is overworked,
and becomes exhausted and disordered in consequence, he recov-
ers from the effects much more slowhr than the white man ; as he
does, also, from sudden prostration by bloodletting, and the action
of medicines. His reasoning faculties are dull and inactive, and
his judgment defective, but he learns to do his work skilfully,
and from long practice becomes very adroit in the use of the im-
plements of husbandry, and the tools of the mechanic; but his
attention must not be directed to more than one thing at a time,
and he needs to be particularly instructed upon every change in
his daily tasks. Counseled and dealt with in a spirit of kindness.
and patiently directed in his duties as a child, he is easily ruled
and governed by white men, to whom he concedes a high degree
of mental superiority and judgment ; but becomes restless, and
oftentimes depressed and sulky, under an exercise of impatience,
and undue severity, on the part of his master or overseer.

Vascular and nervous action in the negro is comparatively
sluggish, but his senses of seeing, hearing, and smelling, are apt
to be acute and active; those of touch and taste, obtuse. He
requires less sleep than the white man ; has greater insensibility
to pain ; is warm, but impulsive, in his affections; suffers deeply,
but not enduringly, from affliction; is strongly imbued with reli-
gious and superstitious feelings; a greal lover of music, apt at the
.production of musical sounds, and at vocal imitations; and when
uninfluenced by superstitious fear, he is courageous and stoical.

1856.] Peculiarities of the Negro Race. 35

His mind is continually exercised npon supernatural agencies, is
easily depressed by his confidence in witchcraft, and much of his
unhappiness, as well as many of his diseases, proceeds from purely
imaginary causes. He venerates age, but mingles with his vener-
ation a superstitious dread of the control, which the aged are
supposed to possess, over spiritual and ghostly influences; often
assigning disease and misfortune solely to these agencies. In his
religious devotions, he finds it an easy matter to work himself up
to the highest pitch of enthusiasm, and even ecstacy, realizing in
his excited imagination the felicity, almost, of the heavenly state ;
but the rapid subsidence of the excitement leaves him in the prac-
tice of certain vices, to which he is impelled by passion and habit;
and from which, under temptation, he is scarcely able to refrain.
The venereal excitement is one of these, to which his anatomical
and physiological constitution strongly inclines him, and to the
promiscuous indulgence of which he is apt to be led, by the
habitual disregard of the sanctity of the marriage relation, and the
wickedness of its violation. Another vice to which he is addicted,
is theft; in which he indulges, with the exercise of the most ingen-
ious expedient to escape detection, traveling sometimes many
miles during the night, after a hard day's work, and with the
prospect of another hard day's work before him, on the morrow,
to accomplish a theft of little value to himself, and one which
affords him very small remuneration for his labor and risk.

Thoughtless of the future, and improvident to a degree, the
negro stands constantly in need of counsel and advice, and he is
ever ready to place himself under the guidance and instruction of
the white man, the superiority of whose judgment and intellect he
is always willing to acknowledge. This trait of confiding depend-
ance in the negro, is not less remarkable and uniform, than it is
in the children of the white race ; and the treatment he requires in
return, to make him contented and happy, is the same that our
children look for at our hands. In a spirit of parental kindness,
he may, in general, be governed and worked to the best advan-
tage, and his attachment and devotion to his master, when so
managed, know no bounds. We have heard of an attachment
which will induce a man to die for his friend ; but if we were to
look through the world for practical illustrations of this remarka-
ble virtue, among no class of people would we as soon go, as
among slaves, who have been reared up in immediate association
with the members of the white family to which they belong, and
who have been governed as children and dependents, in a spirit
of kindness.

But slaves are submissive, and effective laborers, under very
different treatment. They submit to and bear the infliction of the
rod with a ^surprizing degree of resignation, and even cheerful-
ness ; and indeed manifest in many cases a strong and unwavering
attachment to the hand which inflicts the punishment, particularly

N. S. VOL. XII. NO. I. 3

36 On Wldte Swelling. [January 7

if it be the hand of the owner, or some person who has the right
to exercise government over them. They are a submissive and
yielding race, wholly incapable of bearing malice on account of
their degraded condition as slaves ; and equally incapable of form-
ing and maintaining, an effective and permanent organization
among themselves, to assert their freedom, or to avenge their
wrongs. They differ from their white masters in no one particu-
lar more than in this. Most of them, perhaps, desire their free-
dom, but when obtained, they know so little how to use it, and
stand so much in need of the direction of the thinking and reflect-
ing white man, as to become wretched and miserable, and often to
desire a return to the state of slavery. Whether this be his
rightful position in our counfry or not, an unprejudiced observer
can hardly fail to arrive at the conclusion, that it is the one above
all others, in which he enjoys the highest degree of health, the
greatest happiness, and the longest life. [Memphis Med. Recorder.

On White Swelling. By M. A. Kichet.

M. Richet believes that many erroneous ideas prevail respecting
the pathology oi articular 'diseases, which has been retarded by the
uncertainty that has so long prevailed in respect to certain points
of structural anatomy as, e. g\, the vascularity and nutrition of the
cartilages, and their investment with synovial membrane. The
microscope has now led to the solution of these questions, and, by
availing himself of the results of its teaching, M. Richet believes
that he can steer clear of many of the difficulties that beset the path
of earlier pathologists. His own researches date some time back,
he having published upon the subject of white swelling in 1844.

While approving the mode adopted by Brodie and Velpeau, of
viewing these affections through the pathological changes they give
rise to, he believes that they and other writers have not sufficiently
followed the succession of these changes as they are observed in the
different tissues. His object is to supply this deficiency, in show-
ing that the different stages of the same chronic inflammation have
been mistaken for special affections. He believes that all "white
swellings" may be included under two fundamental varieties viz.,
chronic inflammation of the synovial membrane and of the articu-
lar extremities of the bones. The changes which take place in the
fibrous tissues are, as Brodie has advanced without demonstrating,
always consecutive, while ulceration of the cartilages is not admit-
ted by M. Richet. The synovitis, osteitis, or osteo-synovitis, may
undergo modifications, by the constitution and temperament of the
individual, or by the causes that have induced them, such modifica-
tions being of the more importance, inasmuch as they often affix a
special seal to these affections, causing them to be regarded as dis-
tinct maladies.

1856.] On White Swelling. 37

Tlie Pathological Anatomy of White Swelling, constituting the
basis of the essay, is given in minute detail ; but we are only able
to glance at some of the more salient points. M. Richet has, during
several years, taken every opportunity offered by cases of arthritis
or experiments on animals, of tracing the progressive changes that
take place in the synovial membrane. Between the fifth and twelfth
day after irritation has occurred, a pseudo-membranous-like exuda-
tion is effused from its surface, and becomes attached to granulations
that are there more or less developed. When the chronic stage of
synovitis arrives, these granulations may expel the false membrane
covering them, and become themselves developed into fungous
vegetations ; or the pseudo-membrane may become more and more
intimately united to the surface of the synovial membrane, undergo
organization there, and prevent the farther development of the
granulations. The two cases are respectively termed by the
author Fungous Synovitis, and Pseudo- Membranous Synovitis.

In Pseudo-Membranous Synovitis, layers of pseudo-membrane,
intimately connected with vessels, unite the synovial membrane to
the fibrous tissues of the joint ; and when sufficient irritation is not
induced "to cause death or amputation, a natural cure may take
place through the agency of a fibrous transformation. Retraction
ensues, and all the soft parts becoming closely applied around the
ends of the bones, the joint then appears less than the opposite one.
This form of synovitis is not infrequent after acute rheumatism,
and it constitutes one of the varieties of incomplete anchylosis.

In Fungous Synovitis the granulations, in place of becoming
organized, become, under the influence of a special diathesis (as e.g.
the scrofulous,) cedematous and fungoid, and are, after different
periods in different individuals, converted into reddish, softish
vegetations, analogous to those which spring from carious bone.
Containing some arterial vessels, they are chiefly made up of a
venous network, in the midst of which is found a translucent jelly,
exhibiting small spots like extravasated blood. The vegetations
present an epithelial layer at their surface, and within, the fusiform
fibres and elongated nuclei characteristic of fibro-plastic tissue.
Brodie and other pathologists, from want of having sufficiently
studied the alterations of the synovial membrane, have made of this
a special affection, of a malignant nature. Occasionally, it becomes
arrested in its course, a conversion of the fungosities into fibro-cel-
lular tissue taking place, and a more or less complete anchylosis
ensuing. In other cases, the fungosities become indurated, having
cartilaginous plates diffused amidst their tissue. This induration is,
however, only observed here and there, amidst the thickness of the
changed synovial membrane, and gives rise to the development of
irregular, so-called foreign, bodies, varying in size and density, being
sometimes found loose in the joint, or only attached by a pedicle.

Brodie admits primary ulceration of the synovial membrane; but
the cases he adduces are too briefly narrated to justify the appella-

38 On White Swelling. [January,

tion. In M. Richet's opinion, the most frequent sources of ulcera-
tion are small centres of suppuration, met with in the altered
synovial membrane, which, by breaking both externally and inter-
nally, establish sinuses, the extremities of which have all the
characters of ulcers. The synovial membrane may also become
ulcerated consecutively to the morbid changes taking place in it,
while, when much distended with fluid, a sudden movement may
cause its rupture.

The Fibrous Tissues are endowed with a very feeble vitality.
The author's researches lead him to regard the ligaments- as insen-
sible, although, as their insertions into the bones are continuous
with periosteal or osseous tissues, tearing or stretching these may
cause pain. By no experiments has he been able to induce inflam-
matory action in the ligaments or capsule, even when the synovial
was quite red, and the joint full of pus. When, in exceptional
cases, they do become somewhat reddened, it is not the redness of
inflammation, and it is almost always consecutive to lesions of
surrounding tissues. One of the changes most frequently met with
is a puffiness of the capsule and ligaments, produced by serous
infiltration into the inter-fibrillary cellular tissue which separates
the ligamentous fibres, these assuming, also, a dull tarnished appear-
ance. This relaxation allows of great separation of the articular
surfaces. At a later period, the fibrous parts become hypertrophied,
or even indurated.

The Articular Extremities of Hhe Bones. M. Richet believing that,
however well osteitis in general has been described by Gerdy and
Miescher, the form that affects the spongy tissue in the vicinity of
joints is imperfectly known, describes it, from his own observations,,
with a minuteness that defies our following him. It must suffice to
say, that he admits three stages of primary osteitis. In the Jirst of
these, a section of the bore presents a vascular surface and enlarge-
ment of the cells, its compact surface being pierced with numerous
minute holes for the passags of vessels. The secretions of the
periosteum become diverted to the surface, and the bone is increased
in size, in consequence of new layers deposited at its surface, as
well as by the enlargement of its cells. Although such enlarge-
ment of bone is not admitted by Crowther, Russel, and S. Cooper,
M. Richet has proved its existence by admeasurement, after sepa-
ration of the soft parts. In primary osteitis, periosteal effusion is,
however, not constant, occurring only as the inflammation approach-
es the surface ; but in secondary osteitis, it is the earliest change
observed. In the second stage, the red colour is concentrated at
certain points, little collections of blood taking place. The cells
become more and more spacious, and true abscesses are formed
within the bone. Sometimes, however, hypertrophy of the inter-
cellular parietes leads to a diminution in the size of the cells, and
4he spongy tissue is resistant instead of yielding. In the third
stage, the pus which had been infiltrated into the cells destroys the

1856.] On While Swelling. 39

vessels, and the lamella?, deprived of nutriment, become necrosed.
At other times, ulceration, terminating in caries, occurs, and bleed-
ing fungosities, or vegetating granulations, spring from the cells.
Sometimes the cartilage is perforated only in places, at the bottom
of which bleeding vegetations are seen, an appearance mistaken by
Brodie and others for true ulcers.

Arrived at this stage, it is rare for the osteitis to be confined to
the articular extremities, and, on cleaving the bone, the entire
medullary canal is found to exhibit an intense redness throughout
its entire extent, while small sanguineous effusions, and the other
phenomena of the early stage of osteitis, are observed at the other
extremity of the bone, although externally this exhibits no evidence
of the change.

Consecutive Osteitis. As synovitis may be secondary to an ostei-
tis, so this last may supervene upon a synovitis. An osteo-periosti-
tis so produced differs much from an osteitis properly so called,
there not being the enlargement of the cells or the vivid injection
of the spongy tissue, with its purulent infiltration. It is the perios-
teum which undergoes the chief alteration, the bone, at a later
period, undergoing hypertrophy even to its centre. It is, however,
the cartilaginous surface that chiefly suffers, the synovial fungosi-
ties rapidly leading to its perforation and destruction, and entering
into immediate relation to the bone. The compact lamellae become
necrosed, and the pus penetrates into the spongy tissue, inducing
more or less deep-seated changes. Vegetations are often found
within the cells; but beneath the fungosities the intercellular lamellae
are found more resistant than normal, while in primary ulcerative
osteitis they are softened. Consecutive osteitis is a less refractory
disease than the primary, the aiticular surfaces sometimes becoming
covered with fibrous tissue that allows of some movement.

There is another change in the bone which, although not rare,
has not been described, and to which M. Richet considers no better
appellation can be at present applied than fatty degeneration. A
few spoonfuls of a sero-sanguinolent or purulent fluid are found in
the cavity of the joint, the synovial membrane not exhibitifig
changes proportionate to the symptoms observed during life. The
articular cartilages are eroded, thinned and perforated by a great
number of minute apertures. On raising them, which is easily
done, a large layer of blood, having the colour and consistence of
currant jelly, is found interposed between the spongy cells and the
thinned compact lamellae which is detached with the cartilage. On
sawing the bone, in place of finding the cells more or less inflamed
and gorged with blood and pus, the section presents a yellow color,
deeper as the centre is approached. The cells are enlarged, and
pressure by the finger produces slight crepitation, and expels a
quantity of yellowish oily fluid. No trace of the smallest vessel
can be found amidst the spongy tissue. The medullary canal is
abundantly filled with this yellow fluid. The periostemis not in-

40 On White Swelliny. [January,

flamed, no trace of the vascularity seen in osteitis existing, while
the size of the bone is diminished rather than increased.

Changes in the Articular Cartilages. M. Richet regards cartilage
as possessing a very rudimentary organization, coming between
fibro-cartilage and the products of epidermic secretion. Its mode
of life is, as it were, parasitical, living by absorption of the liquids
amidst which it is placed, its component utricles or cells operating
osmosis. To the question, whether the articular cartilages are sus-
ceptible of inflammation, and of participation in the diseases of sur-
rounding parts, M. Richet replies in the negative. By no experi-
ments can vascularity be induced, and no attempts at reparation
are found after old injuries. Amidst the completest change in sur-
rounding parts, they exhibit only some roughening or thinning from
commencing absorption. Vascularity, supposed to have been seen
on their surface, is really due to the development of new vessels in
a pseudo-membrane that covers them. Ossification, adduced as a
proof of vitality, is never found in the case of true cartilage ; but
the eburnation of the bony extremities, after the cartilage has dis-
appeared, has been confounded sometimes with this.

The articular cartilages are, however, liable to various kinds of
alterations, resulting from perversion of their nutrition, or from me-
chanical or chemical causes. Among such is a loss of elasticity,
noticed by Delpech, and frequently observed by the author. Ra-
mollissement, which appears to be another stage of this loss of elasti-
city, occurs also pretty frequently, especially in those who have
died in advanced years. This change, which has by others been
termed velvety, has been the object of much research by M. Richet
since 1840, and he thinks there is always coincident with it a
diminution of synovia, probably due to a lessened nutritive activity
in the bones and articular secretions. A total or partial disai^pear-
anceoftJie cartilages seems to be a third stage of these alterations,
which, while they cannot be called normal, can yet hardly be de-
scribed as pathological, as they are met with in persons whose
joints were healthy.

As regards the changes in the cartilages of diseased joints, they
are due either to loss of cohesion ramollissement or are char-
acterized by thinning, inequalities, or erosions. The last especially
claim attention, as by some authors they have been termed ulcera-
tions. When the cartilage is found roughened and unequal, this is
due either to wearing away or resorption exerted at certain points,
to a perversion of nutrition due to disease of the bone, or to the
presence of abnormal fluid within the joint. As the cartilages live
at the expense of the parts which surround and support them, they
become more or less changed, according to the duration and
severity of the disease of the part.

When we examine a joint thai has suffered from white swelling
originating in osteitis or advanced synovitis, we almost always find
the appearance as if the cartilage had been irregularly punched

1856.] On White Swelling. 41

out. Around these spots it is quite normal, not having even lost its
cohesion and elasticity, unless effusion or other altei'ation of the
cavity of the joint be present. Generally there is more or less
synovitis present ; but when this is not the case, a superficial
examination might lead to the affection being considered a primary
lesion of the cartilage. But if the bone be so cleft that the saw falls
in the centre of the erosions, osteitis will be found occupying the
articular extremity of the bone, and most intense where the loss of
the cartilage is seen. Brodie and other surgeons have contended
that such loss of substance is due to a primary affection of the car-
tilage, which, extending to surrounding parts, gives rise to one of
the most painful varieties of white swelling. The facts cited by
Brodie are valueless, in consequence of the very superficial manner
in which the examination of the joints was conducted. The history
of the condition of the joints in the aged, in which, when the carti-
lage is gone, ebumation takes place, a change inducing little or no
pain, is contradictory to the accuracy of Brodie's assignation of
severe pain as a sign of cartilaginous disease. Osteitis induces the
most dreadful suffering.

Symptoms. While alluding to the gradual manner in which the
disease may come on, M. Richet observes, that in the case of such
superficial bones as the tibia and ulna, we may often detect early a
little puffiness of the periosteum rounding off the edges of these
bones that are naturally so sharp and distinct.

The soft parts may be at first more considerably swollen than
the articular extremity, the disease then seeming to have more
tendency to attack the diaphysis, or even the opposite articular
end, as, e.g., the pain and swelling of the knee in coxalgia. M.
Richet, several years since, proffered the explanation of this circum-
stance by the propagation of the inflammatory action along the
medullary canal from one extremity of the bone to the other ; and
all subsequent observation confirms him in its correctness. Such
pains are important in diagnosis, showing that we have to do with
an osteitis and not a synovitis.

Diagnosis. In this section M. Richet chiefly occupies himself in
pointing out the distinguishing marks between osteitis and chronic
synovitis. The latter may be due to a local cause, although its
progress is usually dominated by a general one : but osteitis is
almost always referable to a general cause. Synovitis often suc-
ceeds rheumatism. Osteitis is usually of scrofulous origin. In
synovitis, the various symptoms may appear almost simultaneously;
but in osteitis they are more gradual and progressive. In synovitis,
there is hypertrophy of the synovial without swelling of the bone,
and the softened ligaments allow of considerable and abnormal
movements, while consecutive displacements occur frequentlv and
rapidly, without deformity of the articular surfaces. In osteitis,
there is appreciable enlargement of the bone, the limited motions are
terribly painful, and the displacements, which take place slowly, are
due to the flattening down of the deformed articulations.

42 On Wliite Swelling. [January,

Treatment. Upon the general treatment of the diatheses upon
which the disease depends, M. Richet has not much to say. He
speaks highly of iodine and cod-liver oil in certain cases ; but he
does not find that the former can be used as a substitute for the
latter. He considers that the tonic effects of hydropathy are suffi-
ciently shown to induce medical men to avail themselves of its aid.
Sea air and mineral waters are useful in appropriate cases. Vege-
table tonics are of little use ; and iron, to be even harmless, requires
care in its administration.

In the local treatment of synovitis, although leeches sometimes
give great relief, they seem at others to do harm ; and when the
relief obtained is not prompt, they should be discontinued, as they
enfeeble. M. Richet attaches considerable importance to the
prolonged use of local baths. He thinks the large flying-blisters, so
much recommended by Velpeau, should not be employed until the
subacute stage has been reached. The nitrate of silver ointment is
very useful, and sometimes dissipates violent and obstinate pains.

In pseudo-mernhranous synovitis, issues and the actual cautery,
used transcurrently, may be resorted to when the ligaments are
relaxed, and the bones, consecutively inflamed, are nigh luxation.
In the fungoid form they are indicated early, and must be employed
boldly. In this form, too, compression, combined with immovabil-
ity, is useful. When the synovial membrane is much distended, it
should be opened with a trocar. M. Richet has only sometimes
derived benefit from iodine injections in fistulous openings ; but finds
the fungosities that spring up are well treated by the tincture.

Syphilitic Osteo- Synovitis. M. Richet remarks upon the silence
of authors with respect to the influence of syphilis in relation to
white swelling, their attention being confined to scrofula and rheu-
matism. M. Ricord informs him, that although he has met with
certain cases of white swelling, the cause of which has been influ-
enced by syphilis, he has never seen any that seemed to have been
directly determined by it. He believes, also, that this disease
influences the compact rather than the spongy tissue of bone. Not-
withstanding this opinion, M. Richet believes that syphilis may
alone determine a synovitis or osteitis, and so constitute an import-
ant variety of white swelling. Since his attention has been turned
to the subject, he has met with sevei'al cases of syphilitic chronic
synovitis of the knee-joint, and reports three of these in the present
essay. The effusion takes place gradually, and is liable to inter-
missions. The skin is never red or swollen, the tumefaction entirely
arising from the amount of effusion, which is sometimes great, and
the thickening of the membrane. This thickening may assume the
form of indurated plates, which soften and rapidly disappear under
the influence of iodide of potassium. The pain is not great, and is
worst while at rest. Left to itself, it tends to pass slowly into the
fibrous condition, producing partial anchylosis. M. Richet feels
certain that several white swellings that resist all treatment are

1856.] Treatment of Pneumonia. 43

syphilitic, although the detection of this cause is often difficult. As
the effused fluid has no tendency to become purulent, or the syno-
vial membrane to become fungoid, the occurrence of consecutive
osteitis is rare. It is rather the history of the case, than any pecu-
liarity of local symptoms, that reveals its nature; the treatment
often becoming the test of the accuracy of the diagnosis.

Osteitis arising from syphilis is a far more serious affection than
synovitis, and in M. Richet's opinion, it is as common. He furnishes
the particulars of three cases. The pain is severe, deep-seated,
lancinating, and especially nocturnal. It is propagated along the
shaft of the bone, which is swollen and tender. On motion, it is
very severe, and sometimes terrible. The articular tumefaction is
partly due to enlargement of the bone, and partly to hypertrophy of
the synovial membrane. The general symptoms are little marked,
but the impoverishment of the blood by the syphilitic poison, and
the terrible suffering sometimes induced, may produce emaciation
and the straw-coloured skin. There is less tendency to suppurate
than in simple osteitis. The pus is viscous, and the sinuses assume
the syphilitic aspect The prognosis is much less serious than in
simple or scrofulous osteitis, but more so than in syphilitic synovitis.
The preliminary, erratic pains may be mistaken for rheumatism by
the most skilful ; but in the latter there are febrile symptoms, while
the joint is red and swollen from effusion. As compared with
simple osteitis, the syphilitic form involves the articular structures
earlier, but it does not give rise to local heat and oedema. The
pain seems more concentrated in the deep-seated parts, and its
nocturnal exacerbation is better marked. In simple osteitis, all the
bones constituting the joint may become simultaneously affected ;
but in the syphilitic form, one bone usually alone suffers, as the
femur in the case of the knee-joint.

The essay is illustrated by thirteen fully detailed cases, besides
six of syphilitic white swelling, as well as by several good litho-
graphs; and it must be regarded as a valuable contribution to
articular pathology. [British and Foreign Med. Chir. Review.

The Experience of Various Kinds of Treatment in Pneumonia.

The author, after recapitulating the leading points of his former
paper, considered,

1st, The question as to the influence of blood-letting in the treat-
ment of pneumonia in regard to mortality. He denied that the
normal mortality from that disease could be accurately given,
showing, from a table he had collected, that it varied from 3 up to
31 per cent, out of some 7000 cases. He particularly alluded to
age, sex, and complication as affecting mortality. At the extremes
of life it was very fatal, but benignant at intermediate periods.
It was more fatal among females ; and complications of other dis-
eases, chiefly phthisis and Bright's disease, greatly increased it.

44 Treatment of Pneumonia. [January,

Thus, a selection of favorable ages only, a diminution of the num-
ber of females, in the number of complicated cases, would gener-
ally diminish the mortality.

2d. The author then considered the treatment by blood-letting
singly, instancing first two series of cases from Bouillaud, which
he showed were not fairly selected according to age, sex and com-
plication. Also, two series of cases from Grisolle, in one-third of
whioh only had blood-letting succeeded in curing the disease ; in
the remaining, it had failed, necessitating the conjunction of anti-
monials; lastly, he alluded to cases similarly treated by Dietel, of
Vienna; the mean mortality from the blood-letting treatment was
16'5 per cent. Dr. Kouth then considered the treatment by blood-
letting, combined with tartar emetic, instancing the cases recorded
by Dr. Hughes, of Guy's Hospital and others occurring in the
practice of Drs. Walsh, Peacock, and Taylor. These cases appear-
ed to be in no way selected ; indeed, as a rule, very unfavorable,
the complicated cases amounting, in those of Dr. Hughes, to 51
per cent.; in the others, 53 per cent. He also alluded to some ca-
ses similarly treated by Grisolle. The mortality obtained by these
gentlemen was

Simple AU

Pneumonia Cases.

Per Cent. Per Cent.

Dr. Hughes 2-2 24

Drs. Taylor, Peacock, and Walsh .... 3 -2 30

Grisolle 254

Mean 26

3d. He then alluded to the treatment by tartar emetic singly,
instancing cases from Louis, and Grisolle, and Dietel, giving a
mortality, out of 170 cases, of 18 per cent. These cases were re-
markable as generally recovering with very little loss of strength ;
and in comparing this kind of treatment with that of tartar emetic
and blood-letting, conjoined by blood-letting singly, the result
proved that by blood-letting and tartar emetic conjoined was the
most fatal, because the most depressing.

4th. Dr. Routh then dwelt on the treatment by chloroform, se-
lecting Varentrapp's cases as the best recorded ; but even these
were not fairly selected, because containing too small a number of
females. The mortality he obtained was 4 per cent., or, including
some other cases, which he ought not to have omitted, 11^ per ct.
A large number of cases collected by Vacherer, Baumgartner, and
Helbeing, (193) gave a mortality only of 4| per cent, but he could
not speak as to their assertion, not having been able to find the
original documents.

5th. The author then spoke of the results obtained by dietetic
treatment only. These were of two classes, those obtained by
homoeopaths, (i. e., in those cases where they had been also diag-
nosed uud investigated by legitimate practitioners), and those ob-
tained by experiments directly made by legitimate practitioners

1856.] Treatment of Pneumonia. 45

themselves. From Jessier's cases the mortality was 14 per cent. ;
from Dietel's experiments, out of 189 cases so treated, the mortal-
ity was 74 per cent.; Dr. Todd's treatment was also much less
energetic. He discouraged blood-letting and tartar emetic, trusting
chiefly to the liquor ammonia acetatis, and giving the patient
support.

6th. Dr. Eouth then proceeded to speak of the treatment which
he recommended. The indications were, first, to diminish the gen-
eral fever, especially the increased cutaneous and pulmonary res-
piration. The former was effected by the tincture of the root of
the aconitum napellus, on the action of which, in small and poison-
ous doses, he dwelt at length, and especially in reference to its
certainty of action and utility as compared with the ordinary
tincture of the Pharmacopoeia ; the latter indication was effected
by oleacous inunctions, which cooled the skin very rapidly.

The second class of indications was to relieve the local symp-
toms, which was best effected by the employment of Junot's ex-
hausting apparatus, which did all that blood-letting could do, but
saved the patient's blood, and by dry cupping or counter-irritation
largely, by turpentine, according to Dr. Todd's plan, or blisters
followed by repeated dressings of cotton, so as to deprive the sys-
tem of a large quantity of fluid ingredient. The last class of in-
dications to be fulfilled was that which had reference to the support
of the patient. He objected altogether to the 'diete absolue' of the
French, recommending the ordinary middle diet of hospitals, or
beef-tea from the first, to obviate tendency to death by depression.
He occasionally gave small doses of tartar emetic during the first
days of the disease, to promote expectoration, and perhaps an al-
terative mercurial. Under this treatment, he had been generally
very successful in pneumonia.

Dr. Webster remarked that more men died of pneumonia than
women, the proportion being 13 of the former to 10 of the latter.
It was usually fatal among children ; but most fatal after the mid-
dle period of life, the greatest mortality occurring in persons be-
tween 50 and 60. He referred to the occasional termination of
pneumonia in gangrene, and of its rarity in sane as compared with
insane patients. Thus, in 3102 dissections of sane persons made
in the Civil Hospital at Prague, 55 exhibited gangrene of lungs,
or 1 in every 56 cases ; whereas in 123 dissections of lunatics,
lately published by him in the Psychological Journal, 17 cases
exhibited gangrene of lungs, or nearly 1 in every 7 autopsies,
which makes the ratio eight times greater among insane than or-
dinary patients. With respect to treatment, he observed that the
experience of French, German, or Italian physicians, could not be
compared with that of physicians in our own country, as the con-
stitutions of the people were different, and consequently the same
kind of treatment not applicable. In this country, though bleed-
ing could not be resorted to to the same extent as formerly, it

46 New Treatment of Subclavian Aneurism. [January,

might be still employed, according to circumstances, either locally
or generally, followed by tartar emetic and the repeated application
of blisters ; mercury afterwards, to the extent of slight salivation,
was most serviceable. [Dr. Rouili London Lancet.

Remarkable Case of Subclavian Aneurism ; New method of Treat-
ment ; Recovery.

Mr. Fergusson presented to his class on the 4th of August, a
most interesting case one of a series, as we subsequently learned
where a very remarkable cure has been effected in well-marked
subclavian aneurism, by a new and specific method of manipulation
which he has adopted. We may state here that we saw the case
about a year and a half ago also, when the man was previously
under treatment. Some short period before that time Mr. Fergus-
son conceived the plan of stopping the circulation in the aneurism
by pressing the sides of the aneurismal sac together, with their in-
tervening fibrinous deposit; and in this case, from the phenomena
attending the manipulation, there appear to us very little doubt
that the object held in view by Mr. Fergusson had been attained
viz : the clots of fibrin in layers in the aneurismal sac had been
displaced, and, spreading from the subclavian into the auxiliary
and brachial, a new sort of Brasdor's operation, at the distal side
of the subclavian had been the result. In other words, we believe
Mr. Fergusson here, without ligature, had attained all the advan-
tages of the last-named operative proceeding ; for not only had a
blocking-up of the axillary and brachial been followed by a par-
tial stoppage of the current through the enlarged aneurism of the
subclavian, but even with very marked, but not so satisfactory,
results as regarded the pulse in the radial at the wrist, which be-
came completely stopped for a time, with symptoms of paralysis in
the arm, all resulting from the displacement of the fibrinous clots.

The aneurism in the present case was situated in the subclavian,
in the usual site of subclavian aneurism namely between the
scaleni muscles, and to us seemed almost to invite some modifica-
tion of the Dublin surgeons' plan by compression on the first rib.
The plan by compression, we need hardly observe, is in general
applied to the artery above the aneurism, between the latter and
the heart. Crampton, however, in 1816, showed that the oblitera-
tion of an artery can be effected without rupture or ligature of its
coats, as generally conceived, simply by this blocking-up process.
The early volumes of the Lancet contain cases also cured by Bras-
dor's operation ; it seems, however more applicable to carotid than
subclavian aneurism.

Mr. Furgusson related to his class on the 11th, at some length,
the details of a previous case of subclavian aneurism, of the same
character as the present, in which his ideas on this subject were

1856.] New Treatment of Subclavian Aneurism. 47

first matured. In both cases the method of cure by deligation at
the tracheal side of the scaleni, as well as Brasdor's operation at
the distal end of the aneurism, were inadmissible ; yet it was
gratifying to find the present plan, by firm pressure of the thumb
on the aneurism, so as to displace some of the fibrinous clots, fol-
lowed up by local pressure, succeeded in obtaining most striking
and in many respects curious but satisfactory results. Intimately
associated as the subclavian is at the right side with the vertebrals
and carotid, the method of displacing fibrinous coagula is not with-
out danger. A patient under such circumstances will fall down
perhaps in a fit from want of circulation in one side of the " circle
of Willis," formed by these arteries ; yet as the cause is so appa-
rent, the danger may not be very alarming. Some instances of
cure of aneurism of even the innominata have been given by
American surgeons, in which recourse was had to ligature on
Brasdor's plan of the subclavian ; the result here ought to be
equally dangerous. Hodgson gives us cases also in which a plug
of effused lymph had nearly obliterated the subclavian ; while
Gendrin has imitated all the phenomena of arteritis and blocking
up of aneurisms by injecting irritant substances into a portion of
artery contained between two bgatures. In Mr. Fergusson's new
mode of operation, we believe an entirely novel idea is acted on
namely, the displacement of the lamcllated fibrin of the aneurism,
on which no operation has been performed, and so directing the
clots of fibrin that they shall block up the distal end of the artery
so diseased. As Mr. Fergusson has expressed an intention of
bringing the entire subject under the notice of the Medico-Chirur-
gical Society, we purposely abstain from giving the cases in detail.
The method of treating aneurism by compression, originating with
Desault and Hunter, and recently revived with such excellent re-
sults by the Dublin surgeons, will gain an immense accession of
interest, if it should prove that the fibrinous deposit of the sac of
the aneurism may be thus as it were utilized in bringing about the
results hitherto gained in a different mode by Brasdor's operation
at the distal end of the aneurism. Considerable caution will be at
first necessary, as observed by Mr. Fergusson, in selecting cases
which are fitted for the present method, as premature or ill-judged
experiments in the shape of direct pressure or manipulation on the
sac of aneurism not requiring it, one of which we mentioned re-
cently as brought into Guy's where direct and prolonged pressure
had been made in the popliteal space before the patient came into
hospital would be certain to be followed by severe inflammation of
the sac and other dangerous results. The spontaneous cure of
aneurism is not unknown in practice ; it may take place, it must
not be forgotten, by a coagulation of the contents or increase of
the quantity of lamellated blood in the sac, the cavity becoming
filled, and the circulation conveyed to the parts beyond the disease
by the collateral vessels ; or, again in some rare cases the aneuris-

48 Dislocation of the Femur. [January,

mal tumor may be doubled up and press upon the portion of artery
leading directly to the aneurism ; or in a third fashion, as in a
remarkable case given by Mr. Liston, where the patient had well-
marked subclavian aneurism, which subsided and disappeared
an aneurism of the innominata pressing on and obliterating the
aneurism of the subclavian !

Whatever may prove to be the correct pathological explanation
of the phenomena in Mr. Furgusson's present cases, we deem it our
duty to state here briefly that the cure seems complete and unequi-
vocal without any ligature of vessels, nor is there any reason to
believe the case was one of spontaneous cure of subclavian aneu-
rism, as in the case given by Mr. Liston. It is now two years
since the man came first under observation ; he has been, on and
off, under treatment all that time in King's College Hospital and
at home in the country ; but happening to be in town within the
last fortnight, Mr. Fergusson took advantage of the opportunity
to exhibit the case to his class. [Lancet.

Dislocation of the Femur into the Ischiatic Notch. Reduction by
Manipulation. By Frank H. Hamilton, M. D., Professor of
Principles and practice of Surgery in the Medical Department
of the University of Buffalo.

In my report on " Dislocations" made to the New York State
Medical Society in February last, and just published, I have stated
that in reference to the reduction of dislocations of the hip by
"manipulation" alone, I did not feel authorized to speak authorita-
tively, having as yet had no experience in this mode. I ventured,
however, to express a hope, based upon the testimony before me,
that it might hereafter prove, in a majority of cases, both safe and
practicable. Since then an opportunity has been presented which
has enabled me, in some measure, to determine, by personal ex-
perience, the value of this procedure, and I hasten to lay the case
before the profession.

March 23, 1855. Charles McCormick, aged 21 years at work
for the "State Line P. P. Co.," was caught between two freight
cars, with his back resting against one and his right knee against
the other ; his thigh being raised to a right angle with his body.
As the cars came together he felt a " cracking " at his hip joint, and
was immediately unable to walk or stand.

Two hours after, I saw McCormick, and assisted by my son
Theodore, and Austin Flint, Jr., I examined the limb and made
arrangements for its reduction. The patient was lying upon his
back and left side. His right thigh was flexed upon his body to
nearly a right angle and adducted, the knee being carried across the
opposite thigh. It was also rotated inward, but not forcibly.

Turning the lad upon his back and rasing the left leg to a posi-

1856.] Dislocation of the Femur. 49

tiort corresponding to the right, both legs were carefully measured
with a tape line from the anterior superior spinous process to the
patella, and the right leg was found to be shortened one and a
half inches. Measuring again from the ant. sup. spin. p. to the
most prominent point of the trochanter major the distance on the
dislocated limb was six inches, and on the sound limb five inches.
The head of the bone could not be felt, but no doubt remained as
to its position/ The limb was nearly immovable, except in one
direction. It could neither be abducted, or rotated outward or
carried downward.

Procedure. The patient lying upon his back, I seized the right
leg and thigh with my hands, the leg being moderately flexed
upon the thigh, and carried the knee slowly up towards the belly
until it had approached within twelve or fifteen inches, when, no-
ticing a slight resistance to farther progress in this direction, I
carried the knee across the body outward until I again encountered
a slight resistance, and immediately I began to allow the limb to
descend. At this moment a sudden slip or snap occurred near
the joint, and I supposed reduction was accomplished; but on
bringing the limb down completely I found it was in the same
position as before. I think the head had slipped off from the
lower lip of the acetabulum, after having been gradually lifted
upon it.

Without waiting, I commenced to repeat the manipulation, and
in precisely the same manner. Again at the same point, when
the limb was just beginning to descend, a much more distinct sen-
sation of slipping was felt, and on dropping the limb it was found to
be in place and in form, with all its mobility completely restored.

No anaesthetic was employed, and no person supported the body
or interfered in any way to assist in the reduction. No outcry
was made by the patient, yet he informs me that moving of the
limb hurt him considerably. The amount of force employed by
myself was just sufficient to lift the limb, and the time occupied in
the whole procedure was only a few seconds.

After the reduction, he remained upon his back, in bed, eleven
days, in pursuance of my instructions. At the end of this time
he began to walk about, but was unable to resume work until after
eight weeks or more. It is probable that he could have walked
immediately after the reduction, without much if any inconve-
nience, so slight was the inflammation which resulted from the
accident. He never complained of pain, but upon interrogation he
replied that there was a slight soreness back of the trochanter, near
the head of the bone. This soreness continued several weeks and
was especially present when he bent forward. Even at the pres-
ent time, four months after the accident, be occasionally feels a pain
at this point when he is stooping. The motions of the joint arer
however, free, and he walks nimbly and without any halt.

In short, if I may judge correctly from a single example, nothing

50 Seat and Varieties of Cataract. [January,

could be more complete than the triumph of this process over a
dislocation hitherto so formidable. Nothing could be more sim-
ple and easy of execution, and nothing more gratifying both to
the surgeon and to his patient. Unless, therefore, experience
shall demonstrate in its practical working defects or dangers which
I cannot now anticipate, I shall regard it hereafter as one of the
most valuable contributions to our art, and its inventor as a true
public benefactor. [Buffalo Med. Journal.

On the Seat and Varieties of Cataract. By M. Malgaigne.

Not only is M. Malgaine one of the ablest practical surgeons of
the present time, but he has, by his patient research and great crit-
ical sagacity, been the means of overturning more than one time-
honored but erroneous doctrine. He thought he had succeeded in
doing this as regards cataract, in his communication to the Acade-
mie de Medecine, in 1841 ; but finding some persons still holding
erroneous ideas upon the subject, he, in this paper, re-states the
case at some length.

The history of opinion upon the seat and nature of cataract may
be divided into an ancient and a modern period. During the for-
mer, extending from the school of Alexandria to the beginning of
the eighteenth century, the site of cataract was placed in front of
the crystalline. The modern period is divisible into certain
epochs viz., 1. That of 1705, in which Brisseau demonstrated
that the crystalline itself was the seat of cataract. 2. Between
1755 and 1763, Tenon and Hoin announced the existence of cap-
sular cataract and cataract of the liquor Morgagni. 3. From 1790
to 1817, the German school multiplied the varieties of cataract
beyond all measure. 4. M. Malgaigne published in 1841 the re-
sult of his necroscopical researches upon the subject. Prior to
1840, he believed in the existence of lenticular and capsular cata-
ract, as other people did, when accident led him to investigate the
matter in a succession of persons dying with cataract, at the Bice-
tre, and to his astonishment he never could discover any traces of
a capsular cataract. In 1841, he communicated accounts of twenty-
five autopsies, and since then, these have reached to more than
sixty. In none of these did he ever find the capside opaque, or
the opacity of the lens beginning at its centre the cataract inva-
riably commencing in the soft layers of the lens lying nearest the
capsule, the opacity, in the great majority of cases, being complete
at its anterior and posterior surfaces, while the nucleus continued
transparent. In some rare cases the nucleus was also opaque. In
other rarer cases, the capsule was found thickened from the depo-
sition of coagulable lymph attaching it to the iris ; but in no in-
stance could he find an example of a simple capsular cataract.
After a full consideration of the subject, and an examination of

1856.] Treatment of Yellow Fever. 51

the criticisms that have been advanced, he comes to the final con-
clusions 1. That the existence of a cataract commencing in the
centre of the lens is as yet purely hypothetical. 2. There is no
example of a simple capsular cataract without opacity of the lens.
3. Complicated capsular cataract may form an exception to this
rule ; only two instances of this, however, having been demon-
strated. As to the cataract of the liquor Morgagni, the author's
researches lead him to deny the existence of any such fluid. As a
final resume, it may therefore be stated that, to the present time,
two varieties of cataract only are known, lenticular and capsulo-
lenticular the change in the crystalline always commencing in
the layers adjoining the capsule, although this itself remains trans-
parent.

In a note, M. Malgaigne makes an observation respecting the
mode of judging of the transparency of the sound crystalline,
when removed. The light can be very well seen through it, but
objects cannot be distinguished. The surface has lost the polish
bestowed on it by its capsule, and it resembles a piece of broken
crystal, which, although transparent, refracts the rays too much
to allow of distinct vision. If however we attach the object to the
lens, we then discern it wonderfully the smallest fibres, for ex-
ample, of the tissue of a dissecting-room apron, upon which the
lens has been laid, being distinctly visible. Applying this test to
opacities, whether central or peripheric, slight or thick, yellow or
brown, it becomes impossible to see the texture of the apron.

[Rev. Med. Chir. Brit, and For. Rev.

Professor W. Stone's Treatment of Yellow Fever.
We extract from the New York Medical Times the following
remarks of Prof. Stone, whose acknowledged ability and success
in the treatment of Yellow fever entitle his testimony to great
weight. The learned gentleman's views were delivered at a recent
meeting of the New York Academy of Medicine.

Treatment. Yellow fever is a self-limited disease ; it is not to
be treated it is to be managed. All that is to be done is to keep
the patient alive for a certain time, and he will get well.

The disease is ushered in with a chill or slight rigor, often
scarcely noticeable, followed by heat in the forehead, pain in head,
limbs, and back. This is again followed by a hot fever, and if the
patient be kept under cover, and carefully treated, these symptoms
will quietly terminate in two or three days * but if left to them-
selves to toss about and not remain under cover, the sweating
stage passes on for five or six days, and collapse, black vomit, and
death result.

The only treatment found by Dr. S. to be useful, is to favor the
efforts of nature in prolonged sweating, calm, and rest of the sys-

N. S. VOL, XII. NO. I. 4

52 Treatment of Yellovj Fever. [January,

tem, and the fever will generally be got rid of in the first two or
three days. It terminates in favorable cases on or before the third
day, leaving the skin natural. Those who treat it otherwise than
expectantly do not understand the nature of the disease.

Among those who may be said to understand the disease, there
are two methods of treatment: the expectant cups to temples to
relieve cephalalgia, slight laxatives to open the bowels, hot baths
under the bedclothes. Others give quinine. Dr. S. was the first
to do so, whoever has the credit, but no matter about that. The
only difference is that they do not give it with any specific object.
His method was a full dose at the beginning of the disease, but not
afterward. Thus given, it promoted and prolonged the sweating
stage, and while this was kept up, the patient was safe. It was
remarked, that they would get well without quinine where it was
generally prescribed. He was physician for many years to a hos-
pital where there were 40 to 50 cases a day, and he noted that
those in favor of this quinine treatment were about 10 per cent.

Dr. S. remarked, that in 1847 he treated forty cases in sueceffi
sion by quinine, among mechanics, who had no nursing except
what was provided by friends, and did not lose a single patient.
It was in a favorable epidemic, but considering their destitution of
proper nursing, deaths would have been as likely to occur as in a
worse epidemic.

As to the use of calomel in this disease, there is no possible con-
dition of the system where there could be any benefit derived from,
its use there was no local disease. The liver has nothing to do
with it. He knew this, for he had followed the patients of the
Calomelites to the dead house in plenty.. While serving as sur-
geon of the Charity Hospital, the medical side of the hospital was
full, and there were several mechanics who applied for admittance,
and wished to be treated by Dr. S. and as he had some empty beds;
he received them. But one was sent to the medical wards, and
he gave him foot-baths, kept him warm, regulated his drinks, &c,
and gave quinine. The attending physician came in the morning ;
he ordered a drachm of calomel, but Dr. S. put up magnesia. The
next day he was better, and the doctor repeated the dose,- but he
took the liberty to repeat the magnesia. He got Avell, and thence-
forward was one of the attending physician's " brag cases." for he
dared not tell him of his doings. Then eame new physicians from
Paris, full of Broussais' theory, and they bled and boasted of their
successes also for a while, and in truth they did succeed as well as
the former. Then eame eclectics with fanciful theories; they gave
a little calomel to disgorge the liver a little, cups a little, leeches
a little, and with a result very little different from the others. In
fact some will get well in spite of the treatment, and then again
iome forms of the fever are fatal in the beginning. When, howe-
ver, they are brought side by side, and we can observe them en
masse, we can more properly judge of the relative value of the dif-

1856.] Treatment of Yelloiv Fever. 53

ferent modes of treatment, than in the isolated cases met with in
ordinary practice. The difference is very manifest all perturba-
ting treatment is alike bad.

There are some peculiarities in the disease that might not at
first strike one the disturbed nervous system, and especially de-
lirium one of the worst symptoms. This may appear at first,
but not usually. Its first evidence is restlessness and want of sleep ;
objects are seen very much as in mania-a-potu. Narcotics produce
stupor and death, for the patients with this disease are peculiarly
susceptible to morphine : stimulants are much better. You must
watch to give the stimulants as early as possible ; they then sweat
off, and are relieved in 24 to 36 hours ; but even then they must

not be disturbed if raised up, they faint away. Perfect and ab-
solute rest, body and mind, are indispensable. If they are excited,

i the heat returns, and they die. Watch for sleeplessness, and give
minute anodynes and stimulants, such as they are able to bear.
Of those cases that run on and approach the period of black vomit,
if managed properly as to drinks, by avoiding bitter infusions,

j &c, very many recover; and those that do not vomit would have

i the black vomit if they vomit at all. Some have a preference for
certain kinds of drink, as porter; others prefer brandy, &c. Give
those agreeable to the palate. As they approach the black- vomit
period with previous restlessness and acid secretions, give some
alkali, with minute doses (say a 20th or a 30th of a grain) of mor-
phine, with champagne, ale, beef-essence, &c. Impart to the pa-

| tient a feeliug of safety and security. And yet I have thought,
in proportion to the mildness of the disease was the danger ; for

i quiet is absolutely necessary, and coercion does not answer. The

patient is to be managed, not treated.

Foot-baths under the clothes, will often produce favorable

Bweats. When in a state of dry heat, forced perspiration is bad;

sponging with tepid water is then better. The douche is but of

temporary benefit, and the subsequent reaction leaves the patient

worse. Sponging with lemon-juice, sweet oil, and salt is used by

the Creoles and Spaniards, but pure water is better. All that is to

be done is to ease them through,

* * -x- * * * * *

Dr. Gardner stated that Dr. Ashbel Smith laid great stress on
covering, and said the patient should be enveloped in blankets
and carefully excluded from the air. Was this correct, and what
drinks are proper ?

Dr. Stone.- Careful covering of the entire body and limbs is ab'
solutely requisite, but not to swelter under too much covering.
K the hands were but exposed, sometimes the heat would return
and a relapse ensue. Some mild diaphoretics may be given ; such
drinks as the patients desire ; one year all want brandy and water,
other years malt liquors. Give that which is desired, and carefully
avoid even the nervous shock caused by a bitter or disagreeable

54 Treatment of Sciatica. [January,

medicine. Sponging the body under the clothes, ice water to

head, generally were followed by reaction and more pain. Dr..

Cartwright had pursued the opposite plan of enveloping the head

in warm fomentations.
********

Dr. Corson wished to know the doses of quinine which Dr. S.
gave, and the vehicle.

Dr. Stone replied that he usually gave a single dose of fifteen
or twenty grains, according to circumstances, at the onset, per-
haps ten grains more 12 hours after, but none unless on the first
day ; and the second day it is entirely useless, and after that
actually injurious, although they bear it better than any other
remedy. It causes vomiting when given late, and is not necessa-
ry, for its effects last several hours after its administration.

Treatment of Sciatica. By Peyton Blakiston, F. R. S.

Dr. Blakiston has pursued the following treatment for twenty-
years with considerable success. He first saw it adopted in Paris
in 1833 : A blister, about the size of a crown-piece, is placed over
the chief seat of pain, which is usually the flattened part of the
buttock. After it has risen well, and the cuticle has been thor-
oughly removed, the raw surface is sprinkled with a powder, con-
sisting of one grain of acetate of morphia on an average, and a
little white sugar. This dressing is repeated for six successive
days, the surface of the blister being kept in a raw state, if requi-
site, by cantharides or savine cerate, or else by Albuspeyeres' plas-
ter. This suffices for a very mild case ; but in severe cases of old
standing, the pain will now be found to have left its original seat,
and to have seized on the knee of the affected side. The same
treatment is then applied to the ham; and after six dressings, the
pain will have generally disappeared, and the patient will rapidly
recover. By this mode of treatment, eighty-three eases of uncom-
plicated sciatica have been cured, without a failure having come to
the knowledge of the writer. This number might have been great-
ly augmented had it included the results arrived at by such of his
friends and former pupils as had employed it at his suggestion,
and which have been no less successful than those which occurred
in his practice; but he is desirous of recording such only as have
come under his own immediate notice, and for the accuracy of
which he consequently can hold himself responsible. In the great
majority of these cases no other drug was administered ; but in a
few some laxative medicine or injection was given to remove con-
stipation. In two or three cases, there was a tendency to double
sciatica, and then the pain passed from the sciatic region first
treated to that of the opposite side, and from thence down to the
knee of this last side, but never attacked the knee of the side first

1856.] Chlorate of Potash in Mercurial Stomatitis. 55

affected. It is right to mention, that in hospital practice three
cases were placed under the writer's care, which he considered
more than doubtful, and they were therefore treated under protest,
so to speak. They all turned out cases of hip disease, and there-
fore they are not included in those above enumerated. The
difference in the sensations felt by the patients on the first appli-
cation of the morphia was remarkable; and without any attempt
to generalise, it may be stated that a close connexion was obser-
ved between the sensations felt and the previous state of health.
Thus the effect produced on three persons in robust health a
blacksmith, a gamekeeper, and a lady was most intense; an
! extraordinary thrilling was felt over the whole body, particularly
i at the extremities, with great nausea, and a tendency to faint.
The lady vomited incessantly for twelve hours, so that it was found
advisable to reduce the quantity of morphia in the powders to
half a grain. On the the other hand, a gentleman, who had been
much reduced by overwork and by long suffering, felt no effect
j whatever from the application of the powders, and yet he recover-
| ed in an equally short time with the others. A lady, also, who
! had been taking considerable doses of opium, hardly felt the appli-
cation of morphia until it was increased to two grains ; but this
. case has been excluded, because, although the sciatica was remov-
ed by the treatment, there remained an incurable disease, which
eventually destroyed her. One ladjr, aged 26, in whom the
I disease was not of long standing, obstinately refused to have a
j second powder applied ; but happily the one application sufficed
; to effect a cure. In six cases the disease recurred after an interval
; of from five to eighteen months ; and in two of these it recurred
twice; but each attack was less severe than the one which prece-
ded it, and yielded readily to the same treatment. It is possible
however, that relapses might have more frequently taken place
without having come under the notice of the writer ; but he thinks
this cannot have happened very often. Some other forms of neu-
ralgia were also benefited by this mode of treatment. Thus a very
distressing case of neuralgia of the scalp yielded at once ; and
shooting pains, which frequently accompany cancer of the stomach,
were sometimes much relieved by it. [Med. Times and Gazette.

On the Use of Chlorate of Potash in Mercurial Stomatitis.

From the experiments of M. Herpin, of Geneva, from those of M.
Blache(6raz. Bebdomadaire, vol. ii., No. 8, p. 147), as well as from
some well-detailed facts that M. Demarquay has just reported, it
would appear that chlorate of potash, given internally, arrests,
with rapidity and certainty, the effects of mercurial stomatitis.
This effect has been established in patients in whom the mercurial
intoxication supervened on the exhibition of mercury for syphilis,
puerperal peritonitis, and ophthalmia.

56 Treatment of Fistula in Ano. [January,

The chlorate is administered in a mucilaginous mixture, the
dose commencing with half a drachm, which is frequently suffi-
cient to remove the symptoms. But it has been given to the
extent of four scruples, two and a half drachms, half an ounce,
and upwards.

As this medicine, notwithstanding its remarkable efficacy, is by
no means a specific, we must not neglect to combine with it local
astringents and caustics, which, even alone, possess -so powerful
an action in mercurial ptyalism.

M. Grustin, intern in pharmacy, wishing, for the sake of experi-
ment, to submit himself to the action of chlorate of potash, took
two drachms at nine o'clock in the evening. On awaking, a sort
of astriction, with slight nausea, was perceived in the mouth ; the
gums were a little rough to the touch. Although the saliva was
not sensibly lessened, it appeared to him to be more watery than
usual, This observer has also proved that the chlorate of potash
is, in great part, eliminated by the urinary secretion. [Bulletin
General ale T herapeutiaue, and Gazette Hebdomadaire, N. Y. Jour,
of Medicine.

Treatment of Fistula In Ano. By T. K.Mitchell, M.D., F.B.C.S.I

I am anxious to direct the notice of the profession to a modify
cation of treatment in the cure of fistula in ano. It is, I believe,
an established axiom that in all cases it is necessary to divide the
sphincter ani muscle, the usual operation consisting of the intro-
duction of a probe-pointed bistoury as far as the sinus extends.
Others recommended the mere division of the sphincter in a lower
situation. Whichever operation is performed, the result is very
often a relaxed state of the sphincter for some time afterwards.

In a case on which I operated twelve months ago, the gentle-
man had considerable difficult}^ in retaining the bowel up, particu-
larly after violent exercise or defecation. In this case I found that
the fibres of the sphincter ani were much relaxed, so much so as
to allow the rectum to protrude for several inches, so as very
closely to resemble a prolapsed uterus. The constitution began to
suffer from the constant discharges of muco-purulent matter, and
he was quite incapacitated from following his employment. Hav-
ing previously emptied the rectum by an aperient, I directed him
to force down as much as possible, and then proceeded to touch
the tumor with strong nitric acid ; this was done with a piece of
thin wood, four stripes extending from the upper part of the tumor
to the sphincter being made on the surface; the part was then
smeared well over with oil, and returned. The operation requir.
ed to be repeated at the end of ten days, when only about two
inches of the rectum could be forced down, and he has since then
been able to go about his employment without the slightest incon>
yenience,

1856.] Sulphate of Bebeerine in Menorrhagia. 57

The profession are indebted to the late Dr. Houston, of Dublin,
for the introduction of nitric acid in the treatment of vascular
tumors of the rectum, many cases of its successful employment
being given by him in the twenty-third volume of the Dublin
Journal of Medical Science.

Since the above case was treated, I have had several of a similar
nature, and the result has been the same. It would, therefore, be
unpardonable in me to enlarge further on the subject, particularly
as a similar treatment has been adopted very extensively by other
surgeons, and is well known to the profession. It, however, struck
me that if, instead of the great relaxation of the sphincter which
so frequently follows its division, we could cause a constriction as
great or nearly so as before the operation, we should be doing
good service. Now this I think may be accomplished hj a very
simple method employing the nitric acid before the relaxation
takes place, or prior to any protrusion; and the plan I adopt, and
which I have hitherto found very successful, is to apply the strong
nitric acid around the margins of the sphincter ani which have
been divided, and this I do on the fourth day after the operation ;
the pain of its application is quickly removed by smearing the
parts over with oil, and it is only necessary to apply it twice.

Before concluding these remarks, I wish to state that I have found
patients laboring under diseases of the rectum particularly difficult
to get under the influence of chloroform, and have found the pro-
cess much facilitated by employing it locally as well as by inspi-
ration, as I have found the parts excessively sensitive even when
the patient has apparently been fully under its influence, and
when pricking or pinching was unheeded. This, I think, may be
easily explained by the fact of the patient's sufferings having been
for some time directed to the part, and to the nerves being in a
highly sensitive condition. [Lancet.

On the Use of Sulphate of Bebeerine in Menorrhagia. By Prof. A.
P. Merrill, M. D.

A few weeks ago I was summoned, in haste, to a lady suffering
from an attack of menorrhagia. She had been long subject to
excessive menstrual discharges, and uterine haemorrhages, and had
been treated for them by several physicians without succes. I
administered five grains of the sulphate of bebeerine, which
I happened to have in my pocket, and ordered twenty pills of
four grains each, one of which she was directed to take every two
hours, until relief should be obtained. On visitingher the succeed-
ing day, she showed me the twenty pills, and said the dose I had
given her suspended the discharge before they were brought from
the druggist, and she deemed it unnecessary to take them. One
other case, occurring about the same time, in all respects very

58 Editorial. [January,

similar to the above, was relieved, also, by a single dose of five
grains.

I could relate more than a dozen cases besides the foregoing,
more or less severe, in which the sulphate of bebeerine has been
successful. Several women in this city are now in the habit of
keeping the remedy always at hand, with perfect confidence, from
the results of their own experience, of being able to restrain exces-
sive menstruation, and uterine haemorrhage, whenever they may
occur. In several cases, also, I have known it relieve leucorrheal
discharges, and to give tone and vigor to the vagina, suffering
relaxation from the effect of such discharges ; and it is the only
internal remedy upon which I have been able to rely, for the re-
lief of pruritus vulvae, et vaginae.. Whether this remedy will prove
to be as valuable as the above experiments would seem to indicate,
remains to be proved; and it is with a view to elicit such proof,
that this publication is made. [Memphis Med. Recorder.

EDITORIAL AND MISCELLANEOUS.

Local Ancestkesia by cold. The efficacy of the frigorific mixture of
ice and salt as a local anaesthetic, in surgical operations which do not in-
volve the deep seated tissues, and the slowness of its adoption as a general
rule of practice in such cases, will plead my apology for again directing at-
tention to it. An instance of its successful application as late as yesterday,
also prompts me to say another word upon the subject, in the hope that
the same relief may he vouchsafed to other patients. Bob, a negro boy
about 15 years of age, was sent to me from Barnwell District, S. C, with a
tumor about the size of a woman's fist, situated on the leg, about the
upper end of the fibula. This proved to be a lipoma of five or six j'ears'
standing. The patient was brought before the Class of the Medical College
and placed upon a table, when the freezing mixture was applied for four
minutes. The surface being blanched by the cold, an incision six inches
long was made and the tumor extirpated without the knowledge of the pa~
tient, who was lying in such a position that he could not see what was being
done. The insensibility was so complete that when the operation was over,
on being asked if it gave him any pain, he said that he had felt none what-
ever, and that he did not know we had commenced cutting; he could not
be made to believe the tumor was removed, until it was shown to him.
There was no bleeding until reaction took place, when a slight oozing en-
sued, which ceased upon bringing the edges of the wound together with
adhesive strips.

Although I have been now resorting to this mode of inducing local anaes-
thesia for about a year, in all cases to which it was applicable, this is the first

1856.] Editorial. 59

instance in which total unconsciousness of the operation has been manifest.
In most cases the patients feel the knife only as it reaches the deep tissues
in passing behind the tumor, and then only slightly, inasmuch as the
sensibility of the cellular structure is not great.

When it is remembered that the greater number of surgical operations
involve superficial parts alone, and that we may by the use of so simple and
harmless an application as the freezing mixture, render them comparatively
painless, it must be conceded that the discovery is one of great importance
and that it should in all suitable cases take the place of the more hazard-
ous expedient of chloroformization. Yet, if we are to judge from the
paucity of recorded testimony, surgeons have been unaccountably dilatory
in its adoption, in comparison with the alacrity exhibited in trying other
anaesthetics. The freezing mixture maybe substituted for other anaesthetics
in the amputation of the fingers, toes, and wrist, as well as the opening of
furuncles, abscesses, and whitlows, the extirpation of superficial tumors, &c,
thus reducing to a very small figure the number of operations in which
chloroform or the ethers would be necessary or proper.

Augusta, 20th Dec, 1855. L. A. DUGAS.

BIBLIOGRAPHICAL.

Clinical Lectures on the Diseases of Women and Children. By G. S. Bed-
ford, A. M., M. D., Prof, of Obstetrics, &c, in the University of New York.
2d Edition. New York: S. S. & W.Wood. 1855. 8vo. pp. 568. (For
sale by T. Richards & Son.)

Whilst systematic treatises are necessary in the study of Medicine, much
good may be accomplished by the publication of clinical lectures or remarks
suggested by the presence of individual cases of sickness, and designed for
the ear of Students. It is true that the printed lecture loses a part of its
value to the reader, in not being accompanied by the presence of the pa-
tient ; still, there are countless modifications and peculiarities met at the
bed-side, which can find no place in a systematic treatise, and which may
yet be made the subject of interesting observations to a class of novices,
either orally or otherwise. In short, the relation of cases, with running
comments upon them, constitutes one of the very best modes of conveying
valuable information to the student of medicine.

The work before us is one of this kind, written in an easy, lucid, and happy
style, eminently practical, and therefore valuable as a contribution to med-
ical knowledge. Prof. B's extensive opportunities have enabled him thus
to bring together a large number of the most interesting specimens of
female and infantile affections, and to indicate his views of their treat-
ment. In the accomplishment of the task, the author has evinced a degree
of discernment which will doubtless add materially to his already extended
reputation.

60 Editorial. [January,

A Treatise on Venereal Diseases By A. Vidai., (decassis) Surgeon to the
Venereal Hospital of Paris, &c, &c. With colored plates. Translated,
with annotations, bv Geo. C. Blackmax, M.D.,fec 2d Ed. New York:
S. S. & W. AVood. 1855. 8vo.pp. 500. (For sale by T. Richards & Son.)

Having already had occasion to notice this work, upon the appearance
of its first edition, we can only reiterate our commendation of it, as one
of the most complete and useful treatises on syphilitic diseases we know.

History of Medicine, from its origin to the Idth Century, with an appendix
containing a Philosophical and Historical Review of Medicine to the
present time. By P. V. Renouard, M.D.. Translated from the French,
by Cornelius G. Comegys, M. D., Prof, of the Institutes of Medicine in
Miami Medical College. Cincinnati: Moore, AATilstach, Keys & Co.
1856. 8vo., pp. 719.'

We are indebted to the publishers for this valuable work, the mechanical
execution of which, reflects great credit upon the taste and ability of West-
ern printers.

It has long been a source of surprise to us that we had no History of
Medicine in the English language, while the French and Germans are so
well provided with them. We are happy to find the deficiency supplied
by the industry of Prof. C. The translator has judiciously selected for pre-
sentation to the American reader, the standard work of Renouard, in one
volume, instead of the more extended and elaborate History of Sprengel,
which would have been too voluminous for the mass of our practitioners,
who will doubtless feel grateful to Prof. C. for the opportunity thus afforded
of becoming acquainted with the history of their profession.

M. Renouard divides the history of medicine into, 1st, the Age of Foun-
dation, which comprehends the '"Primitive Period, or that of instinct,"
the " Sacred or Mystic Period" the " Philosophic Period" and the " An-
atomic Period" and extends from the earliest ages to the death of Galen,
A. D., 200. 2d, the Age of Transition, which includes the Greek and
Arabic periods, ending A. D. 1400; and 3d, the Age of Renovation, em-
bracing the "Erudite" and the "Reform" periods, from the 15th to the
19th centuries.

We cheerfully commend this book to the patronage of the profession.

The Anatomical Remembrancer, or Complete Pocket Anatomist : Contain-
ing a concise description of the structure of the human body. 2d Amer-
ican, from the 4th London Edition. AYith corrections and additions by
C. E. Isaacs, M. D., &c. New York : S. S. <fe W. Wood. 1855. 18mo.,
pp. 270. (For sale by T. Richards & Son.)

A very complete and convenient little book for the use of Students in
the dissecting room.

I{oiu to Nurse Sick Children. Intended especially as a help to the Nurses
at the Hospital for Sick Children ; but containing directions which may

1856.] Editorial and Miscellaneous. 61

be found of service to all who have the charge of the young. New York :
S. S. & W. Wood. 1855. 18mo., pp. 70. (For sale by T. Richards
& Son.)

This little work contains much useful information, and should be in the
bands of all young mothers. It would do no harm even to those who
think themselves experienced matrons.

Prof. Joseph A. Eve's Address to the Class of the Medical College of
Georgia, at the opening of the Session of 1855-6.

This very creditable production has been published by the Class to whom
it was addressed. We regret that it is out of our power to do it justice
by any notice we may pen within the limits assigned us. We cannot
refrain, however, from reproducing the following tribute to departed worth :

" During the prevalence of the epidemic that scourged our city, last
year to the honor of our physicians be it spoken no one was known to
decline a call to a poor patient ; but on the contrary, such were sought out
and attended with the greatest zeal, with no expectation of reward beyond
the approbation of heaven and their own conscience. It is not my design
to eulogise my professional brethren; they need no eulogy from me ; they
enjoy that far richer reward the consciousness of having acted well their
part ; but I cannot forbear a passing tribute of respect to departed worth :
to the memory of the amiable and lamented Mackie, our accomplished
and talented alumnus.

"The humane physician, the truly "good Samaritan," in both capacities
he sought out the destitute and ministered to their wants, whether his
own or others' patients, a minister of mercy to the poor ! Long will his
name be embalmed in grateful remembrance. Long shall the widow's and
the orphan's tear bedew his tomb. With a fixed presentiment that he
would fall a victim to the pestilence, he quailed not, nor faltered in the dis-
charge of his duties, preferring like a good soldier to fall at his post with
his armor on. With more cool, unflinching courage, more true heroism
than inspires the warrior in the wild excitement of battle, he braved dan-
ger in its most appalling form, and nobly fell a martyr to the cause of
humanity, a sacrifice on the altar of benevolence. Emulate his example,
and let his name, as it is on ours, be engraven on the heart of every student
and graduate of this college."

Ecraseur {crusher) of M. Chassaignac.
To the Editor of the N,ew York Medical Times ;

Sir The new instrument for linear section, the Ecraseur of M. Chassaig-
nac, is now daily employed for removing tumors, and in operations for
fistula, varicocele, &c, and is destined soon to be universally known to sur-
geons by its legitimate use, if not, also, by its abuse.

The ecraseur is so adjusted as to embrace the part to be cut by a loop of
chain, presenting a plane surface with which the section is made. The
two extremities of the chain, entering the tube of the instrument, placed in
contact with the point where the division is to finish, are successively and
at determined intervals drawn by a balance lever worked at the opposite
extremity of the tube. Every successive diminution of the loop is retain-

62 Miscellaneous. [January,

ed, and thus the operation may be completed within any specified time
deemed expedient, having reference to the state of the patient, and the vas-
cularity or hemorrhagic tendency of the parts.

The end proposed to be attained by the ecraseur is, section without the
inconvenience of ligature or the hazards of haemorrhage ; forming a new
epoch in operative surgery.

A work containing plates and a full description of the several forms
manufactured by M. Mathieu, of Paris, adapted to operations of the exterior
of the body, and in sundry cavities, is soon to be published; therefore it
will be preferable on this occasion simply to state a few cases of its appli-
cation. Let us commence with hcemorrhoidal tumors. In the case of
tumors exterior to the orifice of the rectum, each separately, or several
united, are, in the first instance, surrounded at the base, as in ordinary
cases, by ligature. Over the thread, and in the groove thus formed, and
separating the tumor from the healthy part, is placed the loop of the chain
which is to penetrate by alternate progressions of each half of the loop,
operated by the balance lever at such intervals of fifteen, thirty, or sixty
seconds. Internal haemorrhoids are seized by an "erigne" or are brought
to view by other usual modes, and are embraced and removed in the same
manner as those already described.

Several of the cases operated on by M. Chassaignac have been of the
most vascular kind, and yet their removal has not been attended, or fol-
lowed by any loss of blood, or any of the grave accidents, which some-
times occur in the treatment by cauterization, ligature, or excision by the
usual mode. Polypi of the rectum have been successfully removed in a
similar manner.

One of the most remarkable applications of the ecraseur is in the oper-
ation for fistula in ano, which alone entitles it to full rank among the
" armamenta, chirurgice" combining, as it does, all the advantages of the
apolinose of the ancients, and the section of modern practice.

About three weeks since, M. Chassaignac removed a testis degenerated
into an encephaloXd tumor some five inches long, three broad, and two
thick, occupying the right portion of the scrotum. A ligature was at first
applied in such a manner as to define, as nearly as possible, the limits be-
tween the healthy tissue and the tumor. The pedicle thus formed was
severed by the ecraseur without the loss of any blood. A considerable
portion of healthy integument was necessarily involved in the operation.
This was to be regretted, and an observer might have hesitated to approve
of the employment of the ecraseur in this case. A wound was thus left
six inches in length, the edges of which were coaptated and retained by
suture ; but three or four days after, adhesion by first intention having
failed, as might have been expected, the sutures were removed and simple
dressings applied, and the wound is now rapidly healing by a process of
healthy granulations.

Tins instrument has been successfully used in excising the neck of the
uterus and in the removal of erectile tumors. It is not my object to enter
into a minute description of these cases; nor shall 1 attempt to criticise
what to many would Seem an abuse of the ecraseur in a case of pbymosis,
and another of varicocele now under treatment at the Hospital Lariboissiere.

I should not omit to mention a case of great interest at to-day's clinique,
October 1st. A man aged about sixty, of strong constitution and vigor-
ous frame, had a cancroid affection on the right lateral portion of the

1856.] Miscellaneous. 63'

tongue. The tumor was about two inches long-, one broad, and three
fourths thick, projecting forward to near the tip of the tongue, from which
it was separated by a narrow fissure, giving the appearance of a double'
tongue. Most of the patients mentioned have been under the influence of
ether or chloroform ; but this man, of strong nerve, used no anaesthetic
The operator, seizing with his left hand the entire mass, circumscribed the
tumor by a strong ligature, and placed in the groove thus formed the loop
of the ecraseur, and commenced the alternate motions of the lever. As
the hazards from haemorrhage in operations on the tongue demand special
care, M. Chassaignac directed an assistant to give the progressive move-
ments at intervals of one minute each, thus prolonging the operation more
than an hour.

The patient seated in his chair, himself supporting the instrument, pre-
sented the appearance of an oriental with his pipe. Occasionally hi sr ee
and walked to the window, if not to view the beautiful court, parterre, and
pavilions of this model hospital of Paris, at least to breathe the refreshing
air as it circulated around the heights of Montmartre.

While the excision of the tumor was thus slowly progressing, M. Chas-
saignac was at liberty to proceed to the operation for fistula in ano, removal
of a polypus from the rectum, and the elimination of luemorrhoidal tumors
from three other patients. Verily, thought I, this is a new era in operative
surgery.

Permit me to add, that my observations are yet too limited and crude
to judge of the actual merits of this new practice ; but, granting all appa-
rent claims in favor of the ecraseur, there yet remain some positive feai^in
regard to its popularization. The facility of operations by this instrument
may tend to its unwarrantable application in cases imperfectly diagnosed
by incompetent operators. Your? truly,

" Paris, Oct 1, 1855. DAVID P. HOLTON, M.D.

Lizard in the Stomaeh. Dr. Clark, of Montpelier, has exhibited to the
Society (Vermont Medical Society) a red lizard, about three inches in length,
living and well, which was vomited by a patient of his on the 1st of Sep-
tember. He gave the following history :

A healthy farmer, set. 50, under his care for two years, for occasional
severe nervous symptoms. During the first year, occasional sudden attacks
of insensibility, falling and remaining for several hours unconscious, and
then recovering completely. These attacks occurred at irregurar intervals,
and under all circumstances separated by several weeks, more or less, of
perfect health. In the second year, these attacks gave place toporoxysms
of epileptic convulsions, sometimes repeated many times in a day, with
intervals of perfect health, as before. For several hours, however, after an
attack, usually headache or uneasy sensations in the stomach, lasting sev-
eral hours, which symptoms occurred at no other time. Was repeatedly
purged with cathartics never vomited till, on the 1st September, 1855,
after dining on fresh pork, was much distressed at stomach, and vomited,
with much strangling, a quantity of pork and the lizard which Dr. Clark
exhibited. Patient was in his chamber at the time, and immediately sent
for Dr. C, who found him as described. Vomited a little blood after the
lizard.

The patient has since been in perfect health has had neither epileptic
paroxysms nor any unusual sensations in the stomach or head. As soon

64 Miscellaneous. [January,

as lie saw the lizard, the patient said he remembered that a little before he
began to suffer in health (twenty-eight months ago), he had the sensation
of swallowing some small substance one day when he was drinking at a
spring, but had forgotten it.

This case is worthy of record, from its authenticity. It has been denied
that animals which have a known existence out of the body, can live with-
in it. We have here indisputable evidence that a lizard lived in a man's
stomach for a considerable time ; and should the patient continue three or
four months without a recurrence of the symptoms, we shall have no reason
to doubt that the nervous affection was produced by the presence of the
animal in his stomach. He had passed a much longer period than usual
without an attack, at the time the case was reported/ [Boston Med. and
Surg. Joarnal.

New Remedy for Hemorrhoids. By C. E. Buckingham. The Journal
of Nov. 15th contains a translation, from the Gazette des Hopitaux, of a
conversation concerning the extract or powder of capsicum as a remedy for
hemorrhoids. Tbere is another preparation of the same plant, more agree-
able to take, which will probably be found quite as efficacious. I meat*
the pickled unripe pepper, which I have been in the habit for years of pre-
scribing, as an article of diet for patients with this disagreeable disease.
The results of the treatment are quite as successful as from any remedy in
any other disease. Many patients are unwilling to try the pickled pepper,
unless permission is also given them to render their clothing filthy with
some greasy substance. Such patients may be indulged with safety, but
the pepper alone, in the large majority of cases, the bowels having first been
emptied, will be found treatment enough. Ward's paste, the confect. piper,
nig., has for an indefinite time b*en used for this purpose, but it has not
one half the virtue. Dose one pepper for dinner. [Ibid,

Aneurism of the Superior Palatine Artery. By M. Tetrlinck^ This
surgical curiosity was met with in the case of a man, set. 74. The tumour
occupied the roof of the palate, which bled so frequently that the patient
was much exhausted. The tumor was soft, elastic, and pulsated synchron-
ously with the heart, alternately expanding and diminishing. Its cause
was unknown, and it had lasted for three weeks. The actual cautery was
employed, the slough separated in eight days, the hemorrhage did not re-
cur, and a perfect cure resulted. [Dublin Hosp. Gaz., from Gaz.Mcd.

Eczema. The external use of cod-liver oil in chronic eczema and other
troublesome affections of the skin, has been found very efficacious in vari-
ous trials lately made by Mr. Paget of St. Bartholomew's, who derived Ihe
idea from Professor Malmsten of Stockholm. In the Allgemein Med. Zei-
tung, a Berlin journal, we find Professor Malmsten detailing his experience
on the use of the fish oils in chronic diseases of the skin, including espe-
cially chronic eczema, impetigo, psoriasis, and that most distressing and
intractable eruption, prurigo formicans. The affected parts should be
constantly soaked with the oil for about two weeks, when the disease has
generally yielded. The itching always gives way at once, and the remedy,
however disagreeable, is more bearable than the disease. The use of an
alkaline bath once a week is permitted, and the oil at once reapplied.

[ Virginia Med. and Surg. Journal.

1856.] Miscellaneous. 65

Prof. Agassiz. As most well informed physicians are fond of Natural
History, we cheerfully give a place in our Journal, to the following

Prospectus.

Contributions to the Natural History of the United States. In Ten Vols.
Quarto. By Loos Agassiz. To be published by Messrs. Little, Brown
& Co., of Boston, Mass.

For more than eight year?, I have now been in this country, devoting
my attention chiefly to the study of those classes of the Animal Kingdom
which American naturalists have, thus far, not fully investigated. The
amount of materials I have already brought together is so great, that the
time seems to me to have come when I should proceed with the publica-
tion of the more important results of these investigations. Desirous of
contributing mv share to the rapid progress natural sciences are making at
present in this part of the world, I wish to present my work to my fellow-
laborers in this field in the form most easily accessible to them. It has,
therefore, appeared to me desirable to bring it out in a series of independ-
ent volumes. This plan will, moreover, leave me entirely free to present
my contributions to science with such minute details, and to such an extent
as I shall deem necessary to the fullest illustration of my subject.

"Without entering into a detailed account of the contents of this work,
it may be sufficient here to state, that it will contain the results of my era-
bryological investigations, embracing about sixty monographs, from all the
classes of animals, especially selected among those best known as charac-
teristic of this continent; also descriptions of a great number of new genera
and species, accompanied with accurate figures, and such anatomical details
as may contribute to illustrate their natural affinities and their internal
structure.

I shall not extend my publications to classes already illustrated by others,
but limit myself to offering such additions to the Natural History of the
States I have visited as may constitute real contributions to the advance of
our knowledge.

From a careful estimate of the materials I have now on hand, I am sat-
isfied I shall be able to include the most valuable part of my investigations
in ten quarto volumes ; each volume containing about three hundred pages,
with at least twenty plates. I therefore now open a subscription for such
a work, in ten volumes, quarto, in cloth binding, at the price of twelve
dollars each volume, payable on delivery. Each volume shall be complete
in itself, containing one or several independent monographs ; so that, if
any unforeseen difficulties should interrupt the publication of the whole,
the parts already published shall not remain imperfect. As for as possible,
I shall always select first such of my papers as contain the largest amount
of new matter, or may contribute most directly to the advancement of
science. Having devoted the greatest part of my time to the investigation
of the embryonic growth of our animals, I shall make a beginning with
the embryology of our turtles, several of which I have traced through all
their changes. I trust this monograph will afford our medical students a
fair opportunity of making themselves familiar with the modern results of
one branch of physiology, which has the most direct bearing upon their
science, and for which the different species of the family of turtles found
in every part of the United States will afford them a better opportunity

Miscellaneous,

even than the artificial breeding of hens' eggs. Moreover, the extent of
my embryological researches, covering, as they do, all the classes of the
animal kingdom, will furnish, I trust, a new foundation for a better appre-
ciation of the true affinities, and a more natural classification of animals.
I foresee the possibility, upon this basis, of determining, with considerable
precision, the relative rank of all the orders of every class of animals, and
of furnishing a more reliable standard of comparison between the extinct
types of past geological ages and the animals now living upon earth.

I shall have frequent opportunities of acknowledging the many favors I
have received from naturalists of all parts of the country, from the Atlantic
to the Pacific Coast, and from the shores of our great Lakes to those of the
Gulf of Mexico; and also of mentioning the many specimens which have
been furnished to me from every part of the Union, and of which I shall
publish descriptions.

It is a matter of course, that a work like this, illustrated by a large num-
ber of plates, cannot be published without a liberal and extensive patroTi-
age. As it has been prepared solely with the view of throwing additional
light upon the wonderful diversity of the animal creation of this continent,
its structure, and its general relation to that of the other parts of the world,
without the slightest hope of compensation for myself, I trust I may meet
with the approbation of those conversant with the importance of the sub-
ject, and receive sufficient encouragement from the enlightened part of the
community to enable me to bring to a successful close an undertaking upon
which I enter now, and in this form, for no other purpose than to contrib-
ute my share towards increasing the love of nature among us.

As the printing of this work cannot begin until a sufficient guarantee is
secured for the publication of the whole, I take the liberty of making an
appeal to the lovers of Science to send to the publishers their own subscrip-
tions, and such others as they may procure, as soon as convenient, and, if
possible, before the first of August next, that I may be able to proceed at
once with a work which, relating to animals peculiar to America, I wish to
make, in every respect, an American contribution to science, fostered and
supported by the patronage of the community at large.

To render the work more generally accessible, it is intended to publish
at the rate of about one volume a year. Such an arrangement will bring
the whole within reach of every student of Natural History, and of every
friend of the progress of science in the country. The periods of publica-
tion, however, cannot be more definitely fixed, because the required uni-
formity of execution of the plates, to which particular attention will be
paid, will demand that they be all entrusted to the same artist, who has
drawn on stone most of the plates of my firmer works.

Cambridge, May 28, 1855. L. Agassiz.

Treatment of Chronic Entropium by Collodion. Mr. Wm. Butten reports
in a late number of the Lancet two obstinate cases of entrepium, both of
which had resisted a great variety of treatment, but which were cured by
the application of collodion to the skin of the eyelid, previously corrugated
by the thumb and finger. Several layers are successively applied and al-
lowed to dry before the fingers are removed. The application is made at
first every other day, and afterwards at longer intervals. [Boston Medical
and Surg. Journal.
ERRATA. On page 719, in our last No., second line from top, for " finger," read firmer.

SOUTHERN

MEDICAL AID SURGICAL JOURNAL.

; Vol. XII.] NEW SERIES. FEBRUARY, 1856. [No. I

ORIGINAL AND ECLECTIC.

ARTICLE 17.

LETTERS FROM SAUL. D. HOLT, M. D., UPON SOME POINTS OF GENERAL PATHOLOGY.

LETTER NO. 8.

Montgomery, Ala., Dec. 17th, 1855.

Messrs. Editors I do not intend to commit an act of superero-
gation by attempting a history of the practice of blood-letting, for
the reason, that I have nothing to add to the many complete and
valuable essays which have been written upon the subject, as none
connected with the history of medicine has been more thoroughly
discussed, as there is no remedy whose effects have been better
understood by the profession, none whose value in the treatment
of certain forms and conditions of disease is better established, and
none more generally used noth withstanding which, there are
very few remedies which have been more misused or abused : and
it is with the hope of correcting, to some extent, that abuse, and
to vindicate its use, that I shall attempt an enquiry into the causes
which have led to it. That the lancet, in skilful hands, has
always, and deservedly, held the foremost rank among the remedies
for the reduction of high states of nervous excitement and vascu-
lar action, and for subduing inflammation both local and general
there is no doubt ; and that it will continue to hold the same rank
with all intelligent physicians, there is as little, notwithstanding
there may be a Sangrado now and then, who may " change his
method,1'1 and betake himself to " chemical preparations.'''' But the
question is not whether the lancet^ or blood-letting is proper in

N. s. VOL. XII. no. il 5

68 Holt's Letters upon General Pathology. [February,

those conditions, but whether it is proper in those diseases in which
it has been chiefly recommended ? And here we are brought at
the very threshold of our inquiries, in direct conflict with the no-
sological classification and arrangement of diseases ; for, as I have
said on a former occasion, the class of pyrexial diseases, the exan-
themata, and febrile diseases in general, have the idea of exalted
nervous excitement and increased vascular action, as intimately
and inseparably associated with them, as heat is with ffre - and the
class of remedies, to-wit : antiphlogistics and sedatives, are as
clearly indicated for their reduction, as water is for the extinguish-
ment of fire. It is not, therefore, strange, that the lancet, which
stands foremost among that class of remedies, should have been
misused and abused, especially in those parts of the world where
diseases of that class are not all of that character, indeed, where
they seldom assume the character of high nervous excitement and
vascular action, but where, on the contrary, they are usually char-
acterised by the signs of depression and debility. But it is strange
that this and other kindred remedies should so long have held a
talismanic sway over the minds of Southern practitioners, or rather
that they should have been so long in discovering that the same
class of diseases which usually require the use of the lancet, ca-
thartics, diaphoretics, &c, for their proper treatment in northern
latitudes, seldom require or even tolerate their use in southern
climates ; and the most satisfactory explanation which can be given,
may be found in the old saying, that it is "a hard matter to teach
old dogs new tricks," for most of the Southern practitioners, and
especially the older ones, having received their medical education
in Northern schools-, and derived their principles from books writ-
ten by northern men in this country and Europe, who have uni-
formly held and taught the doctrines, that high nervous excitement
and vascular action constituted the essential characteristic condi-
tion in all the diseases of that class, and properly enough, no doubt,,
for the reason that they found such to be their general character*
and with such principles fixed in their minds, it is not unreasona-
ble, but very natural to suppose that they found great difficulty in
reconciling the character of diseases as they found them to exist
in the South, with the character of the same diseases, as they had
been taught to regard them in their northern aspect. It may be
supposed, too, that those Northern writers, mostly Europeans, who
have had an opportunity of observing the diseases of hot climates,.

1856.] Holt's Letters upon General Pathology. 69

and who have furnished us with the best descriptions, as to the
character of those diseases, were influenced in their minds by the
same early impressions, of which they never could fully divest
themselves, as is evidently manifested by the general inflammatory
character and tendency of those diseases, according to their de-
scriptions, and their general resort to the antiphlogistic plans of
treatment, and the free use of the lancet and purgatives. And it
is moreover evident that they were in the habit of regarding the
opposite condition of depression as dependent upon adventitious
influences, and consequently of a temporary and fugitive char-
acter, and comparatively of little import ; and if the question was
to arise, as to which of the two conditions constituted the essential
pathological condition of those diseases, I would unhesitatingly ac-
quiesce in the decision, that the character which they assume in
northern climates, namely, exalted nervous excitement and in-
creased vascular action, constitutes the essential pathological con-
dition ; and that their prevalence in southern climates, under the
character and condition of depression and its consequences, is the
result of extrinsic or adventitious influences. But, while acqui-
escing in such a decision, I would still maintain that, notwith-
standing the admitted character of the diseases in northern climates,
an opposite condition and character obtains with respect to the
same class of diseases in the South ; and the condition of depres-
sion, though depending upon adventitious influences, is as essen-
tially pathological in all practical respects, and for all practical pur-
poses, as if it was the universal and only condition; and I acqui-
esce the more readily in the decision, for the reason, that notwith-
standing the adventitious influences which generally invest our
diseases with the character of depression, (which I have already
endeavored to point out and explain, and which it is unnecessary
for me now to recapitulate such as the influence of climate, me-
teorologic and epidemic influences, &c.) they often stand out in
their full northern aspect, divested of almost every sign of depres-
sion. This, however, is by no means an event of uniform occur-
rence, for nearly thirty years of constant observation in the same
locality, has served to convince me, that besides those causes which
would necessarily produce a difference in the character of individ-
ual cases, under the same general influence, such as age, sex, tem-
perament, &c, not only have diseases of a particular class, some-
thing like a cycle to run, and a definite period for recurrence, but

70 Holt's Letters upon General Pathology. [February,

that the same disease often presents itself under very different, and
sometimes new aspects, which changes we can ascribe only to the
greater or less intensity of action of the adventitious causes or
influences spoken of. It is this peculiar feature or fact, with re-
gard to our diseases, which renders it impossible for our southern
practitioners to follow successfully a uniform, or routine system
of practice, but which renders it necessary that they should always
be on the " qui vive" and constant lookout for those changes, and
that they should at the same time be well fortified with correct
views of general pathology, which alone is sufficient to enable
them, at all times, to meet the emergency of such changes. It is
this peculiar feature in the character of our diseases, which has
suggested to my mind the propriety and the necessity of classify-
ing them, according to the pathological condition under which
they appear, without disturbing, or interfering with the general
nosological arrangement and classification of these diseases; and
the want of such a classification, or the want of proper attention
to the pathological conditions upon which the classification is
founded, and the habit which southern practitioners generally
have indulged, of viewing and treating them in the aspect of their
inflammatory character, has been the principal cause of error in
the use, or the abuse of the lancet, and other kindred remedies
hereafter to be considered.

Now, with respect to the classification which I have adopted,
of dividing our febrile diseases, of whatever class or type, into the
inflammatory or congestive, and the intermediate grades of irri-
tant, congesto -inflammatory, and congesto-irritant, to which I
would add the typhoid condition, being somewhat an innovation
upon the usage of the profession, I deem it proper that I should
offer a few arguments, in addition to those which I have already
presented, in support of the policy or propriety of the measure.

Although Dr. Wood, Dr. Bartlett, and other late American,
and some of the English writers, have improved largely upon the
plan of the older ones, by adopting the more rational one of con-
sidering and treating diseases according to their physiological
relations, and upon the broader principles of general pathology,,
they seem not to have recognized or considered necessary, any
other division or classification of the grades of fever, than the one
recognised by the older writers, under the names of synocha and
synochus, the former representing the condition of excitement and

1856.] Holt's Letters upon General Pathology. 71

inflammation, and the latter that of depression and congestion ;
and while they recognise the condition of excitement as inflam-
matory, they recognise the opposite condition of depression under
the terms asthenic, adynamic, or typhous, (See Wood's Practice,
art. 5, Fever, sec. 3, Grade of Fevers.) "Besides the two grades
of fever above described, (says Dr. Wood) there are often inter-
mediate or mixed conditions, of which it is difficult to say to which
they belong."

And here occurs the hiatus which I have attempted to close,
with the classification which I have suggested ; for though Dr.
Wood has thus acknowledged the existence of intermediate or
- mixed conditions, he has failed or neglected to tell us what they
are. But Dr. Wood further says : " The state of the vital forces
. on which these different grades depend, may pre-exist, or may be
I induced by the cause or causes of the fever itself- Whatever tends
I to increase the powers of the system, predisposes to the inflamma-
tory condition of fever, whatever diminishes these powers, to the
i typhus." And he goes on to enumerate some of the leading
" causes which predispose to these conditions, concerning which, and
' the inflammatory condition, there can be no doubt or disagreement
: whatever; but his use of the term typhous, to express the opposite
: condition, creates a difficulty, to obviate which it is necessary that
1 we should have a clear and definite understanding of the import
. and meaning of the terms. Now, the term typhous, which is sy-
nonymous with typhoid, is with us, used to express a condition in
which, beside depression, there exists also a depraved and vitiated
condition, or a broken constitution of the blood, with a certain
hemorrhagic and eruptive tendency, such as petechia, sudamina,
&c, and usually delirium and coma. And such is the idea of the
condition which Dr. Wood, no doubt, intended to convey by the
use of the term typhous: for, he further says, "But it also not
unfrequently happens that the exciting cause of the fever is of itself
of a depressing nature in relation to some, at least, of the vital
functions, and that a typhous (typhoid) condition of the system, as
well as the febrile movement, results directly from its operation.
Such, beyond all doubt, is the case with the poisonous effluvia
which cause the proper typhus fever, and to a certain extent, also,
! that which produces scarlatina," and to which I would add, yel-
low fever also. The character of the foregoing extracts shows
. very plainly that Dr. Wood's typhous condition is the same which

72 Holt's Letters upon General Pathology. [February,

I have arranged under the typhoid condition with which congestion
has little or nothing to do.

Having on a former occasion expressed my views with regard
to the typhoid condition, which it is unnecessary, and would be
irksome for me to repeat, and having from the very outset endeav-
ored to prove the existence of a pathological condition of depres-
sion and congestion, as the true physiological, as well as patholog-
ical, antagonistic condition of excitement and inflammation, the
opinions of Dr. Wood, and others to the contrary, notwithstanding,
it remains only for me to say, that though both conditions are
characterised by depression, they are altogether of a different
character. That the depression of the typhoid condition relates
chiefly to the cerebral and animal nervous system, and recpiires
for its production an animal poison or effluvium, and has necessarily
for its existence a depraved or vitiated condition of the blood,
either as cause or effect, and does not necessarily require a dis-
turbed balance in the circulation. While the congestive coudition
implies depression chiefly of the organic nervous system from the
influence of atmospheric, meteorologic and malarial or miasmatic
causes, and necessarily implies a broken balance in the circulation,
and an undue accumulation of blood in the venous cavities, but does
not necessarily require that the blood itself should be depraved.

With these views and explanations, with regard to the charac-
ter of these conditions, and the classification which I have made of
them, the necessity of which for practical purposes, I am, upon
review, more fully convinced than ever, I shall proceed in con-
formity therewith, to the examination of the remedy in question,
continuing as formerly to use pneumonia for illustration.

As remedies are valuable in proportion to the power which they
possess, of increasing or diminishing the vital forces, and regulat-
ing and changing the vital actions, the lancet must always hold
its rank among the most valuable, as it posesses the power in an
eminent degree of diminishing rapidly the vital forces, and of
moderating excessive vital action, and such being its power, such
must be the necessity for its use. The first important and essen-
tial point to determine, then, is whether the general system is in
such a condition as to justify or require its use, that is to say,
whether there exists in the system such an amount of nervous ex-
citement and vascular action, coupled with and sustained by, such !
an amount of vigor and tonicity in the general system, as to threat

1856.] Holt's Letters upon General Pathology, 73

en vital organs with the invasion of inflammation, or to endanger
the vitality of organs already hi a state of inflammation, for blood-
letting is often as important in such a condition as a prophylactic,
as it is a therapeutic remedy. In ascertaining and settling this
important and essential point, great nicety and precision of judg-
ment is often required to determine, whether the excitement is
sustained by sufficient vigor to constitute the inflammatory condi-
tion, or whether the excitement is a state of irritation only, de-
pendant upon a state of debility, or atonity of the general system.
And to aid in arriving at a correct decision upon this point, it is
necessary to keep in view, not only the peculiar symptoms pres-
ent in each case, but to take in review the adventitious influences
which are most likely to affect the condition, proximately or
remotely, such as age, sex, temperament, habits of life, climate,
seasons, epidemic influences, &c, &c, all of which, are not more
necessary in determining the condition which requires blood-let-
ting, than in determining the second important point, namely, the
extent to which it should be carried, which, of course, must be
regulated and controled by the practitioner, in each individual
case.

As the advantages to be derived from blood-letting in local in-
flammation, which often exists under very different and even op-
posite conditions of the system, (as I have already shown to be
the case with pneumonia, and in like manner, with other diseases)

J must necessarily be incidental to a general reduction of the vital
forces, and of general excitement and vascular action, the only
safe rule which can be adopted with respect to this second point
is, that in attempting such a reduction by blood-letting, no more
blood should be withdrawn, than will be sufficient to bring the
general inflammatory condition of the system down to such a point
as will enable other adjutory remedies, aided by the recuperative
powers of the system to complete the reduction. This object
may often be accomplished by the extraction of small quantities

, of blood, and at other times much larger quantities may be
necessary to be drawn, and the operation may even be required
to be repeated ; but under no circumstances can we venture upon
the use of the lancet, in the bold, fearless, and confident manner
in which it has been recommended by our northern brethren, for

I the treatment of rheumatism, pleurisy, pneumonia, and other in-
flammatory affections; for the reason that the tendency of all these

74 Holt's Letters upon General Pathology. [February,

affections, to the opposite condition of depression and congestion
is so strong, as to admonish us, under the most imperative circum-
stances, to take hold of it with prudence and caution, and some-
times even with "fear and trembling." For fear that it should be
suspected that the great prudence and caution which I recommend
should be observed in the use of the lancet, is prompted by the
working of a tender conscience, from the reminiscence of past
misdeeds, it is but truth and justice to myself, to say, that upon
the subject of the abuse of the lancet, I have nothing to " disabuse"
myself of : for, in the days when the lancet was in the greatest
vogue, and the standard of a physician's skill was measured by
the number which he carried in his pocket, and his knowledge by
the exact number of ounces of blood which his patient was able
to lose, and the precise amount of purging which he could stand,
without sinking under the operation, which the test oj experiment,
too often, proved to be fallacious ; my voice was then raised, as
now, in remonstrance against its reckless use, and consequent
abuse, as the following extracts from my manuscripts written many
years ago upon the subject, will show, and to which I have now,
nothing material to add or take away :

" Although I fully appreciate the value and importance of
blood-letting, in inflammatory diseases, when regulated by a pro-
per discretion, I must confess that I have never been able to
understand the propriety of bleeding for the purpose of preventing
or removing congestion a condition dependent upon a state of
debility and depression, which the loss of blood cannot remove,
but which, on the contrary, is always accelerated by it; for, be-
sides the loss of the stimulus of the red capsules, and the fibrin of
the blood by their extraction from the circulation, as well as the
quantity drawn, the blood taken by venesection, comes not from
the congested vessels, but from that division of the circulation (the
arteries) which are already deficient of their due proportion, blood,
which has just passed with difficulty the pulmonary extremity of
the circulation, to be hurried too rapidly through the capillary
extremity, (for such is the general effect of venesection) thus de-
priving the brain, heart, &c, of their accustomed and necessary
stimulus, inducing syncope and convulsions, increasing the amount
of depression and rendering the state of congestion more complete.
It is owing to these effects of venesection, and the great tendency
which prevails with all our diseases, to assume a congestive char-

1856.] Holt's Letters upon General Pathology. 75

acter, especially when aided by excessive depletion of any kind,
which renders the use of the lancet a matter of so much cautiou,
even in those cases which appear to be more decidedly inflamma-
tory in their general character. The object of bleeding in any
disease, is to protect or to relieve important organs from the effects
of undue determinations and accumulations of blood, (understood
to be arterial) the result of undue excitement in the general sys-
tem, while the organs affected are the weaker ones. Hence, the
extraction of blood is to be made in reference to a reduction of the
general excitement, thus giving protection to weak organs, and
enabling them to regain their lost tone and activity, and allow
them to repair the damage which may already have been done.
But in the effort at a reduction of the general excitement, great
care must always be taken that it be not done so suddenly, or by
such violent means, as to produce the opposite state of depression
and congestion. Instead, therefore, of the erect posture, large orifice,
and the draft of blood by the pint or quart, for the purpose of
cutting off disease, or subduing inflammation by a decisive blow,
our patients generally require to be bled, (if they require to be
bled at all) when in a recumbent position, from a moderate orifice,
and in quantities proportioned to the effects upon the strength and
frequency of the pulse, and the general vigor of the system. In
judging of the propriety of a resort to the use of the lancet in any
case, the existence of pain which usually indicates the seat of in-
flammation, must be regarded as fallacious on account of the
extent and play of the nervous sympathies, especially as this
symptom is often more intense, and the ordinary signs of excite-
ment are more manifest when the investing membranes are in-
flamed or irritated in a slight degree, than when more extensive
and serious inflammation exists in the parenchymatous structure
of organs. To justify the use of the lancet from these signs, the
pulse should always furnish evidences of strength, (the sign of
arterial plethora) the pain should be fixed and permanent, whether
acute or obtuse, and the evidences of excitement continuous, irre-
spective of the influence of regular exacerbations and remissions.
Nor can we recognise the stage of a disease, as acting either as a
warrant or bar to its use, for the reason that it is often contra-
indicated in the earlier stages of a disease, when during its pro-
gress, and even in the latter stages, the necessity for its use may
become imperative and absolute."

76 Holt's Letters upon General Pathology. [February,

Now, it must be recollected that the foregoing remarks upon
the use of the lancet, were penned many years ago, and before I
had thought of making any systematic classification of the condi-
tions which J then had in view, and which are now embraced in
the intermediate grades between inflammation and congestion, to
which they are as applicable now, as they were then, and if those
intermediate grades which I have designated as irritant, congesto-
inflammatory and congesto-irritant, had not existed, in fact, if not
in name, my remarks would have been altogether unnecessary, as
no one, I imagine, could have been found to deny the value of the
lancet, or question the propriety of its use in the "inflammatory"
condition, or who would have advocated its use in the "conges-
live" condition, upon any more rational or philosophic principles
than would suggest the propriety of holding a man's head under
water to prevent him from being drowned.

There is a condition or state of the system, which is sometimes
met with and recognized as a state of oppression, which, though it
has some peculiarities which might entitle it to a separate consider-
ation, may very properly be arranged with the congesto-inflamma-
tory varieties. It is observed in robust and middle aged, or old
persons, and is characterized by a slow, full and moderately strong
pulse, attended with many of the signs of depression and conges-
tion as palor of the countenance, a sense of prostration, with
stupor or low delirium, a furred tongue and constipated bowels.
This condition appears to be dependent upon torpor and conges-
tion of the liver, with visceral obstruction, accompanied with a
general arterial plethora, without inflammation, and will always
be relieved by bloodletting. The typhoid condition, though usu-
ally characterized by the signs of depression, often presents cases
of such unquestionable inflammatory character, sustained by such
an amount of general vigor as to justify and require the use of
the lancet as in cases of typhoid pneumonia, yellow fever, &c, in
which blood-letting often aids, not less in the elimination of poisons
from the system, than in relieving or defending organs from in-
flammation ; and in its use, the same rules of prudence and cau-
tion should always be observed, as in other cases which tend to a
state of depression..

With a few general remarks concerning the effects of Blood-
letting, I will bring this branch of my subject to a close :

Suppose, then, a general inflammatory condition, or such a con-

1856.] BlLLlNGSLEA. Uterine Hemorrhage. 77

dition of oppression as I have just described, to exist, in which the
arterial division of the circulation is replete to an unhealthy excess
with blood, (the only condition which requires, or will justify the
use of the lancet) and a vein be opened to allow of the escape of
blood in any considerable quantity, the first general effect will be
a reduction of the vital forces, which will be shared in by the heart,
arteries and capillaries, and the latter becoming relaxed, from the
loss of power, allows of the free passage of blood through them,
while the lungs, sharing in the general reduction and loss of pow-
er, fails to transmit the blood as fast as it escapes through the
capillaries, and the arteries become emptied, precisely in the same
way as they do in the cold stage of an intermittent, though from
a different cause. The effect upon the action of the heart, which,
though sharing in the loss of power with other organs, (which
otherwise would be reduced,) is to increase its action, or rather to
accelerate its movements, in a like ratio as the arteries become
emptied of blood. Now, if to the condition thus produced by
bloodletting, we may suppose the lungs to transmit the blood as
fast as it passes the capillaries in their relaxed state, and the heart
should receive excitement, from increased excitement of the brain
or other nervous centres, we will have before us the irritant and
congesto-irritant condition a condition, so far as external appear-
ances go, similar to a state of reaction from the loss of excessive
quantities of blood, and one in which the lancet may be used with
about the same propriety.

As I expect soon to join the anti-periodic and sedative family, I
hope none of the brethren will call me Old Fogy, for thus holding
on to the old Sangrado "platform."

In the bonds of friendship and physic, I remain, as usual,
yours, &c. Saml. D. Holt.

ARTICLE V.

Sulphate of Quinine in Uterine Diseases. By Jas. C. BlLLlNGSLEA,
M. D., of Tuskaloosa County, Alabama.

Messrs. Editors Having seen Dr. J. S. Wilson's article in your
June number, on the " Action of Sulphate of Quinine on the
Uterus," in which he solicits investigation and reports, I have
concluded to give you some of the results of my experience and

78 BlLLlNGSLEA. Uterine Hemorrhage. [February,

observation, as regaaxls the use of this remedy in uterine diseases.
I am certainly of Dr. Wilson's opinion, that this great medicine
acts on the uterus by some more direct and specific manner, than
by simply relieving congestion or anemia ; and in such a degree
as to lead us to believe, that it possesses considerable emenagogue
properties.

I had adopted this opinion, previously, from observation in my
own practice, but felt a diffidence in bringing it to the notice of
the profession through the press, yet I had expressed my views to
some of the faculty privately. Since Dr. Wilson has given us his
views, I take pleasure in giving any results, which may tend to
substantiate his ; and I do not know how I will do it better,
than by giving you the notes of some cases I find in my case-book;

Case I. Nov. 1st. 1853. Called to see Mrs. , in child-
bed first child. The patient is robust, and of good constitution.
The labor was of usual duration, and terminated favorably.
Everything went on well, until three days after confinement;
then the lochia ceased. Pain in the uterus, slight peritonitis, and
considerable fever supervened. I prescribed quinine 4 grains,
camphor 2 grains, every three hours. After three doses, the lo-
chia appeared, the pain ceased, and the fever abated. The patient
went on well. Since then, I have used quinine in several similar
cases, with a like result ; and sometimes the lochia would be of a
sanguineous character upon reappearing*

Case II. Miss , ait. 17, fleshy and florid, was attacked in

the fall of '53, with severe headache, pains in the loins and abdo-
men, attended with much fever. I ascertained that she should have
menstruated a few days prior to this, but she had by exposure
gotten her feet wet, and the catamenia not appearing, she attribut-
ed her illness to the exposure. Ordered a saline cathartic, to be
followed by quinine 4 grains, every three hours. Eighteen hours
afterwards, I found her quite deaf, and fever gone ; and was in-
formed that profuse diaphoresis and the catamenia had appeared
after the third dose of quinine. She recovered rapidly. I have
since attended this young lady in two similar attacks, pursued the
same treatment, with like results.

I have this year attended two cases of dysmenorrhcea, which I
thought were materially benefited by the use of quinine, in seda-
tive, doses. For two years, I have used quinine in suppressio-
mensiurn with great success.

1856.] Hubert & Culver. Gun-shot Wound. 79

Remarks. The first case might well have stood depletion, by
the lancet and purgation, but I contented myself with giving this
sedative, with an anti -spasmodic; but I attribute the marked effect
to the quinine. And this led me to use it in similar cases, and
afterwards in amenorrhcea and dysmenorrhcea ; so, that now, I
feel even more sanguine, as to its effects in these diseases, than
Dr. W. ventured to express. I desire not to make myself conspi-
cuous by reporting these cases ; but, I am so thoroughly convinced
of the efficacy of this potent remedy, in certain uterine diseases,
that I cannot refrain from adding my feeble testimony to that of
Dr. W., who, ever seems ready with a vigorous pen, to give to the
profession the results of his experience, in alleviating disease (it's
a pity there are not more like him.) And until I am convinced,
by experience, that my practice in these diseases is not right, I
shall pursue the same.

ARTICLE VI.

Gunshot Wound of the Brain. Reported by Drs. Hubert & Culver,
of Warrenton, Ga.

A young man, about eighteen years of age, was wounded in the
head October 4th, 1855, by the discharge of a pistol. The ball
entered the brain, one inch above and a little posterior of the left
meatus auditorius extern us. He was found immediately prostrate
upon the ground, unable to give any account of the accident.

As soon as possible, he was visited by Dr. Sterling Gibson, and
found in a very delirious condition, tossing himself to and fro on
the bed, and speaking incoherently pulse about 90 to the minute.
From the wound, a small portion of the brain escaped mixed with
blood. The wound was probed superficially only one or two
inches, the ball was not felt and further probing considered im-
prudent. From the direction the probe entered, it was concluded
that the ball had gone directly across the brain.

The case being considered hopeless, but little treatment was di-
rected ; chiefly cold applications to the head. He was sensible of
pain ; would answer when called very loudly, but could never
reply to a qiiestion sensibly ; he would swallow water by the
spoonful and coffee also; but when weak soup was offered, he
would spit it out invariably.

In this condition, with no notable change in symptoms, he re-

80 Peculiarities of the Negro Race. [February,

maiued about four days, when it appeared that the vital forces
were yielding to physical laws. He gradually declined and died,
surviving the injury five days and eighteen hours.

A post-mortem examination discovered that the ball had pene-
trated through both hemispheres of the brain and struck the lower
portion of the parietal bone of the right side, indenting the inner
table. Thus the course of the ball was almost directly across the
brain, a little upwards and backwards. Had the ball passed en-
tirely through the head, its exit would have been about one inch
higher than its entrance and a little posteriorly.

The feature in this case of most interest, both to the surgeon and
physiologist, is how was life continued so long? Without in-
dulging in speculative remarks ourselves, we submit it to the
profession.

An Essay on some of the Distinctive Peculiarities of the Negro Race.
By A. P. Merrill, M. D.

No. II.

After what has been said, in a former essay, upon the anatomical,
physiological and psychological peculiarities which distinguish the
negro from the white race, it seems natural to infer the existence
of certain equally striking peculiarities in reference to the diseases
to which the negro is subject, and the action of remedial agents in
their cure. To this, the more practical part of our subject, we
bring, as in our former essay, little else than the results of our own
experience and observations. We have met with no elaborate or
standard work on the subject, and the few fugitive monographs, to
which we have been able to refer, in the periodical journals, afford
us little assistance in the well-established facts and practical argu-
ments which they supply. In writing and speaking upon the
subject of the diseases of negroes, physicians are apt to take it for
granted, that the negro race undoubtedly has its peculiar and dis-
tinctive diseases, which require equally peculiar and distinctive
plans of treatment; all which are to be described and illustrated,
by separate and distinct practical treatises, upon the principles and
practice of medicine, as adapted to this particular variety of the
human race.

The facts in the case do not, according to our apprehension,
justify this extreme view. Peculiarities undoubtedly do exist, requi-
ring particular and careful notice, and to such an extent as to great-
ly impair the value of medical treatises as guides of practice, which
have been written with reference to the diseases of the white race,

1856.] Peculiarities of the Negro Race. 81

and particularly in European and northern countries. Still less
can the principles and practice be applied to the negro race, which
derive their importance from observations made in large cities, and
in European hospitals and prisons. These remarks are applicableT
also, to a somewhal less extent, to the white race, natives of hot
climates ; and the differences between the white and colored races
in such climates consists, not so much in the existence of any dis-
tinct class of negro diseases, as in the modifications of the same
diseases, as they affect the different races. It has been found true,
with few exceptions, that whatever diseases prevail among one race,
may prevail, also, among the other, under similar conditions, affect-
ing the negro race sometimes more and sometimes less severely
and fatally ; but the disease itself is ordinarily characterized by the
same, or very similar pathological conditions, indicating the appli-
cation of similar therapeutical measures. It has happened very
rarely in the southern states, that any disease has prevailed to a
large extent, or become epidemic, exclusively among the colored
race, and to which the white race was not subject under the same
circumstances of exposuse to its cause.

The Pathological Peculiarities of the negro race ihen, are depend-
ent more upon their anatomical and physiological peculiarities,
and upon their condition and habits of life, as these influence the
action of causes of disease upon the human body, than upon any
inherent and distinctive liability of the colored race, to the influence
of causes of disease peculiar to it. It is true that epidemics not un-
frequently prevail, which are confined mostly to negroes, both in
city and country localities, but these do not differ essentially in their
characteristics, from the same diseases as they attack the white race,
whenever that race happens to suffer from them. Indeed it may
be considered a very rare occurrence in the southern states, that
the colored population is invaded by an epidemic from which white
persons are exempt. There are seeming exceptions occasionally
upon large plantations, where very few white persons reside ; but
even there, the overseer and other white subjects, undergoing simi-
lar exposures, are only a little less liable to attacks, which subject
them to the disease in most cases at a later period in the season.
Most of the epidemic diseases which prevail in the south, prove to
be more violent and fatal to one race than the other, and attention
is always required to the particular treatment suited to each, but
the disease itself is the same, arising so far as can be known from
the same cause, exhibiting in its progress very much the same local
and constitutional symptoms, and requiring the application of the
same general plan of treatment; the differences in the manifesta-
tions of the disease, and the differences in the curative measures
required, being in fact mostly differences in degree, rather than in
kind.

In treating, therefore, of the diseases of the negro race, as they
appear in our southern states, we must allow ourselves greater lati-

82 Peculiarities of the Negro Race. [February,

tude, than would seem to be indicated by the expression, distinctive
peculiarities ; or, if this title be adopted, it must be understood as
having reference, more particularly, to those peculiar differences,
which are supposed to be dependent upon circumstances incidental
to the negro, as fitted by nature for the enjoyment of health in a
hot climate, and upon his habits of life as imposed upon him by his
master, in a state of slavery. Vitality in negroes, as we have seen,
is of a less vigorous and normal character, than in white persons ;
and there is, in general, less activity and acuteness in their nervous
susceptibilities. These are peculiarities which tend strongly to
modify the diseases to which they are liable, and such as call for a
corresponding modification in the treatment. The pathological
peculiarities, therefore may be considered as largely dependent
upon the physiological ; and therapeutical distinctions are required
to be made, as in the different temperaments and idiosyncrasies of
the white race, in accordance with the teachings of science and ex-
perience.

The habits of our slave population in living upon a more liberal
and regular diet, and in being clothed with greater uniformity
together with a good degree of regularity in the hours of working,
and resting, and sleeping, as compared with the same race in a state
of savage freedom, must, of course, have some influence over their
functions both in health and disease, and also over the therapeutical
operations to which they are subjected. Upon many plantations,
it must be confessed, these things are not judiciously and skilfully
managed. Ignorance of the proper physiological requirements of
the negro, and mistaken views as to the true policy of the planter
in giving liberal supplies of food and clothing, lead many who are
engaged in the working of slaves, to practices at once injurious to
their negroes and unprofitable to themselves. But it must be very
rarely, if ever the case, that slaves are so badly cared for by their
owners, as to render their condition worse, or more unfavorable to
health, than in their native country, and in a state of savage freedom.

The vices too, which exercise such destructive influences
over all ignorant and savage people, and particularly those vices
which they derive from association with more civilized nations, are,
in the case of the slave, constantly and vigilantly guarded against,
by the interest and better judgment of the master. Intoxicating
drinks, in the excessive use of which savage tribes are so prone to
indulge, and which are proving at this day, so destructive to the
lives of free negroes in all parts of out country, are not allowed to
slaves except in a k\v instances, and at long intervals, unless pre-
scribed as a remedy for disease. Drunkenness, therefore, is a vice
which is almost unknown among slaves ; and it is, perhaps as much
due to the restraints imposed upon them in this respect, as to any
.other single condition of their state of bondage, that their lives and
the vigor of their bodily and mental constitutions, are so well pre-
served from one generation to another ; affording them chances for

1856.] Peculiarities of the Negro Race. 83

intellectual and moral improvement, which they could not otherwise
enjoy, and which is so essential to their ultimate elevation in the
scale of being. Were the slaves of the southern states to be eman-
cipated upon the grounds they now occupy, and permitted to indulge
without restraint in the use of alcoholic drinks, all hope of such im-
provement in the race, in our country, would at once be at an end ;
and, instead of a progressive increase in numbers, as at the present
time, there would undoubtedly be a rapid diminution of them, until
extinction, as with some of the Indian tribes. The indolent and
sluggish nature of the negro, renders him more liable to such con-
sequences than the Indian, and unless he be perpetually guarded
from the evil effects of a mistaken philanthropy, which wars against
philosophy, religion, and law, such may, in the long future, be the
late of the negro race in America.

Although alcoholic drinks are withheld from slaves with such
vigilant care, on account of their acknowledged evil tendency, the
same is not true of tobacco, which is allowed in nearly all cases ad
libitam. On sugar and cotton estates a liberal allowance of this
article is not only furnished, in most cases, by the owner, but the
slaves are, besides, allowed the privilege of cultivating any quantity
they please, for their own consumption The use of tobacco is,
therefore, pretty general, the males indulging from an early age in
both the quid and the pipe, while the females are generally content
with the latter. Their sluggish nervous action preserves them, to a
large extent, from the nauseating and sedative influences of this
narcotic, in acquiring the habit of its use ; enabling them to escape,
if taken in moderation in the beginning, the severe ordeal through
which most white persons have to pass, before they can become
adepts in this common vice. It is for like reason, perhaps, that we
observe less injurious effects of tobacco upon the nervous system of
negroes than white persons, arising from the long habit of its use.
It rarely ever results, in the case of the negro, in the establishment
of those serious and often fatal nervous derangements, so common-
ly the effect of its habitual use, in the white race. If they could
obtain it in sufficient quantity, negroes would prefer opium to tobac-
co, on account of its greater excitation of the mental faculties; and
it is not improbable, that the habitual use of this drug may yet be-
come a serious evil in the south, where the poppy can be successful-
ly cultivated.

The southern slave, then, when he is controlled and cared for by
a judicious, intelligent, and humane master, has all his principal ha-
bits of life so well regulated, and is permitted to indulge in so few
health-destroying vices, as to protect him from the attacks of many
diseases to which he would otherwise be subject, and moderate the
violence and frequency of others to which he is constantly liable.
Excepting the mortality which occurs among negroes in early in-
fancy, of which we shall have something to say hereafter, the slaves
of the south are probably subject to a less number and variety of

N. S. VOL. XII. NO. n. 6

84 Peculiarities of the Negro Race. [February,

diseases, and enjoy a longer average duration of life, than the white
population of any large section of our country. Upon well conducted
plantations, the natural annual increase is commonly estimated at
three per cent., and but for the casualties among new-born infants,
above alluded to, and from which scarcely any plantations are
exempt, this increase would be much larger. Slaves are not more
liable to suffer from discontent with their lot in life, than their mas-
ters, or other portions of the white race ; and are, as a class, less in-
fluenced in health and spirits by mental disturbances and perturba-
tions, calculated to exalt and depress the vital powers ; and it is
partly on thi3 account, perhaps, that they are less obnoxious to the
class of diseases called neuroses.

In making the foregoing remarks upon certain peculiarities of
the negro race, we wish to be understood as confining ourselves to
the unmixed portions of it. The mulatto or hybrid population, em-
bracing various degrees of admixture" of white blood, now amount-
ing to a large number in the southern states, present some peculi-
arities of their own, which perhaps have hitherto received less
attention than they deserve However it may affect the question,
of such interest to ethnologists, in reference to the diversity of
origin of the human species, it cannot be denied, that the amalga-
mation alluded to, exercises important physiological and pathologi-
cal influences, one of the tendencies of which is, to impair the
energy of the vital forces, predispose to adynamic diseases, and to
shorten life. These conditions, it is natural to suppose, must have
a tendency, also, to the impairment of the procreative powers, and
thus to retard increase ; while the congenital debility and disorder-
ed innervation resulting, give rise to a still greater sacrifice of
infant life, than with the full-blooded negro. These deleterious in-
fluences increase in force, as the mulattoes intermarry among them-
selves, and probably become more intense in proportion as they
recede from the original stock ; as they do, also, from furthur ad-
mixtures of white blood.

We venture to put forth these views, as the result not only of
our own long-continued personal observations, but as embodying
the opinions of many others of equally extended experience in such
matters ; and, what may be considered even more reliable still, as
being a true representation of public opinion as it exists among all
classes of southern people, and especially among the mulattoes
themselves. Physicians of experience in the treatment of the dis-
eases of negroes, whose opinions we have been able to obtain, are
in general fully impressed with the truth of such views, and it is
rare to meet with one, who is not constantly influenced by them,
in his practice among this class of people. Still, it must be remark-
ed, that the information obtained upon this subject, may not be of
% that exact and definite character, which should form the basis of
grave ethnological conclusions ; if such can indeed result from the
actual determination of the question of deterioration either way.

1856.] Peculiarities of the Negro Race. 85

As a practical question, however, we are by no means disposed to
admit, that it can be at all doubtful, that the mulatto, or mixed race
of all grades, is more liable to those diseased conditions, principal-
ly of the nervous system, and to those depressions of the vital ener-
gies, which are supposed to be predisposing conditions to tubercular
and kindred affections, as well as to all the various phases of neu-
ralgic disease ; and which are presumed to present serious difficul-
ties in the way of successful treatment in all chronic affections and
cachexies. This may account, in a measure, for their want of
prolificness, and for the prevalence of hereditary diseases among
them, checking their natural increase, and curtailing the average
duration of their lives.

There is, manifestly, a discrepancy existing between the physical
and mental constitution of the mullatto, as affected by admixture of
the blood of the two races. While the physiological and pathologi-
cal deteriorations, above referred to, pretty constantly show them-
selves, and in tolerably uniform proportion to the extent of white
admixture, and the remoteness of the hybrid from the original stock,
the mental constitution, on the contrary, as constantly approaches
to, and partakes of the superiority of the white race, in nearly the
same ratio of relationship, and remoteness of descent from the origi-
nal African. On this account this hybrid race are selected, in the
slave-holding states, to occupy places of trust and responsibility,
requiring the exercise of judgment and reflection, as well as tact
and ingenuity; such as house-servants, carriage-drivers, market
men, sugar-makers, cotton-ginners, drivers, &c, making themselves
exceedingly valuable upon large cotton and sugar estates, in the
performance of labors and trusts, which would otherwise be assign-
ed to white persons hired for these purposes. The mental qualities
of this class are not less strikingly exemplified, in the lives and
practices of families of mixed blood in a state of personal freedom.
Feeble as they generally are in their physical constitutions, they
often become prosperous, trustworthy and skilful in their several
occupations, which are nearly always other than agricultural pur-
suits. As nurses for the sick, laundresses, cooks, hair-dressers,
mantua-makers, &c, the mulatto women of Louisiana are justly
celebrated for their excellence ; while the men of the same blood
are scarcely less conspicuous as mechanics, porters, hotel-waiters,
&c, some of them becoming successful and thrifty, also, as mer-
chants and brokers.

Whatever use may be made of these facts in the ethnological
controversy, it matters nothing to our purpose. The fact of the
deterioration of physiological vigor, consequent upon an admixture
of white and negro blood, and of the infusion of mental energy into
this mongrel race, in proportion to the preponderance of Caucasian
blood, are fully sustained by observation ; and what is of more im-
portance in such an inquiry, by the practice of slave-owners and
others, whose judgments are sharpened by pecuniary interest. As

86 Peculiarities of the Negro Race. [February,

a class, these slave-owners may justly be ranked among the best
informed and intelligent of American citizens. No branches of in-
dustry in this age of improvement more strongly exemplify this fact,
by the improvements made in them within the last half-century,
than those connected with slave labor. We may therefore safely
receive the predominant sentiment and practice of these people, as
acceptable evidence of the truth of almost any question, connected
with the character and capabilities of the colored population. The
constant and almost uniform practice, of selecting the mulatto, for
the execution of ingenious enterprises, requiring the exercise of rea-
son and judgement, is the highest proof of their mental superiority
over the negro ; while the preference as uniformly bestowed upon
the latter, for the labors of the cotton and sugar fields, is equally
good evidence of the superior physical powers of the negro of un-
mixed blood.

But it is of the peculiar characteristics of the real negro that we
propose, mainly, to treat in these essays, and principally with a view
to the prevention and cure of the diseases to which he is principal-
ly subject, in a state of slavery. In speaking of his physiological
and psychological peculiarities in our first essay, we briefly adver-
ted to some of the precautions proper to be taken, in view of these
peculiarities, for the preservation of his health. Much more might
be said upon this subject ; but it is our purpose at present to con-
fine our remarks to a few of the commonly reputed causes of pre-
vailing and epidemic diseases upon plantations in the south, so that
when we come to speak of special diseases incident to the negro
race, we can with better propriety confine our remarks to other
branches of inquiry than those which relate to the question of
etiology. This becomes the more necessary, because of the great
uncertainty and discrepancy of views, in reference to the causes of
disease, the unsettled condition of which question, does not in the
least prevent the constant assignment of epidemics, to particular
and specific influences, making the same disease the product of a
great variety of distinct casuations, as it appears under different cir-
cumstances, and in different localities.

The febrile diseases to which slaves are subject, and which con-
stitute more than one-half of all their sicknesses, like those which
affect the white race in the south, are almost uniformly attributed
to the influence of malarial exhalations. Fevers are, therefore,
expected to occur oftenest and prevail most, in the near neighbor-
hood of marsh lands, or upon low alluvial soils, into which dead and
decaying vegetable matter largely enters as a constituent part.
Our largest and most productive plantations are mostly situated
upon just such soil as would seem best adapted, according to the
commonly received doctrine upon this subject, to the production of
this class of diseases. Yet it is notoriously true, that many such
are particularly exempt from the prevalence of fevers, while others
upon less productive, because less vegetable, soils are more liable

1856.] Peculiarities of the Negro Race. 87

to them. Some which are situated upon the worn-out and impover-
ished clay-hills, which can be made productive only by a system of
manuring, which seeks to enrich the earth by this artificial process
about every third year, and others established upon sand-plains of
moderate productiveness from the beginning of their cultivation,
are constantly liable to visitations of periodic fevers, sometimes as-
suming a very grave and fatal character.

From all we can learn of the prevalence of periodic fevers among
negroes, there is no part of the world in which they enjoy a greater
exemption 'from them, than upon the shores of the Mississippi and
some other rivers in the south, where the soil is, perhaps, the most
productive of any in the world, from its alluvial character; and
which contains a large proportion of dead vegetable matter, not
only upon the surface, but to a great depth beneath ; enabling plan-
ters, whenever their fields show signs of exhaustion from long-
continued tillage, or from a want of rotation in crops, to avail them-
selves of the advantages of a virgin soil, by merely dipping their
plow-shares a few inches deeper into the substratum of earth. It
is not, therefore, from any a priori reasoning, that we can judge of
the healthfulness of particular localities, in this respect. Expe-
rience alone is the safe guide in forming this judgment, as it is, also,
in reference to other plantation diseases, arising from other causes.

Similar remarks are aplicable to the etiology of other prevailing
and epidemic diseases, such as pneumonia, cholera, diarrhoea and
dysentery. Independent of those exciting causes which relate to
errors in diet, clothing, exposure, &c, we know of no one condition
which uniformly attends upon, or precedes their appearance among
plantation negroes. Frequently it happens, that contiguous estates,
whether similarly situated or not, are visited by epidemics of a very
different kind, or one is visited while the other is exempt, without
our being able, by the most careful investigation, to ascertain the
existence of any essential differences either in the police of the
places, or in the manner of living and exposure, to account for it.
There is an epidemic influence of some kind existing, no doubt, and
it is generally assigned to some apparent cause, for there is no sub-
ject about which men are more ingenious than the discovery of
causes of disease. The water, the food, the exhalations from stag-
nant water, the influence of old buildings, shade trees, prevailing
winds, &c, all come in for their share of blame ; but if we scru-
tinize all these things carefully, we shall generally find, that precise-
ly the same conditions have existed often before, without producing
the same effects ; while the same disease has often been known to
appear, without the existence of the reputed causes.

We have known the yellow fever to become epidemic on a plan-
tation which had always previously maintained a character for
uncommon healthfulness, succeeding a general scraping and clean-
ing up of the place, with the removal of heaps of decaying cotton-
seed, and other noxious accumulations, with the express view to

88 Peculiarities of the Negro Race. [February,

prevent the occurrence of epidemic disease. The general cleansing
having taken place in the spring, and the disease occurring in the
succeeding autumn, there could be no just reason for attributing
the visitation to the exposure of decomposing substances, in the act
of their removal. Upon another occasion, we have witnessed the
rapid decomposition of several thousand bushels of sweet potatoes,
stored in stables and other out-houses, near a very large negro quar-
ter, and seen the rotten masses carted away upon the fields to be
used as manure, subjecting nearly two hundred persons to the great-
est intensity of putrid effluvia for several weeks, and without the
occurrence of a single case of disease all the while, or subsequently,
which could be attributed to such an influence. The harmlessness
of decaying cotton-seed, which emits a very fetid and depressing
odor, and of refuse cane, or begasse, together with the want of
deleterious influence from large stables, and immense heaps of
compost manure, all which are common upon cotton and sugar
plantations, have had the effect to deprive both slave-owners and
slaves, in many places, of all di"ead of the deleterious influence of
vegetable decomposition, in the production of disease; and they are,
consequently, disposed to ignore the common etiological theory upon
that subject.

Nor do negroes, in general, experience much dread of the influ-
ence of contagion. Their religion or superstition makes them pre-
destinarians or fatalists, and they therefore see the special hand of
God in every calamitous visitation, not doubting that life and death
are the inevitable consequences of particular and unalterable de-
crees of Providence, which can neither be suspended nor mitigated
by human agency. They do not appear to suffer any the less on
this account, however, from apprehensions and forebodings of evil,
which tend to depress their vital energies, and thus predispose them
to disease. As in epidemics affecting all other races of men,
whether in cities or in country localities, the most important, and
only certainly effective measure of relief, is removal beyond the
infected region. Negroes are fond of changes of this kind, and
repose great confidence in their efficacy; hence its powerful effect
upon their spirits ; and if these exciting influences are well sustain-
ed by liberal supplies of wholesome and nutritious food, by a little
recreation and amusement, by encouraging conversation and ad-
vice, and by regular and systematic labor, they soon loose sight of
their danger, and feel secure in the renewed buoyancy of their
spirits

Among other predisposing causes of disease, to which the field-
laborer is subjected, no one, perhaps, has a more deleterious effect,
than the practice of taking slaves out to their work, in the cool and
damp air of early morning, with their stomachs empty. The prin-
. cipal meals are breakfast and dinner, and it is only at these, in
general, that slaves eat meat. The dinner is ordinarily taken at
twelve o'clock, after which, in summer, they are permitted to rest

1856.] Peculiarities of the Negro Race. 89

from one to two hours, and sometimes longer, which interval is apt
to be spent in sleeping. This secures rapid digestion of the dinner,
and the supper which follows in the evening being a meager meal,
consisting of corn-bread or hominy, with occasional additions of
milk, it is reasonable to conclude that the stomach is pretty well
emptied of food by morning, when they are subjected to the most
chilling exposure of the whole twenty-four hours. The remedy
which suggests itself to every physiologist is, to supply the stomach
with food or drink, one or both, upon first rising in the morning,
which is, indeed, the important period for the negro's lunch. A
piece of coarse corn-bread, and a small cup of hot and well sweet-
ened coffee, would answer the propose perfectly well ; and the
coffee might be charged, in times of prevailing periodic fevers, with
a grain or two of quina as an antidote to the fever poison. Strych-
nia might be substituted in case of cholera or diarrhea, to give each
person one-twentieth or one-fifteenth of a grain, as an antidote of
equal efficacy, to the cholera poison.

To nothing do slave-owners attach more importance, in their
efforts to preserve the health of negroes, than to the quality of the
water used as common drink. And, with the single exception of
the mistaken notion now prevailing somewhat extensively, that rain
or cistern water is a certain prophylactic against cholera, the im-
portance of the subject is not over-rated. Rain-water properly
preserved in cemented cisterns, is undoubtedly the most wholesome
of any in use, inasmuch as it is known to contain a less amount of
mineral impregnations, and the vegetable and animal matters which
may be infused, are in a short time, if permitted to stand undisturb-
ed, precipitated to the bottom. That rain-water, however pure it
may be, is not a certain preventive of cholera, has been too often
proved to admit of further question. Doubtless the use of impure
water is often a predisposing or exciting cause of this, as of other
diseases, and therefore those who drink good water are less liable to
suffer, than those who do not; but in no other respect can it be
considered a prophylactic, than as wholesome food, and proper pro-
tection from vicissitudes of the weather, are prophylactic. All
observation goes to show, that they who habitually drink well-water,
made hard or brackish by solutions of the salts of lime and soda, are
scarcely more liable to attacks of cholera, or other diseases, than
others as habitually accustomed to the present cistern-water. Upon
plantations, however, good cisterns are important, particularly on
the low alluvial lands, because the wells dug in these soils, are sup-
plied with water, to a large extent, by the percolation of the rains
through masses of vegetable and animal materials, taking with them
more or less of whatever is soluble ; and these are the kind of im-
purities most to be feared, in their deleterious effects upon the slave
population. But it must be considered, that slaves are not addict-
ed to one of the principal habits which cause artificial thirst, the
use of alcoholic potations, and therefore they consume less water

90 Peculiarities of the Negro Race. [February,

than intemperate white laborers would, under similar circumstan-
ces. The use of tobacco is the only habit which proves injurious
to slaves in this respect, and this to a much less extent than intoxi-
cating liquors, which are taken by white workmen with the water,
constantly increasing the evil which it is their aim to remedy.

From all that has been said, it appears evident, that although the
distinctive peculiarities of the negro as a southern slave, place be-
tween him and the white man a less extent of interval than some
have supposed, yet there are, in his habits and character, as well in
his bodily and mental constitution, such differences, as must render
inapplicable, to a large extent, the teachings of medical authors,
whose study and practice have been confined to the white race in
northern latitudes. On this account it is of the utmost importance,
that young men educated with a view to become southern physi-
cians, should not only receive the advantages of southern instruction
and experience, but should have ample opportunities to observe the
habits, diseases, and treatment, of the slave population. If it be

'true, as has often been remarked, that the writings of European
authors, who form their opinions upon their observations of diseases
and treatment in large cities and hospitals, are not well adapted to
instruct and qualify for successful practice, the physicians of the
northern states of America, it is equally and still more strikingly
true, that the same European authors, even when commented upon
and explained by American editors, and even the writings and
teachings of the eminent physicians of our northern cities them-
selves, can be but poorly calculated to give wholesome instruction,
touching the diseases and treatment of the white population of the
southern states. How much less are any of them qualified, howe-
ver learned they may be, to give instruction for the successful man-
agement of the negro race in a state of southern slavery. As well
might we expect, that the New England farmer would be qualified,
for the succassful management of cotton and sugar plantations,
without southern teachings and experience in his particular calling.
The peculiarities of the mental constitution of negro slaves, render
these special qualifications for practice among them the more impor-
tant. No class of people more urgently require, that the physician
who attends them in their diseases, should rightly understand their
mental characteristics ; without which, indeed, it will be found im-
possible to secure their confidence, and inspire them with the hope
of recovery, so essential to success. They all have sufficient pene-
tration to discover the existence of any want of acquaintance with
their peculiar accentricities, and necessities, and whenever they
adopt the belief that their physician is deficient in this respect, he
labors under great disadvantages in his treatment, and in many
cases all his efforts will, on this account, prove nugatory. When

,we come to treat of special diseases, we shall have occasion to show
that no people can be more completely under the the influence of the
mind in sickness, than the negro race, [Memphis Med. Recorder.

1856.] Peculiarities of Empyema. 01

Clinical Observations on the Peculiarities of Empyema.

Dr. Finn exhibited to the County and City of Cork Medical and
Surgical Society, March 28, 1855, some pathological specimens
illustrative of empyema, and made the following clinical observa-
tions on the peculiarities of the disease.

Influence of Sex. In 30 cases, 25 were males a result exhibit-
ing a remarkable discrepancy between the sexes, in respect of
liability to this disease ; but which result, however, harmonizes
with the general experience. In Dr. Hamilton Eoe's table of 21
cases, 21 were males ; in that of Dr. Hughes, of Guy's Hospital,
out of 25 cases only two were females.*

Age. The average age varied from 18 to 85, 4 only having
exceeded 40, 8 not having reached the tenth year, the youngest
having been about 5. According to Dr. Hamilton Roe, 12 or
one half, were between 18 and 45 ; under 18, 6 ; above 45, 6 ;
the oldest having been 62. According to Dr. Hughes, 18 in 25
cases occurred between 18 and 45 ; under 18, 4 ; and above 45,
8 ; the oldest having been 48.

Side affected. The left was the side affected in 19 out of 30
cases ; in the several cases of effusion into the left pleura, displace-
ment of heart towards the right side was observed ; in one case of
very considerable effusion into t the right pleura, the heart was
observed to pulsate in the left axillia. In no case that came un-
der notice were both sides affected.

Decubitus. The cases observed were only seen at an advanced
period of the disease, when the decubitus was almost uniformly
on the affected side. In one case of circumscribed empyema of
the left side, overlying the diaphragmf (which formed its floor,
adhesive inflammation having united the opposed surfaces of the
lung and diaphragm around it,) the decubitus was indifferently
on either side, but more conveniently dorsal. In another case, the
decubitus was on the unaffected side, notwithstanding the exist-
ence of dexiocardia.

Pain. In 9 only of 30 cases was pain complained of; and this
varied much in its character, having been in some instances acute,
whilst in others it amounted to a mere sense of uneasiness in the
affected side, and sometimes in the opposite one. This result
would suggest a conclusion quite antagonistic to the preconceived
notions on this subject, pleuritis being par excellence associated in

* It is not a little remarkable that, during the recent prevalence of ague in this
city (which immediately succeeded the epidemic pleuritis forming the subject of
these observations,) the influence of sex was also remarkably manifested, a compar-
atively small number of female? having suffered from this disease.

\ The inflammation in this case involved a portion of the diaphragm, which oc-
casionally, under such circumstances, manifests a very high degree of sensibility,
as referred to in the interesting article on "Pleuritis," in the Cyclopedia of Practi-
cal Medicine; and yet the subject of this case complained of no pain, but suffered
much from constant irritability of stomach during the whole course of his illness.

92 Peculiarities of Empyema. [February,

the popular mind, with pain. A very slight acquaintance, how-
ever, with thoracic pathology suffices to demonstrate that absence
of pain is not incompatible with pleuritis of a very decided char-
acter, as exemplified in those rigid adhesions which almost uni-
formly unite the opposed pleurae in the vicinity of tuberculous
deposits in the apices of the lungs. In tuberculous pleuritis, the
inflammation takes the initiative in the pulmonary pleura; and a
question naturally suggests itself whether the absence of pain in
such cases generally is to be attributed to its concentric origin ?
The author of the article "Pleuritis," in the Cyclopedia of Practi-
cal Medicine, observes, however, that the pain present in such
cases indicates the existence of tubercles long before they may be
recognized by auscultation. This observation is not consistent
with Dr. Finn's experience, as he has rarely observed the subjects
of tuberculous disease refer pain to the part of the lung affected ;
and in the majority of cases, pain, if present, was referred to the
prsecordia region, or in some instances to the unaffected lung, the
increased requirements of respiration having imposed upon it a
compensating duty. In pleuro-pneumonia, or pneumo-pleuritis,
according to the more correct nomenclature of Dr. "Watson, acute
pain is referred to the region of the chest corresponding to the
affected portion of the lung; but in this instance, in consequence
of the sudden increase in the volume and consistence of the lung
(the result of rapid engorgement,) the pressure on the costal pleura
probably occasions the pain in question.

The susceptibility to pain of the costal appears to contrast re-
markably with that of the pulmonary pleura, the nervous sensi-
bility of the latter being modified by the laws which preside over
organic life. Should any viscus, whether above or below the
diaphragm, become the seat of organic change, the investing se-
rous membrane is necessarily more or less involved, due allow-
ance being made for the difference of the phenomena of serious
inflammation in the localities referred to ; and yet such deviations
from the normal state, in which inflammation, in some form, plays
its part, are not in general manifested by any consciousness of
pain on the part of the individual.

In pleuritis terminating in empyema, the almost uniform coin-
cidence of pulmonary disturbance suggests the probability of the
concentric origin of that disease also ; and this fact, if established,
may offer, if not a solution, at least an approximation to one, of
the absence of pain, and of the insiduous progress which this affec-
tion so frequently presents.

Relation between Pleuritis and Bronchitis. In proceeding to
canvass the subject of the relation between pleuritis and bronchi-
tis, Dr. Finn recalled the attention of the society to the epidemic
institution which characterized the close of the year 1818 in
this city. During the autumn of that year, on the occasion of
the subsidence of the epidemic fever and dysentery of the years

1856.] Peculiarities of Empyema. 93

1846-'47, influenza supervened, and prevailed with unusual se-
verity to the summer of the year 184b. During that period and
the two subsequent years, the writer exhibited, at. almost every
meeting of the Medical Society, pathological specimens illustra-
tive of every variety of pleuritis, and specially called the atten-
tion of the Society to the remarkable frequency of this disease
at the period referred to, as observed in the several hospitals in
this city.

On inquiring into the history of each case, it was ascertained that
this affection was preceded in almost every instance by bronchi-
tis, or the prevailing influenza.

This result would appear to establish the relation of cause and
effect between bronchitis and pleuritis, in the cases referred to in
this paper, the congestion of the lungs, in the asthenic type of the
former disease, determining more or less of structural change in
the contiguous pleura ; which change subsequently involves a cor-
responding extent of the opposed costal pleura; and this view is
rendered further rjrobable by the analogy offered in the order of
succession of the pathological phenomena in phthisis and pneu-
monia*

Tuberculoxis Disease of the Lung. Of 30 cases, only 2 died of
tuberculous disease of the lung; in Dr. Roe's table, 3 out of 25 ;
in that of Dr. Hughes, 6 out of 25 (a much larger proportion) pre-
sented that complication. The comparative infrequency of pul-
monary tubercle, in connection with this affection, would imply
that there existed a slight relation, if any, f between these diseas-
es ; and this view is further confirmed by the fact that the tuber-
culous complication in one of the cases was confined to the oppo-
site lung ; as if the serous inflammation, however much it may
have interfered with the functions and altered the form and con-
sistence of the lung, yet exerted a conservative influence in
preventing tuberculous deposit. This exemption from tubercle
should excite surprise, when it is taken into account that, in
almost all the cases that came under notice, there existed a ph}-si-
cal condition eminently calculated to call into activity the tuber-
culous diathesis.

Bulijiny of the Intercostal Spaces. In one case only was protru-
sion of the intercostal muscles observed. The subject of this case
was a child, aged eight years, whose illness, previous to admission
to the hospital, had been referred t phthisis ; an opinion not con-
firmed by the physical examination of the chest, which imme-
diately revealed the real uature of his illness, the intercostal spaces

* It may be important to observe that, contemporaneously with the influenza
and pleuritis, the so-called cattle disease prevailed.

f In sixteen cases of empyema observed by Dr. Walshe, as referred to in the last
edition of his work on Diseases of the Lungs, &c, no single case of hrenioytysis oc-
curred.

94 Peculiarities of Empyema. [February,

.at the left side occupying a plane considerably anterior to the ribs,*
whilst, at the same tune, the heart pulsated under the right nipple.
This case, after a very protracted illness, terminated fatally ; and,
on making a post-mortem examination, the affected pleura was
found to contain an enormous quantity of fluid, entirely purulent.
The result of the autopsy in this instance favours the views of
those who connect protrusion of the intercostals with the purulent
character of the contained fluid ; but in two out of four other cases,
which also terminated fatally, the products of inflammation were
equally purulent in the absence of any change in the muscles re-
ferred to. The inference, then, appears to be, that the phenome-
non in question is irrespective of the purulent character of the ef-
fused fluid merely, and that other conditions are necessary to its
production.

Paracentesis Thoracis. In one case of great urgency, f this
operation was resorted to, other means having failed to afford re-
lief; and owing to a recurrence of the urgent symptoms, it was
twice repeated with great benefit.

In this case, the expectoration, previously profuse and purulent,
immediately presented a marked diminution m quantity, and al-
teration in quality, which both continued for several days.

This result coincides with the observations of the late Dr. Greene:}:
on this subject, and should perhaps excite surprise, as dp? -iori rea-
soning would suggest the reverse, a large area of secreting surface
being released by the operation from the pressure of the superin-
cumbent fluid. The explanation of this interesting fact may pro-
bably be referred to the physical phenomena of endosmose and ex-
osmose, the sphere of there activity being, in this instance, the por-
tion of the pleura interposed between the effused fluid and the
mucous membrane of the air-passages. Under such circumstan-
ces, the exosmose to the mucous membrane may be supposed to
cease, or at least to be considerably diminished, on the occasion of
the removal of the fluid contents of the cavitjr of the pleura.

Were fistulous communications between the lung and cavity
of the pleura of frequent occurrence under such circumstances, a
satisfactory explanation may thus be afforded ; but such compli-
cations are rarely observed, and the pathological changes that
ensue are admirably calculated to provide against this contingen-
cy ; the investments of the lung being generally much increased
in width, whilst the lung itself .is diminished in volume. [Dublin
Quarterly Jour, of Med. Sciences.

* Hie comparatively rare occurrence of protrusion of the intercostal muscles may
further imply that the inflammation had its i m-i-j >t i< >n in tin1 pulmonary, not the cos-
tal pleura; but, in the more advanced period of the disease, the internal aspect of
the cavity of the pleura, -when presented to the notice of the pathologist, is, in gen-
eral, so assimilated 1 > y the structural changes observed, that it is impossible to as-
sign to either pleura a priority in morbid action.

)- In this ease only, a loud splash was heard on succussing the patient.

| Dublin Journal, vol. xvii.

1856.] Acidity of the Mouth in the Muguei of Infants. 95

On the part which Acidity of the Mouth plays in the Muguei of Infants.
By Dr. Seux, Head Physician to the Hospice de la Charite of
Marseilles.

The mouth of the adult, which in health has an alkaline reac-
tion, may in the morbid state become acid. Thus M. Donne has
found the saliva to be acid in cases of gastritis, and it is known
that in the muguet of the adult the mouth presents a very decided-
ly acid condition. This acidity has also been found to exist in the
muguet of infants ; in fact, M. (rubier, in a note on muguet insert-
ed in the Gazette Medicate of the 26th of June, 1852, observes "I
ascertained that children labouring under this singular affection
have always extreme acidity of the mouth. The mucus covering
the tongue, the cheeks, and every other part of the bucco-pharyn-
geal cavity strongly reddens litmus paper even the moment after
the child has suckled. This reaction exists before any trace of
muguet is percepiible; but then there is already a very intense
raspberry-like redness of the mucous membrane lining this first
portion of the digestive tube ; so that from the coincidence of these
two peculiar conditions we may anticipate the invasion of the cryp-
togame." But it was especially important to ascertain if the mouth
is alkaline in an infant in good 'health, as it is in the adult. In
order to decide this point, I have made numerous researches, from
which it appears that the mouth of children at the breast in good
health is ordinarily acid. I have verified this fact repeatedly both
in private and in hospital, and as well at the moment of birth as
some days and even some months subsequently ; I have found it
to be the case whatever was the strength of the child, or whatever
were the hygienic conditions by which it was surrounded. My
observations have been attended with the same result in children
who have continued well, as in those who have, at a later period,
suffered from illness.

Not satisfied with having established the fact myself, I requested
Dr. Magail, junior, assistant-surgeon to the Maternite, to under-
take similar investigations, and the results obtained by him have
agreed with mine.

I did not commit to writing the results of all the observations I
had the opportunity of making ; but the following are the details
contained in the notes I possess on this subject:

These notes refer to one hundred children in good health, aged
from a few minutes to ten months. Of these one hundred sub-
jects, eighty-seven were at the" Hospice de la Charite, and thirteen
in private. In five only the mouth did not present a trace of
acidity on the first examination, made some hours after birth ; but
on a second examination instituted in three of them two hours
subsequently, the mouth was acid ; in the ninety-five other chil-
dren there was invariably proof of acidity from the first.

I have arranged these children in three classes ; those who had

96 Acidity of the Mouth in the Muguet of Infants. [February,

not yet suckled ; those who had suckled, and had always been
well ; those who had suckled, and had had the muguet. The first
class contained forty-nine; the second, thirty-eight; and the third,
thirteen.

In the forty-nine belonging to the first class, the mouth was ex-
amined in eleven immediately after birth ; in eight, some hours
later, and in thirty, from two to three days after birth.

In the thirty- eight of the second category, the examination was
made in thirty -four from two to fifteen days after birth ; in three,
from a fortnight to a month; and in one, in a little more than a
month after birth.

In the thirteen belonging to the third class, I examined the
mouth in nine, at the age of from a fortnight to a month ; in two,
at two months; in one, at four months; and in another, at ten
months.

In testing the condition of the mouth, I made use of litmus pa-
per rendered more sensitive by the addition of some drops of acid;
this paper retained its blue colour when introduced into the mouth
of an adult in good health. In the children of the three classes, it
was more or less reddened. I did not observe any difference in
the degree of reaction between the children who had and those
who had not been suckled, nor between those who had just left
the breast, and those who had not taken it for a long time. Neither
was any difference perceptible between those who had not been
ill, and those who had had the muguet. But a remarkable differ-
ence always existed between children at different ages. Thus at
the moment of birth the paper was feebly reddened, at the end of
some days, and particularly after the first fortnight, it was strong-
ly reddened, and at two months, or later, it assumed a still more
decidedly red color.

I had also frequent opportunities of examining contemporane-
ously children of the same age, some of whom had the muguet,
while some were free from it ; in all, the paper assumed the same
red tint; in children of a month old especially, it was easy to ap-
preciate this circumstance, because at that age the paper reacts
strongly.

From the foregoing I infer : 1, that the mouth of infants in
good health is acid ; 2, that this normal acidity becomes more de-
cided as the children grow older ; 3, that suckling is not without
influence on this acidity.

The fact of the normal acidity of the mouth of the infant being
thus established, I am inclined to look xxpon this condition as a
predisposing cause of muguet, for every one at the present day
knows that the presence of acids is favourable to the development
of the vegetable element of which this production is composed.
.This normal acidity of the mouth in infancy may therefore explain
the predilection of muguet for that age.

Since, then, it is probable that acidity of the mouth in the adult

1856.] Seven Cases of Tetanus. tt7

affected with muguet precedes this affection, it may, perhaps, be
its cause and not its effect. It will be easy to ascertain if, in the
adult, in the chronic diseases which are sometimes followed by
muguet, the mouth is acid before the development of the latter.
The facts I have just pointed out call for new observations, and for
my part I shall neglect no opportunities of completing the re-
searches I have commenced on this subject. Thus it would be
important to know at what period of childhood the mouth be-
comes alkaline. Hitherto my object has been to ascertain the part
played by the acidity of the mouth in the muguet of infancy ; I
think I have attained it in proving that it ought to be considered
as a cause, and not as an effect of that disease, as this acidity con-
stitutes the normal state. [Gaz. Med. de Paris. Dublin Med. Press.

Seven Cases of Tetanus. Communicated by C. Stilwell, of
Long Island, New York.

Case I. A strong, active woman, injured the sole of her foot
by stepping upon a nail. A week after the injury, symptoms of
locked jaw supervened. The spasms where regular and frequent.
A consultation agreed in the diagnosis. Treatment I administer-
ed half a drachm of tinct. opii. and one sixth of a grain of tart,
antimony until one ounce was" taken of the former, without any
symptom of narcotism. Emetics were used after the eighth close
with a temporary relief of all the symptoms. I applied, to the
entire length of the spine, a liniment of turpentine and laudanum,
and administered half a drachm of sp. terebinth, by mouth, every
two hours, until seven doses were taken. On the second day, the
character of all the sj^mptoms assumed more the peculiarities of
hysteria than true tetanus. The spasms were of every variety.
Emprosthotonos, opisthotonos and pleurothotonos would succeed
each other. Eecovery took place at the expiration of two weeks
by a gradual subsidence of the spasms.

Case II. A lad of 12 years of age received an injury in the
bottom of the foot. When called to him I found slight rigidity of
the jaws and muscles of the back. He complained of an aching
sensation in the back and neck. The expression of his counten-
ance was anxious, and the corners of his mouth were slightly
drawn down closely approximating in expression the urisus
sardoyiicus." Treatment. I covered the wound with a tobacco
poultice. Applied to the spine a liniment of tinct. opii., aconite
and turpentine, and administered internally tinct. opii. and spts.
terebinthinse. There were no spasms, and recovery was imme-
diate.

Case III. A man aged 35, of intemperate habits, slightly in-
jured the nail of his thumb. A week after the accident,, he com-
plained of rigidity of the muscles of the neck. Complete trismus
soon supervened, with regular spasms. He died on the third day.

98 Seven Cases of Tetanus. [February,

Treatment. Dover's powders and quinine every four hours, tur-
pentine in drachm doses, with liniment to spine of tinct. opii. and
terebinthinaB.

Case IV.' A youug mechanic, of sound health, received a slight
contusion in the palm of the hand, A few days after the accident
he was seized with a spasm. The jaws were locked for a few
minutes. He complained of stiffness of the neck and back. The
wound was opened, and a sedative poultice applied. A large to-
bacco poultice was applied to the throat, and Dover's powder
administered internally. No further treatment required.

Case V. A lad, 12 years of age, was taken with idiopathic
tetanus. I administered chloroform by inhalation, applied tur-
pentine and laudanum to spine, gave turpentine and laudanum in
large doses internally. He died.

Case VI. This case, of a boy 13 years of age, presented several
peculiar and interesting phenomena. For several days previous
to any alarming symptoms manifesting themselves, his counten-
ance would assume at times a peculiar and sardonic expression.
His parents threatened to punish him for making faces not be-
lieving anything to be the matter with him. There was complete
trismus, with general spasms, during which his body would form a
complete arch on the bed. There was strabismus of both eyes.
Treatment. Quinine and Dover's powders. Turpentine liniment
to back, combined with chloroform and laudanum, occasional
doses of calomel to move the bowels, followed by enemata of turpea-
tine and oil. He recovered in ten days by a gradual subsidence
of spasms. For several weeks after convalescence he occasionally
had a slight spasm. During his illness a splinter was discovered
beneath the nail of the big toe.

Case VII. This case was a child, 10 years of age, and admitted
of more doubt than either of the preceding. A consultation de-
cided that it was idiopathic tetanus. There was no trismus or
stiffness of the muscles of the neck, but the spasms were confined to
the back and lower extremities. I applied lint wet with chloro-
form to the spine, until partial restoration occurred, and exhibited
internally camph., tinct. opii. and chloroform every half hour.
The spasms soon ceased.

That the eastern end of Long Island predisposes to this disease
from slight causes, I think no longer admits of doubt. Every do-
mestic animal, excepting the clog and cat, are subject to it. The
emasculating process produces more accidents from this cause
alone than all others combined. The nature of this endemic in-
fluence I fear will never be satisfactorily explained ; the fact that
it exists, I think, is proved. Where no cure is known, prophy-
lactic treatment deserves increased attention. A domestic remedy
of almost universal application here, is salt pork worn upon the
wound. As all the cases I have treated had availed themselves of
this application, nothing further can be said in favor of the "por-

1856.] Opacity of the Cornea. 99

cine fomentation." It has also been the custom here to have every
wound opened, and, frequently, irritating liquids injected. I have
never believed any benefit was derived from this course. Of
wounds (particularly punctured and contused) I have never known
a single accident occur when treated with tobacco and opium. Of
the pathology of tetanus we are entirely ignorant. I believe the
traumatic form originates first locally in the wound, and the excito-
motory nerves become deranged from this local cause. The
chances of successful treatment, then, consist in powerful sedative
applications to the wound. But if the wound exists, then make
the applications to the spine. Chloroform by inhalation gives only
temporary relief the frequent repetition soon exhausts the vital
powers. Bleeding and warm baths I have never derived any
benefit from. Active medication by mouth I think will disappoint
expectations. Strychnine I have never used, but if any future
cases present the opportunity for its trial I will give you the re-
sults. [Boston Med. and Surg. Journal.

Opacity of the Cornea treated by Operation.

Dr. M. Davis reports the following cases of opacity of the cornea
treated by operation under the care of Mr. Haynes Walton and
Dr. Taylor. A man about 50 years of age, a patient of Dr. Tay-
lor's, had a quantity of lime thrown into his eye four years ago.
The eye was immediately washed out, and it was supposed that
all the foreign matter had been removed, but a dense white opaci-
ty remained, covering nearly two-thirds of the cornea, and com-
pletely concealing the pupil when in a state of medium contrac-
tion. Many ineffectual attempts had been made to remove or
diminish the impediment to vision, by means of lotions and other
local applications. On examining the eye minutely, it was seen
that the opacity was smooth and uniformly covered by the epithe-
lium ; its upper edge, where it did not extend to the margin of the
I cornea, was shaded off gradually, and the surface generally ap-
peared slightly more elevated than that of the clear part of the cor-
nea. This elevation, taken in connection with the history of the
case, led Dr. Taylor to suspect that the apparent cicatrix was
formed by a portion of the lime which had not been removed at
the time of the accident, and had become incorporated with the
corneal tissues. He therefore with a fine iris knife, carefully raised
the epithelium in front of the pupil, and found that, by careful
manipulation, the opacity could be chipped off in small flakes, and
that in no part, towards the centre of the cornea, did it appear to
have penetrated the anterior elastic lamina. After clearing the
pupil, the operation was suspended for the time, partly on account
of the severe pain which it occasioned, and partly to avoid the
risk of inflammation. On a subsequent occasion, the remainder
was removed, with the exception of a few small spots towards the

N. s. VOL. XII. NO. II. 7

100 Opacity of the Cornea. [February,

margin of the cornea, which appeared to be due to interstitial in-
flammatory deposit.

The slight haziness which remained after the operation was
speedily dissipated, and the man was dismissed with almost perfect
vision. Chemical examination showed the opaque matter to con-
sist of carbonate of lime.

In another case, also under the care of Dr. Taylor, the opacity
was removed, partly by operation, and partly by the process of
absorption, excited by mechanical irritation.

The patient, a female, 24 years of age, had been subject, till
within the last six years, to attacks of ulceration of the cornea?.
She now applied on account of a central milky opacity of the right
cornea, shading the pupil and destroying useful vision in the eye.
It had remained undiminished in size for six years, notwithstand-
ing a great variety of local applications. Near the centre of the
opacity were two small, dark-brown spots, situated apparently, in
the substance of the cornea. These were, probably,, the effects of
a former long-continued use of nitrate of silver solution, while the
cornea was ulcerated. The surface of the opacity was readily
peeled off in small flakes, by a cautious use of the iris knife, but
the brown spots were found to be so deep-seated, that Dr. Taylor
did not consider it prudent to interfere with them, especially as
they would not impede vision. The result of this little operation,
which has since been repeated, has been the rapid diminution of
the opacity, and corresponding improvement in vision; and as
absorption is still going on steadily, there is every prospect that
the sight of the eye will be completely restored.

It might be objected,, that the following ease ought not, in strict-
ness, to be placed under the heading of this report, but it is given,
not only on account of its great peculiarity, but because it is some-
what allied to the above.

T. P., aged 38, a meteorological instrument-maker, discovered,
about four years ago, that the left eye was misty. The mistiness
increased slowly, and attributing the failing of sight to the inju-
rious effects of his trade, he disregarded professional advice, till
the right eye had given evidence of the same kind of obscurity
that had attacked its fellow, and now he applied to Mr. Walton.
The eye first diseased, the left, is virtually blind, for nothing can
be seen with it, as in the centre of the cornea there is a brown oval
opacity, placed transversely, large enough to cover the pupil, and
dense enough to intercept light. It is of a sepia colour, and
shaded towards the extremities, not raised, and possessed of the
same lustre as other parts of the surface of the cornea.

The right eye is affected in a similar manner, but in a less

, degree, and enough of the pupil is yet uncovered, that with a

magnifying glass the coarser works of his trade can be executed.

There have not been any subjective symptoms, and he himself is

quite unaware that there are brown spots on his eyes.

1856.] Cancer in Children. 101

Mr. "Walton directed atropine to be used to the left eye, the
effect of which was to dilate the pupil beyond the opacity, and
thus to enable objects to be seen with that eye nearly as well as
with the other.

The right eye was then treated in the same manner, and the
vision was improved. The patient now expressed himself quite
satisfied with the benefit received, and desired to cease attendance,
but yielded to the request of Mr. Walton to attend another day,
that he might ascertain how far the opacities were capable of
being removed by operation. An attempt was made to scrape a
portion of one away ; but a clear surface beneath could not be
obtained, as the disease had extended into the true texture of the
cornea, and perhaps completely pervaded it.

Dr. Taylor, who had taken his microscope to the hospital, to
examine, in a fresh state, whatever might have been removed,
found that the portion separated consisted of epithelium, some of
which contained pigment granules.

I must beg to observe that, so far as my personal experience
goes, opacities resulting from loss of substance of the cornea ; in
fact, cicatrices and interstitial deposits from inflammation axe not
capable of being pared away, but depositions, for the most part
consisting of earthy materials on the surface of the cornea, and the
accidental impingement of a foreign substance, as in the first case,
may be so removed. [Medical Times and Gazette.

On the Occurrence of Cancer in Children. By M. GlJERSANT.

The subject of cancer in children is nowhere treated of, proba-
bly on account of the rarity of this affection during the early
periods of life; however, there is not a year in which the author
does not see some cases of it.

For a very long time, cancer was met in children only in the
orbital cavity, whether it took its origin from the globe of the eye
or from the base of the orbit. It has since been proved to occur
in the testicles. Dupuj'tren operated on several such cases ; M.
Gruersant has also removed six or seven testicles effected with en-
cephaloid cancer. Cancer has also been found in other parts, but
less frequently, unless in the vulva. Ought we now to make a
distinction between fibro-plastic and cancerous tumours? M.
Ghiersant is strongly disposed to class them together, on account,
he says, of the tendency the former possess, in common with the
latter, to relapse. He admits, however, that their relapse occurs
less frequently ; and in this point of view they have a character
of relative benignity which should be borne in mind, but they are
nevertheless, according to this surgeon, closely allied to cancer.

The progress of a cancerous affection in a child is much more
rapid than at a more advanced age. At the Salpetriere and Bice-
tre, cancer is seen in old patients to remain stationary for from

102 Treatment of Chancre. [February,

fifteen to twenty years. In children, on the contrary, trie progress
of the disease is terrific. In a young boy, under M. Guersant's
care for a cancerous tumour in the orbital cavity, the eye was
driven out of the orbit in less than six weeks. The sufferings of
this little patient were fearful ; the globe of the eye was extirpated,
but the disease returned with extreme rapidity, and at the end of
a month the ethmoid was destroyed.

The prognosis in cancer in children is, therefore, very unfavora-
ble; and because there is no chance of the disease remaining
stationary, the indication is to operate with more rapidity and
energy than in adults. But, on the other hand, relapse is so gen-
eral and occurs so quickly, that we ought to resolve on operating
only with the view of procuring temporary relief from intolerable
sufferings ; nor should we fail to warn the friends of the patient
of the likelihood of the disease returning.

M. Guersant quotes, in support of these remarks, a case which
terminated fatally; although on post-mortem examination, nothing
but fibro-plastic tissue was found in the tumour, the destruction
of which had been attempted. The patient had been a little girl,
aged thirteen months, who had a tumor in the vulva. This tumor
was tied by a surgeon on the 6th of November, and came away.
The disease relapsed, and on the 18th December a secon d ligature
was applied ; relapse occurred still more speedily than on the first
occasion. In January, the second tumor was pretty large, and its
presence gave rise to sympathetic vomiting. The child was pre-
sented to the Surgical Society, the members of which body verified
the existence of a multilobular tumour, with prolongation into
the vagina. Although it was difficult to trace its limits, M. Hu-
guier advised removal with the bistoury, and cauterization of its
roots. M. M. Lenoir and Guersant were of opinion that the re-
sults of such an operation would be incomplete. However the
tumour mortified, and the child fell into a state of marasmus. M.
Guersant thought it advisable once more to have recourse to liga-
ture ; but the little patient was already exhausted, and sank in a
few days from adynamia.

Should excision have been more successful ? It is not probable..
Nevertheless, in another case, M. Guersant considering such an
affection as a sort of polypus, would excise it early, and cauterize
its base with liquid caustics ; and if the vagina was large enough
to admit of these means, he would not despair of obtaining a more
or less permanent cure. [Dublin Med. Press, from Jom,r. de Med.,
etde Chirurg.

Treatment of Chancre.

From observations conducted on a large scale at the Vienna
Hospital, Dr. Sigmund concludes 1. Chancre can only be treated
locally during the first four days, and the further we recede from

1856.] Mathyseii's Gypsum Bandage. 103

this, the greater the urgency of the general treatment. 2. The lo-
cal treatment consists in cauterization, which effectually destroys
all the chancrous exudation to the sound tissue. 3. The observa-
tion of more than a thousand cases during eleven years, assures
Dr. Sigmund that secondary symptoms never occur when the
chancre has been completely destroyed within the first four days.
He is only aware of two doubtful cases in which cauterization on
the fifth day even has not prevented accidents. The best caustic
is the Vienna, composed of quicklime and two or three parts of
caustic potass. Cauterization should also be practised even after
the fifth day, for although the chances of preservation from secon-
dary syphilis are diminished, they are not totally abolished ; and
we prevent the chancre being communicated to other parts of
the same patient, or to other individuals. 4. The general treat-
ment consists in the methodical employment of mercury, no other
means curing so quickly and so surely. 5. In the exceptional
cases in which secondary symptoms occur in spite of general treat-
ment, they are not found in an aggravated form. 6. According to
circumstances, the general treatment should be continued for six
or twelve weeks. The levity with which the public and the pro-
fession at the present time regard venereal symptoms, should be
met by the strongest opposition. 7. Clinical observations shows
that every chancre, well diagnosticated, and not carefully destroy-
ed, leads to secondary symptoms, if general treatment has not
been instituted. This will be admitted by all who establish a rig-
orous diagnosis, and look for secondary symptoms soon enough
where they are first to be found, viz : in the lymphatic glands.
8. Positive diagnosis is alone attainable by inoculation or the pro-
duction of secondary symptoms. 9. Secondary symptoms are
usually observed about the sixth week after infection, and very
rarely later than the twelfth ; and we must not always depend
upon the patient's assertion, but make ourselves a rigorous search
for their early manifestation. If between the sixth and end of the
twelfth week no secondary symptom has shown itself, and the
local manifestation has disappeared, the patient maybe pronounced
cured the few exceptions that occur notwithstanding. 10. The
amount of mercury administered varies according to the indica-
tions offered by differentjpatients. The dietetic and hygienic man-
agement, both during and after taking the mercury, is too much
neglected. [_V Union Medicate. American Jour, of Med. Sciences.

Report on the Employment of MatliyserCs Gypsum Bandage. By
Drs. Geimm and Jungken.

Dr. Mathysen's bandage was employed in thirty-six cases of
fractures of various kinds early in 1854. The bandage is pre-
pared by stretching it upon a table, and well rubbing powdered
gypsum into it on each side. It is then rolled up or otherwise ar-

104 Chloroform in Midwifery Practice. [February,

ranged, according to the use to be made of it. Immediately before
applying it, it is dipped in water or other fluid, the limb being
protracted by a flannel or other bandage prior to its application.
Any portion of the bandage that is found not to have become wet-
ted is moistened by a wet sponge. Flannel will take up twice as
much gypsum during the rubbing as linnen ; but it is more clumsy,
and not so easily applied. If a very firm, immovable bandage is
required, some of the gypsum, in the form of a thin paste, should
be applied during the last turns of the bandage. Its appearance is
much improved by passing a damp sponge several times along it
while still wet, and at a later period it may be smoothly polished
by means of glass. To remove the bandage, it only requires to be
again well wetted.

The Reporters pronounce this bandage to be the best of all hith-
erto invented, including those that most resemble it, as the starch
bandage, i\pon the following grounds: 1. The rapidity with
which it hardens. 2. Its simplicity and easy application. 3. Its
small cost. 4. The ease with which it may be removed the linen
composing it being available, after twenty-four hours' soaking, for
new bandages. 5. Its firmness and immovability render it suita-
ble for the most oblique and difficult fractures. 6. From its rapid
hardening and its firmness, it is well adapted for those cases which
require extension and counter-extension to produce coaptation of
the fractured parts. The position obtained remaining unchanged,
apparatus of extension, so uncertain in operation, and so annoying
to the patient, is not required. 7. The ease with which it is borne.
8. Its porosity. Cutaneous transpiration is not quite suppressed,
and if the fracture be complicated by wounds, ulcers, &c, these
are indicated by the discharges making their way through the
bandage. 9. The gypsum bandage is a good conductor of heat,
and a bladder of ice placed over some oil-skin, around the fractured
part, takes effect in five minutes. 10. When the bandage is prop-
erly applied, the form of the limb is so well displayed, that any
irregularity of the fractured part may be judged of externally. 11.
Its handsome appearance and regularity distinguish it from all
analogous bandages. 12. Fractures seem to unite sooner under
its employment. [Brit, and Foreign Med. Chiurg. Rev. from An-
nul, des Charite-Krankenhauses.

The strictest Caution requisite in Chloroformization in Midwifery
Practice.

Dr. M'Clintock briefly relates (June 6, 1855) to the College of
Physicians in Ireland, the history of a case of chloroformization
in midwifery practice, in order to show the great necessity that
existed for always using the utmost caution and circumspection in
the employment of chloroform inhalation in labour, as well as the
great importance of intrusting its exhibition to none but a medi-

1856.] Chloroform in Midwifery Practice. 105

cal man. He did so because the writings and practice of some of
the foremost advocates for anaesthesia bad led many persons to
suppose that the administration of chloroform to parturient cases
was almost, if not entirely, free from danger a most dangerous
fallacy, and one that would inevitably lead to disasterous conse-
quences is generally acted on.

The leading circumstances of the case he brought forward were
these : A healthy woman, aged 28, was admitted into the Lying-
in Hospital, in labour of her first child, some days before. The
first stage was very tedious, in consequence of an unyielding con-
dition of the os uteri, and much general irritability. With a view
to relieve this state, and to give her some rest, as she was much
harrassed by frequent short pains, it was thought advisable to put
her under the influence of chloroform. For about an hour she
got it in small quantities in fact, merely chloroform d la reine
but without experiencing any benefit, and without its producing
any anaesthetic or soporific effect. The quantity put on the sponge
a large cup-shaped one, was now increased, but still could hardly
have exceeded one drachm, and was not more than is habitually
given in the hospital to patients undergoing obstetric operations,
to which cases its use is chiefly limited; and it was administered
by the senior assistant, who has had ample experience of its use,
having given it before in hundreds of instances. After the sponge
was reapplied to her mouth, and she had taken three or four in-
spirations, a change came over her countenance, the eyeballs
turned up, the pulse left the wrist, respiration was suspended for
a space of time that would have occupied about three or four in-
spirations, and some froth collected at the angles of the mouth.
On the first appeararance of these alarming symptoms, the sponge
was instantly withdrawn, the free circulation of fresh air was pro-
moted, the face and chest were aspersed with cold water, and
ammonia was applied to the nostrils. It should, perhaps, be
mentioned that during the entire of the above period she was in
bed, and lying down. Under the influence of these restoratives,
animation gradually returned. It was evident, however, to all
around and many of the pupils were present that she was all
but gone, and that her life was preserved by the early recognition
of the poisonous effects of the medicine, and the prompt and judi-
cious employment of appropriate restoratives. Hardly any one
will venture to deny that had this woman been in non-professional
hands , her life would have been lost. That she got a dose of
chloroform which, to her, was an overdose, is sufficiently obvious ;
and yet the quantity given, the quality of the chloroform used, the
mode of exhibition, and even the administrator, were all the same
as on hundreds of previous occasions, when everything went on
favorably. Hence, then, the absolute necessity for invariably and
uniformly observing the strictest caution, prudence, and circumspection
in the employment of this powerful agent, and never intrusting its ex-

106 Dislocation of the Lower Jaw. [February,

hibition to a non-medical person. A case that strikingly illustrates
these remarks is recorded in the Medical Times and Gazette for
April 14, 1855, where a lady died in the course of a natural labour,
from the effects of chloroform administered to her by the nurse,
on a handkerchief, without the sanction or knowledge of the doc-
tor, who was in the house at the time. The quantity used in this
case, with fatal effect, could not have exceeded five fluidrachms.
[Dublin Quarterly Journal of Med. Science.

Complete Dislocation of the Lower Jaw reduced by a new method.
By W. Colles.

Miss , aet. 25, whilst indulging in a protracted yawn, felt a

jerk in the jaw, and found she could not close her mouth. She
immediately applied to a medical man in her neighborhood, who
recognized a dislocation, but failed in his efforts at reduction. She
then applied to Mr. Colles. " The mouth was open, the symphy-
sis of the jaw slightly projecting. On applying the fingers to the
angle of the jaw, and tracing the ramus upwards, it led in a direc-
tion much anterior to the position of the articulating surface. The
posterior edge of the bone could be most distinctly felt, and a
broad furrow or hollow existed between the bone and the ear.
The heads of the bone were felt and perceived prominent in front
of their natural position, so that the face appeared broader at this
place than natural.

" Before attempting reduction, I wished to ascertain the position
in which I would have most command of the force to be used.
Standing before her, I passed both thumbs into the mouth, but
felt I would not have a position the most favorable for applying
all my force, if necessary.

" I then stood behind her, and it at once struck me this was the
position which afforded most advantages.

"Placing her head against my chest, I passed each thumb as far
back on the corresponding side of the jaw as possible. By making
a rotary motion from the wrist, I found the bone to yield; by now
adding a motion of drawing the hand in towards the chest, the left
side first, then the right, slipped into their positions, and the
patient closed the mouth, the rows of teeth falling into their rela-
tive positions, and she now could speak plainly.

" I think there are many advantages to be derived from attempt-
ing reduction in this posture, viz: the surgeon standing behind
the patient, the head applied to his breast, and the thumbs turned
inwards on the corresponding angles of the jaw, the fingers under
the bone in front.

" In the first place, the head is much more secure than in the
original process, where it is applied against a wall, because in the
latter the surgeon may press down the bone, and the patient gen-

1856.] Iodine Paint in Cutaneous Xcevi. 107

erally will draw the head in the same direction by moving the
body forward in the chair.

" By standing behind the patient, while depressing and pushing
back the thumbs, he is pressing forwards with the chest, and thus
fixes the head more steadily, and assists his manipulations; and
even if the patient do move on the chair, a slight motion of his
body will suffice to counteract this movement, and retain the head
steadily fixed.

"Another advantage is, that he can use much more force, be-
cause when standing in front he can only use the museles that
depress the hands ; whereas standing behind the patient he has
the power of those muscles, and is assisted by the powerful class
of muscles that rotate the thumbs inwardly ; and, besides, in the
former case his pressure is away from his bod}*, whereas in the
new position the pressure is more directly downwards and towards
himself. The only disadvantage in this proceeding, if it can be
considered one, is, that the mouth is stretched more than in the
original plan." [Dublin Hospital Gazette.

Cutaneous Nozvi cured by Application of Iodine Paint.

S. Edwards, M. D., relates two examples of this. In the first
case, the naevus was unfortunately situated on the side of the neck
of a female infant. At birth it appeared simply as a small, red
shining spot, which in three months increased to the size of a four-
penny piece. The mother of the child at this time positively
refusing to have any escharotics employed, fearing that it might
give rise to a permanent and greater deformity, I recommended
astringent and cold applications to be applied constantly, and this
was kept up for some time, but with no good result. The na^vus
at the end of ten months had acquired additional size, and was
observed to become redder and a little more elevated, whenever
the circulation was increased by awing, etc. The parents still
refusing any of my former suggested remedies, or even of vaccin-
nation, "until it got worse," I recommended the use of iodine
paint, which was regularly employed by gently painting over the
surface with a camel's hair pencil every alternate day, occasional-
ly leaving it off for three or four days when the skin was very
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 disappeared; a speck or two being alone visi-
ble to mark its former site.

The second case was very similar; occurred in a little boy
nearly two years of age. The naevus was about the size of a shil-
ling, but slightly elevated, and situated on the abdomen, and had
gradually, but very slowly, increased since birth. No treatment
had been employed, the physician who attended the mother of the
child, having advised nothing to be done unless it increased. The

108 Contagiousness of Puerperal Fever. [February,

tincture was commenced in September, 1854, and was continued
more or less up to the last mouth, when the disease had disappear-
ed, leaving scarce a trace of the mischief. [Med. Times and Gaz.

Contagiousness of Puerperal Fever.

M. Depaul believes that puerperal fever, especially when epidem-
ic, is contagious. He relates the following examples. During an
epidemic of puerperal fever at the Matcmite, a midwife was en-
trusted with the case of a woman recently delivered, affected with
a most severe metro-peritonitis. One morning this midwife, in
giving the attention to the patient which her situation required,
was powerfully impressed, and as if suffocated, by the emanations
which escaped on raising the bed-clothes. The same evening a
strong shivering fit occurred, her abdomen became very painful,
pulse small and frequent, greenish vomiting, diarrhoea; at last all
the symptoms most characteristic of puerperal fever. She died in
forty-eight hours. At the autopsy the changes usually observed
in cases of this nature were found, the tissues of the uterus being
ulcerated. M. Depaul was enabled, moreover, to establish that
this young woman was not only not in any form of puerperal state,
but that she presented all the signs of virginity.

A physician was engaged in making the post-mortem examina-
tion of a woman who had died of puerperal fever, when he was
summened to attend a labour. Precautions of every kind, change
of clothes, washing, could not rid him of the smell that autopsies
of this kind commonly leave on the hands. The labour took
place in the usual way, but in the evening the patient was seized
with a most severe puerperal fever, and died the next day. M.
Depaul relates also another similar case in which the woman died
in a few hours. \L' Union Medicale. American Jour. Med. Sci.

Pathological Anatomy of Chronic Hydrocephalus.

M. Blache, in a communication read before the Academy of
Medicine, describes the details of the pathological alterations re-
sulting from this disease. The following arehis conclusions:

1. In internal hydrocephalus, the serum accumulates in the
cerebral ventricles, but not in the cerebellar or fourth ventricle ;
it does not communicate with the cephalo-rachidean liquid.

2. Contrary to the opinion of some authors, the white and the
gray substances are recognizable in the nervous laminae, into which
the fluid pressure transforms the ventricular walls ; when the dis-
tension has not been excessive, the circumvolutions are also to be
found, and, in all cases, thickenings, which are the vestiges of
them.

i 3. The corpus callosum, fornix, and septum lucidum, are almost
entirely destroyed and converted into fibrous laminae.

1856.] Experiments on the Smoke of Tobacco. 109

4. The tuberculum annulare, the cerebellum, and the origin of the
cranial nerves, preserve their integrity, with the exception of
more or less alteration always existing in the optic and olfactory
nerves.

5. The ventricular membrane is thickened so much as to be
capable of dissection throughout its whole extent, by which it has
been established to be continuous with the choroid plexus, and
prolonged across the aqueduct of Sylvius aud the foramen of
Monro.

6. In the interval between the two laminae, which, by facing
each other, form the septum lucidum, it is easy to demonstrate the
existence of the fifth ventricle, and its communication with the
third.

7. The pituitary body is canaliculated.

8. The anterior orifice of the aqueduct of Sylvius was found
obliterated in the two cases where this wras examined ; the cere-
bral cavities were thus completeby closed.

9. Regarding the nature of the malady, the absence of all soft-
ening of the cerebral substance, and the very slightly plastic nature
of the fluid effused, discountenance the idea of chronic hydroce-
phalus being the result of inflammation. In our opinion, says M.
Blanche, it is a pure and simple hydropsy .\_Edinburg Med. Jour.
from E Union Mc.dicale.

Some Experiments on the Smoke of Tobacco.

In Froriep's Journal, of a recent date, an interesting article has
been published on the habit of tobacco smoking, and on poison-
ing by nicotine. Amongst the facts there mentioned, are the ex-
periments instituted by M. Malapert, a pharmacien of Poitiers.
His intention was to ascertain the exact quantity of nicotine
absorbed by smokers, in proportion to the weight of tobacco con-
sumed.

The apparatus used consisted of a stone jar, in which the tobac-
co was made to burn, connected with a series of bottles commu-
nicating by tubes. The bottles were either empty, or contained
some water mixed or not with a little sulphuric acid. From a few
experiments, it was found that, in the smoke of tobacco extracted
by inspiration there is ten per cent, of nicotine. Thus, a man who
smokes a cigar of the weight of seventy grains, receives in his
mouth seven grains of nicotine mixed with a little watery vapour,
tar, empyreumatic oil, &c. Although a large proportion of this
nicotine is rejected, both by the smoke puffed from the mouth, and
by the saliva, a portion of it is nevertheless taken up by the ves-
sels of the buccal and laryngeal mucus membrane, circulated with
the blood, and acts upon the brain. With those unaccustomed to
the use of tobacco, the nicotine, when in contact with the latter
organ, produces vertigo, nausea, headache, and somnolence;

110 On the Minute Structure of the Liver, &c. [February,

whilst habitual smokers are merely thrown into a state of excite-
ment, similar to that produced by moderate quantities of wine or
tea.

From further investigations it is found that the drier the tobacco
the less nicotine reaches the mouth. A very dry cigar, whilst
burning, yields a very small amount of watery vapour; the smoke
cools rapidiy, and allows the condensation of the nicotine before
it reaches the mouth. Hence it comes that the first half of a cigar
smokes more mildly than the second, in which a certain amount
of condensed watery vapour and nicotine, freed by the first, half,
are deposited. The same remark applies to smoking tobacco in
pipes, and if smokers were prudent, they would never consume
but half a cigar or pipe, and throw away the other. Smoking
through water, or with long tubes and small bowls, is also a pre-
caution which should not be neglected. {London Lancet.

On the Minute Structure of the Liver, and on the Nature of the Change
known as Fatty Liver. By M. A. Lereboullet.

From this elaborate prize essay, which occupies many pages, we
-can only extract the author's summary of his observations on fatty
liver.

"1. The fatty degeneration of the liver is due to the accumula-
tion of fat in the biliary cells themselves. 2. Special fatty cells
are not formed, as biliary cells would then be found amidst the
fatty ones, which is not the case. 3. Nothing authorizes us to
admit that fat becomes developed in the interstices external to the
cells. 4. The biliary cells may, by the accumulation of fat, acquire
double or triple their normal volume, this development of the
cells explaining the increased size of the fatty liver. 5. These
cells entirely lose their secretory character, and no longer contain
biliary granules ; the biliary secretion is obstructed, and the con-
tracted gall-bladder contains but little bile. 6. The fatty degener-
ation induces a decolorized state of the liver, which progresses
from the periphery towards the centre of a lobule, giving the
organ a spotted and reticulated appearance. 7. The decoloration
arises from the development of the fatty cells compressing the
portal vesicles, and impeding the circulation in them. 8. In the
artificial fattening of geese, the liver only becomes loaded with fat
after the other organs of the body, and especially the abdominal
viscera, have become saturated with it. 9. The cells of the liver
of fattened geese differ from pathological fat cells, inasmuch as the
fat that fills the former always retains the form of distinct droplets,
accumulated in the cell, to which they give an irregular appear-
ance on distension ; while in the pathological cells the fat becomes
united into larger and larger drops, until the cell is at last distend-
ed by a single one like a balloon. 10. The fatty cells in the
goose resemble, as regards the disposition of the fat in the interior,

1856.] A Sign of Congenital Syphilis, &c. Ill

the physiological fatty cells of the foetus and those of the lower
animals. 11. The nuclei of the normal cells, as well as the biliary
granules, disappear when the fatty degeneration commences. 12.
The degeneration takes place simultaneously throughout the or-
gan, but all the fatty cells do not present the same degree of
development. 13. This change of biliary into fatty cells is ob-
served in tuberculosis, cancer, cirrhosis of the liver, &c. 14. The
deposition of fat in the cells appears to be closely connected with
a diminution of the nutritive process, and consequently of organic
combustion, which is the primary condition of that process. When
the quantity of oxygen absorbed is less than in the normal state
(as in tuberculosis, cancer, and probably all diseases of nutrition);
or, when the respiratory elements (fecula, &c.) are taken in too
large proportions, the combustion of these substances is incom-
plete, and the chemical elements which enter into their composi-
tion combine so as to form fat, which is deposited in the biliary
cells. [British and Foreign Med. Chir. Review.

A Sign of Congenital Syp>hilis derived from a Special Alteration in
the Lungs. By M. Depaul.

M. Depaul, in the introductory remarks with which he prefaces
his account of this new sign, observes that a mother undoubtedly
healthy may become infected by an embryo deriving its diseased
condition from the father at the time of fecundation. He also re-
gards constitutional syphilis as a much more frequent cause of
sterility than it is usually supposed to- be, and perhaps more espe-
cially when it exists in the man than the woman. When it does
not prevent fecundation, it may prove fatal to the infant at vari-
ous periods of intra-uterine life, or after birth. When death is
caused at an early period of pregnancy, no anatomical lesion capa-
ble of accounting for this effect can usually be found ; but when
the disease arrests gestation later, it generally leaves evident traces
of its existence. The skin, of all the other organs, is that in
which its presence is most commonly manifested, pemphigus
being the most characterissic form of disease,, as long since pointed
out by P. Dubois. In all but two or three of more than forty
cases of pemphigus in infants, collected by M. Depaul, constitu-
tional syphilis has been detected in one or both parents. His
own observations have not shown him much with regard to the-
intra-peritoneal lesions described by Simpson as syphilitic ; but he
has met with cases in which traces of peritonitis co-existed with
undoubted syphilitic lesions. He has several times found the
fibro plastic deposit in the liver, described by Gublerr the children
not usually dying until some time after birth, although contract-
ing the disease in utero. He has also seen several examples of
abscess of the thymus, regarded by M. P. Dubois, sinee 1837, as a
pathognomonic sign of congenital syphilis.

112 On the Etiology of Epilepsy, &c. [February,

In 1837, M. Depaul directed the attention of tlie Academie de
Medicine to a change observed in the lungs of children born of
syphilitic parents, viz: the dissemination of multiple collections
of pus through them ; and in the fifteen years that have since
elapsed, he has observed at least twenty such cases, the particulars
of two of which are here given. Microscopical examination shows
that these collections are not tubercular deposits ; and M. Depaul
believes that it is highly probable that the cases of tubercle in
new-born infants given by Billard, Baron, and Husson, were real-
ly examples of this affection. It sometimes exhibits itself under
the form of simple indurations, consisting of infiltrated pus, and at
others of true abscesses, surrounded by more or less thickened
walls. Formerly M. Depaul regarded these as the only two forms
of the affection, but he has now several times met with another,
which may be regarded as its first stage, and which consists in a
greyish induration without pus, but attended with a deposit of a
considerable quantity of fibro-plastic tissue. Sometimes the lesion
occupies very circumscribed spots, but in other cases it is more
generalized, invading several lobes. The pulmonary tissue is im-
permeable to air, even after repeated insufflation. These different
degrees of the lesion are not unfrequently met with in the same
subject. There are also usually other S3q>hilitic lesions present,
as pemphigus, abscess of the thymus, &c.

Various circumstances influence the prognosis in congenital
syphilis. When the skin is affected, although the life of the child
be seriously menaced, if the nature of the disease be recognise<l7
and the treatment appropriate, it may sometimes be entirely cured.
But when organs indispensable for the establishment of extra-
uterine life become disorganized, as in this lesion of the lungs, it
is obvious that death may ensue from a mere mechanical cause
the air penetrating in insufficient quantity. So promptly, indeed,
does death take place, that the practitioner is disarmed ; and hence
the imperious necessity of combating the syphilis of the parents
prior to fecundation, or seeking to mitigate its effects by prompt
treatment of the mother during pregnancy. In M. Depaul s opin-
ion, mercurial treatment is sufficiently justified, even if the exist-
ence of syphilis can be detected in neither parent, when the above
described change has already been observed in a product of con-
ception. [lb.

On the Etiology of Epilepsy, and the Indications of Treatment furnish-
ed by a Study of the Causes. By M. Mokeau.

M. Moreau, as physician to the Bicetre and different establish-
ments for the treatment of the insane, has seen much of epilepsy.
He believes that the very different accounts given by authors of
he amount of success attendant upon treatment, arise from differ-
ent pathological conditions having been confounded together.

1856.] On the Etiology of Epilepsy, d-c. 113

Resembling each, other much in their external manifestations, true
and pseudo-epilepsy may, by hasty observers, be easily confounded.
The convulsion, whatever may be its character, and a more or less
complete loss of consciousness, do not in themselves constitute
epilepsy, properly so called. They may assume an epileptiform
mask, and may depend on various morbid conditions, disappear-
ing on the removal of these. The cause is here everything, while
the symptoms are of little import.

" Under these same sympathetic forms, a special disease may be
also concealed, a deep-seated modification of the nervous dynam-
ism, a special lesion of something unknown but no less real, which
is termed a iieurosity. It is a lesion independent of the various
causes which may induce its external manifestation but do not
create it, since it existed without and before them, and because, to
use the language of the schools, it is essential. Here the import-
ance of the cause entirely disappears in presence of that of the
symtomatic phenomena. We speak here of exciting not predis-
posing causes, which, in our opinion, are not separable from the
disease itself." (torn, xviii. p. 5.)

It is the confounding essential and sympathetic epilepsy that
has given rise, according to M. Moreau, to the vague and uncer-
tain views which prevail respecting the etiology and treatment of
the disease. In his view of the disease, it is the predisposing
causes of epilepsy that are of fundamental importance, being, so
to say, the disease itself; and it is through these alone that the
malady is, if anywhere, vulnerable to attack. He considers them
at considerable length, and we proceed to reproduce his principal
conclusions.

1. Physiological Predisposing Causes:

"(1) Hereditariness. Of all the predisposing causes of epilepsy,
the most serious and fertile, the one whose action is most certain
and inevitable, attacking the majority of, or even all epileptics,
and embosoming, so to say, the secret of the disease, is hereditari-
ness an expression which, in our eyes, comprises the conditions
of organization in the double point of view of physiology and pa-
thology of the ascendants and collateral relationships in which the
descendants derive their predisposition. Thus comprehended, he-
reditariness constitutes the essential and truly fundamental part of
our work. The principal source of the disease, this it is which
furnishes the least vague indications, and those that are most easy
of fulfilment for the prevention and cure of the disease." (torn,
xviii. p. 17.)

To the term heriditariness, the author gives a far wider accepta-
tion than that generally received the mere transmission of a
similar disease from the ascendants to the descendants. He be-
lieves that any abnormal conditions of the nervous system, the
precise mode of manifestation of which may differ, may prove
efficient; hereditariness, indeed, resulting from such transforma-

114 On the Etiology of Epilepsy, &c. [February,

tion of diseased conditions, playing an important part. Mere sim-
ple nervous irritability, slight convulsive movements or tics, have
their hereditary influence; and, in fact, nervous disturbances of
all kinds, whatever their symptomatic form, whether simple or
complex, predispose as much to epilepsy as does epilepsy itself.

Among the predisposing causes we must also range (2) Drunk-
enness. This is well known to be a frequent cause of insanity ;
and the mutual connexion of all nervous affections, especially of
epilepsy and insanity, leads to the expectation of its effect proving
alike in both. Again, (3) Phthisis acts as a predisposing cause, as
shown by the number of phthisical persons found among the rela-
tives of epileptics. There seems, indeed, also a remarkable con-
sanguinity between phthisis and other cerebral disorders having
an affinity to epilepsy, such as insanity and idiocy.

In support of these views, M. Moreau cites the particulars of
12-4 cases of epilepsy which have occurred in his own practice. In
44 of these, individuals below the age of puberty, 83 of their rela-
tives (ascending as high as grand parents, and embracing uncles
and aunts as collaterals) furnished 100 pathological conditions.
Among 51 male adults, 113 pathological conditions were discov-
ered in 115 relatives ; and among 29 epileptic women, 71 such
conditions were noted in 57 relatives.

The following are his conclusions upon a review of these cases .
1. The hereditary sources of epilepsy are far more numerous than
usually supposed. In these 124 cases, epilepsy itself occurred
among the relatives in 30 instances, insanity exhibited itself in one-
fifth, hysteria in one-ninth, and paralysis and apoplexy in about the
same proportion. In 30 of the cases the influence was traced back
to the grand parents. 2. In the great majority of cases the epi-
lepsy is not the product of any single pathological condition, but
of several united, whether occurring in the same relative, or dis-
tributed among several. 3. When we observe the relatively large
proportion attained by certain conditions, which have not hitherto
been supposed to be related to hereditariness as eccentricity, ce-
rebral disturbances of all kinds, drunkenness and phthisis; and
when we observe that these conditions intermingle, alternate
with, and replace each other among the ascendants, we feel justi-
fied in attributing to them the large part we have. While in these
124 cases epilepsy manifested itself 30 times, drunkenness did so
24, insanity 26, and phthisis 35 times. 4. Cerebral accidents, pa-
ralysis, apoplexy, congestion, &c, were found in 52 instances;
paralysis alone occurred in one-twentieth of the cases, and the
frequency with which this condition is met with among the epi-
leptic themselves is an additional reason for attributing to it here-
ditary influence. Forty examples of it were observed among 240
cases of epilepsy at Salpetriere. 5. These considerations exhibit
the powerful special predisposition the majority of epileptics are
born with ; and it may be predicted that a family having the appa-

1856.] On the Etiology of Epilepsy, &c. 115

ratus of innervation thus injured, must, sooner or later, furnish
descendants suffering from epilepsy; and probably there is no
other disease that furnishes such strong proofs of its hereditariness.
In such persons there is a special condition, an excess of excitabil-
ity of the nervous system, which perhaps only awaits some insig-
nificant occasion to become transformed into a morbid individual-
ity. 6. We see in this remarkable hereditary predisposition a
true neurotic diathesis, which explains the essential character of
true epilepsy, and its resistance to curative agents. Epileptiform
convulsions may manifest themselves, whether predisposition ex*
ists or not ; but when the apparatus of innervation is in a normal
state, the cause and effects will appear and disappear together.
When it is deeply vitiated by hereditary predisposition, it is in
vain we remove the occasional cause, for the disease existed in a
latent state prior to its advent, and will persist after its cessation.

(1) Sex. It would seem a priori that sex should exercise a pre-
disposing influence, and that more women would suffer from the
disease than men. Several authors, indeed, have stated this to be
the fact; but the records at Bicetre and Salpetriere, for a consid-
erable period, show that it prevails much more largely among
men. In respect to the influence (5) of Age, M. Moreau's experi-
ence is in accord with that of other observers. In a total of 995
cases, the disease commenced at birth in 87 ; before ten years in
306 ; between ten and twenty, in 364 ; between twenty and forty,
in 170 ; and between forty and sixty, in 68 cases ; the greatest
number becoming developed first between ten and twenty years,
next between two and ten, and then between twenty and thirty.
(6) Temperament. The author's experience goes to show, at least
as far as women are concerned, that lymphatic and scrofulous tem-
peraments are more predisposed, the sanguineous coming next.

2. Pathological Predisposing Causes.~-By those who include sym-
pathetic epilepsy in their consideration, there is no malady or lesion
that may not give rise to the disease ; but even under the strict
limitation imposed by the author, certain diseases may be regarded
as predisposing. Among 364 epileptics, convulsions occurred in
79, for a longer or shorter time, prior to epilepsy manifesting itself.
Of 671 epileptic women at Salpetriere, 61 suffered from some form
of hysteria. In most epileptics who suffer from paralysis, this is a
co-existent or consecutive affection; but it occurs too often prior to
the epilepsy to allow of our denying all causality. Eruptive disease
of the scalp and small-pox seem in several cases to have excited
some predisposing power. M. Moreau believes an etiological value
they do not deserve has been attributed to the pathological changes
in the nervous centres, so often observed in epilepsy. Imperfect
development or vicious conformation of the cranium is often ob-
served in congenital epilepsy, which is frequently combined with
idiocy or imbecility ; but on examination of the heads of 500 epi-
leptics in whom the disease became developed at a later period M.

N. S. VOL. XII. NO. IL. 8

116 On the Etiology of Epilepsy, dec. [February,

Moreau could detect nothing remarkable. The condition of the
system which results from venereal excess or onanism highly fa-
vors the operation of slight occasional causes. Like other observ-
ers, M. Moreau has met with many cases in which the epilepsy
became first developed during sexual intercourse. The chlorotic
condition is often observed in female epileptics, and may furnish
useful indications of treatment. The nervous condition plays as
important a part as regards the individual, as it does in relation
to hereditary influence. A remarkable peculiarity of this condi-
tion is the tendency the various accidents constituting it exhibit
of replacing each other, and undergoing the most varied meta-
morphoses and unexpected transformations fully justifying M.
Cerise's appellation, proteiform neuropathy. Moreover, these protei-
form phenomena have not only this disposition to succeed each other,
but, what is of far greater consequence, they exhibit a marked ten-
dency to transformation into more serious forms of disease, possessed
of more definite, fixed, and complete characters, so as to pass into
some of the great neuroses as hysteria, insanity or epilepsy.

3. Predisposing Causes independent of the Individual. The au-
thor, although convinced that the belief so generally entertained
by epileptics, that changes in the moon influence their condition,,
is a popular prejudice, resolved nevertheless to give the question
an attentive examination. He furnishes a detailed table, exhibit-
ing the entire number of attacks 108 epileptics suffered during five
years. The total of these amounted to 42,637, of which 16,324
only occurred at the lunar phases, and 26,313 in the intermediate
periods. The same tables enable the author to give a similar-
negative response to the question,, whether extremes of tempera-
ture exert any influence. The number of attacks which occurred
in the different months of the year were remarkably similar. The
affection has been sometimes said to be endemic, as in mountain-
ous countries ;. but it is then frequently associated with idiocy, and
may depend on local causes. The operation of endemicity, too,
has been confounded with that of hereditary influence.

4. Occasional Causes. So great is the importance of hereditary
predisposition, that, in M. Moreau's view, it absorbs all the inter-
est of the case, the occasional or exciting causes being, in its pre-
sence, of little importance. With the progress of science, the
immense number of those admitted by the oldest writers have
undergone great diminution. On an examination of his own and
other observers' statistics, he finds that moral causes seem to have
operated in 444 instances as compared with 85 physical; 364 of
these being referable to the influence of fear in some of its varie-
ties. One fact all authors are unanimous in admitting, viz : the
great tendency nervous attacks have to be reproduced under the
influence of the same occasional causes that first called them forth..
M. Moreau believes that the production of congenital epilepsy is
not so frequently due to terror on the part of the mother as is

1856.] On the Etiology of Epilepsy, &c. 117

generally supposed. He also doubts whether imitation can give
rise to true epilepsy, although there can be no doubt of the ease
with which the sight of an epileptic paroxysm induces the like in
one liable to the disease. As to the influence of physical causes,
such as blows, or wounds of the head, &c, it is difficult to distin-
guish this from that of the accompanying mental disturbance.
Drunkenness is an exciting, as well as a predisposing cause; and
epileptics are, in general, much disposed to the abuse of alcoholic
fluids. In respect to epilepsy excited by intestinal worms, the
more exact observation of modern times only admits epileptiform
convulsions being thus producible, although in a child strongly
predisposed, hereditarily, true epilepsy may ensue. It is certain
that epileptics are not liable to worms more than other persons.

5. Indications. Although M. Moreau again dwells upon the
importance of duly appreciating the potency of hereditary predis-
position in our treatment of this disease, we cannot discover that
he puts forward any novel suggestions derived from this consider-
ation, as guides in preventive or curative treatment.

Adverting to the empirical treatment of the disease, he observes,
that every agent capable of exerting a modifying influence on the
nervous system has been again and again tried, further experience
failing to confirm the existence of virtues at first announced. The
only substance the claims of which he examines, is the oxide of
zinc, which has recently been so prominently brought forward by
M. Herpin. By a believer in the almost incurability of true epi-
lepsy like our author, the statements of Herpin (that he cured 26
out of 48 patients, and ameliorated other 10, only 12 resisting all
treatment) would naturally be received with utter incredulity.
He nevertheless entered upon a series of trials with this agent, the
results of which in no wise corroborated these statements ; and he
attributes their having been made to inexactitude and hasty ob-
servation the diagnosis in some of the cases being founded on
hearsay evidence, while in others, the patients had not been long
enough watched after their reputed cure.

With respect to the claim set up for epileptic remedies, that
they produce some relief and diminution in the violence of the
symptoms, M. Moreau observes:

" Whatever may be thought by many estimable practitioners,
we must confess that we altogether reject this statement, for the
following reasons: Every one knows that there are few reme-
dies (or I might say there is no remedy) which, when first em-
ployed in the treatment of epilepsy, does not give rise to some
apparent advantage. Is this attributable to the action of the sub-
stance itself, or merely to the imagination of the patient ? We
are of opinion that it depends a little on both ; for we have
seen these substances act in much the same way upon individuals
susceptible to the influences of imagination, and those that were
not so. It would seem that, in this great perturbation of the neu-

118 On the Etiology of Epilepsy, &c. [February,

rosity, every agent capable of modifying in any manner the disor-
dered condition of the nervous system, may produce temporary
relief. However this may be, it is a fact for me beyond all dis-
pute, that the improvement thus obtained, the few days of respite
gained, are almost always a little sooner or later, dearly paid for
by the prevalence of a worse condition than before. The more
sensible the amelioration seems, the more reason have we to fear
the violence of the disease when it reappears." (torn, xviii. p. 156.)

Thus far no anti-epileptic has been discovered; but M. Moreau
thinks, somewhat inconsistently with the above statement, that, in
so exceptional a state, we should try and re-try every substance
that may possibly exert a modifying influence on the nervous
system. The so-called rational treatment, founded upon the en-
deavor to operate indirectly upon the nervous system, by remedy-
ing faulty general or partial derangements of the entire organism,
has met with little more success, if any. Attempts have been
made to cut short the disease by attacking a particular symptom,
sometimes present the aura epileptica. Various applications have
been directed to near the spot where this manifests itself; but the
benefit reported by Portal and other old writers to have accrued
from these, probably arose from mere epileptiform diseases having
been dealt with. It is possible, indeed, that temporary benefit
might result, even in true epilepsy, from the effect produced upon
the imagination.

Notwithstanding the highly unfavourable prognosis M. Moreau
delivers in regard to true epilepsy, he yet admits that a cure does-
occasionally take place this result, however,, seeming rather due
to the operations of nature than to any form of medication employ-
ed. Hippocrates pointed out the importance of regimen ; and all
subsequent authors have echoed or amplified his recommenda-
tions. M. Moreau also declares, that if any practical indications
are deducible from his study of the causes of epilepsy, these are
embodied in the precepts of Hippocrates. In a constitution so
deeply tainted by hereditary influence, all has to be remodelled
and changed. The indication is to amend, by every means art
places at our disposal,, the morbid disposition amidst which epilep-
tics are placed; and for the production of modifications and trans-
formations like these we can alone look to hygiene. Without
dwelling upon the well-known laws of this branch of preventive
medicine, M. Moreau adverts to one or two points of importance:

1. An almost indispensable condition is a change of climate.
No importance, in this respect, can be attached to any particular
climate. The essential thing is to change the one to which the
patient has been hitherto accustomed. By this very change, the
whole physical and moral habitudes undergo, though slow, yet
certain modification, provided the sojourn be sufficiently pro-
longed. 2. Remove from the patient all that may over-excite his
intellectual functions, and develope his sensibility, passions, and

1856.] Results obtained by Subcutaneous Surgery. 119

affections, while you at the same time engage him in manual labour,
or other exercises favourable to the development of muscular ener-
gy. Exercise in the open air, and the employments of a country
life, where alone the requisite calmness and tranquility can be
found, seem to fulfil these conditions in the best possible manner.
Gymnastics, too, have been found at Bicetre and Salpetriere to
exert a most beneficial effect upon the health of the insane and the
epileptic. They should, however, only be employed under medi-
cal superintendence. 3. Food. Without doubting the importance
of duly attending to the diet in epilepsy, M. Moreau does not
advocate the adoption of too minute regulations. Sobriety and
temperance are essential ; and all drinks capable of exciting the
nervous system' as tea, coffee, and, above all, alcoholic fluids
are to be avoided. The diet should be ample and reparative, but
not in excess. [lb.

A General View of the Results obtained by Subcutaneous Surgery.
By M. Gueein.

In a paper submitted to the Academie des Sciences, M. Gruerin
declares that all his subsequent experience is only confirmatory of
the statements made by him in his celebrated memoir in 1839. In
a general review of the subject, he here re-states in a summary
manner, the principles upon which subcutaneous surgery is based,
and the practical applications it is susceptible of.

1. Tissues when divided under the skin undergo immediate organ-
ization. In the first memoir, he showed that if the absence of
contact of the air, and hermetical closure of the orifice of the incis-
ion were secured, immediate organization, with an absence of local
and general reaction, resulted. He now adds that there are cer-
tain incidental conditions which, if not provided for, may interrupt
this process, and cause failure even when the main condition of
exclusion of the air has been observed. In this point of view the
behaviour of the fluids of the economy is of importance. Some of
these, as arterial blood, are organizable, and while a moderate
quantity effused between the lips of the wound acts as an import-
ant element of their junction, even large quantities thrown out
under the skin are absorbed with great rapidity. Other fluids, as
venous blood, are inorganizable, and while portions of that effused
may be resorbed, the remainder continues to offer a mechanical
obstacle to immediate organization. Then, there are excreted
fluids, such as bile, urine, and pus, which are antipathetic to imme-
diate organization. Pus, confined under the skin, may either
undergo chemical change, or retain its normal characters. In the
former ease, the smallest portion will immediately excite reaction,
and in the other gives rise, by inoculation, to the secondary forma-
tion of small cold abscesses.

The cicatricial tissue resulting from the healing of ordinary

120 Results obtained by Subcutaneous Surgery. [February,

wounds bears no resemblance to any of the normal tissues, and
constitutes a functional interruption in the organs in which it is
deposited. In the immediate organization which takes place after
subcutaneous wounds, all divided tissues are susceptible of produ-
cing their like at the cut surfaces, muscle, muscle, nerve, nerve,
and so on, each endowed with its proper power. When, however
from the effusion of too much blood by surrounding vessels, the
divided surfaces are kept too far separated, and the proper blaste-
ma is not exuded, functional interruption ensues here also, the
extremities of the cut tissues becoming atrophied and losing their
specific organization. This is the case with muscle, tendon, nerve,
&c, but in none so obviously as with arteries, which are some-
times converted into fibrous cords for the whole length of the limb,
contrasting with the integrity of their calibre when the contiguity
of the divided surfaces has been maintained. The lameness which
has often resulted from section of the tendo-Achillis, and the loss
of motion of the fingers almost always produced by a division of
the flexor tendons, are dependent upon the production of hetero-
morphous tissue consequent upon the non-observance of some of
the conditions necessary for immediate organization. So, too, in
the operation of strabismus, the functions of the muscles, when
divided in an exposed state, are more or less impaired.

2. Surgical Applications. Although tendons had already been
divided by operations somewhat analogous to those of M. Guerin,
this was an empirical procedure only, having at most the object
in view of limiting the amount of resulting inflammation. M.
Guerin claims to have raised these subcutaneous operations into a
method, based upon principles deduced from the teachings of ex-
periment, and clinical and pathological observation. The object of
this method is not to merely limit the amount of suppurative in-
flammation, but to absolutely prevent it, and to secure immediate
organization by homogeneous tissue. The means of effecting this
are comprised in four principal rules: 1. Make the wound in the
skin at the greatest possible distance from that of the tissue to be
divided, so that the track joining the two may be sinuous; 2.
Circumscribe the section to the tissues to be divided, isolating
them from surrounding parts by tension, contraction, &c. ; 3. Pre-
vent the effusion of inorganic or antipathetic fluids into the
wound, and expel all such, as well as air, from its track after the
operation ; 4. Close the lips of the external wound securely by
adhesive plaster. The results, when the condition of the opera-
tion are observed, are so satisfactory, that M. Guerin declares that
in many more than 2000 cases, he has never met with a suppura-
ting subcutaneous wound. In conclusion, he gives a summary of
the various applications he has made of this method.

(A.) Subcutaneous Sections : 1. Of the skin and cellular substance.
In five instances, M. Guerin has detached bridles of cellular
tissue, which by displacing the skin, or causing its adhesion, have

1856-] Results obtained by Subcutaneous Surgery. 121

produced grievous deformities of the face or neck. 2. Tendons.
These operations are now so common as to call for no remark,
further than indicating the superiority of the results attained com-
pared with those of ordinary tenotomy. 3. Aponeuroses. Besides
the section of these as an orthopaedic procedure, M. Guerin has
resorted to it with success in debridement in inflammatory tumefac-
tion. One of the most original applications of subcutaneous
tenotomy was its employment in old and congenital dislocations,
and the success that attended this practice has led to its adoptiqn
in aid of the reduction of recent fractures and dislocations. 4.
Muscles. The largest as well as the smallest muscles of the body
have now been divided, some of the operations involving large
muscular masses. Among the most important may be mentioned
those applied to spinal curvature, congenital luxation of the femur
and strabismus. In one case, reported to the Academie, M. Gue-
rin divided forty-two muscles and tendons, for general deformity
of the articulations, at a single sitting, no suppuration or fever
resulting. Myotomy has also been applied to the radical cure of
reducible hernia, and for debridement in strangulated hernia. In the
first of these, the entire thickness of the muscles and aponeuroses
constituting the canal is traversed in various directions, the resulting
exudation proving an effectual obturator, as witnessed in several
of the author's eleven cases. 5. Ligaments. The section of these
in such deformities as resist the mere division of tendons and
muscles has now been performed times out of number. 6. Ves-
sels. In several instances, subcutaneous incision and scarification
have converted vascular tumours into cicatricial tissue, and that
without producing the suppuration consequent on ligatures; and
various subcutaneous operations have been performed on the
veins. 7. Nerves have been thus divided in neuralgia with ad-
vantage. 8. Cartilages. M. Guerin states as a fact of which we
have met with, however, no confirmation elsewhere that subcu-
taneous section of the symphysis pubis, for facilitating labour, is
of common occurrence in France. 9. Bones. Among these we
have the subcutaneous ablation of painful exostoses, and the frac-
ture of rickety bones in order to rectify their curvatures. M.
Guerin has shown that in such curvatures the old bone is reduced
to lamellae, which are lost in bone of new formation. At the se-
cond stage of the disease, the latter is spongy and flexible, and if
we make an incision half through the arch of an angular curva-
ture, a deformity that threatened to become permanent may be at
once removed.

(B.) Punctures and Extractions. Under this head M. Guerin
refers to three of the applications, as indicative of surgical pro-
gress: 1. The opening of large congestive abscesses. So great is the
danger attendant upon this, performed in the usual modes, that
we have no example on record of success; the opening in cases
where recovery occurred, having taken place spontaneously, the

122 Influence of Pregnancy. [February,

i

pus gaining issue through a sinuous track at a distance from the
seat of collection. It is by imitating and generalizing this pro-
cess of nature that the subcutaneous mode has been enabled to
convert recovery into the rule and death into the exception. 2.
Thoracentesis. In a recent memoir, M. Guerin detailed 30 cases of
this operation, deducing from them the conclusion, that the opera-
tion is devoid of all danger, and cures whenever serious complica-
tions do not exist. 3. The extraction of foreign bodies has been
repeatedly performed with success.

(C.) Intermediate between the other two is another category of
applications, comprising: 1, The abortion of imminent phlegmon.
M. Guerin believes that all phlegmon commences by a nucleus, a
thorn as it were, in the cellular tissue, and has found, if this be
divided by the subcutaneous incision, no suppuration will ensue,
though the phlegmon may have reached a considerable size. 2. He
has effected the destruction of painful cervical glands in four in-
stances, by fixing the gland and dividing it in various directions,
thus separating it from the surrounding vessels and nerves. It
becomes converted into an insensible, amorphous, cicatricial tissue,
which is afterwards resorbed. 3. The destruction of painful tu-
mours, forming in the substance of muscles. Under this head, too,
may be noticed the section of fatty and other encysted tumours
(loupes). Trifling as the operation is, when performed in the or-
dinary way, ablation has not infrequently led to fatal results.

[Gazette Medicale. lb.

Illustrations of the Influence of Pregnancy in controlling or retarding
the Development of certain Diseases* By W. F. MONTGOMERY,
M. D., Professor of Midwifery to the King and Queen's College
of Physicians.

On a former occasion, when treating of the condition of preg-
nancy, 4 took occasion to remark that it appeared from experience,
that women who bear children generally enjoy more even health
and are less disposed to disease than those who lead a life of celiba-
cy, or who, having married, remained unfruitful ; so that Gardien
seems to express no more than the truth when he says, " Des
qu'une femme est grosse les probabilities de sa vie augmentent ;"
and this is what we ought, a priori, to expect, because, childbearing
being the ordinance of an allwise Providence, we should antici-
pate that the fulfilment of the duty thus ordained would conduce
to the welfare of those on whom it has been devolved.

It seems in conformity with such a view to believe, what indeed,
I think, experience has taught us, that pregnancy acts in a great
degree as a protection against the reception of disease, and perhaps
on the common principle, that during the continuance of one very
active operation in the system, it is thereby rendered less liable to

* Bead before the Association of the College of Physicians of Ireland,

1856.] Influence of Pregnamcy. 123

be invaded or acted on by another ; thus it has been observed,
that during epidemics of contagious diseases of different kinds, a
much smaller proportion of pregnant women have been attacked
than of others : but when attacked, they suffer severely ; thus,
when the cholera visited this country, the proportion of pregnant
women who took the disease was very small, but all who caught it
died, I believe, without almost a single exception. Gardien's ex-
perience led him to a similar conclusion, he says : " Les femmes
enceintes sont moins exposees a gagner les maladies contagieuses ;
mais lorsqu' elles en sont atteintes, elles succombent plus prompte-
ment." 1 think also I have seen sufficient to satisfy me that preg-
nancy does, at least occasionally, exercise another kind of influ-
ence over disease in the system, namely, of preventing its devel-
opment during that state, although the infection may have been
caught ; as is proved by the disease showing itself immediately
after delivery, as in the following cases :

Mrs. W., when in the ninth month of pregnancy, was much
about her brother, who was dangerously ill of malignant scarlatina;
she seemed to have escaped the danger completely, but the day
after her delivery she was covered with the disease, of which she
died in a few days ; between the time of her exposure to the infec-
tion and her delivery, there had intervened three weeks, during
which she appeared to be quite well.

AVhen Mrs. F. was in the eighth month of pregnancy, her hus-
band had typhus fever, in which she assiduously attended him ;
after his recovery, she went to her father's house, some fifty miles
from town, where she was delivered in due time, and immediately
afterwards was seized with typhus fever, of which she died in
eight days ; between five and six weeks had elapsed between Mr.
F.'s illness and her labor, and during that interval, she seemed in
perfect health.

In the month of November, 1854, I attended a young lady in
her first confinement ; previous to which she had both the lower
extremities much enlarged by anasarca, but she appeared, in other
respects, quite well, with one exception, which was that she had
such soreness of the abdomen, she found a difficulty in laying on
either side : and when I passed my hand over the abdomen, she
complained that the pressure hurt her everywhere.

On the 12th she was confined, after a favorable labor, but the ab-
dominal tenderness remained, and there was a peculiar doughy
feel of the whole abdomen ; next day, this was equally felt, but
with little or no pain or fever, and a perfectly quiet pulse.

On the 14th, I found the insteps of both feet, but particularly
the left, covered with well-developed erysipelas ; her mother, who
seemed very anxious about her, was present when I examined the
feet, and on our reaching the drawing-room said, "Doctor, isn't
that very like erysipelas?" I said, "Yes, certainly, there was no
doubt about it." " Dear me, sir, do you think she could have

12-i Collodion in Chronic Entropium. [February,

taken it from her husband ?" She then, for the first time, inform-
ed me, that some weeks before leaving home, to come to town for
her confinement, her husband had a severe attack of erysipelas,
during which she had assiduously nurse-tended him. Immediate-
ly on the appearance of the erysipelas on the feet, the abdominal
symptoms began to decline, and after two or three days, ceased to
exist. I cannot but believe that this lady caught the infection
from her husband during her close attendance on him, that it re-
mained in abeyance until gestation was over, and was then devel-
oped. She recovered well.

It is, I believe, a matter of common observation, that when
women who have been laboring under certain forms of disease
happen to conceive, the morbid affection previously existing is
oftentimes either greatly mitigated, checked, or even altogether
suspended for a time, as has been frequently observed in persons
affected with phthisis; though I must add that the influence of
pregnancy in cases of phthisis is a question on which a variety of
discordant opinions has been given by high authorities. Andral's
conclusion, from his latest observations, is, "that in the great
majority of cases the symptoms of phthisis are suspended, or at
least remain stationary during the course of pregnancy." Louis
says he is not " in a condition to determine whether pregnancy is,
oris not capable of retarding the progress of phthisis," but he
suggests that the fact might be, that several of the symptoms become
somewhat more obscure during pregnancy, without any check
being in reality given to the advance of the disease. My own ex-
perience would lead me to the conclusion, that if a woman predis-
posed to phthisis, but in whom the disease has not actually be-
come developed, prove pregnant, she is likely to be benefited
thereby ; and I think I have seen life thus prolonged, for years,
in several instances; but, on the other hand, if pregnancy takes
place in a woman already actually in consumption, or if this
disease supervene on pregnancy, the fatal issue is as likely to be
accelerated as postponed, or, perhaps even more so. [Dublin Quar-
terly Jour. Med. Sci.

Treatment of Chronic Entropium by Collodion. Mr. Win. Butten reports
in a late number of the Lancet, two obstinate cases of entropium, both of
which had resisted a great variety of treatment, but which were cured by
the application of collodion to the skin of the eyelid, previously corrugated
by the thumb and finger. Several layers are successively applied and al-
lowed to dry before the fingers are removed. The application is made at
first every other day, and afterwards at longer intervals. [Boston Medical
and Sury. Journal.

1856.] Editorial. 125

EDITORIAL AND MISCELLANEOUS.

The Bearded Woman and Child. We have recently bad an opportuni-
ty of seeing these interesting- freaks of nature, during their sojourn in this
city. Mrs. Clofullia, the person in question, was born in Switzerland, in
1829, and is, therefore, now about seven and twenty years of age. We are
informed, by the printed narrative of her life, that her parents presented
nothing peculiar in their appearance, and that her father had rather a
scanty beard; but that her maternal grandfather had a very strong beard,
and was quite hairy; that she was observed, soon after her birth, to have
the body and face covered with a down ; that this gradually increased, so
that her beard was two inches long at eight years of age ; and that at the
age of fourteen it had attained its present length of about five inches. Slie
is of ordinary stature, rather stoutly built, has a masculine face, (said to
be very much like thai of her grandfather) a well formed female chest,
large mammae, and feminine shoulders and arms covered with as much
hair as seen in strongly bearded men. Her beard is fine and soft, though
very abundant, extending from the ears and the malar bones, over the
whole of the lower jaw down to the neck, as in man, but the upper lip
presents only a downy appearance, such as is occasionally met with in bru-
nettes. In short, with the exception of the upper lip, she has as strong a
beard as we usually see in man. Married early in 1851, she gave birth in
December of the same year to a daughter, in England, as is attested by
Hy. Thos. Cornelius, M.R.C.S., who attended her in her confinement. This
child is said to have died, during the process of dentition, but to have been
very handsome, and to have had no more hair than ordinary children.
Her second child is attested by C. H. Dean and J. B. Evans, surgeons of
Oxford, England, her accoucheurs, to have been born in December, 1852,
and is the one who now accompanies her, under the name of Albert Esau.
He is quite a sprightly boy, (now three years of age,) with a coat of hair
over the body and limbs, especially over the shoulders and back, and a
beard about an inch in length covering the face, as described in the case of
his mother, whom he strongly resembles.

During a judicial investigation in New York, provoked by a person who
alleged that he had been cheated out of his fee of admission to Barnum's
museum, inasmuch as he believed the bearded woman to be a man in dis-
guise, Mrs. C. was examined by Drs. Valentine Mott, John W. Francis, and
Alex. B. Mott, who certify that she is a well formed female.

Mr! C. and her child are unquestionably genuine and most interesting
specimens of anomalous hirsute development, and this is our apology for
placing their history upon record.

126 Editorial. [February,

BIBLIOGRAPHICAL.

A Treatise on Medical Jurisprudence. By Francis Wharton, author of
" A Treatise on American Criminal Law," " Precedents of Indictments,"
"American Law of Homicide, &c, and Moretox Stille, M. D., Lecturer
on the Principles and Practice of Medicine in the Philadelphia Associa-
tion for Medical Instruction. Philadelphia: Kay & Brother. 1855.
8vo., pp. 815. (For sale by T. Richards & Son.)

The growing appreciation, by both the Medical and Legal Professions of
our country, of the importance of correct information upon the subject mat-
ter of the volume before us, will secure for this work a ready sale, especially
when its intrinsic merits are made known. It is the production of the joint
labor of able members of the professions of Law and Physic, who have,
each in his own sphere, brought together a sum of information not to be
expected in the work of any individual of either of the learned bodies.

This treatise is divided into six books : the 1st, on " Mental unsound-
ness ;" the 2d, on " Questions relative to the Foetus and new-born child ;"
the 3d, on " Questions arising out of the difference of sex ;" the 4th, on
" Questions relative to Identity ;" the 5th, on " Questions relative to the
causes of death;" and the 6th, on the "Legal relations of Homicide, Foeti-
cide, and Infanticide." These subjects are all treated elaborately, ably and
perspicuously.

An Introduction to Practical Pharmacy : designed as a Text-book for the
Student, and as a guide to the Physician and Pharmaceutist with many
formulas and 'prescriptions. By Edward Parish, Graduate in Pharmacy,
&c, &c, with 243 illustrations. Philadelphia: Blanchard & Lea. 1856.
8vo., pp. 544. (For sale by T. Richards & Son.)

This is altogether one of the most useful books we have seen. It is just
what we have long felt to be needed by apothecaries, students, and practi-
tioners of medicine, most of whom in this country have to put up their
own prescriptions. It bears upon every page the impress of practical
knowledge conveyed in a plain common-sense manner, and adapted to the
comprehension of all who may read it. No detail has been omitted, how-
ever trivial it may seem, although really important to the dispenser of
medicine.

On Bandaging, and other operations of Minor Surgery. By F. W. Sar-
gent, M. D., &c, &c, new edition, revised and enlarged, with 181 illus-
trations. Philadelphia: Blanchard & Lea. 1856. 12mo., pp. 360.
(For sale by T. Richards & Son.)

This is a popular little work upon an interesting subject to young prac-
titioners. This improved edition will therefore be welcome to those who
may be in need of something of the kind.

1856.] Editorial. 127

The Transactions of the American Medical Association. Vol. VIII. Phila-
delphia : T. K. & G. P. Collins. 1855. 8vo., pp. 763.

This work has been some time on hand, hut has not been noticed earlier
from unavoidable circumstances ; and we even now regret that we have not
as much space to devote to it as we would like. It contains, besides the
minutes of proceedings, and the address of Dr. Pope, President of the Asso-
ciation, a Report on the diseases of Missouri and Iowa, by Thos. Reybnrn,
M. D. ; the Report of the Committee on the Hygrometrical state of the
atmosphere in various localities, and its influence on Health, by Sandford
B. Hunt, M. D. ; a paper on Deformities and Fractures, by Frank H. Ham-
ilton, M. D. ; a Report on the diet of the sick, by Charles Hooker, M. D. ;
an Essay on the Pathology and Treatment of Scrofula, by W. H. Byford,
M. D. ; a Report on the means of preserving Milk, and on the influence of
Pregnancy and Menstruation on the composition and nutritive qualities of
that fluid, by N. S. Davis, M. D. ; the Report of the Committee on Dysente-
ry ; an article on the effects of Alcoholic liquors in Health and Disease, by
R. D. Mussey, M. D. ; a sketch of the Caustic pulverizer, by R. H. Thomas.
M. D. ; and the Prize Essay, by J. D. Trask, M. D., on the Statistics of Pla-
centa Pravia. Several of these papers are highly valuable contributions
to practical knowledge, and are of themselves worth the price of the vo-
lume.

The Mortality Statistics of the Seventh Census of the United States. 1850.
Embracing 1. The cause of Death; 2. The age and sex; 3. The color
and condition ; 4. The Nativity; 5. The season of Decease; 6. The du-
ration of Illness ; 7. The occupation of the persons reported to have
died in the twelve months preceding the first of June of that year with
sundry comparative and illustrative tables. By J. D. B. DeBow, Super-
intendent of United States Census. Washington: 1855. 8vo., pp. 305,
Published by order of Congress.

The magnitude and importance of this work may be estimated partially
by the extracts we have reproduced from the proof-sheets kindly sent us in
advance by the able and indefatigable superintendent of the census.

Mortality Statistics of the Seventh Census. We are indebted to Mr.
DeBow, Superintendent of Census, for the proof-sheets of the u Mortality Sta-
tistics of the seventh census," so far as they relate to Georgia. This census
was taken in 1850, and shows the population of Georgia to have been at
that time 906,185, of whom 521,572 were white, 381,682 slaves, and 2931
free colored. The mortuary statistics for the year 1850 are made ont
separately for the northern, southern, and middle sections of the State, and
are also represented in the aggregate. This last classification we reproduce
below. Admitting it to be as correct as such documents can usually be made,
It reveals some interesting tacts. The whole number of deaths for the year

128 Editorial. [February,

was 9925, or about one per cent, of the population. The mortality among
the whites was 4580, that of the slaves 5304, and that of the free colored
41 showing a much greater ratio of deaths among the colored than the
whites. This is in accordance with the well established fact that in all
countries the laboring classes suffer greater mortality than others.

A reference to these tables shows that the mortality from affections of
the Respiratory apparatus (comprehended under the heads of asthma,
bronchitis, catarrh, consumption, croup, hooping-cough, influenza, lung
disease, pleurisy and pneumonia,) was 1986, of whom 831 were white, and
1155 colored. The negro would, therefore, seem to be much more suscepti-
ble to pulmonary diseases than the white, unless this difference be attri-
buted to the relative degree of exposure of the two races. Upon examin-
ing into the mortality from the /ewers usually termed malarial, (enumerated
as bilious, brain, congestive, inflammatory, intermittent, and remittent,) we
find that the number of deaths was 933, of whom 490 were white, and 443
colored, thus revealing also a greater liability of the black than of the
white to this class of affections, for these numbers, when viewed in connex-
ion with the relative numbers of each color as indicated by the census, will
make one death per 10641 whites, and one per 86 1| blacks. The deaths
from typhus (typhoid?) fever were 287 whites and 270 colored. While
tetanus proved fatal to but one white, it carried off 23 blacks ; whereas,
cancer destroyed 44 whites and only 16 blacks. Convulsions were fatal
to 132 whites and 54 blacks. Scarlatina killed 109 whites and 202 co-
lored.

In a moral point of view, these statistics are truly startling. We find
12 suicides among the whites, and only two among those whom fanatical
philanthropists would suppose most dissatisfied with life. Of homicides,
(shot, killed, murdered, and poisoned) there are no less than 70 during the
year ! 40 whites and 30 blacks. Executed, one white and one black.

These documents sustain the general impression that the African lives
longer than the Caucasian race, 100 whites and 148 blacks being
reported as having died of old age. Although we do not mean to deny the
correctness of the received opinion, we yet believe that it is exaggerated.
Age has advantages to the negro which are not experienced by the whites,
and its immunities are generally claimed by ihe slave long before his
master would think of resting from his labors. Hence it is, that very many
of our slaves, when sixty years of age, imagine and declare that they are
eighty or ninety, and are accordingly indulged with an exemption from
farther compulsory labor. Many of the citizens of this place may recollect
"old daddy Quah," who averred, apparently in good faith, that he was
so old that when he arrived here from Africa, the Savannah river was so
'small a stream that he could "step over it!" He thought himself 150
years of age, but was probably not more than 95 when he died.

1856.] Editorial and Miscellaneous, 129

Fallopian and Uterine Pregnancy simultaneously. The Boston Medical
and Surgical Journal reports that Dr. Buck, of Manchester, N. II., sent to
Dr. H. J. Bigelow, who presented them to the Boston Society for Medical
Improvement, the specimens referred to in the following- account :

"The patient was a married woman, about 25 years of age, and was at-
tacked suddenly with pain in the abdomen at 9 P.M. on the 17th ult., from
which time she sank rapidly and died in about seven hours. Before her
death she told her attending physician, Dr. Tebbets, that she was pregnant
and had taken a medicine to procure abortion ; and that she had, further,
had an operation performed in Boston for the same purpose.

"Dr. B., having been summoned by the coroner to make a post-mortem
examination, introduced a speculum, but found no appearance of injury
about the os uteri; the os and the lining membrane of the vagina being
perfectly blanched. The peritoneal cavity contained six or eight pints of
blood, partly fluid and partly coagulated. The uterus was enlarged to
twice its usual size ; and, upon laying it open, after its removal from the
body, there was found in its cavitjT an ovum, the foetus being about three
inches in length, and in every way well developed externally for one of that
size, as were the membranes. The right Fallopian tube was abruptly dis-
tended towards its distal extremity, so as to form a solid tumor of the size
of an English walnut, upon the surface of which was the orifice from which
the blood had escaped into the peritoneal cavity. Upon incision of the
tumor there was found a second ovum ; the foetus, however, being less de-
veloped than the one contained in the uterine cavity. The right ovary
contained two well-marked corpora lutea, there being nothing remarkable
in the left.

"The uterus, which was sent to Dr. B. without the fetuses, had been
preserved in spirits, but showed several of the points above described per-
fectly well ; the deciduary portion of the inner surface of the fundus and
body of the uterus being thick and well characterised. The case, which
was unique, as far as any one present was aware, seemed to be regarded as
one of twins, in which one of the ova was accidentally arrested in the Fal-
lopian tube."

The Cincinnati Medical Observer. We have received the first number
of this new periodical, published monthly, under the Editorial supervision
of Professors G. Mendenhall and John A. Murphy, of the Miami Medical
College, and E. B. Stevens, M. D. We cheerfully add it to the list of our
exchanges, with our best wishes for its success.

A large lot of pamphlets has accumulated upon our table, which we re-
gret not being able to notice according to their merits. Among them we
should, however, mention the following :

Transactions of the Medical Society of the State of Pennsylvania, at its
annual session, held at Holidaysburg, May, 1855.

Transactions of the State Medical Society of the State of New York,
Transmitted to the Legislature February 13, 1855.

130 Miscellaneous.

The Transactions of the New-Hampshire Medical Society, (sixty-fourth
anniversary,) held at Concord June 6th and 7th, 1854.

Twelfth Annual Report of the Managers of the State Lunatic Asylum.
Transmitted to the Legislature, Jan. 17, 1855.

Report of the Pennsylvania Hospital for the Insane for the year 1854.
By Thomas S. Kirkbride, M. D., Physician to the Institution.

Reports of the Trustees and Superintendent of the Butler Hospital for the
Insane, presented to the Corporation at their annual meeting, January 24,
1855.

Nineteenth Annual Report of the Managers of the New York Institution
for the Blind, to the Legislature of the State : made in conformity to law,
January, 1855, for the preceding year.

Annual Report of the City Inspector of the City of New York, for the
year ending December 31st, 1854.

Discovery of the cause, nature, cure and prevention of Epidemic Cholera.
By M. L. Knapp, M. D., &c, &c.

Essay on Cholera Infantum. By M. L. Knapp, M.D., <fcc, &c.

A Brief History of the Origin, Progress and Extension of the Epidemic
Yellow Fever, in Memphis, Tenn., in 1855 ; with some account of its Symp-
toms, Character, Treatment and Fatality. By L. Shanks, M. D., Prof, of
Obstetrics, &c.

New means for making Extension and Counter-Extension in Fractures of
the Leg and Thigh. By John Neill, M. D., <fec.

Correction of the Erroneous Statements of Henry H. Smith. M. D., pub-
lished in the Medical Examiner, January, 1855, in relation to a case of
Gastrotomy, which occurred in the practice of Washington L. Atlee, M. D.

Reply of J. C. Hughes, M. D., Dean of the Medical Department of the
Iowa State University, to a certain document published by John F. Sanford.

On the cheaper Alkaloids of the Cinchonas. By Powers & Weightman.

Report of the Committee on the Hygrometrical state of the Atmosphere
in various localities, and its Influence on Health. By Sanford B. Hunt,
M. D., Buffalo, New York.

Surgeons1 Splints and Improved Apparatus for Fractures. By Benjamin
Welch, M. D. New York.

Archives de Physiologie de Therapcutique et D'Hygiene sous la direction
de M. Bouchardat, Professor d'hygiene a la Faculte de Medecinede Paris.

An Address delivered at the Laying of the Comer Stone of the Atlanta
Medical College, July 21, 1855. By Henry D. Beman, Esq.

Address delivered at a Supper given by the Faculty to the Students of
the Atlanta Medical College, on the 13th of August, 1855. By N. J. Ham-
mond, Esq.

Introductory Address, delivered at the College of Physicians and Sur-
geons, New York, October 16, 1855. By John C. Dalton, Jr., M. D., Prof,
of Physiology and Microscopic Anatomy.

Introductory Lecture to the Course on the Principles and Practice of
Surgery, delivered in the University of Pennsylvania, October 9, 1855. By
Henry H. Smith, M. D., Professor of Surgery.

Introductory Address, delivered to the Class in the Medical Department
*of the Iowa State University, at the opening of the Course of 1855-6. By
Jno. R. Allen, M. D., Professor of Obstetrics and Diseases of Women and
Children.

1856.] DuGAS, on Dislocations of the Shoulder. 133

head of the humerus from the axilla, from below the clavicle and
from the dorsum of the scapula, would establish conclusively that
the cause of the depression observed, is to be found in a fracture ;
whereas the detection of the head of the humerus in any other
place than in the glenoid cavity would establish the existence of a
dislocation as the cause of the depression in question.

Again : the existence of dislocation may be sometimes deter-
mined by the detection of the head of the os humeri in an abnormal
situation ; and this would be conclusive without reference to any
depression below the acromion. But there are individuals whose
embonpoint or whose muscular development is such as to render
this detection extremely difficult. Moreover, a fracture near the
head of the humerus might be attended with such a displace-
ment of the upper end of the lower fragment as to allow this to be
taken for the head of the bone in the axilla, especially in individu-
als presenting the peculiarities just mentioned, or in cases attended
with much swelling. It should be remembered that the head of
| the humerus becomes more prominent and may be felt in the
axilla when the elbow is elevated, although it may have escaped
I detection while the arm was allowed to hang down.

It is needless to dwell upon the value of the information to be
i derived from the history of the accident, of the degree or kind of
disability experienced by the patient, of the change in the length
i of the arm and direction of the shaft of the bone, of the pain in-
duced by carrying the elbow in different directions, &c. All these
circumstances should of course be studied by the surgeon in doubt-
ful cases ; but neither of them can lead to anything positive.

From these reflexions the necessary inference must be drawn
that a concurrence of circumstances can alone be relied upon in
1 certain cases to make the diagnosis of dislocation clear and posi-
\ tive. The discovery, then, of some one, unequivocal, pathogno-
monic fact, or sign, by which a dislocation of this joint could in
i all cases be readily ascertained, must be a great desideratum. I
| believe that this will be found in the following maxim : if the fingers
of the injured limb can be placed (by the patient or the surgeon)
; upon the sound shoulder while the elbow touches the thorax,
there can be no dislocation ; and if this cannot be done, there must
be a dislocation. I am aware that most writers indicate the diffi-
[ i! culty of bringing the elbow in contact with the thorax as a symp-
.; :i torn more or less marked in the several dislocations of the humerus.

134 DuGAS, on Dislocations of the Shoulder. [March,

but it is obvious that they do not assign to it the degree of ii%
portance to which it is entitled when coupled with the injunction
to place the fingers upon the opposite shoulder, as just enunciated.
Indeed, most authorities merely mention the fact that the elbow
cannot be approximated to the trunk without pain. I insist that
the elbow cannot be brought against the thorax when carried
sufficiently in front to allow the fingers to rest upon the sound
shoulder, either by the patient or by the surgeon, not because this
would be painful, but because it is physically impossible without
a reduction of the dislocation or such a disruption of the shoulder
as no one would think of attempting. This becomes at once mani-
fest by looking to the skeleton. "With this before us, let us place
the head of the humerus in the axillary region, and we observe
that the elbow is at once thrown out from the trunk ; that if we
attempt to bring it towards the sternum the upper portion of the
shaft of the humerus will soon encounter the ribs, and that the
rotundity of the thorax will effectually prevent any contact be-
tween the elbow and sternum, unless, by using the humerus as a
lever, we rend asunder all the obstacles in the way of the rising
of the head of this bone. Our maxim then holds good with re-
gard to dislocations into the axilla. Let us now place the head
of the humerus where it would be found in a forward dislocation ;
that is to say, below the clavicle. We will then perceive that the
elbow is still removed from the trunk, and that it is moreover
directed backward, thus presenting, perhaps even to a greater de-
gree, all the difficulties just specified, if it be endeavored to carry
the elbow against the sternum and the fingers upon the other
shoulder. With regard to the dislocation backward, the impossi-
bility of bringing the elbow and fingers in the positions indicated,,
becomes so manifest that it requires no comment.

Now, can any other accident than a dislocation offer these ob-
stacles to placing the elbow and fingers in the above-mentioned
position ? I unhesitatingly answer, there is none. It is true, that
a severe contusion may render this or any other motion more or
less painful to the patient, and that he will aver that he cannot do
as directed. But the surgeon will find no difficulty in accom-
plishing his design, especially if he proceed gently, so as not to
encounter any muscular resistance, voluntary or otherwise. The
same remarks apply with equal force to fractures of the upper end
of the humerus or of the neck of the scapula. In all these cases

1856.] Dugas, on Dislocations of the Shoulder. 135

the administration of an anaesthetic will save the patient some pain
and facilitate the examination.

If, then, a dislocation of the humerus in any direction, whatever,
renders it impossible to place the fingers and elbow simultaneous-
ly in the position stated, and that no other accident can produce
this inability, the corollary is clearly that such an impossibility is
pathognomonic of dislocation of the humerus; and, conversely,
that the absence of this inability as clearly demonstrates the ab-
sence of dislocation.

Having in this manner settled the all-important question of the
existence or non-existence of dislocation, it will not be found very
difficult to determine the new position assumed by the dislocated
head of the humerus. Indeed the mere direction of the axis of
the humerus will suffice in most instances to lead us directly to its
head. This axis can be usually traced without difficulty, with the
fingers, from the elbow up to at least six or eight inches; a length
sufficient to allow the imagination to prolong it to the upper end,
if the tumefaction or other conditions should prevent more effectu-
al means from being used. A straight rod placed over that por-
tion of the axis which can be felt, would assist the determination
of its extension, and this would lead either to the axilla, the acro-
mial portion of the clavicle, or the dorsum of the scapula, accord-
ing to the variety of the dislocation.

The next step should be to endeavor to feel the head itself, as
distinctly as may be, for there can be no harm in multiplying our
resources, and it is important that the new position of the bone be
accurately determined. As already intimated, the head of the
bone can be more distinctly felt in the axilla when the arm is
elevated than when otherwise. If it be below the clavicle, it will
be made more prominent by carrying the elbow forcibly back-

I ward ; and, finally, if dislocated upon the scapula the elbow should,

II on the contrary, be forcibly carried forward, in order to increase
J( the prominence of the head of the humerus.

I have thus endeavored to direct attention to what I deem an
exceedingly important addition to our means of diagnosticating
' dislocations of the shoulder, and have done so as briefly as the na-
ture of the subject would permit. I may have erred in claiming
for my views any originality, for the " wise man" has long since
said that '; there is nothing new under the sun," and daily experi-
ence confirms the correctness of the apothegm. I have neither the

i

i

136 Holt's Letters upon General Pathology. [March,

leisure nor the inclination to thumb the numerous tomes of Sur-
gical literature for the purpose of settling this point. It is certain,
however, that if the method of examination here recommended
has ever been suggested before, it has not been insisted on by the
systematic writers usually consulted by our practitioners. If I
may, therefore, have simply revived and magnified the value of
what was known before, so that the profession and humanity may
derive any advantage from this paper, my object will have been
attained.

ARTICLE VIII.

LETTERS FROM SAML. D. HOLT, M. D., UPON SOME POINTS OF GENERAL PATHOLOGY.

LETTER NO. 9.

Montgomery, Ala., Feb. 7th, 1856.
Messrs. Editors In accordance with the objects which I have
in view, it is necessary that I should make a few remarks respect-
ing the therapeutic properties of Quinine, and kst it should be
inferred from what I have already said, that I have fostered some
hostility or prejudice against it, I may be permitted to state, that I
entered the profession about the time, or soon after its introduction
into practice, and from that time to the present, have been one of
the most uniform and consistent advocates for its use; and though
I administered quinine more than twenty years ago, in as large
doses as I have ever found it necessary to administer since, I can
lay no claim to credit for the progress which its introduction into
practice has made in the healing art, nor have I been able to keep
pace with the rapid strides which the profession in the South have
made in the uses of quinine for the last few years. For a great
while, and long before the discovery of quinine, Peruvian bark
was held "in high esteem as a stimulant and tonic, by Sydenham,
Darwin, Cullen, and others, notouly for the cure of simple inter-
mittent and remittent fevers, but was freely used and recommend-
ed by them for the treatment of other forms and low grades of
fever, both idiopathic and symptomatic, with the view and for the
purpose of sustaining or building up the sinking or exhausted
energies of the system ; and there is no evidence that I am aware
of which goes to show that tiny regarded it in any other light, or
as possessing any other valuable therapeutic properties than that
of stimulant and tonic. Since the discovery and introduction of

i

1856.] Holt's Letters upon General Pathology. 137

quinine into practice, it has acquired a much greater popularity,
and a much more extended application to the cure of diseases than
the bark ever possessed ; and more recently still it has grown so
rapidly into professional favor, as not only to have led to the re-
jection of other valuable remedies, but has in a measure endan-
gered, for a time at least, its high reputation and its intrinsic use-
fulness, by its application to diseases and conditions to which it is
not suited, and ascribing to it properties and virtues which it does
not possess, or to say the least, which are extremely problematical;
such, for -instance, as its antiphlogistic and sedative properties,
j which are well calculated to lead to error in practice, as well as to
bring the remedy into disrepute. Now, I do not feel inclined at
this time to enter into an argument with the ultra quininists upon
these points; but, as their testimony tends most decidedly to
; establish the truth of one of my first and most important proposi-
; tions with respect to the character of the diseases of our climate
i and latitude, namely, that they are generally not only periodic,
j but that their general tendency is to debility, or depression and
, congestion, and requiring stimuli and tonics for their cure, I may
[ be permitted to examine into and make a few remarks respecting
,, these alledged properties of quinine.

"Well, we have it upon very good authority, that large doses of
j quinine will give a dog Jits, and evidence is not wanting to prove
that it will serve a man in the same way; but that does not prove
that quinine is sedative, as I think I shall be able to show. Nor
can it be received as a stronger argument against the proper use
of quinine, than would be a like argument against the use of pud-
dings, founded upon the popular belief, that "too much pudding
I will choke a dog." But as there are large numbers of the profes-
sion who contend for the sedative and antiphlogistic properties of
quinine, and who persist in its use Infitiferous doses, it will not be
amiss to enquire into the circumstances which have most probably
led them to their conclusions, the chief of which, no doubt, has
been from observing its beneficial effects in those diseases and
{j constitutions of the system, for the cure of which the old writers
spoken of recommended the free use of bark, under the belief of"
its stimulant and tonic properties; in which, however, they may
I. have been mistaken. (!) Observing, I say, the beneficial effects of
| quinine in such affections as pneumonia, and other phlegmasiaa of
the lower grades, bilious fevers, irritant and congesto-irritant fe-

138 Holt's Letters upon General Pathology. [March,

vers, and other fevers of like pathological character and condi-
tions, manifesting the signs of excitement and periodicity, and still
adhering to the preconceived and firmly established belief of their
inflammatory character, requiring sedative and antiphlogistic rem-
edies for their cure, when they came to "change their method," it
became necessary to " disabuse themselves" of an improper use
of the lancet, purgatives and other sedatives and antiphlogistic
remedies, or to accommodate and reconcile the therapeutic pro-
perties of the " chemical" to the existing character and condition
of the disease, which many have yet failed to do. But how it
happens that quinine being sedative and antiphlogistic (?) should
prove to be so proper and valuable a remedy in those diseases and
conditions, in the treatment of which, the lancet, purgatives, and
other sedatives and antiphlogistics once held the lead, but which
are now laid aside as improper, and even hurtful, I must leave to
be answered by those who believe quinine to be sedative and anti-
phlogistic, or the diseases and conditions in which it is most valu-
able and proper, to be inflammatory, requiring such remedies. For
my own part, I reached the quinine platform by a different route,
by assuming that the diseases in question were not inflammatory
and phlogistic in their character, and consequently the lancet,
purgatives, &c, were not proper remedies for their cure, but that
generally they manifested not only the signs of periodicity, but
evidently the signs of debility and depression, requiring the use of
stimuli and tonics, of which quinine has been proven to be the best
of the class. But it matters little what road we may have travel-
ed, since we find ourself at last upon the great platform, which it
seems is large enough to accommodate all the world of doctors, if
not the rest of mankind; for, walking down the street not long
since, I met a gentleman who presented me for inspection, a box
of pills, which he stated he had just obtained from a professed ho-
mceopathist. Curiosity prompted me to examine them, and on open-
ing the box, I found it filled with bgr. quinine boluses. Well, I did
not say so, but I thought that if our people had a right to steal
their thunder, they had as good a right to steal ours.

But, to be serious in this matter, I really cannot perceive upon

what good and sufficient grounds, the ultra quininists base their

belief in the sedative and antiphlogistic properties of quinine. In

all intermittent and remittent affections which are controled by

* the laws which govern their type, each paroxysm consists of a pe-

1856.] Holt's Letters upon General Pathology. 139

rioclic fall and rise of nervous excitement according to that type,
with a corresponding ebb and flow in the circulatory system ; and
each paroxysm, of whatever type it may be, terminates within
twenty-four hours from its beginning. Such appears to be the
general law which governs all malarial and periodic diseases. This
oscillatory state of the nervous system, and the corresponding ebb
and flow in the vascular system, often constitutes the chief element
of disease in simple intermittents, which being once interrupted,
frequently puts a stop to their further progress ; for this purpose,
quinine is successfully used, not, however, with the view of sub-
duing excitement, but for the purpose of preventing depression.
Knowing the precise time at which the nervous depression, and
: the ebb in the circulation is to take place, from knowing the
type of the disease, quinine is used for the purpose of raising a
I state of artificial excitement in substitution for the pathological
j state of depression and congestion. The excitement thus created
I continues until the time of its periodicity has gone by, and sub-
sides with the stimulant effects of the quinine, while its tonic
effects serve as a protection against depression at the period for
the recurrence of the next paroxysm. If quinine will produce
such results, where is the evidence of its sedative and antiphlogis-
I tic properties? Again : if quinine be administered in those forms
j and conditions of disease which I have already noticed as irritant,
j] congesto-inflammatory and congesto-irritant, "either with or without
|| attending local inflammation, in which there is an evident "want
of innervation,'1'' and in which there is an evidently diminished
quantity of blood in the arterial vessels on account of the weaken-
ed and relaxed condition of the systemic capillaries, as manifested
by a feeble and often exceedingly rapid or frequent pulse, and
which condition has too often been the pretext for the use of sed-
atives and antiphlogistics, under the apprehension of the existence
of inflammation. The effects of quinine in all such cases will be
to increase the volume and strength, and diminish the rapidity or
frequency of the pulse, whereas, in such conditions the direct
effect of sedatives and antiphlogistic remedies, such as the lancet,
purgatives, &c, is invariably to diminish the strength and volume
and to increase the frequency of the pulse. Here then we ob-
serve, in juxta-position, the stimulant and tonic effects of quinine
upon the general capillaries, whereby they are enabled to resist
the too frequent transmission of blood through them, thus allow-

140 Holt's Letters upon General Pathology. [March,

ing the arteries to become refilled, increasing the volume and di-
minishing the frequency of the pulse; while the effects of the
lancet, purgatives, and other like remedies, tend still further to
weaken and relax the capillaries, whereby the blood is allowed to
escape more rapidly out of the arteries and thus the pulse becomes
diminished in volume and increased in frequenc}T. If such be the
action or effects of these remedies, where is the evidence that qui-
nine possesses sedative or antiphlogistic properties ? Quinine may
be, and often is administered with the happiest results in febrile
affections with and without the existence of local inflammation, as
pneumonia, bilious fever, &c, in which there is an evident pre-
ponderance of excitement. But it must be remembered that all
such cases are amenable to the laws of periodicity, and few practi-
tioners, I imagine, who profess to be governed in their practice by
the rules of pathology, would venture upon the use of quinine in
conditions of high nervous and vascular excitement or inflamma-
tion before depletion, unless they felt very confident of the approach
of a period of remission, but upon that certainty, or expectation
and belief, they are willing to run the risk of raising the excite-
ment a few degrees in order to meet the approaching state of de-
pression or the remission, with the tonic effects of the remedy.
But it will not do to infer from the beneficial effects of quinine, in
such cases, that it is either sedative or antiphlogistic, for the same
general results will be obtained whether local inflammation does or
does not exist, for quinine when used in such cases (pneumonia
for instance) is not with reference to the inflammation in the lungs,
but in reference to the character of the general febrile condition
which accompanied it, one being amenable to the laws of periodi-
city, the other not so. And it must be remembered too, that while
so few of our diseases of all descriptions are of such high inflammato-
ry grade as to have lead to a general abandonment of the lancet,
purgatives, and other sedative and antiphlogistic remedies, there
are as few which do not admit of, and require the use of quinine
for their cure.

There is a point in relation to inflammation upon Avhich I de-
sire to say a few words, in order to prevent any misunderstanding
of my views upon the subject: Heretofore, I have spoken of in-
flammation rather incidentally than otherwise, and may have used
, too indiscriminately the terms inflammation and its correlative
inflammatory ; and what I now desire to say is, that I regard in-

1856.] Holt's Letters upon General Pathology. 141

flammation as always a local affection of greater or less extent, and
going through a series of phenomena in such location, having (ac-
cording to some of the best physiologists and pathologists whose
views and opinions I am rather inclined to adopt,) as its proxim-
ate cause, first, a state of debility, second, a state of irritation, and
third, a state of inflammation which often does, but by no means
necessarily, bring the general system under its influence to an ap-
preciable extent. The term inflammatorjr, as it has been used,
does not necessarily imply the existence of inflammation, but is
used to express a general condition of the system characterised by
excitement and increased vascular action, sustained by general
vigor and tonicity of the system. And just here we must look for
the characteristic difference between inflammation and irritation, as
local affections, and the inflammatory and irritant, as general con-
ditions, to be found as hereafter explained, in the condition of the
skin, and the state of the pulse. With these explanations, I will
proceed.

Although I am a decided advocate of quinine, in wholesome
doses, in malarial fevers generally, and other affections which fall
under this influence and the laws of periodicity, I cannot sub-
scribe to its use in those "pernicious" doses which give dogs Jits,
and render men blind, deaf and crazy. Nor can I yield my ready
belief, (although the declaration comes to us from high authority,)
that quinine possesses the property of "aborting" fevers of a dif-
ferent type, such, for instance, as yellow fever, and typhoid fever,
as my own observation and experience in those diseases (though
limited, it is true) serves to raise a doubt, whether the cases so
"aborted" may not have been so invested with malarial and peri-
odic influences, if not to obscure their essential typical character,
to have at least brought them legitimately within the dominion,
and under the control of quinine. And my limited observation
has taught me to believe that the typhoid condition is, at best, but
indifferently amenable to the action of quinine, and that the nearer
such diseases approach their true and essential, typical or typhoid
character, the less they become so. This opinion and belief is
strengthened and sustained by the fact, that quinine exerts no
evident chemical or therapeutic action upon the constitution of
the blood and other circulating fluids, and that its action is very
feeble, if indeed it has any at all, in promoting the important func-
tions of secretion, excretion, absorption, nutrition, &c. In such a

142 Holt's Letters upon General Pathology. [March,

view of the case, I cannot well conceive how physicians can rely
with confidence of success upon the action of quinine in the treat-
ment of yellow fever, and other fevers of like type, in which there
is often not only an adynamic condition, but an evident depravity
and vitiation of the circulating fluids, requiring not less the action
of such remedies as promote the functions of secretion, and excre-
tion, than those strictly dynamic in their character.

Of the " modus operandi" of quinine, as little is known, beyond
its effects, little is required to be said. But assuming that stimuli
are those substances which produce excitement and increased vas-
cular action, by increasing the action of the heart and arteries,
and the respiratory movements, such, for instance, as brandy,
ether, ammonia, camphor, opium, &c, the slight and almost un-
appreciable effects of this kind, would lead us to infer that quinine
is but slightly stimulant, and yet it has the power of creating and
sustaining excitement, against the influences of depression, superi-
or to all other stimulants, which leads us to the further inference
that, while brandy, ether, &c, exert their influence upon the brain,
and other great nervous centres, creating general excitement, and
increasing the action of the heart and arteries, the action of quinine
is directed to, and exerted upon, those nerves especially which
control the general capillaries, where its stimulant and tonic pro-
perties are chiefly manifested, as already has been explained. I
would not deny that an impression is made by quinine upon the
nervous centres, and that it will, when first administered, increase
to a slight degree the action of the heart and arteries; but I am by
no means satisfied that the pernicious effects of quinine, which we
sometimes hear of, depend upon its sedative properties, but that
the more probable solution of the matter is, that these effects are
properly ascribable to its stimulant and tonic effects, in excess,
upon the capillaries, giving rise to arterial plethora, thus over-
whelming the brain and other nervous centres, producing stupor
and convulsions, and destroying the sense of hearing, seeing, &c. ;
or in less degree, giving rise to headache, dimness of vision, par-
tial deafness, ringing in the ears, &c, producing a condition very
similar, if not identical, with that which I described in my last
letter, as "a condition of oppression" which may usually be re-
lieved by bloodletting.

. It was my intention to have taken a more extended view of
this subject, but as it will necessarily come up again, in connec-

1856.] Eivers. Case of Peritonitis. 143

tion with the treatment of some of our most important diseases,
according to the classification which I have made of them, I will
dismiss the subject for the present, by saying,, that one effect alone
constitutes the basis upon which the deserved popularity of quin-
ine rests, as a remedial agent, in the management of the diseases
of our climate, which is, its unqualified, stimulant and tonic effect
upon the nerves which control the capillary circulation, enabling
them to resist the influence of periodic states of depression, and
thus prevent the formation of congestion. It was my intention,
also, to have given to Opium a separate consideration, but in
consequence of its diversified modes of action, and its equally diver-
sified applicability and suitableness to the perpetually changing
conditions of the system, I have determined to consider it in
connection with the treatment of diseases as just stated.

My next letter will be chiefly appropriated to a consideration
of the uses and abuses of Calomel.

Yours, as ever,

Saml. D. Holt.

article IX.

Case of Peritonitis, terminating by the extension of Inflammation in
/Suppuration of the Testicles. By C. M. Kivers, M. D., of DeKalb,.
County, Ga., formerly of Charleston, S. C.

While residing in Charleston, I was on the 17th August, '55,.
called to see a patient a few miles from the city. On my arrival,
I found him suffering with an enormous Scrotal Hernia, extending
to the knee. He had been lying in that situation twelve hours
before I saw him. I attempted reduction, but there appearing to
be some constriction (not, however, amounting to strangulation)
about the external abdominal ring, and no assistance at hand, I
determined to put him upon the use of tart. ant. grs. ii, tinct. opii,
3ii, aqua 3 vi, in connection with warm poultices to the inguinal
canal, with a view to promote relaxation, and ordered him to re-
main in bed.

18th. Had slept comfortably the previous night; felt little or no
pain; had an alvine evacuation during the night, and from the
peristaltic action induced therefrom, the greater portion of the
protruded intestine had returned within the abdominal cavity.
The reduction of the remainder was easy, owing to the amount of

144 Eivers. Case of Peritonitis. [March,

relaxation produced by the previous day's prescription. After
the reduction, I immediately applied a suspensory bandage, and
directed him to keep his bed for at least a week. I left him, seeing
nothing in the case to call for another visit.

19th. To my utter astonishment I was again summoned to my
patient, with the startling intelligence that "he is dying." The
request was made that Dr. Toomer, of Charleston, should see him
with me in consultation, to which I agreed. He accordingly went,
and we found him in truly a deplorable situation. Abdomen
enormously distended; tongue fiery red, dry and cracked ; pulse
corded; countenance anxious to the most intense degree; testicles
and scrotum one hard, indurated mass, red and exceedingly hot.
Dr. T. (from my statement as to how I had left the patient the day
before) was extremely puzzled, as well as myself, to account for
this sudden peritonitic state ; but by close examining and cross-
questioning, we discovered that he had gone out the night before,
barefoot, in a very hard rain, and then was the mystery solved.
No leeches being at hand, we scarrified the scrotum and applied
warm fomentations and poultices of chamomile flowers, and ad-
ministered, internally, camphor gr. a (there being considerable
prostration), hyd. sub. mur. gr. 1, pulv. opii. gr. }, omni hora, and
applied a blister 12 by 20 over the abdomen, and left him, ex-
pecting to find him dead the next day.

20th. Contrary to my expectations, I found the patient consid-
erably improved: gentle ptyalism had been produced; tongue
more moist, less red ; pulse softer ; skin warm and moist ; abdomen
less distended, and scrotum in a somewhat less inflamed condition.
But the patient being very weak, I administered, for that day,
brandy, aqua ammonia and laudanum, in stimulant doses.

21st. Very much improved, every symptom of danger having
disappeared, with the exception of the inflammatory condition of
the scrotum and testicles, the latter being so hard as to cause the
apprehension that supp\iration would ensue.

22d. Still improviug, with exception above mentioned; and so
also on the 23d.

24th. Found the patient with his abdomen again tympanitic;
tongue red, dry and cracked ; pulse corded ; countenance utterly
changed, almost of the Hippocratic stamp, and extremities very
cold. ' He had again been out in the wet.' I ordered friction of
dry mustard to the extremities ; the blister re-applied, and small

1856.] Billingslea. Bone in the Rectum. 145

doses of mercury and opium given to keep up the effects of ptyal-
ism. Iodine applied to testicles, the inflammation in which still
continuing.

20th. Found him improved, having slept well the previous
night. Ordered poultices of corn meal to be applied over the part
blistered ; continued the calomel and opium at longer intervals,
and ordered a little beef-tea and rice gruel.

26th. Much better, with the exception of the testicles. Seeing
I could not discuss the abscess which I felt sure had formed, or
was about to form, I applied poultices to promote suppuration.

27th. Still improving. 28th. On arriving, I found that the
evening before the abscess had burst outwardly. I found the
entire tunica albuginea lying loose in the scrotum, together with
the epididymis, which I removed with the forceps. I lanced the
testicle of the other side, and after discharging the contained pusr
I placed a tent in each orifice to promote granulation from the
bottom of the wound.

29th. I found him enjoying himself with his pipe complaining
of no pain, but saying that he felt perfectly easy. I dressed the
wound with common tepid water dressing, applied adhesive straps
around the scrotum, and left him. The last I heard of him he
was at work, as hearty as ever before.

ARTICLE X.

A Bone lodged in the Rectum, simulating Dysentery:

Messrs. Editors: About the 20th of ' November, 1854, while
living in Henderson, Texas, I was called by Mr. S.r to see a man
servant of his, set. about 50 years. On my arrival, I was informed
that the man had been complaining for two days, of sharp, cutting
pains in the bowels, and that he had taken a blue pill the first
night, and subsequently oleum ricini, which operated on his bow-
els without relieving the pain. He then alternately administered
anodynes and cathartics, with no better success. From the pa-
tient, that morning,, complaining of so much pain in the rectum,
with a frequent disposition to go to stool, his master was fearful
he' was taking dysentery, as it then prevailed there. Upon exam-
ining the patient, I found the skin hot and dry, the pulse consid-
erably accelerated, bowels rather tender; the recti abdominis
muscles rigid, and the tongue foul, with red end and edges, though

f

146 BlLLlNGSLEA. Bone in the Rectum. [March,

moist ; and great thirst. I was at first about to prescribe as if it
were a case of dysentery ; but not being satisfied, and as he com-
plained of so much pain about the anus, I determined upon an
examination, and having placed him upon his hands and knees, I
immediately saw something projecting from the anus, which I dis-
covered to be a bone. I interrogated him as to what he had eaten,
in order to arrive at the species of bone, but could get no satisfac-
tion. The projecting part was flat, and the bone seemed, what it
afterwards proved to be, of triangular shape the base being up-
ward and the apex presenting. On seizing it with the forceps and
using slight force, he compiained loudly and trembled violently.
I administered a large anodyne, but still he was no more quiet.
The bone seemed to be bearded, and pulling at it only seemed to
fasten it tighter. I then determined to use the speculum ani, by
dilating the sphincter, so as to disengage the bone ; but he would
not allow me to introduce the instrument, as it gave great pain.
I then administered chloroform by inhalation until he was intoxi-
cated, and readily introduced the speculum on each side of the
bone, and by dilating the parts largely, I saw a flat triangular
bone, each line of the triangle being about If inches long. It being
still engaged with the mucous membrane, I attempted to cut it
with a strong pair of scissors, but could not. I then gradually
worked it out with difficulty, and some pain ; considerable hem-
orrhage followed for an instant. The patient' expressed great re-
lief. I cleansed the parts, then administered full doses of opium
for twenty-four hours, not allowing any passages for forty-eight
hours. He was up and' at work at the end of that time, and had
suffered no bad effects when I left there, two months thereafter.

The bone proved to be a fish-bone the fin of a large cat-fish;
the point presenting was thin, while one corner of the articulating
surface was engaged in the mucous membrane, rendering it hard
to extricate.

Eemark. This case is not a novel one, as foreign bodies are
frequently swallowed and lodged at the anus. Yet I have been
thus particular in describing the symptoms, to show how easily a
physician may be deceived in a case, and that he should be minute
in his examination, or his reputation, as well as his patient, may
suffer. Kespectfully,

JAS. 0. BlLLlNGSLEA, M. D.

Foster's, Tuscaloosa Co., Ala.

H

ml

1856.] Peculiarities of the Nbgro Race. 117

j4n Essay on some of the Distinctive Peculiarities of the Negro Race.
By A. P. Merrill, M. D.

No. III.

Fevers, as we have before intimated, constitute a large propor-
tion, perhaps not less than one-half, of all the ailments to which the
negro race is subject in the southern States, requiring medical
treatment. This fact appears to be the more remarkable, when we
consider, that in their native Africa, the negro race is so much
better able to resist the action of febrific agencies than the Cauca-
sian, as to be considered almost exclusively qualified to inhabit ex-
tensive regions of tropical country, in which the latter race can
scarcely manage to exist. Even there, however, we have reason
to believe, that the two i-aces differ in their susceptibilities to the
influence of the cause of fever, only in degree ; and this distinction
may be dependent entirely upon the fact, that the native race has
been, for many successive generations, inured and habituated to the

| constant action of such cause upon their systems, until it has
ceased to produce its poisonous or morbific influences, or until it is
capable of producing them to such an extent only, as to give rise
to those more moderate attacks of fever which are easily cured, and

i which, in a majority of cases, come to a favorable issue under mere

. dietetic treatment. We are the more willing to adopt this view of
the case, from the constant illustrations it receives from southern
experience; the distinction being scarcely better marked between

' the negro and the white races, either in Africa or America, than is
the same distinction between the native and immigrant white
population in New Orleans and the southern States generally.

Whatever may be the proper explanation of these existing dis-
tinctions between races, and people of the same race, in this and
other countries, it is not more certain that they exist, than that fever
prevails and always has prevailed among the slave population of
the southern States, to a remarkable extent. No existing condition
of life, occupation, exposure, or variety of location, affords our slave
population any exemption from this form of disease. It affects in-
discriminately both sexes, and all ages, from the new-born infant
up to the centenarian, although, it is true, that the two extremes of
the catenary are less commonly affected than the intermediate ages,
and particularly the latter. As with the white race occupying the
same localities, negroes of both sexes are most liable to attacks of
fever between the ages of twenty and forty years, embracing the
most active and vigorous period of life, as well as that in which
men and women of the laboring classes are most exposed to those
influences which are supposed to predispose them to attacks of
disease. It is probably true of both races alike, that laborers in the
open air, tillers of the soil, and all whose occupations subject them
to constant out-door exposure, are more obnoxious to attacks of
N. S. VOL. XII. NO. III. 10

148 Peculiarities of the Negro Race. [March,

febrile disease, than those who are engaged in branches of business
which may be followed under the shelter of roofs.

Idiopathic fevers affecting negro slaves, are mostly of the period-
ic form. From thirty to forty years ago, this was, by most south-
ern physicians, considered the exclusive character of such fevers
among negroes; and although, latterly, since continued, or typhoid
fever, has received so much attention from writers on medicine,
many medical men in the South have recognized the existence of
this variety of febrile disease among slaves, even in an epidemic
form, there is still a respectable number of practitioners, of large
experience in negro diseases, who do not acknowledge the occur-
rence of continued, or typhoid fever, within the range of their own
observations ; or that any change of note or importance has taken
place in the character of the fevers prevailing in the South, either
among the white or colored population, during the past quarter or
half century. They are still content in the pursuit of the same plan,
in designating the different forms and phases of fever, which was
almost uniformly practiced, before typhoid fever was spoken of in
connection with southern diseases. Besides the epithets having
reference to the periods of remission, it has been customary, also, to
designate different cases by such terms as indicate the seat of the
most serious and obstinate local lesion, as well as the general pathol-
ogical peculiarity. In this way have been brought into common
and popular use, the terms intermittent and remittent, brain, gas-
tric, enteric, pneumonic, bilious, congestive, malignant, etc. The
use of these and many other expletives, multiplied and varied, as
they doubtless have been by both fancy and fashion, in no way
interferes with the opinion more or less prevalent throughout the
southern States, that the idiopathic disease, primarily affecting the
whole system, is the same at the present time, as that which came
so constantly under observation in former years, exhibiting, so far
as it may be uninfluenced by treatment, precisely the same symp-
toms, and exhibiting precisely the same therapeutical indications.

The differences of opinion now existing in reference to changes
which are supposed to have taken place in the character of southern
fevers and in reference to the introduction and prevalence of a new
form of fever, of a continued and adynamic or typhoid type, enter-
tained, as they appear to be, by parties of equal capabilities, must
have arisen either from a misapprehension of the true character of
fevers formerly prevailing, from the influence of novel plans of
treatment, or from the fact, that fevers of the kind alluded to, have
actually appeared in certain localities without showing themselves
in others. Our own experience, extending over a period of more
than one-third of a century, does not lead us to the conclusion that
any material changes have taken place during that time in the
character of southern fevers, as they affect either the white or the
negro race. It has not happened to us to meet with a case of ty-
phoid fever, as described by European authors, or one which ap-

1856.] Peculiarities of the Negro Race. 149

peared of necessity to run its own protracted course without a pos-
sibility of being interrupted and controlled by treatment. Nor have
we had the misfortune to witness a case of idiopathic fever, in
which the anti-periodic treatment suitably applied in the early
stages, was unavailing or injurious ; or one which has pertinacious-
ly prolonged its course for weeks, in spite of such treatment. The
experience of some other physicians is in accordance with our own,
and hence the difficulty which exists in reconciling the conflicting
opinions prevailing on the subject.

Periodic Fever, in all its various forms, it cannot be denied, has
been, since the first introduction of the negro race into the south-
ern States of America, not only the principal kind of fever, but the
principal disease, to which the race has been subject. ATor should
this be ranked among the peculiarities of the negro, to distinguish
it from the white race, during the same period ; for this form of
disease has attacked the latter even more generally and violently
than the former; and it has, in some portions of the southern
States, proved exceedingly destructive to the lives of both. Be-
sides the fact that the white race is more liable to attacks of perio-
dic fever everywhere, its greater suffering and mortality in some
parts of the South may be accounted for from the fact, that, in ma-
king establishments for planting purposes, the owner of slaves has
j generally chosen for himself and family the most insalubrious locali-
ty. At the period when a large portion of the country, now
; occupied by cotton and sugar plantations, was in the course of its
first settlement, an opinion prevailed and the same opinion still
: has its advocates that the greatest security from fever was to be
found upon the most elevated and least productive grounds. These
are generally situated, at a moderate distance from water- courses,
' and beyond the immediate neighborhood of the rich alluvial soils to
be subdued and cultivated. Hence the early emigrants to Alabama,
Mississippi and Louisiana, generally aimed, after establishing their
slaves as a matter of necessity, upon the bottom lands, and upon the
immediate shores of the rivers and lakes, to fix their own residences,
whenever practicable, upon the neighboring bluffs or ridges of high-
lands, where they believed themselves less exposed to the causes of
i periodic fever, and where they could better enjoy the cooling
J breezes of the summer season.

Taught to believe that the constitution and habits of negroes
3 render them less liable to the pernicious effects of malarial exhala-
tions, so called, the natural expectation was, that although their
'slaves were located in places where these exhalations are supposed
^especially to abound, this partial immunity of the race would pre-
"j serve them from greater danger, than they themselves would be
subject to in their chosen retreats. Hence there could be no
moral wrong, in the adoption of different and separate places of
abode. But rigid experience, which frequently puts medical theo-
ries to such severe tests, almost daily demonstrated the fact, that,

150 Peculiarities of the Negro Race. [March,

not only were the white race, under this arrangement of dwelling
places, more liable to fevers than the negro, but that the slaves who
were required to be in attendance upon the white family, and those
who were engaged in the limited cultivation of the less productive
soils of the homestead, were more obnoxious to febrific influences,
than their more fortunate but less cherished compeers, employed
upon the cotton and sugar fields below.

The difference in the susceptibility of the two races to attacks of
febrile disease, has been less distinctly marked, whenever, from
choice or necessity, they have fixed their homes in close proximity
with each other upon the rich alluvial soils. This has been suffi-
ciently observed to induce many southern planters, in emigrating
to new and unimproved regions of country, to establish themselves
with their negroes upon the low grounds, as a precautionary
measure against fever, and, whenever convenient, upon the immedi-
ate shores of the rivers, bayous and lakes, which were formerly con-
sidered so detrimental to health. There are now large districts of
country which have been settled in this way and brought under suc-
cessful cultivation, the inhabitants of which bear testimony every
year, in the excellent health ihey enjoy, to the truth of this position.
In the early settlement of Louisiana, large plantations were opened
directly on the shores of the Mississippi, with the broad river in
front, and a vast extent of swamp in the rear, upon which both races
have lived for many successive generations, without suffering more
from fever than communities sometimes suffer in mountainous dis-
tricts.

Negroes, in being prepared by nature and habit for the enjoy-
ment of health and comfort in hot climates, might be presumed
qualified to resist, to some extent, the action of those causes ofdisease
which are dependent, to a partial extent at least, upon the agency
of heat in their production. For this, or some other reason not yet
discovered, they are known to be much less liable to the more violent
and fatal forms of fever in Africa, than white persons, even although
the latter may have been inured to the country and climate by
long residence. This is true also, in a somewhat less marked de-
gree, in the Southern States. The experience of the rice-growers
of Carolina and Georgia afford, perhaps, the best illustrations of this
difference in susceptibility in this country, while the cotton and
sugar estates of Mississippi and Louisiana present only a little less
striking and prominent examples; and this notwithstanding the
greater exposure of negroes to the common causes of disease by
their occupation and habits of life.

In periodic fever, as in many other diseases prevalent in the
South, the prominent peculiarity of the negro ailment consists in
its degree of violence, and, by consequence, in the extent to which
it endangers the life of the patient, rather than in any peculiar pa-
thological characteristics of the disease. A negro attacked by
intermittent or remittent fever, presents to the eye of the physician

1856.] Peculiarities of the Negro Race. 151

all the usual phenomena of those forms of disease, not to be distin-
guished from the symptoms of the same disease, as they appear in
the white subject. The premonitory symptoms are the same, and
the cold stage may be equally insidious, or equally violent, and sub-
ject to the same duration in time. The pulmonary and other con-
gestions are likely to be just as severe and urgent, and the following
reaction just as violent, with the same thirst, febrile heat, and pain,
restlessness, and even delirium, affording indications for the same
antiphlogistic and sedative treatment; yet when these remedial
measures come to be applied, the effects are found to be more de-
cided, and the danger of excessive medication to be proportionably
greater. This is more particularly true of those therapeutical
measures which cause sedation and refrigeration. A negro labor-
ing under high febrile excitement, may derive great benefit from
blood-letting, and under precisely the same conditions which render

this remedy so useful to the white man, but he will require it to be
applied to a less extent to produce the same results ; and the same
is true of other sedative remedies. If, from the want of a proper
understanding of this matter, the physician fail to keep it in view,

. he will frequently be disappointed in results, even although the

remedies used may be proper and necessary.

Previously to the discovery of quinia, and its introduction into

use in the treatment of periodic fever, the management of negroes
! suffering from attacks of this disease was a much more difficult and
-serious matter, than at the present day. Cinchona, although very

generally employed as a remedy, was not generally relied upon for
arresting and curing the disease in its very beginning. The abor-
tive treatment was not then common, nor was the bark resorted to
in most cases, particularly of the remittent type, until the prima?
vice had been well evacuated, and the excitement pretty well sub-
dued by antiphlogistic means, with such relief of the local lesions as
would enable the patient to bear the use of tonic remedies without
inconvenience. Few cases recovered so promptly under this plan

s of treatment, as to save the patient from the inconvenience of sev-
eral successive paroxysms. Until alleviated, either by treatment or
by the powers of nature, each successive paroxysm became, of course,
more and more severe, causing, among other common effects of
such continuance of the disease, constipation of the bowels, and
rapid accumulations of fecal matter in the intestinal canal. For
the removal of these accumulations, the daily use of cathartic reme-
dies was universally approved and practiced, and considered of
essential importance to the safety of the patient. A class of reme-
dies of such obvious necessity in all cases of the disease, may well
be supposed to have been sometimes used to excess, and thus to
afford grounds for the condemnation which the purgative treatment
has received from certain authors. Various evil consequences
have been attributed to the irritation of the mucous tissues caused
j by frequent purgations, under the mistaken idea that the disease

I

152 Peculiarities of the Negro Race. [March,

itself was more or less dependent upon some morbid condition of
these tissues from the beginning. But our own observations have
led us to the conclusion that the more common error in practice
then committed, was in purging too little. Hence the fatal injury
resulting from the influence of medical authors without experience
in the treatment of the disease, about which they undertook to give
instructions, and the impropriety of southern physicians taking for
their guide, the teachings of men who write of the practice suited
to fevers in the hospitals of the metropolitan cities of Europe.

No one feature in connection with the periodic fevers of the
South, has been more generally recognized by southern physicians,
than the surprising rapidity with which these fecal accumulations
take place, and which are often entirely independent of ingesta.
The outpouring of excretions into the intestinal canal, is pretty much
in proportion to the violence and duration of the disease, or the
number of its paroxysms. They are supposed to be excretions
from the liver and pancreas, and from the follicular glands of the
intestinal canal, and in part, perhaps, exhalations and hemorrhages
from capillary vessels, independent of glandular action. The latter
might, indeed, be supposed to be the principal sources, because of
the fact that, when these accumulations take place most rapidly, the
excretions of the system are known to be extensively suspended
from the influence of the disease. In case of the continuance of
the disease for several successive days, unabated by treatment, the
quantity of fecal matter discharged from the bowels, even from the
operation of mild cathartics, which do no more than cause a
moderate increase in peristaltic action, is frequently so large as to
strike both the patient and his friends with surprise, and the greater,
as they are aware that little or no food has been used. This is often
expressed in connection with the inquiry as to the possible source
of such quantities of morbid matter.

The purgative treatment, therefore, while the disease could not
be promptly arrested by any remedy then known, was essential to
the safety of the patient, and could prove injurious only in case of
hvpercatharsis, or the hydrogogue, and consequently debilitating
action of the remedies employed. Unless this indication for cathar-
tics were daily observed, and particularly after every febrile exa-
cerbation, tumefaction of the bowels, attended by tenderness upon
pressure, oppression, and restlessness, were certain to supervene,
with an enhancement of the febrile symptoms, a partial suspension
of healthy secretions, and generally considerable gastric irritability.
These symptoms were thought to contra-indicate the use of cinchona,
the only anti periodic then much relied upon, or to render its ad-
ministration in effective doses impracticable, on account of its
ejection from the stomach.

Although the treatment of fever then pursued may have been,
with propriety, called active, on account of the amount of medication
employed, it was in fact merely expectant, inasmuch as the remedies

1856.] Peculiarities of tlie Negro Race. 153

employed were intended to do little more than to remove the pro-
ducts of the disease, and to guard against their cumulative influence,
and tendency to enhance the gravity of the symptoms ; thus
enabling the powers of nature to overcome the action of the morbific
cause, and gradually restore the patient to a state of health. Cin-
chona, in substance, was not unfrequently used in union with
serpentaria, or some other of the bitter tonics, and sometimes with
the further addition of the saline cathartics, and often with good
remedial effects, but never with that confidence in its anti-periodic
power, which is now accorded to its proximate principle, quinia.
To this treatment was often superadded the use of tartar-emetic, or
j ipecacuanha, in nauseating doses, with a view to moderate and re-
strain the febrile excitement, and frequently with the unintentional
effect of causing watery dejections of a debilitating character from
the bowels.

It will be perceived, from this hasty outline of treatment, that its
tendency was to subdue the vital forces and debilitate the system,
thus favoring the accession of the adynamic condition, which is al-
ways found to present serious obstacles to the rapid recovery of
negroes from febrile affections. Their physiological peculiarities,
-of which we have before spoken, might lead us to expect this.
Recoveries from fever were, on this account, frequently slow and
imperfect, causing the loss of much valuable time, and often result-
ing in the establishment of chronic lesions, not only rendering the
slave of inferior value for the season, but in many cases laying the
foundation for a tedious decline and premature death. An attack
of fever of any considerable degree of severity and long duration,
could scarcely be expected to run its course to final recovery, after
beginning, perhaps, as an intermittent, and passing, for want of
remedial efficacy, into the remittent type, and only subsiding after
great exhaustion of strength and vital energy, and after the estab-
lishment of serious local lesions, without inflicting permanent injury
upon the constitution. Tuberculosis, rheumatism, neuralgia, bron-
chitis, chlorosis, habitual constipation, various forms of indigestion
and of uterine disease, were common consequences of the shock
thus given to the system.

The introduction of quinia into use in the treatment of periodic
fevers worked a great revolution in practice in the South, and par-
ticularly in plantation practice among slaves. Its true value to this
population was slow to be discovered, and even at the present time
- is not, perhaps, fully appreciated, although it may be generally ac-
knowledged, that it has added greatly to the productiveness of slave
I labor, and, by consequence, to the national wealth. The effect upon
i these, produced by a material abridgement of the time lost by sick-
ness, the preservation of the negro constitution from the injuries
i inflicted upon it by protracted fevers, and the material prolongation
M of negro life, is not likely to be over-estimated. It tells largely in-
deed, upon the amount and value of all the agricultural products,

\

154 Peculiarities of the Negro Race. [March,

which are the results of slave labor, in all parts of the civilized world
where negro slavery is known.

But the revolution in practice, brought about by the discovery
and introduction into use of quinia, like most other revolutions in
medicine, was slow and difficult of accomplishment. The new
remedy being considered of the precise character of cinchona, it was
regarded as a mere substitute for that article, and its equivalent
quantity being nearly ascertained, the common practice at first
was to give it only in very small and equivalent doses, and always
under the same conditions, which had come to be considered, from
long experience, indications for the use of bark in substance. In-
deed, it was then shrewdly suspected by many, that greater mischief
might arise from an untimely and immoderate use of quinia, be-
cause the stomach of the patient could not be relied upon to correct
the error of the prescriber by rejecting it, when not in a condition
for its use, as was supposed to be the case with the grosser material.
Fears were consequently entertained that mischief might often
result from its use in too large quantities, and also from its exhibi-
tion without due regard to the period of apyrexia. On account of
these apprehensions, and the uncertainty which always attends
upon new and unproved plans of treatment, experiments were made
with extreme caution, and with what are now considered minute
doses of this remedy. In plantation practice, this minuteness of
dose was, perhaps, favored to some extent by the costliness of quinia
in the early period of its use.

It is unnecessary to enter here into a detailed account of those
experiments, which led to the system of treatment in vogue at the
present time, the object of which is to employ this powerful anti-
periodic remedy, as to cut short or obliterate the fever in its very
inception, and thus to obviate the establishment of those local lesions,
the consequences of fever, which, while they tend to perpetuate the
febrile excitement by the influence of local irritation, create a neces-
sity for the use of alterative and contra-stimulant treatment for an
indefinite period of time. The vast accumulations of excretions in
the intestinal canal, before referred to, as the effect of repetitions of
the febrile pasoxysm, being thus prevented, or very much lessened,
cathartics become less important and often unnecessary. The con-
sequent abatement in their use has led to the more confident
condemnation of the former practice, without due consideration of
the change which has taken place in existing indications. Northern
and European writers exultingly refer to this change of practice,
as evidence that the purgative treatment formerly so much relied
upon was unnecessary ; but every southern physician must be
aware that, if the use of quinia were to be now interdicted, and
thus deprive physicians of the means of subduing the disease at the
very beginning, the same purgative treatment would have to be.
resumed.

These remarks are not less applicable, perhaps, to the white than

1856.] Peculiarities of the Negro Race. 155

to the negro race in the South, but there are some peculiarities in
the treatment of the latter which deserve to be noticed. Either
from the higher susceptibility of negroes to the anti-periodic influ-
ence of quinia, or their exemption from the graver forms of periodic
fever, consequent upon their peculiar adaptation to climates where
these fevers most prevail, rendering their attacks less serious and
obstinate, and probably from both causes united, quinia exerts a
curative influence over them, if administered in the first remission
of the disease, more prompt and decided than over white persons
under similar circumstances. Smaller doses are therefore required
for the negro than for the white man, while the sedative influence
of large quantities of quinia upon the negro constitution is more
serious and alarming, sometimes calling for the use of diffusible
stimuli to a considerable extent to relieve it. The most effectual
remedy of this class which we have used is carbonate of ammonia.
This appears indeed, to be an antidote to what may be considered
the toxical effects of quinia upon the negro constitution.

It appears to be generally conceded that negroes are much less
liable to be attacked by that form of febrile disease, called yellow
fever, than white persons. In tropical cities, they are classed with
the exempts ; and in New Orleans, Mobile, and other cities in the
South, they are also considered as being liable to the disease only to
a moderate extent, and in its mildest form. As we travel north-
ward, we find the negro race more liable to suffer from this form of
fever, whenever the cause of it exists with sufficient intensity to
j produce an epidemic. Two reasons may be given for this peculi-
( arity. The first is the fact that negroes, on account of their
adaptation to hot climates, may be placed among the most favored
i ofclimatized persons; and the second, they are, perhaps, as a race,
and certainly from their habits of life, less liable to gastric inflam-
mation than the white race. Local lesions, therefore, which follow
attacks of fever, although, perhaps, quite as likely to occur among
negroes as white people, more commonly in the former, fix them-
selves upon other organs than the stomach, the implication of which
is the distinctive peculiarity of yellow fever. Whenever yellow
fever is prevailing as an epidemic, therefore, it is common to find
negroes attacked with every symptom of the early stage of the
disease, and with a dangerous degree of violence ; but when the
gastric lesion might be expected to become developed in a white
person similarly attacked, the stomach of the negro remains intact.
The mulatto, and all the grades of admixture of white and black
| blood, are obnoxious to attacks of yellow fever, pretty much in
proportion to the preponderance of white blood, and when persons
of this class do become affected with the gastric lesion, they are
perhapse, even less curable than white persons, on account of their
greater feebleness of constitution. Nevertheless it is no less true,
that every variety of mixed bloods is capable of becoming so fully
climitized, even although they may be natives of northern countries,

'

156 Tephrosia Virginiana. [March,

as to be classed among those who are exempt from attacks of yellow
fever; and this may happen either from a long residence in the
South, or from having suffered an attack of the disease.

[Memphis Med. Recorder.

The Mr diced Virtues of the Compound Fluid Extract of Tephrosia
Virginiana. By B. O. Jones, M. D., Atlanta, Georgia.

Fully impressed with the many improvements and discoveries
of the age, both as regards science and literature, as well as every
other department of life, it would scarcely be expected that one so
humble as myself should bring much that is important to the shrine
of medical literature at the present day : yet, when we reflect that
age after age from the days of iEsculapius down to the present
time have each brought in their contributions to swell the vol-
umes of medical literature, and that discovery after discovery, the
result of thorough and scientific investigation, have greatly aston-
ished the world, still may we be permitted to hope that the end is
not yet, and that the half has not yet been told, and that the "great
healing art" shall take her position co-equal with the wonderful
advancement of other departments of knowledge, and with healing
on her wings give health and comfort to the afflicted of every land
and every clime beneath the sun.

Under such impressions as these, I have ventured to introduce
to the medical world the result, to some extent, of my experience
in the treatment and cure of diseases with the Compound Fluid
Extract of Tephrosia Virginiana, or as I have more commonly
called it, in honor of the first discoverers "Indian Sarsaparilla;"
and if, on farther investigation, it shall meet with the approbation
I contemplate it will, I shall feel I have discharged an obligation,
long resting upon me, in giving the history and virtues of this
plant to the profession.

Tephrosia Virginiana is of the order Leguminosa ; sub ord.
Papilionacea, a well known indigenous perennial plant, growing
abundantly throughout most of the Southern States, putting up
early in the spring, growing to the height of eighteen or twenty
inches, flowers in June and July, and attains its maturity in Au-
gust and September. The whole plant is medicinal, and should
be taken up by the root in early summer, whilst in full bloom and
carefully dried in the shade.

Preparation of Compound Fluid Extract Tephrosia Virginiana :
Tephrosia Virginiana, . . 8 ounces.

Rumex Acutus 2 "

Aqua Font -i quarts.

Boil down to one quart.

With the above mixture prepare the following for use, which
will keep for any length of time without injury:

1856.] Tephrosia Virginiana. 157

Comp. Fluid Ext. Teph. Virginiana. . 4 ounces.
Alcohol Dilutum, (Brandy,) .... 4 "

Saccharum Album. ....... 2

Mix aud digest for several days, and then strain through muslin
and it is ready for use. Dose for an adult from one-half to one
fluid ounce, repeated as often as symptoms demand, with a less
dose in proportion for children. It should be given at all times
with a view to its tonic and stimulant effect, and continued for
some time. I have seen results from this medicine, or from other
unknown causes, nature perhaps, truly astonishing; so much so,
that I should forbear to mention them, preferring that others
should test its virtues also, and decide accordingly, receiving only
the genuine coin and admitting only that which has been unmask-
ed, weighed in the balance, and amply sustained by tangible data.

I will venture, however, to mention in this connection a fact
well known to every practitioner of medicine, that there is a time
in the treatment of many diseases, and especially Typhoid fever,
when there can be little if any use for active medicine the patient
notyet sufficiently recovered to dispense with medicine altogether
when one imprudent act of the physician will prove almost
fatal ; still it is of the greatest importance that something should
be done to perfect the cure already commenced. Some mild stim-
ulating tonic, having a slight action on the bowels and the secre-
tive organs generally, would seem to meet the indication. This,
we feel authorized to say, will be accomplished as well by the use
of this medicine as any other that ever came to our knowledge.

It may not be improper, indeed I think it necessary, to men-
tion a few important cases treated mainly with this medicine :

Case I. Fanny, a colored woman, the property of N. M., of
Coweta County, Georgia, had been sick with general dropsy for
some eight or ten months, occasioned, in all probability, by Inter-
mittent fever, attended with enlargement of the liver and spleen,
together with obstruction of the catamenial discharge. Had been
treated with the usual remedies in such cases, to wit : Cathartics,
Diuretics, and Tonics, to which may be added mercurials, iodine,
&c. ; indeed all the common medicines recommended by the books
of the day for the cure of those diseases, with but little if any effect.
The disease continued gradually, to get worse, until it assumed
strong indications of a fatal result, and thus remained for several
days, when I became satisfied if something more was not done,
and that speedily, the patient would surely die. I then mention-
ed the fact to the owner of the woman and requested consultation,
to which he seemed unwilling, saying at the time he had no hopes
of her recovery now or for some time past, and that he thought it
best to let the woman die in peace ; besides he was unable to de-
fray the expenses of such policy, and that he preferred my contin-
uing in the case to the end, and if I could see at any time that
there was anything possible to be bone, to fill the indication at

158 Treatment of Prolapsus Uteri. [March,

once. I mentioned that the Indians used the Tephrosia Virgin-
iana in the treatment of dropsy with seeming good effect, and
proposed its use in this case, to which he readily assented. The
patient was immediately put under the full influence of this medi-
cine, and kept so for several days, when the symptoms became
greatly improved, and in the course of five or six weeks was almost
entirely cured.

Case 2. A. M., aged 25 to 30 years, of Fayette County, Geor-
gia, Typhoid fever.

, Symptoms. Pain and stiffness in the back of the neck, extend-
ing down the left hypochondriac and lumbar regions. Pulse 120
to 130. Skin of head and upper extremities hot and dry ; infe-
rior extremities cold and shriveled; a dark brown incrustation
upon the tongue, and the teeth and gums covered with sordes.
Had been confined some eight or ten days ; had taken no active
medicine, nor could be prevailed upon to do so ; however was indu-
ced by my suggestion to use the Compound Fluid Extract of Te-
phrosia Virginiana, which he continued with a few other mild
remedies, such as friction and sinapisms to the spine and extremi-
ties, until a cure was effected.

Case 3. Philip, a black boy, aged some 18 or 20 years, had
rheumatism of several years' standing. Left inferior extremity
useless, stiff and emaciated. General health impaired ; subject to
occasional acute attacks in other parts of the system, attended with
much pain, swelling and fever. Put him under treatment with use
of the Compound Fluid Extract of Tephrosia Virginiana, and
continued with little if any other medicine for some two or three
months, when I had the satisfaction of finding the disease entirely
removed, and he has been well, with the exception of a slight
stiffness in the hip joint, ever since.

Thus will be seen, I hope, sufficient to cause at least a farther
investigation, and to the ordeal of critical analysis and experiment
these observations are submitted, with a desire upon my part that
the truth should be evolved, whether the virtues of the article,
which I have brought to the notice of the profession, shall rise or
fall. [Atlanta Med. and Surg. Journal.

Curative Treatment of Prolapsus Uteri, by the local application of
Tannin. By Chaeles A. Budd, M. D., Fellow of the New York
Academy of Medicine.

The many and varied forms of uterine disease resulting from an
injudicious use of pessaries, as well as the irreparable damage done
by means of cauteries, either actual or potential, or by extirpation
of portions of mucous membranes, which have for their object the
diminution of the capacity of the vagina with a view of curing
prolapsus, have led me to add my testimony in favor of a practice
first recommended by Prof. B. F. Barker, of this city. I allude to

1856.] Treatment of Prolapsus Uteri. 159

the application of lint soaked in a saturated solution of tannin ;
and if the perusal of the following cases, selected from a variety
which have come under my observation, will induce a trial of the
treatment alluded to, I feel confident that in all cases to which it
is applicable, the result will be equally gratifying. There are, to
be sure, certain abnormal conditions in which it is not applicable,
as, for example, a very straight sacrum, or a loss of substance in the
perineum due to laceration or other causes ; or if there be any pa-
thological condition of the cervix, it must be removed by appro-
priate treatment ; and then, if the prolapsus continue, the utility,
I may say infallibility, of the method alluded to, becomes apparent.
But in simple cases of prolapsus, whether incipient, partial, or com-
plete, depending upon a mere relaxation of the uterine supports,
I have never known it to fail where the treatment has been faith-
fully persevered in. The manner recommended by Prof. B., and
the one I have followed, in its principal details, is as follows:
From a double thickness of lint a triangular portion is cut out, of
a sufficient size to fill the capacity of the vagina when rolled up so
as to form a cone, near the apex of which is attached a piece of
string to facilitate withdrawal. The patient being placed upon her
back, with the hips slightly elevated, the uterus is replaced in
situ, and the lint, soaked in a saturated solution of tannin, is ap-
plied with its apex downward and its base immediately in contact
with the os tincae. This is repeated once in twenty-four hours, for
a period of time in accordance with the extent of the displacement.
I have usually found a daily application for a period of about a
month, to be sufficient to perfect a cure. During this time, and
subsequently, constipation must be rigidly guarded against, and
the state of the general health attended to. The vagina soon be-
gins to acquire its wonted tonicity and contractility, and the lint
is consequently obliged gradually to be lessened in quantity ; the
strain being taken off the round ligaments, also allows them to
return to their normal condition. The following cases exemplify
the admirable effects of this plan of treatment.

Case I. Mrs. GL, set. 24 years, the mother of two children, the
youngest fifteen months of age, had always enjoyed good health
until the birth of her last child. The placenta in this last ac-
couchement (I having attended her in both) was retained over
three hours, in consequence of irregular uterine contractions. She
has been complaining ever since of pain in the lumbo-sacral region,
with bearing-down pains in the hypogastrium ; great constipation,
with vesical and rectal tenesmus; and a sensation of faintness after
an evacuation, leueorrhcea, &c, &c. Upon examination, I found
the cervix protruding at the vulva, extensive ulceration extending
into the canal of the cervix, inflammation of the posterior wall of
the uterus, and enlargement of the organ itself, its long diameter
measuring 4| inches. After three months' treatment, these condi-
tions, save the prolapsus, were all removed, the applications to the

160 Substitutes for Cinchona. [March,

cervix having been made weekly, and without the aid of a specu-
lum, and the uterus at this time measuring less than three inches
in its long axis. The treatment consisting of the lint and tannin,
was soon after commenced; and in about three weeks' time she
was enabled to resume her ordinary duties. She is now four
months pregnant with her third child, all treatment having been
suspended about six months ago.

Case II.- Mrs. S., aet. 20 years, the mother of one child aged
two years, applied to me in July, 1854, suffering from all the symp-
toms of uterine prolapsus. She had aborted with a three months'
foetus about a month previous, but had been complaining for two
years before. An examination revealed incipient prolapsus, the
cervix lying on the floor of the perineum, and slight epithelial
abrasion of its mucous surface. Two applications of nitrate of
silver removed this ; and the use, for ten days, of the lint and
tannin, effected a perfect cure.

Case III. Mrs. G\, a?t. 54 years ; a widow, the mother of five
children, the youngest sixteen years of age. Had ceased menstru-
ating about ten years previous. She stated to me that upon using
the slightest exertion, such as lifting or straining at defecation, her
womb would entirely protrude from the vulva. She had used a
variety of abdominal supporters, and had attempted on several
occasions to wear pessaries of different kinds, and at that time,
was wearing constantly a T. bandage. Upon examination I found
the uterus just within the vulva; and, requesting her to lift a
chair, the whole organ was protruded, dragging with it the poste-
rior wall of the bladder; it was perfectly healthy in appearance,
though somewhat atrophied. I commenced the treatment with
the lint and tannin, interdicting active exercise, and in six weeks
ceased making any -applications. She gradually resumed her or-
dinary duties, and is now (some two years since) perfectly recov-
ered, and is considered a very active old lady. She has not had
the slightest disposition to a return of the displacement, and enjoys
excellent health.

I have here given an example of the three different degrees of
prolapsus, incipient, partial, and complete, illustrating the cura-
bility of this treatment in each. I could, if it w,ere desirable, cite
many others which have been under my observation, and which
have resulted, without a single exception, in a perfect and complete
restoration. \_N. Y. Med. Times.

Experiments with several pretended Substitutes for Cinchona in the
Military Hospitals at Rome. By Dr. Felix Jacquot.

1. Arsenic.
This paper is a summary of a memoir addressed to the Conseil de
Saute des Armees, on the employment of arsenic in the treatment

1856.] Substitutes for Cinchona. 161

of intermittent fevers in general, and of those of Bome in particular,
and which was based upon 282 observations.

1. Mode of Experimenting-. In order to establish the efficacy of
arsenic as a febrifuge, its administration should be limited to those
cases which have resisted treatment without the use of quinine.
The author of the paper before us has not strictly followed this
course, since, giving the arsenic at the outset in the majority of the
cases, he had no means of judging whether the fever was about to
proceed steadily with its paroxysms, or whether, on the other hand,
it had a tendency to spontaneous disappearance. But as the sul-
phate of quinine was administered in the same way, it was at least
in a position to establish the comparative efficacy of the two medi-
cines. His researches, too, permit him to consider separately the

' treatment with arsenic alone, and the complex treatment by this
remedy, emetics, &c. Arsenic alone cut short the fever only in
8"33 per cent, of the cases, but the complex treatment in 16-66.
But while the efficacy of the arsenic is doubled by the conjoined

. use of emetics, the febrifuge powers of the sulphate of quinine are
so great, that those of emetics simultaneously employed are lost, or
absorbed in them; thus, the percentage of fevers cut short by
sulphate of quinine without emetics is 49-52, and by sulphate of

, quinine with emetics 5047, as calculated on 210 fevers,

2. Formula, Dose, Duration of Use of the Arsenic. The formula
used was the following: Arsenious acid, 1 gramme; distilled wa-
ter, 1 kilogramme. The arsenic is boiled with more than this
quantity of water till dissolved, and the latter reduced to the pre-
scribed quantity, some soda being added should the solution be
imperfect. The dose of solution was administered in canella-wine.

. The author could derive nothing but confused ideas of the proper
dose from writers on the subject, nor yet of the rapidity of its ac-

.j tion.

| 3. General Accidents, Tolerance. Most subjects bear without

. general accidents, three centigrammes at the outset, though the
author has seen one centigramme produce serious local and gen-
eral accidents ; yet, on the other hand, the tolerance has persist-
ed sometimes in spite of long continued large doses. Out of
72 cases treated by arsenic, he has only noted general accidents
six times, never fatal, and only once a source of anxiety. The

' local and general tolerances are quite independent of each other.
The author considers the action of arsenic to be sedative, hypos-
thenic. In one of his subjects the pulse fell to fifty. General loss
of strength, lassitude particularly affecting the legs and loins, have
appeared to him the earliest phenomena of poisoning by moderate
doses of arsenic; and while he thus differs from those who class it
among the tonics, he asserts that it has no tonic operation, even
upon subjects suffering under marsh cachexia.

4. Local Accidents, Tolerance. Out of the 72 cases treated by
arsenic, 24 or 25 presented gastro -intestinal accidents. The first

162 Substitutes for Cinchona. [March,

dose of one centigramme may cause vomiting and epigastric pain;
but, on the other hand, he has seen six centigrammes given by the
mouth tolerated ; and in others he has seen the arsenic continued
for a month without the stomach revolting against it. Although
the conditions favourable to the tolerance are not well known, yet
he can mention the smallness of the dose, its ingestion in divided
portions, and the quantity, and perhaps nature, of the vehicle.
The local accidents are nausea, vomiting, diarrhoea, malaise, and
sometimes pinchings at the epigastrium, and an insurmountable
disgust at the medicine. Either general or local accidents follow-
ed in 31 out of his 72 cases, or in 43 per cent.

5. Autopsies of Individuals treated with Arsenic. In three sub-
jects examined, nothing was discovered which could be imputed
to the employment of the arsenic, either in the heart, or in any
other part of the body.

6. Degree of Efficacy of the Arsenic, Comparison with Sulphate of
Quinine, &c. The cases on which M. Jacquot founds his compari-
son, are those which had not received any previous treatment
calculated to interfere with the accuracy of his experiments. He
thus tabulates his results:

Sulphate of
quinine/ Arsenic.

Fevers cut short i.e., which have not presented a single par- ) .. ..

oxysm from the commencement of the medication . . . ) %
Fevers which had presented one paroxysm in spite of the medi- ) o--hi 29-92

cation, but in which the second has been averted ....)'
Fevers which have presented two paroxysms, but in which the '

third has been averted

Fevers which have presented three or more paroxysms . . .
Fevers which cannot be introduced into these categories, but

which must be regarded as not cut short

7-61 ..

.. 12-50

5-23 ..

.. 34-72

1-42 ..

.. 1666

The arsenic, with or without the emetic, has cut short the fever
13-88 times per cent. ; the sulphate of quinine, with or without
emetics, 50 times per cent. ; that is to say, the arsenic has been
efficacious as 1, the sulphate of quinine three times and a fraction.
The arsenic with emetics cut short the fever 16-66 times per cent.;
the sulphate of quinine without an emetic, 5047 times per cent. ;
that is to say, the arsenic has been efficacious as 1, the sulphate of
quinine as 3 and a fraction. The arsenic witheut emetic has cut
short the fever 8-33 times per cent.; the sulphate of quinine with-
out emetic, 49'52 times per cent; the proportion being arsenic as
1, to sulphate of quinine as 5 and a fraction. Lastly, in compar-
ing the cases the most favourable to the arsenic viz., those in
which it was administered in large doses, three to ten centigramm-
es, accompanied by emetics, and a diet whose only limit was the
appetite of the patient, with the cases least favourable to the quin-
ine, we arrive at the following results :

Fevers cut short by the arsenic, 9 -68 per cent,
" " ' quinine, 49-52 "

1856.] Substitutes for Cinchona. 163

As respects the cases not cut short, it will be perceived, on re-
ferring to the first four figures of the two vertical columns of the
table, that in the instance of the fever treated with quinine, the
numbers are smaller and smaller according as we examine the cat-
egories of cases more and more refractory, whilst the contrary is
noticed in the instance of the arsenical treatment. The contrast
is perfect.

In about 35 cases it was possible to compare the effects of the
quinine and arsenic, the two medicines having been administered
in succession to the same patient, either for the same fever, or in
two separate attacks. In a sixth of the cases, the arsenical and
quinine treatment were of little efficacy; in another sixth, the
two medications were followed by some success ; in the four other
sixths, the sulphate of quinine showed itself the more active, ox
the only active remedy of the two ; and one observation furnished
a very marked instance of fever resisting the sulphate of quinine,
and cured by arsenic. In short, the author concludes that we see
more fevers which resist arsenic yielding to quinine, than we do
fevers refractory to quinine disappearing under arsenical treatment.
He believes, also, that he has established the fact of the greater
activity of the sulphate of quinine in the cases which have received
no previous arsenical treatment (54 per ct. cut short), than in those
first submitted to the action of arsenic (40 per ct. only cut short).

The general conclusion he draws is, that sulphate of quinine is
not replaceable by arsenic ; and especially is this true in respect
to the fevers of hot climates, where it is necessary to apportion the
dose to the intensity of the malady; under the latter circumstan-
ces we are immediately arrested in the arsenical treatment by the
fear of poisoning. In those countries where from one paroxysm
to another, the pyrexia may become more severe, remittent, and
pernicious, arsenic should not be employed during the endemo-
epidemic season.

Confirmation of results by other observers.^-After mentioning
MM. Mayer, Cordier, Pasquier, Armand, and Gouge, as arriving
at similar conclusions to his own, he states that in the Pontine
marshes, Dr. Minzi, physician to the central hospital of that coun-
try, has experimented with arsenic in more than 400 cases, giving
it to the extent of three centigrammes a day, and at last abandon-
ing it from want of success. M. Salvagnoli Marchetti also,- out of
16 cases, found 15 resisting arsenic.

Arsenic in inveterate Fevers1 and in Marsh Cachexia. The ob-
servations of M. Jacquot do not encourage recourse to arsenic in
inveterate fevers ; and M. Cordier also concludes from his expe-
rience in Algeria, that it is the more recent and slighter cases which
yield most readily to arsenic. In the palustrial cachexia he thinks
that arsenic may perhaps be used as an alterative, but that it is
incapable of replacing iron and other tonics, which it is neeessary
to conjoin with it.

N. S. VOL. XII. NO. III. 11

164 Substitutes for Cinchona.. [March,

Relapses. In preventing relapse, arsenic is inferior to sulphate
of quinine. Out of the 72 cases treated with arsenic, the relapses
were 22 or 30 per cent. certainly a large proportion. They
were less frequent in the cases treated with quinine. The relap-
ses occurred even during the period of administration of the
arsenic, which was continued after the cessation of the fever.
This was not observed in the instances of the quinine treatment.

Arsenic in the Ingravescent and Remittent Fevers. In cases it
was observed that, in spite of and during the employment of arse-
nic, the simple fever became aggravated, remittent,, sub-continued,,
and pernicious a fortiori, then, this medicine would have no ac-
tion upon a fever already of this character.

Conclusions. Arsenic is not for a moment to be regarded as a
substitute for sulphate of quinine. It will probably find a limited
place in the treatment of indigenous intermittent fevers, but it has
absolutely no pretentions against the recent endemo-epidemic
fevers of hot countries. We are scarcely authorized to employ it
except in the fevers which resist all the preparations of bark.
Uncertainty and contradiction reign over almost all points relative
to arsenic. It is a medicine which we cannot yet handle with the
double certainty of obtaining the effect desired, and of avoiding
the dangers connected with its administration.

2. Parsley Oil (Apiol), or Juice of Parsley Seed;. Cohphane treated

by Nitric Acid.
The author condemns the colophane almost absolutely. Of the
efficacy of the parsley oil he expresses great doubt. The single
ease out of six trials in which the fever appeared cut short by it,
might have been an instance of spontaneous recovery, since 7 out
of 19 cases submitted to expectation terminated in this way.

3. Hydrochlorate of Ammonia.
The doses employed were eight to twelve grammes in the day,
and the experiments were made upon 21 subjects. The following,
table represents the results :.

Fevers cut short .... 6, or 28 per cent.

Fevers -which presented one paroxysm, . .. .. 1, or 4 per eent.

Fevers which presented two paroxysms . . 1, or 4 per cent.
Fevers which presented three or more paroxysms in

spite of the medicine ...... 11, or 52 per cent.

Fevers which cannot he placed in the above categories,

but which were not cut short . . . . 2, or 8 per cent.

The first number of 28 per cent, of fevers cut short would show
a powerful febrifuge operation, were it not for the fact that more
than a third of the cases submitted to expectation recover sponta-
neously. The remaining numbers, too,, are little in favor of the
efficacy of the medicine, since more than half were uninfluenced
by it. The observations of M. Jaquot have not only established
that the greater part of the fevers are completely refractory to this

1856.] Notes on the Application of Statistics, &c. 165

salt, but that the marsh, cachexia becomes quickly developed, and
assumes an accelerated course during its administration where the
fever is not arrested, and also that the sulphate of quinine suc-
1 ceeds admirably in arresting fevers against which sal amnionic is
-> powerless. The conclusion of the author is, that this salt bears no
therapeutical pretentions in the intermittents of hot countries, and
that there is much doubt of its capability of rendering any service
in those of our own climate. [Archives Generals. Brit, and For.
Medico- Chir. Review.

Notes on the Application of Statistics, to Questions in Medical Science,
particularly as to the External Causes of Diseases. By W. P.
Alison, M D., Edin., D. C. L. Oxon., Emeritus Professor of

I Practice of Medicine, Edinburgh.*

It has so frequently and so plausibly been urged, against all the
. inquiries and studies which are termed Statistics, that the form of
jsuch reasoning may be applied to the support of almost any propo-
sition, that it becomes an object of very considerable importance,
. in the view of any one who is truly convinced of the importance
f and frequent practical application of such inquiries, to point out
the circumstancss of any question, or departments of any science,
:in which this kind of information is truly requisite, and the con-
ditions under which it may be trusted. This is especially true of
the science of Medicine, because there is one great department of
that science, that which we term Etiology, or the doctrine of the
external causes of diseases, in which our knowledge is acquired
almost entirely in this way. It is in very few cases only, that our
knowledge of the essential or intimate nature, either of diseases or
J of the powers in Nature which excite them, enables us to form
I any anticipation of the effects of those powers ; and it is simply by
empirical observation, facts observed and recorded, and the fre-
quency of their recurrence noted, although not explained, i.e., it is
by the mere force of numbers, or by statistics, whether stated exactly
in that form or not, that our information on that subject, and
practical rules for the prevention or treatment of diseases, founded
on that formation, are acquired,

I have elsewhere stated, f what seems to me to be sufficient rea-
sons,for the application of Statistics to inquiries of this kind beino-
more frequently and obviously required, than in any of those
which are made, either into the nature of diseased actions (or of
vital actions in general), or the power and mode of action of reme-
dies. The questions which we propose to ourselves in Etiology are
truly simpler than either in Pathology or Therapeutics, they in-

* Read to the Statistical Section of the British Association at Glasgow, Sept. 1855
(by Sir Archibald Alison.)

f British and Foreign Review, etc., January and April, 1854.

166 Notes on the Application of Statistics, &c. [March,

volve little or no exercise of judgment, simply the observing and
recording of facts, according to directions which are made known,
and the sufficiency of which can easily, at any subsequent timer
be estimated ; the sources of fallacy connected with them are less
numerous ; and, more especially, we can usually remark this, as to
the observations by which we can fix on those antecedents of a
disease, to which we ascribe the power of producing it, that the
positive observation, of the alleged effect following the application
of the cause, is supported by a large body of negative observations,
often not stated in words, but truly essential to the validity of the
inference; and, therefore, this class of observations is often more
truly and efficiently statistical, the number of individual eases
really contributing to the result obtained, is very much greater,,
and the evidence afforded more decisive, than it can easily be
made in the other departments of medical inquiries ; sometimes,,
therefore, greater than those who have accustomed themselves only
to physiological or pathological inquiries, or to watching the ef-
fects of remedies, can easily perceive.

The importance of this observation will not be denied, when we
remember that this is the department of Medical science which is
truly of the greatest practical importance. The knowledge of the
external causes of diseases, is that which leads most directly to
their prevention ; and to the preservation of those lives especially,,
from which the greatest amount of labor of all kinds may be ob-
tained, and which are, therefore, generally regarded as most valu-
able to a state.

In the course of the present century, improvements have been
made in Medicine, which will bear comparison in their practically
beneficial tendency, with those which have made this age and this
quarter of the globe so illustrious, as regards the applications of
any other Sciences to practical purposes. These have been almost
exclusively in this department of medicine, and may be truly said
to rest, as yet, almost exclusively on Statistics ; anticipating, pro-
bably by several ages, any information within the power of the
human race, as to the intimate nature of the phenomena which are
thus recorded. It is simply by the force of numbers, attesting the
simple fact of a disease, easily recognised, showing itself in many
persons within narrow limits of time and space, and there only, that
we have learnt how the poison of Small-pox maybe diffused; and
that it may be disarmed of its power over the human body, by
being first taken into, and modified by its passage through, the
body of the cow, and then applied, in almost infinitesimally small
quantity, to the human body itself, and there exciting a certain
specific inflammatory process, absolutely devoid of danger, and
incapable of communication through the medium of the air, and,
what is still more inconsistent with the knowledge we have of
other changes in nature; that this modifying and preserving effect
on the human body, produced in infancy, continues equally per-

1856.] Notes on the Application of Statistics, &c. 167

feet, in a great majority of cases, after 60, 70, or 80 years, if life shall
continue so long, i. e., after we are certain that the body on which
it has been produced, has been repeatedly worn down and built up
again, so that the poison introduced into the structure in advanced
life, can no more be said to come in contact with living matter
which has gone throgh the process of vaccination in infancy, than,
according to the paradox of an ancient logician, a man can be said
to have bathed twice in the same water, because he has bathed
twice in the same river.

So also it has been simply empirical observation, and, therefore,
by reference to statistics, that we have acquired within these few
years, information touching the extension of another epidemic,
less frequent, indeed, but attended with peculiar interest, and often
with extreme fatality, the Puerperal fever, which enables us, with
almost absolute certainty, to predict that its propagation, after the
manner of an epidemic, may hereafter always be prevented. For, I
believe, I may safely assert, that the statistical observations of Dr.
Semmelweiss, in the great Lying-in Hospital at Vienna, where
upwards of 6000 births take place in a year, being in exact ac-
cordance with what has been seen in this country, have unequivo-
cally shown :

1. That this disease is, in fact, a case of the Diffuse inflammation
or Erysipelas, attended with the same peculiarities in the exten-
sion of the inflammation, and in the nature of the effusion, and the
same variation as to the nature of the accompanying fever in dif-
ferent epidemics.

2. That one immediate exciting cause of this form of inflamma-
tion, which may always be suspected when it prevails epidemically,
is the cadaveric poison, often evolved, duriug the decomposition
of the human body, from whatever cause death may have taken
place; but during one stage of that decomposition only, viz., that
early stage during which the post-mortem inspections for the inves-
tigation of the cause of death are most frequently made.

3. That when this form of inflammation assumes the form of
epidemic puerperal fever, the mode of its transmission from one
patient to another, is by accoucheurs or nurses, themselves in good
health, but to whose persons or clothes minute portions either of
the effluvia from others already affected, or of this cadaveric poison,
have become attached ; and,

4. That when the obvious precautions are taken, to prevent any
persons to whom, in either of these ways, the poison can have thus
adhered, from acting as accoucheurs or nurses until effectually pu-
rified, no " epidemic extension" of puerperal fever is seen.

It is seldom, no doubt, that this last proposition can be submit-
ted to a searching scrutiny, as in the year 1846, at the Vienna
Hospital, under Dr. Semmelweiss, when the number of deaths after
these precautions were adopted, was diminished by no less than
400 in that hospital alone, and in a single year ; but when it is

168 Notes on tlxe Application of Statistics, dec. [March,

added, that each of the propositions above stated is quite in ac-
cordance with observations made and recorded (although the bond
of connection among them had unfortunately not been duly ob-
served) in this country, whenever puerperal fever has been epi-
demic, whether on a large or small scale, so that it would be easy
to collect statistical evidence of the same kind from every such
epidemic, wherever any record of the facts has been left, to estab-
lish each of these propositions, the force of this statistical evi-
dence becomes such as to justify the sanguine anticipation above
announced.

Our information as to the mode of extension of the malignant
Cholera, is, unfortunately, as yet less certain or precise ; yet I think
we may saj' it is so far advanced, that we may entertain a confident
hope of its being very soon such as to disarm any epidemic cholera,
in this climate, at least, of all its terrors.

I allude to that subject here, chieffy because I think it affords
an example worthy of notice, of what I have already stated, as to
the frequent misapprehension of the strength of evidence, simply
empirical, or founded on statistics, which may often be obtained
in inquiries of this kind.

I mentioned formerly in a paper on this subject, which I had
the honour of laying before this Association at Birmingham, a
single case which I saw in the year 1832, and which I have always
maintained to have been sufficient, for any one who duly attended
to the statistical evidence it afforded, to establish the proposition,
that the disease is capable of propagation in this climate, by the
intercourse of the sick with the healthy, without pledging us to
any opinion as to the mode of communication, or as to the exist-
ence of other modes. Now that it is generally admitted, that the
assertion then made was correct, the question for discussion now
being (as stated by the Editor of the British and Foreign Medical
Beview) " not whether cholera is contagious or not, but how often
it spreads by Hue agency of human bodies (i. e, by contagion), and h< >\\
often without that agency," (Journal for January, 1854, p, 298.)
I think myself justified in drawing attention to the grounds on
which it was made; and which, I still think, amply sufficient to
establish that mode of communication, without, of course, exclud-
ing others.

The reason of this strong expression of opinion was, that the
case furnished a remarkable example of the evidence which, ac-
cording to what was formerly stated, a single positive fact may
afford, quite of the nature of the instantia cruris, when supported
by a large body of negative observations. The anxious expecta-
tion of the disease in the town, in 1832, the careful division of the
town into districts, and appointing of stations and medical men to
each, and the number, zeal, and intelligence of these observers,
were known to be such as to justify our sa}dng, that this was the
very first case of the disease which ever originated in Edinburgh

1856.] Notes on ie Application of Statistics, &x. 169

or Leitli, in a person who had not left the town; and that for a
time it was an isolated ease, no other appearing for ten days, in a
population of above 140,000 persons, many of whom were in -cir-
cumstances, in all other respects at least, equally favorable to the
appearance of Cholera, as this woman was; as the subsequent
appearance of the disease in many of them, during nearly a year
that the disease afterwards existed in Edinburgh, proved. If the
poison producing this " nova pestis" had no contagious property,
this woman was not more exposed to it than any other of this
large body of people ; but if it had that property in whatever
other way it might be communicated, she was undeniably and
peculiarly exposed, as she was engaged in nursing her son, in a
close confined room, who was ill of the symptoms of cholera, du-
ring the whole of the day preceding that in which she sickened
and died ; and he had passed the next preceding night in a house
j in Musselburgh, where patients in the malignant disease then were,
and had been for weeks previously. Here, then, was a fair instan-
i tia cruris, to determine whether the transmission of the disease,
from place to place, known to be at that time a frequent event,
was or was not dependent on intercourse of healthy persons, with
those previously sick of it ; and the affection of this one person,
i who had that intercourse, contrasted with the non-appearance of
the disease inl-10,000 was, as I maintain, decisive evidence-
Many cases, equally decisive, have since occurred, of which I
have been informed, on the first appearance of a disease previously
i unlcnoiun in a town or district, carefully observed ; e. g., at Ar-
broath in 1853, where there was clear proof that the two first per-
j sons of 15,000 inhabitants of that town, who took Cholera, "had
. just returned from Dundee, where they had visited persons ill of
cholera ;" their affection, therefore, proves nothing as to the effica-
j cy of intercourse with the sick, in exciting the disease, rather than
j merely visiting a particular locality; but the next six who took
J it in Arbroath, the first six inhabitants of that town who took
j cholera without leaving the town, had repeated and close inter-
;j course with those already affected before they took it ; and the
j inference as to the contagious property is drawn, not from their
n taking the disease, nor even from their taking it at that time, and
in rapid succession, but from their being the only inhabitants of
: Arbroath who took it, during the first week of its existence in that
| town ; i. e., the positive evidence of the six who were known to
,' be exposed to that cause, is supported by the negative evidence of
y the fifteen thousand who could not be shown to be, and the immense
.! majority of whom certainly were not, so exposed.
L I have great hopes that we shall soon have statistical evidence
(i to establish a proposition which no other evidence known to us
, could justify our admitting, but which, if established, would not
jj only reconcile most of the conflicting statements on this subject,
. but serve as a guide to almost complete security from any epidem-

170 Notes on the Application of Statistics, &c. [March,

ics of this disease in future ; viz., that the poison of cholera, like
oilier known animal poisons, is developed during the decomposition
of the animal matter, the appearance of which is most characteris-
tic of the disease, that which constitutes the " rice-water stools"
but only in a particular stage of that decomposition, not immedi-
ately after its formation in, or discharge from, the body; and
again, not after the decomposition has gone to a certain length.
All this can be proved only by Statistics, but is quite susceptible
of proof in that way. The last proposition above stated that no
poisonous property is attached to any part of a bod}r dead of cho-
lera, after a certain stage of decomposition has been passed, seems
nearly ascertained from the number of instances in which dissect-
ing-rooms have been supplied with bodies of persons dead of
cholera, for many weeks together, without any of the students at-
tending them being affected. That the peculiar matter of the
cholera evacuations, during its decomposition, perhaps especially
in dry air, has a peculiarly poisonous quality, was, I believe, first
suspected by Liebig, and partly by the analogy of the poison
already mentioned, causing erysipelatous inflammation and puer-
peral iever, and also of the sausage poison, repeatedly observed
on a large scale in Germany, which is developed during a certain
stage of the decomposition of the animal matter of those sausages,
and disappears when their putrefaction has so far advanced. That
the cholera can be communicated to animals by inoculation with
this matter, of the peculiar rice-water stools, has been sufficiently
proved by the experiments of Dr. Lindsay in this country ; and if
a few more experiments shall give results similar to those of M.
Thiersch, at Munich, I think we may assert that the proposition
above stated, is statistically proved. "Dr. Thiersch collected the
intestinal contents, or the evacuations, of cholera patients, and let
them decompose under the influence of air and heat. From day
to day he dipped into this matter pieces of filtering paper, which
he dried, for subsequent experiments on white mice. Two of these
animals at a time were exposed to infection for four days, by hav-
ing a square inch of the filtering paper, thus prepared, moistened
with water and mixed with their food. Each mouse took thus
1-2000 th gr. daily. The results were as follows: The prepara-
tions from the matter during the first day of decomposition were
innocuous. To this succeeded a period of from six to nine days,
during which decomposition went on, and preparations from the
matter in this second period of decomposition, caused disease in 30
out of 34 animals, and death in 12 of the 34. The symptoms were
peculiar and characteristic. The hair fell off, the ears dropped,
there was languor, then discharge from the bowels, first of white,
then wateiw matter, the urine lost its smell, then was suppressed,
1he appetite became depraved, so that the animals would fill their
stomachs with wool ; there was no apparent sickness, but such
tonic muscular contractions that they seemed dead some time be-

1856.] Notes on the Application of Statistics, &c. 171

fore death. On dissection, accumulation of blood in the vessels
of the small intestines was invariably found, their contents watery,
with abundant epithelial flakes (just similar to those found in per-
sons dead of cholera); the cortical substance of the kidneys
passing into fatty degeneration, the bladder empty, the blood and
the contents of the intestines answering to the test of ready mix-
ture with amygdaliu, as in the cholera of man, which will not
appear in the healthy animal. To this a third period of decom-
position of the matter under trial succeeded, in which these poi-
sonous effects were very slight, or not observed at all." (See Med.
Times and Gazette, Nov. 25, 1854.)

We have already a statement by Dr. Budd, of statistical obser-
vations made on villages in England, where the entrance of
Cholera appeared to be prevented by such expedients as these
observations immediately suggest, for receiving the rice-water
evacuations of cholera patients on linen or cotton, and burying or
burning, or otherwise effectually destroying their substance, du-
ring that period, thus indicated, after they have been passed, and
before they have entered on the morbific decomposition ; and we
have sufficient statistical evidence of the importance of another
measure, which was first adopted, I believe, at Edinburgh, in
1832, and has since been recommended by the Board of Health in
London, and adopted in different places, although not so generally
or satisfactorily as could be wished, founded on the merely em-
pirical statements I have made as to the communication of the
disease from the sick to the healthy, and its apparent adhesion to
particular, often very limited, localities, viz., the establishment of
houses of refuge for the reception of all inhabitants of houses or
rooms which might become infected with cholera in any town ;
not themselves affected, nor required for the care of the first cases
that might occur. Here such persons might be lodged in pure
air, regularly fed, preserved from cold and from other (frequently
concurrent) exciting causes of the disease, and treated with due
attention to cleanliness, immediately on any symptoms of cholera
showing themselves. The London Board of Health report, that
they had information of 1691 persons taken into these houses of
refuge, from rooms where there were patients in cholera, and of
these, only 33 became affected with cholera, and only 10 died. In
cases of which I was myself informed, in Edinburgh, at Glasgow,
and at Oxford, during different epidemics, 1010 persons were ad-
mitted from sick rooms into such houses of refuge, of whom 40
took the disease, and 15 died ; whereas the experience of Dr. Ham-
ilton of Falkirk, of 251 cases of cholera appearing in 86 houses,
where no such means of separation existed, gives only a fair idea
of the extent to which successions of cases will often be observed,
in confined air and dirty districts, possessing no such resource.

I am happy to say, that so far back as November last, having
written to Dr. A, Smith, at the head of the medical department of

172 Notes on the Application of Statistics, &c. [March,

the army, on the subject of the decomposition of the rice-water
stools, as the probable cause of the propagation of cholera, and of
districts becoming tainted with the poison of that disease, I was
informed by him that he had directed the attention of the medical
officers in the Crimea to the facts now stated, so that if the disease
shall appear in a malignant form in that army, we may hope for
at least accurate and truly statistical information as to the reality
of that opinion.

Again, as to the Yellow fever, so frequently becoming epidemic
in the hot climates, although we cannot boast of having acquired
informatton either as to the nature of its cause, the essential char-
acter of the morbid change it produces, or the power of any remedy
over it^ yet by simply empirical observations, i. e., hy Statistics,
we have information to the following effect, as stated in reports in
Germany and France, on inquiries conducted by order of those
governments, on a large scale, and considered by committees con-
taining the names of Humboldt and Dupuytren, that it is a disease
endemic, almost exclusively, "in districts nearly on the level of
the sea, never appearing beyond 48 of north latitude, nor without
a previous temperature of 72, only in certain circumstances pro-
pagated by contagion," but when epidemic, always confined strictly
to certain localities; so that the practical rule of immediately evacu-
ating, i. e., removing all the inhabitants of places where it is de-
clared to exist, and has formerly prevailed, is incontestable, and
"of such proved utility, as will always justify its rigorous execu-
tion."

Without dwelling farther on the effects of Malaria, in this or
any other climate, which we can only expect to be satisfactorily
explained when pathology shall be considerably more advanced
than at present, I may merely add, that such collections of facts
have been made, and are now frequently repeated, as to the pla-
ces and circumstances in which it arises from the earth, and the
laws according to which it extends and multiplies, considered
merely empirically or statistically, as we may confidently expect
to be successful in disarming this cause of disease likewise of its
terrors, long before the nature of the change produced by its ac-
tion on the living body, or the rationale of any line of treatment of
those who may be affected with it, shall become known.

The cure of Epidemic Scurvy, resulting in different cases, as is
now satisfactorily established, from different deficiencies in the
Diet habitually taken, the efficacy, therefore, of different kinds
of diet in counteracting this form of disease, still more remarka-
bly, the power of small quantities of vegetable Acids in producing
the same effect, and the extraordinary rapidity with which such
changes of diet, and these acids, will produce their effect, may
also be stated as examples, on a large scale, and of the most satis-
factory kind, of what is generally called the power of Art over a
most loathsome and virulent disease, but in reality must be re-

1856.] Discoveries of the Functions of the Spinal Marrow. 173

garded now, and probably long after our time, as results obtained
by simply empirical observations of the course of Nature, statisti-
cally arranged, fortunately facilitated by so many of the subjects
being organised bodies of men ; and which have distinguished the
present age to a degree, which those who are not familiar with the
medical writings of the last century will hardly conceive.

We have good reason to hope, that inquiries now on foot as to
the external causes of Scrofulous, or what is now usually called
Tubercular disease, including pulmonary Consumption, an in-
quiry which we must perceive to be more complex, and in which
the operation of various causes must be recognised, will be effect-
ual in pointing out the means of counteracting that tendency in a
very large proportion of cases of persons liable to it, simply on
the principle of empirical observation, enlarged and arranged in
the form of Statistics, long before we shall have information as to
the essential nature of the vital process, or mode of operation of
the causes in question.

In illustration of this, I need only mention two facts, recently
ascertained on so large a scale, that we have no doubt of their
truth and importance, and which, even at present, may be said to
be guides to successful practice in many cases only recently thought
hopeless, although all that was previously known on the subject
was certainly rather adverse than favorable to the supposition that
they would ever be established. These are,' 1. The good effect
of the Cod-liver oil if not of other animal Oils, on many cases
of tubercular disease, in their early stage provided only that it
can be retained on the stomach to the extent of an ounce and a half
or two ounces daily; and, 2. The almost complete exemption of
the inhabitants of the Faro Islands from tubercular disease, not-
withstanding that their climate, as regards cold and damp, is ex-
actly that which, in this country, has been thought most favorable
to it. [Edinburgh Med. and Surg. Journal.

M. Brown- Sequard,s Discoveries of the Functions of the Spinal
Marrow.

Seldom has the scientific world been taken more by surprise
than when M. Brown-Sequard announced his recent discoveries
relative to the functions of the spinal marrow. Whatever may
be wanting to complete our knowledge of the action of this por-
tion of the nervous system, the brilliant investigations of Sir
Charles Bell seemed to have set at rest forever the question as to
the particular fibres which communicate motion to the muscles,
and sensation to the brain. The theory of Bell, in a few words,
is as follows : " The spinal cord has two functions, relative to the
two substances of which it is composed. It serves as an indepen-
dent organ, detached from the brain, for the performance of reflex
actions, a property which it owes to the grey matter contained in

171 Discoveries of the Functions of (lie Spinal Marrow. [March,

its centre. By the white substance it acts as a medium of com-
munication between the brain and the parts to which the nerves
are distributed, the posterior columns conveying sensations upwards,
and the anterior and lateral columns transmitting the power of
motion in a downvjard direction. This theory was less the result
of experiments upon living animals, than of a process of reason-
ing, Sir Chaiiesliaving always manifested a strong repugnance to
vivisections. M. Longet, however, demonstrated, by the applica-
tion of galvanism to sections of the spinal marrow of animals,
that irritation of the posterior columns caused no movement, while
that of the anterior columns occasioned no pain. On the contrary
the galvanic current caused extreme pain when applied to the
posterior columns above the transverse section of the medulla,
and excited movements when directed through the anterior col-
umns of the lower segment. The grey matter was found to be
insensible to the irritation of electricity. The theory of Bell, so
remarkable for its simplicity and apparently so perfectly support-
ed by the demonstrations of one of the most eminent experimental
physiologists, could not fail of universal adoption, and although
pathological facts were occasionally made known which appeared
to contradict, to some extent, its conclusions, it seemed natural to
believe that these were inaccurately reported.

It will be observed, that in the experiments of M. Longet, the
spinal cord was always completely cut across. We may not un-
reasonably ask whether the organ thus divided is in the same con-
dition for transmitting sensation and the power of motion, as
when its continuity is in a great part preserved, and why this
method of experimenting was employed, instead of cutting
through each portion in succession, and observing the effect pro-
duced upon the function attributed to that part? In reply to the
latter inquiry, M. Longet states that the operation of laying bare
the spinal marrow, and evacuating the fluid which is contained in
the cavity of the arachnoid, is always followed by paralysis, both
of sensation and motion, of the posterior extremities, thereby ren-
dering further investigation impossible. Here was the great ob-
stacle to researches in the functions of the spinal cord, and the
removal of this obstacle was the first step taken by M. Brown-
Sequard. He ascertained that the nervous disturbance following
the opening of the spinal canal was caused by the loss of blood
and by the pain and shock consequent upon the operation. By
operating in such a manner as to prevent a great flow of blood,
and by allowing the animal time to recover from the depressing
effects of the operation, he found that both sensation and motion
returned to the posterior extremities in almost, if not quite, their
original degree.

Thus enabled to experiment upon the cord in a normal state
(as far as its functions were concerned), he proceeded to isolate va-
rious portions of the different columns by sections made with ex-

1856.] On Chalk Metastases, 175

treme care, and demonstrated a series of laws relative to the spinal
functions, the principal of which are the following:

1. The posterior columns may be divided without destruction
either of sensation or motion.

2. Sensation and motion are destroyed when the grey substance
is cut across.

3. Integrity of the antero-lateral columns docs not interfere
with the loss of motion, nor does integrity of the posterior columns
prevent loss of sensation.

4. Division of the posterior fibres of the cord., so far from abol-
ishing sensation in the parts to which these fibres are distributed,,
appears, on the contrary, greatly to increase it.

5. When the posterior columns are divided, sensation continues
to be transmitted between the lower portion and the grey sub-
stance, which transmits the impression to the sensorium by means
of fibres descending from the upper portion, and joining obliquely
the grey substance below the point where the section is made.

Our limits forbid us to detail the experiments upon which the
above conclusions are founded. They have been repeated over
and over again with the same results, in the presence of a com-
mittee appointed by the Societe de Biologie, consisting of MM.
Claude Bernard, Bouley, Broca, Giraldes, Goubaux and Vulpian,
to whom was referred M. Brown-Sequard's memoir, and who were
entirely satisfied with his conclusions. The interesting report
which they made to the Society is the most convincing evidence
of M. Brown-Sequard's skill as an experimenter and his eminence
as a physiologist. [Boston Medical and Surg. Journ.

On Chalk Metastases (Kalk Meiastasen). By BuDOLPH VlRCHOwV
(Virchow's Archiv fur Pathologische Anatomie, &c.)

Some years ago Professor Virchow performed the post-mortem
of a young lady whose case had thoroughly puzzled all the lead-
ing physicians of Berlin. She had complained of pains throughout
the body, but these, Avhich were attributed to rheumatism, had
resisted all the means employed for its removal. After death nu-
merous and large nodes of cancer were found in almost all the
large bones, occupying cavities of a corresponding size in the
osseous tissue, and no where rising above the level of the bone.
A large quantity of white sandy deposit was found in the calyces
and pelvis of the kidneys, and on dividing the lungs considerable
deposits of a hard greyish white substance were found, and a simi-
lar deposit occupied the mucous membrane of the stomach. The
salts which had been absorbed in consequence of the caneerous
deposits in the bone appeared to have found a fresh nidus in the
kidneys, lungs, and stomach. Professor Virchow has recently
met with four similar cases ; the following is a brief abstract of the

176 On ChaVn 3Ie(astases. [March,

characteristic features found on cadaveric inspection. It may be
premised that in all four there was evidence of recent degenera-
tive nephritis, in the second or third stage of the disease, in that
period at which the disturbance of the secretion is greatest ; a point
upon which Professor Virchow lays great stress, as he attributes
the chalky deposit to impeded secretion of the urine. In the first,
a maid-servant, aged forty -threer the upper lobe of the left lung
exhibited posteriorly a hard spot, the size of a nut, on section yel-
lowish white, dry and friable, which proved to be chalky infiltra-
tion. Similar smaller spots were disseminated through the lung.
The second case occurred in a girl, aged fifteen, who presented a
large mass of sarcoma, which had perforated the temporal bonus
from without inwards. The right parietal bone was occupied by
a similar growth ; the posterior part of the inferior lobe of the right
lung presented several dense, dry, hard nodes of chalky infiltration.
In the third case, a young man of nineteen years, who died of
necrosis of the left femur, the mucous membrane of the stomach
was found infiltrated with calcareous matter. The fourth case oc-
curred in a man, aged seventy-three, who had labored imder a
cancroid affection of the lip, of the clavicles, and several ribs, and
died of gangrene of the lung. Here the lungS' exhibited, in addi-
tion to spots of cancroid disease and gangrene, dense calcareous
infiltration in a part that was very emphysematous, so that the
septa of the tissue resembled hard spicule, and the inner surface
of the pleura was invested with thick deposits. The last three
cases resembled that of the young lady in Berlin in regard to the
co-existence of extensive bone disease. In the first there was no
apparent source from which the lime salts could be derived, but
the bones were not especially examined. The chalky infiltration
of the mucous membrane of the stomach, which is noted in two
cases, deserves a little further attention. In both, the altered parts
were altered in appearance and to the touch. They appeared
opaque, whitish, more or less spotted, feeling dry and resistant; in
the first case observed the tissues' crepitated on section. The
microscope demonstrated a fine granular deposit (blackish by
transmitted, white by reflected, light), external to the follicular
structures, which would probably mean that a portion of the
glandular tissue had been absorbed to make way for the deposit.
Acids dissolved the granules, and caused an evolution of carbonic
acid gas ; after the application of sulphuric acid, sulphate of lime
crystals formed. The co-existence of extensive disease of the
bones with extensive ossification of the vessels of the medullary
portion of the brain, in the case of a young man aged twenty-six,
is also quoted in illustration of the view advocated by Professor
Virchow.

Professor Virchow was of opinion that in these cases he had to
deal with a direct cretification of the tissues, bearing, as he thinks,
very materially upon the doctrine of metastases, on which account

1856.] Healing of Abscesses. 177

he has selected the title for his paper that we have placed at the
head of this notice. [British and Foreign Med. Chir. Rev.

On the Healing of Abscesses by the First Intention. By M. CHAS-
SAIGNAC.

M. Chassaignac has for some time past endeavoured to unite
abscesses by the first intention, after their complete evacuation ;
and he reports that his success has been very considerable. His
method of procedure may be judged of by the narration of a
case which recently occurred at the Lariboisiere Hospital and was
observed by all who attend there. A healthy man, aged 19, was
admitted February 17th, presenting all the symptoms of an acute
abscess of the axilla, which had been about a week in forming.
On the 19th, chloroform having been given, a considerable quan-
tity of well-conditioned pus was discharged by the bistoury, pres-
sure being exercised in all directions for the purpose of securing
complete evacuation. The cavity of the abscess was next tho-
roughly washed out with water introduced through the tube of an
irrigator, in order to bring away any remaining pus, the injection
being continued until the water returned completely limpid.
Pressure was again employed to force out every drop of the water,
and the orifice was strapped up. A large pad of charpie was in-
troduced into the axilla in order to make pressure over that region,
and the arm was confined in one of Mayor's bandages, as if for
fracture of the clavicle. On the 21st cicatrization was complete,
no discharge of pus whatever being visible. The bandage was
continued as a matter of precaution for two or three days, and then
the arm was allowed to hang down, no pain being reproduced.
In the site of the abscess a little indurated spot could be felt. On
the 27th he was discharged quite well. \_Oaz. des Hop., and lb.

\ On the Removal of Articular Bodies by the Subcutaneous Section.
By M. Chassaignac.

The author prefers this designation to that of loose cartilages, as
prejudging in nowise the nature of the bodies. In the present pa-
per he relates two cases in which the operation devised by M.
Goyraud of Aix was performed with success. This consists in
opening the joint by the subcutaneous section, and forcing the
articular body through the track of the incision into the cellular
,. tissue, and leaving it there for future removal. The following are
the conclusions the observations of these and other cases have in-
duced M. Chassaignac to arrive at :. 1. The pain, which is indu-
i ced by the pinching exerted by the surfaces between which they
j are compressed, is not felt when the bodies are voluminous. 2.
; The character of this sudden pain is not pathognomonic, pain quite
: similar to it accompanying certain invasions of rheumatism or gout,

178 Hemostatic Agents. [March,

and the dislocation of the semi-lunar cartilages. 8. Our diagnosis
may be at fault from our mistaking the slipping of the fingers over
the walls of the articular sac for the displacement of a mobile
body a mistake that may far more easily occur than would be
supposed. We have also to distinguish these bodies from partial
indurations of the capsule, and from inequalities of the edges of
the osseous articular extremities. 4. Among the concomitant af-
fections that may be produced by the presence of these bodies are
hydrarthrosis and anclrylosis. 5. Although when hydrarthrosis
produces great tension it is an obstacle to our diagnostical exam-
ination, a moderate repletion of the capsule favours the explora-
tion. 6. The place of election for the operation on the knee-joint
is the lower cul-de-sac of the synovial membrane on the inner side.
7. Before commencing any operation, small articular bodies must
be previously fixed by acupuncture, as there is always great dan-
ger of their escaping at the moment of operating. 8. When these
bodies are multiple, we should collect them all at one point, so as
to expel them by a single operation. Still, where one or two es-
cape us, the operation does not always fail. 9. Articular bodies
left under the skin for a considerable period, undergo a great
diminution, so that a secondary operation for their removal is not
always required. 10. So important is it to avoid suppurative in-
flammation after the operation, that leeches should be freely appli-
ed at the root of the limb, both as a preventive and curative
measure. 11. Angioleucitis is- the species of inflammation mos-t to
be dreaded after operation upon the knee. 12. In expelling the
foreign body from the joint, we should endeavour that its course
should be made as long as possible, experience showing that in
such cases a portion of the track may stippurate with impunity, or
at all events without the pus invading the cavity of the joint.

[Revue Med. Chirurg., and Ih,

Comparative Value of the Different Hemostatic Agents.-

A correspondent sends us the following translation, which we
publish as conveying valuable information upon an important sub-
ject. [Boston Med. and Surg. Journal.

The Gazette des Hopitaux of Sept. 29th, in an article on the
comparative value of different substances as means of arresting
haemoptysis, after remarking that bleeding for this purpose has
deservedly fallen into general disfavor, alludes to the clinical re-
searches of Dr. Aran, published in the Bulletin Gen. de Therapeu-
tique, and gives a resume of the interesting and valuable results
to which he had arrived. We translate passages which seem to
us of considerable value.

M. Aran has successively tried agents belonging to the class of
haemostatics, properly so called, such as resinous substances, the
ergot of rye and common salt ; then astringents acetate of lead,

1856.] Haemostatic Agents. 179

alum, eau de Babel, tannin, and gallic acid; nauseantsand emetics
ipecac, tartar emetic, veratrine ; and sedatives of the circulation
nitre and digitalis.

Of the agents belonging to the first group, hemostatics proper,
the essence of turpentine has seemed to M. Aran especially to de-
serve the attention of physicians. He has prescribed it pure, in
doses of from ten to thirty drops, in a glass of water, or made up
into a bolus with magnesia, and taken enveloped in moistened
wafer {pain d chanter). Generally within a few hours after the
patient commences taking it, there is a very marked diminution in
the amount of the hemorrhage, and in twenty-four or thirty-six
hours at the most, it is reduced to a very small quantity or entire-
ly ceases. On the other hand, M. Aran is convinced, as many
English and German physicians have already proved, that the
essence of turpentine is less suitable in hemoptysis, with a tenden-
cy to inflammatory action within the chest, a febrile movement, or
when it occurs in young or rather plethoric subjects, than when it
happens in debilitated, cachectic subjects, with characters of pas-
sivity or atony.

Ergot of rye and the ergotine ofM. Bonjean, have shown much
less efficacy against hemoptysis than essence of turpentine. The
former, even, when given in a very large dose, has seemed to ex-
ert only the most moderate influence upon the hemorrhage.

The same is not the case with chloride of sodium or common
salt, which has been proved to possess an undoubted efficacy in
doses of from sixty to one hundred and fifty grains taken in the
course of a few hours in solution, or in the form of powder. It is
particularly deserving of recommendation in such cases, as it is
constantly at hand.

Among the astringents, M. Aran has found none worthy of
confidence except tannin and gallic acid. Gallic acid seems to him
preferable to tannin, as, with the same styptic properties, it has not
the same drying action upon the tissues, and does not produce the
obstinate constipation which occurs when the latter is employed.
The medium close of gallic acid, as he administered it, was, from
ten to twelve grains in twenty-four hours, in powders of two grains
each, given at intervals of two hours.

M. Aran acknowledges the power of nauseants and emetics to
arrest hemoptysis, such as tartar emetic, ipecac and veratrine.
With regard to the first two this property has been known for a
long time. As for veratrine, in three cases in which it has been
prescribed, the hemoptysis was arrested as if by enchantment as
soon as nausea and vomiting took place. These agents would de-
serve, then, to be placed in the first rank of hemostatics, if there
were not others of equal efficacy, which do not produce nausea
and vomiting, effects which are always painful or disagreeable to
the patient.

Nitre and digitalis have been equally, and with good reason,

N. S. VOL. XII. NO. III. 12

180 Hcemostalic Agents. [March,

extolled in this case by the name of sedatives to the circulatory
system. Following the example ot Schmidtmann, who conceived
the idea of combining sea salt with digitalis to combat haemopty-
sis, M. Aran, for the same purpose, combined digitalis and nitre.
This mixture, it appears, produced very remarkable results.

In ordinary cases he gave in the course of twenty-four hours
four grains and a half of digitalis and twenty-three grains of nitre
in four powders. But when the hemorrhage was very profuse the
quantity of nitre was carried as high as thirty-eight grains, and
that of digitalis to eight or even twelve grains ; in some very
grave cases the quantity of digitalis given was carried to twenty-
three grains, and of nitre to sixty grains. A remarkable circum-
stance noticed was, that when these remedies were given in this
quantity the system was not affected in any unfavorable manner;
the pulse did not suddenly abate in frequency, nor was there a
very abundant diuresis. On the other hand, the effect upon the
haemoptysis was most marked ; in a few hours the flow of blood
was considerably reduced, and often after twenty-four or thirty -six
hours there remained only a little bloody expectoration. The
diminution of the hemorrhage was generally accompanied by a
great calm. Nevertheless M. Aran observed that never, after the
administration of essence of nitre and digitalis, was the arrest of
hemorrhage so sudden as after the administration of turpentine or
gallic acid.

M. Aran sums up his opinion of the respective value of the dif-
ferent agents in question, in the following words ; In profuse
haemoptysis, but not immediately threatening life, the physician
may take his choice of either of the precediug remedies. In very
profuse haemoptysis, on the contrary, where it is necessary to ar-
rest the bleeding as soon as possible, and by means the least likely
to depress the system, the physician cannot trust the tardy reme-
dies. Neither the ergot, nor sugar of lead,, nor eau de Rabel, nor
alum, nor rhatany, &c, will be equal to the emergency. Only
turpentine, gallic acid in a large dose, salt, nitre combined with
digitalis, can be employed with success; but the necessity of pro-
portioning the dose of the medicine to the intensity of the hemor-
rhage, in administering the chloride of sodium, but particularly
the nitre and digitalis, is productive of great inconvenience; the
danger of too great a depression from too large a dose, or from too
long a continuance of the remedy.

" It is then to gallic acid and to turpentine that I give the pre-
ference in these grave cases ; yet, under the apprehension of their
insufficiency, I do not think the physician should limit himself to
their use. It is under such circumstances that bandages applied
to the limbs, which are very useful in other kinds of hemorrhage,
and ice applied to the chest, have saved the life that was in dan-
ger, by stopping the hemorrhage for the moment, and allowing
the internal remedies to complete the work." A.

1856.] Methodical Cauterization. 181

On Methodical Cauterization of Abnormal Divisions of certain Or-
gans. By M. Jules Cloquet.

In two memoirs recently read at the Academie des Sciences,
M. Cloquet furnishes some account of his mode of cauterizing fis-
sures and fistulous openings, founded upon the observation of the
powerful contractile effects exerted by cicatrical tissues acting at
the angles of wounds caused by burns. He adopted it first in the
case of fissure of the velum palati. The object was not to cauterize
the entire extent of the edges of the division, and bring the granu-
lating surfaces into contact by means of sutures and apparatus a
plan long tried, sometimes succeeding, but oftener failing. The
caustic is applied over a very limited surface, at the exact angle of
the fissure; and, after the cicatrical tissue, which results has had
time to produce its retractile effect, the caustic is again applied to
the angle of the remainder of the division. The application is re-
pealed again and again, at intervals, so that the fissured parts are
thus brought towards each other bit by bit, and united by a series
of cauterizations that may be regarded as so many points of suc-
cessive suture. The operations for this infirmity, devised by Grafe
and Roux, are difficult of execution, and not infrequently fail in
success. M. Cloquet first put his plan into execution in a case in
which the whole left side of the palate was fissured as a result of
syphilitic ulceration. From eighteen to twenty cauterizations with
the acid nitrate of mercury sufficed to effect a complete reunion.
In another case of congenital fissure, the patient had already been
operated upon by Roux's method, but violent coughing had caused
the sutures to tear through. Successive cauterizations firmly uni-
ted one-half of the fissure, with which the patient was satisfied,
and refused to persevere. In a third case, M. Nelaton healed a
traumatic division by a similar employment of the electric cautery.
In 1851, a congenital fissure existing in a child eleven years old,
was completely closed after twenty applications. In all these cases
the pain was slight, no change had to be imposed in the regimen
or mode of life, and no accidents resulted. Even unpractised sur-
geons may perform so simple an operation without the aid of an
assistant. It is slow in the production of its results, but this is one
of the conditions of its success, and is of little consequence, as it
does not interfere with the business of life. M. Cloquet thinks the
actual cautery is the best means to employ, but for patients who
dread this the electric cautry may be substituted.

Another affection usually intractable is recto-vaginal fistula, and
encouraged by the above success, M. Cloquet applied successive
cauterization to its management. The index finger, guarded against
the heated body, is introduced into the rectum, and, the external
parts, being held open, the apex of the fissure is touched by a
small cautery, the patient being able to at once get up and pursue
her occupations as before. The pain and inconvenience of the

182 Synopsis of Thirty Cases of Ovariotomy. [March,

application are so slight, that the women readily submit to it. A
more considerable amount of union is produced by the early cau-
terizations than by those made later, so that the complete cure
becomes tedious a less inconvenience from the fact that the most
serious consequences of the infirmity disappear after the early cau-
terizations. [Gazette Medicate.

[M. Cloquet refers to but six cases of cure of this fistula, and to
six of fissured palate : and we cannot but feel surprised that a pro-
cedure known by him since 1826 so easy of execution and so
fertile in success as he states it to be, does not exhibit more abund-
ant results.] Ed. Brit, and For. Med. Chir. Rev.

Synopsis of Tlxirty Cases of Ovariotomy. Performed by Washing-
ton L. Atlee, M.D., Philadelphia.

Dr. Washington Atlee gives a summary of all the cases, thirty
in number, in which he has performed the operation of ovariotomy.
Such an assemblage of facts constitutes a valuable contribution to
the history of this subject. We can only give a condensed view
of the leading facts.

Case. Died. Recovered. Tumour found. Operation

completed.

1. Sixth day peritonitis .. Double ovarian . Yes.

2. .. Yes .. Fibrous extra-uterine, Yes.

8. .. Yes .. Ovarian, fibrous Yes.

4. Six months erysipelas .. Uterine No.

5. .. Yes .. Cystiform Yes.

6. In 3% years, from progress of disease .. Yes .. Uterine No.

7. Thrty-nine days after, of cholera, caused ) Vo i?^,,. . i.. v,

w ;,. ,i,,\, I - *es Extra-uterine fibrous. les.

by eating duck . j

8. Sixth day peritonitis .. Cystiform Yes.

9. Third day exhaustion .. Cystiform Partly

10. Third day exhaustion .. Cystiform Yes.

11. .. Yes .. Uterine No.

12. .. Yes .. Cystiform : .. Yes.

13. .. Yes .. Cystiform Yes.

14. Pregnant two months at time of opera- I _ B fe] tiform Yes.

tion ; died in 30 days of exhaustion. ) J

15. Third day peritonitis .. Cystiform Yes.

16. Third day haemorrhage .. Extra uterine fibrous Yes.

17. Yes .. Extra-uterine fibrous No.

18. .. Yes .. Cystiform Yes.

19. Thirteen hours exhaustion .. Cystiform . Yes.

20. Nine hours exhaustion .. Ovarian Yes.

21. Third day peritonitis .. Three fibrous extra uterine Yes.

22. Cystiform Yes.

23. 22 days gangrene of jejunum .. Cystiform Yea.

24. .. Yes .. Cystiform Yes.

25. Fifth day exhaustion .. Cystiform Yes.

26. Cystiform Yes.

27. Fifth day-hamorrhage .. - .- { ^^*^.fo:** } Yes"

28. - Yes .. Cystiform Yes.

29. Sixth day haemorrhage .. Cystiform Ye8.

80. Yes ... Cystiform Yes.

From the tabular statement we have thus constructed, it appears,
that out of 30 cases in which the operation for ovariotomy was un-
dertaken, ovarian tumours were found in 22 cases, and fibrous
tumours of the uterus in 8 cases ; that in 4 cases the operation was
abandoned, in as far as related to the object of the operation the
removal of the tumour ; that 13 cases only recovered with life, in
2 of these the tumour being left behind ;, that in 17 cases the pa-

1856.] Epithelial and Villous Growths. 183

tient died, at intervals of from nine hours to thirty days after the
operation, with the exception of one that survived six months.
The causes of death were in 3 cases, haemorrhage; in 6, exhaus-
tion; in 4, peritonitis ; in 1, gangrene of jejunum; in 1, cholera
from indigestion ; in 1, erysipelas. It is right to state, that in
some cases the author attributes the death to causes independent
of the operation. In 7 cases the operation was undertaken under
desperate circumstances, and with a view of arresting impending
death; 5 of these died; 2 survived. [Amer. Journ. Med. Soc.

On Epithelial and Villous Growths. Py Prof. Bruch, of Bale.

The majority of pathologists are at present agreed that cancer-
ous growths are primarily of local origin, and not the result of a
cancerous dyscrasia; the proofs are also being multiplied that a
transition from non-malignant to malignant growths may take
place. Professor Bruch enters into an interesting disquisition on
the nature of epithelial and villous growths, with a view to deter-
mining their pathological classification. He admits, with Lebert,
Schuh, and others, the occurrence of new growths, consisting of
cylindrical epithelium, which have hitherto been observed only in
parts normally presenting that variety of epithelium, viz., stom-
ach, rectum, collum uteri, male urethra, eye, and fourth ventricle
of the brain. Professor Bruch regards epithelial growths as the
result of a morbid development of the epithelial investment and
-epidermis, of the papillary body and of the cutis vera, which he
considers to be non-malignant ; and he establishes a subcutaneous
variety of epithelial growth, which he regards as malignant. "An
essential characteristic," he observes, "of epithelioma, papillary,
hypertrophy, and epithelial growths generally, is an intimate
union and adhesion of the cells, which prevents their extrusion
and causes their accumulation.

The villi of the chorion of mammalia are regarded by Professor
Bruch as the prototype of all normal and abnormal villous or pa-
pillary formations; all being originally formed as simple eleva-
tions of the integuments of the surface, and especially of the base-
ment membrane. After reviewing the various forms of villi oc-
curring in the body, he concludes that the growth of the papillary,
villous, or fringed formations is an attribute of all the surfaces of
the body, and that it is impossible to draw the exact line of demar-
cation between that which is normal and that which is abnormal.
Many warty excrescences, most condylomata, Clarke's cauliflower
excrescence of the os uteri, the incipient condition of some villous
cancers, are mere varieties of the same thing in different parts of
the body. We cannot conclude this brief notice without advert-
ing to an almost unique case observed by the author of the morbid
formation of ciliary epithelium. It occurred in a woman aged

184 Vapour of Iodine in Ophthalmia. [March,

forty, who died of phthisis, but had previously suffered from pain
in the head, spasmodic action of the right arm, furred sensation of
left hand, and burning of the soles of the feet. After death a
rounded, well-defined tumour, of the size of a filbert, was found
under the cerebellum, attached to the walls of the fourth ventri-
cle. The microscope showed the tumour to be composed of villous
prolongations, or pencils of vessels, closely aggregated in a dendri-
tic or foliaceous arrangement. The surface was invested by a
layer of cylindrical epithelium, many individual cells of which
were recognized as ciliary epithelium. The form and size of the
cells, the nature and seat of the nucleus, and the distinct, though
naturally immovable, cilia, precluded all doubt as to their charac-
ter. [Vierordt 's Archiv : Jahrgang : Brit, and For. Med. Cliir.Rev.

Vapor of Iodine in the Treatment of Ophthalmia. Reported at a
Meeting of the Society for Medical Observations, Oct. 15th,
1855. By Calvin G. Page, M. D.

Case I. John "Williams. Married. Coal-heaver, aged 35 a
dispensary patient. First applied to me in March, 1855, for treat-
ment of his eyes. He had partial capsular cataract of one eye,
with absence of the crystalline lens, caused by a wound with a
pointed arrow, when he was a boy. The lids of both eyes were
swollen and everted, and covered with exuberant granulations.
There was great intolerance of light, pain and chemosis, with
sclerotic and conjunctival injection, and constant lachrymation
with some discharge of pus. I commenced using freely the sul-
phate of copper with cooling applications, and in a fortnight he
was able to work a little, which he had not done for four months
previously. Dr. H. W. Williams saw him with me about this time.
He has been under my care since that time, but the improvement
would not progress beyond a certain point, though all means
known to me to be used in such cases were applied. His constant
exposure to coal dust probably prevented the usual action of
remedies. I lost sight of him during the month of August and
the early part of September.

About the middle of September he again applied to me, when
the condition of the eyes was as follows. The lids of both eyes
were somewhat swollen, the inner surfaces were covered with
granulations; there was some injection of both conjunctiva and
sclerotica, intolerance of light, dimness of vision, and lachryma-
tion with a small amount of pus. All other means having failed,
I availed myself of the fact, that iodine, when dissolved in chloro-
form, evaporates without leaving the stain of iodine, and I deter-
mined to apply this vapor to his eyes. I commenced using it on
the 20th of September and continued it daily until the 29th.
After two applications the injection about the eyeball disappeared,
leaving it in a perfectly normal condition, At the end of eight

1856.] Escape of Fluid from the Peritoneal Cavity. 185

days there was a spot near the inner eantbus, on the upper lid of
eaeh eye, entirely tree from granulations. He has been seen seven
times since the 28th of September, and the vapor has been applied.
The granulations have nearly all disappeared from the upper lids,
except at points near the outer angle. There is no intolerance of
light, and the dimness of vision has disappeared.

Case II. Annie Fowler, aged 11 years, No. 11 Friend St., a
dispensary patient, was sent by a benevolent lady to Dr. Reynolds,
Sen., who sent her to the Eye and Ear Infirmary, where she was
somewhat benefited. She has scrofulous tarsal ophthalmia. Her
mother, seeing the benefit to Williams (the patient first men-
tioned,) requested me to take charge of her. I have applied the
vapor eight times. One eye is nearly well, the other very much
improved. Both these patients are still under treatment.

The advantages of this method of applying iodine seem to me to
be that the effect of the agent is obtained more rapidly and with-
out the usual discoloration. The sensations to the patient are not
disagreeable; the effect of smarting, &c, passes away in less than
a minute. In applying it to the eyes, the lids should be closed.
The vapor seems to penetrate through them. It appears to be ap-
plicable wherever iodine is called for, as in scrofulous glands, hy-
drops articuli, &c. The atmosphere should be excluded from the
surface during the application of the vapor. [Boston Med. and
Surg. Journal.

Spontaneous Escape of Fluid from the Peritoneal Cavity. (From the
American Medical Monthly.)

Mr. Editor: The following case was recently communicated
to me by Dr. Wm. Burns, of Littleton, 1ST. H., and I have thought
it might prove interesting to the readers of the Monthly.

Mrs. H., of Bethlehem, N. H., was married at the age of 32,
having always enjoyed good health. Four years after, she became
pregnant, and during pregnancy she became dropsical. It was
believed that she had not less than fifty pounds of dropsical fluid
in the peritoneal cavity at the end of pregnancy ; but all of this
escaped spontaneously, per vaginam, during and immediately after
delivery. This occurred in the year 1791. Two years after the
birth of the child (1793,) the peritoneal cavit}'- has again become
largely distended with the dropsical accumulation, and Dr. Moore,
of Bath, N. H., performed the operation of paracentesis abdominis,
removing sixty-four and three- fourths pound of fluid.

During the following twenty-six years, up to 1819, Mrs. H. had
filled with dropsical fluid nineteen times, for which she had been
tapped six times, and had had thirteen spontaneous evacuations per
vaginam. At neither of the six tappings had she lost less than
sixty-three pounds of fluid ; and at each spontaneous evacuation

186 Luxation of the Knee. [March,

the fluid had drained off in about forty-eight hours, flowing from
the vagina once in two or three minutes. After the water had
been removed, either by tapping or spontaneously, the sternum
was so prominent relatively, on account of the collapsed state of
the abdominal walls, that a common quarto family bible could
stand on end in the hollow beneath its lower extremity. The
ribs, also were correspondently prominent, and two of them had
been broken by the distension.

Dr. Burns tapped the patient, October 21st, 1819, removing
twenty-two quarts of fluid, which weighed forty-nine pounds.
She was then in the sixty-fifth year of her age, and had been blind
four years. She had another spontaneous discharge of the fluid
(the fifteenth in all) per vaginam ten months afterwards, August,
1820. At this time more than fifty pounds were supposed to be
removed. Not long afterwards she died of some disease not con-
nected with the dropsy.

In this case there is reason to believe that the distension became
bo great that the wall of the vagina gave way from the downward
pressure, at the cul de sac, between this canal and the rectum; and
thus the fluid was spontaneously discharged in the course of about
forty-eight hours. Afterwards the rupture probably healed by
the first intention, and everything remained in the natural state
till the tension again produced the same result. And this state of
things continued for more than thirty years, without much impair-
ing the general health. The only thing worthy of remark was an
occasional attack of vomiting during the last ten or eleven years.

This case illustrates the method adopted by nature in perfor-
ming the operation of paracentesis abdominis ; and I have for
some time past been convinced that it is better to imitate the ex-
ample she has given in this instance, and tap from the vagina, in
all cases in which there is such a projection downwards of the cul
de sac between it and the rectum as to indicate the presise point
where the puncture should be made, and enable the operator thus
to make it without risk to any vessel or any neighboring part. A
report of a case under my direction, in which this operation had
several times been performed, is contained in the American Journal
of the Medical Sciences, for January, 1855. In every instance the
puncture healed by the first intention, and no unpleasant symptom
occurred. Yours truly,

New York, Dec. 1855. E. E. Peaslee.

Luxation of the Knee.

M. Royer communicated to the Imperial Academy of Medicine,
18th Sept. 1855, a case of complete luxation of the knee forward,
the tibia mounting many centimetres before and above the articu-
lating surface of the femur, without tearing of the external parts.
This luxation was easily reduced by forced flexion of the leg on

1856.] Editorial and Miscellaneous. 187

the thigh, and a prompt cure was effected. In a month the patient
could walk, and in six weeks the cure was completed. [Revue de
Therap. Med. Chiurg. Medical News and Library.

EDITORIAL AND MISCELLANEOUS.

A Manual of the Practice of Medicine. By George H. Barlow, A. M.,
M. D., Physician to Guy's Hospital, <fec, <fec. With additions by D. F.
Condie, M. D., <fec, &c. Philadelphia: Blanchard <fe Lea. 1856. 8vo.,
pp. 607. (For sale by T. Richards <fe Son.)

To those who are fond of the multum in parvo, this work will doubtless
prove quite acceptable. It is a very fair condensation of the principles
and practice of Medicine. Whether such studies ought to be condensed
at all or not, is a question upon which we have repeatedly expressed our
opinion. While a manual is well suited to the beginner, those more ad-
vanced should not be afraid to encounter more elaborate works which can
alone convey a full knowledge of disease. The additions to the work be-
fore us, by Dr. Condie, have very materially enhanced its value.

On the Organic Diseases and Functional Disorders of the Stomach. By
George Budd, M.D., F.R.S., Prof, of Medicine in King's College, London,
<fec, <fec. Philadelphia: Blanchard <fe Lea. 1856. pp.252. (For sale
by T. Richards & Son.)

The profession, already indebted to Prof. Budd for one of the best mon-
ographs on diseases of the Liver, will not fail to appreciate the present
excellent work on gastric afiections. As the stomach is one of the most
important organs in the body, and at the same time one very often invaded
by disease, any new light or even a compilation of accumulated lore on
the subject, must be valuable to every practitioner. The author has ac-
complished his task in an able manner and shows himself to be a sound
observer.

Proceedings of the American Pharmaceutical Association, at the ith Annual
Meeting, held in New York, in Sept. 1855.

Among the several Reports presented to the Association, is one on the
subject of " Home Adulterations of Drugs," from which we make the fol-
lowing extract :

Balsam Peru has been met with, possessing none of the characteristics
of genuine balsam except in color and consistency, and upon analysis af-
fording no cinnamic acid.

Pulv. Capsicum. The sample examined had a brick dust color, little
pungency, and filled with yellow specks and strong odor of turmeric. It
was a mixiure of turmeric and American capsicum, and, of course, almost
inert.

188 Editorial and Miscellaneous. [March,

Castor is found with the follicles filled with saw dust to half the weight
of the castor.

Opium. Since the circular of the Secretary of the Treasury fixing a per
centage of morphia for this drug, a more uniform quality has been found
in market; but a great many samples have been observed the past season
with foreign substances, most commonly lead, inserted in the lumps, in
some instances equal to 20 per cent, of the weight of the mass. We are
of the opinion that this was done abroad, and probably at the port whence
shipped. The different examiners should seek to detect this fraud before
passing it.

Musk in pod has been observed loaded in the same way, to the amount
of 20 grains in a single pod.

The Essential Oils are largely adulterated in this country.

Oil of Peppermint sometimes contains 50 per cent, of alcohol. Oil of
Rosemary is adulterated largely with turpentine, and in short, the whole
class are shamefully sophisticated.

Otto of Rose in the same class.

Cream of Tartar, adulterated with carbonate of lime, some samples to
the extent of 33 percent., others in less proportion. Sul. potash is also
used for this purpose, and alum largely. Of six specimens examined by a
gentleman of New York City, purchased at various shops, but one was found
pure, some of them being adulterated 30 per cent. The same gentleman
says, in reply to our enquiries, that from twenty-two specimens or samples
of essential oils, fourteen were found to contain turpentine and other im-
purities. The same gentleman reports samples of powdered opium adulter-
ated 50 per cent.

Cod Liver Oil. All kinds of fish oil may be found neatly bottled and
carefully labelled as the genuine article.

Sulphate of Quinine. Samples have been detected with the old adulter-
ation of mannite, and one gentleman reports quinine mixed up with fine
picked raw cotton, adding to the bulk so as to fill the vial without using
the requisite quantity of this valuable chemical.

Ipecacuanha in powder and Jalap in powder, each mixed with spurious
matter, and English rhubarb in powder, put up for fine powdered Turkey,
are not uncomon in all the markets.

Of crude materials, Nitre, or Saltpetre is one of the most commonly so-
phisticated, being adulterated with common salt and nitrate of soda largely.

These are some of the reports made to us, all from reliable sources.

The Committee have endeavored to establish points of observation in
different sections of the United States, and as far as possible to obtain the
names of houses from whom these various sophistications have been obtained.
Such information they deem it best to withhold from publication at present,
lest they might do injustice to parties ignorantly sending out such drugs ; but
they also intend from time to time to compare notes, and when satisfied of
continued practices of ibis kind, will report such names to the Association.

In the mean time, they cannot too strongly urge retail apothecaries
especially, to be cautious of whom and what quality of medicines they pur-
chase. It is to the dispensing apothecary that medical men and the com-
munity look for such medicines as are pure, not only "good of their kind,"
but of the best kind.

The Association offers the following prizes :

1856.] Editorial and Miscellaneous. 189

1st. Twenty-three volumes of the American Journal of Pharmacy. For
the best Essay which shall develope the commercial history of all drugs
indigenous to the United States, as Senega, Spigelia, Serpeutaria, &c, as
regards the manner and places of their collection and preparation for the
supply of commerce, the amount annually collected, and the channels
through which they enter general commerce.

2nd. Six volumes of Gmelin's Hand Book of Chemistry. For the best
Ifcsay on any question relating specially to Pharmacy.

Committee of Judges. Charles Ellis, William Procter, jr.

All Essays contributed for the Prizes must be delivered free of charge to
Charles Ellis, Philadelphia, on or before the second Tuesday in August,
1856.

A Plea for the establishment of Veterinary Colleges in the United States.
By James Bryan, M. D., Prof, of Surgery in Phila. College of Medicine.

This is quite an eloquent appeal to the Agricultural Society of Pennsyl-
vania, in behalf of our domestic animals, who would doubtless vote the
learned author a service of plate, if it were as fashionable with them as it
is with their masters. Veterinary institutions of learning exist in every
country in Europe, and number among their professors some of the first
order of talent and scientific acquirements. We see no reason why similar
ones should not exist in our country. Boston, we believe, has established
one, or is about to do so.

The Monthly Stethoscope and Medical Reporter. Under this title we
find another periodical issued at Richmond, Va., edited by G. A. Wilson,
M. D., and R. A. Lewis, M. D. The original "Stethoscope" having been
combined with the Virginia Medical and Surgical Journal, the new, or
" Monthly Stethoscope " is started for the purpose of continuing the advo-
cacy of the principles and policy of its predecessor. Hoping that the old
Dominion may afford sufficient patronage for two respectable medical
journals, and that the parties will not deem it advantageous to science to
quarrel about their subscription lists, we wish them both success in their
enterprise.

Deaths from Chloroform. Fatal cases of chloroformization continue to
multiply. One has lately occurred in Edinburgh, and another more recently
in Boston. How many more will the profession, and especially dentists,
need to make them more circumspect in the use of this valuable, but dan-
gerous agent ?

American Medical Association. The Ninth Annual Meeting of the
American Medical Association will be held in the City of Detroit, Michigan,
on Tuesday, May 6th, 1856.

The secretaries of all societies and other bodies entitled to representa-
tion in the Association, are requested to forward to the undersigned correct

190 Editorial and Miscellaneous. [March,

lists of their respective delegations, as soon as they may be appointed ; and
it is earnestly desired by the Committee of Arrangements, that the ap-
pointments be made at as early a period as possible.

The following extracts are from Article 2d of the Constitution :

" Each local society shall have the privilege of sending to the Association
one delegate for every ten of its regular resident members, and one for
every additional fraction of more than half this number.

"The Faculty of every regularly constituted Medical College or chartered
school of medicine, shall have the privilege of sending two delegates. The
professional staff' of every chartered or municipal hospital, containing a
hundred patients or more, shall have the privilege of sending two delegates ;
and every other permanently organized medical institution, of good stand-
ing, shall have the privilege of sending one delegate.

" Delegates representing the Medical Staff' of the United States Army
and Navy, shall be appointed by the Chiefs of the Army and Navy Medical
Bureau. The number of delegates so appointed shall be four from the army
medical officers, and an equal number from the navy medical officers."

The latter clause, in relation to delegates from the army and navy, was
adopted as an amendment to the Constitution, at the meeting of the Asso-
ciation held in New York, in May, 1853.

*#* Medical Journals, &c, please copy.

William Broddie, M. D., Detroit, Mich.,

One of the Secretaries.

State Medical Soctety. The Seventh Annual Meeting of the Medical
Society of the State of Georgia, will be held in the City of Macon, on
the 2d Wednesday (9th April) next, and the annual Address will be deliv-
ered at 12 o'clock, M., on that day. D. C. O'Keefe, M.D.,

Greensboro' March 1st, 1856. Recording Sec'y.

Notice to Subscribers. The Editors beg leave to say that they have no
pecuniary interest whatever in the subscription list of this Journal, and that
all communications relating to money matters should therefore be addressed
to the publisher, Mr. Jas. McCaft'erty, who is alone concerned in the man-
apement of the financial affairs of the work.

On a New Parasite in Man (Pentastomum Denticulatum Pud.) By
Dr. Zenker, of Dresden. It was Professor Siebold who first demonstrated
from the observations of Drs. Primer and Bilharz, Physicians in Cairo, the
existence of a species of the genus pentastomum living in the intestines of
man; Siebold gave it the name of P. constriction. The author states that
Eo-ypt is not the only country which has the good fortune to possess a pen-
tastome ; another species, the pentastomum denticulatum Rue, which had
hitherto been met with only in animals, is found in man; and is even very
common in Germany. The author has observed this worm seven times,
and always in the same organ, on the superior surface of the liver, under
the peritoneum. It is contained in a dense fibrous capsule which adherea
to the parenchyma of the liver and to the peritoneum, but which admits of
being easily detached ; it appears under the form of a little tubercle of from

1856.] Miscellaneous. 191

2.25 to 3.37 millimetres (.0935 to .1326 of an English inch), usually filled
with a calcareous deposit with which the animalcule is itself incrusted.
The capsule is proportionally very thick, and it is difficult to extract the
worm from it uninjured ; sometimes, however, the capsule separates easily
from the earthy concretion, and the worm can then be withdrawn.

The author gives a detailed description of the animal, and the descrip-
tion is accompanied with figures to exhibit more clearly the form of the
worm, and especially that of the tentacula with which the head is furnish-
ed. [Zeitscrift fur Rationelle Mullein and Gaz. Med. de Paris. Ameri-
can Med. Monthly.

Glass Female Syringes. By Frank H. Hamilton, M. D. Gradually
the old pewter female syringes have gone into disuse, and physicians have
substituted the neater, and perhaps, cheaper glass syringes; but the occur-
rence of several accidents, in some of which my surgical services have been
required, induce me to question the value of the substitution.

In three instances I have been called upon to remove from the vagina
the broken fragments of these syringes. In one instance the accident oc-
curred in consequence of the sudden alarm of the female while she was
using the syringe, and was in no measure, probably, due to the imperfec-
tion of the instrument; but in the two other cases the glass gave way from
the mere pressure of the fluid while the piston was ascending the accident,
certainly, might occur when the piston fits snugly even though there was
no defect in the glass : but if there chances to be the slightest irregularity
in the walls of the syringe, or a fissure, such as might easily escape detec-
tion, or an unusual tenuity of the round extremity, a fracture would be
almost certain to follow. It was this latter circumstance, viz., the extreme
thinness of the extremity of the instrument, which occasioned the accident
in two of the cases mentioned. Two other cases have been related to me
as having occurred in the practice of neighboring physicians, making in all
five that have come to my knoAvIedge.

It is probable that no examination, however critical, would enable us to
determine, before the fracture has taken place, whether the end of the in-
strument has a suitable thickness, and it is very likely that a majority of
them are blown too thin for safety. I have found the fragments not as
thick as my finger nail.

Of late I have, therefore, uniformly recommended either some appropri-
ate metallic instrument, or perhaps more generally the gum elastic bag
with an ivory nozzle. [Buffalo Med. Journal.

On the Utility of Decoction of Rhatany in Keratitis. By Dr. A. Qua-
nRi. Dr. Quadri observes, that of all the inflammations of the eye, keratitis
is one of the most frequent and most obstinate. Experience has proscribed
the employment of mineral astringents. Among those of the vegetable
kingdom the laudanum formed by the combination of crocus and opium
sometimes produces excellent effects ; but in scrofulous ophthalmia, which
is frequently but a keratitis, it occasionally gives rise to prolonged and
mischievous irritation. The author had tried various other substances, as
tannin, calumba, &c, without any definite results, when he resorted to
rhatany. The experience of six years has convinced him of its value. Its
application merely induces a sensation of dryness in the interior of the eye,,

192 Miscellaneous. [March,

and in a short time the pain and photophobia are mitigated, and the weep-
ing is much diminished. When the irritation has thus become calmed in
two or three days, the rhatany may be replaced by the more powerful
laudanum, more or less diluted. The rhatany is insufficient in the corneitis
accompanying blennorrhceal ophthalmia, but in scrofulous and all other
forms of keratitis its efficacy is constant. It is prepared by boiling half
an ounce of the root in twelve ounces of water, or decoction of elder-flowers,
down to half the quantity, and filtering. It should be freshly prepared,
and may be used three or four times a day. [Annales d1 Oculistique. Med.
Chir. Rev.

Hydrocele. At the Clinique of Dr. La Farge, (Gaz. Med. Italiana Tos-
cana,) first surgeon of the hospital Del Greve at Tolosa, it is stated on the
authority of Dr. Bellucci, that five cases of hydrocele had been cured by an
ointment of digitalis leaves. Dr. La Farge declared that he had cured a
hydrocele the size of a pear, in seven weeks, which had been in existence
for many months. The ointment is made by uniting one part of the digi-
talis leaves to five parts of lard. [Charleston Med. Journ. and Rev.

Female Medical College at Boston. This institution, which a stupid
Legislature incorporated as a concession to " Woman's Rights," we under-
stand has recently underwent that interesting process called a "blow up;"
and Miss Doctor II. M. Gasset has published a pamphlet which implicates
the directors in the perpetration of numerous fraudulent transactions, by
which the fund that has been raised for the endowment of the Institution
has been ignominiously squandered, or rather perhaps, concentrated in
wrong pockets. Sic transit gloria mundi. [Ohio Med. and Surg. Jour.

Statistics of Insanity in France. From an official document, published
by the Minister of Commerce and Agriculture, on the Statistics of France,
it appears that there are at present, for every one hundred thousand of the
population, 105 persons blind, 82 deaf and dumb, and 125 insane. [Ameri-
can Jour, of Insanity.

Anaesthetics in the Austrian Army. A circular has just been issued,
ordering that in future the army medical officers shall always employ,
for the purpose of inducing anaesthesia, a mixture consisting of one part
chloroform and nine parts ether, this being the proportion long employed
by Dr. Weiger, a Vienna dentist. [Medical Times and Gaz.

Puerperal Convulsions prior to Labour. During some recent clinical
remarks, M. Paul Dubois observed that it was formerly generally believed,
and is so still by many, that in these cases we should induce premature la-
bour. He does not agree to this view, and thinks the practice may even
be injurious. It is indeed useless, because labour always comes on of
itself, under the influence of convulsion, and it is injurious, by reason of its
irritating the uterus, and thus aggravating the convulsions. For the same
reasons, he objects to the use of ergot. He employs general bleeding, as
far as the strength will permit it, leeches behind the ears, and purgatives.
Of these last, calomel and jalap, mixed up with honey, and laid on the
tongue every hour until it operates, is the best. Sinapisms should also be

1856.] Miscellaneous. 193

applied to the feet, and ice to the head. The only operation justifiable is
the application of the forceps, when the head is engaged in the pelvis, and
solely in aid of the last expulsive efforts. [Med. Times and Gazette, flora
Oaz. des Hopitaux.

Sweet Whey in Pertussis. Dr. Lowenthal slates, as the result of numer-
ous trials, that this substance given several times a day in doses beginning
with half a spoonful, cures the disease more rapidly and more pleasantly
than any other means. [Medical News and Library.

Painless Tooth Extraction without Chloroform. With Observations on
Local Anwsthesia by Congelation in General Surgery. By Walter Blun-
dell, Surgeon Dentist. Though written in too party a spirit, Mr. Blundell's
tract maybe recommended to perusal as containing much interesting mat-
ter. Dr. Arnolt's proposal to produce temporary annihilation of local
sensation by intense cold was at first disregarded ; but now almost every
day furnishes us with some testimony of its value. We have no doubt the
method here proposed will become still more general with respect to the
minor and superficial operations, and it may be applicable, for aught we
know, in the practice of dentistry. Nevertheless, we shall require far more
evidence than at present exists in support of its power of curing (!) cancer,
its availability where deep incisions have to be made, and its neverfailing
immunity as respects devitalization, &c, of the tissues to which it is applied.
Mr. Blundell has invented a particular apparatus for the production of in-
tense cold, capable of producing it in very limited spots, and such as are
difficult of access. Stumps and large molars are removed, according to the
author, without the least inconvenience. [London Lancet.

Local Ancesthesia. We have seen and conversed with Dr. Branch, of
Galena, who has called our attention to the following notices, published in
the Galena Daily Advertiser, and Weekly Northwestern Gazette. He states
further, that he has tested it in nearly two hundred instances, and finds
that it more than meets his expectations. He is now in New York, having
manufactured the apparatus necessary for its use, which, when completed
in sufficient number, will be offered to the profession, together with proper
instructions for its use. We have strong hopes it will prove to be all that
it promises; we have not witnessed any operation performed under its influ-
ence, but from our knowledge of the man and circumstances connected with
it, we are led to expect something really useful in connection with it; we
are assured that delays in the mechanical portion have prevented a demon-
stration of its effects in time for us to speak more positively in this number.
He says he anticipates that in two weeks he shall be ready to demonstrate
its power and offer it to the profession generally.

The editor of the Advertiser says :

New Ancesthetic Agent. The following communication of Dr. Branch, in
relation to the application of a new anaesthetic agent, which he has used
successfully in preventing pain in dental operations, will attract the atten-
tion, certainly of the humane and the suffering. Our personal knowledge
of the matter is limited to a particular case, where a friend of ours was re-
lieved, and where the effects appeared to warrant all that is claimed for it
by Dr. B., as a uniform rule. From all we know, we are led to hope much

194 Miscellaneous.

from it. But, it is one of these matters around which doubts cannot long
hang, for we conclude that when a man having a tooth pulled, declares that
the operation is accompanied by no pain, his testimony should be taken as
valid in all charity, though he be not under oath.

Is it true ? Mr. Editor : Will you allow me to answer through your
paper the many questions propounded to me in reference to the success of
the new agent for producing insensibility to pain, or rather doing away with
the pain of dental operations. Those questions are Is it True? Will it do
it ? Are you humbugging ? &c.

As to the first two questions, I will answer them by quotations from what
my patients have said of it. One lady, the first case I used it in, July 27th,
said of the extracting of six strongly rooted teeth : " all the suffering ex-
perienced was fear that it would hurt."

A little girl six or seven years old, having a large double tooth extracted,
though persuaded in every way to tell exactly how it was, asserted and
reasserted that " it did not hurt a bit."

Another, a lady, said " I did not know it was out."

Another, a man, who was told if it succeeded he would be charged a fee
for its use, if not he would not, (this was a large, long-rooted wisdom tooth,)
said when through, " I am perfectly satisfied, and willing to pay the extra
fee," and paid it accordingly, notwithstanding he was under no obligations
to do so, except on the above conditions, &c. <kc.

Those are the facts on which I built my advertisement of its application.

If any wishing operations performed by me, doubt the above, they can
have reference to the individuals or their friends.

As for humbug, I wish to live by other means ; if this is humbug, I hope
my patients will always humbug me in the same way, by telling me and
others that I don't hurt them when I extract their teeth.

As to its safety, there is no possible chance of doing injury with it, ex-
cept that which might result from ignorance and carelessness.

As to its discovery, I claim my own compound, apparatus and manner
of using it. Also, as far as J know, its first successful use in dental opera-
tions. Very respectfully yours,

I. B. Branch, Dentist,

Galena, August 2, 1855. No. 85 Main street.

Then follows another of a later date, which says :

"Painful as pulling teeth," will soon cease to be a proverb. The new
application of Dr. Branch, in preventing pain in the most difficult cases of
tooth-drawing, works like a charm, as far as we are able to learn. A gen-
tleman called on us on Saturday, who had just been relieved by the process,
of a deeply rooted grinder, which had become highly inflamed, and like all
aching teeth, about " as painful as it could be." He informed us that
scarce a twinge of pain attended the extraction. That the application will
become universal in such cases, hardly admits of a doubt, and as it is per-
fectly safe, we do not see why it will not answer a similar benevolent
purpose inmost cases of surgery. [Dental News Letter.

SOUTHERN

MEDICAL AID SURGICAL JOURNAL.

Vol. XII.] NEW SERIES. APRIL, 1856. [No. 4.

ORIGINAL AND ECLECTIC.

ARTICLE XI.

A Thesis on the Detection of Arsenic .' presented to the Faculty of the
Medical College of Georgia, FeVry, 1856. By H. W. Dessy Ford,
one of the successful candidates for the Doctorate.

It may be both instructive and interesting to glance at the
marked difference in the position which chemistry now occupies,
relative to this particular subject of critical analysis, and that it
held at former periods. Instructive, because showing the wide
difference between ancient and modern chemistry, and also how
rapidly it has developed itself into the form and stature of a per-
fect science, repudiated many of its theoretical speculations, and
fixed itself itpon a firm foundation, which the cavils of the skeptic
cannot shake. Interesting, because in perusing its literature of
the sixteenth and seventeenth centuries, we are forcibly struck by
the fact, that when secret and slow poison was first introduced
into England, a few true stories of poisoning formed the nucleus
j of a thousand more, that were the creation of fancy, terror or ma-
lignity.

A writer, in speaking of the infant science, says: "It was only
natural that the wonders of the new science should excite the terror
of the ignorant, and be the subject of numerous exaggerations.
The destructive powers of arsenic, furnished a readier theme for
the marvel loving, than its powers of healing."

This arsenic was used to so great an extent, as the means for
poisoning, that many eminent, learned men, were victimized by

N. S. VOL. XII. NO. IV. IB

196 Ford, on the Detection of Arsenic.. [April.

their contemporaries; "no reckoning made, but sent to their ac-
count" suddenly by its administration at the hands of their most
intimate, ambitious friends.

The science of chemistry was then in such a state, that, although
it was called in to aid legal investigations, yet, the world had little
confidence in its powers. Then, indeed, the demands upon chem-
istry asserted themselves,, and society called out for some new light,
and scientific men were morally bound to work energetically, and
faithfully to answer these demands, or else, see their infant, though
advancing science, sink into disrepute. These devotees, then, did
begin their noble work, with minds which would not flog, though
frames would yield. They studied the properties of this newly
discovered metal more thoroughly ; noticed the different phenome-
na it presented, under numerous circumstances; perceived its-
specific effects upon the viscera of living man in short, all its
properties and different phases came to be known. This know-
ledge, with such minds as Campbell, Gordon, Magendie, and
ethers, was soon acquired, by their diligent research and number-
less experiments. Then, if a person supposed to have been poi-
soned was examined, another all important question arose: What
was the specific article? for there are numerous poisons, animal,
mineral and vegetable, each capable of causing death, and marked,
by its peculiar specific effects.

We perceive,, then, that as rapid as the discoveries in the pro-
perties and actions of arsenic advanced, the learned Profession of
the Law put forth some new questions in legal investigations,
which tended to bewilder the physician and chemist, thereby
showing that, though he supposed himself in possession of all
knowledge of arsenic, in his post-mortem examinations and ex-
periments, yet there were some items wanting to make his testi-
mony complete. The chemist and his science doubtless owe much
to the urgent demands which the Law has always presssed upon
them. These demands of the Bench have forced the chemist to a
rapid advance in methods of detection as if, unwilling that the
rational demands of one of the learned professions should remain
unanswered by the other, to its reproach. Instead of being offend-
ed by the cavils and objections of a rival profession, they have
always used these as arguments rather for more diligent study and
research. The result has been the development of methods, by
which the most stringent demands of the Law have been fulfilled,.

1856.] Ford, on the Detection of Arsenic. 197

so that this poison can not only be extracted from the organs of
the person poisoned, but actually reproduced, free from any trace
of organic matter, in its original state of arsenious acid, and of
metallic arsenic.

This art of detecting arsenic, we find, has been advanced and
perfected by another cause, the strict criticism of the proposed
method of one chemist, by many rivals for fame, in the same
arena; we must recognize this as one of the causes of progress,
even whilst deprecating the extreme rancor and bitterness, which
this rivalry has, in many instances, engendered ; even the factious
objections suggested by this spirit of rivalry, thus degenerated
into coarse personality, may not have been without their good
fruits. A striking instance of this is furnished by the history of
the Laffarge case, in 1840.

The body of M. Laffarge had been examined by three different
commissions of chemists, each of which failed to discover evidences
of arsenic, to the satisfaction of the tribunal of justice. A fourth
commission was conducted by Orflla, and others, and metallic
arsenic produced from the organs.

M. Kaspail was called by the defence to contest the results ob-
tained by Orfila. Subsequently, in the medical journals, M. Easpail
commented on these results, to his disgrace, charging M. Orflla
with using materials, known by him to contain arsenic; and with
a predetermination to find arsenic: and raising the most frivolous
objections only to give one example that the arsenic, if found,
might have been furnished by the arsenite of copper, coloring a
small piece of green paper, found on the top of the grave. In
answering these frivolous objections, the whole subject of the re-
actions of arsenical preparations was most fully again gone over.
Most triumphantly did Orfila vindicate himself from all objections
leaving his objectors to the scorn of science, for this base attempt
to invalidate his testimony, by ridiculous objections, and to stig-
matize the name of such an one a man endowed with such clean
thoughts: "his only talisman being Truth his only spell-word"
Humanity.

This same cause of rivalry, (though more honorable than in the
foregoing case,) has furnished us with very many methods of
detecting arsenic unequivocally in the dead body, which may con-
tain it.

Having thus cursorily and hastily glanced at some points in the

198 Ford, on the Detection of Arsenic. [April,

history of this subject, I shall detail some experiments undertaken,
to determine for myself, the relative value of some of the many of
these methods. This I was induced to do by the interest awaken-
ed in the subject, whilst assisting my father, Professor Ford, in
examining the organs- of a child, suspected to have been poisoned
by arsenic, during the past summer. In these experiments the
animal matter used was eoarse glue.

First, was prepared a solution of arsenic, of the strength of 1 gr.
to 3 viii. of water.

A. Cold water 3xvi. in a capsule, 3 j. of arsenical solution,,
equal to ?' gr- arsenic, four small pieces of copper wire, half inch
in length, thoroughly polished, and 3ij. of muriatic acid. This
was boiled for one hour, when the copper wires were taken out,
placed in filtering paper, and laid aside for further examination.

B. Glue iss. in a capsule, with 3j. of arsenical solution equal
to TV gr. arsenic, and 3 jss. sulphuric acid. This was boiled near-
ly to dryness, when nitro. mur. acid (nitric acid 3 parts, mur. acid
1 part) enough to moisten it, was added. Then dried by heat.
When cool, 1 vi. of water added boiled and filtered. Also liv.
water again added to remaining charcoal boiled and filtered, and
added to the above, This was done in order fully to dissolve any
arsenical preparation.

C. Glue I ss. in a capsule with water, add 3 j. of arsenical so-
lution, which was boiled to dryness and scraped from capsule.
Nitric acid 3x. in a capsule was heated and the above gradually
added, and as soon as dissolved, the mass charred instantaneously,
without flame,, leaving a dry, light charcoal. To this 3 iv. of wa-
ter added, boiled and filtered. Charcoal remained in capsule.

Biv. of water again added, boiled and filtered. Charcoal still re-
maining, was boiled in previously filtered solution and filtered,,
and filtered solutions mixed together.

D. Gluo I ss. placed in capsule, with 1 xvi. water,. 3j. arsenical
solution and 1 jss. muriatic acid ; this was boiled a few minutes to
dissolve the glue, and 4 pieces of copper wire, half inch in length,.
put in, and this boiled for an hour and a half. The wires were
placed in filtering paper and laid aside.

1 xii. water put in Marsh's apparatus, 3 j. arsenical solution,.

5 jss. sulphuric acid. Metallic spots obtained, but very equivocal.

Solution of C, 1 vii. put in Marsh's apparatus and j. sulphuric

acid. Four or five spots were obtained in about thirty minutes,.

1856.] Ford, on the Detection of Arsenic. 199

having a metallic lustre, though but two were unequivocal. Foam
not embarrassing.

After long use of the apparatus, as above, a glass globe, two
inches in diameter, having a perforated stem one-eighth of an inch
in diameter and two inches long, was perforated at the point op-
posite the stem ; the stem and the half of the globe, to which the
stem was attached, were covered with several folds of cotton cloth.
The gas from the apparatus was then inflamed, and the nozzle
introduced through the opening in the globe, so that the flame
burned about the centre of the globe. This combustion was con-
tinued for an hour and a half, the cloth on the outside being kept
saturated with water. At the end of the process about 3ss. of
fluid was found condensed in the lower part of the globe. To one
half of this condensed fluid was added a drop of ammo, sulphate
of copper. The result was a decided green precipitate Scheele's
green.

Solution of B, I vii. was put in Marsh's apparatus, and j, sul-
phuric acid added. Four or five spots, having a metallic lustre,
were obtained, but very faint. Foam was very embarrassing.
The above was taken from apparatus, and boiled to disencumber
it of sulphate of zinc; again plaeed in the apparatus, with more
of same solution added. The foam was still so embarrassing as to
induce abandonment.

The copper wires from A were put into a glass tube, and heated
to redness. The film of arsenic, in crystals, was chased by heat
into the smaller end of the tube, which part of the tube was
crushed. A small quantity of water was added, and this boiled
in a small capsule. This process was very unsatisfactory. The
copper wires from D were treated as the former; this was as un-
successful.

The solution of B was boiled in muriatic acid, to get rid of the
foam; after which, it was put into a small apparatus, of domestic
manufacture. Foam was still embarrassing. It was then put into
a capsule, boiled to dryness, and then charred with nitric acid.
Water was added, and resulting solution was put into apparatus.
From this were procured unequivocal arsenical spots. After ob-
taining these spots, the flame was burnt in a glass globe, as above,
for one hour. Took the condensed liquid and tested it with
ammo, sulphate of copper. The result was an unequivocal pre-
cipitate, though not so decided as of solution C.

200 Ford, on the Detection of Arsenic. [April,

Having undertaken these experiments for the purpose of deter-
mining the relative value of the methods used, I shall draw my
conclusions from these; not presuming to insist upon them, in
opposition to any one of expertness in such chemical manipula-
tions, who may have a different opinion, remembering that so
much depends, in such investigations, upon that expertness, which
practice can alone give. Although many writers and experts have
given the preference to the process with sulphuric acid, yet I am
constrained to believe, that the process with nitric acid is the bet-
ter of the two, and the most reliable of them all. The manner of
conducting the experiment is simple, yet exquisitely delicate. Al-
though that part of the glue, treated with sulphuric acid, gave a
similar result, in the glass globe, yet it had been treated by nitric
acid, to dissolve all the animal matter, and with all was the result
not so palpable. Another very essential difference between the two
experiments was evident, showing more fully, that the nitric acid
is more reliable. The foam was so embarrassing with that treated
by sulphuric acid, as to induce abandonment, while that by nitric
acid showed, at no time, the slightest indications of this foam. In
my notes, where the experiments are enumerated and commented
upon, it will be seen that the process with copper wire proved
unsatisfactory. This, doubtless, was owing to the coarse manner
in which the experiment was conducted from which circum-
stance, I am unable to compare that delicate process with the
others.

The process with the bulb has certainly much more to recom-
mend it as the most reliable of all processes for detecting, and
which doubtless will be considered by all intelligent experts as
paramount. In my experiments (even after a long and continued
use of the solution in the apparatus, which circumstance tended
somewhat to exhaust the arsenic), by burning the flame through
the glass globe, and testing the condensed liquid with ammo,
sulphate of copper, I procured the decided green precipitate, which
fact seems to show, that arsenic may be detected, by this method,
in very minute quantities. I did not make the test with ammo,
nitrate of silver, which doubtless would have given the peculiar
characteristic yellow precipitate, because there was none at hand
properly prepared. It may be well to add, that . whenever these
two precipitates are obtained from the same liquid condensed, the
semblance of a doubt of the presence of arsenic is immediately

1856.] F 'okd, on the Detection of Arsenic. 201

dissipated ; for the uncertainty which attaches to these liquid tests,
under ordinary circumstances, will not attach to them in this in-
stance, inasmuch as this liquid being condensed from a burning
flame, all animal and vegetable matter must necessarily have been
destroyed by that flame. In the process of metallic spots, often
they are so feeble, that although the chemist himself may be satis-
fied with the results of his tests, yet his testimony may often be
objected to, either by the counsel for the defence, or the Bench,
whereas this process with the bulb would come in as a most per-
fectly satisfactory one.

From the intricacy of this kind of critical analytic investigation,
it may be said, that one of the most difficult and responsible of-
fices of a physician is called in question, when he is required to
institute a post-mortem examination, to detect the presence of
arsenic in the viscera of the body. Difficult, because it requires
the deepest, indeed exacts a most thorough knowledge of Chemis-
try, without which he must submit to the mortification of display-
ing his ignorance of that branch of medical science, which is
actually necessary that the accomplished and educated physician
should possess. Eesponsible, because in legal investigations,
where there is a suspicion of poisoning with arsenic, it often hap-
pens that j ustice will depend on the decision of the expert. From
this last fact, then, how noble is that science which can arrive at
these conclusions and in these days with such a degree of cer-
tainty ; and what an enviable man he, who can embrace this
knowledge to arrest and detect the villainous steps and practices
' of the homicide. Besides a perfect acquaintance with the laws of
Chemistry, and with the difference between the normal and dis-
eased states of the body, a precise and delicate manipulation is also
requisite. The precaution of the systematic arrangement of every
article used, should always be taken, so as to avoid even the pos-
sibility of any accident happening from their misplacement

202 Holt's Letters upon General Pathology. [April,

ARTICLE XII.

LETTERS FROJI SAME. D. HOLT, 11. D., UPON SOME POINTS OF GENERAL PATHOLOGY.

LETTER NO. 10.

Montgomery, Ala., Feb. 25th, 1856.

Messrs. Editors To say that Calomel is one of the most valuable
of the mercurial preparations, and one of the most valuable arti-
cles of the materia medica, is but to re-assert a truth, which all
candid and unprejudiced physicians must acknowledge as having
been long since established, upon the accumulated evidence of
experience and observation, notwithstanding the unceasing and
unmeaning hostility and obloquy which it has encountered, not
only from those out of the profession, whose ignorance of its pro-
perties, and uses, is a sufficient justification for their prejudice and
hostility ; but from those of the profession, who have less justifiable
and less creditable grounds for theirs. And though we may never
expect to see the time arrive, when ignorance and selfishness will
cease to inveigh against its use, we do hope to see the time come
when honest and intelligent practitioners everywhere, will rise up
as one man, and assert and maintain the honor, dignity, and the
independence of the profession, and throw off the ban of proscrip-
tion, which has been placed upon them by popular prejudice,
fostered and encouraged, as it has been, by designing Charlatans.
For it is not only disgraceful to the profession at large, but it is
exceedingly humiliating to the honest and conscientious members
of the profession, to be compelled, in the present enlightened age
of the profession, to become apologists to popular opinion or pro-
fessional sentiment, for avowing an advocacy of the use of Calo-
mel, or any other well known and valuable article of the materia
medica.

Now, as I am addressing myself to the honest, candid, and in-
telligent portion of the profession, whether the advocates for the
use of calomel, or not, I will propound a few questions for their
consideration, and ask : What are the properties and uses of Calo-
mel?what its injurious effects? Are not its injurious effects,
more often the result of its rash or injudicious use ? Do its pow-
ers of injury, even in the hands of recklessness and ignorance, so
far outweigh the good which it possesses, when in the hands of the
prudent and skillful, as to require that it should be discarded ? or,
does the possible injury which may sometimes attend its judicious

1856.] Holt's Letters upon General Pathology. 203

administration, justify or require an abandonment of its use?
And, are there not hundreds of other remedies, which are capable
of inflicting far more serious and deadly injury, such as the lancet,
drastic and hydragogue cathartics; emetics, mineral and vegeta-
ble; lobelia, tobacco, opium, and other narcotics and poisons,
against which no hue and cry has been raised or condemnation
uttered? To answer these questions properly, and others which
would be equally pertinent to the subject, it will be necessary for
me to draw upon such authority as will be less likely to be called
in question ; but before doing so, I will take the liberty of offering
m3' own views, in order that they may have the benefit of the
testimony which I shall introduce.

The therapeutic property of Calomel, upon which its great value
depends, and indeed, the only one which I have been able to re-
cognize, is its stimulant effect upon the secretorj7, and secerning
vessels generally, having a special elective affinity for the salivary
glands and the liver, but which may be extended to the other
secretory organs, less impressible, by its combination with other
remedies having such a tendency and direction Calomel is un-
questionably purgative, in the common acceptation of the term;
but as such, its purgative effects are consequential to its stimulant
action upon the secretory and excretory vessels, and ducts of the
liver, and as the "sine qua non" to such action, it must first be
taken into the general circulation, and as this result must depend
in a great measure upon the state and condition of the absorbent
vessels., so its purgative effects will depend upon the quantity and
quality of the secretions which it causes the liver to throw out,
which, sometimes being abundant and acrid, give rise to griping
pains, and active vomiting and purging, which have too often
been ascribed to the direct purgative and irritating effects of calo-
mel. But my experience is, that calomel in the stomach and
bowels, unabsorbed, is just about as inert and as unoffending as so
much chalk; and that it is not only unirritating. but is one of the
mildest and most soothing applications to an inflamed or irritable
surface ; and acting upon such a belief, I have often succeeded in
obtaining the very best effects of calomel, by putting a sudden
and effectual stop to obstinate vomiting, which had resisted the
action of all other remedies.

In some of my former letters, I have endeavored to show the
influence of atmospheric heat, and other causes, tending to render

204 Holt's Letters upon General Pathology. [April,

the liver torpid, inactive, and liable to congestion; and I have
also shown, or called attention, at least, to the anatomical and
physiological relations which the liver sustains to all the other
abdominal viscera through the portal system of veins, which it is
necessary should be kept in view, in order that we may have a
better understanding of the action of calomel upon the liver, and
its value and importance as a remedy for the deranged conditions
of that organ, and all the organs connected with, and dependent
upon it.

I will first notice some of the peculiarities of calomel, in what is
recognized as its purgative action, and then its constitutional and
alterative effects.

The absorption of calomel when taken into the stomach, is ef-
fected chiefly by the radicles of the gastric branch and the superior
mesenteric branch of the portal vein, and this function is inter-
rupted always, and even suspended, when these vessels become
extensively congested, and in cases of high gastro-duodenal irrita-
tion, which is often the result of such congestion. In such a con-
dition of things, a certain amount only will be absorbed, before it
passes the reach of the principal absorbents, however much may
be administerd ; hence it is, that, in certain diseases and conditions,
large doses of calomel will pass through the entire alimentary
canal, without making the slightest perceptible impression, or un-
dergoing any change whatever; and hence it is, that large doses
do not purge as much, in proportion to the dose, as smaller
ones, even when the absorbents are more active, for as soon as
sufficient has been absorbed to excite the liver to throw off its
secretions, the residue will be soon carried beyond the reach of the
absorbents, and become inert: hence the necessity, even in large
doses, of combining with it opium, to prevent its too rapid pas-
sage, and thus secure its action upon the liver; or what, perhaps,
is sometimes better, a repetition of the close.* The usual effect of

* A few years ago I was called to see a man, some twenty-five or thirty years
of age, who had been treated some short time before for what his physician called
Rheumatic fever, which was accompanied with an obstinate diarrhea, anil which,
though lie had recovered so far as to be able to go about, had never been arrested.
When I visit inI him he had been in bed two or three days, and was in the following
condition: His countenance sallow, and hypocratie; his eyes wandering, with a
vacant expression; delirium; picking at the bed-elothes, and catching at imaginary
objects; jerking of the tendons. The skin hot and dry, and the pulse 140 to 150,
.when he was at all excited, small and wiry ; tho tongue dry, with a dark fur in the

1856.] Holt's Letters upon General Pathology. 205

a full purgative, or a large dose of calomel, (by which I mean from
twenty-five to thirty grains and upwards,) is to produce, after a
few hours, one, two, and sometimes three, full and free fcecal and
bilious evacuations, when its purgative effects will cease for some
hours, when it will re-commence in small and frequent and more
bilious evacuations, which, though they evince the best action upon
the secretory function of the liver, require to be checked at once
by the use of opium, in order to prevent hypercatharsis and the
consequences attending it, even though it should be necessary to
re-establish its action by its re-administration, which is sometimes
the case ; but more often the action will return upon the subsidence

centre, and tlie edges red and shining. The urine scant, and frequent serous dis-
charges from the bowels.

A review of all the circumstances of the case, led me to the conclusion that his
safety depended upon the favorable action of calomel; and if I had then been ac-
quainted with Dr. Jno. Reid's method of treating typhoid fevers with small and oft-
repeated doses, " so as to change (as he says) the existing deranged condition of the
biliary organs, and gastro-enteric mucous membrane," I perhaps might have adopted
it ; but as it was, being desirous of making an early impression, I chose twenty
grain doses, to two grains, and accoi'dingly portioned four powders of twenty grains
each of calomel, and directed one to be given every four hours, which was strictly
carried out. On the second day, perceiving little or no change, I left four other
powders of twenty grains each, to be given as before, and so on for six days, making
in all 480 grains, or just Jj of calomel. On the third day there was very little
change the pulse was less frequent, and had some more volume ; the discharges
less frequent and a little more consistent, or less liquid. On the fourth day there
*vere evident signs of improvement the pulse 130 ; tongue not so dry; less purging
and less delirium. On the fifth day the pulse was from 115 to 120, fuller and softer;
tongue and skin more moist; discharges reduced to two or three, leaden or slate
color; can be aroused to consciousness, but still slight delirium. Sixth day: has
had one discharge, 6late color, but more consistent; pulse about 100 ; almost, or
quite rational, and other symptoms in proportion. Ordered a dose of castor oil to
be given four hours after the last powder, which was given. Seventh day: pulse
full and soft, at about 90; all traces of delirium and subsultus tendinum gone;
tongue moist, and cleaning off; skin moist, pleasant and natural; countenance clear
and cheerful ; has had one large black or tar-colored bilious discharge from the
bowels, and one smaller, which was less so ; had some desire to take food, which I
allowed, and directed, in case of any more purging, to give a teaspoonful or two of
paregoric. Eighth day: called to see what damage had been done found him fully
convalescent, without the slightest trace of salivation, and I turned him over to
the cook.

In about ten days he called at my office and introduced himself, (I did not know
him,) paid his bill, thanked me for my services, and said that he never had a dose of
medicine to do him as much good as the one I had given him, as it had cured him of
a very troublesome bowel complaint, and he felt as well as ever he had done in
bis life.

206 Holt's Letters upon General Pathology. [April,

of the restraining effects of the opium, with less tendency to hyper-
catharsis. For the cathartic, or rather the purgative action of
calomel on the liver, the larger are the safer doses, for the reason
already stated, that a certain amount only will be taken up, and
when the impression is more suddenly made, is more apt to excite
the excretory vessels and ducts, and cause them to be relieved at
once of their Liliary engorgement ; hence the large, but/eu.', bilious
evacuations which follow its action in full purgative doses. By
using calomel in this mode, a double object is obtained, namely,
relieving the liver of biliary engorgement, and establishing the
biliary secretion, thus obviating the necessity for a continuance of
its use, and diminishing the risk of producing salivation, an occur-
rence which is generally a matter of temporary inconvenience and
discomfort, and of trivial consequence and importance, compared
with its great value in other respects.

There can be no doubt that mercury, slowly and gradually intro-
duced into the system, has a tendency more directly to the salivary
glands, and that endermically, and otherwise, slowly introduced,
it may excite salivation, without materially or perceptibly exciting
the secretory functions of the liver. Owing to this tendency, the
introduction of calomel by small and repeated doses, often fails in
producing its proper purgative effect; that is, it fails to disgorge
the liver of its bilious contents, unless""by the slow, tedious, disa-
greeable, painful, and dangerous process of washing them out by
a bilious diarrhea, and often fails to establish perfectly the secreto-
ry function of the liver, notwithstanding the existence of salivation,
which often occurs as the consequence of such a mode of adminis-
tration. In such a condition of things, when salivation has been
induced by repeated small doses of calomel, and the liver remains
unimpressed, which is not unfrequently the case, the very best
effects of calomel may be obtained by its administration in a full
purgative dose, which will have the effect of relieving the liver of
its engorgement, establishing the biliary secretion, and relieving
the salivation. This idea may perhaps be horrifying to the unini-
tiated, but it is nevertheless true, as I shall show by the relation
of cases illustrative of this, and other important points connected
ivith the subject.

With respect to salivation, I must say, that without being in-
sensible or indifferent to its occurrence, I have never attached
^ much importance to it, either for its good or bad consequences, for

1856.] Holt's Letters upon General Pathology. 207

the reason, that the salivary glands are not implicated and do not
require the action of calomel in those malignant affections in which
it is most serviceable on account of its action on the liver, and
other dependent and important organs; and the existence of sali-
vation does not, by any means, furnish evidence, conclusive, that
those organs have been, or will be, impressed by it. And as to its
injurious effects, my seeming indifference, no doubt, grows out of
confidence, as I can truly say, that fox the quantity of calomel
which I have used during thirty years of practice, (which the
reader may suppose has been no little,) I have salivated compara-
tively very few patients, and have never had one to suffer perma-
nent injury, or any thing more than temporary inconvenience;
and these favorable results I must ascribe, in a great measure, to
the liberal manner in which I have used it, from having been
early impressed with a similar idea respecting the action of calo-
mel, that

" Tender handed, stroke a nettle,

And it stings you for your pains ;:
Grasp it like a wan of mettle,

And it soft as silk remains."

And having acted upon it, I can boast of having generally ob'
tained the best effects of calomel, without the bad ; and all the
regrets which I have ever had in connection with its use have been
from the restraints imposed upon me, by the unreasonable opposi-
tion and unfounded objection to its use, by the patient or his
friends, in cases in which it was absolutely and imperatively de-
manded.

Having said sufficient for the present upon my own authority,
I will now introduce such testimony as will corroborate my views,
at least as to the value of calomel; and the first is the U. S. Dis-
pensator}r, by Wood & Bache, from which I will select such pas-
sages and make such comments as may seem best suited to my
purposes, (referring the reader to the entire artiele for perusal.)
Dr. Wood, who seems to have penned the article upon the proper-
ties and uses of calomel, says: "Whether the object is to bring
the system under the general influence of mercury, or to produce
its alterative action upon the hepatic or other secretory functions,,
calomel, on account both of its certainty and mildness is preferred
to all other preparations, with the single exception of blue pill."
" As a purgative, calomel owes its ehief value to its tendency to

208 Holt's Letters upon General Pathology. [April,

the liver, the secretory function of which it powerfully stimulates.
It is usually slow and somewhat uncertain in its cathartic effect,
and though itself hut slightly irritating, sometimes occasions severe
griping pain, with bilious vomiting, attributable to the acrid charac-
ter of the bile which it causes the liver to secrete. It is peculiarly
usefulm the commencement of bilious fevers, in hepatitis, jaundice,
bilious and painter's colic, dysentery, especially that of tropical
climates, and all other affections attended with congestion of the portal
system, or torpidity of the hepatic vessels." Now, it does appear, to
my mind, that this evidence is sufficiently clear and pointed in
favor of the uses of calomel (particularly as a purgative) in the
diseases of our climate, and the South generally, whose chief (if not
essential) characteristic features are biliary derangements and com-
plications, to convince any one of its value, who is not entirely
carried away by his prejudices. But while I am laboring to prove
the uses and value of calomel in such affections, it seems to be
equally necessary and incumbent upon me to prove, that " con-
gestion of the portal system, or torpidity of the hepatic vessels,"
really constitutes any part or parcel of our malignant fevers, and
other diseases of like character, which it has become fashionuble
for the opponents of the use of calomel to deny, which I can re-
gard in no other light, than as a hollow subterfuge and a flimsy
pretext for their opposition. Of this, I shall say something more
hereafter, and so will proceed with my extracts.

" In large doses, calomel is supposed, by some, to act directly
as a sedative, and with this view has been given in yellow and
malignant bilious fevers, violent dysentery, malignant cholera, &c.
The quantities which have been administered in such affections,
with asserted impunity, and even advantage, are almost incredible.
A common dose is one or two scruples, repeated every half hour
or hour, or less frequently, according to the circumstances of the
case. We have had no experience in this mode of administering
calomel." So says our author, but I have had considerable, as the
reader may suppose, by reference to the case reported in a note to
this letter.

But this case, though it presents several important and valuable
points connected with the use of calomel, is not to be taken as an
example of my ordinary mode of using it, as in this case, three or
four times the quantity was used, to what I have had to use in any
other case ; for though my common dose is from one to two scru-

1856.] Holt's Letters ztpon General Pathology. 209

pies, and sometimes drachms, I seldom have them to repeat often.
With regard to the sedative action of calomel in large doses, I
can say this, that if the term sedative is used in the sense of some
writers, to allay irritation, as a local remedy, I can testify most pos-
itively ; but if used in the common acceptation of the term, to
reduce the vital forces of the general system, and diminish the
action of the heart and arteries, I have never observed any such
action. In proof of the non-irritant properties of calomel, whether
sedative or not, the following testimony, furnished by a note to
Dr. Williams' Principles of Medicine, is very satisfactory; it is this:
"He who is familiar with the effects of mercury, calomel, for in-
stance, in common disordered digestion, with some febrile irrita-
tion, and in gastritis, cholera and dysentery, can hardly deny its
soothing and sedative operation, fully as manifest as, and in some
of these cases, more procurable than from opium. Its constitutional
effects, short of ptyalism, are often sedative and enfeebling in the
extreme." Now, the constitutional effects spoken of in the last
sentence, which I have often observed to an extent requiring the
< use of opium and brandy, I have been in the habit of regarding as
an evidence of the best effects of calomel upon the functions of the
liver. That these sedative and enfeebling effects are the result of the
passage of the pent-up products of the liver, through the intestines,
! which being thrown off, these effects subside, generally leaving
the system under the constitutional effects, "short of ptyalism."
1 And Dr. Williams himself says, "This remedy (calomel) has no fuj-
j ther sedative effects than those which proceed from its action on the
intestinal canal," which can have reference only to its local effects,,
or its sedative effects as a purgative, in the manner before stated.
But let us go on with the Dispensatory : "When the stomach or
j bowels are very irritable, as in cholera and diarrhoea, from an
, eighth to a quarter of a grain may be given every hour or two.'r
i With a view to salivation, the dose is from half a grain to a grain
three or four times a day, &c. " As a purgative, from five to fif-
L teen grains, or more may be given. Calomel has the peculiarity
that its cathartic action is not increased in proportion to the dose,
i and enormous qua?itities have sometimes been given with impunity.
In yellow fever, tropical dysentery, &c, from twenty grains to a
I drachm have been given, and repeated at short intervals, without
-producing hypercatharsis (see note); but this practice is justifiable-
. only in cases of extreme urgency, in which the constitutional ac-

,1

210 Holt's Letters upon General Pathology. [April,

tion of mercury, as well as purgation, is indicated. For children,
larger doses are generally required, in proportion, than for adults."

Now, my experience is, that in cases of irritable stomach and
bowels, and it is necessary to use calomel, the large doses are pre-
ferable, for the reasons already given. As an alterative, in chronic
cases, where the action of mercury is desirable, there can be no
question that its gradual introduction by small and frequently
repeated doses, is the most certain (if not the most speedy) method
for exciting salivation ; or, if it is desirable to procure its antiphlo-
gistic effects, by the power which it is believed to possess of
diminishing the quantity of fibrin in the blood, and of removing
the deposites of lymph and other products of inflammation, for
which properties it is held in most repute in Northern latitudes,
the objects will no doubt be obtained by such a mode of its ad-
ministration. But it is a very different affair with the acute and
malignant forms of disease in the South, in which there is sup-
posed to be rather a deficiency of fibrin than otherwise, and conse-
quently no such action of mercury is required, or if it was, they
are often so rapid in their progress, that the patient dies before the
inflammation has time to kill him, an expression which will be
explained, if it is not now understood.

Although such cases are uncontrollable by calomel, in what are
termed alterative and salivating doses, from the want of time, if
nothing else,. I have generally found the most malignant of them
amenable to large doses of calomel, Avhen it Avas used before the
nervous system had become too much depressed, or before the
healthy or sound constitution of the blood had been broken down,
not, however, from the power of calomel directly to raise excite-
ment and increase the general vital forces, or to change suddenly
the constitution of the blood, but from its certain tendency to the
liver, the secretory function of which it powerfully stimulates,
whereby "the congestion of Hie portal system, and the torpidity of the
hepatic vessels" are removed, dependent and congested, irritated
and inflamed organs, relieved and restored to the performance of
their functions of absorption, secretion, excretion, &c, whereby the
effete and poisonous matters which have accumulated in the sys-
tem in consequence of those suspended functions, are thrown off,
and continue to be, as fast as they are eliminated, thus preventing
the depravity and breaking down the constitution of the blood,
and consequent prostration of nervous power, which gives such

1856.] Holt's Letters upon General Pathology. 211

malignancy to the diseases in question, and often, as I have said,
destroys life, before any process of inflammation could accom-
plish it.

In confirmation of my views respecting the part which the liver
plays in the malignant diseases of warm climates on account of
the congestion and suspended functions to which it is liable, as
well as the value which attaches to calomel in the treatment of
those diseases, on account of the certainty with which it acts upon
that organ, and others that stand in intimate relation, nothing
could be more satisfactory or conclusive than is to be found in a
few sentences in "Wood's Practice of Medicine," where this dis-
tinguished author, speaking of the treatment of dysentery, says:
" But another important object in the use of purgatives is to unload
the portal veins. The capillary circulation in the liver is often
sluggish, and in many instances the secretion of bile appears to be
suspended. Blood, therefore, accumulates in the veins, proceeding
from the abdominal viscera, and must press injuriously upon the
capillaries of the bowels. By stimulating the hepatic circulation and
secretion, we remove this evil. Hence one great advantage of calomel.''''
Here I would stop, if the next sentence did not contain an im-
portant fact for which I have contended respecting the action of
calomel, which applies not more to dysentery than to other dis-
i eases: "This is indeed one of the most useful cathartics in dysen-
tery, having the advantage of mildness in its action on the mucous
I membrane, while it excites the liver." But the consequences of such
a condition of the liver are not less injurious, or is calomel less
i efficient in diseases of the stomach and smaller bowels, the spleen
| and pancreas, and the liver itself, all of which are in closer prox-
! imity and as likely to be effected by pressure from the distended
I portal veins, which it is important to unload as in dysentery. It
j is not, however, the congested condition alone of the liver which
ji gives to our diseases the character of their greatest malignancy, but
!| it is the consequences of the suspended secretions which usually
attend that condition, but which may exist without the congestion,
I which generally gives to our diseases their dangerous and too often
I fatal character, by poisoning and breaking down the constitution
| of the blood from the non-elimination of the impurities generated
'\ in the system, as is the case in our worse forms of bilious remittent
- fever, yellow fever, dysentery, pneumonia, &c.' and in all of
\ which calomel is not less prompt and certain (if properly used) in
N. S. VOL. XII. UO. IV. 14

212 DUGAS. Lithotrity in the Female. [April,

restoring the suspended secretions, than in unloading the portal
veins. But the beneficial effects of calomel upon the liver are not
confined to the chylipoietic viscera, especially so far as concerns
the restoration of the secretions. Dr. Chas. I. B. Williams tells us
that (p. 243) " The congested state of most organs, which occurs
when the respiratory process is imperfect, renders necessary reme-
dies suited to remove this state. The lungs, the brain, and the
liver, suffer most. The best remedies in these cases are mercurial,
and other remedies which act freely on the secretions. Probably
these remedies act in part by making the liver assist the lungs in
the office of decarbonizing the blood. The speedy relief afforded
to dyspnoea by a bilious diarrhoea, has several times seemed to me
to countenance this notion.." Now, what Dr. Williams here states
as "probable," I know to be positively true; for having myself
been afflicted for more than, twenty years with asthma, I have
never failed of being relieved very soon by the occurrence of a
bilious diarrhea, which often comes to my relief, and puts a stop
to a violent paroxysm. And who is there,, who has had any expe-
rience in the treatment of bilious or congestive pneumonia, that
has not seen the most prompt and decided relief from free, bilious
purging, from the use of calomel? Indeed I can say, to the best
of my recollection, I have never lost a patient with pneumonia,
where such a result was early obtained; and, in this disease (in
cases attended with torpor and congestion of the liver), I have al-
ways regarded calomel in the light of a life-preserving, if not a
disease-curing remedy.

As the space allotted to my letters will not allow me to go on,
having already reached the usual length, and having a desire to say
something more upon the subject, and to present a few oases illus-
trative and confirmatory of my views respecting the uses of calomel,
I will stop for the present, and resume the subject in my next letter.
Bemaining yours, as usual,

Saml. D. Holt-

article xiii.

Lithotrity in the Female. By L. A. DuGAS, M. D., &c.

Since the perfection of the instruments for crushing stones in

the bladder, and the extension- of their use, there must be but few

surgeons who would consider themselves excusable for resorting

to the knife in calculous affections of females, unless circumstances

: i

1856.] Dugas. Liiholrity in the Female. 213

of a peculiar character rendered lithotrity impracticable, which is
very rare. Indeed, the shortness and great dilatability of the
female urethra, very materially facilitate the introduction of the
lithotrite and the manipulations subsequently necessary to the
seizure and crushing of the stone ; so that the cases in which this
operation cannot be performed are infinitely more rare in females
than in the other sex.

In May last, (1855) Miss E. H., about 8 years of age, was placed
under my charge. She had been a sufferer with stone from her
infancy, and was in a truly deplorable state when she arrived here.
Very much emaciated, sallow and hectic, she suffered excruciating
paroxysms of pain almost every half hour, during which her
screams were heart-rending to her friends. Incontinence of urine
and prolapsus ani added to her discomforts. Upon endeavoring
to sound her, the slightest contact of the instrument with the ori-
fice of the urethra would bring on a paroxysm of pain. Under
these circumstances, she was placed under the influence of con-
centrated chloric ether, and a careful examination was made with-
out difficulty. This confirmed her own belief, by revealing the
existence in the bladder of two calculi, which could be felt by
placing the instrument between them so that they could be strick-
en alternately by inclining the blades to one side and to the other.

A week was consumed in quieting and preparing her for the
operation, and on the 29th of May, in the presence of several pro-
fessional brethren, having secured the limbs with bonds, as for
lithotomy, and administered the chloric ether by inhalation, a
(calculus of one inch and a quarter in diameter was seized and
crushed. The crushing was done five times at this sitting.

7th June. Has had no severe paroxysm of pain since the oper-
ation. Has passed a large number of fragments, say about a tea-
jspoonful. Has had cholera-morbus twice from improper food,
which reduced her very much. The crushing was this day repeat-
ed six times, the largest stone seized measuring one inch and the
=mallcst half an inch in diameter. The etherization was only par-
tial, as she conversed during the operation, but felt no pain.

14th June. Has passed a quantity of fragments, most of which
i.vere lost in the alvine discharges, which became frequent and dys-
enteric, attended with a great deal of fever and some cough. An
ittcmpt was made to operate to-day, but she was so much exhaust-
ed that it was not completed ; yet the bladder did not partake of

214 Remarks on Uterine Affections, [A^rW,

the general disturbance, and her paroxysms of pain had pretty
much ceased.

21st June. Finding her health pretty much improved, the
crushing was done to-day six times without inconvenience ; the
fragments seized were all small.

26th June. Passed fragments and detritus for two or three days
after the last operation, but none for a few days past. Introduced
the lithotrite to-day, but could find no calculus.

29th June. Explored the bladder carefully with the lithotrite
and finding no vestige of stoner discharged the case. The patient
returned home in a few days and has ever since enjoyed fine
health, as I have been recently informed by the family physician.

The history of this case illustrates the happy influence of anaes-
thesia in such operations, for the apprehensions of the little patient
and her excessive nervous susceptibilities were such that it would
have been utterly impossible to operate without it. The chloric
ether was therefore used at each sitting. Bonds were used to pre-
vent accident.

The calculi were composed of ammonio-magnesian phosphate
of lime.

Augusta, Oa., 1st March, 1856.

Remarks on Uterine Affections,, based on the Discussions /"1849 and
1854 at the Academy of Medicine of Paris. By Camille Mel-
chior GrlBERT, Physician to the Hospital St, Louis, Secretary
of the Academy of Medicine, etc., etc. (Translated from La
Revue Medicale.)

Twenty years ago, Lisfranc adopted and extended a theory
already abandoned by his master Dupuytren, by attributing to
Chronic Metritis every symptom peculiar to woman almost, and
making this morbid state the starting-point and origin of cancerous
affections of the womb. It was an easy matter, consequently, for
Lisfranc, to prevent malignant uterine disease, or ever* to arrest
it in its early stages.

The popular applause with which his lectures were greeted, and
the crowd of terrified women which sought at his hand the cure of
diseases that others had rightly pronounced incurable, turned Lis-
franc's head. He carried a list of his achievements to the Institute.
He had the temerity to ask for the chair of Dupuytren, and the
Monthyon Prize. He declared that amputation of the neck of the
uterus, as the prophylactic or curative treatment ofcances, was one
of the most brilliant conquests of modern surgery.

1856.] Remarks on Uterine Affections. 215

Two years had scarcely elapsed, after the presentation of this
academic memoir,* when another surgeon, a pupil of Lislranc, and
an assiduous and impartial witness of his practice, struck down the
pretentions of the great operator, in a book which made a great
sensation in its day. I will leave the ashes of the dead in peace,
and refer the curious reader to M. Pauly's work f for details of that
scandalous episode in modern surgical history. I will only mention
here, that Lisfranc himself abandoned his brilliant operation soon
afterwards, that he withdrew his memoir to the Institute, and that
he never replied to Dr. Pauly's work.

Still the surgeon of La Pitie continued, in his lectures and prac-
tice, to base the special pathology of women on Chronic Metritis
and its results : granulations, engorgements, ulcerations of the neck,
congestions of the body of the uterus.

In 1837, when I first endeavoured to convince practitioners by a
multitude of clinical facts, J of the abuses which had been brought
about by a theory based on an application to uterine diseases of the
system of Broussais, attention was especially directed to ulcerations
of the cervix uteri, and it was this lesion more particularly that was
j supposed to be prevented or cured by various topical remedies, es-
pecially by repeated cauterizations.

I do not hesitate to reproduce here the plain language which a
just indignation then extorted from me; for these are ail matters of

I history :
" It is sad to reflect that in the era of industrialism and moral degrada-
tion in which we live, some men of real attainments, who occupy stations
which command the public confidence, do not fear to descend to the level
\ of those healers of ulcers and the whites, whose putrescent advertisements
j sully the columns of the public journals, or offend the public morality in
street-corner placards."

" There are to-day, in this capital, a multitude of lazy or hysterical
women confined to bed, subjected to a useless regimen, and wrongfully
harassed by explorations, caustic-applications, or operations designed to
cure diseases which have no existence /"

I will recall also as a starting-point in any discussion as to the
value of the uterine lesions revealed by speculum-examinations, two
assertions that I advanced in the Academy without a word of con-
tradiction.

1. The different alterations and variations in colour, size, form, texture,
and position of the neck of the uterus, which certain surgeons have incor-
rectly regarded as the origin and exclusive cause of a multitude of morbid
symptoms, may exist, and be clearly ascertained to exist by the touch and

* In 1834.

\ Maladies de V uterus, d'apres les lecons cliniques de M. Lisfranc, faites a Vhipital
de la Pitie. Par H. Pauly, ex premier prosecteur de M. Lisfranc, etc,. Paris, 1836,
.jl vol. 8vo. Germer Bailliere.

| Memoire sur les ulcerations du col de la matrice, et les abus da speculum, uteri.
Revue Medicale. Dec. 1837.

216 Remarke on Uterine Affections. [April,

Speculum-examination, without giving rise to any of those symptoms which
have been ascribed to them.

2. That the symptoms which Lisfranc, in particular considered the ne-
cessary concomitants of uterine engorgement (as others, at the present day
attribute them to uterine deviations) are observed in cases in which noth-
ing" is found of those local alterations that are supposed to be their source.*

So that it is demonstrated, to my satisfaction at least, that on the
one hand, these material lesions are far less important than has been
asserted ;jhat sometimes, indeed, their existence produces no in-
convenience : and, on the other hand, that the various pains, the
local discomfort, the nervous sufferings, observed in many women
condemned to Lisfranc's treatment, should be referred to a very
different cause from the one which was thought to indicate the ne-
cessity for that sort of practice.

In Dr. Pauly's book may be learned the extent to which errors
in diagnosis and abuses in practice were earned in those days. The
neck of the uterus was not unfrequently amputated when perfectly
healthy, and the appearances due to incipient pregnancy were mis-
taken for morbid lesions !

And it must not be fondly thought that in our day, when Lis-
franc's treatment is no longer popular, that these errors are not
committed. Although the majority of surgeons have been brought
to confess that ulcerations of the cervix are commonly mere tempo-
rary alterations, connected with uterine catarrh, and of little im-
portance in themselves, they still treat these unimportant lesions by
applications of caustic, and not unfrequently some of the most emi-
nent of their number have pronounced women affected with ulcers
of the womb, (and what alarm this phrase excites in patients' minds!)
whose wombs were not ulcerated at all, but simply presented at the
os tincae a redness caused by an uterine discharge and following
its phases, or even a permanent scar, or spot, such as is left occa-
sionally after the process of parturition.

It cannot be repeated too often that the uterine lesions revealed
by the speculum depend on two principal causes : 1. Syphilis (pri-
mary and consecutive venereal ulcers, depressed and circumscribed
granulations of the cervix, the lesions resulting from blennorrhagia ;)
2. Uterine catarrh or leucorrhoea, which may accidentally be ac-
companied by redness, irregular granulations, superficial erosions,
passive congestions of the neck, engorgements, etc. In the latter
group there are two important divisions ; sometimes the leucorrhoea
is only the symptom of a general condition or diathesis, (whether
strumous, gouty, or dartrous.) that demands the physician's chief
attentionf ; sometimes on the contrary, the local catarrh assumes

* Bulletin de VAcademie clr Medicine, Tome XV. p. 147.

+ Many of our patients at St. I.oujswith eczema and impetigo are subjected to
discharges which have their periodica] exacerbations im<l remis.-ions corropoiuliut:
to dartrous (psoric) crises. Oftentimes redness and excoriations of the cervix uteri,
which are but temporary, supervene on these exacerbations.. Note of the Axiihor.

1856.] Remarks on Uterine Affections. 217

apredominant importance, and becomes the source of general and
local nervous symptoms which require topical treatment from the
first, treatment consisting chief!)' in free injections of cold water
{douches ascendantes) and astringent washes.*

While opposing the exaggerations of the theory and practice of
his master, and especially the useless amputations of the uterine
neck, Dr. Pauly retained the teachings of La Pitie in relation to
the local treatment of engorgements, which Lisfranc regarded as the
climax of uterine pathology.

It was reserved for another pupil of Lisfranc to reduce to their
real value the assertions which the surgeon of La Pitie advanced
on this subject, with so much confidence.

Dr. Baud undertook in a memoir addressed to the Academy of
Medicine in 1849, to establish that the uterine affections on which
Lisfranc particularly fixed his attention had their source, almost all
of them, in a constitutional affection, of which the local lesions were
simple consequences. This author maintained that Lisfranc be-
guiled by the errors of the Physiological doctrine, had made inflam-
mation the origin of all the chronic diseases of the uterus, and
engorgement their constant result. (And many a surgeon in our day
has got no farther.)

On the other hand, Dr. Baud, attaching great importance to cer-
tain deviations of the womb, regarding them as the causes of most
cases of dysmenorrhoea and sterility, discovered in one particular
displacement {anteversion, which he proposed to remedy by a
special instrument) the source of a multitude of disorders, of en-
gorgements among others. Engorgements were thus made a
secondary local lesion, altogether refractory to the treatment for
chronic metritis.

M. Hervez de Chegoin regarded the opinions of M. Baud as too
general and too exclusive. He attached as much weight to retro-
version as the author of the essay did to anteversion.

The conclusions of Dr. Baud's memoir are remarkable, and they
agree so closely to some of my own assertions, that I shall quote
them literally. They are summed up in the three following gen-
i eral propositions :

1. All treatment which ameliorates the condition of the functions in
j general is one step towards the cure of uterine diseases.

2. All treatment the effect of which is to benefit the local disorders at
the expense of the general economy aggravates these diseases.

3. The treatment should be in accordance with the idea that the condi-
tion of the uterus is passive and mechanicaL

This last proposition might serve for an epigraph to M. Valleix'
\ recent cases ; but let me not anticipate. The memoir of Dr. Baud

*See my Memoir on the Treatment of Leucorrhaa (Rev. Med. April, 1845;) and
remarks on the Therapeutics of Diseases of Women, (Bulletin de Therapeutique,
January, 1848.) Note of the Author.

218 Remarks on Uterine Affections. [April,

and the remarkable report of M. Hervez de Chegoin, excited a dis-
cussion in which many distinguished surgeons expressed their
views.

The day the report was read, I could not forbear remarking that
I had opposed for twelve years past the practice which some modern
surgeons adopted, in consequence of ascribing an undue importance
to the uterus, and attending solely to local symptoms, a practice
pregnant with errors and abuses. How much wiser was the theo-
ry and practice of the enlightened and concientious savants of the
last two centuries, who considered that the non-gravid uterus played
a subordinate part in the economy, and regarded that organ as a
sort of emunctory, whose fluxes and congestions usually depended
on some cause affecting the system at large ! Long since, I propo-
sed to substitute for caustic and the antiphlogistic treatment in
vogue, the use of astringents, cold, injections of cold water, sitz-
baths, etc., combined with such means of support or readjustment
as the mechanical displacements of the uterus might indicate.*

At the following meeting, I had occasion, in reply to different
speakers, to review some of the assertions made in the discussion,
many of which were contradictory, and could prove were it neces-
sary, how anatomical diagnosis may lead the prejudiced into error,
notwithstanding the perfection to which it has been brought, and
that its advocates are pleased to term it the only true foundation for
rational practice ! Thus while Lisfranc proclaimed engorgements
the mother-lesion of the disorders peculiar to women, his disciple Dr.
Baud considered them a secondary result, and M. Velpeau went so
far as to doubt their existence. But, by way of compensation, the
professor of La Charite announced the frequency of an inflexion of
the neck, the source of a great number of symptoms, a morbid state
which many eminent surgeons, MM. Moreau, Malgaigne, and Roux,
among others, declared they had never seen. Then came M.
Robert, seeking to extricate ulcerations of the cervix from the kind
of discredit into which they had gradually declined, and ascribing
to granulations of the uterine meatus all those symptoms which
Lisfranc referred to engorgements. Lastly, while the author of the
memoir considered anteversion as the commonest and most serious
deviation, the author of the report maintained that retroversion was
the predominant lesion. If we consider, also, the discrepancies of
opinion in regard to anteflexion and retroflexion of the cervix, we
shall form some idea of the want of unanimity not only in regard to
the value of the diagnostic signs of uterine disease, but in respect
to the very existence of these signs.

For my part, I am quite disposed to admit, with MM. Lisfranc,
Joberr, Malgaigne, Roux, and Huguier, that chronic engorgements
of the cervix uteri exist ; but I regard them almost invariably as the
effects of a lymphatic diathesis, the consequences of parturition, or

* Bulletin d I'Academie, T. XV, Seance du 9 Octobre 1849.

1856.] Remarks on Uterine Affections. 219

the complications of leucorrhoea. When, under such circumstan-
ces, local and general morbid processes are developed, these proces-
ses being nervous and congestive rather than inflammatory, will not
yield, as a general rule, to the antiphlogistic treatment advised by
Lisfranc. nor to cauterizations of the neck of the uterus. In addi-
tion to the sedative and astringent local treatment I have mentioned,
I insist on the necessity of general treatment adapted to the lympha-
tic, herpetic, gouty, or syphilitic diathesis, which frequently keep
up discharges from the uterus, and prevent the cure of the engorge-
ments, granulations, and ulcerations revealed by the speculum.

On the other hand, I am altogether inclined to recognize, with
MM. Velpeau, Moreau, Huguier, Hervez de Chegoin, and Baud,
uterine deviations, as the source of local symptoms, provided they
are sufficiently grave and lasting to constitute real diseases. But I
also admit, with MM. Jobert, Huguier, and Moreau, that there are
abnormal states that are quite harmless, which are sometimes im-
properly treated as morbid conditions.

As to M. Amussat's opinion, which makes no account of the
notions our predecessors have left us, and dates the commence-
ment of the science of uterine affections from the application of the
speculum, I reply that he forgets two things: 1. That the errors in
diagnosis exposed in the discussion also date from the invention of
that instrument; 2. That the principal object of that debate was to
pass judgment on the special pathology and therapeutics which Lis-
franc and his imitators substituted for the history of Leucorrliaza or
uterine catarrh, as described by the physicians of the last century
and the commencement of the present. I leave it to the profession
to decide whether that judgement has been advantageous of the
modern theory and practice. As to those moral influences, which
were so little regarded in the surgical discussion, which neverthe-
less present such curious phenomena in all the diseases of woman,
and especially in those women whose imaginations are excited by
the fear of what they term an ulcer, I have already described their
effects, and presented them to the attention of practitioners ; * and
I purpose hereafter to return to this interesting subject.

I come now to the late discussion, excited by a report of M. De-
paul on various documents relating to the treatment of uterine dis-
placements by Professor Simpson's intra-uterine pessary, which M.
Valleix adopted and introduced in France.

The extended and judicious report of M. Depaul terminates with
a series of conclusions, some of which I will quote in substance.

"1. The influence of uterine deviations on the health of women has been
considerably exaggerated."

I extend this proposition, and apply to it all the other local lesions

* See my article on the neuroses in the March number of the Revue Medicale, for
1840 ; the report of M. Jolly, in the number for Septembar, 1843. Lastly, the num.
ber for January, 1848, of the BulLetin de Therapeutique. Note by M. Gibert,

220 Remarks on Uterine Affections. [April,

which have heen successively brought forward as the causes of
nearly all the discomforts experienced by women, (ulcerations en-
gorgements, granulations.)

" 2. In many cases, the symptoms referred to these deviations, are pro-
duced by some other pathological state of the uterus."

I suppress the words: of the uterus; for in many women treated
as if affected with some lesion of that organ, the uterus presents no
morbid alteration that can be appreciated by the senses ; in some
cases even, moral causes alone produce the symptoms.

" 3. Deviations (within a certain limit and under certain conditions)
constitute only a simple unimportant deformity, which has no deleterious
influence on the health."

"4. There are some deviations, however, though they are infrequent,
which appear to induce serious disorders, and to require the intervention
of art."

" 5. Those who have attributed the ameliorations and cures of a large
number of women to the use of the intra-uterine pessary, have overlooked
the fact that, in these cases, other means were employed, whose well known
action (in chronic phlegmasia", or a neuralgic condition) explain the results
which were obtained."

' 6. The cases communicated by MM. Broca and Cruveilhier to the
Academy, and other cases observed in France and England, demonstrate
only too clearly the danger atteuding the employment of the intra-uterine
pessary. "

" ?. ^Ye therefore think that instruments of this kind (from which we care-
fully distinguish the hysterometer, or uterine sound, an exploring instru-
ment applicable to certain exceptional cases) should be condemned and
proscribed, for they are useless, being incapable of producing the effects
expected of them, and exposing patients to the most serious dangers."

Many of the orators who participated in the first debate, engaged
in this, sustaining, with some modifications, the opinions which they
advanced in 1849, in regard to the general question, and examining
the points which were more especially the object of the report. One
of them, M. Malgaigne, who had previously argued against M. Vel-
peau's views on inflexions of the cervix, admitted that a more
attentive study of the subject and an extended experience, had
changed his opinions in this particular.

I shall briefly review the principal topics embraced in the discus-
sion which followed M. Depaul's report, commencing with the
speech of M. Malgaigne.

The orator referred, in the first place, to the discussion on the nature and
treatment of uterine affections, which took place five years ago. "The
difference of opinion which were then manifested still prevail ; what some
attribute to uterine displacements, others refer to engorgements, to metri-
tis, uterine catarrh, or simple neuroses, while others again discover in some
general condition of the organism, the source of every local disorder.
What is now required according to M. Malgaigne, is exactitude of diagno-
sis, which may enable us to connect certain symptoms with some precise

1856.] Remarks on Uterine Affections. 221

species of alteration, and to get rid of the confusion which involves those>
who see the same kind of lesion in simple and complicated cases, and em-
ploy the same treatment in all. Having directed his studies with this view,
M. Malgaigne had arrived at the conclusion that the uterine affections under
discussion might be distributed in three principal divisions, viz :

1. Displacements, (prolapsus, anteversion, anteflexion, retroversion, re-
troflexion.) The principal diagnostic sign is found in the effects of the
vertical and horizontal positions of the body, which suddenly and com-
pletely aggravate or relieve the patient's sufferings.

2. Chronic Metritis of every variety, (engorgement, catarrh, granula-
tions, etc.) The cervix is painful when touched, and the recumbent
posture (which is necessary for a cure) only moderates the pain, without
relieving it altogether.

3. Neuroses, or neuralgia?, which are observed under two forms: neural-
gia of the cervix, and neuralgia of the appendages of the uterus.

JV1. Malgaigne considered M. Depaul's condemnation of the intrauterine
pessary too absolute. It was proper, in the first place, to make a distinction
between simple catheterization of the uterus, which was almost exempt from
danger and the employment of an intra-uterine pessary. It was also neces-
sary to take into account, the rare and exceptional cases in which mechan-
ical treatment, by the pessary, redressor, or hypogastric girdle, have pro-
duced sudden and instantaneous relief, and also those vet more remarkable
examples, in which the simple contact (cittouehement) of an instrument
with the cervix uteri has sufficed to dissipate the symptoms.

M. Malgaigne's general conclusion is, that the intra-uterine pessary
should not be condemned until it has been thoroughly tested, by being used *
with prudence and precaution in those cases in which diagnosis clearly
indicates the necessity of a redressing instrument.

It is obvious that this is an incomplete view of the subject. In
his three grand divisions, the orator makes no mention of constitu-
tional causes or diathesis. Does he not admit, with us, that
syphilitic, strumous, gouty, and dartrous diathesis are the sources of
catarrhs, erosions, and engorgements, which cannot be considered
mere local lesions of the uterus ? What value does he attach to the
influence of the moral on the physical faculties, by which morbid
symptoms are so readily engendered in women? What are we to
understand by metritis, if congestions and fluxations, passive and in-
flammatory engorgements, discharges, ulcerations, and divers speci-
fic lesions are classed under this term.

M. Depaul replied to M. Malgaigne; he did not, however, ap-
proach the main question, but insisted on this fact, which, he
maintained, was established by incontestible statistics, viz:

That a great number of uterine displacements produce no symptom
whatever ; and that, in many other cases, when concomitant lesions are
cured, the symptoms erroneously attributed to displacement disappear of
themselves.

M. Huguier came next, and by a precise and logical argument
attempted to prove, from anatomical, physiological, hygienic, and

222 Remarks on Uterine Affections. [April,

pathological data, that some displacements (anteversion, retrover-
sion, inflexion, anteflexion and retroflexion) were the direct causes
of special disorders of the functions of the pelvic viscera, and that
oftentimes they could be rational]}' treated and cured.

He believed that latero-flexions and latero-versions usually depended on
irremediable anatomical anomalies, but that they usually produced no
in commodity ; the same tiling nearly was true of anteflexions, (the very
deviation that M. Velpeau had pronounced, in the former discussion, the
cause of the symptoms usually ascribed to so-called engorgement.) The
retroflexions and retroversions, direct causes of sterility in some cases,
involved difficulties, M. Huguier said, that it is not easy to remove. Often-
times, however, he had succeeded with his fingers, aided by an uterine
sound, and a bougie, or pledgets of lint in the rectum, in reducing or par-
tially rectifying such deviations. Of all displacements, anteversion could
be treated most advantageously, by an hypogastric bandage, by astringents,
and appropriate decubitus. Not unfrequently an abnormal mobility of
the uterus produced unpleasant symptoms, and in these cases the hypogas-
tric belt was particularly efficacious.

M. Hervez de Chegoin followed M. Huguier, and, in his turn,
maintained the practical importance of displacement as an element
of uterine disease, and discussed its treatment by mechanical means.

M. Hervez established three principal classes of deviations : anteversion,
retroversion, and prolapsus. He declared that he had often relieved dis-
tressing general symptoms, unaccompanied by local symptoms,(which prac-
titioners would consequently hesitate to refer to their true source,) by
replacing the uterus by means of a special extra-uterine pessary. He for-
merly denied that deviations were harmless, as has been maintained by some
surgeons, who mistook the exceptions for the rule. He was positive that
displacements produced sterility and a variety of serious symptoms, which
could only be relieved by a mechanical treatment. He advocated his own
pessary, which was innocuous, and pronounced the instrument of Simpson
irrational and dangerous. In consequence of its communication with the peri-
toneal cavity, he considered all irritation of the cavity of the uterus unsafe.

M. Paul Dubois replied to M. Hervez, expressing his disbelief in
the efficacy of the method of reduction employed by the letter.
He though that replacing the uterus by acting on its internal walls
was a rational proceeding in certain cases. The question was,
could it be modified so as to avoid the dangers that now attend its
use. In 1849, M. Dubois pronounced an extended discourse on the
whole subject of uterine affections, in which, although he attached
more importance to the etiology of chronic metritis than I do, yet,
the distinctions he established and the reservations he made, approx-
imated his views much nearer to mine than to those of any other of
the speakers. It was at the meeting of the 10th of June that the
judicious and eminent professor replied to M. Hervez de Chegoin.
On June 27th, he resumed, and took up the subject of uterine dis-
placements and their treatment.

As in 1849, M. Dubois attributed primary importance to chronic metritis,

1856.] Remarks on Uterine Affections-. 223

and he ascribed to this complication, like the reporter, M. Depaul, the
majority of those symptoms which other* made to depend on displacement.'
He believed that most of the patients suffering from these symptoms, even
those successfully treated by the Simpson Valleix method, were cured by
the removal of the co-existing chronic uterine inflammation. By tempo-
rarily replacing the womb, and keeping it in a state of immobility, time
was afforded for the resolution of the concomitant metritis. The orator ad-
mitted also, that an intra-uterine instrument might favorably modify a state
of local nervous irritability which existed in many women. He believed
that the intra-uterine instrument was applicable in the exceptional cases in
which the gentler means in common use, antiphlogistics, sedatives, astrin-
gents, cauterization, pessaries, etc., have failed. He observed that in con-
sequence of disordered menstruation depending on. uterine lesions, a state
of chloro-anaemia was often induced, which only yielded to general treat-
ment. He had two grievous faults with which to reproach the intra-
uterine redressor, regarded as a special method of treatment : 1. It caused
pain and inflammation which might become fatal ; 2. It did not procure a
durable reduction or replacement of the deviated or displaced womb.
Operators were utterly deceived on this point.

M. Cazeau objected to ascribing to an hypothetical metritis the symptoms
observed in women palpably affected with displacements- or engorgements.
He denied the existence of chronic metritis, as far as related to the par-
enchyma of the womb, (imitating the scandalous incredulity ofM. Velpeau,
who in 1849, denied engorgement, and substituted therefore, anteflexion.}
M. Cazeaux admitted with MM. Huguier and Hervez de Chegoin, that pro-
lapsus, retroversion, antevers-ion, and even anteflexion, were direct causes
of symptoms remediable by mechanical means. He thought that the
reporter, M. Depaul, had strikingly displayed the dangers of the intra-
uterine pessary, but had not appreciated its advantages. M. Cazemi agreed
with Professor Dubois in thinking that cures might be obtained, in excep-
tional cases, by the prudent and careful application of this instrument,,
which were not attainable by any other method.

I avow that MM. Dubois and Cazeau appeared to me too lenient
towards the intra-uterine instrument, restricted as are the advan-
tages they attribute to it. M. Gillebert d'Hercourt, of Lyons, has-
demonstrated in my opinion, by his experiments on the dead subject,
the superority of pessaries of volcanized caoutchouc, which can be
inflated after introduction, over all other mechanical means for the
adjustment of uterine displacements.* At the meeting of July 4th,
the discussion was continued by Professor Velpeau.

He opposed the opinions of his colleague M. Dubois. He believed that
the uterus could be replaced by the Simpson-Valleix instrument, or by any
analogous intra-uterine bougie carefully applied and properly superin-
tended ; and a radical cure was attained thereby, whereas pessaries and
hypogastric belts are palliatives which must be habitually and indefinitelv
employed. He had often used similar instruments, and had acted on the
internal surface of the uterus by catheterism, injections, cauterizations, etc.,

* M. Gillebertr8 researches are published in a pamphlet {Etudes sur le mode'd ac-
tion des pessaires, 8 vOi Lyons, 1854) which we have been unable to obtain. -*-0.

224 Remarks on Uterine Affections. [April,

so frequently, that he was inclined to think the dangers of M. Vaileix's
method were grossly exaggerated ; the method, moreover, could be modified
and perfected. M. Vaileix's results were remarkable and deserved atten-
tion. The three fatal cases which have been so bruited abroad should be
compared with the very numerous cases in which intra-uterine redressement
had been successfully em ployed. The orator regretted that M. Depaul had
not discussed the fatal cases reported by MM. Broca and Cruveilbier,
instead of making a condemnation of the method of M. Valleix the special
object of his report.

M. Velpeau entertained doubts in regard to the neuroses and phlegma-
s-iae invoked by some of bis colleagues in explanation of the obscure points
in this question. He referred to the frequent blunders to which Lisfrauc's
engorgements had given rise, and insisted that the anteflexions and retro-
flexions, to which he had first called attention, were the sources of charac-
teristic, local symptoms. These displacements were not always curable ;
but hypogastric bandages, pessaries of different forms, and intra-uterine
sounds and redressors were resources of art that were sometimes employed
with complete success, after the failure of all other remedies.

This debate, like the one that preceded it, has proved that the
greatest diversity of opinions may exist among the most eminent
and enlightened men in regard to material lesions, which are acces-
sible to vision and to the touch *

Uterine displacements, which were barely mentioned in the dis-
cussion of 1849, and which many surgeons at that epoch, contested
or altogether denied, at least as a pathological species, with a char-
acteristic array of symptoms; these uterine displacements we?e the
turning point of the discussion of 1854.

Now if we recall the predominant importance which surgeons
have, in the last 30 years, successively assigned to chronic metritis,
to ulcerations of the cervix, to engorgements of the neck, to granula-
tions of the internal surface, and lastly, to deviations, we may safely
predict that the latter lesions will not long enjoy their "bad emi-
nence" in uterine pathology. If, on the other hand, we rellect on
the serious and disasterous consequences which have resulted from
the practical application of these wild etiological theories, we shall
appreciate the value of words of caution promulgated by an esteem-
ed and enlightened Academy.

* It is curious to see how certain aristarchs, with the arrogance and imperturba-
ble impudence engendered by the habit of being eloquent in the closet, have under-
taken to lecture the orators of the Academy, and to assign subjects for their expres-
sions of opinion.

"No one [if we believe these gentry] has laid down Hie true basis of the discus-
sion. . . To make displacements of the womb and their treatment by the intra-
uterine pessary a simple practical question, is [in their judgment | the way to leave
the Academy as much in the dark as before the discussion.

0 profound logicians, eminently positive philosophers! I think that you might
learn a lesson of modesty in these various appreciations and interpretations of mate-
rial and positive facts, elicited from the learned and skillful men who engaged in the
discussion which you regard as so unphilosophical Note of M. Qibert.

This indignant growl is intended for Dr. Auiedce Latour, editor of the VUuion
Medicate. Translator.

1856.] Remarks on Uterine Affections. 225

When we see great surgeons so possessed by illusive hypotheses,
as to propose and practice amputation of the uterine neck in women
with no serious lesion, or no disease whatever of the uterus; when,
in other instances, incipient pregnancy has been mistaken for grave
uterine disease requiring the most energetic treatment ; when,
over and over again, we observe patients subjected to cauterizations,
pessaries, bandages, protracted decubitus, and the remedies of a.
whole special therapeutical arsenal, who continue to suffer until
they abandon their unfounded apprehensions, and abstain from all
surgical treatment ; it is impossible to deny that flagrant abuses
have been introduced in the treatment of diseases of women, abuses
which it is the right and duty of academic bodies to signalize.*

To caution the learned and skilful against their own delusions;
to enlighten the ignorant who accept, with blind confidence, the
theories promulgated by the former, and practice whatever is advi-
sed by men of eminence ; lastly to admonish the public at large of
the dangers to which too great credulity will expose it, these are
the objects which may be accomplished by a decided expression of
opinion by the Academy. This may be attained by a slight, but
important modification of the conclusions of M. Depaul's report.

I cannot now refer to all the facts in favour of the version which
I advocate. But I may be permitted to advert briefly to the fact
that the nervous, strumous, dartrous, syphilitic, rheumatismal, gouty,
and hemorrhoidal diatheses, very frequently give rise to symptoms
that are commonly ascribed to those uterine lesions which occupied
the exclusive attention of Lisfranc and his pupils, lesions that are
purely secondary when they really exist.

I hasten to admit that local lesions not infrequently coexist witfe

* "I have examined," Dr. Duparque writes, " portions of uterine tissue, in a per-
fectly normal state, which had been removed in consequence of supposed schirrous
induration of the cervix."

"lean affirm," Dr. Deligny said to me, "that while Lisfranc was temporarily
clinical surgeon at St. Come, I saw him amputate the cervix rn three cases in which
only slight erosions existed."

A woman in the commencement of pregnancy was on JLRoux's operating table,,
at Hotel-Dieu, to undergo amputation of the cervix uteri. From some cause, the
operation was postponed, when the patient's condition was happily discovered.

An eminent surgeon examined a lady of twenty-six years bj the touch, and gave
an alarming prognosis ; he thought that if she continued to neglect herself, in two
months it would be necessary to have recourse to extreme measures. He had just
amputated her elder sister's cervix. Subsequently this young lady attributed every
uneasiness to her -ulcerated uterus. I had great difficult}- in eradicating these notions;,
but after venisection, baths, rest, and mental discipline, her symptoms were amelio-
rated, and her cervix was in the healthiest possible condition. [Quotations f rem i the
work of Dr. Paidij.\

For my part, I hare attended two young women, in whom incipient pregnancy
was mistaken for uterine disease. It was proposed to amputate the cervix in one
case, and, in the other, to burn it off with the actual cautery. In both, pregnancy
was normal and regular.

I am also acquainted with two ladies of over srxty years, in whose cases a cele-
brated surgeon advised removal of the oervix thirty years ago, who now enjoy per-
fect health. Note of M. Gibert.

226 Hemarks on Uterine Affections. [April,

the general diathesis. The most common is uterine catarrh, of
which, redness, tumefaction, superficial ulceration, and passive con-
gestion of the cervix, are incidental accompaniments, which occur
particularly in women who have borne several children.

But the degree of importance ascribable to these lesions is to be
estimated from a multitude of local and general circumstances In
many cases, it depends entirely on the amount of mental disorder
excited by apprehension of uterine disease, which disorder re-acts
on the physical organization. It is thus that we are able to account
for cures obtained by the most dissimilar and singular methods.
Some local phenomenon ceases, which has kept up what I call the
uterine monomania, and presently all the nervous symptoms excited
by this monomania cease likewise.

I will adduce a single illustration of these strange recoveries, in
which moral influences are chiefly effectual, although attention to
the local condition is also requisite :

A weak and nervous lady became alarmed by the reports of several
friends, who were undergoing speculum treatment for womb-disease. She
presented an anteversion of the womb, the organ being very moveable in
a large pelvis; there was a decided anteflexion of the cervix, and uterine
catarrh. In addition to these local signs, there existed the cortege of
symptoms that Lisfranc attributed to engorgement: gastralgia, hysterical
spasms, bearing-down pains in the loins, sense of weight in the perineum,
and pain in locomotion.

After divers ameliorations and relapses, a menorrhagic attack supervened,
which was a finished stroke to the terrified lady, who took to her bed, and
remained there for some months, the bleeding recurring from time to time.
At last, I resolved to employ a kind of pessary recommended by old Dr. Dev*
illiers, which is nothing else than an unripe orange. The soft and polished
surface, and rounded form, of this fruit, allows it to remain in the vagina
without causing discomfort, while its rind furnishes an astringent juice.

The green orange was introduced during an intervel in the metrarha-
gy ; the next day, the lady left her bed ; the pains ceased ; no more blood
appeared except at the regular monthly period, when its quantity was
moderate. Two years have elapsed, during which this lady has enjoyed
uninterrupted health.

The pessary escaped during an effort of defecation five days after it was
applied.

In this case as in many others, I attribute the cessation of the
symptoms to the moral reaction which took place when the imagi-
nation was calmed, and diverted from eternal contemplation of the
uterus. It is useless to add, that in the case reported, the deviations
of the womb continued notwithstandidg the restoration of the
patient's health.

We must not forget that, barely twenty years ago, the cervix
uteri was amputated for simple ulcerations, and that if this opera-
lion had not almost immediately produced several disasterous
results some surgeons would still practice it. Now there are innu-

1856.] Etiology and Hygiene of Cancerous Tumours. 227

merable examples of women who refuse to submit to this operation,
who are now in perfect health.

I trust that the operation of intra-uterine redressement will be
abandoned in its turn. Meanwhile, there is both utility and pro-
priety in a salutary announcement to the medical public, of the
abuses in surgical practice in uterine affections. It was on this
account, that I proposed to amend the conclusions of M. Depaul's
report, which apply only to displacements, so that they should em-
brace diseases of the womb in general. Thus modified, the conclu-
sions would read as follows : >

1. There has been great exaggeration of late years in regard to
the influence of displacements of the womb, and other uterine lesions,
such as ulcerations, engorgements, etc., on the health of women.

2. In many cases, the symptoms ascribed to these lesions, are
produced by pathological causes of an entirely different nature.

[ Virginia Med. and Surg. Journal.

On the Etiology and Hygiene of Cancerous Tumours. By Professor
Bouchardat, of the Faculty of Medicine of Paris.

Having devoted a good deal of attention to some of the points
involved in the great discussion on cancerous tumours which has
lately agitated the academy of medicine, I had resolved to take
part in the debate. But in preparing my remarks for that occa-
sion, I found myself wandering so much from those subjects to
which the discussion was limited, that I have determined to ar-
range my ideas in this form, hoping that the facts which I am
about to produce, may, one day, be of use in the investigation of
those difficult and important questions which relate to the etiology,
hygiene and prophylaxy of cancerous tumours.

Before entering upon the matter before us, I cannot resist the
temptation of expressing my opinions, with regard to one of the
parties to the late academic debate. I mean that party who deni-
ed the value of the microscope in clearing up the diagnosis of
cancerous tumours. To some of these persons who have taken
part in the debate, I am tempted to address a question, which I
never fail to propose to those who talk with me about the alco-
holic ferments, and who regard with doubt, the admirable discov-
eries of M. Cagniard Latour. " Have you studied the ferments
with the microscope ? No. Well, begin at once to study them
conscientiously, and then we will discuss the subject."

I well know that the subject of cancer presents many serious
difficulties, but by ascertaining precisely the definition of the term,
we can for the most part, explain away the difference of opinion.
It is very evident that if we retain the old definition of cancer, the
microscope will furnish information of great value without doubt
but which will still not be pathognomonic.

Cancer, they say, is an accidental production, capable of being

N. S. VOL. XII. NO. IV. 15

228 Etiology and Hygiene of Cancerous Tumours. [April,.

transmitted hereditarily r lmt produced more frequently from un-
known causes. It generally increases rapidly, invading the sur-
rounding tissues; ulcerates in process of time, producing great loss
of substance, and sometimes large and repeated hemorrhages ; de-
veloping in the neighbouring glands and ganglions engorgements
of the same nature as the primary tumour; returning most gener-
ally after ablation, either in the cicatrice or in the neighbouring
glands, or in some other part of the economy; producing in its last
stages a peculiar cachexia, and giving birth, in at least one-half
the cases, to the production of many tumours either in the liver,
lungs, or some other part of the system.

We comprehend without difficulty, that some one of these symp-
toms might be absent, and yet, that the existence of cancer would
be not less certain. But does the manifestation of these various
characters constitute a unique, fundamental disease, as for instance,,
the various manifestations of the syphilitic poison constitute a
malady identical in its origin?

If we pursue this comparison carefully, it is plain that if from
its causes, progress, and treatment, we should conclude that syphi-
lis is a special disease, assuming various forms, we must conclude
that the cancer of the old authors cannot be considered as a mor-
bid unity. Diseases, certainly presenting many points of resem-
blance, yet differing in many important features, have been group-
ed together under the general name of cancer^ I doubt not that
the time ia coming when these distinctions will be established, and
I believe that we approximate the truth when we say, that cancer
does not form a morbid species,, with distinct varieties, but should
be rather considered as a class of diseases with many symptoms in
common.

Nevertheless, before determining this great question of the mor-
bid unity of cancer, we should examine the objections to be urged
against that large number of partizans who group cancerous'
affections together,, just as they group syphilitic or tuberculous-
affections.

There is no doubt that from the point of view in which many
authors- have placed themselves, this morbid unity seems very
apparent, but when we regard this difficult question in its other
aspects; when we consider the important facts which can be ob-
tained from its etiology and therapeutics, our faith in this morbid
unity diminishes; We can understand how an illustrious surgeon
can say " I appeal to* my study of this affection at the bedside,,
and I divide cancer into three classes those which always return,
those- which frequently return, and those which rarely return,"
( Velptfflt, session of l/he Academy, 9lh January.) The great surgical
experience "which has led to this opinion, deserves our highest
respect, particularly when it emanates from one who has so ably
and patiently examined this difficult subject. But to the physi-
cian, this problem, can receive another solution. To him, the dis-

1856.] Etiology and Hygiene of Cancerous Tumours. 229

tinction of the micrographer leads to useful results which cannot be
appreciated by the surgeon who views the question in a different
aspect.

Before going farther with this discussion, I will reproduce vari-
ous extracts from the Moniteur des Hopitaux, the work of M. Broca,
a young surgeon, who at the same time is a micrographer and
clinician. That he has studied the subject with great diligence is
proved not only by the beautiful essay which was received with
so much approbation by the academy of medicine, but also by
many other remarkable articles which appeared in the journal
edited by M. Caslelneau.

We have the most profound conviction, that future investiga-
tions will show the precise distinctions which exist between the
j varieties of cancerous tumours. At this time, the majority of phy-
! sicians confound the simple glandular hypertrophies and cancerous
tumours properly so called. But although the science is not suffi-
ciently advanced, to determine accurately the lines of difference,
yet we cannot doubt that some progress has been made.

Let us now examine the etiology of cancerous tumours. We can
take up successively the influence of hereditary causes and of age,
before we discuss the important questions of diet, moral influence
and external violence. We should sift to the bottom the chaos of
malignity, and endeavour to shew by what rules we may either
avoid cancers, or retard their progress when the evil has develop-
ed itself.

Hereditary influences play an important part in the pathogeny of
cancer. M. Leroy d'Etiolles estimates that there is an hereditary
transmission in one-tenth of the cases; M. Lebert in one-seventh.
Without disputing these statistics, I will remark, that the heredit-
ary influence in the genesis of diseases, comprises not only a native
l predisposition, but also a group of habits formed by a similarity
'of education or even of organism, and that very often these hygi-
enic habits lead many generations to the same end. Hereditary
predisposition is not alone the fatal cause, but we can by rectifying
the customs and bad habits of our predecessors, avoid the curse
under which one or more generations have fallen. I am convinced
ithat this view of the subject deserves serious attention.

Functicnis of the skin in connexion tuiih age. We see cancers at
all ages. It has been observed in children that the eye is usually
'the part affected, but it is a well established etiological fact that
jthe relative frequency of cancer is much greater in the decline of
adult life or in the beginning of old age.

The appearance of the three principal species of cancer; cancer
properly so called, cancroids and fibroids, coincide most generally
with a degeneracy of the functions of the skin and especially in
that important function (and yet one but little studied in its patho-
genic effects), the production of the epidermis, with its appendaceS'
"ithe nails and hair.

230 Etiology and Hygiene of Cancerous Tvmours. [ApriTr

The important principles which are eliminated by the skin under
the form of epidermic scales and hair, play an important part in
the animal economy, and many diseases of the latter years of life
appear at this period of giving way in the functions of the skin.

External violences. We attribute in the etiology of cancer, much
importance to the influence of external violence. I am far from
denying this influence, but it is evidently indispensable that the
other conditions of age and predisposition should be also present
to give any value to this cause.

Depressing moral influences and passions. The moral affections,
and more especially grief, has a certain influence on the develop-
ment and progress of cancerous affections. The effects of sorrow
are depressing, they repress the energies. The skin is the first
organ which feels the general languor. We can very well under-
stand then, how these emotions lead to cancer, if the conditions of
age and of nutrition are also present. We can also see how these
depressing influences are involved in the word malignity, an ex-
traordinary expression in scientific language, and which means
something that we do not understand. However this may be, we
have two principal interpretations of this word in connexion with
cancer.

Cancer is called malignant either when it leads rapidly to death,
or when it extends quickly into the neighboring glands or into
different organs than those originally attacked. That both of
these results are greatly encouraged by the influence of the emo-
tions of grief, we well know, and hence the influence which these
passions have over the question of the maKgnity of cancerous tu-
mours.

We say that a cancer is malignant, when it extends very rapidly.
This occurs when there is a change in the nutritive functions, in
fact, when there is an anomalous action established in the organ-
ism. It continues, indeed, because the movement advances in the
direction it first assumed. Stahl has adopted this maxim of Plato,
which expresses the idea: facilius est movere quieiumquam quietare
motum*

Without doubt, the skin does- not alone participate in this ab-
normal direction of the vital movements, but it plays a part worthy
f attention. It is very probable that the three principal species
of cancer are caused by different modifications of nutrition. So
we will say, though with great reserve, that the true cancer arises
from a diminution of the epidermoid productions, and is influenced
by age, or by some modifications of nutrition in the glands and
lymphatic ganglions; that the development of fibroid coincides-
with a diminution in the epidermoid production and a diminution
or aberration in the production of fib re, and that cancroid owes its
origin principally to a perturbation in the epidermoid functions.

Diet. Deducting the many glandular hypertrophies which are
often confounded with cancer,. I am convinced that diet has a great

1856.] On Urcemic Eclampsia. 231

influence in producing the three species of cancer. An exciting
and largely predominating animal diet may do much in develop-
ing this disease.

The reasons I have for this opinion are drawn from the fact,
that this affection is almost always met with in carnivorous ani-
mals; the remarkable immunity of the Trappists who never eat
meat, which is attested by M. Debreyne, and the mode of destruc-
tion and elimination of the residue of animal matters.

Prophylaxy. I will sum up, iu conclusion, the rules I believe
most useful to follow, to prevent cancer, or to arrest its progress
when the malady has displayed itself:

1st. To rouse the functions of the skin by cold baths, by daily
frictions with coarse flannel or hair gloves.

2d. To stimulate the muscles by daily and regular exercise, and
! "by gymnastic exercises in proportion to the powers of the system.

3d. To prefer a vegetable diet, and to eat very moderately of
i meats.

4th. To avoid moral emotions particularly of a depressing char-
acter, and to keep the mind amused and agreeably occupied.

5th. To obtain either by regular habit or by some purgative, one
\ or two regular operations from the bowels every day. [ Virginia
Medical and Surgical Journal.

On Uratmic Eclampsia. By F. WlEGER.

Dr. Wieger proposes to defend that new view of eclampsia
which regards it as a complication of uraemia, against the older
views sustained by L'Huillier and Depaul. He divides his me-
moir into six parts :

1. Critique of the Negative Observations. The author seeks to
i show that the cases of eclampsia without albuminuria, recorded
j by L'Huillier, Depaul, and Mascarel, must be eliminated, either
j because the albumen was not searched for with sufficient care,
i or because the absence of albumen does not prove the absence of
! uraemia.

i 2. On tJie Condition of the Kidneys.- He seeks to invalidate the
, assertion of Blot, that the kidneys in eclampsia are not always dis-
i eased, by the collection of as many cases as possible. He main-

tains that in albuminuria, fibrinous cylinder-casts are always found
|i in the urine, and that these often increase after delivery, and are
I found, ras Braun and Litzmann have shown, so long as there is

albumen in the urine.

He gives a table, which shows that up to the tenth day of the
j puerperal state anatomical lesions in the kidneys are always found ;
and that profound alterations of the kidneys are more frequent
i than congestive conditions.

He concludes this section with the following deductions :

232 On Urcemic Eclampsia. [April,

a. The kidneys may be diseased without albumen being separ-
ated in the urine in observable quantity.

b. The absence of albumen at a given time is no sure proof of
the absence either of disease of the kidney or of uraemia. The
presence of albumen at a given time stands in no relation to the
stage of the disease.

c. The albuminuria increases at the approach of labor, during
labor, and the fits of eclampsia.

d. The kidneys cannot pour out albumen in any considerable
quantity, or during a certain time, without becoming clogged up
and diseased.

e. The appearance of the kidney-disease is often complete, and
effected in a short time ; often it persists in a slight degree, and be-
comes aggravated in following pregnancies.

/. When it persists during the puerperal state, the disease of the
kidney induces other attacks, or causes complications, or aggra-
vates existing ones.

g. Albuminuria grows with the occurrence of complications.

3. Albuminuria and (Edema. a. On Albuminuria. Is there
albuminuria without nephritis? The author cites instances from
Simon, Schmidt, Henoch, and Canstatt, to prove the affirmative.
As to the curability of the nephritis which attends pregnancy, he
shows that as it depends upon transitory conditions, it is not like
Bright's disease, which is commonly dependent upon persistent or
recurrent external causes, as cold, &c.

By adducing the statements of Blot and Litzmann, which ex-
hibit the presence of albuminuria in fifty-six primipara? out of a
hundred and seventy-eight, and in twenty-two multipara out of a
hundred and fifty-nine, he confirms the opinion, that the first la-
bor is a predisposing cause of albuminuria and eclampsia.

b. Of GMema and Anasarca. The presence or absence of this
symptom has no constant value in diagnosis. It is not always
present in Bright's disease,

4. On Unemia and Uramiic Symptoms. a. On Uraemia. Uras-
mia, the result of nephritis, is characterized in its chemical relations
by the retention of water and excrementitial matter in the blood,
which in its turn is impoverished by the loss of albumen and some-
times of globules. The excrementitial matter is thus driven to
the skin, stomach, or salivary glands, and even to the lungs, or
accumulated in the serous cavities or cellular tissue, to be taken
up again into the blood, to aggravate the uraemia. For this reason.
a strong diuresis may often persist a long time without exercising
a remarkable influence on the nervous system. The degree of
intoxication can only be determined by simultaneous examination
of the blood and of the urine. He cites two cases of Gegenbauer
and Chaiari; in the latter, urea, and, by decomposition of this,
ammonia, were found in considerable quantity in tha blood, and

1856.] On Urcemic Eclampsia. 233

the prophecy that eclampsia would break out was verified. The
woman died.

b. On Urcemic Convulsions. In seventy-eight cases of Bright,
Barlow, and Frerichs, there was amaurosis and amblyopia tea
times; syncope, nineteen times; singing in the ears and deafness,
ten times; convulsions, fourteen times. The cerebro-spinal symp-
toms which precede the attacks of eclampsia have the closest
resemblance with those of Bright's disease. Out of a hundred and
forty cases of eclampsia collected into a table, forty-three showed
premonitory symptoms. Of the cases in which the eclampsia broke
out before labor, there were forty per cent ; of those in which it
began during labor, thirty per cent ; and of those in which it began
after labor, twenty per cent., which were attended with premonito-
ry symptoms. As premonitory symptoms, the author enumerates
vomiting and diarrhoea, but principally headache, disturbance of
intellect, and often delirium ; cramps and amblyopia, sometimes
followed by blindness, not unfrequently precede. The changes of
the pulse and pupils were too uncertain to be considered.

As characteristic of the so-called ursemic eclampsia, the author
mentions that no predisposition lies at the foundation of eclamp-
tic convulsions; they cannot become habitual; as a rule, the fits
are frequently repeated. The disease is never chronic; it makes
' no periodic relapses, and seldom returns in subsequent pregnan-
l cies. The symptoms are those of epilepsy, without the cry at the
I onset.

The question as to the relation between epilepsy and eclampsia
| the author regards as not settled, but inclines to the view that
' epileps}*- predisposes to eclampsia. Apoplexy of the brain and
> membranes may cause fatal convulsions, and appears frequently
| as a complication of Bright's disease, and makes the diagnosis more
i serious.

5. Etiology aud Prognosis, External Predisposing Causes. The
j bad method of living of the poor favors the disease, and is the rea-
I son why it is more frequent in lying-in hospitals than in private
i practice.

Individual Predisposing Causes. First pregnancies, twin preg-
i nancies, are mentioned. Dubois has pointed to distortion of the
N pelvis and rachitis, duration of labor, and mal-position of child,
1 asphyxia, indigestion ; mental excitations, as fright, anger.

The mortality is, according to Murphy, 24 per cent ; Blot, 354-
' per cent: Lever, 28 per cent; the author, 30 per cent The mor-
tality among the children is given by Blot as 67 per cent, and by
i the author as 45 per cent. Many children died shortly after
! birth, without inspection revealing any tangible cause of death.
j Frerichs, Litzrnann, and Braun ascribe this death to intoxication
of the blood.

U 6. Treatment The author divides the prophylaxis into a remote
(against the albuminuria), and a treatment against the ursemic pro-

234 Cesarean Operation. [April,

dromata, shortly before the labor. The peculiar condition of the
blood indicates the following fundamental rules of a rational treat-
ment:

a. The blood must be improved by good nourishment, tonics,
and iron; Miquel recommends a vegetable diet,

b. Exciting diaphoresis by baths, &c.

c. Gentle purgatives,

d. Maintenance of the urinary secretion by gentle diuretics.

e. Direct action upon the renal obstruction, by abstraction of
blood from the region of the kidneys.

Treatment of the Uraimic Pre-current Symptoms before Labor.
Tartar emetic, vapor baths, and scarification of the cedematous
parts, are considered. Chailly recommends chloroform when there
is great tenderness in the uterus. The author regards it only as a
palliative against the convulsions, and not as against the funda-
mental evil, the urgemia. General bleeding he regards as a precious
means. The expectative method, the author regards as admissible
when the convulsions are not strong, or first appear during the
expulsion of the child. Opium, much praised by many authors,
is, according to the author, chiefly useful after delivery. Cold
affusions, are recommended by Recamier and Booth,

Coma after cessation of the fits, the author treats with diaphoret-
ics, salines, and diuretics, since the condition of the brain is caused,
for the most part, not by hyperemia, but by serous infiltration.
Of revidsive measures, the author rejects cantharides. Of anti-
spasmodics, musk has been useful after too great depletion.

The author then adduces several cases in which artificial delive-
ry was resorted to, showing that often there is a rapid cessation of
the attacks after the emptying of the uterus, and that the mortality
is about the same.

Abortion. Convulsions which appear before the period of via-
bility of the foetus, end for the most part with its expulsion.

In eclampsia before the beginning of labor, he enjoins excitation
of the pains and hastening of delivery. He uses secale corimtum
for this purpose, when the head cannot be reached by the for-
ceps, [Schmidt's Jahrb. Med. Chir. Rev,

On the Cesarean Operation, and its performance more than once on
the same subject. By Prof. Stoltz, of Strasbourg.

For upwards of fifty years, says M. Stoltz, this operation, al-
though fretpaently resorted to in Paris, has not generally been
followed by success, whilst towards the close of the last century it
was, in numerous instances, attended with the best results, in the
hands of the celebrated accoucheurs of that period, Lauversat,
Deleurye, Coutouly, Millot, etc. This failure of the operation, in

1856.] Ccesarean Operation. 235

the practice of modern surgeons, he considers as having led to its
being regarded as much more hazardous than it really is, and to
its consequent restriction to those cases in which it is found impos-
sible to effect delivery by any other method. Thus, the aceoxich-
eurs of Paris have nearly all been induced to adopt the English
practice, according to which, rather than risk the life of the mo-
ther, they sacrifice that of the child, wherever the difficulty appears
surmountable by so doing ; a proceeding which our author believes
to be unjustifiable, on the grounds that one life is taken without
any certainty of thus saving the other. M. Stoltz has performed
the Gaesarean operation six times, with the result of saving both
mother and infant in four of these instances, and the child in the
remaining two. The latest of these cases is that which he commu-
nicates to the Academy of Sciences, as possessing additional
interest in the fact of its being the second occasion in which the
operation had been performed, with complete success, on the same
individual.

The patient, AdeleFenninger, set. 39, was the subject of gener-
al rachitic deformity, and had been operated on, three years pre-
viously, by Dr. Bach, of Strasbourg, who published the case in the
Gazette Medicate, of that city, in 1846. On that occasion the
operation was successful, although performed under very unfa-
vourable circumstances, the patient being "radicalement" rachitic,
in very delicate health, ill nourished, and suffering from consider-
able obliquity of the uterus. At the time of the operation, some-
what too large an incision in the abdominal and uterine walls was
attended with troublesome protrusion of the intestines ; and during
the progress of the case, erysipelatous inflammation of the points
of suture, and phlebitis, followed by oedema of the left inferior
extremity, were circumstances which more than once threatened
the life of the patient ; however, by careful attention, these dan-
gers were averted, and a complete cure was obtained in the space
of two and a half months.

The second operation, which presents no features of much im-
portance, is minutely described by M. Stoltz, who remarks, that
from the ordinary course of the second pregnancy, three years af-
ter the first operation, it may be concluded that the cicatrization
of the uterus had been sufficiently perfect to resist with impunity
a second dilatation of that organ; and that the second operation,
like the first, had been complete in its success, mother and child
being both saved. In conclusion, he refers to a number of other
instances where the operation had been repeatedly performed on
the same patient with successful results. The following published
cases are enumerated by him, and the publication mentioned in
which they are to be found :

Dr. Mangold, of Bale, operated, first in 1797, and again in 1801,
and M. Mautz, in 1807, upon the same patient, who died on the
twenty-second day after the third operation.

236 On the Pathology of the Pancreas. [April,

Dr. Bacqua, of Nantes, operated successfully on one patient, first
in 1797, and again in 180(1

Dr. Dariste, of Martinique, operated successfully on one patient
in 1805 and 1807.

Dr. Lemaistre, d'Aix, operated three times on one patient, in
1805, 1807, and 1814. The patient died five days after the last
operation.

Dr. Charmed operated in 1813 (?,) and another surgeon in 1814,
on one patient, each successfully.

Chaussier communicates the successful performance of the oper-
ation a second time.

Merrem of Cologne, operated successfully on one patient, first
in 1812, and again in 1826. Dr. Zwanck operated for the first
time on a patient named Adametz; Dr. Weideman operated a
second time ; Dr. Michaelis a third, and again a fourth time, with
success.

Dr. Kouvin communicates a case where the operation was re-
peated with success. Dr. Bowen performed the operation twice
on one patient, in 1833 and 1835, with success.

Professor Kilian, of Bonn, operated successfully on one patient,
first in 1832, and then in 1838. In another case, he operated in
1837, and the same patient recovered from a repetition of the
operation in 1843.

Dr. Mestenhaeuser operated successful^ on one patient in 1840
and 1844.

Here then, adds M. Stoltz, are fourteen well authenticated in-
stances of this operation having been successfully repeated on the
same patients. In two of the cases mentioned, the operation was
performed three different times, but, on the last occasions, followed
by the death of the mother. In a third instance, however, it was
performed no less than four times with complete success. This
example would almost induce him to believe in those cases quoted
by some authors, where women were said to have undergone the
Caesarean section six or seven times. [Gazette Medicate. N. Y.
Jour, of Medicine.

On the Pathology of the Pancreas. By Dr. ElSENMANN.

The interesting experiments of M. CI. Bernard upon the uses of
the pancreatic juice, have led the author .of this article to consider
whether or not the results obtained by that physiologist, are capa-
ble of being applied to the diagnosis of disease in this organ.

If the pancreatic juice assists the digestion, and consequently the
absorption of fatty matters, the conclusion is, that when the func-
tions of that gland are destroyed by disease, fat should pass with
the dejections, and be found in them in an unaltered condition. It
is interesting to observe how nearly science has anticipated what
the observations at the bedside of patients laboring under such

1856.] On the Pathology of the Pancreas. 237

disease have confirmed. The author has united the facts observed
by others with those presented in a case of his own.

Of seven cases adduced, six terminated iu death ; there had been
abundant fatty evacuations, and post mortem examination showed
the existence of induration, or other alteration in the pancreas.
In the seventh case^ quoted from Lussana, the patient recovered.
The principal symptoms in this case were copious salivation, a
sense of weight in the epigastrium not increased upon pressure,
eructations, flatulence, coldness of the surface, and a small and
slow pulse. The expression indicated abdominal disease. Consti-
pation was present, but the faeces contained yellowish particles
resembling fatty concretions, and which were in fact composed of
fatty materials. These occurred in increased quantity after purga-
tives. Mr. Eisenmann regards Lussana as the first who applied
to pathology the discovery of Bernard. In the instance observed
by himself the author had diagnosed pancreatic disease, but had
not made out the presence of fat in the evacuations. This circum-
stance induced him to suppose that the pancreatic juice did not
exclusively produce the absorption of fatty matters, but was as-
sisted in this action b}r the bile. Budge and Wistinghausen have
made experiments which countenance this idea, and the author re-
calls a case cited by Pearson, of a woman who evacuated daily 3
oz. of a fatty substance, and did not present, upon post mortem
examination, any trace of pancreatic disease, but the liver was
pale, large, and destitute of bile. One remarkable circumstance,
is, that in many of the coses cited by M. Eisenmann, the oily eva-
cuations had ceased, while the pancreas was so indurated as to
render the performance of its functions impossible. The author
also alludes to another circumstance, not less worthy of remark,
viz, the large quantity of fat yielded, a quantity much greater,
than that contained in the food, and which leads to the supposi-
tion that part of the foecal matters is transformed into fat. How-
ever that may be, the fact shows us that the presence of fat in the
intestinal evacuations indicates with probability, but not with cer-
tainty, derangement in the functions of the pancreas; while, on
the other hand, the absence of fatty matters does not authorize us
to conclude that there is no disease in this gland, if other symp-
toms exist indicative of such an affection.

The author has endeavored to employ the facts collected by him
in establishing a more correct symptomatology of disease of the
pancreas. He divides the symptoms into two classes, those ac-
companying degeneration of the gland, and those arising from its
acute and chronic inflammation. For the first of these, the symp-
toms are too various to afford any certain signs of the affection;
the presence of fat in the evacuations, and the examination of the
abdomen by the hand, suggest, but cannot positively determine,
its presence. It is otherwise, according to the author, with inflam-
mation of the pancreas. This is distinguished by a sense of weight

238 Laryngotomy and Tracheotomy in Croup. [April,

in the epigastrium, which is especially manifest about two hours
after eating, extending towards the breast with a feeling of oppres-
sion ; loss of appetite, inodorous eructations, malaise, retching or
even vomiting, although the tongue may remain clean ; constipa-
tion; small, diminished pulse; emaciation; expression of features
indicative of an abdominal affection; melancholy and sometimes
weariness of life.

The author recommends as a mode of treatment, the waters of
Friedricks-hall, in small doses. [Vierteljahrschrift fur die Praktis-
clie Heilkunde. Buffalo Med. Jour.

On die Comparative Value of Laryngotomy and Tracheotomy in the
Treatment of Croup. By J. P. Bachelder, M. D. (Read before
the New York Medical Association.)

Among the remedial measures employed by surgeons for the cure
of croup, that of making an opening into the trachea (tracheotomy)
has been most frequently resorted to, while that of opening into
the larynx through the crico-thyroid space, has been almost entire-
ly overlooked and neglected. This preference of tracheotomy to
laryngotomy, has never seemed to the writer to be predicated upon
any sound reasoning; but, on the contrary, that the very nature
of things was not only against it, but indicated most clearly that
the other alternative should be preferred. With a view to a more
correct appreciation of the comparative merits of the two operations,
we have been induced to institute an examination into their respec-
tive claims to be adopted by the profession. We shall consider

I. The Objections to Tracheotomy. /
These arise principally from the anatomical relations of important
parts to that which is the immediate field of the operation :

1. The middle and inferior thyroidal veins, and the plexus or
network which they form in front of the windpipe, some of which
almost necessarily are wounded when tracheotomy is performed,
give rise to a haemorrhage, which endangers and sometimes actually
destroys life, either by draining the system, by blood getting into
the trachea, or the delay occasioned by its flow.

2. The proximity of the carotids to the trachea, and the irregular
distribution of blood vessels in this region.*

3. The thyroid gland is proportionally larger in the child than

* The right carotid sometimes traverses the windpipe ; also now and then a middle
thyroid artery mounts upwards directly in front of the trachea to the thyroid. Dr.
C. E. Isaacs, the Demonstrator of Anatomy in the University of New York, who is
one of the most indefatigable and accurate anatomists in the country, says " I have
seen seven cases in which the middle thyroid artery arose from the innominata, and
was distributed to the thyroid gland. In two subjects it was remarkably large, and
its division in tracheotomy would have occasioned a very profuse haemorrhage."
"In two instances, no innominata existed; but the arch of the aorta gave off,
. 1. the right subclavian ; 2. the right carotid."

1856.] Laryngotomy and Tracheotomy in Croup. 239

in the adult, while other parts (particularly the trachea) are small-
er; and the cervical portion of the thymus gland rising, in some
cases in childhood, considerably above the sternum, shortens very
much the tracheal space between it and the thyroid,

4. The depth and small size of the trachea, especially in children,
render it difficult to open, and sometimes, it is said, even to find
that organ, and greatly enhance the danger of wounding import-
ant parts in close proximity.

5. The deficiency, at the posterior part of the trachea, of the
fibro-cartilaginous rings, which therefore occupy only two-thirds
of its circumference.

These, when entire, by their elasticity, keep the windpipe fully
distended; but when divided in front, as in tracheotomy, this re-
sult no longer obtains, the divided extremities fall together, and
not only close the opening made by the knife, but actually dimin-
ish the calibre of the tracheal tube. This state of things is also
aggravated by the action of the sternohyoid, and stern o-thyroid
muscles, which lie on the sides and partly in front of the trachea,
where their inner margins are nearly in contact, at the very place
in which the opening is made when tracheotomy is performed.
These ribbon-like muscles, when acting forcibly, swell into round-
ed masses, in consequence of which, the sides of the trachea are
compressed and forced together, and the opening,, made by the
division of its rings, closed. These muscles, when they act, also
draw the larynx downwards, which, by compressing the rings into
a smaller space, and forcing them backwards, still further dimin-
ishes the tracheal cavity. These circumstances, the action of the
muscles and perhaps the flow of blood, render necessary the in-
troduction of the metallic tube, through which respiration may be
carried on, and matters which block up the air passages discharged.

Objections, growing out of the danger, difficulty, and inexpedi-
ency of this operation, will be noticed in another place.

II. Objections raised against Laryngotomy..

The objections most frequently urged against laryngotomy, and
of course regarded as arguments in favor of tracheotomy, are that
in the former the wound is made in the inflamed part, and that the
tube (the necessity for which, in this operation, is only assumed)
could not be tolerated; therefore, the opening should be made be-
low the seat of the disease. These, I am aware, have been consid-
ered and adduced as the most cogent reasons against the opening
being made in the crico-thyroid space. To the writer,, however,
this reasoning has always seemed strangely inconsistent.- Let us
examine its validity.

1. Cutting into the inflamed part. What is croup? Just what
its technical name, tracheitis, implies, an inflammation of the
trachea. Dr. Watson, whose authority in this matter will not be
questioned, tells us that " the essence of this complaint is a violent

240 Laryngotomy and Tracheotomy in Crovp. [April,

inflammation affecting the mucous membrane of that portion of
the air passages which lies between the laryngeal cartilages and
the primary bronchi ; in a word, of the trachea, or windpipe.
That is the genuine seat of the disease, but the inflammation some^
times ascends into the larynx, and not unfrequentlv dives into the
bronchi, and into their ramifications. Usually, the adventitious
membrane commences just below the larynx, where it is thin and
soft; about the middle of the windpipe" (the tracheotomic region)
"it is more dense and firm ; lower down in the trachea, and in the
bronchi, it is general^ looser again, pulpy, and broken."*

With due deference, and in all candor, we would ask gentlemen
who adopt the mode of argumentation alluded to, to consider to
which place the reasoning most legitimately points? But with us,
the idea of cutting into the inflamed part has little Weight, when
we reflect how often it is done. What surgeon would hesitate to
cut off an inflamed tonsil which endangered life? Or, who that
has tried it, has failed to find that it is the most prompt and cer-
tain method of curing that disease ? Who does not cut into car-
buncles and inflamed parts to let out matter, and sometimes into
parts affected with erysipelas for the same and perhaps other pur-
poses? And who ever saw any injury result from the practice?

2. Intolerance of the tube. The other objection brought against
laryngotomy is, that the tube cannot be borne when passed into
the larynx. The fallacy of this objection will be presently pointed
out, when it will be shown that the tube, should one be necessary,
is equally well, and indeed better borne, than in tracheotomy, and
is much more readily replaced after having been removed and
cleansed, than when inserted into the trachea. After what has
been said, we shall, of course, be free to admit the necessity of the
tube when tracheotomy is resorted to ; but in that very necessity
is to be found a serious objection to the operation itself, which is
instituted for a double purpose, the admission of air, and the
ejection of a superabundant morbid secretion. If, for the former
only, the tube might not be so objectionable; but being made of
inert materials, it cannot facilitate, but must necessarily impede
and prevent, the discharge of matters, which thickened,, inspissa-
ted, tenacious, and adhesive cling to its inner surface, and pro-
duce obstructions which require its frequent removal.

* To the remarks of Dr. Watson, we would add that the inflammation, which
commences in the mucous membrane, not unfrequentlv, and in severe cases of croup
generally, extends to all the other tissues and structures which enter into the con-
stitution of the trachea. This involvement of the structures, somewhat peculiar in
their organization, causes a contraction which not only diminishes the capacity of
the trachea, hut interferes with Hie movements of that part as a whole, and also of
its constituents among themselves. This diminution of calibre and mobility, with
its morbid irritability, renders this organ much less tolerant of the metallic tuhe.
Another objection to the tube in the trachea, grows out of the difficulty of adapting
its size to the exigencies of the case: if too small, neither respiration nor the expul-
sion of the morbid secretion can be carried on through it; if too large, it occasions
great distress, by putting the trachea on the stretch/

1856.]

Laryngotomy and Tracheotomy in Cronp:

241

The rima glotticlis being the natural aperture through which
matters within and below that orifice are discharged, the artificial
opening, it would seem, should be as near it as circumstances will
admit. If through the crico-thyroid space, and as large as that
space will allow, the trachea entire and all its parts in possession
of their vital properties, powers, and actions will contribute to-
the expulsion of those matters; which it would, not do if crippled
by the division of its rings in front, and also shackled and ob-
structed by an inert tube within its cavity. This tube, if inserted
through an opening in the crico-thyroid space, may be short, and
therefore less likely to interfere with the functions of the trachea
than it would if long and passed far into that organ, at or near its
middle portion; in which case the patient, although he has the
tube through which to breathe, gets on badly.

Tracheotomy in comparison with Laryngotomy.

Tracheotomy is a dangerous opera-
tion, and under almost any circum-
stances difficult to perform, especially
in the child. It is sometimes follow-
ed by or is the cause of immediate
death, by haemorrhage, by the shock
it gives to the system either by its
violence or loss of blood, which the
exhausted state of the patient cannot
bear, or the delay occasioned by the
bleeding or other circumstances.

Tracheotomy requires a skillful,,
practiced surgeon and anatomist,
with divers instruments, for its per-
formance.

Laryngotomy is an operation easi-
ly and quickly performed without
hemorrhage or delay ; is attended
with no danger, there being no parts
of importance in the way of the op-
erator's knife. It is, indeed, very lit-
tle more difficult or hazardous than
venesection in the arm of a tatchilcL

Laryngotomy may be performed
on the spur of the occasion, by almost
any medical man, with the lancet
only. The operator needs merely to
pinch up a fold of integument -direct-
ly over the thyroid cartilage, and an
assistant to do the same over the
cricoid, and then thrust a lancet,
scalpel or bistoury, through, and di-
vide the duplicative; this done, and
the integuments being allowed to
resume their natural condition, the
operator, steadying the thyroid car-
tilage between his thumb and fore-
finger, pushes the lancet through the
crico-thyroid membrane, close to the
npper border of the cricoid cartilage,
and makes a free opening into the'
larynx ; which may, if required, be
enlarged upward, two thirds the
length of the thyroid, and downward,
entirely through the cricoid cartil-

242

Laryngolomy and Tracheotomy in Croup.

[April,

Tracheotomy, in every instance,
requires the insertion of a metallic
tube, through which respiration may
be carried on, and the morbid secre-
tions discharged.

age; and furthermore, through one
or two of the tracheal rings, without
trenching on the thyroid gland, and,
besides, a portion of the cricoid in
front may be removed.

In laryngotoray the insertion of
the tube is seldom necessary. The
membrane occupying the crico-thy-
roid space, being composed of the
yellow elastic substance, contracts
Tchem divided, and prevents the clo-
sure of the opening ; the more cer-
tainly if an incision be made upward
so as to give the artificial opening
the shape of an inverted J_. If ne-
cessary, the angles with a portion of
the thyroid cartilage, on each side
of the perpendicular cut, may be
clipped off; and also, as suggested,
a portion of the cricoid cartilage in
front may be removed. In this way,
the artificial opening may be made
considerably larger than the calibre
of the trachea itself. Generally, we
believe, it will be found that two
strips of adhesive plaster applied, one
on each side near the margin of the
wound, (if longitudinally made,) and
drawn backward and crossed behind
the neck, wiO be all that is required
to keep the wound patent.

Tracheotomy is so difficult to per- In Jaryngotomy no anaesthetic is
form, that the administration ofclilo- required; consequently, no risk from
roform has been deemed necessary this cause need be incurred-
to its best performance, and there is
reason to believe that in more instan-
ces than one, the influence of this
agent, superadded to the exhaustion
induced by the disease, the loss of
blood, and the shock, notwithstand-
ing the employment of this substance,
has caused death or rendered it more
speedy and certain.

In favor of tracheotomy, it is urged that almost all authority is
on its side. This is true, most strangely so; for the nature of
things, anatomically considered, and common sense based on them,
and also on sound reasoning, seem to be all in favor of laryn-
gotomy.

1856.] Laryngotorny and Tracheotomy in Croup. 243

To this objection, as well as that already alluded to, the intoler-
ance of the tube in the larynx, we beg leave to refer to the last
June number of the London Lancet, in which will be found '"Some
cases of Laryngotorny, by John Erichsen, Esq.," which seem to be
exactly in point. They derive additional value and interest from
the fact that they were all cases of laryngitis. In case first, he made
an opening through the crico-thyroid membrane, and introduced a
large silver tube. On the third day, the tube was finally withdrawn,
and the wound gradually closed ; the patient recovered without a
bad sjmiptom. Case 2. Mr. Erichsen says, "I lost not a moment
in opening the crico-thyroid membrane, and inserting a large silver
tube, which she has never been able to lay aside. It has been worn for
between six and seven years, and in close proximity with the vocal
cords f and, he continues, " the action of these has been in no tvay
impaired.'1'' Pretty good evidence this, that the tube in the crico-
thyroid space can be borne quite as well as in the trachea. Case 3.
"A short, stout, thick-necked woman, about thirty years of age.
There was not a moment to lose. I immediately proceeded to
operate, but on making an incision through the integuments, the
vessels of the neck, over-distended by asphyxial congestion, poured
out so large a quantity of dark blood, that it was necessary to wait
a few moments before opening the windpipe. During this delay
the patient, who was seized with a severe spasm, ceased to breathe,
and fell back to appearance dead. / immediately plunged the scal-
pel through the crico-thyroid membrane, cut this freely across, and put
in a large silver tube. She made a good recovery."* These were
cases of laryngitis : of course the opening and insertion of the tube
were in the inflamed part, yet not only no inconvenience resulted,
but the most perfect success followed. They annihilate the objec-
tions raised against cutting into the inflamed parts, and the intol-
j erance of the tube in laryngotorny.

A few short extracts from cases reported in the London Lancet,
(December, 1855,) by Henry Thompson, F.K.C.S., M.D., will close
this paper: Case 1. "A man about forty years of age," with "an
attack of acufie laryngitis." "There was no time for delay. I
proceeded at once to make an opening into the larynx, sufficient
to admit a full-sized double-trachea tube. The relief was instan-
taneous." This occurred on the 27th of September; and on the
" 1st of October, the apparatus was removed, and the edges of the
wound approximated;" which on the 8th "had entirely closed."
"Case 2." "A little boy, three years of age, livid and almost insen-
sible, struggling violently for breath. There was evidently no
time to be lost. Opening first the crico-thyroid membrane, I
found it necessary subsequently to divide the cricoid cartilage, and
upper ring of the trachea, in order to introduce the tube. We had
the satisfaction, however, of leaving him, in the course of half an

* The italicizing is ours.
N. S. VOL. XII. NO. IV. 16

244 Treatment of Pseudo-membranous Angina. [April,

hour, completely relieved, and enjoying comfortable sleep." The
next day, "June 3d," he was breathing comfortably, taking nour-
ishment freely, and in all respects improving. Contrary to express
orders, the tube was removed for a short time by the attendants of
the child on the 5th instant, and he suddenly died of asphyxia, in
less than ten minutes after taking, with considerable relish, a ba-
sin of beef tea." Mr. Thompson very significantly and justly adds:
"These cases are practically valuable, inasmuch as they present
additional evidence in favor of an opinion, the accuracy of which
is becoming more and more apparent, namely, that a tube may be
introduced into the interior of the larynx, and be retained there
for some time, without exciting irritation of the organ, even in
the presence of acute laryngitis; and that it is therefore unneces-
sary to resort to the severer method of tracheotomy, on the assumed
ground that it is calculated to occasion less disturbance to an alrea-
dy diseased larynx. [New York Medical Times.

Treatment of Pseudo-membranous Angina* by the Alkaline Carbon-
ates. (Translated from the "Gazette des Iiopitaux," April 7thr
1855, for the Boston Medical and Surgical Journal.)

The solvent action attributed to the alkalies, upon the fluids of
the body, and particularly upon certain abnormal products of se-
cretion,, has already been taken advantage of in quite a large
number of diseases. We are not sure whether pseudo membran-
ous angina figures among the great variety of affections to winch
this treatment has, of late years especiallv, been applied; our
recollections on this point are not exact. Were this so, however,.
the interest which attaches to the case recently communicated to
the Academy of Sciences, by M. Marchal (de Calvi,) would be
none the less real. Its clinical and practical bearing gives it na-
turally a place in our pages.

Starting with the idea that the principle which is the cause of
the disease known under the name of pseudo-membranous angina
[anrjine couenneuse\ is unknown to us, but manifests itself by a
phenomenon, the formation of false membranes, indicating an
excess of plasticity in the blood; and regarding this excess of
plasticitv, if not the immediate cause, the most striking phenome-
non of the pathology of the malady, at least the fact which nearest
approaches it, and to which, consequently, we must address our-
selves, in order to attack the evil as nearly as possible to its source,
M. Marchal had for a long time, he sa}Ts, conceived the idea of
resorting in such cases to the employment of alkalies, without, at

* The French expression, angine eouemieuse, is one which it is difficult to render
satisfactorily in English, but the literal translation, which we have adopted, will be
sufficiently intelligible. The disease is also called pseudo-membranous inflamma-
tion of the fauces, membranous angina, diphtheritis, <fec. The latter synonym was
introduced by Bretonneau, by whom the precise nature of the disease was first satis-
factorily made known. [Translator.]

1856.] Treatment of Pseudo-membranous Angina. 245

the same time, neglecting the inflammatory indications. This he
has done successfully in the following case, which we give in his
own words, adding that we adopt the conclusions of our confrere,

; with the reservations which he has made.

" M. B., Chief Engineer of the Vincennes Eailway, was attacked
in the beginning of March, 1855, with a sore throat, which at first
appeared slight, but which rapidly grew worse. When first called,
at the beginning of the attack, I prescribed simple remedies. The
next day, the inflammation was much more intense ; the mucous
membrane of the posterior fauces was very red and cedematous ;
the suffering very acute both in the posterior fauces, and in the
sub-maxillary regions, and much increased by the act of degluti-
tion. But what especially struck me, and from the first glance
caused me the greatest uneasiness, were streaks of a pearl-white
color, on the surface of the tongue, and more particularly on the
palatine mucous membrane, and that of the tonsils (which were
not much swollen,) forming by their agglomeration very evident
patches, concerning which there could be no mistake. It was, in
fact, the product of a plastic exudation ; only, in the mucous mem-
brane of the throat, the product was interstitial, in other words it
had not passed through the epithelium ; whereas, on the tongue,

\ the false membranes, one of which was of the size of the nail of

'' the little finger, were superficial. I endeavored, for the sake of

I greater certainty, to scrape off one of these spots from the soft
palate ; I was unable to do so, and the effort occasioned in the
patient a violent attack of vomiting. He complained of extreme
distress in the posterior part of the nasal fossa?, which attained its
height during the action of deglutition. The pulse was 130, large

I and soft. On account of the greater number of cases of eruptive
fever which existed at that time, the idea of commencing scarlet
fever naturally presented itself to my mind ; but, on the one hand,

: the mother of the patient had died (in 1845,) of an attack of pseu-
do-membranous angina, and it is well known that this form of

i angina may be called a family disease. On the other hand, the
I plastic infiltration of the pharyngeal mucous membrane, and the

',! false membranes on the surface of the tongue, were unmistakable.
I Diphtheritis then existed, and in a man hereditarily predisposed,
; there was reason to fear that this affection, arresting the scarlati-
! nous eruption, would pursue its course, the same as if it were
idiopathic.

"I therefore decided to apply leeches, in order to diminish the
inflammation, and to give the bicarbonate of soda, in large and
often-repeated doses, to counteract the excess of plasticity of the
> blood. I prescribed twelve leeches to the submaxillary regions
(six on each side,) and 12 grammes (3 drachms) of bicarbonate of
soda, in twelve powders, one to be taken every half hour, in a
-i spoonful of sweetened water.

" This was at nine o'clock in the morning. At one o'clock, the

246 Pitt of the Iodide of Iron. [April,

patient had taken 8 grammes (2 drachms) of the bicarbonate.
The leeches had drawn a large quantity of blood, which still flowed
abundantly, evidently less plastic than in the normal state. As to
the throat, the appearance of things was astonishing, and afforded
me as much surprise as pleasure. The false membranes on the
tongue remained, surrounded by a pultaceous, dirty -grey layer,
which also covered the gums, where it was white ; but the plastic
infiltration of the posterior fauces had completely disappeared; not
a trace of it was left. In the space of four hours, a most alarming
state of things, capable of inspiring the deepest anxiety, had wholly
subsided. Was this owing to the influence of the bicarbonate of
soda ? Such is my opinion.

" In the evening, red points appearing upon the skin, announced
the scarlatinous eruption, which was general and intense, and
which had hardly begun to fade before it was followed by a mili-
ary eruption of white, serous vesicles, very close together, on the
neck and arms, accompanied by short paroxyms, during which
the heart beat violently, as in the suetie.

"I return now to the essential point in this communication, the
disappearance of the diphtheritis in the throat, under the probable
influence of an alkaline salt. In the first place, no conclusion can
be established in therapeutics from a single case. Moreover, this
instance is not so demonstrative as we could wish, since in my
patient the diphtheritic angina was connected with scarlatina, and
the pseudo-membranous angina of scarlatina is much less grave
than the idiopathic variety. But, as I have already observed,
there was one circumstance, its hereditary character, which gave
to the angina, although scarlatinous, a peculiar gravity. Besides,,
when we reflect upon so sudden a disappearance of the diphtheritis,.
after the administration of the bicarbonate of soda, we can hardly
fail to see in it an effect and a cause; and we may ask whether the
same effect would not take place in idiopathic diphtheritis.

"I have said that the object of the alkaline salt was to counter-
act the excess of plasticity in the blood ; it might also have another
mode of action, a local or direct effect upon the diphtheritis. This
did not escape the attention of M. Trousseau, to whom I commu-
nicated the case, which so much interested him that he desired to
try the alkaline carbonates in the treatment of pseudo- membran-
ous angina. The local effect which I have mentioned is easily
understood,, since a gramme (15 grains) of bicarbonate of soda,
in a teaspoonful of water, is rather hard to swallow, and 'scrapes
as it goes down/ according to the expression of the patient."

Blancwdr$ Pitt of the Iodide of Imn.

Five years ago, M. Blancard, a pharmacien of Paris, proposed
an unchangeable pill of the iodide of iron, made directly from its
elements, which was officially approved by the French Academy

1856.] Pill of the Iodide of Iron. 247

of Medicine. The excellence of this preparation was generally
acknowledged, and it is already, in France, the most common form
for the admininistration of iodide of iron. Our pharmaceutical
authorities at Philadelphia, however, adhere to the saccharine so-
lution which Dr. Jackson introduced many years ago, and Prof.
Bache declares that the solid iodide "might well be dispensed
with." Practitioners will differ sometimes from the chemists, and
so it has proved in this case. It is found that, notwithstanding
the assurances of the self-constituted authorities, the syrupy solu-
tion of iodide of iron, does undergo change: that it often injures
the teeth, disagrees with the stomach, and contains free iodine.
Consequently, as our dispensatory-authors and colleges of pharm-
acy simply advise us, if we must have a pill, to evaporate their
syrup, or to use the antiquated and unreliable process of Callond,
practitioners have found it of advantage to import M. Blancard's
preparation, which is now very commonly prescribed, not only in
New York and Boston, where there are agencies for the sale of it,
but in many remote country towns. And here we may take the
liberty of recommending to the gentlemen who have taken on
themselves the direction of pharmaceutical matters in this country,
that they should not be too dictatorial or dogmatic, if they expect
to retain the authority which has been conceded to their talents
and learning.

With these preliminaries, we give at length the process for pre-
paring Blancard's pills, which we take from the Bulletin de VAca-
demie de Medecine. It is founded on the volubility of ether, and
the insolubility of the iodide of iron in this vehicle:

Take of iodine seventy-seven grains; Iron filings thirty-seven
grains ; Distilled water two and a half drachms ; Honey one drachm
: and thirty-four grains ; Absorbent powder (say powder of Althaea)
i a sufficient quantity. Make 100 pills.

Place the water, iodine, and iron in a Florence flask ; shake the

| vessel as the reaction takes place ; filter the green liquor that re-

i suits, into a small iron capsule, the weight of which is known.

Wash the flask, and filter with two and a half additional drachms

j of water, slightly sweetened with a portion of the honey to be

; used in making the pills. Pour both liquids into the capsule, and

' evaporate, at first rapidly, then at a gentler heat, until the weight of

the mixture is equivalent to the combined weight of the iodine and

the honey (171 grains, or 3iij. nearly). Add a sufficient quantity

-< of powdered althaea root, or, still better, equal parts of althaea and

liquorice powder, about 3ij. Divide the mass into four equal

j parts ; roll each part in powdered iron. Make each mass into a

cylinder on an iron slab; divide each cylinder into twenty-five

.pills, and roll each pill in powdered iron, to cover the iodide ex-

1 posed by the spatula. Expose the pills to a gentle heat that they

' may contract no moisture, and proceed at once to the second part

< of the process varnishing the pills.

248 Congenital Phymosis. [April,

Make a solution of balsam of Tolu in three parts of ether. Place
the pills in a porcelain capsule, pour on them a portion of the
ethereal tincture, and impress a rapid motion of rotation, that the
pills may be moistened on every side, and that the ether may
evaporate rapidly. As soon as the pills begin to stick together,
throw them on a dry surface, separating those that are agglutinat-
ed and leave them exposed to the air for twenty -four hours ; then
dry them over a stove at a gentle heat.

It is well to give them a second coating of varnish. Blancard
puts them in a bottle with a stopper covered with silver, which is
at once tarnished by the vapor of free iodine.

Each pill contains abont one grain of iodide of iron, and one-
fifth of a grain of powdered iron on its surface. Two to four pills
daily is the ordinary dose in chlorotic, scrofulous, tuberculous and
syphilitic diseases. C. E. [Gazette Med. Sardin. Buffalo Med.
Jour, and Month. Review.

The Simplest Operation for Uncomplicated, Congenital Phymosis.
By T. Fueneaux Jordan, Esq., M. B. C. S.

Not only are Surgical authorities of opinion that circumcision
is rarely, if ever, necessary ; but those truly frightful slits, exten-
ding half-way up the penis, to be seen in the pretty engravings
which adorn some (of our best, too) Surgical manuals are fast get-
ting into chirurgical disfavor. The present mania, however, of
attributing uncomplicated, congenital phymosis in every case to
the unfortunate mucous lining of the prepuce alone, and the prac-
tice of heroically slitting up the same to the very point of its
reflection from the penis, has arisen rather from the hypothesis
of theorists than from the enlightened experience of acute ob-
servers.

The non-dilatability of the con geni tally phymosed prepuce is
confined to the margin of the preputial orifice and to the skin and
mucous membrane in its immediate vicinity ; such non-dilatability
undoubtedly extending to a greater distance on the inner than on
the outer aspect of the foreskin.

The received opinion, touching the non-elasticity of the prepu-
tial lining in its entire extent, is so far from being correct, that
ordinarily such lining, for some distance anterior to its point of
reflexion, is arranged in rugous folds, like all other mucous mem-
branes that are too large for the organ they line, save when the
peculiar function of that organ is being exercised.

The opinion that the skin is not implicated in phymosed stric-
ture, is equally incorrect. In one patient, on whom I operated
with complete success, by far the tightest portion of the prepuce,
after recovery from the operation, was the skin for two lines behind
the cicatrices.

1856.] Congenital Phymosis. 249

From the above remarks, it will be inferred that any incisions,
which extend further than the parts forming the margin of the
prepuce, and for a short additional distance on the mucous surface,
are unnecessary, and hence cruel. A single incision, however,
as described, would fail to secure the retraction of the prepuce, not
because the incision is too limited, but because a single incision
cannot possibly relieve the whole circumference of the congenital-
ly contracted preputial orifice two, however, or at most three, of
the small incisions in question would afford complete relief.

The mode of operating which I have adopted, and with signal
success in its results, is this: Having first induced local anaesthe-
sia, by applying pounded ice to the penis for two minutes, I
introduce one blade of a pair of scissors (blunt-pointed, yet cutting
to the end) to the distance of an inch, between the glans penis
and the prepuce, on one side of the penis, at a point midway be-
tween the frenum posteriorly, and the mesial line anteriorly.
Both layers of the prepuce being divided to the extent mentioned,
a similar incision is made at a similar point on the other side of
the penis. The prepuce is now retracted to the extent allowed by
the incisions, which by this proceeding are brought quite external,
enclosing between their lips an uncut layer of lining membrane.
This is divided on each side, by introducing one blade of the scis-
sors, to the extent of, and immediately under, the original wound.
The entire prepuce may then be retracted, apiece of wet lint
wrapped round the penis, and the whole supported by a proper
suspensory bandage. The patient need not lie in bed. Where
three incisions seem preferable, they should be equidistant from
each other, the third being at the mesial point anteriorly, the two
lateral incisions should be a little nearer the frenum, than when
two only are made.

The incisions may of course vary a line or two, one way or the
other in extent, according as the constriction is more or less ag-
gravated.

The recapitulatory points to which I would draw attention,
are:

1. That the skin is more, and

2. That the mucous membrane is less, involved, than is gener-
j ally supposed.

3. That two, or at most three, comparatively small incisions
will afford complete relief.

4. That no assistant is required, and

5. No instrument save a pair of scissors.

6. Two or three small incisions cause much less irritation, and
heal much more quickly than one large one.

7. That the patient need not lie in bed. [lied. Times and Gaz.

250 Nitrate of Silver in Burns. [April,

Nitrate of Silver as a Remedy for Burns. By John WlLTBANK,
M. D., of Philadelphia.

I wish to call the attention of the readers of the Examiner to
the value of the nitrate of silver as an application to burns and
scalds. I have used it frequently both in deep and superficial
burns, and I have been equally surprised and gratified by the re-
sults. The advantages of the caustic application are numerous.
It furnishes a complete protection to the inflamed surface, subdues
the pain, arrests the serous discharge, changes the character of
the inflammation, promotes a speedy cure, and if I am not mista-
ken, prevents the formation of those ugly cicatrices and the irregu-
lar contractions of the skin which so often occur in the healing of
burns.

The mode of application is simple. In superficial burns a strong
solution 20 to 40 grains of the nitrate to the ounce of water
should be applied over the whole surface with a camel's hair pen-
cil, vesications should be opened and the surface carefully wiped
. dry before the solution is applied. If the burn is deep and the
discharge of serum abundant, the entire surface of the ulcer should
be touched lightly with the solid stick. [Medical Examiner.

Formic Acid in the Blood of a Person, killed by the Inhalation of
Chloroform.

The following note, received from a source which entitles it to
credit, will be read with interest.

"In the Journal of January 17th, an account of a recent death
from chloroform in this city, was given. A quantity of the blood,
removed at the autopsy, was placed in the hands of Dr. C. T.
Jackson for chemical examination. He has ascertained that the
blood contained formic acid, and that it could readily be separa-
ted by distillation in the heat of a chloride of calcium bath.

" Chloroform consists of formyle and three equivalents of chlor-
ine; formic acid of formyle and three equivalents of oxygen. The
three atoms of chlorine leave the chloroform and unite with the
blood, while three atoms of oxygen leave the blood and unite with
the formyle of the chloroform, replacing the chlorine and producing
formic acid. Thus the blood is not only deprived of its oxygen,
but it is so altered as to be incapable of absorbing vital air and the
patient dies from asphyxia. The production of formic acid under
such circumstances has never before been known, and of course it
is to be regarded as an important physiological fact of no small
practical moment." [Boston Med. and Surg. Journal.

Anaesthetics in the Austrian Army.
A circular has recently been issued, ordering that in future, the
army medical officers shall always employ, for the purpose of in-

1856.] Editorial and Miscellaneous. 251

ducing anaesthesia, a mixture consisting of one part chloroform
and nine parts ether, this being the proportion long employed by
Dr. Weiger, a Vienna dentist. [N. Y. Med. Times.

Pathology of Diabetes.

M. Andral stated at the meeting of the Academy of Sciences
(Paris) in July last, that in five cases of diabetes which he had
examined after death, since the publication of the researches of
M. Bernard, he had uniformly met with one alteration. He had
found in each instance all the anatomical characters of a very in-
tense hyperaimia, and different in its aspect from ordinary hyper-
semia of that organ. The tissue of the liver of the diabetic patient,
is everywhere gorged with a large quantity of blood. M. Andral
regards this as being at the same time, a change peculiar to diabe-
tes, and a proof of the sugarforming function of the liver. \N. Y.
Med. Times.

EDITORIAL AND MISCELLANEOUS.

Another Bearded Woman. Our city has been visited this month by
another of those anomalous beings heralded as bearded women. The sub-
ject of this notice is announced as the " Bear Woman," " a most extraor-
dinary nondescript," "a half-human half-beast creature," "otherwise called
Julia Pastrana, a hybrid root-digger Indian, from California" !! The pamph-
let sold at the door contains, as usual in such cases, certificates from " Dr.
Mott " and other " distinguished physicians." We do not envy the taste
of the "distinguished" members of our profession who would lend their
names to such purposes of humbuggery. We are happy to say, however,
that the valued and respected name of Valentine Mott is not among the
-certifiers. But, lest we might do injustice to the "distinguished" gentle-
men, we beg leave to append their own language :

" Dr. MotCs Certificate.

"New York, December 3, 1854.
"Sir : To naturalists alone we leave the task of solving the enigma con-
cerning the origin of Julia Pastrana, the ' Semi-Human Indian,' which would
have puzzled the Sphinx. From her uncouth gait, it may be conjectured
that the mysterious animal moves as if an elongation of the Spinal column
should have taken place, producing a tail, which in consequence of human-
ity predominating, has been denied.

" She is a perfect woman a rational creature, endowed with speech,
which no monster has ever possessed. She is therefore a Hybrid, wherein
the nature of woman predominates over the brute the Ourang Outang,
Altogether she is one of the most extraordinary beings of the day.

"I remain yours respectfully, ALEX. B. MOTT,"M.D."

252 Editorial and Miscellaneous. [April,

" From Professor Brainerd.

"Cleveland, August 5, 1855.
"Sir: In compliance with your request, I will state that I examined the
hair of the specimen of the Genus Homo which you have in charge, and
compared it with the hair of the African, under a high magnifying power,
and from this comparison, have no hesitation in saying that the individual
in question possesses, by this test, no trace of negro blood. Her other
peculiarities, the hair upon the body, its length and structure, the form of
the mouth and nose, the size of her limbs, peculiarity of her breasts, &c,
and various other features, entitle her, I think, to the rank of a distinct
species. Yours, truly,

"S. BRAINERD, M.D."

We must leave it to others to say how " a perfect woman " can be " a
Hybrid, wherein the nature of woman predominates over the brute the
ourang outang," to say nothing about the sapient conjecture of "the elonga-
tion of the spinal column " which "should have taken place, producing a
tail." It is assuredly not surprising that whole communities should be
duped, when men in high places, and therefore supposed to be well inform-
ed, certify to such nonsense. AVe do not know the meaning attached by
the certifiers to the word Hybrid, and will not stop to discuss the value of
this term as applied to varieties of the human family, or to mixed races;
yet, notwithstanding their opinion as based upon an inspection of the hair,
we think this woman's flattened nose, thick lips, projecting jaws, and
swarthy complexion, testify unmistakably to the infusion of negro blood in
her veins. Her straight hair is like that of our savage, or other blanches
of the red family, who probably furnished the other element of her origin.
Be this as it may, Julia Pastrana is an exceedingly homely bearded woman,
and nothing else. Her arms and shoulders are not more hairy than those
of many men. The whole of her forhead, nose and face is covered with a
downy beard about one-eighth of an inch in length, but which, beneath the
chin, reaches two or three inches. There is nothing uncommon in her
person nor in her gait.

Medical College of Georgia. The Commencement exercises in this insti-
tution took place on the 3d day of March. The Dean reported that "there
were one hundred and seventy students in attendance upon the course of
Lectures just concluded ; of whom 119 were from Georgia, 22 from Ala-
bama, 18 from South Carolina, 5 from Mississippi, 2 from North Carolina,
2 from Florida, 1 from Texas, and 1 from Nova Scotia." The Degree of
Doctor of Medicine was then conferred by Ex-Governor AVm. Schley, Pre-
sident of the Board of Trustees, upon seventy-three gentlemen, and the
Honorary Degree of Doctor of Medicine upon Dr. John Harwood Burt, of
South Carolina. An able and appropriate Address to the Graduates was
then delivered by the Rev. Mr. Ryerson, which was followed by a chaste

1856.]

Editorial and Miscellaneous.

253

and eloquent Valedictory by Dr; W. L. M. Harris, of I he graduating class.
These interesting proceedings were attended by a large and respectable
concourse of ladies and gentlemen. The Graduates were :

A. G. W. Stephens,
J. G. Brown,
G. F. Smith,
T. A. Boddie,
W. L. Selman,
G. T. Clarke,
William Goulding,
Thomas Burdell,
J. 0. Holloway,
W. R. Murphey,
T. M. C. Rice,
H. N. Mitchell,
G. W. Walker,
J. C. Orr,
A. W. Henley,
Thomas Searls,
T. W. Tison,
Asahel Beach,

M. C. Cox,
J. L. Hughes,
G. W. Wasson,
J. J. Scott,

W. C. Neal,
J. T. Handley,
M. A. Roach,

FROM TEXAS 1

J. W. Veazey.

from Georgia:
R. T. Barton,
Benjamin Garrett,
J. L. Eshom,
J. D. Young,
J. G. McMath,
J. T. Dismukes,
Z. C. W. Davis,
S. J. Robert,
Joseph Wise,
J. H. Wallace,
J. R. Powell,
J. M. Burns,
D. A. Mathews,
W. L. M. Harris,
J. D. Moore,
V. H. Shelton,
0. H. P. Slaten,

FROM SOUTH CAROLINA \

B. W. Glover,
T. E. Jennings,
W. T. McFall,

FROM ALABAMA ".

G. W. D. Lawrence,
Elias Davis,
J. W. Smith,

0. S. Means,

E. M. Newman,
J. S. Beazley,
A. C. Neal,
W. M. Greene,
C. L. Blair,
J. J. Hardin,
T. B. Ford,
J. W. Cochran,
J. M. Dent,
J. W. Proctor,
H. W. D. Ford,
J. M. Matbis,
John S. Bell,
A. M. Parker,

1. J. M. Goss,
A. C. Mathews.

D. T. Riley,
Charles Agar,
A. J. Nagel,

Job Thigpen,

L. M. Underwood,

J. F. Reynolds.

FROM MISSISSIPPI !

D. S. Watts.

Medical College of Savannah. The following gentlemen received their
diplomas at the commencement, on the 6th March :

E. L. Burton, J. S. Butts, Thomas Charlton, John Eckhard, James God-
frey, D. O. C. Heery, G. P. Padelford, R. W. Skinner, R. E. Campbell, J.
H. Hendry, J. S. Thomas, and A. A. Watts.

Oglethorpe Medical College. The first annual commencement of the
Oglethorpe Medical College of Savannah, took place on the 8th March.
The following are the names of graduates :

John W. Barber, S. D. M. Byrd, James A. George, J. J. Jones, W. J.
Orr, Wm. M. Marsh, John A. Mayer, and John A. Owens.

254 Editorial and Miscellaneous. [April,

Savannah Spring School of Medicine. An organization under the
above name has been formed in our sister city. The term of Lectures is
to be from the middle of March to the end of June. The lecturers are
Holmes Steele, M. D., on Obstetrics, the Physiology of Generation, and
Diseases of Women and Children ; John M. Johnson, M. D., on Medical
Chemistry and Materia Medica ; Joseph J. West, M. D., on Anatomy, the
Physiology of .the Viscera, &c; and Charles H. Colding, M. D., on Minor
atud 'Operative Surgery. Fee $50, in advance.

Medical Society <oj 'ihe State of Georgia. The next annual meeting of
this Society will take place on the 9th April, at Macon.

The American Medical Association will convene at Detroit (Michigan)

on the 6th of May.

A protection against Puerperal Fever. A case of labor recently occurred
in. the Boston Lying-in Hospital (reported in the Boston Medical and Sur-
gical Journal,) which Dr. H. R. Storer was called to attend. Having that
day seen a severe case of Erysipelas, and believing that he might impart
the infection te the woman and thereby induce puerperal fever, he declined
going. Compelled by circumstances to go, however, he determined to put
the female upon the use, as a prophylactic, of 15 drops of mur. tr. of iron,
every .six hours. Although he had to extract the placenta with his hand,
no bad results followed, and the iron was discontinued on the fifth day.
Dr. S. regards the case as confirmatory of the efficacy of the preventive
treatment, already recommended by others.

Although the production of Puerperal fever in the way just alluded to,
is stiM a mooted question, there is a growing disposition on the part of the
profession to admit the fact and we should therefore not omit a resort to
any measures of prevention that may be proposed, especially when these
are in themselves harmless.

Works received. We acknowledge the reception of the following works:
Report of the Pennsylvania Hospital for the Insane, for the year 1855, by
Thos. S. Kirkbride, M. D., Physician of the Institution. The American
Journal of Science and Arts, (full of valuable matter as usual). An Essay
on Intermittent and Bilious Remittent Fevers, with their Pathological rela-
tion to Ozone, by E. S. Gaillard, M. D., of Charleston, S. O, (a very interest-
ing and creditable production). Treatment of Displacements of the Uterus
with the Abdominal Spring Pessary, by J. McF. Gaston, M.D., of Columbia,
S. C, (an ingenious contrivance to obviate some of the many objections to
such instruments). A Paper on the Effects of Lead on the Heart, by John
. W. Corson, M D., of New York, (a valuable paper on a subject but little un-

1856.] Editorial a?xd Miscellaneous. 255

derstood). A Tabular View of the Signs furnished by Auscultation and
Percussion, and their application to the Diagnosis of Diseases of the Heart
and great Vessels, 2d ed., enlarged and improved, by O. Bilnngham, M. D.,
(a great convenience to students). Also, a number of Introductory Ad-
dresses, Circulars, <&c.

American Physicians in Russia. There are at present twelve American
doctors serving in the Russian army in the south of Russia. Eight of these'
doctors, Marshall of California, Smith of New Orleans, "Weems, Hank and
Johnson of Baltimore, Md., Hart of Memphis, Tenn., Parks of Illinois, and'
Clarke, of New York, are stationed at Simpheropol, in the Crimea. I>rsv
Bostwick, of New York city, Oliver, of Boston, Mass., Morton, of Nashville;
Tenn., and Smith, of Vermont, are stationed at Odessa. Thirteen others
have served in the Crimea, of whom five have died there; seven have re-
turned, and one died at Berlin, on his way to America;. Dr. Draper, of
New York, died of typhus fever at Sebastopol, on the 19th of March, 1855*.
Dr. King, of Charleston, S. O, died of typhus fever at Kertch, on the 20th
March, 1855. Dr. McMillan, of New Orleans, died of cholera at Sebasto-
pol, in June, 1855. Dr. Jones, of Maryland, died of cholera at Simphero-
pol, on the 24th of October, 1855, and Dr. Deninger, of Reeding, Pa., died
of cholera at Simpheropol on the 25th of October, 1855. Dr. Stoddard,
of Baltimore, Md., died at Berlin, on the 21st January, 1856. Over the-
graves of Drs. Jones and Deninger, a very pretty monument has been
erected by their comrades, and at the time of the taking of Kertch by the'
allies, a monument to Dr. King was in process of construction, the monu-
ment being erected by the city authorities. Drs. Harris, of New York,
Turnipseed and Davega, of South Carolina, Henry, of Mobile, Ala., El-
dridge, of Maryland, Read, of Norristown, Pa., and Holt, of Georgia, have
retired from the Russian service. \Cor. N. Y. Herald.

The March number of the New York Journal of Medicine, contains an
able paper from the pen of Dr. John W. Corson, "On the Effects of Lead
on the Heart," in which the author arrives at the following conclusions :

1. That allowing a due excess of force to carry on the embarrassed
circulation in organic affections of the heart, it appears that certain symp-
toms in slow poisoning from lead, as well as in cardiac disease proper,
typhus fever, and apparent death from catalepsy or other causes, all tend
to prove that, as a rule, the impulse may be termed the pulse of the heart ;
and that, its more careful study than heretofore, may aid us in the general
diagnosis and treatment" of disease.

2. That the symptoms of weakening of the heart in lead poisoning,

are confined to cases of partial paralysis, or general muscular debility,

j accompanied usually by the purple streak of the gams, indigestion, consti-

| pation, pains in the head, muscles, or joints, and sometimes by lead jaun-

i dice; and that commencing and emphasizing with the most frequent, these

heart symptoms from lead are : weakened or soft tapping impulse ; faint-

ness on unusual exertion ; feeble and generally slow pulse ; palpitation ;

cardiac uneasiness ; and to these are occasionally added, great despondency

256 Editorial and Miscellaneous. [April,

or morbid fear of death ; suspicions of organic disease of the heart, fainting
fits, night-mare, or troubled dreams.

3. That these depressing heart symptoms are absent in the earlier and
more acute stage of lead poisoning, known as " lead colic" when, on the
contrary, the stimulus of pain generally renders the impulse of the heart
and the pulse at the wrist more firm than natural.

4. That skill in the detection of minute variations in the impulse of the
heart, naturally requires a little careful attention and practice.

5. That these debilitating effects of lead most commonly occur in hearts
previously sound, hut they sometimes complicate existing organic cardiac
disease from rheumatism or other causes.

6. That the agencies or causes of lead poisoning are very numerous,
and often obscure ; and that slighter cases supposed to be ordinary dyspep-
sia, constipation, debility, or bilious colic, are frequently undetected.

7. That the above tests of the immediate influence of lead on the heart
in disease, are further corroborated by experiments upon animals; showing
that, more mildly and slowly, lead, like digitalis, oil of tobacco, upas antiar,
the woorara, and some other poisons, tends specially to paralyze the central
organ of the circulation, and, like these, ultimately to produce what Bichat
termed " Death by the heart."

8. That the remedies for the paralyzing influence of lead may be divided
into two classes: Disinfectants, such as the iodide of potassium, and pre-
parations of sulphur ; and Antiparalytics, such as strychnia and electricity ;
that the best treatment combines these two elements; and that, on the
whole, the most convenient and efficacious are free doses of the iodide of
potassium, and minute proportions of strychnia or nux vomica.

9. That the above conclusions are founded mainly on the evidence of
ten cases, principally among the badly-nourished and improvident poor
finally resorting to public institutions; and they may possibly be some-
what modified in future by more extended observation in private and more
favorable practice.

Vaccine Matter. As it may be interesting to physicians to know where
fresh vaccine matter can be obtained, we insert the following:

" Physicians wishing Vaccine virus, by addressing Dr. Win. Hutson Ford,
City Vaccinator, Charleston, S. C, and enclosing one dollar, will receive, by
return mail, ten points, or a set of glasses charged with fresh virus; or, by
particular desire, a recent scab. Seventy -five points, or seven sets of glasses,
will be sent for five dollars."

Results of some Statistical and Physiological Researches on Twins. At
a meeting of the French Academy of Sciences, Nov. 26, Mr. Baillarger
read a paper containing the results of some statistical and physiological
researches on twins. We have thought the subject presents some features
which might interest the readers of the Examiner.

"Numerical distribution and relative proportion of the sexes in twin
births ; hereditary influence.

"I. The facts group themselves into three categories:
"The first, two boys at a birth.
" The second, two girls at a birth.

1856.] Miscellaneous. 257

i

" The third, a boy and a girl.

"The result obtained in computing 256 double births- shows :
Two boys in . . . . . 100 cases.
Two girls in .... 5& ""

One boy and one girl in 9"& ""

" It would seem as if the presence of two boys in twin pregnancies is>
almost twice as frequent as that of two girls. And also* that the third,
class, that of the presence of the two sexes, is almost eqsal to the first.

"II. The solution of the second question, viz: the- selative proportion
follows from the above figures.

In 512 twin children are found: Girls, 214; Boys, 298i
"The number of boys exceeds that of girls, therefore, by more than one1
third. This result will certainly seem remarkable if we- bear in mind that
the proportion of the sexes in the totality of ordinary birth. \ is of 16 girls
for 17 boys. So that the difference is in the one case more- than a third,
and in the other, only a sixteenth. The relative proportion of the two-
sexes is governed then in twin pregnancies by special laws, quite distinct
from those which govern normal births. This fact, interesting, in itself,
becomes still more so when compared with the documents already collect-
ed by M. Flourens on the proportion of the sexes in animals, in which the-
predominance of males over females is one sixth instead of one sixteenths
I would connect the great predominance of the male sex in twin births
with another fact, which is deduced from the general statistics of births,,
and which at first sight may seem strange. I refer to the far greater pro-
portion of boys among still-born children. This amounts to IT boys to 12*
girls. This singular predominance of boys among still-barn children canr
in my opinion, be in part if not fully accounted for by the excess of the-
male sex in twin births, which furnish, as is well known, a pretty consider-
able contingent to the statistics of still-born children.

" III. Twin births are hereditary in certain families, but in different de-
grees and different conditions. A large number of facts show, that the-
daughters of mothers who have had twin pregnancies, have often them-
selves two children at a birth. This disposition occasionally passes over
lone generation, when the grand-daughter instead of the daughter has one-
'or several double pregnancies.

"The facts which I have collected would seem to prove that this heredi-
tary disposition is transmitted also through the male. Seme- men would
thus have the faculty of procreating two children at once-, althouo-h no
such hereditary disposition existed in their wives. This fact would hare a
great physiological importance, and I admit that it should be based on in-
disputable proofs. I merely indicate it now, and will return to- ft in a future
paper.

"Before closing, it may not be improper to call attention to- the fact, that
the hereditary disposition of which I have been treating, seems to have
been taken advantage of to obtain among animals, species which procreate
two young instead of one. Flocks of sheep have thus been formed, con-
sisting of individuals which normally bear two lambs. Single birth among
them become the exception instead of the rule. I have seen a flock com-
posed of nearly one hundred head of sheep, of which each ewe annually
brinsre forth two lambs."

258 Miscellaneous.

Robert Collins, in his Practical Treatise on Midwifery, gives the result of
16,654 births, occurring in the Dublin Lying-in Hospital, during a period
of seven years, from 1826 to 1833. Among these, as appears in a table,
pages 164 and following, (Am. Ed.,) there were 240 twin births, in which
the sex of the children is mentioned. By a computation of this table, we
arrive at results relative to the numerical distribution and proportion of the
sexes, materially different from those which Mr. Baillarger's facts would
lead us to expect. Thus in 480 twin children, there were : Girls, 234 ;
Boys, 246; distributed in the following manner:

Two boys in . . . . 73 cases.
Two girls in .... 67 "
One boy and one girl in . . 100 "
By these figures, the presence of two boys in twin pregnancies is only one-
eleventh more frequent than that of two girls, and the presence of the two
sexes is more than one-fourth more frequent than that of two boys. The
number of boys exceeds that of girls by only one-fifteenth, a result but
little larger than that obtained from the totality of ordinary births, viz :
one-sixteenth.

On the other hand, if we turn to the statistics of the same Hospital, as
reported by Alfred H. McClintock and Samuel L. Hardy, for the three
years of their connection with the Institution, from Jan. 1st, "1842, to Jan.
1st, 1845, (Practical Observations on Midwifery, p. 329,) we find that during
that period, there were 6,634 births, of which 95 were twin births. In
these there were: Girls, 79; Boys, 111; distributed thus:
Two boys in .... 38 cases.

Two irirls in .... 22 "

One boy and one girl in 35 "

Here we are struck with the similarity of the relations existing between
the above figures and those which Mr. Baillarger found to exist between
the facts collected by him.

The presence of two boys is eight-elevenths more frequent than that of
two girls, while in Mr. B.'s cases, it is twenty-one twenty-ninths, or the
same thing.

The presence of the two sexes is less than that of two boys, as with Mr.
B., though not quite so near being equal.

The number of boys exceeds that of girls more than one-third, as in Mr.
B.'s cases, the ratio differing but a unit. [Medical Examiner.

Albany Medical College. The donations to the Albany Medical College
have amounted to $75,000. Of this sum, $50,000 have been expended in
buildings, land, and for the support of the institution during the four years
of its existence leaving a surplus of $25,000. Thirty gentlemen of Albany
contributed to its permanent endowment $1,000 each. [N. Y.Med. Times.

Asylum, for Inebriates. A petition is before the Massachusetts Legisla-
ture, praying for the establishment of an Asylum for Inebriates, wherein
they may receive such treatment as shall restore them to soundness of
health and sanity of mind; and also to afford such facilities as shall render
the asylum a self-supporting institution. [lb.

SOUTHERN

MEDICAL AND SURGICAL JOURNAL.

(NEW SERIES.)

Vol. XII.] AUGUSTA, GEORGIA, MAY, 1856. [No. L

ORIGINAL AND ECLECTIC.

ARTICLE XIV.

IETTERS FROM SAUL. D. HOLT, M. D., UPON SOME POINTS OP GENERAL PATHOLOGY,

LETTER NO, 11.

Montgomery, Ala,, March 20th, 1856.
Messrs. Editors In a few prefatory remarks in my first letter I
j stated that I had no motive in offering my views upon certain
l medical subjects to the profession, beyond a desire to add my tes-
timony to the truth or falsity of the principles and the practice of
medicine in the present day, which, of course, will be understood
1 as being confined within the limits of my own observation and
experience, otherwise I should consider my testimony as worthless,
I and would have spared myself the trouble of writing it out, and
you of reading it ; and I may add, that this desire is strengthened
! by a sense of duty which I think is incumbent upon every man,
who has devoted the greater portion of his life to the alleviation of
; the sufferings of his fellow beings, (especially if he is conscious of
having been generally successful,) to let his views and plans (by
' which he has accomplished the greatest good) be known, whether
they have resulted from his own unaided observation and experi-
ence, or whether he has acted merely upon the suggestion of others
and followed out plans which had already been laid down for his
direction.

Now, the testimony which I have to offer in favor of the value
and efficacy of calomel in the treatment of most of the malignant

N. S, VOL. XII. NO. V. 17

260 Holt's Letters upon General Pathology. [May,

fevers, and other diseases of our climate, though by no means novel
or original, is nevertheless the result of my own experience, and
more particularly is it so with regard to the modes of its adminis-
tration, and the peculiarity of its effects, according to the manner
of its administration. I can not expect, however, that my testimo-
ny will be received by the profession with much favor, when there
are so few who have the boldness and independence to avow
themselves the advocates of its use, or, are willing that the world
should know, or believe, that they ever used it at all in their prac-
tice. Some such / wot of, who boldly discard this, and other
cardinal remedies, and endeavor to foist upon the profession, as
their substitutes, such articles as phosphorus, bryonia, and aconite E
Well, it is not for me to say who shall believe, and who not; it is
only my business to testify, and all that I ask of the profession is to
award to me the candor and honesty of purpose equal, at least, to
my zeal and devotion to my profession, the honor and dignity of
which I have so long endeavored to uphold.

In -my last letter, I gave, in support of my views upon the uses
of calomel, some testimony which was very good as far as it went,
and upon high authorit}7. But Dr. Wood, upon some of the most
important points, namely, the use of large doses of calomel, gave
us only heresay evidence. I now introduce a witness, who is not
only able to testify to all the points which I wish to establish, but
he does it from his own knowledge,4which renders his testimony
the more valuable. Doct. Jno. E. Cook, whose general principles
I can not endorse, on account of his extravagant and ultra cathartic
notions, which Avere at one time very popular in the western coun-
try, has done more to bring calomel into disrepute, by combining
it with drastric cathartics, than by the quantities used, which were
often unnecessarily and extravagantly large, notwithstanding
which, his observations with regard to its peculiar properties, its
mode of action, its value, and efficacy in certain diseases and con-
ditions, will be found to be correct, by any one who has the bold-
ness to test them by practice ; and those who have not, are not
competent to sit in judgment upon them. His general views,
with regard to the cathartic action of calomel, are, that it draws
directly from the biliary ducts, and relieves the vessels of the liver,
and others connected with it, of engorgement or congestion; while
ordinary cathartics draw upon the arterial capillaries, which open
upon the internal surface of the intestinal canal. But I will let

1856.] Holt's Letters upon General Pathology. 261

him speak for himself. As a cathartic, he says: "Calomel is slow
in operation, often requiring twelve hours ; it does not operate
frequently, but the discharges are large ; it gripes little or none,
in general, and is perhaps the most effectual medicine known in
producing consistent discharges from the biliary ducts." Speaking
of the difficulties often to be encountered in the treatment of au-
tumnal fevers, Dr. Cook says: "These are a great disposition to
serous discharges from the bowels, .... and extreme irritability
of the stomach, in consequence of which almost every medicine is
rejected as soon as swallowed." Now, these conditions I have
seen presented by the opponents of calomel, as cases unsuited to
the action of calomel, and they have argued that calomel, not only
aggravated, but often produced them.

But I have no doubt that in these cases, as in many others,
calomel has been made to bear the sins of other remedies with
which it has been coupled or combined. A notable instance may
be found in Wood's Practice, which deals calomel a hard blow, on
account of the quarter from which it comes. Under the treatment
of Pernicious fever we find the following: "Not long since, under
the notion that congestion was the evil to be encountered, copious
bleedings and large doses of calomel were the remedies most relied
on by many practitioners. Experience, however, has proved the
frequent inefficiency and even danger of this practice, and the pro-
fession generally are rapidly abandoning it." In this case, it is
very certain that calomel has to suffer for being caught in bad
company, as, on the next page, we find its character somewhat
cleared up by the following sentence: "Another remedy which i3
decidedly called for, is calomel." But to return. My experience is
most decidedly with Dr. Cook, who says, "The disposition to serous
I discharges is readily overcome by the use of calomel ; and it is a
i remedy that will not fail. There is almost no danger of exciting
, ptyalism, while these serous discharges continue, and therefore
there ought to be no hesitation in administering calomel, until dark
and consistent discharges are obtained. If the case is urgent, from a
j scruple to a drachm should be given at once, in order to obtain the
desired effect as speedily as possible, and repeated, according to
j the necessity of the case." Of irritability of stomach, Dr. Cook
|says, "In some cases there are incessant and violent efforts to
vomit for days together, or even until death. I have, in these cir-
cumstances, given, with the best effect, a drachm of calomel. It

262 Holtts Letters upon General Pathology. pfay,

produces a copious, tenacious, or viscid discbarge, of a deep green
r nearly black color, and affords the roost marked relief. It
very frequently happens that a physician will not venture, as he
terms itr to give so large a dose, but will not hesitate to persist for
days in repeating small doses, until they far exceed the quantity
which, given at once, would have completely succeeded ; thus the
risk of salivation is incurred, without obtaining the full benefit of
the cathartic operation for it is to be remembered, that one or two
large doses often so completely remove the irritable state of the
stomach, that the case may be afterwards managed without calo-
mel, , , It is exceedingly rare to find a patient require more than
% dose or two, of the size above mentioned, to effect the object in
view.'f

For fear that I may be accused of having borrowed my views,
with respect to calomel, from Dr. Cook, I will state that, until very
recently, I had never read a page from that author in my life. A
young professional friend, knowing that I was engaged in writing
out my views, and knowing also that I entertained opinions,
which, if not peculiar, were not entertained generally by the pro-
fession, and supposing that I might find something corroborative
or confirmatory of my views and opinions, placed his book in my
hands, in which I find so much, which so perfectly coincides with
my own experience, that I almost feel at a loss sometimes whether
I am writing out Dr. Cook's notions or my own, so far as the ac-
tion of calomel is concerned. This is my apology for drawing so
largely upon Dr.. Cook's- book, with which I am not entirely
done yet

Dr. Cook, after giving the statement of a case, in which he
gave a boy a little over an ounce and a half of calomel in seven-
teen days, with good effect, says, "The risk of salivation in these
extreme cases is less than is- supposed. I have never known a pa-
tient in the circumstances, as above stated, absolutely requiring
some- energetic mode of procedure, to be badly salivated after taking
the I'avgest dseef ~&r. Cook further says, M I have even known
salivation cured by purging with calomel alone,"' After giving
the particulars of the case, and stating the condition of the patient,
who, he says, was pale ; the pupils- were dilated; was restless and
a little delirious; the stomach rejecting every thing, even watery
the mouth sore, and saliva abundant he states that he gave his
patient a drachm of calomel each, day, for six successive days -, a*

1856.] Holt's Letters upon General Pathology. 263

the end of which time the patient could sit up and eat, and every
appearance of soreness had ceased in the mouth.

One more draft upon Dr. Cook, and I will close with his evi-
dence. "Many," says he, speaking of salivation, "consider a
patient safe, as soon as this affection of the mouth appears. This
opinion is, however, erroneous. The safety of the patient depends,
not on producing ptyalism, but upon daily evacuations of consist-
ent bilious matter. Without the latter, in cases of any violence,
the patient will die, even in a state of salivation ; having tiiem, he
will get well without it"

I will now give a summary of the testimony, which I have ad-
duced in support of the views which I have expressed in my last
letter, respecting some of the peculiar properties of calomel, some
of which are not recognized or acknowledged generally by the
profession namely : That, as a catartic, calomel acts directly upon
the vessels of the liver, and not, like most other remedies of that
class, upon the mucous surfaces of the intestinal canal; that it is
slow in its operation, and produces few, but large discharges ; that
it is little or not at all irritating, and that it is the most certain and
effectual medicine known for producing consistent bilious dis-
charges. (I will add, that the sooner these effects are produced,
in all cases which require its use, the better it will be for the pa-
tient, and the less will generally be required ; hence the necessity
of giving it in full doses, or in such quantity as will soonest effect
the object.) That in those irritable conditions of the bowels, at-
tended with frequent serous discharges, which are always trou-
blesome and often dangerous, calomel is the best remedy, and will
very certainly afford relief, if its use be persisted in until its action
is impressed upon the liver ; that large quantities are sometimes
required to accomplish this, and that while these serous discharges
continue, or while the condition lasts, which gives rise to them,
there is little or no danger of producing salivation. (The ease pre-
sented in my last letter is very conclusive upon these points, and
I have several others, to the same effect, though none which re-
quired so large an amount of calomel.) That in cases of irritability
of stomach and obstinate vomiting, calomel in a full dose will
generally arrest it promptly, even before it has time to act upon
the liver, and when arrested in this way, it is seldom apt to re-
cur. (I have an innumerable quantity of cases demonstrative of
this fact.)

264 Holt's Letters upon General Pathology. [May,

With regard to the statement of Dr. Cook, that he had known
salivation cured by purging with calomel, I must say that he has
taken my thunder, as I have a case of the same kind to report, and
thought I stood alone, never having heard of any other case of the
same kind. As it is a practice, however, which should be resorted
to only in extreme cases, I will give it notwithstanding. I con-
cur with Dr. Cook, in opinion, that the risk of salivation in those
extreme cases is not as great as is generally supposed ; and that the
largest doses, seldom produce it. This is explained by the fact,
that large doses will act soonest and most effectually upon the
liver, whereby a repetition of large doses are generally rendered
unnecessary, and that in cases requiring a repetition of the doses,
such as have been mentioned, attended Avith an irritable condition
of the bowels, and serous discharges, which generally depend upon
plethora or congestion of the portal veins. Thus a double barrier
is placed in the way of its action ; for while the plethoric state of
the vessels retards absorption, the serous discharges from the arte-
rial capillaries tend to hurry it away from the absorbents. It may
be, too, that the same torpor, or insensibility, which would retard
its jurompt action upon the liver, would pervade the whole system,
and prevent its action upon the other organs ; but this is not pro-
bable, as we sometimes see salivation produced from the repeated
administration of small doses of calomel, while the liver remains
insensible to its action, and the disease goes on unchecked, as be-
fore, Such are the cases in which Dr. Cook says, he has known
"salivation cured by purging with calomel alone." In such, I
have seen both the salivation and disease removed by zfull cathar-
tic dose of calomel. The safety of the patient does not depend
upon salivation, but upon the prompt action upon, and the unload-
ing of the vessels of the liver,

While some physicians hail the appearance of salivation as the
harbinger of safety to their patients, there are others who dread
its appearance to such a degree that they will not venture to uso
calomel at all, whether from a regard for the welfare of their pa-
tients, or a greater regard for their own reputation, I will not de-
cide. The popular sentiment, however, is unquestionably against
it, under any circumstances, and so am I. Salivation is not what
we want in the malignant and death-dealing diseases of the South;
and if calomel is properly used, in these diseases, there is generally
little or no risk of exciting it. Now, it is not always becoming

1856.] Holt's Letters upon General Pathology. 265

for one to speak of himself but professing to speak far myself, I
may be allowed to say not, however, in an arrogant or boastful
spirit that the success which I have had in the use of calomel,
(for which, I am not too modest to acknowledge, the professional
brethren, acquainted with my practice, have awarded to me a full
share of credit,) has been, in a great measure, the result of the
manner in which I have used it; and the few general rules which
I have observed in the use of calomel have been after determin-
ing the necessity of its use, then to use it in such a manner, and in
such quantities, as will soonest accomplish the purposes for which it
may be used ; and when this is done, then to discontinue its use.
Now these rules, though few, and apparently very simple, to be
reduced to successful practice, requires the exercise of judgment,
prudence, and discretion; for if cannot be denied, that the evils re-
sulting from the use of calomel have often been from a lack of
these, and that it has often been used when it was not required;
has been used under circumstances, and in such manner, and in
such quantities, as to produce its worst, without its good effects,
in cases in which it was required; and has often been continued after
its use had ceased to be necessary. From observing these few rules,
(the minute details of which I purpose giving hereafter, such as
the circumstances which indicate the necessity of its use the time
and manner of its administration, and the quantity necessary in
each case ; the signs for its discontinuance, &c.,) which I have
found little difficulty in reducing to practice, on account of popu-
lar prejudice; having always been an open and avowed advocate
of the use of calomel, I do not hesitate to declare that, with it, I
have been the means of doing more good, and saving more lives,
than with any, and I might say, all other remedies.

Quinine, which may also be styled a life-preserving remedy,
stands next to calomel, in value and importance, each having the
highest claim upon the profession in their respective spheres of action ;
for while calomel possesses the power of often rescuing or snatching
a man from the jaws of death quinine has the power of keeping
him out of them. Opium, too, has its claims ; and though high in
the sphere of its action, which is more extensive than either of the
others, it can be regarded only in the light of an auxiliary remedy.
These, with the lancet, may be said to constitute the four cardinal
remedies of the profession, with which, under proper management,
the most malignant diseases may be successfully combatted.

266 Holt's Letters upon General Pathology. [May,

Now, these remedies can aid each other in the work of preserv-
ing life, but they cannot perform each others' work. Can quinine
unload the liver and bowels? can it restore suspended secre-
tion ? can it stop vomiting and purging ? can it eliminate poisons
from the system ? Calomel can. Can calomel break up the peri-
odicity of disease? can it prevent or remove depression, conges-
tion and collapse ? can it give tone and energy to the nervou8
system? Yes, to a certain extent it can do all these things,
though not so well as quinine. Can calomel and quinine subdue
a burning fever, arrest a raging inflammation, or assuage a throb-
bing or an aching pain ? Only to a limited extent, and in an
indirect manner ; yet the lancet and opium will do it promptly.
Is it not strange ! "passing strange!" that with all these things,
full in view, there are physicians in our midst, whose opinions
ought to be entitled to credit, who have openly denounced some
of these remedies, (calomel and the lancet in particular,) as unsuit-
ed, or unsuitable, in the treatment of some of our most formidable
and dangerous diseases, and have offered us for their substitutes,
phosphorus! aconite! and hryonia! Nor is it less strange, that
large numbers of our southern physicians should have assumed,
that the free use of quinine will enable them to dispense with the
use of calomel in our dangerous diseases, and malignant epidemics.
And, stranger than all, that there should be some old and long
tried physicians, who advise that little or nothing should be done,
alledging that one system, and set of remedies, work about as well
as another, and all are of no avail.

Now, to show all this matter up in its true light, I will give you
an allegory: A poor fellow accidentally fell into a river, and in
the act of drowning, called to some men on the shore for help.
They had at hand a boat, and life-preserver, and a bundle of straws.
One of them said to the other, I will throw him my life-preserver,
it will hold him up better than the boat ; besides, I do not know
much about boats, and I am told that they are dangerous things
any way : so he threw him the life-preserver. Another one said,
that's just what I think about boats ; they are dangerous and use-
less things to my certain knowledge, for I have tried them often;
let me throw him some of my straws. The third one said, I know
the boat will not do under any circumstances, and I have no con-
fidence in your straws, or your life-preservers either one is as
good as the other ; let us watch him until he drifts ashore, and then

1856.] Dugas. Cases of Lithotomy. 267

we will help him. So the poor fellow drowned. And when the
facts came to be known, how they had all refused to send him the
boat, when they might just as easy have saved his life, the people
all thought that it was very strange, that the men did not send
him the boat, and give him a chance, at least, for his life. Some
said they thought it a very cruel act, not to send him the boat ;
others said they thought that it was a very foolish one ; but the
men themselves did not seem to think or care much about it, and
it all soon passed off and was forgotten.

Finding that I shall not be able to make a statement of the cases,
which I had purposed doing, illustrative of the more important
points concerning the action of calomel, I will reserve them until
I come to speak of the diseases to which they respectively belong.

Having generalized to a sufficient extent, in my next letter I
will make a summary review of the general principles which I
have maintained, and afterwards will make a therapeutic applica-
tion of them to some of our more formidable diseases. It is said
that "drowning men catch at straws." For mercy's sake, let us
offer them something better ; and if I can persuade one man only,
that there is not so much danger in a boat, I shall consider myself
well paid for my trouble.

Respectfully yours, &c. Saml. D. Holt.

ARTICLE XV.

Cases of Lithotomy. By L. A. Dugas, M. D., &c.

Case I. Henry S., the son of a highly respected professional
brother of Coweta county, in this State, had experienced the usual
effects of stone in the bladder from early infancy until the age of
six years, when the bi-lateral operation of lithotomy was perform-
ed in June, 1851. This operation was, however, productive of
only partial relief, as he continued to suffer, although at first less
severely than before it. In a short time his symptoms became as
bad as ever; the wound, instead of healing as usual, was at the
end of three months reduced to the size of a quill, and finally
closed entirely about three months later.

The little patient was brought here and placed under my charge
in February, 1853. On endeavoring to sound him, I found that
although the integuments cut in the previous operation had healed,

268 Dugas. Cases of Lithotomy. [May

such was not the case with the urethra, for the sound would pass
from this caual into a pouch in the perineum, and could be felt
just within the thin skin which covered it. This circumstance
rendered catheterism somewhat difficult, as it was not easy to carry
the sound into the canal beyond after it had entered the pouch.
I succeeded, however, in detecting a large calculus, and at once
determined to operate.

On the 22d February I performed the bi-lateral section, under
the influence of anaesthesia, and seized the calculus, which
crumbled into pieces on endeavoring to extract it. The scoop was
then used, and about a table-spoonful of chalk}- -looking fragments
removed. The bladder was carefully explored with the finger
until every particle was brought away with instruments and re-
peated injections of tepid water. On the seventh day the wound
had entirely closed.

The child returned home, with the injunction to use vegetable
acids as freely as possible, so as to prevent a reproduction of the
calculus, which was evidently ammoniaco-magnesian. How long
these instructions were carried out I am unable to say. In a letter
received from his father, I am informed that the child "for twelve
months after the second operation enjoyed fine health, and was
growing rapidly, without any symptoms of a return of the disease.
After the expiration of this time he was attacked again, and suffer-
ed as much as he had at any time previous, discharging quantities
of pure pus, occasionally mixed with a little blood and small frag-
ments of stone, which very much resembled those you extracted.
He continued in this way some two or three months, suffering by
paroxysms, when he was suddenly attacked with violent colic, ac-
companied with vomiting and purging, which terminated fatally in
two or three days." He died on the 27th September, 1854.

Remarks. This case derives interest not only from the fact
that the patient underwent at so early an age two operations of
lithotomy, but also from the persistence, or rather recurrence, of
.the calculous diathesis even after the second operation. I say
recurrence, because there is no evidence of any reproduction of the
disease for upwards of a }'ear after the second operation. From
the little relief afforded by the first operation, the non-closure of
the wound for many months, and the continually increasing severi-
ty of the symptoms, it may be questioned whether some portions

1856.] Dugas. Cases of Lithotomy. 269

of the calculus had not been left in the bladder. Yet the opera-
tion was performed by an experienced surgeon, who could hardly
be presumed to have committed such an error. I am informed by
the parent that the first stone was of the same character as that I
removed, and that it was likewise crushed in the extraction.

Case II. James F., of Dooly county, about twelve years of age,
had suffered with symptoms of stone in the bladder from early
childhood, but his general health was unusually good. Finding,
upon examination, that the calculus was small, I determined to
try to crush it with the lithotrite. Dilating bougies were accord-
ingly used some days, but occasioned so much irritation in the
urethra that they had to be discontinued, and I had to wait until
this had subsided before making any further attempts. His ure-
thral canal being very small, a correspondingly small lithotrite
was passed into the bladder, and the stone seized ; but its hardness
was such that it could not be crushed by any force that could be
applied without danger of breaking the instrument. A few days
later another attempt was made, with similar result.

Lithotomy being now the only alternative, the bi-lateral opera-
tion of Dupuytren was performed on the 29th July, 1855, under
the influence of concentrated chloric ether, and a calculus of oxalate
of lime removed. Its shape was a flattened ovoid, seven-eighths of
an inch long, three-quarters of an inch wide, and half an inch
thick. It weighed seventy grains.

No unpleasant symptoms manifested themselves, and on the 9th
August, being well, he returned home.

Case III. Columbus A., of Columbia county, had experienced
symptoms of stone from early childhood, and was very much
emaciated and debilitated. Although in his eighteenth year, his
physical development had been retarded by excessive suffering to
such a degree that he did not appear to be more than ten years of
age. For several years his urine was continually dripping, so that
there was rarely any accumulation in the bladder. Sometimes he
would pass off once in the course of twenty-four hours as much as
two or three ounces of urine. It was remarkable that moderate
walking, or riding in a carriage, did not aggravate the symptoms.

Having been put under the anaesthetic influence of chloric ether,
the bi-lateral operation was performed on the 13th November last,

270 Dugas. Cases of Lithotomy. [May,

and an hour-glass shaped calculus was removed, of which the ac-
companying wood-cut is a faithful delineation. It weighed about
an ounce and a half, and was composed of ammonio-magnesian
phosphate of lime.

Upon making a longitudinal section of this calculus with a fine
saw, a nucleus of darker and more dense material was found occu-
pying the centre of the neck, and projecting about equally into the
two enlarged portions of the stone. This nucleus presented more
length than breadth, being about three-fourths of an inch long and
half an inch wide. The shape and size of this nucleus will serve to
account for the position occupied by the calculus, the large ex-
tremity being found to be within the bladder, while its lesser end
was in the urethra, and its neck consequently grasped by the
orifice of the bladder. It would therefore seem that while small,
as represented by the nucleus, it attempted to escape from the
bladder, but was caught at the origin of the urethra, and remained
there until by deposits upon its surface it reached its present
dimensions. The deposit being more copious within the blad-
der, this portion of the stone grew faster than that in the
urethra.

The abnormal position and form of the calculus rendered the
introduction of instruments quite difficult, and much care was
required not to break it in the extraction. On being removed,
the pouch in the urethra was found lined with soft detritus, which
had to be scooped out. The bladder was then carefully and re-
peatedly washed out until no vestige of fragment remained. On
the fourteenth day after the operation the patient began to pass
his urine per urethram, and he went home on the 10th of December.

1856.] Placenta Prcevia. 271

The wound finally closed a few days after. He has continued to
improve ever since, and is now in fine health.

The position of the stone and its consequent immobility will
explain the stillicidium urinas and the non-aggravation of symp-
toms by walking and riding.

Observations on Hcemorrhages arising from Imjjlantation of the
Placenta upon the Cervix of the Uterus; with Pemarks on the
Pathogeny and Therapeutics of this Accident. By M, Legroux,.
Physician to Hotel-Dieu of Paris, Agrege Professor to the Facul-
ty, etc. etc.

Haemorrhage consequent upon the insertion of the placenta over
the cervix of the womb, has, latterly, been the subject of much dis-
cussion, both in learned societies and medical periodicals.

The most complete and important document which has appeared
among recent publications is Dr, Depaul's report* to the Academy
of Medicine on a case of complicated labor, communicated by Dr..
Gerard.

More recently, Professor Dubois has taken up this matter in his-
clinical course ; and his lectures, which first appeared in the Jour-
nal de Medecine et de Chirurgie Pratique, have been very
generally republished.

After such imposing authorities in obstetrical matters have given
their opinions, I almost fear to enter on the question, or to give
the results of my personal experience. For, if I have observed
and appreciated facts aright, the generally admitted doctrine in
respect to the pathogeny of placenta praavia must be laid aside.
If I am not deceived, some of the precepts of the masters of obste-
trical art must be modified or revised, and a new therapeutical
element must find a place in their teachings. May the desire and
hope of being useful to humanity justify the boldness of my un-
dertaking f

In the first place let me briefly recall the reigning doctrine ob
the pathogeny of this haemorrhage.

" It is generally admitted that the flooding becomes more profuse as labor
advances, and the separation of the placenta, from which the haemorrhage-
arises, becomes more considerable; that whatever increases the uterine-
contractions necessarily augments the bleeding; that the means of arrest-
ing this are precisely those which suspend the contractions, for the'
haemorrhage lessens and ceases only in the intervals between the pains,'r
(Gardien, 2nd ed. t. ii. p. 404.)

And farther on, (p. 406,) it is stated that " the flooding produced by the-
separation of the after-birth, at any other part of the internal surface of the

* Bulletin de l'Academie, July 1852,

272 Placenta Prcevia. [May,

womb, augments when the true labor pains are suspended, and ceases
when the pains are active."

The reason of this difference is that, in the latter case, the womb
closes the orifices of the uterine vessels, as it contracts ; whereas,
in the former, the contractions of the body and fundus dilate the
cervix, and separate the placental attachments more and more, the
distended vessels remaining open-mouthed.

According to this theory, the haemorrhage is placental. A mul-
titude of objections are at hand,, but I pass them hj for the
present. With the opinion of Gardien, I collate those of Desor-
lneaux and Professor Dubois.

" Blood flows more abundantly during uterine contraction in haemorrhage
from insertion of the placenta over the cervix, while, in other hemorrha-
ges, the compression of the womb suspends the flooding. The blood in the
former case, is forced out of the vessels of She cervix and of the placental
parenchyma by the recession of the circumference of the uterine orifice,
and by the pressure of the child on the placenta." (Diet, de Med. art. Me~
trorrhagie, t. xix. p. G60.

This doctrine, attributed to Dupareque, admitted by Desor-
meaux, M. Depaul, and Professor Dubois, and uncontradicted, so.
for as I know, is very similar to that of Gardien ; only the latter
attributes the haemorrhage to the gradual separation of the placenta,
the vessels of which remain gaping ; whereas the other theory takes
account of the pressure of the foetus, and assigns an utero-placen-
tal origin to the haemorrhage. In both theories, however, the
uterine contractions are considered the primary cause.

The haemorrhage is in direct relation to the activity of the labor,
and the haemostasis depends on its suspension.

The practical deduction is this : to arrest the haemorrhage, moder-
ate the uterine contractions.

But inasmuch as parturition must go on, after all, we are advi-
sed, in the face of theory, to hurry the labor by ergot, in order to
hasten the delivery of the placenta. But we are necessarily placed
between two perils. If we excite uterine contraction, as practical
sense would seem to dictate, we incur the hazard of profuse and
fatal flooding. If we moderate the pains, according to the indica-
tions of theory, the blood does not flow so fast, but the patient
almost invariably succumbs to the progressive anaemia.

I hope to substitute for this theory one which subordinates the
hozmostasis to uterine action and reciprocally, and which will permit
uterine action to be augmented without danger.

I shall state, in the first place, the facts on which this theory is
based. My first cases* are designed to determine the source of the
haemorrhage.

* We have found it necessary to abridge the reports of cases, but have endeavored
to omit no important fact. Otherwise, we could not have published M. Legroux's
paper in a single number, as it occupies over thirty pages of the Archives, a greater
space than we can afford. Translator's note.

1856.] Placenta Previa. 273

Case I. A woman set. 30, had been flowing, at intervals, for a fort-
night, when she was brought to the Beaujon hospital in April 1852.

She was near her term. She had lost much blood ; the fetal movements
had ceased. She was still flowing moderately and though of robust habit,
was pale and feeble. The os uteri admitted the end of a finger, and present-
ed no abnormal appearance. (Rest in horizontal posture, astringent drinks
and injections.)

The haemorrhage ceased, but returned in a few days ; the patient be-
came faint. I asked the advice of Dr. Robert, surgeon to the hospital.
By digital and speculum examination, we made sure of a prominence of the
posterior lip ; the finger, after passing the os, perceived a spongy substance.
The woman bore the examination, in both the horizontal and vertical posi-
tions, without discomfort.

We decided to give ergot. The medication had not been commenced,
however, when, towards the close of the day, the woman, without more
flooding, died unexpectedly in a swoon.

Autopsy. Central implantation of the placenta over the os uteri. Pla-
centa soft, brown, decomposed, not foetid, however ; placenta easily de-
tached. Foetus decomposed. No visceral lesion to explain the sudden
death.

The decomposition of the placenta, resulting from the death of
the fcetus, forbids us to locate the haemorrhage in that organ. If
the bleeding was utero-placental at the outset, it was assuredly
purely uterine after the child's death.

Notice also a fact, which is constantly observed in cases of pla-
centa pra?via, that flooding occurred long before labor, and there-
fore independently of uterine contraction, to which theory assigns
the chief share in its production.

The following is a succinct summary of a case observed in 18-44,
at the hospital Saint- Antoine, and recorded with great care and
detail by my friend Dr. Bernutz, who has kindly communicated it
to me.

Case IT. A woman, jet. 44, was in the eighth month of her thirteenth
pregnancy. She menstruated the first four months, but had seen nothing
since, until towards the end of the eighth month, when, after bad treat-
ment from her husband, she began to flow, and Tost considerable blood at
intervals for three days. The flooding ceased after a protracted syncope,,
and the next day the woman was brought to the hospital.

She was pale, but there was no haemorvhage. The os was dilated to the-
size of a quarter of a dollar, and was filled with a substance which felt like-
cup moss.

In the night, copious haemorrhage, sighing respiration, epi'grastric pain,,
feeble, frequent pulse, no uterine contraction, same state of os. (Cold va-
ginal injections.) The haemorrhage ceased. The patient took a little wine,
and felt better. The tampon was employd, but the patient complained of
it, and of a great pain at the epigastrium; the stomach retained two scru-
ples of ergot, which had been given in three doses. Soon after, the patient
became delirious, the pulse failed, and a state of syncope ensued, which re-
sisted every mode of stimulation..

274 Placenta Previa. P^a7i

Autopsy. Heart contains black and fibrinous coagula ; in the great ves-
sels a quantity of blood analogous to what is usually found in examinations
post-mortem. The uterus contains a foetus at term in a state of decomposi-
tion. The placenta, implanted on the anterior surface of the cervix,
completely closes the orifice, and rises a few lines beyond the posterior
border. The os is dilated to nearly the size of an half dollar piece, and is
filled by the tampon, which is hardly stained. No open vascular orifices.

The anatomical conditions of the placenta are not mentioned in
this case. Notwithstanding this omission, we may assume that the
utero-placental circulation was more or less completely intercepted
after the death of the foetus; for, according to Professor Moreau,
when the foetal circulation ceases, the blood coagulates in the
uterine vessels, and many of the latter are obliterated. Only
enough blood goes to the womb as may suffice for its nutrition ;
the stimulus which invited more is gone, and hence dilatation may
occur without much haemorrhage, albeit the vessels which unite
the placental borders are torn. This is Dr. Cazeaux's rational ex-
planation of the dilatation of the cervix without haemorrhage.

Death, in the two cases I have cited, was not the direct and
immediate, but the secondary, effect of the haemorrhage. In the
second case, indeed, the fatal termination was brought about by a
series of accidents ; but in the first it occurred unexpectedly, and
without extreme exhaustion.

I think it useful to dwell on the dangers of the anaemic state in-
duced by repeated floodings, dangers which continually menace
the patient, even after a protracted cessation of the bleeding. I
shall insist, also, on the danger of some of the obstetrical manoeu-
vres which may be requisite under these circumstances.

Case III. A year ago, a woman was brought, at the hour of my visit,
to my lying-in ward at Hotel-Dieu, who had been several days in labor,
and was exsanguined by repeated haemorrhages.

A spongy substance, that was evidently the placenta, filled the orifice of
the womb, which was detailed more than two inches, (6 centim.) The case
was urgent. The extreme debility of the patient indicated that she could
not withstand another haemorrhage. I attempted to deliver. Contrary to
my anticipations, the cervix was so unyielding that I could not dilate it by
introducing my fingers. I had scarcely commenced my manoeuvre when
the woman swooned and seemed about to expire. I desisted, and ordered
stimulants, broths, sinapisms, and left directions that the tampon should be
used on the slightest recurrence of haemorrhage.

Haemorrhage did not recur, but the patient sank gradually, and died in
a few hours.

Autopsy. Placenta over cervix, as had been recognized during life. No
clot between the uterine and placental walls to explain the haemostasis. It
was impossible to discover, at points where the placenta was separated, the
orifices of any vessels.

"What else could have been done for this poor woman, in her
state of extreme exhaustion ? Artificial delivery would obviously

1856.] Placenta Prcevia. 275

have caused instant death, since even the introduction of the hand
into the vagina induced syncope. Should the membranes and pla-
centa have been perforated ? There were no uterine contractions,
and the sudden removal of pressure from the abdominal contents,
after the escape of the waters would have aggravated the syncope.
I have since regretted that I did not use the tampon, which might
have induced uterine contraction, and stimulated the vital powers.

In this case, also, death took place many hours after haemorr-
hage had ceased, and was a secondary result.

I observe the same thing, lately, in the case of a lady of Cour-
bevoie, whom I attended with two eminent colleagues. She was
exhausted by repeated haemorrhages occurring in a lingering labor.
When I saw her the flooding had stopped. The os was largely
dilated; a large, spongy mass was behind it; the tissues were all
relaxed. Extraction of the placenta, version and extraction of
the child seemed easy. We decided that this operation was indica-
ted. I practiced it. The whole manoeuvre required less than a
minute. The lady complained, at the moment of extraction, of
faintness and a sensation of anguish. No blood followed. Not-
withstanding, and despite the devoted care and attention she
received, this patient succumbed in a few hours, without reacting.

In the last six months, two cases of artificial delivery in placen-
ta praevia have been in my lying-in ward, under the care of Dr.
Danyau,* specially charged with cases of dystocia. Both of them
succumbed two or three days after the operation.

The simple extraction of the placenta, after the child is born,
produces the sensation of anguish I have alluded to, in a woman
exhausted from haemorrhage. One morning during my visit, I
found a young woman blanched by haemorrhage, which doubtless
was due to inertia of the womb after expulsion of the child. The
extraction of the after-birth seemed urgently requisite. I relied on
the contractions which the introduction of the hand would excite;
but this simple operation, as rapid as it was easy, produced, at the
moment the placenta came away, a dying sensation, which was
followed, in a few instants, by actual death. Death was certainly
impending, and inevitable perhaps, in the exsanguined state in
which I found this woman ; but I asked myself if I had not accel-
erated the fatal event, by performing an operation.

From these facts, the number of which I could readily increase,
two conclusions may be drawn : 1. That anaemia due to repeated
haemorrhages, an anaemia which I would term acute, in contradis-
tinction to the chronic anaemia induced by unfavorable hygienic
conditions, which may be extreme without endangering life that

* Dr. A. C. Danyau, son of an accoucheur formerly in great vogue in Paris, and
son in law of old Roux, is surgeon to the Maternite, He is one of the eight members
of the section of accouchments at the academy, and is great authority at the Surgi-
cal Society on matters pertaining to obstetrics. He has been in practice twenty-
six years.

N. S. VOL. XII. NO. V. 18

276 Placenta Previa. [May,

acute anaemia, I say, exposes patients to sudden and unexpected
death, and demands all the solicitude of the practitioner. 2. That
the slightest obstetrical manoeuvre, during the debility of acute
anaemia, may superinduce a fatal perturbation.

After this digression, which 1 have thought might not be devoid
of practical interest, I return to the facts which illustrate my views
of haemorrhage in placenta praevia.

Case IV. Mrs. Lemasson, *t. 28, rue St. Antoine, reached the eighth
month other eighth pregnancy in May 1847, at which date she had an
haemorrhage which seemed to threaten a premature labor.

Moderate venesection, indicated by a somewhat plethoric habit, and cold
applications to the abdomen and thighs checked the bleeding. It returned,
however, on three occasions, before term, and was thrice controlled with
the same facility ; but the third time, the bleeding was not restrained en-
tirely, and it became abundant after three or four days, when labor began.

The presumption of placenta prrevia was confirmed as soon as dilatation
was sufficient to admit the ringer, which encountered a spongy mass, so
thick as to conceal the prominences of the foetus. The dilatation reached
about two inches and then ceased, notwithstanding the intensity and fre-
quency of the pains.

On exploring the orifice, carrying the ringer as high as possible, I passed,
on th i left between the internal surface of the cervix and the placenta, and
ascertained the following facts:

During the uterine diastole, the finger passed readily between the separ-
ated parts ; but then the blood streamed by it into the vagina. ,

During the systole, the finger was driven out by the tense membranes,
which were pressed firmly against the uterine walls; the blood then ceased
to flow, but that ichich had been poured into the vagina during the diastole
was expelled by the downward jjressure of the womb.

Having repeatedly satisfied myself of the correctness of these facts, I con-
sidered it evident that the issue of blood from the vessels, the hcemorragie
fact, was diastolic, though the appearance of the blood externally, the appa-
rent haemorrhage, was systolic indeed, and coincided with the suspension of
the real haemorrhage.

The haemostasis was manifestly the consequence of the uterine contrac-
tion, of the firm application of the membranes on the inner surface of the
cervix.

In order to arrest the haemorrhage, it was necessary to maintain this
state of things during the repose of the womb ; to cause the combined mass
of the waters and the foetus to press on the cervix in the intervals of the
pains. The vertical posture fulfilled this indication.

I boldly substituted it for the horizontal position hitherto adopted. The
patient, too feeble to stand alone, was held by strong persons on either side,
while I sat in front, supporting her feet and knees by mine, and sustaining
her with one hand, while I manceuvered with the other. As soon as she
was placed upright, there came a torrent of liquid blood and coagula well
calculated to frighten me and cause me to repent of my experiment. But
my fears were speedily dissipated ; the first gush over, the haimorrhagt
ceased entirely !

I satisfied myself by the touch that, in the intervals between the pains,

1856.] Placenta Prcevia. 277

the womb remained on the floor of the pelvis, and that the weight of the
waters and fetus maintained the separated vascular surfaces in apposition.

The uterine contractions became at once stronger and more frequent. But
the os did not dilate. What was the obstacle to dilatation ? Undoubtedly,
the peripheric adhesions of the placenta, detached on a small part of the
left side only.

I attempted, passing my finger up on the left, to reach the membranes,
but unsuccessfully. I presently detected, however, a fissure between the
placental lobules which I separated, tearing with the finger nail the parts
that offered resistance. I finally reached the membranes, and ruptured
them during a contraction. A large rent was immediately torn in the pla-
centa as the waters escaped. The placenta was thrust to the light by the
head, which engaged at once, and after delivery was accomplished without
any accident. The child was living and lusty.

In a portion of its circumference, the placenta was torn for about two
and a half inches. Near this rent was a smooth white surface, the cicatrix,
probably, of an antecedent laceration.

The woman had a good getting up.

Case V. A few months after this confinement, Mrs. Lemasson became
pregnant again. The abdomen increased rapidly in volume. By the eighth
month it was enormous.

During this month, she suffered from several haemorrhages, each of
which lasted several days, and was treated by rest, refrigerants, astringents
and injections. Before her confinement, the bleeding became continuous,
and produced a state of anaemia. The pains were feeble ; they were not
aroused by ergot ; the os did not dilate.

The feebleness was such that I could not resort to the vertical posture.
I plugged the vagina with bits of lint saturated with a solution of alum.
When the tampon was removed, it was evident that it had suppressed the
haemorrhage completely.

The presence of the tampon excited contractions. In three hours, I
cleared out the vagina, and found notable dilatation of the orifice, which
wras occupied by a spongy mass. Following the periphery of the orifice, I
found, on one side, a fluctuating membranous protrusion, which I ruptured.
The head engaged and rapidly enlarged the opening. In a very few
minutes two children were born. They had been dead for some days.
The after-birth was delivered without difficulty.

The subsequent history is less pleasing. The patient narrowly escaped
death from metro-peritonitis. She had double phlegmasia dolens, followed
by uncomplete anchylosis of the knees, which was not ultimately relieved,
until she had passed two seasons at the Bourbonne springs.

The menses have not returned since ; but at the supposed mouthly
periods, the patient suffers from hypogastric pains and hysteriform symp-
toms requiring anti-spasmodics, and occasionally, leeches to the anus. The
general health is blooming, however, and these periodical indispositions are
less severe at each return.

This complete observation furnishes a demonstration of the

propositions I have advanced, as will appear, I hope, from the
following considerations :

/Source of the hcemorrhage. When the child is dead, and the

278 Placenta Pravia. [May,

placenta decomposed, it is obvious that the bleeding is purely
uterine. This was the ease iu the first patieut whose history has
beeu detailed.

Admitting that after the death of the child, the placenta remains
graited to the Avails of the womb, from which it receives materials
for its nutrition through special vessels, it is evident that the vas-
cular connections between these organs must be too restricted, the
utero-fcetal circulation having stopped, to produce a notable haemor-
rhage, such as caused death in case 2.

In one case as in the other, the bleeding was exclusively, or
almost exclusively, uterine.

Is it so when the circulation between the mother and child is
intact?

A priori it might be argued that, nothing being changed in the
progress of the accident, the blood comes from the same source.
This rational deduction receives a practical confirmation from the
case of Mrs. Lemasson. In her case, the bleeding was arrested by
maintaining the placental and uterine surfaces in contact, while a
portion of the placenta was exposed over an orifice two inches in
diameter. If this organ had been the source of the haemorrhage,
would it not have bled freely, while thus exposed, during the active
pains excited by the vertical posture?

Therefore, in all cases, the haemorrhage is almost exclusively
uterine.

The death of the child, which precedes deliver}- in the majority
of cases, (in seven out of eight that have been under my care,) would
allow us to suppose that the haemorrhage, at the onset, was placen-
tal and fcetal. But there was no placental haemorrhage in Mrs.
Lemasson's case, and her child was living and not anaemic by any
means. The death of the foetus is due to the interruption of the
utero-placental communications.

It may be objected that Dr. Simpson's plan of extracting the
placenta at once arrests the haemorrhage : Sublata causa, lollilur
effectus.

If this objection was valid, the decomposition of the placenta
should have the same effect, which it has not. Why this difference?
In the latter case, the placenta, although deprived of vitality, still
retains its mechanical connections with the uterine walls. As
these connections are broken up by the retraction of the walls of
the womb, vascular orifices are exposed. Hence those intermittent
haemorrhages, which occur during labor, although the child has
ceased to live. In Dr. Simpson's operation, the portion of the
uterine surfiice corresponding to the placenta is exposed at once;
uterine contraction is excited by operative manoeuvres, and the
vascular orifices are closed. Hence the cessation of the haemor-
rhage.

It is unquestionable that this operation would be injurious in
cases of inertia of the womb.

1856.] Placenta Prcevia. 279

The practical deduction from this theory is: hasten, expedite Hie
labor.

The suspension of haemorrhage is commonly attributed to the
formation of an obstructing coagulum. I have never been able
to find this coagulum in any of my autopsies. If the haemostasis
was due to such a salutary clot, the therapeutical deduction would
be: let the clot alone, retard the labor, a most pernicious result.

In the exposure of the uterine sinuses by the growth of the womb
during pregnancy, and by the dilatation of theos during labor, id
this mechanism, we find an explanation of the phases of apparition,
suspension, and recurrence of haemorrhages from placenta praevia.
Nature of the haemorrhage. Dr. W. Mackenzie's experiments on
bitches near the full term of gestation, equally tend to prove that
in partial separation of the placenta, bleeding occurs from the de-
nuded uterus, and not from the separated placenta. From these
same experiments, and from injections into the uterine vessels,
through the hypogastric arteries, of defibrinated blood, this
English author concludes that inter-utero-placental haemorrhage is
arterial. With Dr. Jacquemier* I am unwilling to admit this con-
] elusion, when I consider the prodigious developement of the
uterine venous apparatus during gestation, and the free communi-
cation between all parts of it. This question, however, has more
theoretical than practical importance. The capital point is to de-
termine what organ furnishes the blood.

Relation of the haimorrhages to uterine contractions. I repeat my
remark that haemorrhage in placenta praevia occurs long before
term oftentimes, and is consequently independent of uterine con-
tractions.

It has been asserted that the haemorrhage, in placenta praevia,
takes place at each pain, and is arrested in the interval, and that
the reverse obtains when the placenta is separated from its attach-
ment to the fundus or body.

In the first case, the observation is correct, but the interpretation
ris erroneous. I have shown that the placenta is, at the most, only
' a very secondary source of haemorrhage. Common sense suggests
the improbability of much effusion of blood between the surfaces
of the ovum and uterus, when these surfaces are strongly pressed
;' together; and what common sense indicates, experience corrobor-
ates. It is, indeed, a matter of ordinary observation that, in the
.horizontal posture, the flooding ceases in the interval, and returns
[with the pains; but the interpretation of this fact is that the real
'haemorrhage occurs in the interval, and that the apparent haimor-
'rhage is only the elimination of blood already effused.

In the second case, observation has certainly been defective, but
the conclusion is correct. The haemorrhage does occur during the
repose of the womb, but it is impossible to believe that the flooding

Gazette hebdomadaii'e de Med. et de Chir. March 24tb, 1S54.

280 Placenta Prcevia. [May,

is manifested externally at this period ; it is only when the womb
contracts that the blood that has filled the vagina during the dias-
tole is expelled.

It is incorrect, therefore, to institute any distinction between the
different insertions of the placenta, in respect to the time at which
the haemorrhage takes place.

Vertical position in labor. In the horizontal position, in which
the parturient woman is commonly placed, the uterine contractions
force the womb towards the vulva and the foetal extremity towards
the cervix. When the pain is over, the womb reascends in the
pelvis, and the child falls back in the uterine cavity. The weight
of the ovum is supported by the posterior wall of the uterus ; a part
of the force of each contraction is expended in raising the fcetal
mass, and depressing the womb to the pointatwhich the preceding
pain left it ; this force is lost as far as expulsion is concerned.

In ordinary labor the womb is equal to its double task ; but
when the pains languish, the force of the contractions is barely suf-
ficient to raise the fcetal mass and imperfectly depress the womb.
The labor becomes stationary, and may remain so for hours or
days, unless art intervenes.

Ergot may render good service in such cases, or it may be insuf-
ficient, and the forceps may be resorted to. Now, under these
circumstances, the vertical posture alone, or aided by a dose of ergot,
will almost invariably induce sufficiently active labor to bring a-
bout a natural delivery.

In this position the fcetal mass presses constantly on the cervix,
and is a permanent cause of dilatation. However feeble the con-
tractions may be, they are exclusive^ employed in expulsion, for
the womb ascends but little in the intervals. Moreover, this
position almost always excites more frequent and energetic pains.

By this means, the use of the forceps maybe avoided* in a
great majority of cases, a desirable result, inasmuch as many per-
sons who practice obstetrics are not familiar with the application
of these instruments.

I have already treated of the haemostatic effects of this position.
It assuredly does not always succeed, however, and may often be
prohibited by the exhaustion of the patient. What resource have
we then?

The Tampon. Methodical plugging of the vagina, advocated
in 1776, by Leroux of Dijon, is now generally admitted to be an
invaluable remedy. f

*I was present, a short time since, when ii distinguished obstetrician delivered a
robust lady by means of tin- forceps. She had been in labor three days in the hor-
izontal posture. While the operator was preparing the bed, the patient experienced

a desire logo to Btool, and was placed for a moment on a chair ad hoc; such violent
pains came on, thai if the operation had been delayed for a few minutes, the child
would inevitably have been precipitated into the vessel. Author snote.

\ Dr. Legroux introduces here a long extract from a lecture of Prof. Dubois on the
tampon, which we omit, as we intend to publish that lecture entire. Translator.

1856.] Placenta Prarvia. 281

I usually introduced the speculum, and filled the vagina with
little balls oflinen or charpie by means of a long pair of dressing
forceps, and when the tampon nement is complete, I apply a T
bandage. Many accoucheurs employ the simple pessary of vulcan-
ized india-rubber, invented by Gariel, and recommended particu-
larly by Dr. Chailly. This is inflated after its introduction; the
facility with which it is applied permits frequent examinations
during the labor, without discomfort to the patient.

Perforation of the membranes. To evacuate the waters, and al-
low the uterus to contract and close the vascular orifices laid bare
by the separation of the placenta, is a practice advised by the
majority of authorities, in all cases of profuse flooding towards the
end of gestation.* Nearly all, however, require that the com-
mencement of labour should be clearly indicated by unmistakable
pains.

The author of the excellent treatise from which I learn these
facts, considers rupture of the membranes preferable to the tampon.
Professor Dubois is so convinced of the utility of rupturing the
membranes, that he lays it down as a maxim that this manoeuvre
should be employed in preference to forced delivery by the podalic
version ; but he makes it necessary that there should be strong and
frequent pains, a certain degree of dilatation and dilatability of the
cervix, and a favorable presentation. This is something more than
a " commencement of labor," certainly. It reduces us to the or-
dinary indications for the operation almost.

Dr. Cazeaux (loc. cit.) observes that, after haemorrhage, the
pains are generally feeble, and that labor may advance considera-
bly without any noticeable pains; that the pains may be suspend-
ed after having been strong and frequent, although the cervix is
dilated and soft. In these two cases, the condition of the cervix
i will determine the accoucheur's conduct. If this is favorable, the
j best way to excite or renew the contractions will be to rupture the
! membranes.

But, notwithstanding the authority of Dr. Cazeaux, I cannot be-
;, lieve it prudent to perforate "when the end of the finger can be
I introduced, and feels the membranes growing tense at intervals."
I am more struck by the dangers than by the advantages of per-
foration at this stage. It is not certain that this operation will
arrest haemorrhage. If delivery is not rapidly accomplished, the
contractions will separate other parts of the placenta, and the
haemorrhage will return. A premature evacuation of the waters
. retards the labor, and far from being favorable to the child, sub-
jects it to the dangers of uterine compression. When the tampon
affords this security, why not wait until the os is sufficiently dila-
ted and soft? Moreover, if haemorrhage returns after premature
\ evacuation of the waters, we cannot have recourse to the tampon
with the same confidence ; the blood may accumulate in the uterus.

* Cazeaux, Trait6 des Accouchemeuts, p. 775. Paris, 1S50.

282 Placenta Prcevia. [May,

When the placenta is partially implanted on the cervix, a period
always arrives when a portion of the membranes protrudes at the
os. It is at this point, obviously, that they should be ruptured at
the opportune moment. But when the placenta is centrically
implanted, should it be directly perforated? Dr. Gendrin adopted
this procedure in two cases. He traversed the centre of the pla-
centa with a female catheter ; the Avaters escaped, and the haemor-
rhage ceased. Notwithstanding his success, I should not dare to
imitate him. If such a perforation is converted into a laceration,
and the foetal head passes through it, the placenta may be caught
upon the shoulders, and constitute a grave obstacle to delivery*
I deem it safer to wait for dilitation, and to rupture as near the
edge of the placenta as possible. The escape of waters will make
a rent, through which the foetal extremity will pass, pushing the
placenta to one side.

The proposal to rupture the membranes early is attributed to
Prezos. But it is to be observed that this accoucheur, by dilita-
ting the os with his fingers, in the first place, excited contractions,
and that active pains being induced, the membranes could be rup-
tured with less hazard.

It is admitted that, when the waters are evacuated, the contrac-
tion of the womb brings the foetus in contact with the vascular
orifices, whence a salutary compression. Now it is not certain that
contraction will ensue ; neither is it certain that some prominence
of the foetal ellipse will be pressed against the part at which the
placenta is separated. Do we not deprive ourselves of the most
efficacious compressor, of an upper tampon or bladder pessary, by
evacuating the waters prematurely? Before disgorging the ovum,
is it not rational to wait until the foetus, closely compressed on all
sides, will suffice for a tampon ?

To sum up what I have said, the conduct of the accoucheur in
the fioodings towards the end of gestation, due to separation of the
placenta, is as follows :

1. To use the tampon, in the form, if possible, of the bladder
pessary, which allows the condition of the parts to be examined,
Avithout discommoding the patient.

2. To place the patient in a vertical position, having her held
if necessary. This position completes the tamponnement. It
suffices alone, if the labor is active.

3. Induce and promote pains by ergot, if requisite.

4. Perforate the membranes when the pains are strong and re-
gular, Avhcn the cervix is soft and dilated, Avhen the presentation
is good.

5. If the tampon and vertical posture fail, the membranes must
be ruptured prematurely, which will temporarily restrain the
haemorrhage.

G. Lastly, if the haemorrhage still persists, and menaces life, the
placenta must be extracted.

1856.] Placenta Prcevia. 283

Extraction of the placenta. Complete separation and extraction
of the placenta, advised by Dr. Simpson of Edinburgh, will arrest
the haemorrhage immediately, at least in the majority of cases.
This operation is indicated when the means I have described are
unavailing. It is an extreme resource. It is inadmissible unless
the child is dead or not viable, and delivery by version or the for-
ceps is impossible. (Dubois.)

Case. A woman, at term, was seized with an haunorrhasce, which was
attributed to insertion of the placenta on the inferior segment of the uterus.
Unsuccessful efforts were made to peforate the placenta ; but, even after
tearing away a portion of the placental parenchyma, the operator failed to
reach the amniotic cavity. The tampon did not arrest the bleeding.

The woman was carried to the hospital des Cliniques. The membranes
were ruptured, and ergot was administered. The uterus contracted incom-
pletely ; the haemorrhage moderated, but was still alarming.

Professor Dubois presently arrived, and found the vagina filled with blood.
The os was dilated to the size of a silver dollar; the placenta was implant-
ed over it centrically. The pulsations of the foetal heart could not be per-
ceived.

As the want of dilatation forbad an attempt to deliver by version or the
forceps, M. Dubois observed that it was legitimate to separate and extract
the placenta. He introduced his hand, secured an edge of the placenta,
separated, twisted, and extracted it. The haemorrhage ceased. Tn an half
hour, active pains came on, and the child was delivered in five hours.*

This case proves that I was correct in supposing the rupture of
the membranes was not a certain haemostatic. Inertia of the womb
might allow the haemorrhage to continue after the placenta was
extracted, also. There cannot be complete security, therefore,
after that operation.

Artificial and forced delivery. If the means that have been de-
scribed did not arrest haemorrhage, rather than standby helplessly
while life was ebbing, it would be right to resort to an hazardous
operation, to deliver forcibly, making an incision in the cervix if
necessary. Such an operation will be very rarely indicated.

But when there is good dilatation, and a soft and yielding cer-
vix, ought we to deliver immediately by version or the forceps?

I may be wrong ; but in such a case, I should wish to wait for
natural delivery, if I was master of the haemorrhage. I should be
still more inclined to this course if the waters were intact, and I
could count on the amniotic bladder as an upper tampon to aid
my vaginal or lower tampon. If the waters have escaped and the
woman is exhausted, artificial delivery is the onty resource. But,
I repeat, I have a dread of the perturbation produced by obstetri-
cal manoeuvres at such a moment. If the woman is so feeble that
artificial delivery is deemed too hazardous, she should be placed
with her head low, her limbs raised by pillows; a bandage should
be placed around the abdomen ; hot wine, broth, and other resto-

* Journal de Medicine et de Chirurgie Pratique, June 1S55.

284 Cataleptic Hysteria. [^a7,

ratives should be administered ; sinapisms should be placed on
various portions of the skin. Perhaps these means will revive the
powers, and the labor may be accomplished.

I will not dwell long on these great obstetrical difficulties. My
experience does not warrant me in saying more.

Let me in conclusion, adduce a single etiological remark.

All the cases of placenta prasvia of which I have learned the his-
tory, occurred in women Avho had borne several children, in whom
the uterine cavity was necessarily larger than in primiparaj, a con-
dition favorable to the descent of the fecundated ovum into the
lower part of that cavity. Prophylaxis is at fault in such circum-
stances, unless it might be prudent for a woman predisposed by an
antecedent placenta pnevia, to pass the early part of a subsequent
pregnancy in an horizontal posture. [Archives Generals de Med.
Virginia Medical Journal.

Cataleptic Hysteria.

Dr. Eingland communicated to the College of Physicians, in
Ireland, April 4th, 1855, the following very curious case of cata-
leptic hysteria:

Mrs. , an English lady, of literary tastes and sedentary hab-
its, about thirty years of age, and married eight years, had been
very delicate from her earliest infancy. During the six years
antecedent, and the year immediately subsequent to her marriage,
she suffered from most intense headache. Two years prior to her
marriage she was under treatment for spinal irritation, as she was
informed by her then medical attendant. About this period, too,
she voided several portions of tapeworm, and had frequently, both
before and after her marriage, passed large quantities of ascarides.
She was at all times subject to palpitation of the heart, and had on
one or two occasions a slight hysterical fit. She suffers intense
pain on touching the last dorsal vertebra, which for some years
has projected to about the size of a nut. A sound as loud as the
snapping of the fingers is frequently heard proceeding from this
locality whenever she is much fatigued, or has been standing for a
considerable time ; and this sound Dr. Eingland has more than
once heard. She also experiences, since her first confinement,
great pain on the least pressure being made against the coccyx,
which has been slightly dislocated downwards and backwards, and
has become anchylosed in that direction.

On the second night after she was married, whilst engaged at
prayers, she was suddenly, and without the least premonitory
indication, seized with the first of the series of fits about to be
described; and this was shortly followed by a second, of a like
character. An interval of six months then elapsed without their
recurrence; when, however, being much about that length of time
pregnant, she was again attacked, and, as on the former occasion,

1856.] Cataleptic Hysteria. 285

without any premonitory symptom, and whilst in a state of com-
plete mental quiescence, having been previously engaged in calm,
unexciting conversation with her husband. The headache from
which she had previously suffered was greatly aggravated from
this period until after her confinement, and sue has described it
as though a tight iron cap was violently pressed on the upper half
of her head, to which the headache was strictly limited. The fits
now returned with but very short intervals, and it was with con-
siderable difficulty her medical attendant prevented a premature
confinement.

Some little time after the fits became completely established, she
observed that, if she was engaged in conversation immediately an-
tecedent to the access of one, she could not command the words
she uttered, although fully aware of what she ought to say, and
thus she frequently appeared to give expression to the most absurd
ideas, and to opinions which were quite opposed to what she had
intended to convey. Often, too, having spoken a portion of a
sentence, she terminated it on a subject quite different from that
upon which she had commenced her observations, or came to an
abrupt close, finding herself totally deprived of further utterance.

Up to, and during her confinement, she had frequent attacks,
sometimes so many as thirty in the twenty-four hours, and seldom
less than fifteen or twenty. After her confinement, which was
easy and natural, they were reduced to two or three in the da}',
and on very rare occasions one whole day has elapsed without
their recurrence. Within the last eighteen months her health in
this respect has considerably improved, as, repeatedly, days, fre-
quently weeks, and sometimes even a month, has elapsed without
a fit.

The origin of this affection she attributes to excessive fright,
produced by witnessing very violent paroxysms of hysteria, almost
amounting to insanity, in a female relative, with whom she was
on a visit shortly before her marriage.

Fatigue, excitement whether pleasurable or the reverse or
even music if loud or prolonged noise the slightest start the
least pressure against the painful part of the spine, or against the
coccyx, instantly induces a fit; they frequently, however, come on
without any apparent exciting cause.

The duration of each fit is very variable; sometimes it lasts
only three or four minutes, and sometimes it is prolonged to an
hour and a half. Dr. Ringland has witnessed several which lasted
from twenty minutes to half an hour each.

She has never had less than two fits when attacked, the second
being of much shorter duration than the first, and invariably suc-
ceeding it after but a short interval.

She appears to have been obnoxious to the attacks at all times
and seasons, in all postures, and under every circumstance. She
has been liable to them in summer as well as in winter; has been

286 Cataleptic Hysteria. [May,

attacked whilst in bed or at her meals ; whilst engaged in read-
ing, writing, or in conversation; whilst standing, walking, or
sitting ; whilst alone or in the midst of strangers ; frequently with
a word half uttered, or a piece of food partially masticated ; and
more than once has her life been placed in jeopard}' by the fit oc-
curring when she was near a fire, or whilst she was engaged in
the act of deglutition. The presence or absence of menstruation
has no apparent connection with the attacks, nor has that secretion
ever been in the least affected by them; neither does the existence
of pregnancy or lactation seem in any respect to influence this
strange affection, excepting that the fits have been much more fre-
quent from the moment of impregnation up to the period of quick-
ening, than at any other time.

Instantly, on the access of a fit, she falls backwards and forwards,
according to the direction in which her head has been at the mo-
ment. iShould she, however, have her baby in her arms at the
time, she holds it firmly clutched in her hands, which cannot,
without considerable violence, be opened; although, when the fit
ensues at any other time, her hands, though closed, can be easily
opened.

The particulars of this lady's case Dr. Ringland. learned from
herself some months prior to her then approaching confinement
her fourth and which took place early in December, 1854. Im-
mediately after the birth of the chiid, which was mature and
healthy, she had one of her customary fits, which was followed by
a second, immediately after the expulsion of the placenta. The
following is a brief description of the first fit witnessed by Dr.
Kingland.

Without any previous indication whatever, she suddenly seem-
ed to faint, and lay in a state of apparently total unconsciousness.
,She, however, was quite aware of every circumstance that occurred
.around her, and could afterwards detail the conversation which
had taken place in the room. Her limbs remained in whatever
position they were in at the time of the attack, or in any other to
which they were subsequently changed. There was no alteration
in the color of her lips, in her complexion, or in the appearance of
her skin, which remained of the natural temperature. Her eye-
lids were closed, but when raised, continued open until closed
again. The pupils contracted well on exposure to light. Her
pulse was about 100, but very feeble. There were no apparent
Leavings of the chest nor movements of the nostrils. Repeatedly
during the existence of the fit, but more violently towards its
close, there were convulsive twitchings of the muscles of the face,
/spasmodic clenching of the fingers, and forcible supination of the
hands on the forearm. There were no convulsive movements of
tin' lower extremities, although such occasionally occurred, as she
informed Dr. Kingland, and were always present during the first
few months of the existence of the fits.

1856.] Pharyngeal Abscess. 287

No restoratives were applied during the fit, as she bad previous-
ly intimated to Dr. Eingland that the employment of the most
simple of these had always produced violent and prolonged hys-
teric paroxysms, which never presented themselves when inter-
ference was not had recourse to.

After the lapse of about five minutes she gave a deep sigh, then
opened her eyes, looked about her, and feebly held out her hands.
On this signal, which is well understood by her attendants, she
was without delay raised into a sitting posture, and after a brief
interval of quiet she was perfectly restored.

Had not her attendants, as she informed Dr. Eingland, at once
placed her in the erect position, she would have relapsed again and
again into the fit. She, too, is so concious of this necessity, that
instantly ou the subsidence of the fit she holds out her hands,, as
described, thereby indicating her desire for the requisite assistance.
Should she at this time be handled roughly, or should the tender
part of the spine or the coccyx be touched, she at once relapses
into the fit.

She is not able until after the relapse of considerable time, and
not even then without the greatest effort, to utter a single syllable,
the peculiar condition excited throughout the system appearing in
her case to attach itself more firmly to the tongue than elsewhere.

After the subsidence of the attack she is greatly distressed with
tremors of the whole body, which last sometimes for only a few
minutes, but at times continue for several hours.

Dr. Ringland, before concluding, made a brief summary of this
singular case, directing attention to its leading characteristics and
points of interest; especially to the previous existence of spinal
irritation ; the occurrence of the attacks in summer as well as in
winter; the existence of consciousness during the fits; the erect
position being necessary at the close of the fit, and neglect in this
respect causing relapse; the loss of speech being prolonged after
the subsidence of the other symptoms ; and finally, to the fact that
restoratives induced hysteria, [Dublin Quarterly Jour. Med. Sci.

Cases of Pharyngeal Abscess.

Dr. "VVm. Lochhead, of Glasgow, records (Glasgow MedicalJour-
nal, October, 1855) the two following interesting cases of pharyngeal
abscess :

"Case I. On 1st April, 1855, I was called to an infant, aged
six months, that was very much reduced by the discharge from
abscesses, which had formed on various parts of the body, but
which had now dried up. It was breathing with some difficulty,
every inspiration being accompanied with a sound, as if the nasal
passages were obstructed. On examining the nose, nothing could
be found sufficient to account for the symptoms; neither was there

&88 Pharyngeal Abscess. [^ay,

any enlargement of the tonsils, nor indeed any morbid appear-
ances, so tar as I could observe, except that the mucous membrane
was redder than natural, this being the only evidence of the pre-
sence of inflammation. The dyspnoea appeared to me to depend
ou some obstruction connected with the posterior naresr and not
upon auj" inflammatory action going on in the organs of respira-
tion, as the sounds of the chest were quite normal. I ordered the
child to be placed in an easy posture, allowing it perfect liberty to
move its head in whatever direction it seemed to be most at ease.
while it was made to inhale the vapor from warm water, and had
a blister applied to the nape of the neck. Next day, and indeed
for several days afterwards, the breathing got very little worse.
But on the 8th of April the symptoms were much aggravated, the
breathing being accomplished with difficulty, and attended with a
loud noise, the head thrown back, the face pale and anxious, and
the mouth wide open, with great restlessuess. Ou examining the
throat minutely, there was observed the rounded form of an ab-
scess, deep in thepharvnx, situated in front of the fourth cervical
vertebra. Its real position, however, could not be accurately
ascertained, as retching was induced whenever the tongue was
touched. I was satisfied that it was an abscess, from ite having so
suddenly assumed its present prominent position, nothing having
been observed the day previously. Deeming the ease now of suf-
ficient interest and danger to justify a consultation,. Dr. Lawrie
was called in, who at once confirmed my views, both as regarded
the nature of the ease, and the immediate treatment to be adopted.
The swelling being very deeply situated, and not easily brought
into view, was with some difficulty reached; but by pressing dow n
the tongue with the index finger of the left hand, a bistoury,
guarded to within a short distance of its point, -was thrust into the
swelling, when there issued a copious discharge of pus, with in-
stant relief to the little sufferer.

" On the 9th the dyspnoea had again partially returned, from the
sac of the abscess having again filled. I did not, however, inter-
fere until the symptoms were more urgent, thinking that the mat-
ter would soon find its way through the old opening. Early ou
the 10th I was summoned in great haste, as the child was said to
be dying. I found all the appearances of impending suffocation
more marked than ever they had been. So hastily, having guard-
ed my abscess lancet, I proceeded to make a free incision into the
tumour, as far down as I could reach, when a large quantity of
fetid pus was discharged, and complete and permanent relief fol-
lowed. For a lew days I emptied the sac occasionally, by pressing
upon it with the finger; but from that time up to the 3d May the
child has done well, and is at present in vigorous health.

"I ought, perhaps, to state that the patient had been put upon
syrup of the iodide of iron, quinine, port wine, and every other
means that could be thought of to improve the general health ; but

1856.] Pharyngeal Abscess. 289

these means having nothing to do with the abscess under consid-
eration, need not be enlarged upon.

''Case II. On the 2d of August, I was requested by my friend
Mr. R. Renfew to see a child, aged eleven months, with an in-
flamed submaxillary gland, which had been gradually subsiding
under appropriate remedial measures. But as the dyspnoea seem-
ed to increase, although the swelling was not so great, he thought
there might be some inflammatory action going on in the larynx.
On accurate examination, however, it was found to be a case of
abscess in the pharynx. As the danger was not imminent, we
agreed to defer interference until the swelling became more point-
ed. On the succeeding morning there was still no urgent necessi-
ty for interference, and as the breathing was not worse, we thought
it better still to wait. In the evening the symptoms became more
alarming, the dyspnoea very great, and the abscess more enlarged
and prominent. As I found great difficulty in reaching the ab-
scess, guided, as in the former case, by the index finger, I pressed
down the tongue by means of a spoon, bent to nearly a right an-
gle, which enabled me to see the tumour, and to open it exactly in
the mesial line, and at its most dependent part, which had the sub-
sequent advantage of allowing the sac to empty itself completely,
without further interference, which certainly happened, as the case
gave no further trouble.

"Remarks. These cases of abscess do not differ essentially in
their nature from abscesses in general, but derive their peculiar
interest from their situation alone; and as, according to the adage,
to be 'forewarned is to be forearmed,' I may save some of my pro-
fessional brethren much anxiety by having given them a hint
regarding the formation and means of diagnosis ofabsceses in this
region of the body, I have presented the details at what some may
think a greater length than their importance demands. When,
however, we consider the comparative frequency of inflammation
in the air-passages and surrounding structures, more especially in
'children and infants, practitioners cannot be too well acquainted
with every concomitant circumstance that may assist the diagnosis
in each particular case. Indeed, no one who had not really seen
such cases as those described could believe the dificulty in the
diagnosis in the earlier stages of the disease. For my own part,
although watching my little patient carefully for some days, it
was only when the case reached its height that I was sure of its
real nature. Many might think they had to treat a case of ordina-
| ry laryngitis, when the violence of the dyspnoea suggests a particu-
i lar examination of the air-passages, and an abscess is discovered.

"As to the exact situation of the abscess, I believe in both cases,
that it was about the fourth cervical vertebra, or between the fourth
and fifth ; but it is difficult to fix its real position, as the movable
pharynx ascends when the tongue is pressed down. But from the

290 Minute Anatomy of the Liver. [May,

great obstruction which it causes to the respiration, it appears to be
immediately behind the larynx.

" The treatment when the real nature of the case is made out, is
simple enough, viz : to open the abscess in the mesial line, and at
the most favorable point for the free exit of the pus. In order to
avoid the loss of blood, which is of importance when the child is
weak, and to prevent the necessity for a second operation, I would
not recommend the use of the lancet until the abscess became well
defined.

"The causes of pharyngeal abscess may be found in that of ab-
scesses in general, and, consequently, the prophylactic as well as
remedial measures must be adapted to the exigency of each parti-
cular case. But as my object in this paper has been merely to
call attention to the termination of the inflammatory process, and
to put upon record these two cases, it is not necessary to go into
the origin and history of this very rare and highly interesting af-
fection." \_A mer. Jour, of Med. Science.

Minute Anatomy of the Liver.

The minute anatomy of the liver has been lately examined by
Beale,* who, from his dissections and injections, comes to the fol-
lowing results :

1. That the essential constitution of the liver is that of a double
network of minute vessels, one of capillary bloodvessels, and ano-
ther of cell-containing tubes, naturally adapted to each other.
Both of these sets of tubes in each lobule appear to communicate
with those of the neighboring lobules in all livers excepting that
of the pig ; and this circumstance is connected with the fact, that
in all other animals but the pig, the hepatic lobules are not isolated
by intervening and limiting fibrous tissues or capsules. As to the
latter position, Beale agrees with Weber.

2. That the cell-containing tubes are in all vertebrata continu-
ous with the ultimate fine ducts of the viscus; in some cases directly
so, whilst in others, as in the rabbit, and slightly in man and the
dog, a fine network of the ducts themselves intervenes. The base-
ment membrane of those tubes being, after foetal life, incorporated
with those of the capillaries, so that the secreting hepatic cells are
only separated from the stream of blood by a single intervening
membrane. The cell tubules contain the hepatic cells, as also
granular and coloring matter and cell debris; the cells observing
no order of arrangement, as some have thought, and contrasting in
size, &c, greatly with the epithelium lining the ducts, from which
they are strictly separated.

3. That the fine ducts are many times narrower at the point
where they are continuous with the cell tubes, than those tubes

* Proceedings of the Royal Society, June, 1855.

1856.] Gypsum or Stucco Bandages. 291

themselves; and that the larger ducts and larger interlobular ducts
freely anastomose with each other.

4. That whilst the finest biliary ducts are only composed of
basement membrane, that of the larger ones is more complex, con-
taining numerous cavities; especially in the pig, which, although
generally considered to be glands, are in fact reservoirs for the bile,
retaining it, and bringing it into intimate relation with the
abundant surrounding bloodvessels, so that it may undergo requi-
site changes. This the author also considers to be the function of
the vasa aberrantia, so named by Weber.

In this view, it will be seen that Beale considers the structure of
the liver to be strikingly different from that described by Kolliker
and Hanfield Jones, and assigns a different office to the secreting
and epithelium cells ; for, whilst the latter looks upon the cells of
the ducts as chiefly forming the bile, Beale considers that they
stand in relation to the hepatic cells as the columnar epithelium
(lining the stomach tubes) does to the secreting cells at the bottom
of them.

Beale prepared his specimens by injecting the portal vein with
lukewarm water until the bile was washed out of the ducts by it,
and then injecting the ducts ; after which the portal vein was in-
jected with size. The ducts were also examined in specimens
hardened in alcohol, to which a solution of soda had been added,
in order to render the sections transparent.

Dusch* finds that the hepatic cells are dissolved in bile and in
solutions of glycochlorate of soda. They also enlarge on the addi-
tion of chloroform, according to Lereboullet, their contents be-
coming very clear. [Brit, and For. Med. Ghir. Rev.

We find in the " American Medical Monthly" a report of some
exceedingly interesting " Practical Lectures on Military Surgery,"
delivered at the New York Medical College, by Isidor Gluck, M.D.,
Chief Surgeon to the Hungarian Hussars, and to various Hospitals
during the late war in Hungarjr, &c, &c. His description of the
mode of using Gypsum or Stucco bandages in the treatment of frac-
tures on the field of battle, will suggest to the ingenious surgeon
the use of such dressings in civil practice. Western Lancet.

Gypsum or Stucco Bandages.

"Although even in compound fractures, where the wounded
place has to be left uncovered, the application of Scutin's starch
bandage answers this purpose best, still there are some objections
to its being used in the field, or even in the hospital.

1. It dries too slowly, and cannot replace therefore immediately
manual extension, that is required in order to retain the ends of

* See Caustatt.
N. S. VOL. 511. NO. V. 19

292 Gypsum or Stucco Bandages. [May,

the broken bone in mutual contact. It is, therefore, necessary to
use machines or apparatus till the bandage becomes dry for 24^8
hours.

2. The thickness of the walls of the bandage diminishes, while the
bandage becomes dry, and thus receding somewhat from the liinb,
cannotserve instead of the manual extension.

8. The application of the starch bandage costs on the field much
time and trouble. The limb must first of all be surrounded by a
roller, then covered with compresses, and rollers; pasteboard and
splints are then applied, and the whole again surrounded by a
roller. The application of openings (windows) in Scutin's band-
age is combined with difficulties. If the windows are made at the
time when the bandage is applied, the same keeps badly together,
the fractured ends and wood or tin splints must be used; if the
windows have to be made when the bandage is dry, the wounded
portion remains covered for a day or longer, and the excision or
formation of the openings is in the hardened starch bandage yet
more troublesome.

4. However dexterously we may apply the bandage, it will be
pretty difficult to make so large openings as required, in order to
expose the injured portion without loosening at the same time the
whole bandage, while small openings or windows expose but a por-
tion of the injured part.

5. In suppurating wounds, the pus discharged, as well as the
fluid applied for cleansing the wound, and the moisture of the
cataplasms, will run under the bandage and destroy the epidermis.

6. The hardening and unequally contracting starch bandage,
(i. e. quickly hardening at its thin portions and slower in its thick-
er ones); exerts an unequal pressure and therefore an injurious
effect on the swollen parts.

7. The starch bandage cannot be applied for transporting the
wounded soldier, who receives on the battle-field a compound
fracture, because it requires warm water, (not always ready in the
field) for preparing it; then again it dries slowly, the formation of
windows causes loss of time and trouble, requiring the application
of splints, and because the parts being covered for a day or two,
are injured as suppuration may follow, and the pus stagnates and
runs into the bandage : in damp weather it becomes moist and soft
in the rain; it is, therefore, necessary to have ready made capsules
of starch bandage, and the so-called movo-amov ible bandage, which
often do not appose sufficiently, and cannot therefore replace man-
ual extension.

Recently gypsum bandages have been suggested in Belgium,
but their application, according to Dr. Mathieson and Van De Loo,
is troublesome, and takes much time, so precious on the battle-
field. This bandage is not lasting, its preparation and preservation
still more difficult than that of Scutin's starch bandage, much more
preferable and practical is the preparation and application otgyp-

1856.] Gypsum or Stucco Bandages. 293

sum bandages, as made by Pirogoff,* and used by him to the great-
est extent with the best results.

The gysum bandage is, on the battle-field, in many respects pre-
ferable to the starch bandage.

The gysum solution requires but cold water, and turns hard as
soon as applied, and replaces therefore immediately manual exten-
sion, and neither machines nor apparatus are required for that
purpose. The dry gypsum bandage becomes so hard, that no
splints are required, even if large windows are made, and trans-
porting of the wounded soldier is, immediately after the application
of the bandage, possible without injury.

The gypsum bandage is simple and cheap, as it consists of old
coarse linen and gypsum ; its application is simple and quickly made.
The gypsum bandage replaces manual extension perfectly, the assist-
ants need only for a few minutes keep the limb extended after the
bandage has been applied, then the gypsum bandage is stiff and
hard enough to retain the ends of the broken bone in the position
given to them. Their displacement is impossible as long as the
swelling does not diminish, and a considerable interspace is not
formed between the limb and the bandage. Thus the gypsum
bandage renders superfluous all machines for extension, as required,
while the starch bandage becomes dry. Only by the application of
the gypsum bandage in oblique fractures of the thigh it is necessary
to fix the pelvis, and to retain the limb extended by means of a
bed-table, and by weights attached to the extremity.

More apparent yet are the advantages of the gypsum bandage in
oblique fractures, where the ends of the broken bone are distant
from each other, in compound fractures and generally everywhere
where it is necessary to keep open a wounded spot.

In Pirogoff's mode of applying the gypsum bandage, the open-
ings (windows) may be made at once, through them it is possible to
view the position of the broken ends, the excoriations and wounds,
and the curative process may be watched in its course.

The gypsum bandage does not contract like the starch bandage,
interspaces form slower between it and the leg, as in the gypsum
bandage the interspaces depend upon the decrease only of the swell-
ing, and not like in starch bandages also, from unequal hardening
of the bandage, and then again it does not become moist and soft
in rainy weather.

In complicated fractures the pus may be discharged, and find
exit through the large windows made, and does not burrow itself
under the bandage as is common in the starch one.

Wet dressings are applied immediately on the wound itself. The
gypsum bandage becomes hard immediately after having been ap-
plied ; wounded soldiers may therefore be safely transported im-
mediately after application of the gypsum bandage, from one
place to another, even in the rain, without the bandage being dis-

*Pro of Surgery in St. Petersburg (Russia.)

294 Gypsum or Stucco Bandages. V^&Ji

turbed, although the gypsum bandage may appear wet externally,
which sometimes lasts for a few hours.

The gypsum bandage may therefore be cut through immediate-
ly after the application in the interspace of the splints, if that
should be required, in consequence of too great a pressure or
pains, &c.

In the battle-field, as well as in the hospitals, for transportation
of the wounded soldier in the treatment of complicated fractures,
with great dislocation of the ends of the fractured bones, the gyp-
sum bandage is preferable to every other kind of bandages.

Requisites necessary for the application of Gypsum Bandages in the
battle-field as well as in the liospitals.

1. Long, old hospital stockings made of linen, cut in front along
the seam, (if the seam is behind the stocking it must be turned and
cut); old drawers also cut along the seam, and divided for one or
the other limb ; sleeves of old shirts, (or instead of those, long linen
flaps cut in the form of stockings); drawers or sleeves; jackets or
old vests, abdominal bandages covering the body once and a half;
for fractures of the bones of the rump, pelvis, and of the neck of
the thigh bone.

These pieces of linen used for surrounding the limb must be
equal, soft and dense. All seams must be removed.

2. Cotton or cleaned soft flax, pads filled with soft material, lint
or flax for filling up, (for instance, around the trochanters, around
the malleoli in the popliteal region, and around the achilles tendons)
simple and graduated compresses.

3. Splints of different dimensions in regard to length, width and
thickness, made of old coarse sack linen, as used for instance in
hospitals for mattrasses or straw mattrasscs.

The old sack linen is folded twice, thrice, or four times, to the
width of two fingers to one-third of a yard. The splints must in
fractures of the leg, the upper and forearm, exceed at least one-
third of a yard the fractured bone, and in fractures of the thigh,
and that of the neck of thigh it must be one-third of a yard longer
than the whole extremity.

4. Strips (compresses) of the same linen from two inches wide,
and of such a length as to surround the limb once or twice; they
are calculated to fasten the splints, and are called transversal stripes.
(Pirogoff.) These transversal stripes may be made also of fine
linen, if the bandage should be a light one.

5. Plaster of Paris (gypsum) in form of fine powder and well
dried. For the application of a bandage, never less than 2 lb. have
to be used, (as for fracture of the forearm,) nor more than 7 lb., as
for fracture of the neck of the thigh bone.

6. A vessel with cold water. The gypsum solution should not
harden sooner than in five or eight minutes, in order to allow the
application of the bandage. Although hardened, it still looks wet

1856.] Gypsum or Stucco Bandages. 295

from the evaporation of the water, out of the bandage painted.
over with gypsum solution, and the patient may safely be carried
with it.

7. Large brushes as used by house painters.

Besides those necessary requisites in hospitals, may be used finer
linen rollers for simple fractures and splints made out of paste-
board, and for complicated fractures, with large wounds, splints of
wood, of different dimensions, together with pads attached to them
on both ends, and also a few pieces of sheet iron or tin may be
held ready.

The Application of Gypsum Bandages, is made in the following ivay:
The injured limb is first surrounded with dry linen, a sleeve, a
linen stocking, or with half a drawer.

Bony prominences must be wadded, and hollows filled out with
cotton. The linen surrounding it must not be too thin, nor have
holes in it, in which case the linen must be doubled, or the limb
first covered by cotton. If this is not done the moisture passes
to the skin, and the patient complains of a cold or burning sensa-
tion.

2. The broken limb is put in the required position, the extension
is then made, and the fractured ends then approximated. Some-
times it is necessary to begin with the reduction, and subsequently
follows the surrounding of the limb.

3. The splints and the transverse strips of sack linen, each three
or four times folded, are put near the patient in that order as re-
quired to be later applied to the limb.

An assistant prepares the solution of gypsum, and paints with it
the splints and strips, or rather dips them into the solution and
brushes them with it.

4. The proper application of the bandage depends now upon the
gypsum solution. If the solution be too thick it dries quick, the
splints and transverse strips are not united firmly together: nor
are the splints firmly fixed if the solution be too thin. When the
solution becomes denser, water must not be added to it, as the so-
lution becomes through it creamy, is not imbibed by the linen,
cannot be smoothed, does not adhere, and takes a long time to
become dry.

5. The splints and strips of linen must be dipped in the solu-
tion, which I now prepare by adding to two pounds of water the
equal weight of gypsum. They must be extended and swinging
free, and must thus be brushed over on both sides with the gypsum
solution.

6. The splints must be applied longitudinally to the limb, and
must be fixed by the transverse strips, carried around both the
limb and splint. The transverse strips are applied in pairs, so that
the one should cover the other partially.

The splints may be applied in such a manner that the one should

296 Dislocation of the Femur. [May,

cover the other partially, or, what is preferable, in such a way that
between the splints should remain a free ojDen space on the side in
front of or behind the limb. The assistants producing extension
must continue to do so until the bandage is hardened i.e., about
eight minutes after the gypsum bandage has been applied. Du-
ring its application the limb must be kept extended free, in order
to be accessible from all sides. The splints must be pressed firmly
to the limb by the hand. The transverse strips must be drawn
firmly and tightened around the limb, and by the hand or brush
well covered with gypsum solution, in order that all prominences
and hollows should be equalized. In oblique fractures and dislo-
cations of the fractured ends, at least two layers of transverse strips
are necessary. But if the bandage has yet to be removed, it is
necessary

1st. To apply the splints so as to leave a space between them.

2d. The transverse strips are covered from the middle (where
about the extent of two inches remains uncovered) towards their
ends with gypsum solution.

3d. The transverse strips are applied so that the uncovered part
should correspond- in its situation to the longitudinal interspace
between the splints.

In the field it is necessary to have arranged, before the applica-
tion of a bandage, all requisites in one package for each fracture
separate. Thus, for fracture of the forearm the bandages should
be separate from those for fracture of the leg."

Report of Three Cases of Dislocation of the Femur Reduced by Manip-
ulation. New Method of Reducing Dislocations of the Femur on
the Pubes. By E. J. Fountain, M.D., of Davenport, Iowa.

Recently I sent to Dr. Reid, of Rochester, New York, a brief
report of three cases of dislocation of the thigh, one of dislocation
upon the dorsum ilii, and two upon the pubis all reduced by
manipulation. At his suggestion, I send a full report of these
cases for publication. The case of dislocation upon the dorsum
was reduced very quickly and easily by following exactly the di-
rections given by Dr. Reid, with whom this vastly improved method
originated. The two dislocations upon the pubis, I reduced by
manipulations based upon the same principles; but by a mode of
manipulating quite different from that required for the reduction
of a dislocation upon the dorsum ilii. The report of these two
cases will be the first of the kind upon record. A concise summa-
ry of the rules for the operation will be appended to the report.

Dislocation upon the dorsum ilii. Oct. 7th. I was called in the
night to go in haste to the relief of a lady, Mrs. S , who had re-
ceived, as stated, some serious injury of the hip, or thigh, by being
thrown from a wagon. I was accompanied by my partner, Dr.
Adler. We found the patient in bed, complaining of pain in the

1856.] Dislocation of the Femur. 297

left hip. The examination revealed at once the nature of the in-
jury, which was a dislocation of the left femur upon the dorsum
ilii. On placing the patient erect, the characteristic appearance
was presented. The knee resting upon the lower third of the
thigh, the great toe of the foot upon the instep of the opposite
limb, and the trochanter major approximated to the crest of the
ilium. The diagnosis was confirmed by an attempt to rotate and
abduct the limb. A mattress was thrown upon the floor, and upon
this the patient was placed upon her back. A towel was carried
around the sound thigh and hip, and held down by Dr. Adler ; but
this assistance 1 found to be quite unnecessary. I then grasped
the knee with my right hand, and the foot with my left; flexed
the leg on the thigh, and carried the knee and thigh over and upon
the sound one, and then upwards as high as the umbilicus, keep-
ing it constantly pressed down upon the body. I then carried the
knee outward, bringing the heel inward and the foot over the op-
posite limb, at the same time making gentle oscillations of the
thigh, when the head of the bone slipped suddenly into its socket.
The force required was quite moderate, and the pain almost no-
thing. The time occupied by the manipulation, from the instant I
took hold of the knee and foot, until tin: operation was completed,
did not exceed ten seconds. The manipulations were made by one
continuous uninterrupted motion. The knee was caused to make
a " semi-circular sweep " over the sound limb and across the body,
then a few quick oscillations, and it dropped down into its natural
position. I held the thigh up firmly and steadily, while making
the oscillations; and in this position, at right angles with the axis
of the body, and abducted, and the foot over the opposite thigh,
the head of the bone entered socket.

Dislocations on the Pubes. Case 1. In June, 1854, I was called
to see a man who had fallen from the second story of a house to
the ground, upon some pieces of timber. His lower jaw was frac-
tured, and his left hip dislocated. The limb was a trifle shortened
and the foot strongly everted. The prominence of the trochanter
major was lessened, and the head of the bone could be felt upon
the pubes. While waiting for the appearance of Dr. Arnold, who
had also been sent for, I was reflecting upon the necessary arrange-
ments to be made for the application of the putties. While thus
meditating upon the subject, I began to think of the possibility of
reducing the dislocation by manipulation. Considering the posi-
tion of the head of the bone and its relation to adjacent parts, it
occurred to me that by rotating the limb still more strongly out-
ward, I might elevate the head of the bone from its resting-place
the trochanter major acting as a fulcrum. Then, by carrying the
leg and foot, and after it the knee and thigh, over the opposite
thi<2'h, while the limb was still strongly rotated outwards, the head
of the bone would be made to move upwards and outwards in the arc
of a circle of which the trochanter major would be the centre, and

298 Dislocation of the Femur. [May,

the neck the radius. After being thus brought over and upon
the edge of the acetabulum, a motion of the limb directly upwards
would, in the same way, throw the head of the bone into its sock-
et, the muscles attached to the trochanter major holding that
point comparatively fixed.

Before the arrival of Dr. Arnold, I had determined to test the
theory; and on explaining my views to him, he at once expressed
his willingness to have the attempt made as I suggested. At
worst, it could only fail without much, if any, harm, and then we
had the pullies ready for application after the " classical method."

The patient was placed upon the floor on a quilt. Being a man
of strong muscular development, I thought there would be more
certainty of success if relaxation was first produced by the inhala-
tion of chloroform. He readily came under its influence. When
quite unconscious, the limb was taken by the foot and knee and
rotated outwards, the leg flexed and carried over the opposite knee
and thigh, the heel kept well up, and the knee pressed down. This
motion was continued by carrying the thigh over the sound one,
as high as the upper part of the middle third, the foot kept firmly
elevated. Then the limb was carried directly upwards by eleva-
ting the knee, while the foot was held firm and steady, at the same
time making gentle oscillations by the knee, when the head of the
bone suddenly dropped into its socket. Time required in the
operation, from twenty to thirty seconds. The force used was
slight ; I believe it could have been reduced about as well without
the chloroform.

Case 2. Oct. 31st, 1855. John McCarthy, an Irishman, had
his hip dislocated by falling with a horse he was riding. The
horse slipped and fell, rolling over upon him. I found the limb
about the same in length, as the sound one ; but greatly everted,
the toes pointing directly outward. On attempting to rotate and
flex the limb, pain was produced, and a comparative immobility
manifested by resistance. The head of the bone was felt forward
upon the pubes. As soon as I discovered it was a dislocation, my
first thought was to send for Dr. Adler to witness the operation.
But the temptation to take hold and reduce it immediately, was
too strong. The patient was resting upon a low couch. I imme-
diately took hold of his knee and foot, rotated outwards and flexed
the leg by carrying the foot over the sound thigh, keeping the
heel well up, and pressing the knee down. After I had brought
the thigh in this way over the upper part of the sound one, I car-
ried it directly upwards, holding the foot firmly up and making
oscillations by the knee, when the head of the bone slipped into
its socket, and the limb at once assumed its natural appearance and
mobility. A little more force was required in this, than in the
other case; but it was still quite moderate, and the pain very slight.
In this case I had no assistance whatever. Time occupied in ope-
rating, about twenty seconds.

1856.] Prize Essay on Placenta Prcevia. 299

The history of these cases fully demonstrates, to my mind, the
immense value of this new method of reducing dislocations of the
hip. Notwithstanding the unsatisfactory results of the trials at
the New York Hospital, I have perfect confidence in the correct-
ness of Dr. Eeid's method of manipulation. It is certainly one of
the greatest improvements of modern surgery, the value of which
may be understood when contrasting an operation requiring but
ten or twenty seconds and without pain, with the instructions of
Sir Astley Cooper, viz : Venesection to syncope, hot bath, tart,
antimony to nausea, and then the application of the pullies from
four to six hours, if necessary ! To Dr. Beid is due the credit of
this splendid improvement, in which the whole profession must
participate, as a most valuable contribution of scientific surgery to
the relief of suffering humanity. It remains to be seen how far
the test of future operations will confirm the value and correct-
ness of the method of reducing dislocations on the pubes, as illus
trated by the two preceding cases.

It is my opinion that dislocations into the thyroid foramen may
be reduced by the same method as the last.

In conclusion, I will recapitulate the method of operating for
dislocations on the pubes.

Taking the knee in one hand, and the foot in the other, rotate
the whole limb outwards, and flex the leg on the thigh by carrying
the foot over the opposite knee. Then carry the limb, foot for-
wards, over the opposite thigh, at the same time twisting the heel
upwards, and pressing the knee down. Carry the thigh in this
way over the sound one as high as the upper part of its middle
third, then elevate the limb by raising the knee while the foot is
held firm, at the same time making gentle oscillations, when the
head of the bone will slip suddenly into its socket. [iV. Y. Jour,
of Medicine.

Dr. J. D. Trash's Prize Essay on Placenta Prcevia.
The following are the corollaries deduced by the author of this
interesting paper : (published in the Transactions of the American
Medical Association.)

1. " We have shown that, as a general rule, cases in which de-
livery takes place prematurely, are attended with greater risk to
the mother than those occurring at the full time, with the exception
of those before the seventh month, which rarely prove fatal, in
consequence of the undeveloped condition of the blood-vessels of
the womb at that early period. The probabilities of the child being
saved are probably better at full term, though this is not so dis-
tinctly shown by our statistics. Hence, if it be possible, cases in
which premature delivery is threatened ought to be conducted to
the full period.

ay,

300 Prize Essay on Placenta Prarvia. [M;

"This was the advice of Mr. Kinder Wood, a successful obste-
trical teacher, who was in the habit of detaching the placenta in
cases of dangerous haemorrhage from its presentation. When
haemorrhage comes on before the completion of the term of preg-
nancy, absolute rest and cold, with, in some cases, opium, should
be resorted to for the purpose of restraining haemorrhage, avoiding
the use of the tampon until the progress of the case indicates that
extreme measures must be resorted to; for the introduction of the
tampon, in the cases in which it is noted, was, in certain instances,
soon followed by labor pains more or less effective. But, when its
use is determined upon, a suppression of the haemorrhage ma}' be
confidently relied upon for a time, at least, provided its introduc-
tion be skillfully effected. In many instances, however, at kthis
early period, the haemorrhage continues, and artificial delivery is
the only resource.

2. " Most cases of partial placental presentation require only
rupture of the membranes. By this simple expedient, the uterus
is brought into active contractions, and haemorrhage restrained
within, moderate limits, or entirely suppressed, until delivery takes
place spontaneously, as occurs in a large proportion of cases, or is
accomplished by art. But haemorrhage, in cases of partial presen-
tation, is not always thus controlled, and our first table furnishes
not a few which were attended by most alarming loss of blood.*

3. "In cases of complete presentation, if haemorrhage does not
yield to simple measures, and in dangerous cases of partial presen-
tation, early delivery is of the first importance. To select the
most favorable opportunity, for this is often one of the most criti-
cal tests of the physician's skill. To do this before the os has be-
come dilatable is to incur the risk of inflicting serious lesions upon
the uterine neck, and a difficult and protracted withdrawal of the
child; while, to wait unnecessarily long, is to expose the patient
to great hazard from unnecessary loss of blood. The rule should
be to wait not i~or a dilated, but a dilatable condition of the os.
The great source of danger in the conduct of cases of placenta
praevia is the delay required to permit the necessary dilatation of
the mouth of the womb ; while waiting for this necessary prerequi-
site to delivery, exhausting haemorrhage has often taken place,
from the eifects of which the patient has never recovered.

"With the hope of keeping the bleeding in check during this
necessary delay, the membranes may be advantageously ruptured;
for we need not, in these cases, fear any embarrassment to deliv-
ery from this cause, inasmuch as the uterus is almost invariably
relaxed after severe haemorrhage. The administration of ergot,
under such circumstances, in the manner already described, with
the view of keeping up a pressure upon the mouths of the bleed-
ing vessels until the os should dilate, is sanctioned by the results

* Of the eight cases lost among Dr. Lever's eases, foub were eowplete, and koub
partial presentations.

1856.] Prize Essay on Placenta Pravia. 301

in some of our cases in which it was employed; and although not
often given, as we judge, with this particular view, it promises to
be, in many cases, a valuable resource. In Dr. Fountain's two
cases of complete presentation, rapid dilatation took place under its
repeated administration ; a compression of the placenta was kept
up until the os permitted the introduction of the hand for turning,
and both mothers and children were saved. In this way we imi-
tate, to a certain extent, the course pursued by nature in sponta-
neous expulsion of the child.

"The inhalation of ether , in one instance, quickened labor, and
chloroform, in another, seemed to favor relaxation of the uterus.
How far these agents, especially the latter, may prove subservient
to this important object, experience has not yet determined.

4. ' But whatever means may be resorted to for keeping in
check the flow of blood while the os is undergoing dilatation, the
physician should not leave his patient after that process has begun.
Dangerous, and even fatal, flooding sometimes takes place even
when the os is yet undilated, as happened in a case recorded by
Smellie. Dr. Bigby laid down the rule, that the patient should
not be left by her physician after the placenta was discovered to
be presenting. This rule he afterwards modified, as the interval,
in such cases, is too long to justify the sacrifice of time. But the
physician should remain beside his patient until active haemor-
rhagehas ceased; and if dilatation is in progress, it is imprudent to
leave the bedside until delivery has been effected. It has occurred
in the experience of every physician to be surprised by the unex-
pectedly sudden dilatation of the os in some cases of ordinary
labor. On reading several of our cases, it is very apparent that
from a neglect of the precaution here urged, the physician failed
to be at hand when sudden and fearful haemorrhage took place,
followed by perilous and even fatal exhaustion. Such sudden
losses of blood are not uncommonly accompanied by a degree of
dilatation of the os uteri that would render immediate delivery in-
admissible, as in Case 69, from Rigby.

" It corresponds with the experience of those who have had the
largest opportunities for observation, and is an inference certainly
warranted by a general survey of our cases, that of patients who
enjoy intelligent and active medical assistance from the commence-
ment of haemorrhage until the termination of labor, a very large
proportion are conducted through their perils in safety, and no
inconsiderable proportion of the children are saved. An early
delivery by turning has been sanctioned by long experience, as
the best general mode of treatment for securing safety to mother
and child.

5. "But in some instances, haemorrhage will not yield to the
means thus far recommended, and the os continues unprepared for
artificial delivery. In these cases we may separate the placenta,
with the confidence of almost certainly putting an end to the

302 Fistula in Ano. [May,

hemorrhage, and with an almost equal certainty of destroying the
child; unless the os should permit artificial delivery within a short
time after the separation is effected. The urgency of the symp-
toms in such instances, is sometimes very great, and it must be left
to the judgment of the practitioner, in each individual instance, to
determine whether to separate the placenta or to wait still longer.
6. "The os may be dilated or dilatable, and the patient in a
state of extreme exhaustion. Here, turning could be performed
with facility, but delivery would be hazardous. In these cases,
the placenta may be detached with much less disturbance to the
mother than would occur in turing under such circumstances, and
an opportunity afforded for the patient to rally before she should
be delivered. Table III. affords several instances in which spon-
taneous delivery took place after such separation, and the patient
recovered. Yet even in these cases, we must bear in mind that
children are by no means necessarily destroyed by excessive loss
of blood by the mother; and a resort to the stethoscope would
doubtless often prove of great assistance, where in doubt as to the
propriety of detaching the placenta. When we have satisfactory
evidence that the child is dead, there can be no objection to an
early resort to the separation of the placenta." \_N. Y. Jour. Med.

On certain forms of Fistula in Ano, with reference chiefly to their
Treatment without dividing the Sphincter Muscles.

Mr. Hird read, Oct. 20th, before the Medical Society of London,
a paper on this subject, and also gave his opinion in favor of the
treatment of many special cases of complete fistula by means of
the ligature. After alluding to the painful and hazardous opera-
tions practised by surgeons for the cure of fistula until a more
correct view was taken of the disease by Percevall Pott, by whose
influence and example the barbarous treatment at that time had
recourse to was renounced by the profession in this country, the
author gave a minute description of the anatomical structure of the
lower part of the rectum, and of the tissues which fill up the
ischio-rectal fossae, and observed that many obscure collections of
matter can only be diagnosed by those who are familiar with the
complicated fascial and muscular boundaries of the space surround-
ing the extremity of the gut. Mr. Hird then described the varie-
ties of spontaneous abscess which affect this region, and gave the
result of several cases of fistula which had not entered the rectum,
or laid bare its walls, in which no operation was performed; and
strongly opposed the assertion made by Mr. Syme, and many other
surgeons who have written on this disease, " that all remedial
measures, except the knife, are ineffectual." As a preventive
treatment against the formation of fistula, he urged the necessity
of freely laying open all abscesses in the neighborhood of the rec-
tum before the walls of the bowel are laid bare. The incision

1856.] Tracheotomy in Croup. 303

should be directed from before backwards, and not transversely,
so that the discharge may have no mechanical difficulties to over-
come in its exit. When the abscess does not close by the ordina-
ry process of granulation, Mr. Hird advises the use of mild injec-
tions of nitrate of silver (four grs. to the ounce), and the application
of well-adjusted pressure on the part. In two cases of eight and
ten years' standing in which this treatment was not successful, he
effected a cure by means of a platinum wire heated by electricity,
and connected with the poles of a galvanic battery, similar to the
one used by Mr. Marshall for applying electric cautery to fistulous
openings in the cheek, and advises the use of this agent before re-
sorting to division of the septum. In cases of complete fistula, the
author has no confidence in any treatment except that of laying
the cavity of the abscess and of the rectum into one by dividing
the sphincters. This, he said, might be accomplished either by
means of the*knife, the ligature, or electric heat. Although the
knife is the favorite instrument of the majority of surgeons, he
prefers the use of the ligature in all cases where the hemorrhoidal
veins are unusually large, or when the patient has a dread of the
knife. He considers, also, that this method of operating possesses
advantages over the knife in many special cases, and, if judiciously
applied, and only tightened by means of the fistula- tourniquet to
a degree of tension sufficient to accomplish the division of the sep-
tum, is not so painful as the operation with the knife, less so in the
after-treatment, and frequently accomplishes a cure in a shorter
space of time. Hemorrhage and the dread of a cutting operation
are avoided by this plan. Mr. Hird's experience does not confirm
the opinion of Sir. B. Brodie, that all fistulas have an internal ori-
fice leading into the rectum ; neither do his observations verify the
opinion of many writers, that fistulas are most frequently found in
phthisical patients; but, on the contrary, are in harmony with the
views of Andral and Louis, both of whom demonstrate, by statisti-
cal inquiries, that these affections, occurring simultaneously in the
same individual, are merely the result of accident, and that they
do not stand to each other in the relation of cause and effect. [Med.
Times and Gazette.

Tracheotomy in Croup. By Dr. TROUSSEAU.

I am firmly decided, for my part, not to be discouraged, but to
advocate tracheotomy with so much the more conviction, as the
proportion of successful cases increase ; and if that proportion re-
mained, even as it was ten years ago, I will still proclaim the
necessity of tracheotomy, and I would not cease to uphold it as a
duty a duty as imperious for a surgeon as the ligature of the
carotid artery, after a wound of that vessel, even if death followed
the operation as often as the cure. Here are the results of my
operations for tracheotomy, during the year 185i : I operated on

30-i Excision of Joints. {^-^Ji

nine children. Of these, two died, while seven were cured, and
are now living in perfect health. Certainly, the proportion of
cured is not always so great ; still, if I make the sum total of the
operations I have performed in the last four years, I find twenty-
four operations, and fourteen cures, equivalent to more than half.

At the Hopital des Enfans Malades, in the last five years, the
proportion of cures has been nearly a quarter. Here are the offi-
cial numbers viz :

1850 . 20 operations . 6 cures, about l-3rd.

1851 . 31 " .12 " more than l-3rd.

1852 . 59 " .11 " less than l-5th.

1853 .61 " . 7 " onlv l-9th.

1854 .44 " . 11 " only l-4th.

215 " 47 " about l-4th.

This result is considerable, if we remember the social condition
of the children who are brought to the Hospital, the deplorable
treatment they are subjected to, by "sagefemmes," quacks, etc.,
in a word, those persons the poor generally consult in preference
to doctors. We should bear in mind, too, the unfavorable condi-
tion of the Hospital, where the children operated upon are placed
in the midst of the most varied and fatal contagion; so much so,
that often, when the operation for tracheotomy is succeeding as
well as could be desired, the scarlet fever, measles, small-pox, or
whooping-cough, cause the most fearful complications.

I do not doubt that half the operations performed out of Hos-
pital are successful, always provided tracheotomy takes place when
the chances of cure are possible. This restriction is important*
for, if the diphtheritic infection is thoroughly rooted in the system,,
if the skin, and particularly the cavities of the nose, are invaded
by this special phlegmasia; if the quickness of the pulse, delirium,
prostration, indicate a profound poison, and if the danger is rather
in the general state, than in the local lesion of the larynx or of the
trachea, certainly the operation should not be tried, for it is inva-
riably fatal ; when, however, the local lesion constitutes the prin-
cipal danger of the disease, no matter at what degree asphyxia has
arrived, even if the child has but a few moments to live, tracheoto-
my succeeds invariabl}'-, as well as though it had been tried three
or four hours sooner. [Ibid.

Excisions of Joints.

On a recent occasion, Mr. Fergusson submitted to the inspection
of the pupils of King's College Hospital, a number of patients on
whom excision of the various joints had been performed from
time to time, and took the opportunity of making some valuable
remarks upon the improvements which had been made in this de-
partment of surgery, and upon the individual cases now submitted

1856.] Excision of Joints. 305

to notice. He first made some observations upon the introduction
of excision of the elbow joint, in the place of amputation through
the arm. Passing a eulogium upon Professor Syme for the part
he had taken in introducing and recommending this operation, he
observed that it was not followed out even yet, as it ought to be,
notwithstanding its acknowledged superiority over all other modes
of treating incurable disease of that joint. As illustrative of these
remarks, two patients were introduced in whom excision of the
elbow-joint had been performed, in one of which it had not been
done more than ten weeks, and yet the patient (a woman) had
already got an excellenl arm.

Mr. Fergusson stated that, in reference to this proceeding (in
the elbow), there was now no question in the mind of any surgeon;
but in the instance of some other joints, there had been much
controversy, and he would now draw their attention to a case
where he had performed the operation of excision of the head of
the thigh bone several years ago with the most complete success.
[The individual on whom this operation had been done, was
brought into the theatre ; he was a fine healthy young man, and
walked with the greatest facility, and stated that he sometimes
walked sixteen miles in the day], lie was particularly glad at
being able to show them this patient, inasmuch as some very erro-
neous remarks had been made in reference to the propriety of this
operation. Mr. Syme had, in his lectures in the Lancet, recently
published, stated that, if the head of the thigh bone had been taken
away with success, the limb could not be of any use for the sup-
port of the body ; but those who now had the case before their
eyes could see for themselves how gratuitous such an assertion
was.

Three patients were next brought forward, upon whom excision
of the knee-joint had been successfully performed. The first was
a fine healthy woman, who had undergone the operation about
two years since; a perfect anchylosis had taken place, and by the
help of a high boot, well fitted to the limb, she walked with the
utmost facility. The second was a little boy who had undergone
the operation twelve months since, and could also walk, even
without artificial assistance, with great facility ; and the third case
was also a lad upon whom his friend, Mr.Henry Smith, had opera-
ted nine months since, under the greatest disadvantages; but here
also, as the pupils could see, the patient had made an excellent
recovery, and could walk about with the same facility.

Mr. Fergusson made some lengthened remarks upon the opera-
tion in question, and stated that although, to his regret, most
unjustifiable and unhandsome remarks had been directed by Mr.
Syme against the promoters and pursuers of this mode of treat-
ment, the proceeding had been followed out by several surgeons,
and the success was so admirable that, notwithstanding the veto
of the Edinburgh Professor, the operation was now fairly estab-

306 Structure of the Spinal Cord and Spinal Nerves. [May,

lished ; taking the opportunity of eulogising Mr. Jones, of Jersey,
and the late Dr. Mackenzie, for their efforts in this direction, he
concluded his remarks by stating that he hoped his pupils would
endeavor, in fitting instances, to follow out the same line of prac-
tice, for which they had ample authority in the cases he had just
had the pleasure of bringing before them that day. [Med. Times
and Gazette.

Structure of the Spinal Cord and Spinal Nerves.

In an inaugural dissertation before the University of Dorpat, by
Philip Owsjanuikow, the author has entered at great length on the
structure of the spinal cord and spinal nerves. The conclusions
drawn from the observations were as follows :

1. That all the fibres of the spinal nerves which enter into the
spinal cord are united to gangliated cells.

2. That one filament extends to each gangliated cell from the
anterior spinal root, and one from the posterior root; a third, a
commissural one, from the other part of the spinal marrow ; and
in many fishes a fourth, passing from the brain. The presence of
this single fibre passing to the brain, may, as the author throws
out, be of moment in reference to the question of the possibility of
the same fibre being both afferent and efferent in function, a posi-
tion which Du Bois-Raymond thinks tenable, as judging from his
experiments, though, as a rule, this power is not put into action,
in his opinion. The author of the paper now considered, thinks,
on the contrary, this aforesaid power is always put into use.

3. That from each cell of the spinal marrow, a filament extends
to the brain, forming the white substance.

4. That the chief mass of the spinal marrow, containining fibre
and cells, is a united areolar web, which being arranged in great
abundance about the central canal, and furnished with numerous
bloodvessels, produces the ruddy gray color of the substance which
is generally supposed to be owing to pigment cells.

5. That the gelatinous substance of Rolandi is connective tissue.

6. That the cells found as well in the posterior horns as in the
surrounding substance of Rolandi, are corpuscles of the united web.

7. That the cylindrical axes are of a round form, and are com-
posed of the same substance as the nervous cells.

8. That the cylindrical axes in the grey substance are formed of
a membrane peculiar to themselves, which surrounding also the
nerve cells, may be separated from the fundamental mass composed
of the united web.

9. That in some fishes, the cylindrical axes of the spinal cord
are exposed, the cellular web in which they arc placed forming no
especial investment.

10. That in those fishes which have anterior and posterior spinal
roots, round gangliated cells are found, sending out in various
directions divided branches. [Brit, and For. Med. Chir. Rev.

1856.] Premonitory Diarrhoea. 307

Premonitory Diarrhma.
The New York Journal of Medicine, for January, 1856, con-
tains an article by Dr. Macloughlin, of London, upon the Pre-
monitory Diarrhoea of Cholera, from which we extract the following
important conclusions:

1. That cholera that is, vomiting, spasms, etc., is always
preceded by a diarrhoea, for a few hours, or for a few days, or for
a few weeks.

2. That there is, as yet, no well-authenticated case of cholera
without an attack of spasms.

3. That a painless diarrhoea may drain away almost the whole
serum from the blood, until the blood has ceased to circulate, and
until the heart has ceased to beat, before the patient is attacked
with vomiting, spasms, etc., that is with the second stage of cholera.

4. That if the disease is scientifically attended to in its diar-
rhceal stage, it can be cured, and, consequently, the developed
stage prevented, and life saved.

5. That these two pathological facts are now acquired to
medical science, viz : 1. That every case of cholera is preceded
by a diarrhoea, for a few hours, a few days, or a few weeks. 2.
That the disease, scientifically treated in the diarrhceal stage, is
easily cured.

6. That it is in the power of human foresight to prevent an
attack of developed cholera.

In a letter dated 2d July, 1855, inserted in the Association Med.
Journal, it was attempted to point out what diarrhoea, if left to itself,
will run into cholera in a few hours ; and what diarrhoea, if left to it-
self, will not run into cholera for a few days, or for a few weeks.

" I am fully aware that this pathological point requires to be
further studied. I, therefore, submit it to the profession, in the
hope that more careful and more attentive observers will be ena-
bled to give us valuable information on this important subject,
so that the medical attendant, on arriving at the bed-side, may
be enabled to pronounce whether his patient will be attacked in a
few hours, or in a few days, or in a few weeks, with cholera, if the
diarrhoea is not scientifically attended to, or whether the diarrhoea
will be cured by the efforts of nature ; and so that the medical
attendant may not be left, as he now is left, to establish his progno-
sis on conjectures.

There is, also, another point to which I beg leave to call the
attention of the profession.

I have now seen five severe outbreaks of epidemic cholera, and
I have reason to believe that a great and an important change
takes place in the constitution of every individual, where epidemic
cholera is about to break out, which change in the constitution of
every individual, persists while the disease rages, and after the
disease has passed away for some time.

N. S. VOL. XII. NO. V 20

S08 tSIcm Diseases. [^av>

That tins change in the constitution of individuals is manifest
by the facts, that those of a costive habit, who have a passage
from their bowels only every twor three, four, or five days, of hard
fecal matter, have now a passage from their bowels daily, of soft
fiecal matter.

That those who are jn the habit of having a passage daily, of
solid fyecal matter, have now two or three passages daily, from
their bowels, of soft fa?eal matter.

That those who usually require laxatives to keep their bowels
free, now do not require laxatives; or if they take any, they find
that one-half, one-third, or one-quarter, the usual dose has the
same effect as a full dose had formerly.

And further, that it is now dangerous to give a full dose of pur-
gative medicine, lest this dose should induce diarrhoea, followed,
too often, by fatal cholera. The Medical Times, of September,
1854, page 272, contains the report of four cases of cholera, which
were induced in St. George's Hospital here, by the administration
of the full dose of purgative medicine, and of which, one died.

That, further, every individual in the locality is troubled with
more flatus than usual, especially between one and five in the mor-
ning, and that every one about to be attacked with diarrhoea has
a pressure, and a weight on the sphincter of the anus, and a feeling
of insecurity, as if at any moment, he would lose command over it.

If in consequence of the observations and of the researches of
the profession in every country, it is ascertained that this change
in the constitution of all the individuals in a locality where cholera
is about to break out, does take place, and that this change per-
sists while cholera rages, and after it has passed away some time,
it may throw some light on the etiology of the disease, and prove
that cholera is not a contagious disease."

Skin Diseases.

The following notes from Professor Uebra's Annual Report of
Diseases of the Skin, treated at the Vienna Hospital, is from the
Assoc. Med. Journal:

I. Acne. 17 cases (13 males-, 4 females). Vapour bath and
washing with soap and alcohol, sufficed to cure all these cases.
There were 4 cases of the allied affection sycosis, all of which were
successfully treated by inunction with iodide of sulphur ointment,
and the application of strong nitric aeid as a canstic.

II. Ecthyma. 13 cases (11 males, 2 females), generally associ-
ated with scabies or pediculi, and induced by tl>e scratching. Warm
fomentations sufficed for the cure.

III. Eczema.- 150 cases (96 males, 54 females). Hebra includes
under this term the various forms of impetigo, tinea, and porrigo;
there being, as he believes, no difference between them and eczema
impetiginosum; for, on destroying the efflorescences, or removing

1856.] Skin Diseases. 309

the crusts and scabs, we then perceive the characteristic phenomena
of eczema red, moist places, with more or less infiltration of the
cuticle. With regard to the cause of the disorder, it was traced
with certainty to an elevated temperature (either exposure to the
sun or working at the oven) in 22 cases; to irritation of the skin
by ointments, plasters, etc., in 21 cases; to the repeated action
of water in washing clothes, to fomentations, etc., in 9 cases ; to
scratching the skin, in consequence of the irritation caused by
pediculi, in 20 cases ; to varicosity of the veins in 19 cases ; and in
eight cases it was associated with anomalies of menstruation.

The modes of treatment were very various, but in each patient
the system commenced with was adhered to.

1. In 46 cases, cold water alone was used, in the form of fomenta-
tions, baths, douches, etc.

2. In 6 cases, a wash of sulphate of zinc ( 3 j to the pint of wa-
ter) was used.

3. One case was treated with corrosive sublimate baths.

4. In 2 cases, the parts were kept moist with a dilute solution of
potash ( 3 j to the pint of water).

5. In 3 cases, the caustic action of a concentrated solution of
potash ( 3 j 3 ij of water) was tried.

6. In 70 cases, soft soap was used. It was usually applied night
and morning for three consecutive days, to the diseased places,
which were then covered with flannel, and left untouched for four
consecutive clays. This process was repeated till the moisture and
itching disappeared, and there was merely a red, dry, squamous
surface remaining, (pityriasis rubra,) which was treated with tar.

7. In 19 cases, tar was used; the best being that obtained from
the wood of the beech or of the juniperus oxycedrus (the product
in this case being the oil of cade). The action of both these agents
is nearly the same, but the latter is the least disfiguring, and, there-
fore, most applicable for diseases of the face. We have already
indicated the proper period for commencing this form of treat-
ment. The affected parts are smeared over once or twice a day,
till an unbroken blackish brown investment is formed, which usu-
ally happens after about half a dozen applications. During this
time, the parts must not be touched with water. The longer the
tarry covering remains, the more certain is the result of its action.
If it soon falls off, this is a sign that moisture is still exuding, and
we must return to the preceding treatment (merely with soft soap).

8. In 3 cases, the expectant method was trusted to.
Whatever was the external treatment, internal remedies were at

the same time used, to improve the general health : as, for instance,
cod-liver oil in the scrofulous cases, aloes and iron in the chlorotic
cases, etc.

IV. Elephantiasis Arabum. 6 cases (4 males and 2 females).
In 5 cases, the leg was affected ; and in one, the penis and scrotum.
One patient recovered in consequence of prolonged pressure by

310 Apoplexy in Relation to Chronic Renal Disease. [May,

bandaging; and in 4 others, an improvement was manifested. One
woman died from phlebitis, but compression had not been used.

V. Favus. 13 cases (7 males, 6 females). In all these cases
the scalp was the seat of the disorder; and in this position the dis-
ease is especially persistent, from the fact that the peculiar micro-
scopic fungi of favus occur within the hairs, which thus form a
reservoir of spores, from which a new development of favus masses
springs up when the older masses have either fallen off or been
removed. [When favus occurs in any other part, it always runs
an acute course, and disappears spontaneously in a few weeks.]
The treatment consisted in keeping the affected spots as clear as
possible, and extracting the diseased hair with the fingers.

YI. Herpes. 28 cases, (21 males, 7 females). One was a case
of herpes circinatus, 2 of herpes iris, and the remaining 25 of her-
pes zoster. The treatment in all the cases was expectant.

VII. Herpes Tonsurans (occurring in 5 men), and Pityriasis
Versicolor (in 13 men) were always cured in the course of a week
or two by active inunction with soft soap, and then covering the
part with flannel. The soap should be rubbed in for the space of
ten minutes daily for from four to six days, and a layer of about a
line thick left, before flannel is laid. [N. Y. Jour, of Med.

Apoplexy in Relation to Chronic Renal Disease.

The following extract is from an interesting paper, by "W. Sen-
house Kirkes, M. D., in the Med. Times and Gazette.

The intimate connection thus apparently subsisting between
sanguineous apoplexy on the one hand, and diseased cerebral
vessels, enlarged heart, and renal disorganization, on the other, as
deduced from the foregoing analysis, will, perhaps, be best appre-
hended by viewing the result of this analysis in a kind of tabular
form. The 22 cases of sanguineous apoplexy may then stand thus:

Cerebral Vessels. Heart. Ki<lneys.

Diseased Diseased Diseased 12 times.

it

U

. . . Healthy . . .

. . 3

ii

Healthy . .

u

.. 1

ii

u
(1
11

11

. . . Diseased . .

u

. . . Healthy . . .
u

1

2

.. 1

ii
ii
ii

. . . Healthy . .

u

. . 2

ii

22
From this it appears that

The Cerebral Vessels were diseased 17 times
The Heart " 17 "

The Kidneys " 14 "

It cannot but be evident, from this impartial analysis of 22 fatal
cases of sanguineous apoplexy, in which the different organs wercl

1856.] Varicose Veins of the Lower Extremities. 311

carefully examined, that disease of the kidneys, heart, and cere-
bral vessels stand in very close relation to the apoplexy ; and this
relation is the more evident when it is borne in mind that in more
than half of the cases, the kidneys, heart, and cerebral vessels,
were found coincidently affected, while in only two cases was
there absence of decided disease of any of these parts.

Such being the principal information yielded by an analysis of
these cases, two questions seemed naturally to be suggested by it:
first, what relation do the renal, cardiac, and arterial diseases bear
to each other? Secondly, what share do they severally take in
the production of apoplexy? As regards the relation subsisting
between the renal, cardiac, and arterial disease in sanguineous
apoplexy, I believe that the affection of the kidneys is the primary
disease, and that the other lesions are developed secondarily, and
in the order just indicated, viz.: hypertrophy of the heart, disease
of the cerebral arteries, and extravasation of blood from l-upture
of these diseased vessels. That structural disease of the kidneys,
of such nature as to interfere permanently, or for a long time, with
their functions, has among its most frequent and prominent ac-
companiments, an hypertrophied condition of the left ventricle, is,
as already said, a fact now almost generally admitted by patholo-
gists. Of the various explanations of this pathological fact, the
most probable, perhaps, is that which regards the blood as so far
altered from its normal constitution by retained principles of urin-
ary excretion, as to move with less facility through the systemic
capillaries, and thus to require increased pressure, and consequent-
ly increased muscular growth of the left ventricle, to effect its
transmission. To this, perhaps, may be added, among other ad-
ditional causes, the direct influence on the circulation, resulting
from the impeded transit of blood through two such large and
vascular organs as the kidneys, in consequence of the structural
change which has taken place in them. On whatever cause, or
set of causes, it may depend, however, hypertrophy of the left ven-
tricle of the heart, in consequence of prolonged renal disease, may,
I think, be regarded as a well established fact ; and to the affec-
tion of the kidneys, therefore, may be referred the enlargement of
the heart found in 9 of the 13 cases of associated cardiac and renal
affections in the analysis above given, and part of the enlargement
noticed in the 4 cases where the valves were considerably dis-
eased. [Ibid.

On the Heal Origin of Varicose Veins of the Lower Extremities.

M. Verneuil lately read a paper before the Academy of Medi-
cine of Paris, on the above subject, in which he endeavoured to
make out the following points :

1. Whenever varicose veins which have sprung up spontane-
ously are observed on the lower extremity, there are deep veins
similarly affected in the corresponding part of the same limb.

812 New Operation. [May,

2. The converse, however, does not hold, for the inter- or intra-
muscular veins may be found dilated, without any change having
taken place in the superficial vessels. But when the deep veins
alone are found in an exposed state, it is almost certain that sooner
or later the superficial ones will in their turn swell, become tor-
tuous, and very apparent under the skin.

3. The varicose state of the veins of the lower extremity, as it is
usually seen, does not primarily arise from the subcutaneous ves-
sels (the internal saphena not excepted,) but generally from the
dilatation of the deep veins, and most often from the muscular
veins of the calf of the leg ! The deep veins are first affected
with valvular inefficiency and dilatation, and these two lesions
then spread to the super-aponeurotic branches of the second and
third order.

4. This succession of phenomena is not only made manifest by
simple dissection, but also by a careful study of the special arrange-
ment of the venous system of the lower extremity.

5. These facts, which may be looked upon as a new discovery,
throw much light on the whole subject of varicose veins of the
lower extremities. The etiology and symptoms of the affection
are thus elucidated, and this circumstance allows of a more ration-
al choice of therapeutical means.

6. The mechanism of relapses will henceforth be more easily
understood ; for it must be confessed that the obstinate return of
the complaint, which experience shows to be so frequent, has been
explained more by a train of reasoning than by direct demonstra-
tion. [American Jour, of Med. Science.

Descriptio7i of a New Operation in Cases where the Joint has been
firmly Anchylosed in the Straight Position after Injury. By Rich-
ard G. II. Butcher, Surgeon to Mercer's Hospital.

There is a condition of the elbow free from disease, the result of
injury, when it has become fixed by bony anchylosis in the straight
position, that requires special notice. I at once cede the point that,
by many, such an inconvenience might be borne with rather than
running risks by submitting to a severe operation; but, on the
other hand, there are some \ipon whom the effect would be to de-
prive them of the means of earning their bread, and, having no
resources, would, of necessity, consign them to be inmates of a
poor-house for the rest of their days. Here, I think, surgery
legitimately offers her powers to relieve. In such a condition of
parts I would not excise the joint, but would execute the follow-
ing operation. I have frequently performed it on the dead body,
and a dexterous hand may readily accomplish it in the living.
The arm being placed in the same position as that for resection, an
incision should be made, about an inch in length, behind the in-
ternal condyle, and the ulnar nerve freed from its bed, and drawn

1856.] Diuretics in Renal Dropsy. 313

forwards with a blunt hook ; a second incision should pass out-
wards to the most prominent part of the external condyle, at right
angles with the first, dividing the integuments and ligamentous
expansion covering the olecranon. The fine blade of the saw
which I use for resection being detached, it should be passed from
the extremity of the transverse incision, that is, from without in-
wards, in front of the condyles and the joint, its flat surface being
applied to them ; the blade, being sharp at the point, can be readi-
ly made to pass along this direction, and by drawing the integu-
ments a little in front of the internal condyle it will appear through
the perpendicular incision, or that made in the first instance ; the
serrated edge may then be turned backwards, the blade connected
with its frame, a few movements will sever all resisting parts from
before backward, corresponding to the line of the transverse in-
cision through the soft parts ; the limb should then be bent at less
than a right angle, and any vessels requiring ligatures must be
secured. The after-treatment should be exactly in accordance
with the rules laid dawn when speaking of resection. An opera-
tion accomplished after this plan is not, I conceive, nearly so seri-
ous a measure as excision of the joint; the brachial artery need
not be considered in danger, except through undue rashness, and
the hopes of a more perfect motion may rationally be expected,
when no muscular attachments are divided. [Dublin Quart. Jour,
of Med. Science.

Diuretics in Renul Dropsy.

The question as to whether diuretics should be employed in the
treatment of those cases of dropsy, which, from the condition of the
urine, are known to depend upon diseased kidney, is one of great
practical importance. Our readers may be glad to know the opin-
ion of so excellent a physician as Dr. Burrows, respecting it. A
few days ago, Dr. Burrows, at the bedside of a patient who was
recovering from a very severe renal dropsy, made the following
remarks: "I wish, gentlemen, that you should notice the treat-
ment which has been here pursued. I well recollect that long ago
it used to be Dr. Latham's observation that this form of dropsy
was often very efficiently treated by the tartrate of potash. That
salt was, indeed, his favorite remedy. Then came the addition to
our pathological knowledge, and the announcement of the fact that
the disease was essentially one of renal disorganization. From
this it was thought to follow clearly, that whatever stimulated or
irritated the kidney must do harm. Diuretics, consequently, fell
into almost universal disuse. Latterly, however, some of us are
again coming back to the old practice; we find that no other reme-
dies effect so much for the relief of the patient as diuretics, and we
therefore, prescribe the latter. The matter is one of experience'
and my own is to the effect that the kidneys, though in a state of

S14 Bromo-Iodureited Preparations. [^ay>

chronic disease, obey diuretics well, and that no inconveniences
are produced." The prescription which the patient, in this case,
had been taking was as follows: R. Potass* tartrat. fas., spirit,
aether, nitr. ss., aqua? piment, 3j. Ft. haust. ter die. The case
was, of course, one of chronic dropsy, and the diagnosis as to its
renal cause, had depended upon the absence of cardiac disease, and
the presence of a large quantity of albumen in the urine. [Med.
Times and Gazette.

Bromo-Ioduretted Preparations: translated from the French, by
M. Morton Dowler, M. D., New Orleans.

The following is a summary of the conclusions arrived at by Dr.
Lunier, in a long memoir contributed by him to L1 Union Medicate:

Part First. 1. The cod-liver oil acts at one and the same time
by its oily matter, and by the iodine and bromine of potassium
which enter into its composition.

2. These two haloid salts, favor the digestion of the oily matter,
by increasing the activity of the pancreatic secretion.

3. This fatty substance, and highly combustible aliment, play
an important part in the act of respiration, and in the development
of animal heat.

4. The iodine and bromine associated together, act with much
more energy than when separately administered.

5. That we can supply the place of the cod-liver oil, by the
bromo-ioduretted preparation, associated with any hydro-carbona-
ceous substances, as chocolate for example.

6. The bromo-ioduretted medicine augments the secretion of the
digestive juices, gives activity to the organic functions, and espe-
cially favors the development of the adipose tissue.

7. This agent sometimes determines on the skin and mucous
membranes, a light inflammation, which has not, however, any
tendency to suppuration.

8. It excites also, some cerebral affections, which take on the
form of nervous fever, and more generally it puts on the form of
general progressive paralysis.

9. The oily matter enters the digestive apparatus, or provides for
the transformation of the immediate non-azotic principles.

10. The oily matter is deposited in the tissues when the oxygen
introduced into the system is insufficient to consume it. {La bruler!)

Part Second. 1. Leanness, which has not its origin in any
serious organic lesion, is successfully treated by the cod-liver oil,
or the bromo-ioduretted agent, mixed with oily matter.

2. Opium, more than any other medicine neutralizes the effects
of this medicine ; (the cod-liver oil) employed with precaution is
capable of being useful in the treatment of obesity.

3. The bromo-ioduretted treatment would appear to modify, ad-
vantageously, certain diseases of the pancreas.

1856.] Bromo-Iodurelied Preparations. 315

4. In phthisis pulmonalis, the cod-liver oil acts in a special
manner, in furnishing an aliment to the pulmonary combustion ;
(iin aliment a la combustion pulrnonaire /)

5. It is therefore contra-indicated in the acute stage of the dis-
ease, when there is an urgent necessity of leaving the affected organ
in a state of repose.

6. The mineral waters, the fucus, the lichens, and sea-salt, owe
their virtues, in the treatment of pulmonary consumption, to the
iodine and bromine which enter into their composition.

7. In tuberculous chloro-anoemia, and in certain inveterate cases
of chlorosis, the bromo-iodine treatment should be associated with
the use of ferruginous preparations.

8. In scrofulous and syphilitic affections, in goitre and glandu-
lar enlargements, the bromo-iodine treatment succeeds by im-
pressing on the capillary circulation, and the secretions, an ex-
cess of activity which eliminates the morbific elements from the
organism.

9. It is especially to the fatty substance that we most attribute
the good effects of cod-liver oil in rickets.

10. In chronic coryza and ulcerated ozcena, bromo-iodine treat-
ment modifies rapidly the state of the mucus of the nasal fossae.

11. This treatment, owing to its direct action on the uterus, and
the active impulse which it gives to the capillary circulation, will
often be employed with success to re-establish or excite menstrua-
tion.

1. Bromo-ioduretted cod-liver oil:

ft. Iodide of Potassium or of Iron, Bromide of Potassium or of Iron, of
each, gr. iv. ; Cod-liver Oil (brown) gxvj.
Ft. Mist, secund. art., of which take from one to five spoonfuls daily.

2. Bromo-ioduretted oil :

ft. Iodide of Potassium or of Iron, Bromide of Potassium or of Iron, of
each, gr. viij ; Neat's Foot Oil, or Sweet Almond Oil, fxvj.
Ft. Mist, secund. art., and take from one to five tablespoonfuls daily.

3. Bromo-ioduretted Chocolate:

ft. Iod. of Potas. or of Iron, Bromide of Potas. or of Iron, of each, gr. iij. ;
Cake Chocolate, Powdered White Sugar, of each q. s.
M. ft. secund. art. a mass of gviij, to be divided into troches, (tablettes,)
of gj. each, of which from one to five are to be taken daily.

4. Bromo-ioduretted Biscuits :

ft. Iod. of Potas. or of Iron, Bromide of Potas. or of Iron, of each, gr. iv. ;
Bread Biscote q. s.
M. ft. secund. art., ten biscuits, and take four or five daily.

5. Bromo-ioduretted Salt :

ft. Iod. of Potas. or of Iron, Bromide of Potas. or of Iron, of each gr. iv. ;
Gray Table Salt iij.
Mix carefully, and preserve in a close vessel. Take from 3ij. to 3 v. daily
by salting.

No. 1.

No. 2.

gr. xix.

gr. xij ss.

gr. xij ss.

gr. xix. :

S"j.;

1 xx.

516 Presentation of Dead Children [May,

6. Bromo-ioduretted Butter :

R. Bromo-ioduretted Salt 3 v. ; Fresh Butter Jxvj.; to be consumed in
two or three days.

I. Bromo-ioduretted Solution :

R. Iodide of rotas, or of Iron,
Bromide of Potas. or of Iron,
Extract of Gentian,
Water,

II. ft. secund. art., a solution of which take from one to three tablespoon-
fuls daily at meals. The extract of Gentian ought to be left out when a
nearly tasteless mixture is desired.

8. Bromo-ioduretted Pills :

No.l. No. 2.

R. Iodide of Potas. or of Iron, gr. xix. gr. xij ss. ;

Bromide of Potas. or of Iron, gr. xij ss. gr. xix. ;

Powder and Syrup of Gentian, q. s.

M. ft. secund. art. pil. xl., of which take from one to three daily at meals.

9. Emmenagogtie Potion :

R. Iod. of Potas. or of Iron, Bromide of Potas. or of Iron, of each, gr. iv. ;

Syrup of Artimesia 3 v. ; Distilled Water of Artimesia; Distilled Mint

Water, of each, 3x.
M. ft. secund. art., a portion of which take one or two tablespoonfuls every
morning on an empty stomach. [New Orleans Med. and Surg. Jour.

On ilie mode of Presentation of Dead Children in Labour.

The Association Medical Journal for Aug. 31, contains an inter-
esting paper on this subject by Dr. J. Mathews Duncan. The
following are the author's conclusions drawn from the observations
he has made :

1. The healthy foetus floats obliquely, with its head lowest, in a
fluid of its own specific gravhy a position corresponding to that
it has in utero.

2. The foetus has a specific gravity of about 1050, while that of
the liquor amnii, at the full time, is nearly 1010.

3. Soon after the death of the foetus in utero, changes take place
in it (probably chiefly in the brain) which alter its position of
equilibrium in a fluid of its own specific gravity, so as to be gen-
erally the reverse of that of the healthy foetus; that is, so as to be
oblique, with its head highest.

4. It may happen that an advanced stage of decomposition of
the foetus, with collapse of the cranium, may make its position of
equilibrium, when floating, again oblique, with the head lowest.

5. These circumstances have probably considerable influence in
determining the frequent malprescntations of dead children.

[Am. Jour, of Med. /Sciences.

1856.] Miscellaneous. 317

EDITORIAL AND MISCELLANEOUS.

The Action of Medicines in the System ; or, "on the mode in which Thera-
peutic Agents introduced into the Stomach produce their peculiar effects
on the animal economy P Being the Prize Essay to which the Medical
Society of London awarded the Fothergillian Gold Medal for mdccclii.
By Frederick William Headland, M.B., B.A., F.L.S., M.R.C.S.. etc.
Second American, from the second revised and enlarged London edition.
Philadelphia: Lindsay and Blakiston. 1856.

We took occasion to speak favorably of this work on the appearance of
the first edition, and the correctness of our estimate of its value has been
demonstrated by the early demand for another supply. It is certainly an
excellent book for students as well as practitioners who may not have kept
pace with the improved views of therapeutics. The action of medicinal
agents introduced into the stomach is treated of under the heads of the
following Propositions :

Prop. I. That the great majority of medicines must obtain entry into
the blood, or internal fluids of the body, before their action can be mani-
fested.

Prop. II. That the great majority of medicines are capable of solution
in the gastric or intestinal secretions, and pass without material change, by
a process of absorption, through the coats of the stomach and intestines, to
enter the capillaries of the portal system of veins.

Prop. III. That those medicines which are completely insoluble in wa-
ter, and in the gastric and intestinal juices, cannot gain entrance into the
circulation.

Prop. IV. That some few remedial agents act locally on the mucous
surface, either before absorption, or without being absorbed at all. That
they are chiefly as follows :

a. Irritant Emetics.

b. Stomach Anaesthetics.

c. Irritant Cathartics.

Prop. V. That the medicine, when in the blood, must permeate the
mass of the circulation, so far as may be required to reach the parts on
which it tends to act.

That there are two possible exceptions to this rule :

a. The production of sensation or pain at a distant point.

b. The production of muscular contraction at a distant point.

Prop. VI. That while in the blood the medicine may undergo changes,
which in some cases may, in others may not, affect its influence. That these
changes may be

a. Of Combination.

b. Of Reconstruction.

c. Of Decomposition.

Prop. VII. That a first class of medicines, called Haematics, act while
in the blood, which they influence. That their action is permanent.

1. That of these some, called Restoratives, act by supplying, or causing
to be supplied, a material wanting ; and may remain in the blood.

318

Miscellaneous.

[May,

2. That others, called Catalytics, act so as to counteract a morbid mate-
rial or process ; and must pass out of the body.

Prop. VIII. That a second class of medicines, called Neurotics, act by
passing from the blood to ihe nerves or nerve centres, which they influence.
That they are transitory in action.

1. That of these some, called Stimulants, act so as to exalt nervous force,
in general or in particular.

2. That others, called Narcotics, act so as first to exalt nervous force, and
then to depress it, and have also a special influence on the intellectual part
of the brain.

3. That others again, called Sedatives, act so as to depress nervous force,
in general or in particular.

Prop. IX. That a third class of medicines, called Astringents, act by
passing from the blood to muscular fibre, which they excite to contraction.

Prop. X. That a fourth class of medicines, called Elimi natives, act by
passing out of the blood through the glands, which they excite to the per-
formance of their functions.

The work is then concluded by considering the action of some of the
more important medicines in particular.

It is for sale by T. Richards & Son, of this city.

Minutes of the Seventh Annual Meeting of the Medical Societg of the State
of Georgia, held in the City of Macon, April 9th, 1856.

The Society assembled in Temperance Hall at 10 o'clock A.M., and was
called to order by the President, Dr. L. A. Dugas. The Recording Secre-
tary, Dr. O'Keefe, being absent, Dr. Ellison was requested to act pro tern.

On calling the roll, the following members answered to their names:

Dr. R. D. Arnold, of Savannah,
" J. R. Boon, of Macon,
" S. W. Burney, of Forsyth,
" H. F. Campbell, of Augusta,
" G. F. Cooper, of Americus,
' L. A. Dugas, of Augusta,
" 1. E. Dupree, of Twiggs county,
" W. W. Flewellen, of Columbus,
" J. C. Ellison,

Dr. J. M. Green, of Macon,

" M. A. Franklin, " "
" D. W. Hammond, " '
" G. Harrison, " "

" P. M. Kolloek, of Savannah,
" R. H. Nesbit, of Macon,
" Thomas Lamar, " "
" E. S. Way, of Pulaski county.
" J. G. Westmoreland, of Atlanta.

The minutes of the last meeting were read and approved.

On motion, the rules were suspended, and the following gentlemen, on
written application, were duly elected members of the Society:

Drs. C. E. Bellamy, of Columbus; B. S. Carswell, of Twiggs Co.; A. A.
Trammel, of Forsyth; 0. S. Promt, of Jasper Co.; Ebon Hillyer, \Y. II.
Oliver, J. 11. Ethridge, of Atlanta; J. Harris, of Crawford Co.; J. R. Janes,
of Slarksville ; W. E. Vason, of Albany ; C. B. Sutton, of Lee Co.

The election of officers being next in order, a ballot was ordered, and the
following gentlemen duly elected :

1856.] Miscellaneous. 319

President Ira E. Dupree, M. D., of Twiggs county,
1st Vice-President Thomas Lamar, M. D., of Macon,
2d Vice-President S. W. Burney, M.D., of Forsyth,
Cor. Secretary F. C. Ellison, M. D., of Columbus,
Rec. Secretary D. C. O'Keefe, M. D., of Greensboro',
Treasurer C. B. Nottingham, M. D., of Macon,

Drs. Flewellen, Arnold and Burney, were appointed a committee to nom-
inate delegates to the next meetinsj of the American Medical Association.

At 12 o'clock M., the hour appointed for the purpose, an interesting
oration was delivered by Dr. W. W. Flewellen, of Columbus, upon " The
Rise and Progress of Experimental Sciences.

After which, on motion, the Society adjourned, to meet again at three
o'clock P. M.

Afternoon Session.

The Society was called to order by the President, and business was re-
sumed.

Reports from auxiliary societies being called for, Dr. Ebon Hillyer pre-
sented a report of the organization, officers and members of the auxiliary
society in the city of Atlanta which, on motion, was received.

Written communications being next in order, Dr. Arnold presented an
instructive and interesting paper upon the Relations between the Remittent
and Yellow Fevers, showing conclusively that they were distinct diseases,
and that they need never be confounded with each other. He also pre-
sented, for the inspection of the Society, representations in oil colors of the
liver in Yellow fever, and in Bilious fever; that of the former being of a
bright box-wood color, and the latter a decided brown. The discussion of
this subject was continued for some time by Drs. Dugas, Campbell, Kollock,
Hillyer, and others all sustaining the views advanced by Dr. Arnold.

Dr. Arnold also presented for the inspection of the Society, a new and
simple method of preserving specimens of morbid Anatomy.

Dr. Kollock next presented an interesting paper upon the Health of the
City of Savannah, during the winter and spring of 185G Epidemic Mea-
sles, and its complications with Pneumonia, Laryngitis and Varicella.

After which, the Society adjourned, to meet again at 8 o'clock P.M.

Evening Session.

The Society re-assembled, the President in the Chair.

Dr. G. F. Cooper, who had just reached the city, appeared, and read a
practicable and interesting paper upon the Influence of Diet in the Manage-
ment of Diseases.

The Committee on Business, consisting of Drs. Dugas, Green, Kollock,
Flewellen and Way, reported the following subjects and essayist, for the
next annual meeting:

320 Miscellaneous. P^fay,

1st. Dr. P. M. Kollock on the Treatment of Vesico-vaginal Fistula.

2d. Dr. J. G. Westmoreland What is the difference between the "Coun-
try fever" of the sea-board, and the Remittent fevers of the middle
counties of Georgia ?

3d. Dr. H. F. Campbell Are there any means by which the extension of
Yellow fever into the interior may be prevented ?

4th. Dr. Joseph A. Eve On the Diseases of the Cervix Uteri.

5th. Dr. L. D. Ford On the connexion of Pneumonia with Remittent fever.

6th. Dr. C. B. Nottingham On the Diseases of the Spinal Marrow.

7th. Dr. F. C. Ellison On the relation of Epidemic Dysentery to Malarial
fevers.

8th. Dr. W. M. Chartres On the relation of Acute Meningitis to Malarial
fevers.

9th. Dr. E. F. Way On the Pathological difference between acute, articu-
lar and chronic Rheumatism.

10th. Dr. Ira E. Dupree On the Treatment of Prolapsus Uteri.

11th. Dr. Ebon Hillyer Under what circumstances is Trepanning justi-
fiable?

12th. Dr. J. M. Green On the value of Escharotics in the treatment of
Cancer.

13th. Dr. R. D. Arnold The Pathology and Treatment of Erysipelas.
On motion of Dr. Dugas, the Essays read by Drs. Arnold, Kollock, and

Cooper, together with the Address of Dr. Flewellen, were ordered to be

published.

On motion of Dr. Arnold, the thanks of the Society were tendered Dr.

Flewellen for his appropriate and erudite oration.

The selection of orator for the next annual meeting being next in order,

Dr. G. F. Cooper was unanimously elected, and Dr. R. C. Mackall his alter-
nate.

The city of Augusta was selected as the next place of meeting. The

Committee of arrangement are Drs. Campbell, Harris, Doughty, AValton,

and Phinizy.

At a late hour, on motion, the Society adjourned, to meet again at 10

o'clock A. M., on the second Wednesday in April, 1857, in the city of Au-
gusta. F. C. ELLISON,

Recording Secretary, pro tern.

Mode of Testing the Translucency of Hydrocele. Dr. W. Frazcr directs
attention (Dublin Hospital Gazette, Nov. 1, 1855) to what he believes to
be one of the best methods of employing the valuable test of translucency
in hydrocele, a test which is practically so important as a differential diag-
nostic in discriminating between mere serous effusions in the cavity of the
tunica vaginalis and various affections of the testicle, or scrotal hernias.
Of course, every one is aware that the test is not free from objection ; thus

1856.] Miscellaneous. 321

it is almost or entirely useless in those instances in which the effused fluid
is of very dark color, or is mixed with blood, &c, and also whenever the
tissues of the tunica vaginalis are of unusual thickness, or are the seat of
cartilaginous or osseous deposit, or when they are coated internally by the
products of previous inflammatory action. Independent of these excep-
tional cases, there are a number to be met with in practice, in which the
test is of value.

As ordinarily employed, by placing a candle at one side of the tu-
mour, and excluding the passage of the light laterally by means of the
hand, it is, at best, a clumsy proceeding, and liable to errors. I have found
the stethoscope much more useful, as a means of excluding the diffused
light, and by applying the eye to its expanded bell-shaped portion the
ear-piece being firmly placed upon the scrotum, held in a tense condition
we can even map out the state of the parts with tolerable accuracy, if the
contained fluid be of ordinary character, and detect the position of the
testicle by the opacity it produces, especially when it occupies any unusual
locality, as the front or sides of the scrotum, or is adherent from inflamma-
tion after previous tappings. We can employ either a lighted candle or
bright sunlight, as our best means of obtaining the requisite illumination ;
but even in diffused daylight I have succeeded very well in the manner I
mention. [Am. Jour. Med. Sciences.

New Form of Astringent Application. By Dr. William Bayes, Brigh-
ton. Pure glycerine dissolves nearly its own weight of tannin, affording a
very powerful local astringent application.

The solution of tannin in pure glycerine appears to me to supply a desi-
deratum long felt, and capable of a great variety of useful applications.

The solvent property of glycerine over tannin allows us to form a lotion
of any desirable strength, as the solution is readily miscible with water.

The solution of tannin in glycerine, in one or other of its strengths, is
peculiarly applicable to many disorders of the mucous membrane, readily
combining with mucous, and forming a non-evaporizable coating over dry
membranes ; hence it may with benefit be applied to the mucous mem-
branes of the eye and ear in many of its diseased conditions. It forms a
most convenient application to the vaginal, uterine, urethral, or rectal
membranes, where a strong and non-irritant astringent lotion is desired.

In local haemorrhages, where the bleeding surface can easily be reached,
it will prove very convenient, and may be applied either with a sponge or
small brush.

The solution must be kept in the dark, and should not be prepared for
any great length of time before used, or decomposition will occur.

It 13 singular that glycerine does not possess the same property towards
gallic acid. [Association Med. Jour.

On Forcible Feeding. Dr. Szigmondy describes a simple and effectual
means of administering fluid nourishment to persons who are unconscious,
suffer from trismus, or obstinately refuse food. The patient is laid horizon-
tally on a bed, with the head somewhat raised, and the food is poured by
teaspoonfuls through the nostrils. Reaching the pharynx, the movement
of deglutition is provoked ; and as soon as this is perceived, another small
portion is poured in. In this way too, physic can be given to children
who resist. He relates a case of severe alcoholic coma, with spasmodic

322 Miscellaneous.

closure of the jaws, which was speedily relieved by the introduction of a
solution of tartar emetic. This means is far easier to practise, and causes
less irritation, than the introduction of the stomach-pump.

Dr. Beer states that by the magnetico-electrical induction apparatus, the
mouth can be sufficiently opened to admit of portions of solid food being
introduced. [ Wien Wochen. Med. Times and Gaz.

Ergot of Wheat. Dr. Jobert makes the following statement, as the
results of his observations : 1. The medical and obstetrical properties of
this ergot are as incontestable as those of the ergot of rye, and its effects
are as prompt, as direct, and as great. 2. Its hemostatic action appears
certain. Dr. Jobert has administered it several times, against abundant
discharges of blood, and immediately after labour it has almost constantly
and fully succeeded. 3. In the dose of from one to two grammes, (fiteen to
thirty grains,) according to urgency, in cases of uterine hemorrhage during
any period of pregnancy, it has frequently succeeded in lessening, if not in
completely arresting, the haemorrhage, and this without appearing to produce
any stimulant action on the uterus. [Gaz. des Hop. Asso. Med. Journal.

St. John Long's Celebrated Liniment. The yolk of an egg; oil of tur-
pentine fgiss.; strong acetic acid f|i.; pure water fiii.; first rub the yolk
of the egg, the water, and the acetic acid together, then add the oil of tur-
pentine, and agitate the whole until they are well mixed. This counter-
irritant liniment is applied by means of a sponge; its effects vary with the
force which is used in rubbing, and the length of time the application is
continued. [Edinburg Med. Journal.

Formula for the Internal use of Chloroform. M. Dannecy, pharmacien,
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. [Lancet.

New Treatment for Itch. MM. Dussard and Tillon assert that itch may
be often cured immediately by painting the body over with chloruret of
sulphur dissolved in sulphuret of carbon. The application kills the acari
and their eggs. Sometimes it is necessary to repeat the application, as
some of the acari, or some of their eggs, may not have been killed by the
first. [Gax. Ilebdom. Am. Jour. Med. Sciences.

Spender's Chalk Ointment in Ulcers of the Leg. Dr. Patterson has col-
lected 125 cases of chronic non-specific ulcers of the leg, in which, under
this mode of treatment, the cure has been rapid and complete. The fol-
lowing formula he prefers :

R Crete preparate, ftiv.; adipis suilli, Ibi.; olei olive, Jiii.

Having heated the oil and lard, add gradually the (balk, finely powdered.

The ointment and a bandage being once applied, it is left until the cica-
trix forms and becomes firm. [Edingburg Med. Jour.

SOUTHERN

MEDICAL AND SUEGICAL JOURIAL.

(NEW SERIES.)

Vol. III.] AUGUSTA, GEORGIA, JUNE, 1856. [No. 6.

ORIGINAL AND ECLECTIC.

ARTICLE XVI.

The Value of Diet in Disease. By G. F. Cooper, M. D., of Ameri-
cus, Ga*

Although much has been -written upon the value of diet, and the
function of digestion, comparatively nothing has been done to direct
attention to its value in disease, and to the importance of that
function though altered in a morbid condition of the body.
Among the many elaborate treatises upon these subjects especial-
ly digestion we know of none of any practical worth to the pro-
fession in the management of disease. In this respect we think
we are, to some extent at least, at fault ; and while we would dis-
like to see any abatement of the interest in the investigations on
the one hand, it is very desirable, on the other, to awaken an
interest not hitherto manifested. We propose, in this paper, to
speak of the value of diet in disease, under two propositions:

1st. Its use in supplying the wastes of the tissues; and,

2d. In the maintenance of the function of animal heat.

And if these two uses of diet have justly deserved, and received,
so much attention, physiologically, we feel assured their import-
ance is in no sense inferior, nor should they receive less consid-
eration in a pathological point of view.

It would be supererogation to dwell upon the part that diet

* This paper was read at the recent meeting of the State Medical Society, and
ordered to be printed.

N. S. VOL. XII. NO. VI. 21

324 Cooper, on the Value of Diet in Disease. [June,

takes in supplying those wastes, constantly in progress, in a nor-
mal condition of the animal economy ; this is more ably and
elaborately discussed in our standard works, than it can possibly
be done here. All recognize the necessity of these wastes being
replenished, and look alone to the introduction of food, for the
accomplishment of this end ; yet, in disease, we can look indiffer-
ently upon the rapid destruction moving apace before our eyes
without regarding it as a matter of much moment, and never
dreaming how this devastation is to be stayed, or the wastes to be
supplied.

In the treatment of much the largest proportion of diseases, one
of the greatest desiderata is to husband the strength of the patient;
ordinarily, however, we conclude, in view of the anorexia and
impaired function of digestion, we can by no means look to diet
to aid us; but by avoiding the imprudent use of depletents, to
keep in store the requisite amount of strength, to enable the pa-
tient to endure, at least, the early period of his attack, though it
have considerable duration. Emaciation, and consequent loss of
strength, in abstinence, make much more rapid progress, in disease
than in health, because there are other conditions present, which
aggravate and expedite the work of destruction. It is true, there
are no expenditures or wastes, from exercise, which are ever going
on in health ; but, whatever the advantage gained in this respect,
it is far more than outweighed by the abnormal conditions inti-
mated above ; and however much this fact may be overlooked, in
disease, it is one of no mean import, and should not be lightly
regarded, but every effort should be made to counteract those
morbid influences which wear down the energies of the subject,
and which we, not unfrequently, though unwittingly, aid, by what
is believed to be the only practicable and admissible plan of treat-
ment.

In health, the processes of decay and replenishing are constant-
ly active, but the supply is more than adequate to the demands of
nutrition ; for nature deposits in the adipose substance, a reserve,
which is always furiously attacked in disease. The question is
not to prevent waste which is really depurative but to provide
material from without, and thereby preclude the drafts which
would, otherwise, be made upon these resources which are provi-
ded, not only for a respectable embonpoint, but for our endurance
both in health and disease.

1856.] Cooper, on the Value of Diet in Disease. 325

The blood is the great medium through which all these import-
ant operations are effected ; and while it conveys those nutritious
substances which build and keep up the human fabric, it is no less
the temporary receptacle of the noxious and effete matters, which
it gathers in the remote points of its circulation, for the purpose of
transmitting them to their proper places of exit. This being the
office of the blood, we readily perceive how important that it be
kept pure, and prepared to supply the various tissues and organs
with such material as is required for their proper nutrition and
functions. Now, one of the principal means of preserving the
blood pure, is by proper supplies from without, and whenever
they are cut off, every circuit the blood makes, of course only
serves to augment its impurities; but when it is frequently re-
ceiving these accessions from external sources, whatever be the
nature of its impurities, they are to a greater or less extent, as the
case may be, constantly undergoing dilution, and the result is, not
only the wastes are supplied, but all the organs are kept in a state
of preservation, whereby they are enabled to perform their several
functions better, and the laws of the economy, if not perfectly
maintained, continue with, comparatively, little interruption.
The blood, when deprived of its supplies, through the ordinary
channel, would naturally invite them from the tissues, with which
it is everywhere in contact; and here a remarkable difference oc-
curs for, while in health it receives its nutritious materials at or
very near the centre of circulation, and the debris at its remote
points, now, indeed, that is when external supplies are suspended,
it takes in both at the same point, and the same instant, which
must insure the more intimate mixture of the two qualities, there-
by deteriorating the blood much more certainly than if its supplies
had been received through (as they are mainly) the thoracic duct.
In this state of things, a double, and, to some extent, unnatural
action is forced upon the capillaries whereas, normally, they are
required only to receive the debris of the tissues ; now, they must
also receive the nutritious elements, because of their failure from
without; and how far this action may go to engender irritation,
and excite and aggravate disease, cannot, in this connection, be
determined.

Second Proposition : the maintenance of the function of animal
heat. Whatever may be the contrariety of opinion of the exact

326 Cooper, on the Value of Diet in Disease. [June,

nature and source of animal heat, its existence and importance in
the animal economy are known to all, and it is of equal moment
that we elevate an abnormally low degree, as we must reduce an
abnormally high one ; for while the powers of the system sink ra-
pidly in the former case, they are no less exhausted in the latter.
In disease, we most frequently meet with an exalted degree of this
function; and it would appear, from a cursory view of this subject,
that the continued introduction of food would not only add heat
to the flame, but serve to perpetuate the trouble. We think,
however, this cannot be shown ; but, on the contrary, as has alrea-
dy been intimated, the absence of food, necessarily, begets this
very condition of the system, and the use of diet, instead of ex-
citing, it seems reasonable to believe that its effects would be
soothing, and would rather allay than provoke excitement. If we
arrest the supply of water to the engine, the heat is not diminish-
ed, but increased; and as cold is often used to arouse the function
of innervation, and thereby restore lost heat, as well as to reduce
it when raised above the normal degree so, in the body, the pru-
dent introduction of food may both excite and diminish, augment
and lessen the temperature. To say the least of it, we cannot hope
to subdue an abnormal degree of heat, by studiously withholding
food, when it is excited and kept up by other causes operating
upon the fluids of the body, and changing their nature and unfit-
ting them for their accustomed actions; but simultaneous with
other treatment, we must essay, by the use of proper diet, to dilute
and weaken, and, possibly, entirely overcome those causes, which,
in the absence of food, would likely become intensified and great*
ly promote disease. The wrecked seaman, when the short supply
of provision is exhausted, which, in haste, he snatched from the
sinking ship, will prey upon his own flesh; and so of the body,
when its external supplies fail, it turns upon itself, until its inward
resources are consumed every round of the blood less ning the
store on hand, as well as adding to its own impurity, andsoon the
operations of nature cease.

In discussing the other phase of this preposition, thai is, wfa p
the temperature is abnormally low, our way is apparently more
clear, though we are not sure that stronger reasons can be adduced
in its support; however, cone will question the necessity of the
rapid introduction, not only of food, hut the most powerful stimuli,
to excite and bring up the degree of heat, especially where its

1856.] Cooper, on the Value of Diet in Disease. 327

failure is obviously owing to the want of adequate nourishment.
When the animal heat falls suddenly below a healthy degree, we
may reasonably suspect the nervous system, with which this func-
tion is intimately aasociated, and over which it exerts a manifest
influence and control, to be involved; in this case, the use of food
may, perhaps, be regarded of secondary importance, but by no
means to be neglected.

As before stated, the blood being the medium through which
this important vital action is effected, it can only do so when its
character affords the requisite elements. It is apparent when the
blood is deprived of its food from without, from which it derives
those elements, required to meet and combine with the oxygen of
the air, received through the lungs, it must be not only materially,
but injuriously modified: nor can its drafts upon the supplies in
store be responded to with that promptness, nor will they yield
those qualities or elements, which the blood requires for a proper
maintenance of this function, or which food, from without, affords.
The capacity of the blood for the reception of oxygen, must be-
come constantly less, and while this may be, in one sense, conser-
vative, yet in the end it will tell upon the energies of the general
system, and hastens the patients dissolution.

Respiration is ordinarily, in disease, accelerated, and while the
capacity for oxygen may be diminished, the quantity of oxygen is,
perhaps, in the main, increased. Now here, on the one hand, we
have one element probably augmented while on the other, when
food is not taken, those elements with which it is to combine for
the production of animal heat, will be found wanting; in which
case the body, which has to furnish them, essentially provides the
means of its own destruction.

The errors of the profession in the premises, to our mind, are
two :

1st. In regarding the appetite as the index to the wants of the
system; and,

2d. That the function of digestion is, in disease, suspended ; or
incapable of preparing food for absorption and nutrition.
. In disease, although anorexia may be present, the wants of the
economy are imperious; and yet, because these wants are not in-
dicated by any rational manifestations, we are' ready to conclude
there can be none a great error: for we are not to suppose, from
anorexia, that the system is free from want, but that it is evidence

328 Cooper, on the Value of Diet in Disease. [June,

of an impure state of the blood, and vitiation of the secretions ;
for this state of the secretions, even of the mouth, does, unques-
tionably, have much influence upon the appetite. Abstractly
considered, I cannot understand why these wants do not exist,
and why we do not proceed to their supply as readily as if the
appetite were present to indicate them.

As a sentinel, who sleeps at his post, would fail to give the alarm
upon the approach of the enemy, so the appetite does not, in dis-
ease, make known the necessities of the system, and the work of
devastation, in case of abstinence, may progress covertty, while the
physician is patiently waiting the return of the lost appetite, which
we always hail with exultation, and regard as the harbinger of
convalescence ; it should never be considered, primarily, as evi-
dence of want, or the re-appearance of the powers of digestion, but
the resumption of the normal actions or functions of the body,
which have been to a greater or less degree impaired : in this
case, the il vis medicatrix natural" is entitled to the credit, rather
than the doctor.

Now, we ask, what would be more likely to provoke appetite,
restore a healthy state of the secernent functions, and aid in sub-
duing disease, than the prudent allowance or introduction of food?
In all cases, this would not be practicable, owing, mainly, to de-
lirium ; but, where there is sufficient mental clearness, the necessity
and object of taking food may be, without difficulty, made obvious
to the patient.

2d. We feel assured that it is erroneous to conclude that diges-
tion, in disease, is suspended, or even measurably so, and inca-
pable of exerting its peculiar actions upon food, and fit it for
assimilation. Although the various organs of the body may be,
more or less, impaired in their functions, yet we know they are
not, ordinarily, suspended; and there is no just reason why diges-
tion should be considered more at fault than the other functions
indeed, there is every reason to believe, from its position and ,
importance to all the operations of the economy, it would be the
last to succumb, or even become impaired.

"We have so often observed food disposed of, comparatively,
easy, and producing desirable results, that we are constrained to i
believe that digestion usually stands ready to do more, and better, |
than we are willing to allow ; and unless there are indications i
which absolutely preclude it, we should presume upon the power i

1856.] Cooper, on the Value of Diet in Disease. 329

and readiness of the digestive organs to perform their part, at least,
adequate to the wants, though unexpressed, of nature. As we
would superintend and exercise control over a stubborn and capri-
cious child, knowing better what he needs and what to provide for
him, than he does for himself: so, in disease, we should become
the guardians of our patients, knowing that the perversion under
which the several functions may be laboring, prevent nature from
exhibiting her usual mien, or making known her accustomed
wants.

If we investigate the symptoms present in cases of starvation,
or long abstinence, we cannot fail to recognize many features
strikingly simulating those observed late in disease ; nor would it
be rash to conclude that, not unfrequently, they may be ascribed
to the same cause in both instances, to wit: want of food. We
mention these facts, more particularly, to show how absurd would
be the attempt to restore persons in this starving condition, except
by introducing food as rapidly as the nature of the case, and pru-
dence, would permit. Because there are no local lesions, in the
beginning, in one case, this fact does not abate the necessity of
food in the other; nor could we be warranted in withholding it
on this account, but guard against such improprieties as might lead
to injury, or aggravation of disease.

A year or two since, the report of a number of cases of Con-
tinued fever appeared in the London Lancet, the treatment of
which consisted, mainly, in the use of brandy, and the result was
most satisfactory. This success may be explained upon the prin-
ciple that the brandy afforded food, it being rich in those elements
needed to combine with the oxygen received through the lungs,
as well as giving tone to the general system. It has also been
proposed to treat delirium tremens by the free, discrete use of
diet ; it being alleged that the delirium and vigilance are the result
of abstinence which is almost alwaj7s the case in that disease
rather than the effects of alcohol, or loss of accustomed stimulus.
We believe the suggestion one of practical importance, and merit-
ing trial at the hands of the profession.

The state of the blood has never received that attention in dis-
ease that it truly deserves perhaps the long reign of Solidism
prevented it ; but of late years, humoral pathology is so univer-
sally acknowledged, it seems that accurate observation, with ex-
periments, should no longer be delayed. So far as can be known,

330 Cooper, on the Value of Diet in Disease. [June,

and is practicable, there should be an adaptation of food to the
wants of the blood that is, when the blood is defective in any of
its normal qualities, we should have recourse to those articles of
diet, simple in their nature, but abounding in those elements, of
which the blood has been deprived, and vice versa, in case of ex-
cess. It is upon this principle we proceed in the dietetic manage-
ment of diabetes, and with more success than by any other method.
Dr. Charles Hooker, in a late paper, entitled, "Report on the Diet
of the Sick,"* a synopsis only of which we have seen, the following
statements occur: "The appetite is regarded as nature's proper
guide, and the general principle is maintained, that, with the sus-
pension of the gastric secretions, the stomach loses its digestive
powers, and food can only prove a cause of irritation. This rea-
soning has led to most erroneous dietetic management." He
might have added, and by consequence, to most ruinous results.
Again : " In diseases, generally, a return of appetite is regarded as
a favorable symptom, indicating a returning healthy action and
condition of the stomach." Would it not have been more rational,
and better in keeping with facts, to have said "indicating a re-
turning healthy action and condition " of the several functions,
instead of simply that of the "stomach?" We are happy to find
that we agree so nearly with sentiments from so distinguished a
source, though we are compelled to dissent from some positions,
or rather rules, which he prescribes for the dietetic management
of the sick. In his first rule, he says : " The food should be com-
pletely masticated and insalivated before passing into the stomach."
The objection is not to the rule, but to the nature of the food im-
plied. It seems to us, that when the secretion, and thereby the
action of the stomach, are impaired, those substances should be
ingested, which would require the least effort of that organ, and
that would be easiest absorbed. Our chief reliance should be upon
nutritious fluids, and looking to that other important action of the
stomach, viz., venous absorption, for the ready conveyance of nu-
trient material to the general system ; at the same time, let solid
food be used as much as the nature of the case will allow.

Dr. Hooker, in his second rule, says: "Food should be admin-
istered at regular times, corresponding with the previous habits of
the patient."

In disease, generally, we must bear in mind, there is no appe-

*Made to the American Medical Association, Session for 1855.

1856.] COOPER, on the Value of Diet in Disease. 331

tite, and so far as previous habits, in regard to eating, are concerned,
we say they are measurably broken up ; the patient would not,
likely, relish food at one hour more than another; besides, the
regular meal hours would not be sufficiently often, for the patient
rather loathing food, and digestion more or less impaired, we can
only give small quantities, and have these digested; they should,
therefore, be repeated at rather frequent intervals, and thus we
may introduce, in twenty -four hours, a considerable amount of
nutrient material, without its proving nauseous to the patient, or
taxing his stomach beyond its powers.

We cannot do better than insert his 4th rule entire. " Medica-
tion should be directed with a view to aid, and not impair, the
appetite and digestive action. Without regard to this precaution,
the purpose of restoring the appetite, and sustaining it during the
progress of disease, will often fail. Medicines, nauseous to the
taste, given just before eating, will sometimes effectually destroy
the appetite for food. Thus, medicines, appropriate to a case, may
do more harm than good, if given at improper times. Quinine,
and other bitter tonics, judiciously employed, invigorate the diges-
tive organs and improve the appetite ; but for this purpose, they
are best administered with the food. Their action, and the stimu-
lus of food then coincide ; but given between meals, or even half
an hour or an hour before the food, they often spoil the appetite."

We must hot forget that, in disease, most usually, we have no
appetite to sustain no appetite to spoil ; and it is to this point we
have endeavored, in this paper, to direct the attention of the pro-
fession the necessity and practicability of using food or diet,
without appetite because it is just here, we think, most fault at-
taches.

From what has been said, it follows :

1st. That, in disease, the want of food is obvious, although there
is no appetite present to indicate it; and,

2d. That the use of diet is entirely feasible, and that the diges-
tive organs are capable of preparing the requisite amount of
food; and,

3d. The prudent and discriminate use of food tends to allay,
rather than to aggravate disease.

332 Kollock, on the Health of the City of Savannah. [June,

ARTICLE XVII.

Health of the City of Savannah during the Winter and Spring of
1856. (Read before the Medical Society of the State of Georgia,
at its Annual Meeting, April, 1856, and ordered to be printed.)
By P. M. Kollock, M. D.

The winter which has just closed, has been the most intensely
cold that I have ever experienced in Savannah, during a residence
of thirty years. The mercury has been depressed to an extremely
low point, and continued at that low point for a greater length of
time, than has ever occurred before, within my remembrance.
This hyperborean condition of the atmosphere, however, has not,
as a general rule, exerted any deleterious influence upon the health
of the inhabitants the city having been entirely exempt from the
prevalence of any epidemic during the winter months. Contrary
to precedent the succession of an early spring to a cold winter
all Nature seems to have been exceedingly averse to donning its
vernal garb, and April finds us nothing loth to the occupancy of
the seat in the chimney corner.

About the beginning of February, we began to be made aware
that the healthful state of existence which had been so long en-
joyed by our city, was about to be interrupted, cases of measles
presented themselves, and we very soon found ourselves in the
midst of an epidemic.

I saw nothing of the disease until the 20th of the month. On
that day, I was called to see Amos Henderson's son, Polk, and
Win. Black's son, Phineas ; the former 5 years old, the other sev-
eral years older.

The rational signs in these two cases were indicative of the ap-
proach of typhoid pneumonia. There were present, fever, with a
very frequent, small pulse (120 in the minute) in Polk's case the
respiration labored and hurried (52 in the minute), cough, without
much expectoration or pain chest resonant on percussion respi-
ration bronchial, without rales. He was treated with cathartics of
ol. ricin., alterative doses of cal. and pulv. Dover., sol. tart. ant.
and nit. pot. and small doses tr. aconit.

On the 24th, the diagnosis of this case was decided by the ap-
pearance of the rubeolous eruption on the face. Immersion of the
whole body in a warm bath brought out the eruption on the rest
of the body. After this, the rubeolous disease pursued a very

1856.] Kollock, on the Health of the City of Savannah. 333

regular course, the eruption disappearing, with some desquamation,
at the usual time; but an obstinate and troublesome cough re-
mained, normal resonance of the chest existing on both sides, with
loud, mucous rales all over the right lung, unattended with fever.
This condition has been gradually ameliorated by the revulsive
action of blistering with cantharides, and pustulation by means of
croton oil and tart, antim. applied, alternately, to the right inter-
scapular space, posteriorly, and the subclavicular, anteriorly ; also,
by the administration of 10 grs. of alum, three times a day, and a
cough mixture composed of syr. senek., syr. scill., syr. tolu., ol.
Jecur. asel. and acid hydrocyan.

The symptoms in the case of Mr. Black's son, were very similar
to those of the case which has just been detailed. To them, was
superadded muttering delirium, dry and brown tongue, sordes on
the teeth and lips. The rubeolous eruption did not manifest itself
until the eighth day, and its appearance was followed by an alle-
viation of all the preceding alarming symptoms.

The treatment of this case was similar to that in the preceding,
a blister having been superadded, applied to the nucha, on account
of the delirium. The tr. aconit. was used in these two cases, in con-
sequence of the favourable influence on the pulse, which has been
lately claimed for it; but it failed to exhibit any such influence.

Desquamation occurred in this last case on the 28th, the attack
having commenced on the 15th, and convalescence was not attend-
ed by any unpleasant sequelae.

As is usual with rubeola, the stage of incubation occupied three
or four days ; the eruption arrived at its climax about the third or
fourth day, and declined from this time, not disappearing entirely,
in some instances, until the eighth or tenth day from its com-
mencement.

The epidemic disease was developed among the younger mem-
bers of my own family, attacking first a boy of seven years. The
eruption showed itself on his body first, on the fourth day. It did
not disappear entirely from the anus and legs until the eighth or
tenth day. He became convalescent, and began to go about, as
usual, and take his regular meals, when symptoms of indisposition
re-appeared, accompanied with fever, anorexia, &c, and in a few
hours after, a vesicular eruption exhibited itself on his face, ex-
tending rapidly to all parts of his body, and in great profusion.
The vesicles were in some places conical, and in others umbilica-

334 Kollock, on the Health of the City of Savannah. [June,

ted, surrounded by a very slight areola without any elevation of
base. Those which first appeared, dried in the course of forty-eight
hours others succeeding them in different places, generally dis-
tinct, but sometimes confluent ; they were filled with a whey-like
serum, not becoming purulent.

While this boy was confined to bed with measles, his elder bro-
ther, about nine years old, who occupied the same room, com-
plained of feeling unwell, having headache, loss of appetite, &c.
In a few hours, an eruption of vesicles occurred on his face, and
extended soon to the rest of his body. These vesicles were dis-
tinct, somewhat umbilicated, with an areola, and supported on an
elevated base. They somewhat resembled varioloid ; but I did
not consider thern worthy of that title.

This vesicular eruption was very much of the same nature as
that of the boy first named, which was doubtless varicella.

At this same time, two young negroes who attended in the
house, and three others in an out- house on the same premises,
showed the same eruption, unattended by fever.

The boy of nine years old (whose eruption was vesicular) was
kept in bed two or three days, and purged with citrate of magne-
sia, and dieted. He then became convalescent, left his bed, and
returned to his usual habits. In a day or two, however, he began
to lose his appetite, to flush in the face, feel pain in the head, with
a dry and hot skin. He was treated to another dose of citrate of
magnesia and put to bed, and a warm bath administered at bed-
time. On the following morning, the rubeolous eruption made its
appearance, accompanied with cough, inflamed eyes, fever, &c.
This disease ran its course regularly, and without any unusual
symptoms, terminating in rapid convalescence.

Two other still younger children, a boy and girl, occupying the
same room with the other cases which have just been detailed,
were attacked in the same way, with the rubeolous disease first,
followed by the vesicular or varicellous.

The rubeolous disease in the little girl's case was unusually se-
vere, being attended with a very profuse eruption ; on the second
day of which her pulse rose to 160 in the minute respiration 48,
accompanied with alarming convulsive jerkings of the head and
extremities, and harrassing cough. She was subjected to hot
mustard pediluvia, mustard poultices to extremities and chest,
dry cupping to interscapular region, alterative doses of calomel
and ipecac, flaxseed enemata. She recovered perfectly.

1856.] KOLLOCK, on the Health of the City of Savannah. 335

The treatment which I have employed in this disease, has con-
sisted of mild purging with castor oil or citrate of magnesia,
diluent drinks of flaxseed infusion, arrow-root, gum-water, mustard
pediluvia, mustard or pepper poultices to extremities, chest, abdo-
men and throat; hot general baths, when the eruption is back-
ward in making its appearance ; occasionally spts. minder., to allay
febrile symptoms. After the decline of fever, and during the de-
cline of the eruption, pulv. Dover, to check diarrhoea (to which
thercis a very great tendency) and to procure rest; flaxseed ene-
mata, to allay tenesmus.

For the purpose of removing cough and bronchitis, which is apt
to continue after the disappearance of the fever and eruption, I
prescribe mixtures composed of syr. senek., syr. scill., syr. ipecac,
syr. tolu, and sometimes, gum amnion, and aq. laur. ceras., or acid
hydrocyan., elix. paregor. and Dover, pulv.

Where there is exhibited any tendency to pneumonia, or cere-
bral disease, alterative doses of calomel, combined with ipecac, or
pulv. Dover, sometimes vin. antim. and blisters. I have used mur.
ammon. where the bronchial affection proves obstinate, but I do
not consider it as efficacious as alum.

Usually, measles is an exceedingly mild and manageable disease
with us ; so much so, that very many persons consider it entirely
unnecessary to send for a physician. The popular notion is, that
it is only necessary to keep the patient warm, and give saffron tea
to bring out the eruption. Some, who are more economically
inclined, give sheep or goat dung tea, instead of saffron, for the
same purpose. I am inclined to consider one quite as good as the
other. The eruption is much more speedily and effectually brought
out by giving cool, demulcent drinks internally, combined with
revulsive stimulating poultices, and warm baths to the surface.

The epidemic of which we are speaking, has proved the most
serious and severe disease, of this character, which I have ever
encountered. It has been attended with unusual mortality, in
consequence, mainly, of the grave complications which it has in-
volved. The most frequent of these are pneumonia and laryngitis ;
in some casjs, tendency to cerebral diseases.

I attended the son of a South Carolina planter, who came to
Savannah to put his children to school. His eldest son, 15 years
of age, had ridden on horse-back from home about a day's jour-
ney. He sickened on the day of his arrival in Savannah, having

336 Kollock, on the Health of the City of Savannah. [June,

fever and cough. His father, without the advice of a physician,
gave him calomel, in broken doses, to the amount of 12 grains,
following it with a dose of castor oil. The rubeolous- eruption
showed itself on his face, full and confluent, but sparingly on the
extremities and trunk. The larynx became, rapidly, deeply in-
volved, cough and respiration croupy, with pain and sense of
suffocation. The eruption assumed a livid tint, typhoid symptoms
supervened, and he died on the fourth day from the commence-
ment of the eruptive stage.

The result of this case might have been different had my direc-
tions been followed in the application of revulsives to the surface.
A general warm bath was not administered, for the want of the
proper conveniences; and although mustard poultices were, subse-
quently, freely applied, the eruption continued scant, and pale or
livid on the surface. An attempt to vomit him with ipecac, failed
(the drug passing off by the bowels); a blister was applied to top
of sternum ; alterative doses of calomel and ipecac, were exhibit-
ed ; and he was stimulated with turpentine, wine, brandy, and
carb. ammonia, without avail.

My friend, Dr. Bulloch, saw the case with me. He considered
it the worst case of measles which he had ever seen, and expressed
the belief, that in cases of this description, proper aeration of the
blood is prevented, and a state of asphyxia is induced by the ex-
tension of the inflammatory irritation throughout the mucous
membrane lining the bronchial tubes and vesicles.

I attended a child of Mr. A. A. Solomons, druggist, aged two
years. There is a strong predisposition in the children of this
family to cerebral disease. This child was attacked with fever,
cough, anorexia, and great irritability of temper. It was purged
with calomel and castor oil, and leeched behind the ears. The
febrile symptoms being thus moderated, and believing that they
were the prodromes of measles, an active and persevering revul-
sive treatment by warm bathing and mustard poultices, was insti-
tuted, and followed by the rubeolous eruption on the third or fourth
day. The eruptive stage passed off with regularity slight cough
and frequency of respiration continuing but conjoined with ex-
cessive irritability of temper, a dull and sleepy appearance of the
eye and perfect aversion to food and nourishment of every de-
scription.

In consideration of the family predisposition to cerebral affec-

I

1856.] Kollock, on the Health of the City of Savannah. 337

tions, these last mentioned symptoms were calculated to create
uneasiness. My friend, Dr. J. B. Eeacl, was called in consultation,
and we determined to watch the case very closely, and pursue a
semi-expectant and alterative course of treatment. Although
there remained cough and some abnormal frequency of respira-
tion, there were presented no physical signs of pneumonia or other
thoracic disease. The most prominent symptoms indicated cere-
bral irritation. But as the child had been considerably reduced
by the rubeolous attack, it was possible that its present condition
might be only hydrocephaloid, the effect of debility, and not hy-
perexcitement. It was enjoined, therefore, upon its nurses, to
persevere in endeavoring to introduce as much nutriment into its
stomach as possible. A pursuance of this course for a few days
was productive of good effects, and the hydrocephaloid symptoms
disappeared entirely. The simple uncomplicated cases of the epi-
demic, as is usual, terminated favorably, with very few exceptions,
requiring very little medical treatment. The various complica-
tions which have been spoken of, required to be met with the
same remedial means as are found effectual in their treatment,
when uncombined with measles or other morbid conditions.

The co-existence of measles with some of the other exanthemata,
is alluded to by authors. Measles and scarlatina have been observ-
ed mixed up together in the same case. Small-pox has been seen
to succeed measles, and measles small-pox. The same with the
vaccine disease: and Gregory states, that "one of the most fami-
liar modifications is, an abundant crop of miliary vesicles on the
anus and trunk, filled with transparent lymph, and of such size
and distinctness as to create the suspicion of the disease being
small-pox." But I do not find in any author, exactly such a com-
plication alluded to, as that which I have described as occurring
in my family.

In one of my children, and in several little Negroes, the vesi-
cular eruption, resembling most nearly varicella, made its appear-
ance first, and was succeeded, several days after its cessation, by
measles. In three other cases, (whites occupying the same room)
measles appeared first, ran its course, convalescence succeeded,
and then a re-development of morbid phenomena, terminating in
the vesicular affection. Desquamation occurred in some of the
3ases of measles; but these were the exceptions the majority ex-
hibiting no desquamation.

338 Diseases of the Female Urethra. [June,

I have heard it suggested that in cases where desquamation oc-
curs, the protection against a second attack may be made more
perfect. I am not disposed to admit this, inasmuch as second at-
tacks are rare, and the cases of desquamation are almost equally-
rare.

The epidemic still lingers in our city, and will probably contin-
ue until the subjects are exhausted. It is gradually extending to
the country and plantations. That it is propagated by contagion
in many instances cannot be doubted. It made its first appear-
ance on Ossabaw island, which is on the sea coast, 20 or 30 miles
from Savannah, on a plantation at the south end of the island,
immediately after the return of a negro boy from Savannah, in
whom the disease was developed. After the disease had run its
course with him, nine other cases broke out simultaneously on the
same plantation there being no case on any other part of the
island at that time, nor had there been previously.

Diseases of the Female Urethra, (Read before the Suffolk District
Medical Society, Feb. 23, 1856.) By Walter Channing, M. D.

These diseases are of the meatus, or are just within it, or occupy
more or less of its lining tissue. Those which are at or nearest the
meatus may arise by a narrow foot-stalk, or may have a broad base.
They have, sometimes, many origins, or proceed as vegetations of
various length, from a single base, or may have independent
origins. At times they are acuminated, at others rounded, with
narrow, or almost filiform foot-stalks. When of broader origin
they may be oblong, or circular. They may not be much elevated,
but lie broad and flattish upon, or within, the meatus. In one case.
the tumor, if such it may be called, arose thin and broad, and pro-
truded, fan shaped, beyond the external labia.

In structure these growths are very delicate, seeming to be a
mere mass of vessels enclosed within the finest, tissue. This it. is
which accounts for their color. This is the brightest ruby red.
We rarely meet with any structure of which the color is more dis-
tinctive than it is in this disease. It explains the hemorrhage which
has been met with after their excision. In some cases this is as
unmanageable as in any surgical operation which has hemorrhage
as a result. We are not always aware of the amount, as the flow
may be towards, and into, the bladder. Subsequent micturition
shows the amount.

Another sign is the sensibility of these growths. It is emphati-
cally exquisite. The slightest touch produces intense suffering.

1856.] Diseases of the Female Urethra. 339

Micturition is dreaded. Walking or sitting brings with it severe
pain, so that the patient is obliged to keep, as much as possible, at
rest. This has been especially annoying to women who live by
work. At times they must abandon all active employment. It
seems hardly possible that so small a disease should produce so
much annoyance. In those instances in which the disease extends
much, especially to, or beyond the labia, there may be a fetid acrid
discharge, which irritates and inflames the surfaces to which it is
applied, or upon which it accumulates.

In some cases the meatus is thickened ; sometimes half round,
at others in two opposite parts of its circumference, forming distinct
lips, with a linear opening. In such the meatus may be patulous,
or easily opened, showing a morbidly red surface of the urethra
within. In these instances there is less suffering than the prece-
ding form of the disease has accompanying it, but it is quite enough
to trouble the patient and to act as a fret upon the mind, producing
depression of spirits, and if it have existed a long time without
being diagnosed, and has been treated as is common dysuria, there
is a hopelessness of recovery which does not promote convales-
cence. This last is marked by paroxysmal attacks of suffering, the
intervals of which may become longer and longer until they disap-
pear.

Another form of structural urethral disease is found in the
urethra itself. The meatus is well, but patulous. There is no
outgrowth. There is nothing unusual in it except its being very
open, or easily opened. Within is the ruby red color. There is
one lesion in it which has rarely been met with by me. This con-
sists of cracks or fissures, appearing as lines only, and often only
attended with pain during micturition.

Of the subjects of these diseases, as to age, it has been met with
from 12 or 13, to between 40 and 50. Sedentary persons, as dress
makers, shop tenders and domestics have furnished most cases.
The most healthful in appearance, and in fact, have been its sub-
jects, and the suffering has been equal in all its subjects.

One fact in the history of these diseases deserves special notice,
and which has been adverted to. This is the accompayning con-
dition of the bladder. It gets to be very irritable. It bears but
little urine without distinct complaint. The patient's occupation
or situation may prevent a prompt attention to the call. The suf-
fering is great ; but worse, the bladder becomes seriously impaired
in its functions, and may always trouble the patient. In this form
of the disease the diagnosis is made with much difficulty, so that
the effect of a disease becomes the leading object of regard, while
the disease itself lies unnoticed and unknown. Symptoms of grave
renal trouble may be developed at length, and a condition of help-
less invalidism may be the result.

Diagnosis. This is not difficult if its means are used. These
are mainly inspection of the part. This may be made sometimes

n. s. vol. xn. no. vi. 22

340 Diseases of the Female Urethra. [June,

with the speculum with a fenestra or window in its tube. If the
disease be beyond vision, then the catheter very slowly introduced,
or a bougie, may point it out. Chemical examination of the urine
will separate urethral from vesical and renal maladies. Symptoms,
and appearances, as above given, will of course form an important
part of the means of diagnosis.

Case I. This occurred many years ago, in a domestic apparent-
ly in perfect health, about 18 years of age. I saw her with my
friend, Dr. Putnam. The local symptoms, so grave in this case as
to make it absolutely necessary for the patient to leave her place,
led Dr. P. to ask for an examination, when vaginal explorations
were rare. He discovered a tumor, projecting from the urethra,
small in size, with a broad base, ruby red color, and of exquisite
sensibility. Dr. Putnam removed the tumor by excision, immedi-
ately afterwards applying the nitrate of silver. The recovery was
speedy and perfect.

Case II. This case was seen by me with my friend, Dr. Bow-
ditch, some years ago. A domestic, aged about 15 years. No
cause was assigned for the disease. It had existed for some time,
and was the smallest in size of any met with. It was little more
than filiform. The suffering was out of all proportion to the size.
This case was treated with the nitrate only, and permanent recove-
ry followed.

Case III. Miss , aged about 30, dress maker, applied to me

on account of very severe, or distressing dysuria. She had great
pain Irom walking, or any exertion, referred to fore part of the front
passage. She had suffered from it for a long time without being
able to make up her mind to apply for relief. She was asked if in
her occupation she had not felt obliged to retain her water when the
calls to pass it were very urgent. She said yes. This question is
always asked by me in like complaints, and it is almost always an-
swered in the affirmative. The largest class of patients who con-
sult me for these complaints, complicated as they often are with
obstinate costiveness, and various uterine maladies, the largest
number of these are folders, and stitchers of books, milliners, dress
makers, shop tenders, slop-shop sewers the most sedentary of
employments, and which to be made at all remunerative must be
steadily pursued for many hours in succession. So true is this that
the noon meal is carried to the rooms in which they have employ-
ment, so that from 12 to 15 hours may be passed without the least
exercise. It is in these that the calls of nature are unheeded and
the surest foundations are laid for incurable invalidism. Dr.
Franklin, I think, died of stone, and traced his disease to his con-
finement to the printing press in early life, and his neglect of the
functional means of health.

Upon examination of Miss 's case, a tumor was found project-
ing from the urethra of a larger size than had been met with by me
before in this situation, and having the characters above described.

1856.] Diseases of the Female Urethra. 341

She consented to have it removed, and this was done next day,
Dr. Putnam assisting me. The base was broad, and it was impos-
sible to remove the whole of it without a hazard of hemorrhage
which it might be found difficult to check. The nitrate was applied
to the wound. Next day the patient was found very comfortable.
As a portion of the disease remained, the nitrate was applied once
or twice a week, until it was entirely removed.

Between one and two years after, the disease returned. This
was after case IV., which follows. The tumor was about the size
of the first, and the same symptoms accompanied it. Before re-
moving it, ice was applied until sensibility was entirely removed,
and with the best result. There was no feeling of the excision of
the tumor, nor from the application of the caustic. After a few
subsequent applications of the nitrate no appearance of the disease
remained.

Case IV. This was a school girl of about 13. Menstruation
had not occurred. She was unusually tall and large for her age.
Health perfect, robust. There was the developement of more years.
Her mother, an intelligent woman, was uncertain of the time of
the occurrence of the disease. There had been, for some time,
smarting and difficulty in micturition, with much chafing of the
external labia and a fetid discharge. At length a thin, bright, flat
substance, with a scalloped edge, was seen projecting between the
labia, which was followed by increased difficulty, and walking be-
came very painful. She was taken from school. Dr. Putnam saw
this case with me. It was as described by Mrs. . The slight-
est touch produced intolerable pain and a sudden spring of the
patient, which stopped the examination at once. It was soon found
that nothing could be done without etherization, and next day this
was tried. Great difficulty was met with in overcoming the power
of the patient, and when the fullest effects of ether were apparent
in the general system, the local sensibility remained so perfect as to

I make the child wholly unmanageable. Chloroform was next used
and freely, but with no effect. It occurred to me, in the failure of
these means of quiet, to try ice. The trial was made and was per-
fectly successful. Not the least uneasiness was betrayed when the

) diseased mass was freely handled, when it was embraced by the
i hooked forceps, nor when it was cut off by the scissors, nor after-

II wards when the nitrate was freely applied to the cut base, which
; was deep within the meatus.

Next day patient was found comfortable. Inquiry was made
if hemorrhage had occurred. There had been no external bleeding,
1 but with urine which had recently passed, a large quantity of co-
agulated and liquid blood had come away. There was no return
of this, and recovery was rapid. This is the only case within my
observation of these diseases in which hemorrhage has followed the
excision of these outgrowths. It is worth remembering. If the
symptoms of this accident occur, and there be no external flowing,

342 Diseases of the Female Urethra. [June,

an examination of the urethra, and the use of the catheter, might
discover the cause, and plugging might prevent farther trouble.
As for the most part the disease has its seat near the meatus, it
could not be difficult to apply here the means to check it, and direct
or mechanical ones must be more sure of the effect than are che-
mical ones.

Case V. Mrs. , a widow, about 40, called on me on account

of long-continued pain in the back and hips, sense of weight and
dragging, leucorrhaea, and disturbed menstruation. She had also
dysuria, internal hemorrhoids, which much embarrassed defecation,
and had almost cartilaginous and numerous vegetations surround-
ing the anus. Her general health was wretched. Emaciation
great, and upon the whole she was as severe a sufferer as is often
met with. Examined by the speculum, a tumor was seen pro-
jecting beyond the os uteri, of the size of a small walnut. It was
soft, easily bleeding, and insensible. Quite a large vegetation was
found at the meatus urinarius. It had the usual color of such growths,
but was the least tender of any before seen by me.

Treatment was first directed to the uterine outgrowth. This
was too soft for the ligature or foreceps. Caustic was freely and
frequently applied. The good effects were soon obvious in the
entire disappearance of the disease. The os uteri closed and pre-
sented the linear diameter and size of health. The same means
were successfully used for the disease of the meatus. The caustic
gave pain, but the free use of cold water soon removed it. Much
more time passed before the cure, than was required for the remo-
val of the uterine disease. The hemorrhoids were removed by
ligature, the tumors being forced out of the bowel by the patient
for the use of the ligature. After those had been removed which
were pendulous enough to be tried, a tumor with a broad base re-
mained, and kept up the old irritation. To this caustic was
applied by the rectal speculum having a lateral opening. The ex-
ternal vegetations were removed by the scissors, to the bases of
which caustic was applied immediately after the excisions. Alter

several months' treatment Mrs. recovered, and is now in good

health. She has regained flesh, and uses exercise freely without
any of its former accompaniments. This case was complicated
with heart disease. On ascending heights, distressing palpitation
with dyspnoea were experienced, accompanied by rigors in which
the teeth would chatter as in severe paroxysms of intermittent
fever. The skin became cold and livid. There were no signs
discovered of organic cardiac trouble, and its imitations have
gradually diminished as remote local diseases have disappeared.

Case VI. Mrs. , aged about 30. In this case the whole

urinary apparatus was diseased, and had been so in various degrees]
for a long time. There was an outgrowth from the urethra involv-
ing the meatus. This was exquisitely tender, hardly tolerating the
touch constant dysuria, with frequent calls to pass water. Is con-

1856.] Diseases of the Female Urethra. 343

stantly in bed, the least movement producing increased suffering.
Constant uneasiness in the part diseased, with paroxysmal exagger-
ations which it was not easy to remove or diminish. The catheter
was used and the whole extent of the urethra was found as tender
as was its meatus. The urine was rendered in various conditions.
At times it was bloody. Liquid and coagulated blood was so freely
passed that at times it seemed to make the principal amount of
what came from the bladder. Sometimes it was purulent, and in
no case have I seen so much pus in the urine as in this. At other
times the precipitate was flocculent, branny, reddish, or quite pale.
At others albuminous. Along the back and in the renal places
there was much tenderness.

The treatment of this case was designed to meet obvious indica-
tions. The constitutional symptoms were febrile, or such as very
grave local disorder commonly induces. There was heat, quick
pulse, no appetite, prostration. Local bleeding, counter-irritation,
alteratives, narcotics and subnarcotics, diosma, tinct. fer. mur.,
demulcents, external applications in their endless variety these
were among the means employed. She was etherized and the
urethral outgrowth removed by excision. The nitrate was after-
wards used to check hemorrhage.

At times were signs of improvement and recovery. The vesical
hemorrhage, if it were vesical, would cease. And so would it be
with pus, which replaced hemorrhage, and with other deposits.
The urethra would seem to be recovering, and then without known
cause, the patient not having left her bed, all the symptoms would
in various order show themselves. At length, when much relieved,
Mrs. determined to go home. This she did, her husband com-
ing to go with her. Her travel was more than one hundred miles
j and was without accident, at least I have not heard that it produced
I any. I could not learn what had been the precise relation of symp-
j toms in this case. It had lasted so long that the order of their
i occurrence was forgotten, if it had ever been observed. Thus, was
!' the urethral difficulty the first in the order of symptoms, and the
\ vesical and renal, effects of this, either by contigunous or continuous
k sympathy ? Or were these last first in the order of diseases or
' symptoms ? The outgrowth was cut away because it was a source
c of exquisite suffering during micturition, and during the premonito-
ry actions of the bladder which make up the call to pass urine.
1 Sulphuric ether was used before operating. Its effects were un-
i like any I have observed during or after inhaling ether. The respi-
'] ration ceased, the pulse continuing. There was the same appear-
ance of entire repose, pallor and insensibility, as has been observed
1 in fatal cases from chloroform. Respiration was at length produ-
' ced, and with gradually shortened intervals was re-established.
She was cautioned not to use ether again. But in the night, during
a paroxysm of intense agony, she insisted on breathing it again.
Her attendant yielded. The same result followed as before, and

344 Diseases of the Female Urethra. [June,

from which she recovered after the use of the same means. This
is the only case in which trouble has followed the use of ether in a
very large observation of its agencies by myself and by many
others. It was doubtless owing to conditions produced by long-
continued suffering, and though apparently alarming, was perfectly
recovered from.

Case VII. Mrs. , about 30. This, with other cases, was

complicated with uterine functional disease with displacement.
The dysuria was of long standing, and was independent of any
disease of the meatus. This last was patulous and soft. Within
the urethral tissue was redder than natural, and presented a distinct
oblique fissure. This is the only case in which I have met with
this affection in this organ. It was treated with a solution of nit.
argent, applied with a brush. It is under treatment.

Case VIII. Mrs. has one child ; called on me on account

of displacement of long standing, the os uteri being turned strongly
towards, and resting against, the hollow of the sacrum. With the
symptoms of such dislocation was very troublesome dysuria. As
this last might be owing to the pressure of the fundus upon the
bladder, attention was directed to the womb. It was replaced and
Hodge's lever pessary introduced. The relief of symptoms of dis-
placement was perfect. After a time they returned. Examination
showed the pessary out of place. It was adjusted and worn for
some weeks, but gettingagain displaced, it was removed, and Meigs's
ring pessary substituted. This answered perfectly well. It was
worn four or five months, and as all the symptoms for which it was
used had disappeared, it was removed. It had not at all been in-
jured by this long use. Dysuria continued, and became a very
troublesome disease. The urethra was examined. The lips, or
edge, were found much swollen, but not at all reddened. Upon
opening the meatus, a swelling with a broad base was detected,
bright red, and very tender, and beyond, the lining membrane had
tire same color. At first the solid nitrate was applied. Its good
effects were manifested after a few applications. The solution was
now substituted, with entire relief of the dysuria. There was an
opaque mucous discharge from the urethra, which has been met

with in other cases, but this has nearly disappeared. Mrs. can

now take long walks without inconvenience, and considers herself
well. Cases enough have been given to illustrate the general his-
tory of the diseases under consideration.

Remarks. It may be asked if there were not a specific cause of
these urethral lesions. The answer is distinctly in the negative.
The ages of some of the patients and the social position of others,
and direct inquiries wherever suspicions arose of causes, have satis-
fied me that there was no reason for suspecting or believing in the
action of such a cause. The treatment was in no case specific.
Strictly local remedies were relied on. In one case only am I sure

1856.] Diseases of the Female. Urethra. 345

that the disease re-appeared, and since its second removal it has not
returned.

Few diseases would seem to present greater difficulties in their
diagnosis, and few are more painful and persistent where a correct
diagnosis is not made. The difficulty lies wholly in not using the
only sure means of diagnosis ; for when an examination of the dis-
eased part is made, the discovery of the nature of the malady is at
once made. The sight and the touch should be both employed.

Of the treatment there is but little to be added, and that caution-
ary. Hemorrhage has been alluded to. If my memory serve, one
case is reported which was disastrous in its results from this cause.

There has been but one case in my practice, in which there was
bleeding after the application of caustic, and that was internal into
the bladder. This should be borne in mind, as we may have the
symptoms of large haemorrhage without external flow. Should hae-
morrhage be excessive or continue, then caustic, pressure by a
bougie, or other means, may be employed. Grave peritonitis, we
are told, has followed slight operations on the vagina There is a
case is mind, in my own practice, in which very severe pain and
soreness in the abdomen followed the injection of the cervix uteri
with a solution of nit. argent. No case is remembered in which
operations in the meatus, or urethra, have led to such results.

The first case in which ice was used to destroy sensibility ocur-
red some years since, and I am not aware that such an employment
of it had been made before, or that I had met with the suggestion,
or the authority of its actual use. Quite early in my professional
life, an aged physician, now long dead, said to me that he had used
ice, in the form of icicles, in cases of sore throat in which the ton-
sils were much swollen, and the pain was great, and that relief had
followed, and so nearly to the application, that he could not but
regard it as its consequence. This conversation may have uncon-
sciously suggested the use of ice in the cases reported. It was
perfectly successful. Dr. Arnott, of England, and physicians and
surgeons in America, have more recently recommended and em-
ployed ice previous to surgical operations to prevent pain, and I
think by Dr. Arnott to make other anaesthetics unnecessary. In
my cases the effect was excellent. Under ether or chloroform the
patient will sometimes start at the first touch of the knife, though
apparently under their fullest operation. This has been met with
by me too often to doubt it. In Case IV. it made the operation ut-
terly impossible. Ice at once removed all pain. In a recent case,
in which an abscess of the abdomen was to be opened, ether was
used until its fullest effects were manifest. The first touch of the
knife caused so much starting that it was only by use of force to
restrain the patient that the operation could be completed. When

Mr. recovered his consciousness, he had not the least memory

of having resisted what had been attempted.

After this paper was read, a request was made that the fellows

346 Whooping Cough. [June,

present would communicate such cases of female urethral disease
as might have fallen under their observation. From one, three
cases were reported, and two from another. In one of the last, no
structural disease had been discovered, though carefully looked for.
The pain was confined to the urethra, and was represented as very
severe. Many methods of treatment had been used. Some months
of relief were experienced, but some threatenings of return of the
symptoms had been recently manifested. Another fellow reported
very interesting cases without discovered urethral lesion, though
most carefully searched for, in which the symptoms reported in the
cases in this paper were present in severe form, and in which
injections of narcotics and sedatives into the urethra had been
remedial. [Boston Med. and Surg. Journal.

Wliooping Cough, its History, Nature, and Successful Treatment,
By Laurence Ttjrnbull, M.D., &c.

This disease has been to me one of much thought and con-
siderable personal interest, from having had four of my children
attacked with it in its most aggravated form. My attention was
also particularly called to it during the months of May and June,
1854, when the malady prevailed to a considerable extent in our
city ; cases of it have also continued to occur up to the present
month, July, 1855.

In referring to the works of Hippocrates, (Sydenham Society's
Edit, in two vols., London, 1849,) I find no description of whoop-
ing cough, neither is there any account of it in the Seven Books
of Paulus iEgineta,* so that I would infer that the Greeks, Bo-
mans and Arabians were not acquainted with it as a distinct
disease.

Dr. Willis was the first medical writer who accurately described
whooping or chin cough, his work being published in 1682, (in
two vols.)f It was not until the present century, however, that
this disease was fully investigated and made known to the medi-
cal public, which was chiefly done by the labors of Bosen, Cullen,
Schaifer, Hufeland, Mathai, John, Authenrieth, Watt of Glasgow,
and Albers of Bremen. It is stated by Bosen, that it passed from
the East Indies and Africa into Europe.

First stage. The first stage of whooping cough has no distinct
and prominent symptoms by which it can be distinguished from
ordinary catarrh, or bronchitis, except, perhaps, a slight difference
in the voice and cough which sounds louder and shriller; the ex-

* The Seven Books of Paulus yEgineta, translated from the Greek, by Francis
Adams, LL. D., in three vols., Loudon, printed for the Sydenham Society, 1844.

\ " Tussis puerorum couvulsiva, sue suffocativa et nostro idiomate chin-cough
vulgo dicta." (Opera Omnia, Amst. 1682, vol. ii. p. 169.)

1856.] Whooping Cough. 347

pectoration is usually limpid, but in some instances I have noticed
it opaque, yellow, and even greenish.

This period may last from five days to as many weeks. Lom-
bard states that in an epidemic which occurred at Geneva, it lasted
from one month to six weeks; when the whoop is going to occur,
it is usually noticed in the second or third week, but I have had
several cases where the cough was present without the whoop.

This absence of the whoop is often very unfortunate, for chil-
dren may in this way propagate the disease, and cause whole
families and even schools to be attacked. This fact was proven
in the case of my son, aged seven years ; he sat in school by the
side of a little boy who had a cough, which was very sonorous
and painful to listen to, but the anxiety of the teacher was much
relieved by being informed that his physician did not consider it
whooping cough ; subsequently the youngest child of this family
was attacked by the disease and whooped, and the boy was then
kept from school, but too late to save the other members of his
class, ten of whom took the disease, so that the school was nearly
broken up; my son communicated it to his three sisters, who all
suffered more severely from it than he did.

I therefore think that children should not be allowed to mix
with their companions when suffering from a cough of this char-
acter, if the disease prevail in the locality.

Second stage. The second or spasmodic state of this malady, is
easily known, by the peculiar sound and suffocating character of
the cough. In this stage, almost every organ is irritated, and it
even produces discharges of blood from the nose and mouth. The
expression of the countenance is most distressing. When this
stage is at its height, the child seems to know by some inward
sensation that the attack is coming on, and it either cries or lays
hold of some object by which it can support itself until the parox-
ysm is over. The face and neck become swollen, and in some in-
stances remain so, and the child, at the termination of a fit of
coughing, either discharges some thick tenacious ropy mucous, or
evacuates the entire contents of the stomach.

The least mental excitement, either of joy or sorrow, will pro-
duce an attack, and the number varies with the severity of the
disease. The paroxysms last from one-fourth to three-fourths of a
minute.

The average duration of whooping cough is from six to eight
weeks if not checked, but in many instances it lasts as many
months; second attacks are rare, and yet they do occur. Whoop-
ing cough prevailed in this city with measles, in May and June,
1854, followed in October and November by chicken pox, and in
January, 1855, by scarlet fever, with sporadic cases of catarrh and
croup, showing a connection or relation one with another, so that
the same causes may give rise during an epidemic to simple catarrh,
croup, whooping cough, or even measles.

348 Whooping Cough. [June,

The complications of whooping cough I cannot enter into, but the
chief of them are croup, bronchitis, pneumonia, pleurisy and dis-
eases of the brain and cavity of the abdomen, which are to be
recognized by their characteristic s}Tmptoms.

According to Billard, post-mortem examinations have not re-
vealed anything uniform in this disease, except bronchial catarrh
in its various stages.

Sydenham imputed the disease to a subtile and irritating vapor
in the blood. Hufeland considers that the eighth pair of nerves is
diseased, and is the cause of the double irritation of the bronchia
and stomach. According to M. Guersent (Diet, de Med.) whoop-
ing cough is a catarrhal affection, seated in the trachea and bronchi,
consisting of a specific inflammation, accompanied with spasm of
the trachea and glottis. Dr. Watt, of Glasgow, considers the dis-
ease to be inflammatory and seated in the bronchi. Albers, of
Bremen, considers whooping cough to be an affection of the nerves
of the thorax, with which bronchitis is frequently complicated.
Laennec regards it as a variety of pulmonary catarrh, and from
the convulsive character of the cough he calls it convulsive catarrh.

Dr. Webster (Med. and Phys. Jour.) is of opinion that the symp-
toms, when closely viewed, suggest the impression that whooping
cough depends upon inflammatory irritation of the brain or its
membranes. This is the opinion held by Dr. Copland, and very
many distinguished men of the present day, but to my mind it is
not satisfactory. The whooping cough, in its first stage, is certain-
ly of an inflammatory character, chiefly affecting the lining
membrane of the air passages, but this is of a specific nature. In
the second stage there is no evidence of inflammation indicated
either by the pulse, skin, or any other organ, but there is a power-
ful irritation of the laryngeal constrictor, and bronchial muscles
and nerves, producing a cough which occurs rapidly many times
so that a single inspiration is followed by five or six successive
expirations constituting paroxyms of coughing (tussis accessus,)
accompanied with redness of the face, watery eyes, headache, tin-
nitus aurium, fulness of the cervical veins, retching and sometimes
vomiting.

By some writers it has been considered that ihis disease was
produced by a peculiar miasma, acting chiefly on the nerves, and
is also ascribed to the presenceof minute insects in the air(Boehme
Linnaeus,) or, according to Prof. J. K. Mitchell, its epidemic
origin may be a peculiar fungus; "the spores of these plants are
not only numerous, minute, and indefinitely diffused, but, like the
animal, all have the power of penetrating into and growing upon
the most interior tissues of the human body," passing into the
.systems of those exposed to its influence by the respiratory organs
or stomach, producing the irritation of the mucous membrane of
the air passages. " Introduced into the body through the stomach,
or by the skin or lungs, cryptogamous poisons are known to pro-

1856.] Whooping Cough. 349

duce diseases of a febrile character, intermittent, remittent and
continued and even the disease of the mucous membrane, termed
aphtha?, arises from the presence of minute fungi."*

Dr. M. has not made this application of his doctrine to this par-
ticular disease, yet I do not see any good reason why it should not
be so applied. According to Dr. Spengler, of Ellville, epidemic
diseases depend on the presence or absence of ozone. He states
that in the village of Roggendorf, in Mecklenburgh, towards the
close of 1846, when slight catarrhal affections became prevalent,
but slight traces of ozone were to be detected in the air. With the
opening of the following year, however, these catarrhal affections
assumed the severest forms of tracheal and bronchial disease, and
whooping cough became common both among children and adults ;
then reagents detected a great increase of ozone in the atmosphere."!

Prognosis. The prognosis in uncomplicated whooping cough
is very favorable, and is unfavorable only in proportion to the
dangerous nature of its complications and the age of the child; the
best season for a favorable termination is spring or summer.

The modes of Propagation. The disease may occur epidemically
or sporadically, and it possesses infectious properties. It is propa-
gated through a family from one to another; they are not all apt
to be attacked at the same time, and by removal to a distance a child
may escape. Dr. Cullen believed that it disappeared in from four
to six weeks, but this has not been proved by subsequent observa-
tion. Children who have suffered from this disease, should not
be sent to school or play with their companions for at least two
months.

Treatment. There are but two classes of symptoms to be com-
bated in this disease when no complication exists. The inflamma-
tion must be reduced by depletion, expectorants and refrigerants.
In the second class of symptoms, the chief object is to diminish the
abundant secretion and allay the great irritability of the laryngeal
constrictor, and bronchial muscles and nerves.

The means to accomplish this, in my hands, have been the ab-
straction of blood ; the application of a few cups or leeches to the
nape of the neck or under the clavicle, with counter irritation, by
means of sinapisms and blisters, which will soon allay the conges-
tion of the brain or lungs. To diminish the febrile action small
doses of tartar emetic, combined with Dover's powder or prepared
chalk, with the free use of syrup of ipecacuanha as an emetic may
be given ; these will lessen the bronchial inflammation, and reme-
dy the often disordered state of the stomach and bowels.

During the whole stage of the disease, demulcent drinks should
be freely administered, such as flax seed tea, barley or rice water.
When fully satisfied that the inflammation has been subdued,

* Lond. Med. Gaz. Henlie's Zeitsehrift, vol. vii. p. 1.

\ On the Cryptogamous Origin of Malaria and Epidemic Fevers. J. K. Mitchell,
M.D. Philada, 1849.

350 Whooping Cough. [June,

indicated by a slower pulse, less heat of skin and no active conges-
tion of the brain or lungs, I have then followed the treatment with
belladonna, and my success with this remedy has been most grat-
ifying. Before administering it I tried, in vain, the free use of
cochineal in combination with alkalies, assafcetida, opium, alum,
hydrocyanic acid, &c. In every instance in which the system was
fully brought under the influence of the belladonna, indicated by
dilatation of the pupil with confused vision and reddened skin, I
was enabled to check the annoying cough and whoop of thirteen
children duringthe month of May and June, 1854, and seven cases
since that time, making twenty cases in all, eight males and twelve
females; the youngest was nine months and the eldest ten years.

The following was the method followed : The system being pre-
pared by reducing the inflammation by the means before spoken
of, obtain, if possible, English extract of belladonna, fresh and
good ; let the extract be triturated with water or simple syrup ; if
it is to be kept for some time, add a small quantity of alcohol.
The dose for a child three months old is the sixteenth of a grain
every three hours, to a child one year one-eighth of a grain, and
so to other ages in proportion.

Inform the parent or nurse of the change it will produce upon
the eye, also that it may redden the skin. When full dilatation
of the pupil is brought about, the medicine is to be intermitted
until it has gone off again ; the belladonna is to be administered
in slightly increasing doses, so as to keep the child under its influ-
ence for several da}?s or until the paroxysms are checked, which
will usully occur towards the sixth or eighth day of the second
stage.

In the twenty cases cured by the use of the belladonna the
cough and whoop returned in a few cases on exposure to cold, or
ita disagreeable, windy weather; but by combining the extract
with syrup of ipecacuanha a few doses soon checked the cough and
whoop-; in only one case out of this number was it complicated
with inflammation of the lungs and this case recovered.

The average duration of my twenty cases was ten days after the
whoop had commemced, when the case was free from complications,
which shows the great advantage of this treatment. The ordinary
duration of the disease, when treated in the usual manner, is from
1| to 3| months; even by prussic acid, or the application of
nitrate of silver, the average given is from two to three weeks. It
is stated by Dr. Gibb that with the use of nitric acid, the average
duration was only six or seven days. Several physicians who
have used this remedy, however, do not find such favorable re-
sults from its use.

I have added to my communication some extracts from the
experience of a few distinguished medical men on the use of this
important agent, belladonna.

This remedy was used in whooping cough about the yenr 1783,

1856.] Whooping Cough. 351

by Dr. Buckhaave, of Copenhagen, who gave the powdered root
in doses of two grains, morning and evening, to a child of five or
six years of age. The cure, it is stated, was generally accomplish-
ed in from seven to fourteen days.*

Dr. Miquel. (of Neuerhaus,) says the belladonna is a remedy
upon which he can always depend in this disease. In the course
of many epidemics which he has observed during fifteen years, he
has constantly cured the cough in eight days.f

Dr. Samuel Jackson, of this city, late of Northumberland, who
although he was not the first to employ the belladonna, yet by his
valuable publication in 1834 brought its virtues prominently be-
fore the medical public, has continued its use for twenty years, and
his confidence in its powers to arrest the paroxysm and cure the
second stage of whooping cough in the great majority of cases is
undiminished.

Dr. Hiram Corson, formerly President of the Medical Society of
the State of Pennsylvania, a distinguished practitioner of Mont-
gomery county, Pa., in a paper on the efficacy of belladonna as a
remedy in Pertussis, published in the Amer. Jour, of Med. Science,
for Oct. 1852, makes the following observations: u My experience
in purtussis had satisfied me that of all the remedies in common
use, those recommended by writers upon diseases of children are
almost useless. Children affected in the winter continued to cough
and strangle and suffer for many weeks with scarcely a percepti-
ble amendment. It was painful to visit and mortifying to prescribe
for those afflicted with this malady."

He commenced the use of belladonna in four easos, and in one
week they were all well. His method of using it was to begin
with the sixteenth of a grain to children under one year every
two hours, and increasing a little every day until full dilatation
of the pupil occurred, the skin became flushed and vision confus-
ed ; this he accomplished by dissolving eight grains of the extract
in an ounce of water, nine drops of which contained the eighth of a
grain.

In an epidemic in 1810, he used the belladonna in hundreds of
cases with great relief in nearly all. By giving it in small doses at
first, the fears of the patients were allayed. In 1817-8, he also
prescribecHt in numerous cases with much success. He concludes
his paper in these words: "During the last seventeen years, I
have given the extract of belladonna to hundreds of patients from
two months to fifty years of age, and am firmly convinced that it
has a greater control over whooping cough, than any other remedy
in common use. That while, in a few cases, the system did not
seem susceptible to its action in the doses I have prescribed, yet

*Dr. Duncan's Commentaries for 1793, and Dr. Gibb on Pertussis, p. 282, 1854.
f Vol. vii. Amer. Jour. Med. Sciences, p. 524, from Archives Generales, August,
1830.

352 Whooping Cough. [June,

in nearly all the disease yielded quickly. It is a safe and efficient
remedy for pertussis in children of any age.

Dr. Eberle, in his Treatise on the Diseases of Children, second
edition, remarks "that the belladonna has been highly celebrated,
and is without doubt, b}^ far, the best article of the kind we pos-
sess. My own experience leads me to testify confidently on this
point. I have prescribed it within the last six years, (1834), in
perhaps twenty cases, and in the majority of them with evident
advantage." Professor Borda, he remarks, was the first he be-
lieved who used it as a remedy, and his belief in its efficacy is al-
most unlimited.

Hufeland and Alibert are almost equally decided in their praise
of the virtues of this article.

The mortality from this disease in our city in 1850 was 114;
1852, 168 ; and for 1853, was 64. In 1853, in the district of Rich-
mond, it occurred as an epidemic. In severe cases, Dr. Janvier
used the belladonna with the best results. "It mitigates the par-
oxysms better than any other sedative."*

Dr. Condie remarks in his work on diseases of children, that the
narcotic from which the greatest amount of benefit is to be antici-
pated in this disease, is unquestionably the belladonna ; it has been
very extensively employed, and the evidence in its favor is strong
and conclusive, (by Kahleiss, Janin, Hufeland, Wideman, Raisin,
Guibert, Alibert, Shafer, Laennec, Muller, Blache, Maunsell and
Lombard).

He further remarks that he had given the belladonna a very fair
trial, and has, in many cases, been pleased with the prompt and
decided relief produced by it, "while in other instances it ap-
peared to exert no influence whatever."

I think that this last remark may be often accounted for by the
bad character of the belladonna, which is even found in some of
the drug stores in this city, for it is an uncertain preparation un-
less'when procured by evaporation in vacuo, for some samples
from some of the Parisian shops were found by Orfila to be quite
inert.

Dr. Williams, of London, has used belladonna with great ad-
vantage in his practice. He gives it in quarter-grain doses to a
child of two years, increasing the dose to double that quantity or
more, where it fails to relieve. He remarks that these doses, in
general, cause some dilatation of the pupil, and conceives that
the remedial agency of the drug depends on the same power to
diminish irritability of the bronchial and laryngeal muscles which
is here evinced with regard to the iris." f

Dr. G. A. Rees has found belladonna one of the most efficacious

remedies in Pertussis.:};

-.

* Report I'hila. Co. Med. Society for 1853.

f Gibb on hooping cough, p. 284, from Medical Gazette, Feb. 1838.

\ Diseases of Children, 2d edition, 1844.

1856.] Wfiooping Cough. 353

Dr. Waller cured two cases with the twelfth of a grain of ex-
tract, three times a day; prussic acid and conium had failed in
affording any permanent relief.*

Eberle assigns the highest place among narcotics to belladonna
in whooping cough.

Dr. Churchill says that this is perhaps the most influential nar-
cotic and sedative we possess (in pertussis); it has been very ex-
tensively employed, and the evidence in its favor is very strong, f

Belladonna has been eminently useful in the epidemic of whoop-
ing cough which M. Debreyne has observed, but recourse should
not be had to it until the inflammatory element has been over-
come by leeches, emetics, &c.

Dr. A. T. Thompson says, I have ordered the extract of bella-
donna in doses of one-eighth of a grain to a child of eight years,
and gradually increased the dose to a quarter of a grain. Its
power over the cough is extraordinary.^:

I might bring forward the testimony of many other writers, and
a mass of evidence from medical practitioners, to establish still
more firmly the fact of the efficacy of belladonna in this peculiar
malady, but it will not, I trust, be necessary.

I will now endeavor to give an epitome of the experience of the
best writers in the treatment of whooping cough by means of other
agents.

The first of these which I will notice is alum, which has been
very highly recommended by Dr. Golding Bird ; it has been em-
ployed with success by Dr. John F. Meigs, of this city, who speaks
of it as follows, in his useful work on diseases of children : " From
reading Dr. Bird's remarks on alum, and prompted by my know-
ledge of its admirable qualities in the treatment of croup, I was
led to make trial of it in the disease under consideration, and I
belive I may say that it has exerted a more decided influence in
moderating the violence of the disorder, than any remedy that I
have ever made use of. I have administered it in fifteen eases,
beginning in the course of the second stage.

In all, it was beneficial, and in some the effects were strikingly
useful, the improvement being more rapid than I had ever seen to
residt from other remedies."

Dr. Bird gives from two to six grains every four hours. His
formula is as follows : $. Aluminis, gr. xxiv; Ext. Conii, gr. xii;
Syrup Bhoeados, 3ii; Aquae Aneth. f. ?iij. M. Give a medium-
sized spoonful every six hours. Dr. Meigs gives it in smaller
doses, and without the Ext. Conii. To children under one year,
half a grain to a grain three or four times a day ; and to those
over that age, two grains every six hours.

* Lancet, vol. 1, 1845, p. 137. f Elements of Materia Medica.

X London Jour, of Medicine, April, 1850.

This is considered by Dr. Butter as the remedy, namely conium, for whooping
cough, and he eulogises its use.

354 Whooping Cough. [June,

Dr. Crossly Hall, an English physician, employs the alum in
powder, prescribed in a little water eight times a dajr, and he con-
siders it a very useful remedy.

Mr. Davis highly extols the efficacy of alum in pertussis. In
the last edition of Underwood's Treatise, edited by him, he says:
"After a long trial, I am disposed to attach more importance to
alwn, as a remedy in whooping cough, than to any other form of
tonic or anti-spasmodic. I have often been surprised at the speed
with which it arrests the severe spasmodic fits of coughing; it
seems equally applicable to all ages, and almost to all conditions
of the patient. The dose for an infant is two grains three times a
day; and to older children four, five and up to ten grains may be
given mixed with syrup and water."

I have employed alum both in the case of my patients and my
own children, and gave it freely ; it moderated the intensity of the
disease, but it did not in my hands make a cure, so that, after its
use, for ten days, I had to resort to the belladonna, which, in a
week, completely checked the whoop.

Another agent which has been very highly lauded is the hydro-
cyanic acid, which is considered by Dr. Thompson, of London, to
possess a "specific power" over the disease.

Dr. West, of London, author of a valuable treatise on the dis-
eases of childhood, says, "that the acid sometimes exerts an almost
magical influence on the cough, diminishing the frequency and
severity of its paroxysms almost immediately, while, in other cases,
it seems perfectly inert ; and again in others, without at all dimin-
ishing the severity of the cough, it exerts its peculiar poisonous
action on the system so as to render its discontinuance advisable."

He recommends it to be given by itself, diffused in a little dis-
tilled water, sweetened with simple syrup, and the dose he begins
with is half a minim every six hours for a child nine months old.
He has never but once, however, seen really alarming symptoms
follow its use, though he has employed it in many hundred cases;
still he remarks that although the severity of the cough may be
relieved by the acid, it does not enable the practitioner to dispense
with other remedies.

Dr. Hamilton Roe, in his treatise on whooping cough, gives to
an infant three quarters of a minim of hydrocyanic acid, Scheele's
strength, gradually increasing it to a minim, which is administered
every four hours ; for a child three years of age one minim, gradu-
ally increasing, if necessary, to a minim and a half every four
hours. Dr. Roe says he is convinced, from the result of all the
trials he has made, that this drug will cure almost any case of
simple whooping cough in a short time. Dr. Edwin Atlee first
used it in 1824, and from that year until March, 1832, he says he
has treated more than two hundred patients, and never failed to
cure in from four to ten days.*

* American Jour. Med. Sciences, voL vii. and vol. x.

1856.] Whooping Cough. 355

This medicine is highly recommended by Muhrbeck, Kahleiss,
Yolk, Heller, Granville, Lombard, &c. I have tried this acid, but
it did not at all please me in its effects.

Another remedy which demands our notice is the precipitated
subcarbonate of iron, (ferri sesquioxidum). The following obser-
vations on its use are by Dr. H. C. Lombard, of Geneva, who,
after praising the virtues of assafoetida, flowers of zinc, opium,
prussic acid and belladonna, says, "I come now to my specific, or
rather to the remedy advised by Dr. Steyman, as the best anti-
spasmodic in whooping cough. Dr. Steyman had advised to give
from four to ten grains of subcarbonate of iron in the twenty-four
hours ; he gave as a rule to increase one grain for each year, so
that a child six years old was to take six grains in a day, but from
the beginning I found the dose quite inadequate, and I increased
it to twenty-four and thirty-six grains in young children. I have
given it either with water and syrup, or mixed with a cough mix-
ture. It has never produced any inconvenience. On the contra-
ry, I have found that all the children treated after this method
were much less weakened, and recovered faster than with all other
remedies. The proofs of the advantageous effects of it have been
so numerous that I can scarcely enter into the detail ; however, I
may give a few facts to corroborate my assertion. In a child four
years old I gave the subcarbonate of iron, and the fits, which in
the preceeding week, had been 101 in number, were reduced to
66 in the following week. In a weak and debilitated boy, aged
seven years, the powder of belladonna had proved quite useless ;
when I tried the powder of iron, so prompt was the effect that in
a few days the boy was quite cured ; the sister of this boy was
also cured with great rapidity. The last case of whooping cough
which I have treated lately was of four months duration, and every
thing had proved useless, when I gave the iron powder, which in
the space of a few days succeeded in making the cough less and
less.

In fact, I think I may assert with security, that the subcarbonate
of iron enjoys a remarkable property to make the fits less violent,
to diminish the number, and after a certain number of days to cure
entirely the whooping cough.

It enjoys, besides, the advantage of strengthening the little

fiatients, and gives them force to resist a complaint which sometimes
asts some weeks, and generally leaves the patients weak, low and
exhausted. In some of those who have taken it, I have often seen,
during the first days, a temporary increase of the cough, but it
always subsided after two or three days, and did not prevent the
good effects of the medicine. The beneficial results obtained by
the use of the iron powder are easily explained by its anti-periodic
and anti-neuralgic properties, and it shows a posteriori how much
the whooping cough resembles a true neuralgia, or, at all events,
a true nervous disease."

N. S. VOL. XII. NO. VI. 23

356 Whooping Cough. [June,

I have not tried this remedy, arid can, therefore, give no opinion
of its efficacy; but should judge from its tonic and blood-restoring
properties, that it would prove a iiseful agent in low anaemic or
debilitated cases.

Garlic is a remedy very highly recommended by Dr. Dewees;
indeed he states in his work on Diseases of Children, " that he has
never employed any remedy of equal efficacy."

A child of six or seven years may begin by taking a third of a
common sized clove, morning, noon and evening, in the absence
of all febrile excitement, gradually increasing the dose.

Mr. Sutcliff combined the Peruvian bark with cantharides, and
administered it with great success in whooping cough during
twenty years.

The following is his formula :

3 Tin ct. Cort. Peru v. f. 5vi.

Elix. Paregor. 3ss.

Tinct. Canthar. 3i M.

Of this mixture, small doses were given three or four times- a
day, gradually increasing until a slight strangury was excited, then
the dose was to be diminished.

When the active symptoms have subsided, Dr. Beatty, of Dub-
lin, used the same remedy, and it is also recommended by Dr.
Graves. The following is his formula.

$. Tinct. Cinch. Comp. 3 v.

" Lyttse,
" Camphorse, act. 3ss.

M. S. A teaspoonful three times a day in flaxseed tea or barley
water.

Professor Trousseau recommends the following solution of ni-
trate of silver in whooping cough ; one-fifth of a grain in solution
with simple syrup daily.

Cauterization by nitrate of silver has also been employed as a
remedy in pertussis by Dr. Eben Watson, of Glasgow. The
strength of the solution is gr. xv. to the ounce of water, applied
every second day, by means of whalebone tipped with sponge, at
first to the pharynx, and then to the glottis and larynx. The
whole number of cases treated by M. Joubert and Dr. Watson, in
1854, were 167.
Cured in two weeks, 96 cases, or 57.4 percent.

" in three or four weeks, 61 " 36.5 "

Eesisted the treatment, 9 " 5.3

Died, 1 " or nearly 0.6 "

To prevent the irritability of the stomach, he gives frequent
small doses of of heavy magnesia, combined with a few grains of
the trisnitrate of bismuth. He also employes the index finger or
teaspoon to make the application to the throat of children.

Nitric Acid was was first recommended by Dr. Arnoldi, of
Montreal, as a remedy in pertussis with much success, and it has

1856.] Whooping Cough. 357

been adopted by Dr. Gibb, of London, late of Canada, who has
published a work on whooping cough, in which he has given the
opinion of ninety-three physicians, in relation to its pathology,
with its history, mortality, complications and causes. He has
also entered into a consideration of forty-three remedies, viz.:
venesection, leeches, emetics, antimonials, external applications,
change of air, warm bath, hydrocyanic acid, laurel water, belladon-
na, opium, hemlock, henbane, digitalis, tobacco, arsenic, silver,
iron, zinc, lead, copper, cauterization by nitrate of silver, inhala-
tions, coffee, Peruvian bark, quinine, hydrochloric acid, sulphuric
acid, nitric acid, cochineal, alum, tannin, vegetable acids, alkalies,
vaccination, cantharides, musk, assafcetida, meadow narcissus, cup
moss, castor, nux vomica, and miscellaneous remedies. He re-
marks that the nitric acid has succeeded over and over again
when other means have failed, and it is not such a hazardous
remedy, when administered with ordinary precaution, as many
described by him in his work. Dr. Arnoldi's method of prescri-
bing the acid is as follows :

" To a tumbler full of very sweet water (almost syrup,) add as
much acid as will bring the water to the strength of pure lemon
juice, when it is ready for use ; an adult may consume this quan-
tity in three or four hours, a child one year old may take a desert
spoonful every hour."

"He has remarked that the efficacy depends on the amount
taken, and that especially by the frequency of repetition, to save
the teeth, he advises a solution of carbonate of soda, two drachms
to eight ounces gf water, to be used as a gargle immediately after
taking the acid."

"The object entertained by Dr. Arnoldi, in using this acid as a
remedy, was to introduce the elements of the atmosphere into the
blood by the process of gastric digestion, so as to enable the lungs
to outstand the stage of tempory asphyxia. Whether the theory
be correct or not, the result, he says, of his practice has been
almost universally successful." He then goes on to give the out-
lines of twelve cases which were treated by Dr. A. with success.
The doctor met with a few cases where the disease seemed to re-
sist the action of the acid, owing, he remarks, to " spinal torpor at
the track of the eighth pair and phrenic. In these the application
of an ointment of the biniodide of mercury, so as to produce the
specific eruption, and this produced a second and a third time,
completely restored the efficacy of the acid."

" Dr. Gibb's own cases were sixty-four in number, which are re-
ported as cured ; he combines the acid with honey or syrup, and
compound tincture of cardamom, &c."

Chloroform has been enployed by Dr. Fleetwood Churchill, as
a specific remedy in whooping cough in four cases which he re-
ports ; in two of these the whoop ceased in two days ; in the
third case it required its use for three weeks ; in his fourth case

358 Vicarious Menstruation. [June,

the patient had to resort to the use of Prussic acid to complete the
cure.

"In the case of young children he drops thirty drops on the
palm of the hand, the mother to hold this before the mouth and
nose of the child, sufficiently near to inhale it fully, but not so
close as to exclude a portion of atmospheric air. The best time to
begin is just as the patient feels the irritation in the chest increased
to a cough.

Still he considers it more suitable for young persons of twelve
or fourteen years old and upward. Two successful cases have
come under my notice ; the method was by placing a small por-
tion of chloroform in a vial, and when feeling the inclination to
cough, to inhale by removing the cork, the small bottle being
carried in the pocket."

Before concluding my remarks upon the treatment of this dis-
ease, I must not neglect to state the great importance attached by
some authorities to a change of air in the last stage, or the debility
which results from it. Dr. Lombard remarks, that " in many
cases which had baffled all attempts to stop the cough, a change of
air has accomplished the cure. I have found it equally indiffer-
ent to go out of town, or to come into town, provided there be a
change ; and even in the short distance of half a mile, I have seen
the good effects of this plan of treatment." Dr. West, of London,
says that change of air with the use of alum during the last stage,
generally expedites the cure." According to Dr. Gregory, change
of air after severe and protracted eases is the only thing that will
give the patient a chance of recovery.

Billard states "that goat's milk, pure or diluted, a good nurse,
a residence in the country, particularly in the spring and summer,
will materially conduce to the recovery of infants at the breast."

But nothing can be more pernicious than the exposure of child-
ren suffering from whooping eough, to cold or inclement weather
for it will bring back the cough and cause inflammation of the
lungs. [Medical Examiner

Vicarious Menstruation.
"We find the following cases, reported by Prof. Boring, in an
interesting article contained in the Atlanta Medical Journal:

" The first is, that of a married lady, Mrs. , twenty -two or

three years of age, of rather feeble constitution, sensitive, nervous
habit, poor digestion, and generally feeble health. She menstru-
ated first at the usual age and continued healthy in this respect for
the space of three or four years, when. the catamenial flow was
suddenly arrested by falling into a stream of water, the discharge
being present at the time. Since then she has been the subject of
irregular menstruation, the secretion coming on sometimes too

1856.] Vicarious Menstruation. 359

soon, then too late; at times insufficient in quantity, and at other
periods profuse and exhausting. She has been married about two
years, but without issue. When I first saw her, she was laboring
under what was supposed a dangerous attack of hemorrhage from
the stomach and bowels. I found her vomiting and purging what
seemed to be decomposed blood, with great exhaustion, and the
pulse ranging from 120 to 125 in the minute. It did not occur to
my mind at first, that this was an instance of Vicarious Menstrua-
tion, but the physician who had been in charge of the case, having
blistered over the region of the stomach, and administered the
usual remedies, I determined to wait and extend my observations
before instituting treatment. In the mean time, developments
went far to impress me with the ojDmion, that the disease, was not
one of real hemorrhage, but of menstrual character. Upon insti-
tuting thorough inquiry into the history of the patient, I became
satisfied of the nature of the case, and treated it accordingly.
The attack soon passed off, and the patient recovered a pretty
good state of health. My efforts were then directed to the correc-
tion of the uterine system and the establishment of healthy men-
struation. In this, I have been partially, and only partially,
successful. The catamenial secretion has become almost uniform
in regard to the time of its recurrence, but is sometimes protract-
ed and profuse, and not unfrequently attended with severe head-
ache and distressing nausea. I have also observed a strong
tendency on the part of the stomach, at each monthly period,
to become nauseated, and, as I believe, to take on this remarka-
ble action.

"Before concluding this case, I ought to state, that it not un-
frequently happens with this patient, that at her menstrual periods
the breasts become more or less tumefied and painful, and at the
same time similar appearances occur on other parts of the body,
particularly on the chest.

"The second case alluded to, is that of a negro woman, belong-
ing to Mrs. , about thirty-five years of age, of apparently good

constitution, and, with the exception about to be mentioned, gen-
eral good health.

"She began menstruating at the age of fifteen, and continued
regular in this respect until about three years since. Eight years
ago, when about twenty-seven years of age, she was attacked with
violent pain in the foot, which was succeeded by an abscess, which
was lanced, but did not heal. Ulceration succeeded, which con-
tinued to move upwards until the leg was involved and became
the seat of its permanent location. About three years since, the
catamenial discharge began manifestly to decline, and so continued
until it ceased altogether, when she was seized with severe shoot-
ing pains, passing from the sacro lumbar, to the uterine region,
and to the ovaries. At the approach of her next menstrual period,
she noticed a slow oozing of blood from the ulcer on the leg, (I

360 Suggestions upon Animal Odor. [June,

give her own account of the matter,) which continued about the
usual time of that discharge and ceased. At subsequent periods,
the same discharge sometimes occurred, while at others, instead,
small sacks of blood were formed contiguous to the ulcer, which
were obliged to be opened and the blood discharged, before relief
could be obtained.

" In June last, the ulceration of the leg had become so extensive

and threatening, as to require, in the judgment of Dr. , (whose

patient she then was,) amputation.

" Since the operation, the ulcer being removed, there has been no
regular monthly periodic discharge of blood, but, at each monthly
period, sacks, such as were above described, form around the stump
of the amputated limb, and require to be lanced for the relief of
the patient. I have seen these sacks, and in fact opened them, and
can entertain no doubt as to their true nature. So uniform are
these singular occurrences in their periodic character, as to have
induced this woman to keep a lancet for the purpose, and thus
surgically to perform the work of menstruation. It should be ob-
served that she continues without any vaginal discharge, and that
the determination of blood to the stump of the amputated limb,
together with the formation of these sacks of blood, occur periodi-
cally, and observe strictly the menstrual periods, as to the time of
their recurrence and duration."

Suggestions upon Animal Odor. By Charles Van Alen, M. D.

Each genus, species, and perhaps individual, of the whole world
of animal life, is probably distinguished by its peculiar odor. We
will not discuss with the metaphysician the question, whether odor
exists independently of the sense of smell ; we take it for granted
that it is a property of certain forms of matter, independent of this
sense. This fact, so apparent in animals that come within the
ordinary scope of observation, justifies the conclusion by analogy,
that the whole animal kingdom is similarly endowed. Some of the
more prominent examples will naturally suggest themselves to the
student of Natural History. The musk odor, with its numberless
varieties, belong to the musk deer (moschus moschiferus) to several
of the ape kind, and to the different varieties of the musk rat : the
peculiar smell of the civet, that of the castor (castor fiber) and the
strong offensive odor of the pole cat and of our native skunk ; and
among insects, the delicate musk perfume of the cerambix nmschfr
tus, the apis fragrans, and the tipula mosclri/era, and the odor of the
cerambix saveolens, nearly allied to, though more delicate than, the
rich perfume of the otto of roses, offer readily illustrations of the
extent and variety of animal odor. In man, as in other animals,
there exisis a peculiar distinctive odor, not impressing itself in a
(state of health with much intensity upon our duller sensation, but

1856.] Suggestions upon Animal Odor. 361

always clearly perceptible to the more acute sensibility of some of
the lower animals. It is contended with some degree of plausibili-
ty, that each race of mankind has its distinguishing odor. "The
Peruvians," says Humboldt, " who in the middle of the night,
distinguish the different races, by their quick sense of smell,
have lormed three words to express the odor of the European,
the American Indian, and the Negro." The following observation
is quoted by Blumenbach from Thibault de Chambollon, in refer-
ence to the Caribbeans. " They have all a strong and disagreeable
smell. I cannot," says Chambollon, "give the remotest idea, by
description, of its peculiarity. Whenever a similar odor is obser-
ved, is called at the Antilles, the Caribbean smell, which proves the
difficulty of defining it." It is generally conceded, and most of us
have daily opportunity for obtaining olfactory evidence of the fact,
that the negro emits a peculiar odor, distinguishing him from the
white race. Dr. Carpenter denies this. He allows that the negro,
in common with the Hindoo, secretes a more abundant perspiration
than the white, but asserts emphatically that it is not more odorife-
rous. Dr. Prichard, on the other hand, though an earnest advocate
for the utiity of origin of the whole human family, remarks in
speaking of the perspiration of the dark colored races, that it has a
peculiar odor, which is well known in negroes and the Caribbee
Indians. On the score of sniell, no obstacle exists to the most inti-
mate relations between the white man and the negro, which will not
easily yield to a due application of soap and water.

That each individual as well as race, of the human family, is
endowed with a peculiar odor, seems evident, from the ease with
which the dog scents his master, The interesting history of Julia
Brace, an inmate of the Hartford Asylum, affords further evidence
of the fact. This unfortunate girl, burn blind, deaf and dumb,
having no other mode of communication with the external world
than by the sense of smell, taste, and touch, by the increased power
of which nature strove to compensate her for her severe affliction,
was enabled to distinguish persons, by the exercise of the first sense
alone. The eloquent author of the " Religio Medici," and the
'' Urn Burial," has some observations pertinent to this subject.
" We acknowledge," he says, that " certain odors attend on animals,
no less than certain colors ; that pleasant smells are not confined to
vegetables, but found in divers animals, and some more richly than
in plants; and though the problem of Aristotle inquires, why no
animal smell sweet beside the pard, yet later discoveris add divers
sorts of monkeys, the civet cat and jazelon, from which our musk
proceedeth. We confess that beside the smell of the species, there
may be individual odors, and every man may have a proper and
peculiar savor, which although not perceptible unto man, who hath
this sense but weak, is vet sensible unto dogs, who thereby can
single out their master in the dark. We do not deny that particu-
lar men have sent forth a pleasant savor, as Theophrastus and Plu-

862 Suggestions upon Animal Odor. [June,

tarch report of Alexander the Great, and Tzetzes and Cardon do
justify of themselves." In that charming specimen of self-portrai-
ture, the autobiography of Lord Herbert of Cherbury, the brave
knight, the courteous gentleman, and the learned scholar, present-
ing in his character the rare union of a complete knowledge of the
world and the deepest wisdom of the closet, we read, " It is well
known to those who wait in my chamber, that the shirts, waistcoats,
and other garments I wear next my body, are sweet beyond what
easily can be believed or hath been observed in any else ; which
sweetness also was found to be in my breath above others, before
I used to take tobacco, which toward my latter days, I was forced
to take against certain rheumes and catarres that troubled me,
which yet did not taint my breath, for any length of time." In a
quaint old work entitled " The life of the learned and pious Dr.
Henry More, late fellow of Christ College in Cambridge, by Rich-
ard Ward, A. M.," the author remarks, "I was mentioning some-
what but just now of his body, and this reminds me of some things
that were peculiar in that also as well as in his mind; he has told
us occasionally, in a discourse concerning the famous Greatrakes
and what was extraordinary in that person," " that not only his own
urine had naturally the flavor of violets in it, but that his breast
and body, especially when very young, would of themselves in like
manner send forth flowery and aromatic odors from them, and
such as he daily almost was sensible of, when he came to put off
his clothes and go to bed ; and even afterwards, when he was older,
about the end of winter or beginning of spring, he did frequently
perceive certain sweet and hebaceous smells about him, when yet
there was no such external objects near, from whence they could
proceed."* These reports of sweet smells must be taken " cum
grano salis," to give them the savor of truth. They probably take
their origin in an exaggerated egotism, which envelops in its in-
cense every thing that pertains to self.

In considering the physiology of animal odor, and endeavoring to
trace out its cause, considerable difficulty is encountered from the
unsubstantial nature of the object of investigation, from the impos-
sibility of discriminating with exactness its varieties, and from the
various degrees of sensibility of different observers. Attempts have
been made to classify systematically the various odors. The most
plausible one divides them into Acidulous, Spirituous, Camjrfiorous,
Fragrant, Somniferous, Fetid, and Alkaline; but these terms do not
admit of a strictly philosophical application. All odors are compo-
site, and all individuals are possessed more or less of an idiosyn-

* In a late work, called theTable Talk of Samuel Rogers, we find the following:
"Sir Henry Englefield bad a fancy (which some greater men have had) that there
was about his person a natural odor of roses and violets. Lady Grenville heariog
of this and loving a joke, exclaimed one day when Sir Henry was present, "Bless
me, what a smell of violets 1" "Yes, said he, with great simplicity, "it comes
from me."

1856.] Suggestions upon Animal Odor, 363

cracy of sense. These facts present themselves as insuperable ob-
stacles to an exact definition. The physician, in this as in every
other department of the science of medicine, must not confide too
trustingly in fixed rules, but endeavor to sustain his uncertain steps
by individual experience and observation.

Various animals (of which mention has already been made) more
prominently distinguished by their odor, such as the musk deer, the
civet, and the castor, have peculiar organs, generally situated in the
neighborhood of the genitals, devoted to the particular function of
generating odor. In others, as the pole cat and the skunk, the
stench is due to the ordinary secretions. The odor of these various
animals is not of the same intensity at all times and seasons. With
some it is voluntary, and thrown out as a protection against attack ;
and with others it is generated independently of the will in the rut-
ting season, as a source of attraction between the sexes. Animal
odor in its natural condition, of whatever kind, is unquestionably
a source of pleasure to its possessor, and to those of the same order,
and of repugnance to most others, which contribute towards preserv-
ing the integrity and individuality of the races, thus administering
to a wise purpose in the economy of nature.

The principal sources of odor in man, are the breath, and the
different secretions. The air expired gives out the odor, in dimin-
ished intensity, of the ordinary articles of diet consumed. The
perspiration has naturally an acid odor, differing in degrees in vari-
ous parts of the body, being more sensible in the groin, in the neigh-
borhood of the genitals, and the feet. The other secretions and
excretions have peculiar smells of their own, each of which contri-
butes towards producing in man his distinctive odor. This is affect-
ed in a remarkable manner, and very variously, by habits of life, the
atmosphere, diet, and more especially disease. Persons engaged in
certain employments, whatever may be their attention to personal
cleanliness, are observed to become so impregnated with the pecu-
liar odor of the objects by which they are constantly surrounded,
as to give it out long after a change of occupation. Chomel states
that he had a hostler under his charge at the hospital, who during
the course of a bilious fever, exhaled a strong smell of the stable,
although all his clothes had been removed, and he had been repeat-
edly washed. All who approached him felt assured that the odor
proceeded directly from the patient himself.

The effect of diet and of various articles used as remedies, in
altering the animal odor, is a familiar fact. Those in the habit of
eating garlic and onions, habitually smell of the peculiar odor of
these plants; and the Greenlander, whose constant vegetable food
is of the pea kind, is reported bv travellers to emit a leguminous
smell ; the noisome stench which infects the urine, after eating as-
paragus, cannot have escaped the dullest sense of smell; and the
violet odor from the administration of the oil of turpentine, the pecu-
liar flavor given to the breath and urine and the perspiration by

otj-l Suggestions upon Animal Odor. [June,

copaiba, sulphur, and various other remedies, are the results of
everyday observation. It is doubtless the vapor of the essential oil
belonging to the articles taken into the system, which is thus ex-
haled, and which, though not sensible to chemical tests, becomes
evident to the sense of smell. The varieties of odovamong individu-
al races are attributable probably to their various modes of life.

The effect of disease is increasing and varying the animal odor
of the human body, more especially recommends itself to the regard
of the medical observer, from its direct bearing upon diagnosis. It
is believed that much useful information would be the result of
directing inquiry and observation upon this subject. Its investiga-
tion is urged upon the physician as promising to result in a fair
return of profit, available for practical purposes. Certain diseased
conditions of the system affect in a remarkable manner the odor of
the breath, and thus afford a valuable symptom of their existence.
In some febrile diseases the breath acquires a sweetish, and in vari-
ous affections of the stomach a strong pungent, acid odor. This
acidity is occasionally of such intensity, as to impregnate every thing
which surrounds the patient, his clothes, bedding, and the whole fur-
niture of the room: and is indicative of a severe form ot gastric
disease, which most frequently results in death. In gangrene of the
lungs, the breath emits an odor of putrified flesh, a most unvarying
and important distinctive system of this disease. In several forms
of dyspepsia, in bilious fever, in scurvy, and in the latter stage of
consumption and typhus fever, it assumes a fetid character. Mer-
curial salivation, and various affections of the mouth and throat are
easily discernible by the peculiar and offensive odors they give to
the breath. A fit of drunkenness is invariably detected by the spir-
ituous odor exhaled from the lungs, when otherwise there might be
danger of confounding it with severe disease. The perspiration in
a variety of different affections undergoes sensible changes in odor,
worthy of the physician's regard. In prolonged constipation, a very
marked odor of sulphureted hydrogen is observed, especially in
females, who are more apt to neglect the state of their bowels, and
whose false modesty disposes them to conceal their condition from
their physician. This odor will be found a useful, and often the
only attainable indication in such cases.

In various diseases of the skin, a peculiar smell of the transpira-
tion is an unvarying symptom. In all syphilitic eruptions, the odor
is marked and peculiar. In small-pox it is equally distinctive and
prominent, and is by many compared to the smell of mouldiness ; in
porrigo favosa also, it resembles the stench of cat's urine, and in
miliary fevers, by some it is likened to ihe smell of lime, by others,
to that of decayed straw. A peculiar fetid smell of the perspiration
of the feet is frequently observed, and presents a troublesome and
obstinate disorder. The writers upon the sweating sickness, the
terrible plague which devastated Europe in the 15th and 16th cen-
turies, have exhausted their powers of language, in endeavoring to

1856.] Suggestions upon Animal Odor. 365

describe the rankness of the odor of the perspiration which was the
prominent symptom in that disease. They speak of the horrible
stench of the sick, the odor teterminus, of the afflicted being sur-
rounded by a thick stinking mist of their lying, as it were, in a
stinking swamp of sweat, and overwhelmed with disgust of them-
selves, in consequence of their loathsome and ill-odored condition.
In rheumatic diseases, most of the secretions and excretions are per-
ceptibly changed in odor, and more especially the sweat, which
assumes a nauseous. acid smell. Fevers of alow typhoid character
are easily indicated by an odor like that of mice; and in the latter
stages of typhus, the smrll is decidedly cadaverous. The insane
are observed to emit a peculiar odor from the skin. The urine also
acquires various odors in different diseases. In Bright's disease it
sometimes exhales the smell of boiled beef; and in diseases of the
bladder and some typhoid affections, that of shell fish ; in acute in-
flammatory disease, and in various disorders of the kidneys, an am-
moniacal odor. The smell peculiar to the faeces varies frequently in
disease. It is of a cadaverous nature in typhoid fever and chronic
diarrhoea; and resembles that of macerated flesh in certain malig-
nant dysenteries. In many of the diseases of the digestive organs
in children, its condition supplies important indications. The stools
are offensive in the early stages of cholera infantum, and again in-
odorous in its more advanced periods, and in the severe forms of
dysentery. The odor of what is thrown up in vomiting aids in
forming a just notion of the nature of the disease in which it exists.
The sense of smell is necessarily applied to for a right appreciation
of the condition of certain ulcers, putrescent wounds, gangrene, and
purulent deposits. The odor is the most reliable means for the de-
tection of poisons by prussic acid, and aids in discovering the pre-
sence of the metallic, narcotic, and other poisons. The septic con-
dition generally reveals itself by a smell indicative of the process of
decomposition. It is to this state that may be attributed the various
changes in the animal odor, produced by disease. Whether this
disorganization originates in the solids or fluids, or, as is more pro-
probable, occasionally in both, it becomes no one in the present state
of pathological science dogmatically to decide. That the composi-
tion of the humors of the body, is at least secondarily affected, there
need be no hesitation in asserting.

It is no longer heresy to speak of the corruption of the fluids, the
decomposition, or, in other words, the new chemical combinations
set up in them, uncontrolled by the vis vitas. To what else can be
attributed the loathsome putrid sweats in the sweating sickness, the
cadaverous odor in the last stages of typhus, and the putrescent ex-
halations in scurvy and other analogous affections? Much pro-
gress in pathology has been hindered by the excessive reaction of
opinion against the exclusive doctrines of the Humoralists of a
past age. Liebig, Prout, Bright, and others, have established a
firm foundation of well-ascertained facts, upon which it is hoped

366 Treatment of Scarlatina Anginosa. [June,

the superstructure of a new and rational system of humeral patholo-
gy will arise, fact by fact, cemented fast by experiment and logical
deduction. [New York Medical Times.

Treatment of Scarlatina Anginosa.

Mr. Pye H. Chavassee, F.R.C.S., read before the Medico-Chir-
urgical Society of Birmingham, March 4th, 1856, the following
paper on this disease:

As I have been very fortunate in my cases of scarlet fever, I
consider it a duty to bring my treatment before the notice of the
members of this Society.

My plan, of late years, has been so uniformly successful (not
having lost a case of scarlet fever for upwards of seven years,) that
I have not deemed it necessary to keep a record of cases. The
system I adopt, in a case of scarlet fever, is to keep the bed-room
cool I may say cold and to have a thorough ventilation through
it : I, therefore, throw open the windows, be it winter or summer,
and have the curtains and valances of the bed removed. If it be
winter time, 1 allow the patient to have one blanket and a sheet ; if
it be summer time, a sheet only to cover him. If the throat be not
seriously affected, I merely order a narrow strip of flannel once
round the throat. If the tonsils be much enlarged, I apply a barm
and oatmeal poultice to the throat, changing it night and morning.
I prescribe an acidulated infusion of roses mixture, that is to say,
infusion of roses, with an excess of acid, made palatable with an
additional quantity of syrup, to be taken every three or four hours.
This is the only medicine I give. When the child is old enough,
I find roasted apples, mixed with raw sugar, very grateful to the
patient.

Here let me pause, to advise my medical brethren always to
make medicines for children pleasant. The administration of nau-
seous medicine to children oftentimes causes sickness, disgust and
irritation, which irequently do more harm than the medicine does
good.

But to return to our subject : I avoid purgatives in scarlet fever.
I never, on any account, give a particle of opening medicine for the
first ten days at least. It is my firm conviction, that the adminis-
tration of purgatives in scarlet fever is a fruitful source of dropsy,
disease and death. When we take into consideration the sympathy
that there is between the skin and mucous membranes, I think that
we should pause before giving irritating medicines. The irritation
of purgatives on the mucous membrane may cause the poison of
the skin disease to be driven internally, to the kidneys, throat, peri-
cardium or brain. You may say, do you not purge if the bowels
be not open for a week? I say emphatically, No!

Now with regard to food. If the infant be at the breast, keep
him entirely to it. If he be weaned, and under two years old, give

1856.] Treatment of Scarlatina Anginosa. 367

him milk and water, and cold water to drink. If he be older, give
him toast and water, and plain water from the pump, as much as
he choses ; let it be quite cold the colder the better. Weak black
tea, or thin gruel, may be given, but caring nothing if he take no-
thing but cold water, unless he be an infant at the breast. Avoid
broths and stimulants of every kind.

Now, you must warily watch for a change of temperature of the
skin. As long as the skin is hot, the above plan I steadily follow ;
but the moment the skin of the patient becomes cool, which it will
do, probably, in five or seven days, instantly close the window, and
immediately put more clothes on the bed. But still do not purge.

You will find the acidulated infusion of roses most grateful to the
little patient ; it will abate the fever, it will cleanse his tongue, it
will clear his throat of mucous, it will, as soon as the fever is abated,
give him an appetite. I believe, too, the acid treatment has some
peculiar properties of neutralising the scarlatina poison. I do not
pretend to explain how, or why, or wherefore.

When the appetite returns, you may consider the patient to be
safe. The diet must now be gradually improved. Bread and but-
ter, milk and water, and arrow-root, made with equal parts of milk
and water, may be given for the first two or three days. Then a
light batter or rice pudding may be added ; and, in a few days af-
terwards, a little chicken or a mutton-chop.

Within the last few years, I have had some fearful cases of scar-
let fever; but, relying on this plan of treatment, I have given, even
in very bad cases, a very favorable diagnosis. I have had cases
where there have been violent headache and delirium ; where there
have been immense swellings of the parotid and submaxillary glands ;
where there has been enormous enlargement and ulceration of the
tonsils ; where a great portion of the fluid that has been taken by
the mouth has escaped down the nostrils ; where there has been a
purulent discharge down the nose, which discharge has in many
instances quite excoriated the skin over which it has travelled ;
and yet in such cases the patients have invariably recovered.

There is another important regulation I lay great stress upon. I
never allow a scarlet-fever patient, even if the attack be mild, to
leave the house under the month in the summer, and then not if the
wind be in the East or Northeast; nor under six weeks in the win-
ter. During the last seven years, I have never had anasarca from
the scarlatina ; and I attribute it entirely to the plan I have just re-
commended, and in not allowing my patients to leave the house
under the month until, in fact, the skin that has peeled off has
been renewed. Dr. Watson, in his valuable lecture?, gives some
advice on this subject. From the sixteenth to the thirtieth day, I
watch the case assiduously, to assure myself that there be no drop-
sical approach, carefully examining the urine, ascertaining that
there be plenty of it, and that it be not albuminous.

Let me now sum up the plan I adopt :

368 Treatment of Scarlatina Anginosa. [June,

1. Thorough ventilation, a cool room, and scant clothes on bed,
for the first five or seven days.

2. A change of temperature of skin to be carefully regarded. As
soon as the skin is cool, closing the windows, and putting additional
clothing on bed.

3. Infusion of roses with an excess of acid, sweetened, the only
medicine to be given.

4. Purgatives to be religiously avoided for the first ten days at
least, and even afterwards, unless there be absolute necessity.

5. Leeches, blisters, emetics, and cold and tepid spongings, inad-
missible in scarlet fever.

6. A strict antiphlogistic diet for the first week, during which
time cold water to be given ad libitum.

7. The patient not to leave the house in the summer under the
month ; in the winter, under six weeks.

My firm conviction is, that purgatives, emetics, and blisters, by
depressing the patient, sometimes cause scarlatina anginosa to de-
generate into scarlatina maligna; for although I have had numerous
cases of scarlatina anginosa (my practice being much among chil-
dren,) and some of the cases very severe ones, I have never had,
since I have adopted my present plan of treatment, one single case
of scarlatina maligna. I have such faith in my present plan of
treatment, that if it be duly followed out, I should seldom despair of
even the worst of cases recovering.

I am aware that some of our first authorities advocate a different
plan to mine. They recommend purgatives, which I may say, in
scarlet fever, are my dread and abhorrence. They advise cold and
tepid spongings a plan which I think dangerous, by driving the
disease internally. Blisters, too, have been prescribed ; these I
consider weakening, injurious, and barbarous, and likely to irritate
the already inflamed skin. They recommend leeches to the throat,
which, I am convinced, by depressing the patient, lessen the chance
of battling against the disease, and increase the ulceration of the
tonsils. Again, the patient has not too much blood ; the blood only
is poisoned. I look upon scarlet fever as a specific poison of the
blood, and which will be eliminated from the system, not by bleed-
ing, not by purgatives, not by emetics, but by a constant supply of
fresh and cool air, by the acid treatment, by cold water as a bever-
age, and for the first few days by a strict antiphlogistic diet.

Sydenham says, that scarlet fever is oftentimes " fatal through
the officiousness of the doctor." I conscientiously believe that a
truer remark was never made; and that, under a different system
to the usual one adopted, scarlet fever would not be so much
dreaded.

Let me urge my medical brethren to give my treatment a fair
trial, and I am convinced that they will then add their testimony to
mine, that the plan is a good one. I have spoken out fearlessly and
boldly ; but I feel so satisfied of the truth of my sentiments, and of

1856.] Varioloid and Varicella. 369'1

the immense importance of the subject, that I could not be less em-
phatic. [Ass. Med. Jour.

Varioloid and Varicella. By Prof. Trousseau.

Many practitioners of high scientific repute believe that the same
relationship prevails between varicella and varioloid as between this
last and variola. This it is impossible to admit. If we bring am
individual having genuine vaccine scars in contact with a small-
pox patient, he may take a varioloid, and, while suffering from this,.
he may communicate a true variola to a. subject who has neither
been vaccinated nor had the smallpox. If we take the pus from a
varioloid patient, and inoculate the healthy person, as has been done
in epidemics when vaccine lymph has run short, we produce the
legitimate smallpox. These are so many proofs of the identity of
the two affections. It is not thus with varicella. It neither arise*
from contact with varioloid, or is capable of communicating true
variola. We see it arise just as easily in persons who have had
that disease, as in those who have been exempt from it ; in the un-
vaccinated, and in those who have been vaccinated. M. Trousseau
has seen an epidemic of varicella at the Neckar Hospital which
attacked all the children, a short time after vaccination had been
quite successful. This is an important question in hygiene; inas-
much as varicella, of itself, is an affection destitute of danger; and
we may leave the subject of it in communication with surrounding
persons, without the fear of finding a serious malady developed.
The same practice, pursued in varioloid, might give rise to a mis-
chievous development of variola.

Varioloid. Thirty-five years ago, an authentic example of small-
pox after vaccination was unknown, although Jenner had seen ex-
amples of this, and had indicated them ; but, as there are always to
be found persons more royal than the king, so there were practi-
tioners who accorded to vaccine more than he who had discovered
and propagated it had claimed for it. In 1825, a very violent epi-
demic of small pox prevailed in Paris, during which individuals who
had been vaccinated were attacked. M. Husson, who was one of
the Vaccine Committee in 1800, and one of the most ardent pro-
moters of vaccination, contested the validity of these cases ; and so
extraordinary was the circumstance thought to be, that whenever
a varioloid patient arrived at the hospital, the bells were loudly
rung, in order to call as great a number of practioners together as
possible for the verification of the fact. An epidemic at Edinburg,
and two at Marseilles, multiplied examples. The attention of gov-
ernments became aroused, and especially in Germany, where re-
vaccination has been rendered obligatory. At the present day,
there is no hospital in which we may not see persons having the
vaccine scars the subject of variola, and even dying of it. It may
occur even as early as the second or third year after vaccination ;

380 Varioloid and Varicella. [June,

and M. Trousseau has seen an infant at the Necker Hospital take
a genuine variola six weeks after a successful vaccination. A mo-
ther and her three children also took it soon after vaccination, and
in the woman, who died, it was confluent.

At its onset varioloid differs in nowise from variola. Fever arises
and continues until the eruption appears. We see, however, more
frequently supervene a scarlatiniform or petechial eruption, but it
does not influence the prognosis unfavorably, as in variola. The
eruption does not differ from that of variola, until the eighth day ;
but at the eighth day from the commencement, or the fourth from
the eruption, in place of tumefaction and inflamed areola superven-
ing, we find the integuments become pale and flaccid. The pus-
tules do not become larger, remain accuminated, and umbilicate
but little. They dry without bursting, become rugous, and pass
into the " horny" condition. Those of the limbs, in place of acquir-
ing a size three or four times as large as those of the face, do not
increase, and cornify in the same manner. By the tenth day the
eruption is dry. In more serious forms, when the varioloid, as some
times happens, is confluent, there is sometimes secondary fever ;
but at the tenth day, the tumefaction stops short, without any acci-
dent supervening, while in variola its doing so would be of falal au-
gury. The whole terminates with a rapid desquamation, although
marks may remain, especially in persons with delicate skins.

Varicella. When a child is brought to the Necker with varicel-
la, the date of its admission is noted, and sixteen or seventeen d.
later, other children always exhibit the same disease. If, on the
contrary, it had been a small-pox case, other cases would have been
observed from nine to eleven days afterwards showing that the
period of incubation is very different in the two affections. A
child, in good health, whether vaccinated or not, whether having
had variola or not, becomes suddenly the subject of a sharp attack
of fever, there being present neither vomiting nor lumbar pain.
The next day, or sometimes even the same day, fifteen or twenty
red points are observed upon the skin, and some hours later the
epidermis is raised. Twenty-four hours after the appearance of
the red points we observe bullae or phlyctaenae, quite rounded in
form, and transparent, as if they contained water. They resemble
sudamina, magnified from ten to fifteen times. In variola and va-
rioloid the eruption never assumes this bullar form. In those dis-
eases, too, the fever and the eruption continue until the latter is
completed. In varicella the phenomena take place successively.
There is a day of complete apyrexia, the fever comes on during the
night, and the next day we find from thirty to forty points of erup-
tion. The same takes place during the next twenty-four hours, and
so on for four or five days, so that we have four or five successive
eruptions. Twelve hours after the appearance of the eruption,
there is a limpid bulla formed, and forty-eight hours after the liquid
has become lactescent, which is never observed in any form of va-

1856.] Case of Varicocele. 371

riola. In variola discreta the eruption is of a very regular, rounded
form, like wax dried upon the skin ; but after two or three days the
bullae of varicella become unequal, irregular and puckered, but never
offer any appearance of umbilication. When pus begins to form in
the phlycteenae, a livid red, inflammatory areola is produced, larger
in size than the variolous areola. When the pustule bursts it leaves
a dark brown scab, having nothing in common appearance with the
yellow scab in variola, but much resembling that of echthyma.
From twelve to fifteen days are required for the complete evolution
of a variolous pustule, while four, or at most five, days suffice in
varicella. So little dangerous is this affection, that M. Trousseau
knows of no example of its having terminated fatally. Still, in some
children, who manifest the purulent diathesis, it is followed by suc-
cessive eruptions of pemphigus, which terminate by exhausting the
patient and causing death. But these deaths cannot be imputed to
the varicella itself.

Thus then, variola and varioloid are identical; while varicella is
distinguished from these by the differences in its period of incuba-
tion and febrile paroxysms, by the form and duration of its eruption,
and by the absence of danger. [Ranking's Abstract.

Case of Varicocele cured by Retrenchment of the Scrotum. By Sam'l
B. Richardson, M. D.

The well-known chagrin and mental despondency, resulting
sometimes in mono-mania and suicide, which constitute a part of
the history of this distressing and not unfrequent malady ; not to
mention the uncertainties, danger and sometimes fatal results of
operations for its radical cure heretofore, impart more or less of in-
terest to every well attested case of successful treatment. With
these views, the following observations are placed before the pro-
fession, s

Case. B H , Esq., of Southern Kentucky, aged 29

years, unmarried, of respectable family, possessing a good constitu-
tion, the only disease from which he has ever suffered being inter-
mittent ague and fever, which occurred during his adolescence and
early manhood.

In the midst of health and cheerfulness, on the 27th of October,
1838, an amicable rencounter took place between himself and a
companion, in a tussle or wrestle, resulting in his friend falling be-
neath him. Just at the moment of greatest effort, he felt a sharp
cutting pain, of short duration, in his left spermatic cord near the
external ring. The day succeeding, a tumor was discovered in the
cord near the testes, which gradually increased in size up to the
time of operation. A month succeeding the accident, pain, with
a sense of languor and aching, was felt in the right groin, hip, and
loins, attended with no inconsiderable mental despondency, which
symptoms afterward frequently exascerbated and remitted. In the

N. S. VOL. XII. NO. VI. 24

372 Sulphur in Itch. [June,

month of May, 1839, he came to Louisville to consult me respec-
ting his case, when I discovered a marked varicocele of the left
spermatic veins, with an increase of the constitutional and mental
symptoms, and the digestive organs not acting healthfullv.

I informed him that nothing short of a surgical operation prom-
ised permanent benefit ; but to this he objected ; and, preferring a
trial of other remedies firs-t, and promising if they proved unsuc-
cessful, he would return in the autumn, and submit himself to any
treatment I might consider best. The remedies then prescribed
were designed to correct the disordered state of the stomach and
bowels, and to compress the enlarged veins ; but they only succeed-
ed in ameliorating the general and local distress, without lessening
the original malady. On the 13th of October, this patient arrived
in Louisville a second time ; and three days thereafter I operated
upon him by removing quite a large section of the entire scrotum
and sub-jacent cellular tissue, in the presence of and aided by Drs.
Donne and T. L. Caldwell. The part removed, which laid bare
the testes, measured, when moderately stretched, 5| by 3^ inches
in extent. The wound was closed by five interrupted sutures, and
interposed adhesive strips, over which was placed a light dressing
of lint spread with simple cerate, and the parts placed in an elastic
silk suspensory bandage, firmly drawn up. Adhesion took place
througlwut, with slight exception, and but little constitutional reac-
tion occurred. The fourteenth day succeeding the operation, Mr.
H. visited my office, when I could discover no evidence of varico-
cele. He left for home the eighteenth day after the operation.
The evening before, I was happy to find, upon a careful examina-
tion of the cord, that no enlarged veins existed while he was in the
erect posture, and after continuous exercise about the city ; nor
was he able to enlarge them by the most forcible expulsory efforts
of the diaphragm and other abdominal muscles. All his previous
pains, and the uneasiness of the right groin, hip, and loins, had
ceased, and there remained but a slight fulness of the cord at the
external abdominal ring. [Louisville Kentucky Review.

Cure of Itch in half an hour by SuTpJiur in a liquid form.-

Dr. E. Smith called attention to an article in the Gazette Heb-
domadaire, by Dr. Bourgignon, in which is a confirmation of the
value of the treatment of itch, in Belgium, by sulphur, combined
with lime, in a liquid form. The remedy is prepared by boiling
one part of quick lime with two parts of sublimed sulphur, in ten
parts of water, until the two parts are perfectly united. During
the boiling it must be constantly stirred with a piece of wood, and
when the sulphur and lime have combined, the fluid is to be de-
canted and kept in a well stopped bottle. A pint of the liquid is
sufficient for the cure of several cases. It is sufficient to wash the body
well with warm water, and then to rub the liquid into the skin for

1856.] Editorial. 373

half an hour. As the fluid evaporates, a layer of sulphur is left
upon the skin. During the half hour the acarus is killed, and the
patient is cured. It is only needful then to wash the body well, and
to use clean clothes. In Belgium the treatment is introduced by
first rubbing the body for half an hour with black soap ; but this
does not appear to be necessary. The only essential act is that of
the careful application of the fluid sulphur. The lime is of no im-
portance in the treatment, except to render the sulphur soluble, and
such would probably be the case if potass or soda were employed.
The chief point in the plan thus employed, which is an improve-
ment upon the mode of application of sulphur in substance with
lard, is the more ready absorption of the remedy, and consequently
the more certain and quick destruction of the insect, by using sul-
phur in a fluid form. In so disgusting a disease, it must be of great
moment to be able to cure it in an half hour. [Asso. Med. Jour.

EDITORIAL AND MISCELLANEOUS.

BIBLIOGRAPHICAL.

Physical Exploration and Diagnosis of Diseases affecting the Respiratory
Organs. By Austin Flint, M. D., Professor of the Theory and Practice
of Medicine in the University of Louisville, &c, &c. Philadelphia :
Blanchard & Lea. 1850. 8vo., pp. 636. (For sale by T. Richards & Son.)

Prof. Flint's contributions to practical medicine have already established
a high reputation which will be found fully sustained by the valuable trea-
tise before us. It is high time that the profession in our country should
place themselves above the reproach of ignorance on so important a branch
of their studies as Diagnosis and we need not add that this can only be
done by a careful application of the physical means so elaborately and lu-
cidly developed in this work. No man in this country has done more than
Prof. Flint to incite our countrymen to a proper appreciation of their value.

On some Diseases of Women admitting of Surgical Treatment. By Isaac
B. Brown, F.R.C.S., Surgeon Accoucheur to St. Mary's Hospital, &c, &c.
Illustrated by 24 wood cuts. Philadelphia: Blanchard & Lea. 1856.
8vo., pp. 276. (For sale by T. Richards & Son.)

This work fills an important gap in English medical literature, and cannot
fail to be well received in this country. The author treats of Ruptured
Perineum, Prolapse of the Vagina, Prolapse of the Uterus, Vesico-vaginal
Fistula, Lacerated Vagina, Polypus of the Uterus, Stone in the female
bladder, Vascular tumor of the meatus urinarius, Imperforate hymen, En-
cysted tumor of the labia, Diseases of the Rectum resulting from certain
conditions of the uterus, and ovarian dropsy. We cheerfully commend it
to our readers.

874 Editorial. [June,

The Principles of Surgery. By James Miller, F.R.S.E., &c, <fec. 4th
American edition, from the 3d and revised English edition. Illustrated
by 240 engravings on wood. Philadelphia: Blanchard & Lea. 1856.
8-vo., pp. 689. (For sale by T. Richards & Son.)

Prof. Miller's works on Surgery are so generally known and appreciated
in the United States, that it is barely necessary to state this is an improved
edition of his " Principles," to secure for this book an extensive sale. It is
reproduced in the best style of the distinguished publishers.

The Principles and Practice of Ophthalmic Medicine and Surgery. By
T. Wharton Jones, F.R.S., Professor of Ophthalmic Medicine and Sur-
gery in the University of London, &c, &c. With 110 illustrations. 2d
American edition, from the 2d and revised London edition. Philadel-
phia: Blanchard & Lea. 1856. 12mo., pp. 500. (For sale by T.
Richards & Son.)

This is a capital manual, already favorably known by its former edition,
published under the supervision of Dr. Hays. It will answer the purposes
of a text-book for students, who eannot be expected to study the more
elaborate works on this subject.

Manual of Chemical Physiology. From the German of Professor C. G.
Lebmann, M. D. Translated, with notes and additions, by J. C. Morris,
M.D. ; with an introductory essay on Vital Force, by Sam'l Jackson, M.D.,
&c, &c. Illustrated with 40 wood cuts. Philadelphia: Blanchard &
Lea. 1856. 8vo., pp. 3-31.

This work, after general considerations on the Human organism and its
forces, treats of Zoo-chemistry, or of the nature of the organic substrata of
the animal organism ; of Phlegmato-chemistry, or the science of the animal
fluids : of Ilisto-chemistry, or the science of the animal tissues ; and of Zoo-
ehemical processes, or the forces and laws of the organic movements fol-
lowed by dissertations upon Circulation, Reproduction, &c. It bears the
impress of German learning and industry, and is calculated to enlarge very
much our views of physiological operations.

An Analytical Compendium of the various branches of Medical Science, for
the use and examination of Students. By John Neill, M. D., <fec, <fec,
and F. G. Smith, M. D., &c, &c. a new edition, revised and improved,
with 374 illustrations. Philadelphia : Blanchard & Lea. 1856. 12mo.,
pp. 974.

We doubt whether any medical work has met with more ready sale than
this epitome. It is remarkably well adapted to the purposes of aspirants
for the Doctorate, and although it may enable the lazy and unambitious to
substitute a superficial knowledge for what should be more profound, it
may be made very useful, even to the well read, as a convenient remem-
brancer.

1856.] Editorial. 375

A Practical Hand-book of Medical Chemistry. By John E. Bowman,
F.C.S., Professor in King's College, London. 2d American edition, from
the 3d and revised London edition with illustrations. Philadelphia :
BlanchardA Lea. 1855. 12mo., pp. 285.

This is a valuable little work, which we have already had occasion to
recommend upon the appearance of the first edition. It contains much
useful matter in a small compass, and is therefore well adapted to students
and men engaged in active practice.

Atlas of Cutaneous Diseases. By J. Moore Neligan, M.R.I.A., &c, &e.
Philadelphia: Blanchard & Lea. 1856. 4to.

This atlas is designed as an accompaniment to the author's Treatise on
Diseases of the Skin, and must materially assist in the study of this difficult
class of affections.

The " Woman's Hospital" of New York.
We have before us the first Report of the managers of this humane
institution, of which Dr. J. Marion Sims is the attending surgeon, whose
skill in the treatment of Vesico-vaginal fistula is so justly appreciated by
the profession. "Seventy-three cases have been received since the opening
of the hospital, and twenty of these discharged perfectly cured. All cases
now remaining are perfectly curable." This is certainly a very flattering
account, and must add to the already extended reputation of the distin-
guished surgeon, whose indefatigable zeal and industry have enabled him
to master an infirmity, until recently deemed incurable. It is but fair,
however, to state that vesico-vaginal fistula has been for some years back
treated successfully by Jobert of Paris, Mettauer of Virginia, Hayward of
Boston, and others.

The Louisville Review: a bi-monthly Journal of Practical Medicine and
Surgery. Edited by S. D. Gross, M. D., Professor of Surgery in the
University of Louisville, and T. G. Richardson, M. D., Demonstrator of
Anatomy in the University of Louisville. Terms : $3 00 per annum,
in advance.

We have received the first No. of this work, which takes the place of the

Western Journal of Medicine and Surgery, recently discontinued. From

. present indications the " Review " bids fair to be a valuable acquisition to

i our periodical medical literature. The well established reputation of its

senior editor will doubtless secure to it a liberal patronage.

Necrology. It becomes our painful duty to record the demise of Dr.
Richard Banks, of Gainesville, Ga., who died on the 6th May, in the 62d
year of his age. Born in Elbert county in 1794, he was graduated in
Philadelphia in 1821, and practiced his profession successfully in his native
county until 1832, when he removed to Gainesville. Dr. B. is one of the

376 Editorial and Miscellaneous. [June,

first who acquired any distinction in Georgia as a surgeon, and his success
was such that he was, by common consent, regarded as the leader of the
profession in his section of the State. It is much to be regretted that, be-
ing a very plain, unobtrusive man, and averse to writing, he has left no
record of his observations and extensive surgical experience.

Dr. John C. Warren, of Boston, has also paid the last debt of nature at
the advanced age of 78 years. At the head of Surgery in New England
for half a century, none was more highly esteemed and respected as a
member of society and a man of science. His professional enthusiasm was
proverbial, and is illustrated in one of the provisions of his will, in which
he directs that his body shall be carefully dissected, and his skeleton pre-
pared for preservation in the College Museum. His object in this disposi-
tion of his remains was to aid in dispelling the prejudices of the people
against the dissection of human bodies.

American Medical Association. We are indebted to the kindness of
Dr. Wm. Brodie, of Detroit, for an early copy of the proceedings of the
recent meeting of this body. We regret that we have not room for them
in the present number, and must therefore defer them till our next.

Disinfection and Preservation of Nitrogenous Manure. (Read before the
National Institute, Dec. 3, 1855, by Dr. D. Breed, U. S. Patent Office.)

Intelligent persons are aware that the poisonous effluvia emanating from
gutters, sewers and yard vaults would soon generate a terrible pestilence in
any city or town, but for the constant diffusion of the poison. But it may
not be so generally known that some of these hot-beds of disease can be
easily rendered comparatively harmless and inoffensive. Our affected re-
finement shrinks from the mention of a disgusting evil which from habit
we have come to regard as necessary. Is it not, however, a false delicacy
which makes us content to inhale with every breath such pestilential ex-
halations, and yet forbids a discussion of their properties, origin, or effects,
even with a view of reform? Shall we not be more truly refined when one
single square of some American city is purified from the stench of night-
soil, made ten-fold more intolerable by the ignorance of the scavengers who
infest every neighborhood, administering slow poison to us in our sleep, not
unfrequently falling victims thereto themselves?

Many years ago the atmosphere of Paris had become so polluted as to
excite the most alarming apprehensions as to public health. Attention was
directed to the privies as the chief nuisance, and various reformatory plans
have been tried, until the united skill of chemists and of practical men has
made Paris in this respect a model worthy of imitation. At present com-
plete deodoi'i/.ation and disinfection are accomplished, so that neither scav-
engers nor others need sutler annoyance. Many other European cities have
l'el'oiuied in this respect, and America has no longer an excuse for neglecting
this much needed sanitary reform.

In privy vaults there is a process of putrefaction constantly going for-
ward, and a consequent incessat escape of poisonous gases into the atmos^

1856.] Miscellaneous. 377

phere. Moreover, the fluid portions of the nig-ht-soil percolate the earth
underlying all our cities. These matters, washed forward by the rains,
diffuse the products of putrefaction everywhere ; then the heat of summer,
by evaporation at the surface, may bring poisonous effluvia up from the
whole area of the city. The waters of our wells, as is known, are impreg-
nated with these products. Not long since an intelligent citizen requested
me to make a chemical examination of the water of a well which was for-
merly very good, but was now strongly flavored, and by several persons it
was thought to have the taste of a chalybeate water. Upon testing, the
water was found to have imbibed rather freely from the privy products of
the neighborhood ! Such wells are common.

Not only does public health demand that this grievous nuisance should
at once be abated, especially as the requisite means are simple and well
known, but agriculture seconds this demand, inasmuch as night-soil is valu-
able as manure, particularly when treated so as to retain all the nitrogen,
most of which is liable to escape in the ammonia which is generated during
the process of putrefaction. Indeed it contains all the elements derived
from the soil by vegetation, and hence is an excellent fertilizer.

The reform in Paris, to which allusion has been made, was effected
mainly by the Societe d' Agriculture and the Societe d'Encouragement pour
1'Industrie Nationale, and in the United States we may expect reform from
the exertions of agriculturalists rather than from those of sanitary officers.

One general criticism may be applied to the means commonly recom-
mended for disinfecting and deodorizing privies, sewers, and gutters. The
methods proposed do not meet all the chemical conditions ; they attempt
too much with a single reagent. In night-soil many elements occur, form-
ing various compounds, organic and inorganic, some acid, some alkaline
or basic, some united as fixed salts, others becoming gaseous, and tending
to escape into the atmosphere. Among the gaseous products are sulphy-
dric acid, carbonic acid, ammonia, or carbonate of ammonia, together with
various exhalations not yet investigated. But the quantity of some of these
is so inconsiderable as to require little attention. Now, in order to com-
pletely deodorize and disinfect night-soil, it is necessary to add such differ-
ent chemical reagents as will unite with each of these gases, converting
them into constituents of fixed compounds. But it often happens that a
reagent that will fix one gas will expel another. Lime is in common use,
because at first it mostly destroys the odor by decomposing the sulphydric
acid and forming sulphide of calcium and water, H S ]- Ca 0 = Ca S-|-
H 0. But the sulphide of calcium thus formed is liable to be decomposed
by carbonic acid, which is always present in the mass. The lime also fixes
the carbonic acid, though the former expels ammonia. Moreover, lime
may hasten the oxydation of the nitrogen, forming nitric acid, which lat-
ter may either fix ammonia or expel carbonic acid. Thus lime alone cannot
be an efficient disinfectant.

Again, sulphate of lime, (plaster,) either calcined or simply pulverulent,
is in use. In this case the sulphuric acid unites with the ammonia of the
night-soil, and the lime with the carbonic acid, N H4 0, C02 -|-CaO,
S03=NH40,S03-|-CaO, C02. The lime also, as before, will de-
compose the sulphydric acid, but the resulting sulphide of calcium is still
liable to decomposition. Calcined plaster itself may evolve sulphydric acid
by the simple addition of water, owing to the presence of some sulphide of
calcium. Therefore plaster, though better than lime, can never be an

378 Miscellaneous. [June,

effectual deodorizer. In the play of chemical affinities, when either lime
or plaster is used, some of the sulphur must alternately unite with hydrogen
and with calcium until it escapes in sulphydric acid at the surface. The
employment of bleaching salt (so-called chloride of lime) is very objection-
able on account of the chlorine thus evolved, and the consequent impreg-
nation of the air with a poison often more deleterious than the effluvia
which it is intended to destroy.

If, instead of lime or its salts, we employ a small portion of the salt of a
heavy metal, as sulphate of zinc, iron, or of copper, the sulphydiic acid is
decomposed, as before, and fixed sulphide of the metal is formed. This
sulphide is not decomposable by any substance present. Here, then, we
have a complete remedy for sulphydric acid. Sulphate of iron may be the
cheapest salt for this purpose, but it, as well as salts of copper, forms a black
sulphide, sometimes objectionable on account of the color. The zinc salts,
however, form a white sulphide, which can never render a city smutty, how-
ever freely used. Of a solution of sulphate of zinc (of 35 to 40 Baume)
it is found necessary to employ only 2 p. c. of the volume of night-soil to
decompose all the sulphydric acid, and then lime and its sulphate may be
added to neutralize the ammonia and carbonic acid.

Of all the disinfectants and deodorizers hitherto employed no substance
produces more remarkable effects than fresh charcoal in apulvurulent state.
Its antiputrescent effects were discovered by Lowitz about 1790; but the
discovery has been slowly applied. In 1829, Frigerio proposed to employ
charcoal for preserving meat, and in 1836 he published in the Brevet d'ln-
vention an account of a safe, consisting of a double screen of wire gauze
with the interspaces filled with pieces of charcoal. This safe was found to
preserve meat in the hottest weather perfectly sweet for a whole week.
During many years charcoal has been (especially in Europe) extensively
mixed with human excrements, for which purpose it has been found to be
admirably adapted, not only by its deodorizing and disinfecting qualities,
but also by its being itself a powerful stimulant to the growth of vegetation.
The experiments of Dr. Stenhouse, of Loudon, prove that a carcass covered
with charcoal powder emits no unpleasant odor during its entire decompo-
sition ; that hospital gangrene and other putrid sores are arrested by the
use of charcoal. He suggests the use of charcoal air-filters for admission of
air to apartments in infected districts, and charcoal respirators for those
exposed to infection. He thinks the charcoal decomposes effluvia by sim-
ple oxidation, converting their carbon into carbonic acid, their hydrogen
into water, and thus hastening decomposition, instead of being antiseptic,
as heretofore supposed. The complete success of the charcoal screens used
in London clearly indicate the propriety of using charcoal to arrest the
contagion of yellow fever. During the recent discussion respecting the
burning of bodies, a lady suggested that charcoal be strewn freely into the
grave so as to surround the coffin, thus completely preventing the escape of
effluvia.

For the last twenty years chemists have been employed in applying their
science to the manufacture of poudrette, and in investigating the causes of
insalubrity connected with the management of night-soil. These investi-
gations, conducted in different countries, have required such varied experi-
ments thai the labor may be regarded as only begun. In the present state
of OUT knowledge we may briefly enumerate the chief emanations from
night-soil, with the best disinfectant or corrective known, as follows :

1856.] Miscellaneous. 379

1. Sulphydric acid; sulphate of zinc or of iron, (vitriol solution.) 2.
Carbonate of ammonia ; sulphate of lime, (powdered plaster.) 3. Free car-
bonic acid; lime, (quick or slacked.) 4. Putrid exhalations, (not investi-
gated ;) charcoal, (better fresh and powdered.) Only a very small portion
of vitriol solution is necessaiy at one time, and this should be so sprinkled
over the mass as to meet the gases rising to the surface. Plaster, lime, and
charcoal may be used more freely ; yet a small portion of these, if frequent-
ly strewed upon the surface, will be sufficient. It has been suggested that
the disinfectant be supplied, as water is, from a reservoir, by simply turning
a faucet.

In the manufacture of poudrette the chief objects are, first, to preserve
all the fertilizing matter of night-soil ; and, secondly, to expel the excess of
water, amounting in some instances to nine-tenths of the whole volume,
(ordinary excrements when fresh are four-fifths water.) An excellent me-
thod of accomplishing these objects is to mix thoroughly with the night-soil
a solution of sulphate of zinc, and leave at rest for a time, when the watery
portion may be pumped off and allowed to flow into a sewer or gutter, (Paris
Medical Police,) without forming a nuisance. It may be wTell to allow a
small jet of solution of sulphate of zinc to mix with the stream (Messrs.
Quesney) as it issues from the pump. The disinfected residue in the vault
may now be removed, spread in thin layers on a resin or other water-tight
floor, (A. Wallet,) and allowed to evaporate to dryness under an open shed
or by furnace heat. The poudrette has been sometimes pressed in cubical
masses, pierced wilh holes, to promote desiccation. Thus prepared, it re-
quires no packing for transportation or preservation. A little rain will do
it no harm if the wet surface be immediately dusted with plaster. Poulet
has recommended the employment of an emulsion of oil and alkalies in
connexion with the zinc salts, in order to obtain a clearer liquid to pump off.
But a better method is recommended by Susser & Fouchet, Lepelletier,
(Moniteur Industrie],) by which all the mineral and organic matters are
entrapped in a gelatinous precipitate of silica. This process is employed
after the ammonia salts have been fixed. An abundance of silicate of soda
is mixed with the night-soil, and then sulphuric or some other strong acid
is added to precipitate the silica. Na O, Si 02 -|-S O3 = Na O, S O3 -|-
Si Oa . The silicate of soda is very cheaply prepared by heating in a fur-
nace a mixture of common salt and sand : Na CI -|- Si 02 = Na O, Si 02 -|
Cl. As the refuse zinc salt may be employed for artificial manure, Gaultier
de Claubry has suggested that the extensive utilization of such refuse in this
way may so reduce the expense of operating the galvanic battery as to in-
troduce it as a common power apparatus.

In Paris it was found that one man with a horse would manufacture, in
the old way, with plaster and coal, 25 tons of poudrette per day, and that
the entire cost of manufacture amounted to only $1 87 per ton. According
to chemical analysis the nitrogen in night-soil is 13 per cent, of the dry
matter. Now, the best Peruvian guano contains only 14 per cent, of nitro-
gen, whilst the average quality contains but 6 or 7 per cent. Therefore
poudrette, properly prepared, will be nearly as valuable as the best Peru-
vian guano, and of twice the value of the average. The experience of
farmers sustains the results of analysis.

The nitrogen in urine is from 25 to 33 per cent, of the solid matter. A
manure prepared from urine, and sold under the name of urate, is a most
powerful fertilizer, equal to four times its weight of average guano, or twice
the value of best Peruvian.

380 Miscellaneous. [June,

In the various processes of manufacturing poudrette it is too often forgot-
ten that the night-soil should he treated before the urine is decomposed.
The urine is much richer than the faeces in nitrogen. The nitrogen in
urine is found chiefly in that remarkable compound denominated urea,
which forms white prismatic crystals, tjuite inodorous. Urea contains two
atoms of nitrogen, two of carbon, four of hydrogen, and two of oxygen, and
its formula, deduced from its ultimate analysis, would give, N2. C2.H4.Oa.
But organic chemistry regards such a formula empirical, and groups these
elements according to their products of decomposition, and the compound
which may be formed by a part or all of them with oxygen or with the
halogens, by substitution or otherwise.

The true constitution of urea is expressed by the following formula:
(N C2 H, 02pXH3 ; it is therefore urenoxyd-animonia. Now, this urea
is rapidly decomposed even at ordinary temperatures, and its elements,
with two atoms of water, form two atoms of ammonia and two of carbonic
acid, (N C2 H, 02 )~N H3 -|- 2 H 0 = 2 N H3 -|- 2 C 02 . Both of these
products are volatile, and therefore, if urine be allowed to decompose, the
most valuable constituents for manure are lost in the atmosphere.

In estimating guano the nitrogen is the true standard of value. Esti-
mating night-soil in the same manner, and assuming that we preserve all
the nitrogen, the city of New York and environs would afford manure equal
in value to 51,000 tons of best Peruvian guano, or $2,550,000 per annum.
During the last seven years, according to the Report of the Patent Office
for 1854, the United States has imported on an average 45,869 tons of
guano annually. Much of this guano is worthless, being so when first ob-
tained, or having been washed in order to manufacture ammoniacal salts
for sale. The practice of washing guano is a common trick of trade, and
usually a safe one, since farmers never employ a chemist, and washed guano
can be bought at a comparatively low price. But even estimating all the
imported guano as equal to the best Peruvian, worth 50 per ton, it would
amount to but $2 ,293,450, which is less by $256,550 than the value of the
night-soil of the city of New York, as above estimated. Great Britain has
imported on an average during the last seven years 138,496 tons of guano
per annum, which, at $50 per ton, amounts to $6,924,800. The night-soil
of London and environs would yield annually nitrogen corresponding to
120,000 tons of best Peruvian guano, and would doubtless exceed the
amount of nitrogen imported. As long ago as 1834 it was estimated that
London wasted manure (principally night-soil in the Thames) to the amount
of $2,000,000 per annum. How much London or New York now wastes I
am not informed ; but all will agree that public health and the interests of
agriculture most earnestly demand a thorough sanitary reform in all our
cities and towns. [National Intelligencer.

Alexis St. Martin. We were gratified a few evenings since, in company
with a number of medical gentlemen, by a sight of the veritable individval
who was many years ago the subject of the experiments of the late Dr.
Beaumont, on digestion, and whose name has become so identified with
them in all works on that subject in every part of the world. He is a Ca-
nadian by birth, a man of about medium height, of dark complexion, and
rather bard features, now 52 years old, and bearing his age remarkably well.
He is a laborer by occupation, and never a soldier as has been supposed;
.and at the time of the accident which ended in making his name so fami-

1856.] Miscellaneous. 881

liar to the scientific world, was in the employ of the Hudson Bay Company.
The injury was produced by the accidental discharge of a gun, which car-
ried away a part of some of the ribs, and made an opening into the stomach
on the left side, and was so severe in its character as to threaten to prove
speedily fatal. There is now a fistulous opening, oblong in shape, about
an inch and a half in its longest, and three-quarters of an inch in its short-
est diameter, nearly in a line with, and about four inches below the nipple,
and between two and three inches from the cardiac orifice. It occurred in
1822 ; and since the experiments of Dr. Beaumont, St. Martin has enjoyed
uninterruptedly good health, and has supported a large family by manual
labor. He is now under the care of Dr. Bunting, an English surgeon, who
has made provision for the support of his family, and who proposes to take
him to Europe, where, we trust, he will be made the subject of more exten-
sive, more varied, and more accurate experiments than heretofore. We
also saw him again at the New York Hospital, where a few experiments
were tried, such as introducing a thermometer within the stomach, <fec.
We understand Dr. B. proposes to make him the subject of a public lecture,
for the purpose of realizing something for his benefit. We trust that the
opportunity of his presence among us will be improved for purposes of
science, and that something will also be accomplished towards relieving
him from the necessity of returning to manual labor. \N. Y. Med. Times.

A new view of the Law with reference to patent nostrums. The following
documents, taken from the New York Journal of Medicine, will sufficiently
explain themselves :

Buffalo, March, 1856.
Dear Sir : Will you do me the personal favor to furnish me with a
written statement of your views on the subject of copyrights for labels, etc.
as expressed to me in a conversation yesterday.

Coming from a gentleman of your rank and position, I am certain that
they would possess interest; and I would like to give them publicity
through some of our Medical Journals.

Sincerely Avishing that the public had many more such faithful servants,

I remain yours truly,

AURELIAN CoNKLING, Esq. FRANK H. HAMILTON.

District Court of the United States for
the Northern District of New York,
Clerk's Office,
Buffalo, March 18th, 1856.
Dear Sir : I am much obliged for the interest manifested by you in the
subject with which I lately troubled you ; and although it is probable that
in your politeness you over-estimate the importance of the views expressed
to you, and of those contained in my letter to the Hon. S. G. Haven, still
it is possible that they may be useful to others, and I therefore will proceed
to repeat them here, for such use as you may deem expedient. I am much
pleased with the polite interest you manifest in the subject under consider-
ation, because, I regret to say, I have heretofore experienced very different
treatment from some persons who have found their way into your profes-
sion, and who not only so far forgot their professional obligations, as to
manufacture nostrums, but were also guilty of low abuse of an officer

382 Miscellaneous. [June,

whose sense of duty would not admit of his being made instrumental, im-
properly, in imposing their mixtures upon the public.

The immediate purpose of my letter to our representative in Congress,
was to invoke the attention of the Department of State to what it seems
to me is a great abuse and perversion of the provisions of law in relation
to copyrights. The subject of copyrights is under the general supervision
and control of the State Department of the United States ; and officers
who have subordinate duties to perforin must, to some extent, be subject
to directions and instructions from that department. Applications are fre-
quently made to me, to record, under the provisions of law above alluded
to, labels of medicines, compounds and mixtures, of different grades of
pretension, from an " elixir of life " or a " diarrhoea cordial," to a hair-dye
or a corn-salve.

Upon the occurrence of the first application of this sort, a number of
years ago, being asked my reasons for refusing to treat the subject as one
embraced in the provisions of the act, entitled " An Act to amend the sev-
eral acts respecting copyrights," I made the following reply, a recital, in
part of which, will express the views which have ever since governed me,
.upon the subject :

" I am sorry that my views of the Act of Congress, above mentioned,
are such as to interfere with your interests or wishes. It is not the pro-
vince of the Clerk of the District Court to ' grant ' anything. His duties
.are ministerial, and upon the subject of copyrights he is bound to do what
he is directed to do, by the Act of Congress.

If I should record the label sent by you, and should send you a certifi-
cate of the fact, I would thereby ' grant ' you nothing, nor would you gain
anything, unless the act of Congress embraces such a subject.

I have examined, with considerable care, the Act of Congress above
mentioned, and I will state some of my views upon it ; from which you
will infer that I do not think proper to record a label under that Act.

My opinion is, that the ' map, chart, musical composition, print, cut, or
engraving,' must have a value as such, and be intended for sale as such ;
that, whichever it may be, print, cut, or engraving, it must have a title ap-
plicable to itself, which title is to be recorded.

I am also of the opinion, that the Act of Congress was designed to pro-
mote the acquisition and diffusion of knowledge, and to encourage the
production and publication of works of art, the general purpose being to
advance the people in civilization and refinement.

[ think, furthermore, that, by the act to which I have referred, Congress
did not intend to prevent the imitations of the stamps and labels of any
manufactured article, or goods, or merchandise. That is a subject of such
extensive interest and importance, that, if it had been the intention of
Congress, to embrace it in the provisions of the law, that intention would
have been distinctly and unequivocally manifested. It is not likely, how-
ever, that such a provision by Congress will ever be found so much out of
place, as it would be in 'An Act to amend the several Acts respecting
copyrights?

Furthermore, I am quite certain that Congress did not intend that this
Act should be so prostituted, as to be made instrumental in deluding the
ignorant ami inconsiderate, into the purchase and use of the various nos-
trums, catholioons and panaceas, which are so much worse than useless to
the community.

1856.] Miscellaneous. 383

It is the practice, I am informed, in many of the Judicial Districts, to
make records of such labels as are above mentioned, and I suppose it is
done to avoid the trouble and ill-will engendered by a refusal. It is en-
tirely clear, however, that such a practice is not in accordance with the
intention and design of the Act of Congress above mentioned ; and I have
no doubt that if the mischiefs of the practice were realized, it would be
discontinued.

The course of proceeding above mentioned is that by which almost the
whole number of the miscalled " patent medicines " are brought forth. It
would seem to be unnecessary to state, that there is no force or validity
whatever in this proceeding, for such pretended purpose.

There are means provided in the Patent Laws, for securing to any indi-
vidual the exclusive right to "any aew and useful art, machine, manufac-
ture, or composition of matter, or any new and useful improvement on any
art, machine, manufacture, or composition of matter," which he may invent ;
and the necessary requirements in order to accomplish the purposes are
clearly and definitively prescribed, as follows: -"But before any inventor
shall receive a patent for any such new invention or discovery, he shall de-
liver a written description of his invention or discovery, and of the manner
and process of making, constructing, using, and compounding the same, in
such full, clear, and exact terms, avoiding unnecessary prolixity, as to ena-
ble a person skilled in the art or science to which it pertains, or with which
it is most nearly connected, to make, construct, and use the same."

The Act also provides that the inventor shall accompany his application
"with specimens of ingredients, and of the composition of matter, suffi-
cient in quantity for the purpose of experiment, where the invention or
discovery is of a composition of matter." The Act also provides, that the
applicant shall make oath, that he does not know or believe that the com-
position of matter was ever before known or used. These and the other
requirements of the law being complied with, provision is made for a criti-
cal examination into the merits and character of the alleged invention ;
and, " if the commissioners shall deem it to be sufficiently useful and im-
portant, it shall be his duty to issue a patent therefor." This, it will be
perceived, is a very different course of procedure froin that of filing a label
in the clerk's office ; and a label, not even indicative of the character of
the compound it is to cover. The law it will be perceived, provides for a
truthful statement of the ingredients and proportions of every patented com-
pound. The purpose and effect of the provision are two-fold. In the first
place, the means are afforded for an intelligent and careful examination
into the compound, in order to determine whether it is worthy of the coun-
tenance of the government; and, secondly, after the termination of the du-
ration of the privileges, secured by the letters-patent, the necessary know-
ledge is at hand, to make the invention directly available to the public, by
furnishing to all, a knowledge of its ingredients and mode of preparation.
Moreover the " letters-patent" themselves, in accordance with theiy true
purport, contain a plain statement of these particulars. There is something
open in these requirements, and in the whole course of proceeding marked
out in relation to patents-, and the fact is, just as one would suppose, that
there are really very few " patent medicines." The medicines sold as such,
are, nearly all of them utterly destitute of any real basis for the pretense
under which they are imposed upon the public.

If the practice of recording labels of medicines should be discontinued,

384 Miscellaneous. [June,

in the clerk's offices, one important step will be taken towards clearing away
the delusion which prevails upon the subject. And if your profession, with
that true regard for the general public good which characterizes its worthy
members, will take the subject in hand, I have no doubt that you can obtain
the enactment of penalties against the sale of any medicines under the pre-
tense that the}1' are, when, in truth, they are not, patent medicines. There
has been legislation to prevent the adulteration of medicines; but, it seems
to me, that it is a more important end to shield the people against the
miserable mixtures, which, as things are now managed, are, by the appa-
rent encouragement of the government imposed upon them. I regret,
Dear Sir, that this letter has necessarily been so hasty ; I do not mean,
however, to intimate that its positions are not deliberately taken.
Very respectfully, your obedient servant,
Dr. Frank II. Hamilton. Aurelian Conkling.

CIRCULAR.

Department of State, )

Washington, April 11, 1856. )

Mr. ', Clerk of the District Court of the United States:

Sir The Act of Congress approved February 3, 1831, entitled "An Act
to amend the several Acts respecting copyrights," is " An Act for the
encouragement of learning, by securing the copies of maps, charts, and
books, etc.. to the authors and proprietors of such copies ;" and, inasmuch
as mere labels are not comprehended within the meaning of said Act, you
will, for the future, refuse, in all cases, to record or issue a certificate for
the same under said Act.

I am, Sir, very respectfully, your obedient servant,

W. L. Marcy,

The Influence of Occupation on Mortality. The attempts hitherto made
to determine the influence of professions on health are greatly reduced in
value, in consequence of the inadequate data on which they are based. If
Ramazzini and Thackrah could have known the facts of the last Census,
the observations resulting from their scientific and benevolent labors would
have had the authority of natural law. That Census sheds the light of
statistical truth on the relation of professions and occupations to mortality,
and brings out truths which no less extensive investigation would enable
the most sagacious observer to anticipate.

It will be an incalculable advantage to obtain, by means of the next
Census, a scientific deduction as to the effect of each kind of occupation on
mortality. As the initial step has been taken, we may expect it will be
followed by others, in a path which, if beset with difficulties, cannot be trav-
ersed without leading to the most important and beneficial discoveries.

The last Census Report gave the number of persons in each occupation
in 1861, and the Fourteenth Annual Report of the Registrar-General shows
the numbers in those occupations dying at corresponding ages. In this
early attempt to arrive at the ratio of occupation to the rate of mortality,
it has been found that a difficulty arises from the want of definition of the
various occupations, sufficiently clear and determined a difficulty which
can be overcome by giving more detail to future Census operations. It is,
for example, found impossible to distinguish the rate of mortality among
the different classes engaged in the manufacture of silk, of cotton, of linen,

1856.] Miscellaneous. 385

and of woolen, as great numbers of them are grouped together under the
designation of " Weavers." " Miners," whether in lead, iron, copper, or
coal mines, fall under one general designation ; and "Laborers," in the
field, or railways, in quarries, and on the roads, are not distinguished from
each other in the registers.

Still, there are certain occupations sufficiently defined to obviate all dan-
ger of their being confounded, and whose rate of mortality can now be
recorded with certainty. We give these classes at the decennial period,
ranging from 45 to 55,* as arranged in a Table (XVIII.) which shows the
advancing rate of mortality in twelve occupations.

1. Farmers. Of the twelve classes under consideration, Farmers are the
longest livers, their rate of mortality being not quite 12 in 1000 (11-99).
The number of English farmers of all ages in 1851, including 2429 graziers,
was 225,747, of whom there were 53,608 between the age of 45 and 55.
In that year, the total number of deaths among farmers of all ages was
6426, very much below the numbers which would have been registered had
these individuals been engaged in other pursuits. These facts prove that
the pure air, the daily exercise, the substantial fare, and the other aids to
health enjoyed by this substantial class, considerably modify the influence
of unfavorable weather, bad seasons, open ports, peculiar burdens on hand,
and all the other ruinous things which farmers' friends have been accustom-
ed to depict in such gloomy colors.

2. Shoemakers hold the next place to farmers, their rate of mortality
between 45 and 55 being 15-03 in 1000. They are followed by

3. Weavers - 15-37 in 1000.

4. Grocers - 15-79 "

5. Blacksmiths ------------- 16-51 "

6. Carpenters - - - - - 16-67 "

7. Tailors - 16-74 "

8. Laborers 17-30 "

As will be seen on inspection, there is among these seven occupations a
gradual increase in the rate of mortality, which, considering their great
diversity, is quite remafkable. The near approach of these occupations to
each other in the scale of mortality, arises from the circumstance that they
have peculiar dangers which tend to counterbalance each other. Thus it
is to be noticed, that " the tailor is not exposed to the explosions which are
fatal to the miner, and the laborer has exercise which is denied to the tailor."

Ascending this scale of danger we pass to
9. Miners 20-15 in 1000.

10. Bakers 21-21 "

11. Butchers 23-10- "

12. Innkeepers - 28-3'4 "

A great disparity is observable in passing from laborers into the class of
miners, telling a tale of dangers, many of which result from criminal neg-
lect. Between laborers and the last four classes in this table there is a most
remarkable hiatus. In the classes previously noticed, the difference in no
case is more than one in a thousand, and in some instances less. Here the
difference begins with three, and mounts up to nine, in a thousand.

* The decade from 45 to 55 is the only age to which the Census Returns have
been applied in the Fourteenth Annual Report of the Registrar-General. We shall
have still more important results when these returns are applied to earlier ages.

386 Miscellaneous.

The returns show that the highest rates of mortality are foutid among
the butchers (23-10 in 1000), and the class of Innkeepers and licensed
victuallers (28-34 in 1000.)

The extraordinary mortality of butchers is a fact for which we are indebt-
ed wholly to the last Census. The "red-injected face" of the butcher, has
produced a wrong idea as to the healthy nature of his occupation. This
idea is now corrected by scientific induction, and proper sanitary means will
overcome the evil thus brought to light. To quote the significant remarks
in the report conveying this fact, here is an important problem for solution :
" On what does the great mortality of the butcher depend ? On his diet,
into which too much animal food, and too little fruit and vegetables enter ?
on his drinking to excess? on his exposure to heat and cold? or, which is
probably the most powerful cause, on the elements of decaying matter by
which lie is surrounded in his slaughter-house and its vicinity?"

If the rate of mortality among innkeepers, licensed victuallers, and beer-
shop keepers should be seized with avidity by the advocates of teetotalism,
they must not be forbidden its use ; at the same time they must be remind-
ed, that " many highly respectable men of this class lead regular lives, and
are of steady habits ; but others, exposed by their business to unusual
temptations, live intemperately and enjoy less quiet at night than the rest
of the community. They are exposed also to zymotic diseases, by inter-
course with large numbers of people."

Startling and painful as are these disclosures, they cannot be too widely
published. They have a practical value among those who deal with the
average of life, for commercial or benevolent purposes ; while, to those more
specially concerned, they show the necessity, for their own safety, of em-
ploying the measures by which unnecessary disease and premature death
may be obviated. \_Med. Times and Gazette.

Prize Essay on Cholera Infantum. The successful essayist for the prize
of $100, offered by the New York Academy of Medicine, for the best paper
on Cholera Infantum, was James Stewart, M. D., of this city, author of the
popular work on the Diseases of Children. Dr. Stewart, in acknowledging
the award, generously directed that the sum be paid to the Treasurer of the
Children's Nursery. [W. Y.Jour. of Med.

Ccesarean Section. Dr. D. F.Owen reports (Charleston MedicalJournal,
March, 1856) a case in which the Caeserean section was performed by Dr,
W. H. Merinar, of Miss., for the third time on the same individual. A liv-
ing male child was extracted. The mother died on the fifth day after the
operation. [Ibid.

Manuscript of the Elder Pliny. Dr. F. Mold, Professor at the Univer-
sity of Heidelberg, is stated to have discovered in the Monastery of St.
l'aul, in Corinth, a manuscript of the elder Pliny, containing nearly the
whole of the seventh part of the Natural History, lib. 11 to 14. [Charles-
ton Med. Journal.

SOUTHERN

MEDICAL AND SURGICAL JOURNAL.

(NEW SERIES.)

Vol. III.] AUGUSTA, GEORGIA, JULY, 1856. [No. 7.

ORIGINAL AND ECLECTIC.

ARTICLE XVIII.

LETTERS FROM SAML. D. HOLT, M. D., UPON SOME POINTS OF GENERAL PATHOLOGY.

LETTER NO. 12.

Montgomery, Ala., April 28th, 1856.
Messrs. Editors- Having dwelt at sufficient length upon the
general pathological conditions which usually belong to, and dis-
tinguish the more malignant diseases in the South, I may be
permitted in a few words to recapitulate some of the leading prac-
tical points for which I have contended namely, that they are of
different character, and require different treatment from the same
diseases, as they usually appear in other and more northern lati-
tudes. That for the production of any given disease, the same
general cause, or set of causes, are required, and the disease thus
produced in its simple elementary or typical character, will be the
same, at all times, and in all places, and that the difference in their
character, their modifications, and complications, as observed in
different localities, depend, not upon the cause which produces
them, but upon causes which have acted antecedently, or conjoint-
ly, or which have been superadded to the exciting cause. Hence
an intermittent fever, a pneumonia, or a dysentery, will require
for their production the same general causes in Boston, Philadel-
phia, Montgomery and New Orleans. But from the influence of
climate, the long-continued action of high ranges of atmospheric

X. S. VOL. XII. NO. VII. 25

388 Holt's Letters upon General Pathology. [Juty>

heat, and other causes, which tend to produce nervous depression,
and to derange the functions of the liver and other organs, which
stand in immediate or intimate relation to it, these diseases will
assume very different characters and present very different aspects
in Montgomery or New Orleans, from the same diseases in Phila-
delphia or Boston, and will require a corresponding modification
of treatment; and so of all other diseases.

Dr. Wood, of Philadelphia, has stated that he never saw a case
of malignant, or pernicious intermittent, or remittent fever, except
in the hospital, among sailors recently from the southern coast, or
among medical students from the South or south-western states ; yet
he has, no doubt, seen many cases of simple intermittent and re-
mittent fever. And the reason is, that in Philadelphia, though
sufficient cause may exist to produce a simple intermittent, there
is an absence or want of the causes necessary to create a predispo-
sition to malignancy in them; and our southern students and
sailors having been long subjected to the influence of causes which
tend to impair the general vigour of the system, and create a pre-
disposition to the condition of depression and congestion, when
exposed to the influence of the causes which, in Philadelphia, pro-
duce only simple intermittents, have developed in them the most
malignant and complicated forms of the disease.

The causes of malignancy in these diseases are little less observa-
ble in the influence of seasons, than in climate and latitude, as the
milder and more simple forms of the spring season may be per-
ceived gradually to change, as the season advances, to those of a
more violent and complex character, until the fall season, when
they reach their greatest malignancy. Such is the course of these
malarious affections, in our southern latitudes, when uninfluenced
by the prevalence of epidemic causes, to which they are at all
times liable.

Now, I will not attempt to deeide the question, whether the
greater malignancy of these affections depend upon the gaeater de-
gree of concentration and virulence of the malarial poison, which
is supposed to produce them, or upon the causes, wihch are neces-
sary to generate the poison, acting directly upon the animal system,
"in conjunction with the poison,, impairing its tone and vigor,, thus
laying the foundation for, or creating a predisposition to,, the con-
dition of depression and congestion, which, with the functional
derangement of the Ever, consequent upon the same causes, deter-

1856.] Holt's Letters upon General Pathology. 389

mine their greater malignancy. Eeason and observation incline to
the latter conclusion ; for if we take the case of the sailors and med-
ical students, coming from the South, in Philadelphia, we see the ma-
lignant forms of disease excited in them by causes, which in others
(where no such predisposition existed) could excite only the milder
form of the disease. Now, if it should be contended that these
cases, and similar ones, such as our pneumonias, dysenteries, and
other like diseases, which occur in the fall, winter and spring, de-
rive their malignancy from the presence of malarial poison in the
system, I would reply, that it is not reasonable to suppose that a
poison capable of producing such terrible results, could lie dormant
in the system for weeks, and even months, without manifesting
some signs of its presence, and then, under the influence of some
slight exciting cause, develope all its pent-up fury. The laws of
physiological chemistry would forbid such a thing, as the poison
would, ere long, be eliminated from the system, or shorn of its
virulence-. The more reasonable hypothesis is, that the character
of all these affections is determined by the predisposing and not
the exciting causes, but that they acquire force from each other,
in the manner which has already been explained. To place this
matter in a stronger light, I will suppose two men, equal in gen-
eral respects, one taken from the hills of New Hampshire, and
the other from the bayous of Louisiana, to be inocculated with
small-pox virus, taken from the same subject at the same time; it
would be but reasonable to suppose, (believing that all diseases, in
a malarial region, are subject to the influence of the causes which
produce malaria,) that whatever differences might exist in the
character of the two cases would depend upon the influence of
climate, and not upon any difference in the nature of the exciting-
cause. In both cases, small-pox, in its suigeneric character, would
be the result ; but the probabilities are, that the New Hampshire
man would have a highly inflammatory form of the disease, with-
out complications, and would require antiphlogistic and sedative
treatment while the Louisiana man would have a low congestive
form, attended with biliary and other complications, and require
the use of stimuli and tonics. Apply the same argument to the
cause, whatever it may be, which produces yellow fever. We
hear it asserted, and it is generally believed, that the character of
yellow fever is mild or malignant, according to the virulence of
the cause which produces it. Is this proposition true? I am

390 Holt's Letters upon General Pathology. [Jutyi

willing to admit, that the cause which produces yellow fever may-
be generated in much greater abundance, and affect a mucb great-
er number of persons at some times, and under some circumstances,
than it does at others; and though it is a malignant and fatal dis-
ease in its tendencies, at all times, it sometimes becomes much
more so. But I am not prepared to admit that these results de-
pend upon the more concentrated and virulent character of the
poison, whatever it may be, which produces it, but my position
is this; that yellow fever possesses an essential typical and stiigen-
eric character, having for its production the operation of a specific
cause, which, like the causes which produce small-pox, measles, or
scarlatina, can only produce them in their simple, essential or
suigeneric character, in which, if divested of all adventitious or
extrinsic causes and influences, they would universally be the
same. But as such a thing would be impossible with respect to
yellow fever, and not much less with the others, I am compelled
to believe that the different forms and modifications which yellow
fever assumes, depends upon the adventitious influences which
surround it, and not upon the cause which produces it. The most
common and universal of these are such as relate to the person,
and which modifies the disease to some extent in each individual
case, independently of the influences which determine the general
character of the disease.

All diseases are subject to the influence of these individual pre-
disposing causes, and none exhibit their influence in a more marked
degree, or show so clearly their modifying influence, independently
of the action of the specific or exciting cause, as does scarlatina, it
being not unfrequently the case that we observe in the same fami-
ly, and even in the same room, and at the same time, almost all
grades of the disease, from the mildest and most simple, to the
gravest and most malignant forms. Now, it cannot be contended,
even upon the slender foundation of a probability, that the great-
er malignancy of these cases depends upon the greater virulence of
the exciting cause ; and even if they should all be of that charac-
ter, it would furnish no conclusive evidence that the exciting cause
was more virulent, but that the extrinsic and modifying influences
were more potent and active.

However interesting and important, in a practical point of view,
may be the enquiry into the nature of the specific causes of disease,
and the individual predisposing causes which modify them, I am

1856.] Holt's Letters upon General Pathology. 391

admonished, that to avoid the charge of indulging too freely in
etiological speculations, abstractions and subtleties, it is proper that
I should follow out my original design of endeavoring to point out
the peculiar modifications and complications of our southern dis-
eases, which result from the operation and influence of general pre-
disposing causes, and of urging upon southern practitioners, the
absolute necessity of watching carefully the changes which from
time to time they undergo, and of conforming their practice to the
general pathological condition which exists, modifying it to suit
the exigencies of each case.

In describing these diseases, I shall not follow the plan which
has usually been adopted by systematic writers, of giving in regu-
lar detail, all the causes, symptoms, and distinctive features the
modes of treatment and prevention their terminations, &c, &c,
which make up their complete history in their simple elementary
or typical character, presuming that every physician is familiar
with them in that character, which, as I have before stated, is
universally the same, when not modified by adventitious influ-
ences; but shall describe them only in their modified and compli-
cated forms, according to their general pathological character, and
the classification which I have adopted, observing, however, ac-
cording to the relation of these diseases, the order of arrangement
adopted by the systematic writers generally. The first which
come up in that order, are

Intermittent and Remittent Fevers. My reason for coupling these
: two diseases, is, that they possess no appreciable pathological dis-
i tinctions which entitle them to a separate consideration : they
i result from the operation of the same causes, though perhaps from
different degrees of intensity are subject to the same modifica-
- tions and complications, and in many instances assimilate each
other so closely that it is a difficult matter to draw a distinction
i between them ; especially is it so with respect to those of the quo-
tidian and the double tertian types, which may be said to include
: all their malignant forms and varieties, whether it be their original
i tyPe) or whether they may have changed to one or the other of
those types during their progress. It will not be amiss to include,
with these the double quotidian; but this type is of comparatively
:' rare occurrence, except in the diseases of children; and so far as
any modification of treatment would depend upon the distinction,

392 Holt's Letters upon General Pathology. [Jutyf

whether in a child or an adult, it would matter little whether it be
classed as intermittent or remittent. When the intervals extend
beyond* the types, the similitude between intermittent and remit-
tent fever in a great measure ceases, and I doubt very much
whether there is such a thing as a remittent fever of the tertian,
much less of the quartan types ; and when these fevers, with long
intervals, assume a malignant cast, (which is not often the case,) it
is generally the result of individual predispositions, or of some
controlling epidemic influence.

Now, with respect to the type of these diseases, and the periodic
character of all malarial diseases, it is necessary that I should say
something, for the reason, that a knowledge of this peculiar phe-
nomenon, not only enables us to understand them better in their
true, essential character, as well as in their modified and complex
forms, and also the source from which they spring, but also enables
us to treat them with a certainty of success which could never be
attained without such knowledge ; and I feel very certain that
success often depends as much upon the timely application or ad-
ministration of a remedy, as it does upon the nature and the thera-
peutic property of the remedy itself. Hence I would insist that
no practitioner in the South, however skilled he may be in the
treatment of malarial diseases, can be too well versed in a know-
ledge of the laws of their periodicity, which is the key to success,
whether in the treatment of the milder and more simple, or in
warding off and combating the more malignant and complex
grades.

In noticing this phenomenon of periodicity, I shall not presume
to attempt, what so many wiser heads have failed in, to give a
satisfactory explanation of its cause. Having, however, an idea
with regard to its nature, it cannot be regarded an act of temerity
in me to express it, which is this: that while the general system is
known to be governed by the laws of periodicity in the perform-
ance of many of the vital functions, as observed in gestation, men-
struation, &c, which periods arc but the multiplication of a certain
number of shorter, or diurnal periods, the brain, and animal
portion of the nervous system, under the influence of diurnal
revolutions, and of sleeping and waking, is seen to alternate be-
tween a state of activity and repose, whereby it becomes reinvig-
orated while the organic portion of the nervous system, though
often excited, never acquires less than a passive state of activity,

1856.] Holt's Letters upon General Pathology. 393

-.as the laws of vital action forbid a state of perfect rest. Hence it
is, that in non-malarial regions all diseases may show certain signs
of periodicity, during the twenty-four hours of a paroxysm, mark-
ed usually by an increase of excitement, while in malarial regions
the periodicity will be marked by the signs of depression : hence,
I infer that the cause of such periodicity as belongs to non-malarial
diseases, should be ascribed, in most part, to the influence of diur-
nal revolution, with, perhaps, some degree of reinvigoration of the
animal nervous system, while the periodicity of malarial diseases
should be ascribed to the depressing influences of malaria upon the
organic nervous system, and the influence of diurnal revolutions
combined. Now, if this explanation is not more satisfactory than
the hundred others which have been given, it is at least in con-
formity with what I have said on a former occasion, namely, that
malaria, the supposed product of heat, moisture, and decomposing
vegetable matter, acted chiefly upon the oaganie nervous system,
jprodueisag diseases whose most prominent characteristic is periodi-
city; and that the non-malarial, or those which were produced
from epidemic influences, animal effluvia, and other causes, which
act manifestly with more force upon the brain and animal nervous
system, exhibited none of the signs of periodicity, unless they
were combined with strong malarial influences, under which they
sometimes lose their essential suigeneric character.

To pursue the subject of the particular types of intermittent and
remittent fevers, of which there are three single, three double, and
a number of complex, which are not necessary for me here to
enumerate. The single types are the quotidian, the tertian, and
the quartan having, respectively, intervals of twenty- four, forty-
eight, and seventy-two hours, from the commencement of one
attack or paroxysm, to the commencement of another, according
to the type; the quotidian occurring every day, about the same
hour; the tertian occurring every other day, about the same hour,
and the quartan occurring every fourth day, or at intervals of
every seventy-two hours. The double quotidian has two par-
oxysms in twenty-four hours, occurring each day abou|; the same
hour. The double tertian has a paroxysm each day, occurring
one day in the morning, and the next day in the evening, and so
on, the paroxysms on alternate days corresponding with each
other. The double quartan has a paroxysm on two successive
days, none on the the third, and one again on the fourth, and so

394 Holt's Letters upon General Pathology. [July?

on, every seventy-two hoars. A feature in these types worthy of
note, is, that the longer the interval, the shorter is the paroxysm;
and, inversely, the shorter the interval, the longer the paroxysm.
Thus, the paroxysm of a quotidian will often occupy eighteen out
of the twenty-four hours a tertian will occupy from ten to twelve,
and a quartan from six to eight hours. Another feature worthy
of observation, is, that each paroxysm, of whatever type it may
be, if intermittent, will terminate within twenty-four hours; but if
remittent, it may go on to twenty-four, thirty-six, forty-eight, sixty,
and seventy-two hours, corresponding in its exacerbations and
remissions to its intermittent prototype. As these types, however,
are subject to change, and are more often obscured by extrinsic or
adventitious influences, without being really changed, and as it is
sometimes a matter of the utmost importance to obtain aud pre-
serve a knowledge of the true type, much advantage may be
gained by ascertaining the time of day when the attack commenced,
and watching carefully the duration of the first paroxysm. If,
therefore, an attack commences in the morning, and continues for
fifteen or eighteen hours, we may safely conclude that it is a quo-
tidian; if the parox}'sm commences in the morning or forenoon,
and lasts ten or twelve hours, we may infer that it is a tertian, or
a double tertian ; and if it occurs in the evening, and lasts about
the same time, say eight, ten, or twelve hours, we may rely very
confidently on its being a double tertian ; and if it occurs in the
forenoon, and continues only for six or eight hours, we may as
certainly depend upon its being a quartan, or other type of long
interval. With regard to the triple, quadruple, and other complex
types, not being familiar with them in practice, I know of no gen-
eral rules by which they could be recognized, when masked or
obscured. A knowledge, however, of the prevailing type, will aid
in arriving at a knowledge of the true type of these obscured or
masked intermittents.

A curious, and not unimportant fact connected with intermit-
and remittent fevers, is, that an attack seldom or never comes on
during the hours of the night. This fact may serve to show that
the organic nervous system, which is always more active and busy,
in proportion, while the animal nervous system is at rest, is better
able to resist the depressing influences of malaria at such time,
but succumbs more readily to its influence when the animal pow-
ers resume their accustomed sway. It may serve to show, also,

1856.] Holt's Letters upon General Pathology. 395

that the animal powers are less impressible by the influences of
malaria, otherwise they would fall an easy prey to its influence
during the hours of their repose, but such, we see, is not the case ;
and we may safely infer that fevers, which have their accession
during the hours of the night, are not of malarial origin. But how
stands the case, with respect to the action of epidemic influences,
animal effluvia, and such other causes as are known to act more de-
cidedly upon the animal nervous system, and whose power it may
be able to resist, while in a state of activity, during the day time,
but to which it falls an easy prey at night, when in a state of rest.
Take yellow fever, for example, which we suppose to be the pro-
duct of a specific animal effluvium, and we see that the attacks of a
large proportion, if not a majority of those cases which are more
clearly defined in their essential typical or typhoid character, take
place during the hours of night, while those which occur during
the day, often afford unequivocal evidences of a malarial influence
from their manifest tendency to assume the character of periodici-
ty. These facts, if such they are admitted to be, lend support to
my ideas with regard to the periodicity of disease, and leads us to
the inference, at least, that malaria, though it may modify, has no
positive agency in the production of yellow fever, in its essential
typical or typhoid character.

But, finding myself digressing, and handling a subject which
perhaps should have been reserved for a more appropriate occa-
sion, I will conclude my remarks upon the periodicity of disease,
by relating the particulars of a case, which will tell, in stronger
terms than words could express it, the importance and necessity
of a proper knowledge of the types of periodic diseases, and the
danger which often results from a want of such knowledge, as oc-
curred in the case which I am about to relate.

Miss , a young lady about 17 or 18 years of age, of prepossessing

manners, possessed of intelligence and a remarkably fine flow of spirits, and
in the full enjoyment of health, beauty and loveliness, was attacked on the
10th January last with a slight chill and fever, for which her parents gave
her a little blue mass and quinine, and she had no return of it. But from
that day, to the time when I was called to see her, which was on the 25th
of February, her health gradually, but very perceptibly, declined ; the rose
left her cheeks and the coral her lips, and she now presented a perfect
specimen of anaemia, or leucocythemia, having rather the appearance of
bleached wax, than of flesh and blood. At this time I obtained the parti-.
cularsofher first attack, up to which time she had been perfectly healthy,
without disturbance or interruption in any important function, as might

396 Holt's Letters upon Gerieral Pathology. [July,

have been presumed from her condition ; but after this time, her strength
gradually declined, and though she continued her ordinary pursuits, slight
exercise produced fatigue ; her appetite became impaired, and her sleep
less quiet and refreshing. She suffered no pain or soreness, but at times
felt an uneasiness at the stomach, and sometimes an inclination to vomit.
The tongue was clean and natural in appearance; the bowels were consti-
pated; the urine limpid and abundant; the catamenia regular, but pale
and almost colorless ; the liver and spleen free from soreness or enlarge-
ment ; the spirits cheerful, the mind sprightly, and the pulse generally
regular and natural, though rather feeble.

Upon the best view which I was able to take of the case, finding no par-
ticular organ to whose account I could lay the charge of the mischief,
though I suspected it to be the result of the cause which produced the
chill in the first instance, there being no discoverable signs of periodicity
about the case, and not suspecting the cause to be still at work, I directed
my treatment to a restoration of the tone and vigour of the general nervous
system, by enriching the blood, and restoring its healthy constitution at
the same time. So, after the action of pills of blue mass and colocynth, to
relieve the constipation, (which they failed to do,) I put her upon a gener-
ous diet, with porter, and moderate quantities of Champagne wine, or
brandy, and pills of quinine, ext. of gent, and iron. Under this treatment,
which seemed to me to be rational, she perceptibly grew worse from day
today, until Sunday, the 2d of March, when she took her bed for the first
time, except for the purposes of rest. At this time the symptoms became
more violent ; the stomach was irritable, with frequent vomiting of thin,
bilious matter, with flatulence, and pain at the pit of the stomach; consti-
pation continues, with some pain in the course of the colon; considerable
thirst; some slight evidences of nervous disorder, or rather of desponden-
cy, and the pulse frequent and somewhat irritable. These symptoms con-
tinued to recur, with more or less violence, for which I prescribed various
remedies, and devices such as, sinapisms and enemata, and salts, senna
and manna, to act on the bowels ; lime water, soda, creasote, morphine,
&c, for the relief of the stomach, pains and flatulence; but all, with little
or no good effect, with the exception, perhaps, of the morphine.

On the 4th, finding her condition worse, with an evident downward ten-
dency, and the inefficiency of the remedies which I had used to restrain the
vomiting, or move the bowels, which had not been done for several days,
notwithstanding her enfeebled and ansematous condition, I determined to
resort to calomel, and accordingly gave her 30 grains, which had the
effect of stopping the vomiting, and producing two evacuations from the
bowels. But, notwithstanding the favorable action of the calomel, on the
morning of the 5th she had a chill, which so completely prostrated her,
that she could not be moved without endangering her from syncope, and
I feel confident she could not have survived another ; but this one, dan-
gerous as it was, proved to be the means of her safety, for I saw at once,
from what had transpired in the last few days, that she was laboring under
the baneful influence of a double tertian intermittent, a paroxysm of which
could be distinctly traced from Sunday evening, up to Wednesday morn-
ing; and upon her own review of the case, she could confidently refer to
her better and worse feelings, in the forenoon and afternoon, of alternate
days, from the very beginning.

1856.] Holt's Letters upon General Pathology. 397

With the new lights now before me, I proceeded accordingly. I had
30 grs. of calomel and 30 grs. of quinine made into twelve pills, and di-
rected one pill to be given every three hours ; and in addition, as soon as
the violence of the paroxysm had passed, I ordered some chicken soup,
which she relished, and retained well. At night I gave | gr. morphine,
and 10 grs. quinine.

On the morning of the 6th, her condition was improved ; but as the
battle was to be fought in the evening, by way of preparing her for it, I
ordered 5 grs. quinine to be given at 6 o'clock, 5 grs. at 9 o'clock, and 5
grs. at 12 M. At 2 o'clock P. M., I had her enveloped in blankets, and
surrounded completely with bottles of hot water, and so kept her until
about 5 o'clock, when she was completely drenched with perspiration ; I
then had them gradually removed, her clothing changed ; ordered her a
cup of tea, and a gr. of morphine, and directed 5 grs. quinine to be given
at 12 o'clock, 5 grs. at 3 o'clock, and 5 grs. at 6 o'clock, and the bottles to
be re-applied, as before. By 8 o'clock, on the 7th, she was in a full per-
spiration ; at 9 o'clock, I commenced having the bottles removed, with the
extra covering; by 12 o'clock, she was comfortable; and from this time,
when I considered her danger and disease, alike^ at an end, she continued
to improve. Having taken all the calomel and quinine pills, and had two
or three proper evacuations, there was no further need for their continu-
ance.

I apprehended that, in her anaemic state salivation might take place, but
there were no signs of such an occurrence. As a measure of safety, I di-
rected 10 grs. of quinine, to be given on the septenary days, or at night,
preceding the morning paroxysm of the septenary days, until the fourth,
or twenty-eighth days had passed. I also put her again upon the course
of medicine and regimen which I had at first chalked out, but with better
success, as under it she has gone on steadily to improve, and she now
enjoys rather more than her usual health, as there is somewhat more of
her to enjoy it, having gained considerable upon her former weight, and
lost nothing in other respects, being one of the most lovely girls that Mont-
gomery can boast.

I have related this case, with the hope that it may be the means
of helping some junior, or even senior brother, who may become
similarly involved, out of the dilemma and state of perplexity in
which I found myself involved in this case, for I do not hold to
the truth of the aphorism, that "all is well which ends well."

The subject of " Intermittent and Eemittent fevers," will be
continued in my next.

As ever, yours, Saml. D. Holt.

398 Billingslea's Appeal. [July,

ARTICLE XIX.

An Appeal on behalf of Southern Medical Colleges and Southern
Medical Literature. By Jas. C. BlLLINGSLEA, M. D., of Foster's,
Tuscaloosa Co., Alabama.

Most , persons might think that this communication should be
made through the medium of a popular newspaper, but as phy-
sicians are more nearly interested, than any others, on this import-
ant subject, I have chosen your journal, through which I desire
to call the attention of southern physicians to the necessity of
patronizing our southern institutions, and our southern medical
journals. The necessity of this patronage is demanded, not only
by the political aspects, which are now presented in these United
States, but also by humanity.

First, let every southern ph}^sician ask himself, how much of
patronage is bestowed on our southern literature by our northern
brethren; and also, what views they as Northern men entertain
towards us as Southerners. There is scarcely any article emanat-
ing from a southern pen, which is republished in the Norih, it
matters not how much of merit it may possess. But on the
other hand, see how they are treated by us in return. Our south-
ern journals republish every thing, which they think would ad-
vance the science of medicine, without any regard to the geogra-
phical location of the author. All they seem to care for, is our
patronage, and don't extend to us the same in return.

If we were so poor in medical literature, and so wanting in
great minds, whose thoughts are reflected by their writings if
we were destitute of these, and of colleges wherein our young men
could be trained, and instructed iu all that would make them use-
ful in life, then I would say, of course patronize northern institu-
tions and journals, for it is the best you can do. But on the
contrary, we have medical colleges, which in point of mental
endowments can compare favorably with any in the world. We
also have medical journals, which, to the southern physician, are
always filled with matter of interest and profit. And as our
northern brethren seem to ignore everything southern, simply
because we are slaveholders: and as scientific men North, can so
far forget their duty, as to lend their aid substantial aid and
their voices, to the getting up and sustaining of colonization

1856.] Billingslea's Appeal. 399

societies, for the avowed purpose of prohibiting the extension of
our domestic institutions, we, as southern physicians, should with-
hold our patronage (which is not small), both from their colleges
and their literature. They would then feel, very sensibly, the
extent of our influence. For hundreds of our young men are sent
North, annually, to be taught in their colleges, who spend their
money most lavishly among them, and return to hear themselves
and their institutions traduced, and to see their literature slighted.
But, as I said at the outset, there is another weighty (and I may
say more important) reason, aside from politics. I said humanity
demanded the support of home institutions. (Now I want none
of my professional brethren, who claim anorthern college as their
alma mater, to take offence at what I shall say.) I say, humanity
demands it for the simple reason, that those young men who ex-
pect to practice South, with any degree of success, should be
taught in our Southern colleges; because our practice here, in the
most of out malignant diseases, is entirely different from that
taught in northern institutions, and by northern writers. I con-
stantly meet with physicians of eminence, who graduated North,
who have long since abandoned the most of the fundamental
principles of practice, as taught them in the lecture roomr because
they have learned, by experience by observation at the bedside,
and by communing with southern writers, that they were unsuit-
ed to the diseases as they met them in this climate. It is in vain,
to appeal to the young men, or their parents, not to send them
North to study medicine, for they are almost invariably governed
in their choice of a school by their preceptors. And it is a la-
mentable fact, that these same preceptors generally advise them to
attend lectures where they happened to graduate; and so this
institution is handed clown to the student's student, and so on, as
a sort of heir-loom. At the same time, these physicians, not want-
ing in medical attainments or practical skill, which they have
acquired by long study of the diseases common to our climate, at
the bedside, will acknowledge, when you appeal to their candor
and to their patriotism, that we have equally as good schools (or
even better), for conveying practical information, as they have
North. Some of these brethren will, however, only admit, that as
our diseases are so different from those at the North, and requiring
such different treatment from those, that the student at least should
attend one course of lectures South. NowT this admission, of itself,

400 Billingslea's Appeal [July,

should be enough to convince the student, that if one course South
is important, both are more so. For why send your student
North, when he will have to commence the study of practice when
he gets back, after finding out, by experience, (bitter and morti-
fying as it sometimes is,) that it will not do to put in practice the
theories taught him in his alma mater? You are doing him
a great piece of injustice when you do so. It will be borne in
mind that a large number of our physicians live in the country,
or in country towns, in the midst of large plantations, and where,
of course, the slave population preponderates largely ; and that
owing to the exposure of this class of people to the vicissitudes of
the weather, the southern physician is called more frequently to
visit negroes than whites. And as it has been contended, most
ably, by Dr. Cartwright, and others, (and not without reason,) that
the distinctive peculiarities of the negro race call for a different
mode of treatment than that best adapted to the whites, I would
ask, where are our students to learn this peculiar practice ? Cer-
tainly not in northern institutions! certainly not from northern
journals! As to the study of the rudiments of the science of medi-
cine, (Anatomy, Physiology, and Chemistry,) they can be learned
North, as well as South, for they are the same everywhere. Again,
there is no material difference in the practice of Surgery or Mid-
wifery, North or South ; but the great difference is in the treatment
of our malignant diseases, which, when treated even on the most
approved plans, kill thousands; and this approximation to the suc-
cessful can only be attained readily by attending southern lectures,
and reading southern authors. Then, where is the necessity of
deserting our home institutions, or our home literature, and swell-
ing the catalogues of those northern schools with the names of
your pupils, and the pockets of those who conduct them with their
money, when you have medical colleges at your door, where
Anatomy, Physiology, Chemistry, Surgery, Midwifery and Thera-
peutics are taught as well, and where practice is taught better?
For a man had better never be taught than to be taught wrong.

To the southern student we would say, you can have the satis-
faction of spending your means in supporting southern institutions,
*and southern talent, and at the same time get value received.
We do not pretend to say that the fault is in northern Professors,
for teaching you such practice, as not adapted to this climate;
for they teach such theories as they think best to be practiced

1856.] Billingslea's Appeal. 401

in their climate, and the fault lies in you for going there to be
taught.

To prove what I say in regard to our southern institutions being
equal to any as to facilities, I have only to point you to the alumni
of the Louisville, Charleston, Augusta, Nashville, Memphis, New-
Orleans, and of other colleges, who are now enjoying in our citiesr
in our towns, and throughout the country, most enviable reputa-
tions as practitioners, as writers, and as lecturers. The South
should awake to the necessity of favoring home institutions, which
are springing up so rapidly, and are generally self-supporting*
The founders of, and instructors in, these institutions call loudly
for your support. Georgia has now one old and well-established
medical college, and several others in their infancy; and though
it has been said that the medical college located at Augusta was
defunct, its list of graduates for the present year numbers more
than we have ever seen before ; and I rejoice to learn bat it was
never in a more flourishing condition, and never better prepared to
impart a thorough and practical knowledge of the science of medi-
cine than at present. This institution still lives to see her gradu-
ates occupying the Professor's chair in other colleges. Charleston,
Nashville, Louisville, and New Orleans, all offer rare inducements
to the southern student. New Orleans excels any in the U. States,
and I might say, equals any in the world, in hospital and clinique
facilities. There the Charity hospital is open at all hour&during the'
whole course of lectures, where the student may see hundreds of
patients daily, suffering from all the ills that u flesh is- heir to."
He can see the practice of the professor or physician whose ward
he may visit : he can take notes watch the patient see the re-
sult; and if the disease proves fatal, he can follow the body to the
dead house, with scalpel in hand, and there examine for himself
to see if the diagnosis was correct. In this respect, New Orleans
outstrips all her sisters. But in the majority of our southern col-
leges, the instructions are very thorough, and a young man even of
medium talent and application will most always come out of them
a good practitioner.

As to Literature,, we have most excellent periodicals, conducted
by the most accomplished and scientific members of the profession,
and contributed to by the best southern talent, which will com-
pare favorably with any in the United States, both in style and
matter. Indeed, each number of them is full of matter of vital

402 Remedial and Anaesthetic uses of Intense Cold. [July,

interest to the southern practitioner. There is the New Orleans
Medical and Surgical Journal, published bi-monthly, and edited
by B. Dowler, M. D., which is always full of interesting and sci-
entific matter, and each number is worth the subscription price for
one year. There is the Southern Medical and Surgical Journal,
published at Augusta, Ga, and edited by Prof. Dugas and H. Ros-
signol, M. D., which is one of the most interesting monthlies extant,
supported mostly by southern patronage. There are also the
Charleston, Atlanta, Memphis, and other southern journals, which
deserve greater credit and better patronage than they receive. So
we can't say we have no literature worth supporting.

This article is already more length}' than at first designed. In
conclusion, let me say to my brethren, let us not patronize those
northern schools and northern works, simply because "distance
lends enchantment" to them, to the neglect of our own. Besides
medical colleges and medical literature, the arguments here used
will apply equally to literary institutions, periodicals and journals,
which are also largely patronized by the South ; but I do not pro-
pose to notice these more fully, but will leave it to others.

My object is to get the profession to change their misguided
system of patronizing /o/'eu^i establishments, when we have as good,
yea, better at home. My task is done, but imperfectly so ; but if I
can,: by these few desultory thoughts, hurriedly thrown together,
set the profession to thinking seriously upon this subject, and per-
haps elicit something on my side from more able pens, then we
may look soon for a reform, and then my object will be achieved.
In this, I disclaim all intention of wounding the feelings of any
one, or of drawing any invidious distinctions between southern
institutions or journals. All I want, is to impress upon my south-
ern brethren the necessity of educating their students South, if they
intend practicing their profession South. But if they design loca~
ting North, I also say send them North to study.

Remedial and Anxst/ietic uses of Intense Cold. By James Arnott,
M. D., London.

Although the subjects of the remedial efficacy of congelation
and local anaesthesia from cold have been for some years before
the public, they are as yet but little understood and appreciated.
This has resulted partly from their having been imperfectly ex-

1856.] JRemedial and Anaesthetic uses of Intense Cold. 403

plained, in consequence of the publications respecting them being
severally incomplete, and partly from the strength of the preju-
dice against extreme cold. Dr. Rowley, Avho in his attack on
cowpox, declared that the accounts which he had heard of the ter*
rible effects of communicating the " cruel and beastly" disease
Were enough to " freeze the soul," was probably not more horror-
striken than some have been by the proposal to freeze the body ;
and the introducer of vaccination was hardly more abused than
the proposer of congelation has been. It is in the hope that this
prejudice may be thereby abated, and the subject rendered better
understood, that the following brief statement is published. Even
in France, where both the remedial and anaesthetic uses of in-
tense cold have been turned to account for some time by M. Vel-
peau and other leading practitioners, there is still much doubt
about the best mode of applying the agent. In a paper in the
Bulletin de Therapeutique of the 15th ultimo, M. Richet, Surgeon
of the Hospital Saint Antoine, in Paris, reports thirteen operations
in which local anaesthesia had been produced by the very imper*
feet means of the quick evaporation of ether.

As no remedy has been longer in use, and few are more valued
than the local application of moderate degrees of cold, or a tem-
perature ranging from that of dissolving ice to about 70 of Fah-
renheit, it may at first appear singular that a greater or more pow
erful remedial effect should not have been sought by increasing
the dose of the agent, or employing a lower temperature, in the
same manner as we have sought and found much greater remedial
benefit in many cases by using mercury, antimony, quinine, and
other drugs, in larger doses than had been customary. The
reason is, that medical men were under a most erroneous impress
sion respecting the effects of very low temperatures on the body.
Because a temperature of zero stops the circulation, and because
the vitality of a part has been lost by its long -continued congelation,
whether caused by exposure to severe cold in winter or by the in-
cautious use of ice in hernia and other diseases, it was hastily and
erroneously inferred that there was danger of loss of vitality from
short continued congelation. The mistake would not be greater to
infer from the fact, because a long-continued stoppage of the cir-
culation through a limb from an improper application of a band-
age has occasioned gangrener that it would be dangerous to use
the tourniquet in operations.

The correction of this error will be deemed of no little import-
ance when it is considered that in short-continued congelation,
judiciously applied, we have an unfailing means of immediately
arresting inflammation wherever it can be reached by the remedy ;
of not only giving speedy relief from pain in many diseases, but in
consequence of the organic changes produced by it, of obviating
the return of pain ; and in malignant disease of producing an
amount of benefit much exceeding that yet accomplished by other

N. S. VOL. III. NO. VII. 26

40-i Remedial and Anaesthetic uses of Intense Cold. [July,

means. Although much inferior in importance to these results, it
is jet another great benefit conferred by intense cold, that the
pain which would be otherwise caused by the greater number of
surgical operations can be prevented by it with perfect safety ; and
not only can pain be prevented, but the inflammation proceeding
from the surgeon's knife, that so often proves fatal, may also be
obviated by the same means, and with almost equal certainty. It
will be proper to consider the remedial and anaesthetic effects of
intense cold separately; but before doing so, it is necessary to men-
tion how this degree of cold is produced and applied, as well as
to attempt an explanation of its mode of operation.

That degree of cold may be called intense which immediately
benumbs the part to which it is applied, speedily stops the circu-
lation through it, and congeals the adipose matter. 1 have usual-
ly produced these effects by placing, what are termed frigorific
mixtures either immediately in contact with the skin or mucous
membrane, by means of a net of thin gauze containing them, or
by allowing them to act through thin bladders or metallic vessels
of appropriate form ; but there are various other ways of effecting
the same object, some of which are preferable fbrcertain purposes.
Substances passing rapidly from the solid to the fluid, or from the
fluid, to the aeriform state, strongly abstract caloric from other
bodies in contact with them ; and substances, either solid, fluid,
or aariform, already sufficiently cooled by artificial means, may be
placed in contact with the part; the first, as solid metallic balls of
appropriate shape ; the latter two, when forming strong currents.
When cold is produced by the common frigorific mixture of ice
and salt, aud applied by means of a gauze bag or net, the follow-
ing is a convenient mode of proceeding : If the congelation is not
to be extensive or long-continued, a piece of ice of the size of a
lara;e orange will be sufficient. This is well pounded in a coarse
cloth or bag, and the powder being placed upon a large sheet of
paper, is thoroughly mixed by means of a paper-folder, with about
half its weight of common salt. The mixture is then put into a
net of about four inches in diameter, and as soon as it begins to dis-
solve it is ready to be applied. The net is not kept motionless on
the part, but is frequently raised in order that fresh particles of
the mixture may be brought in contact with the skin ; and the
water that escapes from it may be absorbed by a sponge, or al-
lowed to fall into a basin placed underneath. If the surface to be
acted upon is of small extent, a very thin and large copper spoon
containing the mixture, or a solid brass ball of about a pound
weight which has been immersed in ice and salt, will often an-
swer, and be a neater mode than the net.

The moment a gauze net or a thin metallic vessel containing ice
and salt is applied to the skin it is benumbed. There is hardly a
sensation of cold produced, and no tingling or smarting. If the
contact of the frigorific be continued a few seconds longer, the sur-

1856.] Remedial and Anaesthetic uses of Intense Cold. 405

face becomes suddenly white in consequence, doubtless of the
arrest of the circulation ; and this change of color is attended with
a slight smarting like that produced by mustard. There is now
complete anesthesia, which, if the frigorific were removed, would
remain complete for several minutes. But if the frigorific be
allowed to act, another change is produced the adipose matter
under the skin is congealed, and the part becomes hard as well
as white. The depth to which the benumbing influence of cold
will extend depends upon a variety of circumstances, as the degree
of cold, the duration of the application, the vascularity of the part,
whether pressure is used or the circulation is suspended, &c.
After the usual application of cold for anaesthesia, the circulation
soon returns to the part, and the skin assumes a red color, which
lasts for several hours. If the congelation has been considerable,
there is now some smarting felt, unless the natural heat be more
gradually restored by pouring cold water on the part, or by
placing on it a little pounded ice, or a bladder containing iced wa-
ter. If the application has not exceeded the first stages, there is
no smarting, and no necessity, therefore, for such precaution.

The redness produced does not, as might at first sight be sup-
posed, indicate an inflammatory condition, but the very reverse.
The tonicity of the small arteries appears to be lessened or suspend-
ed for a time, and, instead of being inflamed, the part is render-
ed unsusceptible of inflammation. Parts cut after congelation
healed by adhesion or the first intention more quickly than they
otherwise would ; and, as has already been said, we possess in this
expedient a certain and prompt remedy for every inflammation
accessible to its complete influence.

I. Remedial Uses of Intense Cold. The remedial qualities of in-
tense cold may be described as antiphlogistic, anodyne or sedative
and specific ; and it is useful in the diseases for which other reme-
dies possessing these qualities have been employed, viz : in inflam-
matory, painful or irritative, and malignant diseases. The
circumstances which limits its application in these is the impossi-

| bility of extending its influence beyond a certain extent or depth,
although it is certain, from its effects in deep-seated disease, that
this influence, whether it be direct or sympathetic, is more exten-

I sive than would at first be supposed. It may be laid down as a
rule that in every case in which the local application of moderate

' degrees of cold has been found of service, the use of well regulated
congelation would prove much more useful ; and in those diseases

of similar character, in which moderate cold has not been employ -

ed from the idea that their seat was beyond its reach, congelation
might be tried with reasonable hope of success. Intense could has
this immense advantage over other powerful remedies of the same
class, that it may be used with impunity if it does no good it will

3j do no harm. Who will venture to affirm this of bleeding, mercu-

| ry, antimony, opium, chloroform, arsenic ? Neither in my own

406 Remedial and Anaesthetic uses of Intense Cold. [July,

practice nor (as far as I can learn) in the practice of others has
there been any untoward result from the use of congelation. Its
action being confined to the diseased part, and not uselessly ex-
pended on the rest of the system, affords the explanation. Other
topical remedies have much the same character for safety, but
what other expedient of this class has a tenth part of the power of
intense cold?

Instead of enumerating the diseases in which this agent has
been employed according to the above classification, I shall mention,
first, those in which it has been more or less successful; and, second,,
those in which it might, reasoning from analogy, be tried with
hope of advantage. In administering intense cold as a remedyr
the common or a more powerful frigorific has been generally ap-
plied directly to the part, o"r with the intervention only of the thin
gauze containing it ; and the duration of the congelation has been
from one to ten minutes.

In the spring of the year 1850, I requested the house surgeon
of the Brighton dispensary to apprise me of every case f acute
lumbago that came under his notice, and in all of these, amounting
to nine, I employed congelation with perfect and permanent suc-
cess. The net containing the ice and salt was passed to and fro for
five rrhnutesr over a surface, of about 8 by -I inches, the skin being
blanched during the whole of this period. In only two or three cases
was it necessary to apply the remedy twice. Several of the patients
rose immediately afterwards from their bedsr to which they had
long been confined. In most cases of chronic rheumatism the
remedy has been equally successful ; and this, on account of the
frequency of the disease,, is one of its most valuable applications.
Sciatica has generally yielded to it, but by no means so easily.
In acute rheumatism the local inflammation of the joints is, by
this means,, invariably and completely relieved, and that portion of
the accompanying fever thence arising is consequently removed.
The disease,, thus treated, will run a painless course of about a
week's duration. In no case, of about a dozen in which congela-
tion was almost exclusively employed, was these extension of in-
flammation to the heart ; and I am persuaded that the best plan
of preventing this is to subdue the inflammation of the joints from
which it generally originates. I did not use the remedy in cases
where the heart was already affected, though I have since learned
that congelation is employed in the hospital at Vienna (where it
was introduced some years ago by Dr. Waters of Chester,) as an
application to the chest of rheumatic carditis. That this affection
of the heart would occasionally occur during the treatment of
acute rheumatism by congelation is very probable, because it often
arises, as the same affection of the joint does, from a morbid con-
dition of the blood, over which the remedy can have no control ;
and that such an occurrence, in the present feeling on the subject,
would be called metastasis from cold is very certain ; but I am

1856.] Remedial and Anaisthetic uses of Intense Cold. 407

convinced that it will yet be acknowledged, though probably after
many years, that this affection would be much decreased in fre-
quency by the adoption of any means capable of quickly subduing
the accompanying arthritis. When it is considered what an
immense amount of eventual mischief arises from the organic
disease of the heart that occurs under the common modes of treat-
ing rheumatic fever, to say nothing of the patient's present
sufferings and tedious confinement, it is to be lamented that pre-
judice should oppose any measure of greater promise. In the
rheumatic gout the relief has been as marked from congelation as
in lumbago. In ordinary inflammation of the joints it has also
been exceedingly useful. Ophthalmia has been immediately
cured by keeping the frigorinc in contact with the gently-closed
eyelid for three or four minutes. Glandular inflammation in the
neck and groin yield to a high degree of cold with equal facility.
I have been told that in orchitis its beneficial operation is imme-
diate ; and I have little doubt that, from its closeness to the
surface, the urethral iuflammation causing orchitis would be
quickly suppressed. Congelation has often at once converted an
irritable into a healing ulcer, though sometimes the patient has
complained of the pain of the operation. It is probable that had
the salt in the mixture been prevented from coming in contact
with the irritable surface, this would have been in a great degree
prevented. Certain acute inflammatory affections of the skin are
equally under its influence, as erysipelas, eczema, impetigo. It
has not often failed in prurigo, but in only one case of psoriasis
has it appeared to be of service. Painful nodes are at once re-
lieved by this means and the inflammation subdued. I have only
used congelation in carbuncle as an anaesthetic previously to
cutting it, but it is probable (judging from its effects in severe
boils,) that the incision might have been dispensed with. It has
been mentioned to me that severe cold has been employed with
| . the same view in whitlow, of which it is certainly a sufficient cure.
The inflammation following sprains, contusions, and other similar
injuries is perfectly under its influence ; and the same may be
said of burns. In one of my publications on the subject I have
related the excellent and speedy effects of congelation in a case of
meningitis, and also in a case of peritonitis. I have not had the
opportunity of trying it in other affections of this description.
Headache of various kinds has at once yielded to the application,
for a minute, of a frigorific over the painful part; and in neural-
gia affecting the side it has generally proved efficacious. In neu-
ralgia attacking the face and other parts it has often succeeded and
often failed. If the seat of the disease be deep in the brain, little
can be hoped from this remedy, although there are a few obstinate
cases of neuralgia in which it does not deserve a trial. Toothache
is generally at once relieved by it if properly applied ; and there
is no remedy for the painful affection of the mouth caused by

408 Remedial and Ancesthetic uses of Intense Cold. [July,

mercury comparable to congelation. A spoonful of dissolving ice
and salt is repeatedly put into the mouth, until it becomes benumb-
ed. In one case of severe scurvy of the gums, where I feared a
loss of the teeth, extensive congelation of the gums immediately
arrested the disease.

In many of the diseases just enumerated the promptness of the
cure is as remarkable as its certainty. In military and hospital
practice this advantage is very prominent.

In cancer the effects of congelation have been various. From
my own experience and that of others, I think that in its early
stages, and when from its size the tumor can be thoroughly
brought under the influence of the remed}T, it will be cured by it.
In all stages the progress of cancer will be arrested or retarded,
and the pain accompanying it assuaged. The difficulty in ad-
vanced cases is to cause a sufficient degree of cold to pervade the
tumor. The French translator of a recent paper of mine on the
subject, (l'Union Medicale for May,) thinks that the frequent
occurrence of cysts in cancerous tumors may facilitate this. But
if layer after layer is acted upon it may be enough. In cancer of
the womb the frigorific is applied by means of a speculum, and one
stronger than ice and common salt will generally be required.
The opinions of Dr. Hughes Bennett respecting the nature of can-
cer have much influenced the mode in which I have used conge-
lation in its treatment, M. Velpeau states, in his recent elaborate
work on the diseases of the breast, that he has employed long-
continued congelation as a substitute for caustic in cancer ; but of
this effect of the agent I have no knowledge.

There are other diseases in the treatment of which severe cold
would probably be very useful. It might be applied with such a
hope to the spine in tetanus, or to the scalp in certain varieties of
mania. After gunshot and other severe wounds it would prove a
powerful preventive and cure of inflammation. Even in pleuritis
and other deep-seated inflammation of the chest, as well as in va-
rious uterine affections, beneiit might rationally be expected from
it. In two cases of epidemic cholera I administered a succession
of draughts of a temperature of about 25 of Fahrenheit, with ap-
parently excellent effect; and I cannot doubt that the application
of cold to the interior of the stomach which, as appears by the
recently published report of the College of Physicians, is the only
treatment of cholera which has been unanimously approved of
has not been carried far enough. If the irritation of the mucous
membrane be considerable, (as it must be to account for the ex-
hausting and fatal discharges) the temperature of ice merely is not
sufficient to subdue it.

II. Ancesthetic Uses of Severe Cold. As patients now expect
to have ever}7 operation performed without pain, both they and
their surgeons will be glad to have an easy and agreeable meaDs
of accomplishing this, in all the common operations, unaccompa-

1856.] On Laceration of the Perinmum. 409

mied with the dangers of chloroform. What can be less trouble-
some in opening an abscess, for instance, or making a cutaneous
incision, than touching the skin for a moment with a small brass
ball that has been immersed for a few minutes in ice and salt, or
.a thin spoon filled with such a mixture? It is true that in deep-
-seated operations such a means can only suspend the sensibility
of the skin ; but it is the incision of the skin which constitutes the
most painful part of every operation, and if this be benumbed, a
.smaller, and consequently less hazardous, dose of ether or chloro-
form than has usually been administered would be enough to
remove the sensibility of the other tissues. These deep-seated
operations, however, constitute a small minority, and if the list of
jrecorded deaths from etherization be referred to (now amounting
to more than fifty) it will be found that in three-fourths of the
number complete anaesthesia might have been produced with per-
fect safety by cold.

M. Velpeau, who introduced anaesthesia from cold into France,
has, in a lecture on the subject recently reported in the Gazette
des Hopitaux, expressed the doubt whether in some operations
the hardening of the tissues by this means might not prevent their
being cut with ease. I have not found this to be the case, nor
does he himself allude to this supposed disadvantage, when, in his
work on diseases of the breast, he mentions that he has excised
tumors after anaesthesia from cold.

The fear of reaction I have already adverted to in the prefatory
observations. Instead of reaction being produced, the anaesthetic
| is a preventive of inflammation from the wound ; and were it
1 used for this purpose alone it would be invaluable.

Local anaesthesia from cold may, as has already been observed,
I be produced in a great variety of ways. Some of these may be
I applied so as to cause immediate congelation, but it is questiona-
i ble whether the anaesthesia is not more extensive and lasting
1 when more slowly caused. Such details, however, are unsuited
; to the general view of the subject intended by the present com-
i munication, which, I fear, has already exceeded its proper
i bounds. [Edinburgh Monthly Jour, of Med. Science.

On Laceration of .the Perinaium in Primiparce. By T. Snow
Beck, M. D.

j I have before me the notes of one hundred and twelve cases of

I primiparae, observed within the last five years, of which seventy-five,

or two-thirds, had laceration of the perinaeum through the whole

extent ; while in thirty-seven, or just one-third, no laceration took

place. Unless this result had been fortified by notes made as soon

[ as I returned home, and bv the examination of the parts by the eye,

as well as by the touch, I might have considered that some error

i had crept into these observations ; but, with the precautions taken,

410 On Laceration of the Perinceum. [July,

I feel assured of the accuracy of the result, however contrary it may
be to previous opinions.

The laceration apparently took place just as the head was ex-
truded. The perinaeum was perfect immediately before the head
was expelled, and was lacerated after the birth of the child. In a
few instances, by keeping the finger on the centre of the perinaeum,
it was felt to give way, to allow the head to pass ; but in the great
majority no indication of laceration was perceived until after the
completion of parturition. In the interval between the extrusion
of the head and the expulsion of the body, the parts were so much
on the stretch, that it was impossible to determine with certainty
whether laceration had occurred or not; but, as the shoulders pass-
ed without the least difficulty through an opening of sufficient size, it
appears most probable that the laceration did not take place at this
period, but had occurred previously.

Of the seventy-five cases in which laceration occurred, fifteen of
these, or twenty per cent., healed by the first intention, and the pe-
rinaeum was as perfect as before the confinement ; while fifty-three,
or seventy-five per cent., healed by granulation, and produced a
more or less perfect perinaeum; In not one instance has any in-
convenience followed,' such as prolapsus of the uterus, bearing-
down pains, etc., and in only one case was there any trouble at-
tending the accident. This case was among the first observed, and
while my mind was still imbued with the serious consequences
which followed laceration of the perinaeum. It did not heal by the
first intention, and the granulations were small, and showed little
inclination to unite into those of the opposite side. I became
anxious, applied different remedies, and, finally, the quilted suture.
Nothing which was applied appeared to produce any effect, and the
operation of the sutures was decidedly injurious. In the first in-
stance, it frightened the patient ; was a source of constant annoy-
ance ; produced irritation of the part; and, from the pressure of the
silk inducing ulceration of the deeper structures, became loose, and
was obliged to be removed. The laceration, however, gradually
healed, leaving not more than a quarter of an inch of the rupture
unclosed. In this case, the effects of the ligatures were such as to
deter me from applying them on any subsequent occasion. In all
the cases I have observed, neither the patient nor the nurse was
aware that anything had occurred more than usual. The patient
said she felt very sore, could not sit up in bed for some few days in
.consequence, and when she began to sit up out of bed, required a
pillow, or some soft substance to sit upon. But these were consid-
ered as "nothing more than usual on such occasions."

Little need be said of the thirty-seven cases wherein laceration
did not occur, except that some, at least, were such as might dpriori,
have been supposed likely to suffer from this accident. The patients
were spare, and rather above the average size; the perinaeum small
in extent, firm, and somewhat unyielding. But in women with

1856.] On Laceration of the Perinaeum. 411

this conformation, scarcely one suffered from laceration, and then
only when the size of the child was disproportionate to that of the
pelvis of the mother ; but when the perinaeum was broad, thick,
and soft, scarcely one escaped being torn through.

It, of course, will remain for further observation to determine
whether these cases, taken indiscriminately from the practice of one
physician, fairly represent the average occurrence of this accident
in women confined with their first child. If it does, then laceration
of the perinaeum becomes the rule in such cases, instead of the ex-
ception ; but, even if it does not, it yet shows that this accident is
of much more frequent occurrence than has been supposed. These
cases further show that when laceration does occur, this will heal
perfectly by ordinary attention, rest, and cleanliness. Such, at
least, must be admitted from the result of the seventy-five cases,
every one of which has healed with little trouble, and none have
been followed by any annoying consequences. From these facts
we may, I think, advance a step further and conclude that, in cases
where the laceration has extended through the sphincter ani, there
is great probability that the laceration will heal, in many cases, by
the natural process ; and that time should be given for this purpose,
before any operative procedure is had recourse to.

The majority of those females who form the subject of these ob-
servations, have been confined with the second, and several with
the third, child ; but in no instance has laceration again taken place,
and in only one was there a slight tearing, during the birth of a
large child, which soon healed. It would then appear that the cica-
trix which follows a lacerated perinaeum is less liable to give way
during parturition than the natural structure of the part.

It is an acknowledged fact that severe laceration of the perinae-
um, involving the sphincter ani, has not unfrequently occurred
without the accident having been discovered until some time sub-
sequently, by the inability of the patient to retain the motions, and
other distressing consequences. And it is also known that tearing
of the perinasum, up to the sphincter, has taken place, and has not
subsequently healed. But we have no information as to the cir-
cumstances which have interfered with the healing process, which,
these present cases appear to show, usually takes place. My own
experience would lead me to conclude, that many cases may, and
do, occur, without the medical attendant being aware of the acci-
dent. For, although my attention was specially directed to this
point, yet several occurred wherein the laceration was not per-
ceived until a careful examination of the parts had been made after
the labor was completed. Had this examination, which is unusual,
not been instituted, the accident might not have been discovered,
either at the time, or subsequently, by reason of the strong tendency
which appears to exist for the healing of any tearing or other injury
to the generative organs of the female, when the process of parturi*
tion has been completed. [Med. Times mid Gazette,

412 Congenital Pliymosis. [Juty?

Tlie Simplest Operation for Uncomplicated, Congenital Pliymosis.

By T. Fukneaux Jordan, Esq., M. R. C. S.

<

Not only are Surgical authorities of opinion that circumcision is
rareJy, if ever necessary; but those truly frightful slits, extending
halt-way up the penis, to be seen in the pretty engravings which
adorn some (of our best too) Surgical manuals, are fast getting into
chirargical disfavor. The present mania, however, of attributing
uncomplicated, congenital phymosis in every case to the unfortu-
nate mucous lining of the prepuce alone, and the practice of heroi-
cally slitting up the same to the very point of its reflexion from the
penis, has arisen rather from the hypothesis of theorists than from the
enlightened experience of acute observers.

The non-dilatability of the congenitally phymosed prepuce is con-
fined to the margin of the preputial orifice and to the skin and
mucous membrane in its immediate vicinity ; such nondilatability
undoubtedly extending to a greater distance on the inner than on
the outer aspect of the foreskin.

The received opinion, touching the non-elasticity of the prepu-
tial lkaing in its entire extent, is so far from being correct, that
ordinarily such lining, for some distance anterior to its point of
reflexion, is arranged in rugous folds, like all other mucous mem-
branes that are too large for the organ they line, save when the
peculiar function of that organ is being exercised.

The opinion that the skin is not implicated in phymosed stricture,
is equally incorrect. In one patient, on whom 1 operated with
complete success, by far the tightest portion of the prepuce, after
recovery from the operation, was the skin for two lines behind the
cicatrices.

Fnom the above remarks, it will be inferred that any incisions,
which extend further than the parts forming the margin of the pre-
puce, and for a short additional distance on the mucous surface, are
unnecessary, and hence cruel. A single incision, however, as des-
cribed, would fail to secure the retraction of the prepuce, not
beeause the incision is too limited, but because a single incision can-
not possibly relieve the whole circumference of the congenitally
contracted preputial orifice; two. however, or at most three, of the
snaall incisions in question would afford complete relief.

The mode of operating which I have adopted, and with signal
success in its results, is this: Having first induced local anaesthe-
sia, by applying pounded ice to the penis for two minutes, I intro-
duced one blade of a pair of scissors (blunt-pointed, yet cutting to
the end) to the distance of \ an inch, between the glans penis and
the prepuce, on one side of the penis, at a point midway between
the frenum posteriorly, and the mesial line anteriorly. Both layers
of the prepuce being divided to the extent mentioned, a similar
incision is made at a similar point on the other side of the penis.
The prepuce is now retracted to the extent allowed by the incisions,

1856.] Congenital Absence of the Nose. 413

which by this proceeding are brought quite external, enclosing
between their lips an uncut layer of lining membrane. This is
divided on each side, by introducing one blade of the scissors, to
the extent of, and immediately under, the original wound. The
entire prepuce may then be retracted, a piece of wet lint wrapped
round the penis, and the whole supported by a proper suspensory
bandage. The patient need not lie in bed. Where three incisions
seem preferable, they should be equidistant from each other, the
third being at the mesial point anteriorly, the two lateral incisions
should be a little nearer the frenum, than when two only are made.

The incisions may of course vary a line or two, one way or the
other in extent, according as the constriction is more or less aggra-
vated.

The recapitulary points to which I would draw attention, are :

1. That the skin is more, and

2. That the mucous membrane is less involved, than is generally
supposed.

8. That two, or at most three, comparatively small incisions will
afford complete relief.

4. That no assistant is required, and

5. No instrument save a pair of scissors.

6. Two or three small incisions cause much less irritation, and
heal much more quickly than one large one.

7- That the patient need not lie in bed. [Med. Times and Gaz*

Congenital Absence of the Nose: New Rhinoplastic Operation. By
M. Maisonneuve.

Among the defects of conformation of which the human face may
be the seat, there is one which must be of extreme rarity, as I have
been unable to discover any record of its occurrence; I allude to
congenital absence of the nose. A case of this kind having recent-
ly come under my notice, I have thought it would be useful to
publish it, and at the same time to make known the novel proceed-
ing by means of which I succeeded in remedying the deformity.

Eugenie Marotte, aged seven months, was born strong and well
formed, except that her face was completely devoid of any nasal
prominence, and that in place of this natural projection there
existed only a plain surface pierced with two little round openings
scarcely one millimetre (0-03937 inch) in diameter, and three cen-
timetres (1-1811 inches) distant from each other. In addition to
giving the child a most grotesque appearance, this deformity occa-
sioned her much inconvenience in the act of respiration, and
therefore in that of sucking. In these two points of view, conse-
quently, it was important to remedy this faulty conformation, and
for this purpose her parents came to Paris to consult me.

No similar instance having been known to science, the ordinary

414 On Necracmia. [Juty)

rhinoplastic processes were, of course, inapplicable to the case. I
therefore, devised the operation I shall now describe.

On the 18th of May, 1855, the child having been previously
placed under the influence of chloroform. I carried inwards, from
each of the nasal orifices, a transverse incision one centrimetre
(0.393708 inch in length. Two vertical incisions, commencing
from the inner extremity of the preceding, were now directed
towards the free edge of the lower (sic) lip, near which they were
brought together so as to form a V. From these latter incisions
resulted a narrow flap comprising the entire thickness of the lip: it
was dissected and horizontally raised to form the inferior septum of
the nose.

There then resulted a true artificial hare-lip, the edges of which I
united by means of the twisted suture. But to obtain this union, it
was necessary that the space comprised between the nasal openings
should be shortened by the entire width of the flap detached to form
the septum, and that consequently a projecting fold should be
formed at the expense of intermediate skin. This fold, supported
by the artificial sub-septum, constituted a perfectly regular nasal
prominence.

In order to understand completely the mechanism of the operation
it is sufficient to repeat it on a piece of paper, when it will be im-
mediately seen how satisfactory the result is.

The final issue was not, however, obtained without some trouble.
The infant, irritated with pain, did not cease during the first twenty-
four hours crying, so to speak, and struggling : the consequence was
a partial disunion of the points of the upper suture. This, however,
was attended with the incidental advantage of suggesting to me an
improvement in the operation for hare-lip.

This improvement consists in the subcutaneous division of the
orbicular muscle at each side of the wound, in order to prevent its
contractions from tearing open the cicatrix.

Thanks to this improvement, union took place without difficulty,
notwithstanding the uneasiness of the little patient ; and at the time
of her departure from Paris, the cure was complete.

The nose was of a very regular shape, and the openings of the
nostrils being ample, admitted of easy respiration. [Gazette Medical
de Paris, and Dublin Medical Press.

On Necrcemia. By Dr. C. H. Jones, F. R. S.

This term is applied by Dr. Williams to that condition of the
blood, in which it appears to be itself primarily and specially affect-
ed, and to lose its vital properties. It is, in fact, death beginning
with the blood. The appearance of petechia? and vibices on the
external surface, the occurrence of more extensive hemorrhages in
the internal parts, the general fluidity of the blood, and frequently its

1856.] On Necrcemia. 415

unusually dark or otherwise altered aspect, its poisonous properties,
as exhibited in its deleterious operations on other animals, and its
proneness to pass into decomposition, point out the blood as the
first seat of disorder ; and by the failure of its natural properties and
function, as the vivifier of all structure and function, it is plainly the
medium by which death begins in the body. The blood, the natu-
ral source of life to the whole body, is itself dead, and spreads death
instead of life. The heart's action is faltering and feeble; the
atonic vessles become the seat of congestions, and readily permit
extravasations. The brain, insufficiently stimulated, after slight
delirium, lapses into stupor; the medulla no longer regularly res-
ponds to the besoin de respirer / and the respiratory movements
become irregular. Muscular strength is utterly lost ; offensive
colliquative diarrhoea, or passive intestinal hemorrhage often occurs ;
sloughing sores, or actual gangrene of various parts are easily pro-
duced ; and putrefaction commences almost as soon as life is extinct.
The track of the superficial veins is marked by bloody stains ;
hypostatic congestion takes place to a great extent ; the blood
remains fluid, and stains the lining membranes of the vessels. Ro-
kitansky describes the blood as often foamy, from the development
of gas, and of a dirty red rasberry -jelly color; its serum dark fern
exuded haematine ; and its globules swollen up by endosmosis.
Coagula are either totally absent, or are very soft and small. The
exudations are of a dirty red turbid, thin. There is scarcely any
rigor mortis; the tissue of the heart and of other organs is flaccid
and softened, and stained by imbibition of the serum. Gas is quick-
ly formed in the vessels and in the areolar tissue, in giving rise to
a kind of emphysema. It is verv remarkable that this necraemic
condition, or one closely resembling it, may be brought on by vio-
lent shocks inflicted on the nervous system, as well as by the intro-
duction of miasmatic or animal poisons into the circulation. Vio-
lent convulsions, overwhelming emotions, the shock of an amputa-
tion, a stroke of lightning, even a severe exhausting labor, are
mentioned by the German pathologist as having produced this
effect. More common causes are, however, malignant scarlatina
and typhus, yellow fever, the plague, and the disease called glanders.
It may be said, generally, that the early appearance of sinking and
prostration in any fever, indicates that the blood is thus seriously
affected. We are ignorant what is the exact nature of the changes
which takes place in this condition of the blood. Probably they
are more of a vital than merely chemical kind that is, they affect
the properties of the blood more than its composition. The blood
globules do not appear to be destroyed ; but they circulate probably
some time before death, as so many dead particles prove to be en-
larged and to stagnate in the capillaries, and to part with their
contained haematine. The fibrine is in great part destroyed ; but
how this comes to pass we are ignorant. We can perceive, on the
whole, scarce anything more than that the powers of vital chemis-

416 Iodine, as an Antidote to Poison of Rabid Animals. [July,

try rapidly decay, and those of ordinary chemical affinity supply
their place. [Braitliwaite 's Retros.

Iodine, as an Antidote to the Poison of Rabid Animals. By Wm-
H. Mussey, M.D., of Cincinnati.

Prof. Brainard, of Chicago, has demonstrated the value of Iodine
as an application to snake bites. Early in 1853, I determined to
treat wounds by rabid animals with Iodine, in the belief that it
would decompose the animal poison; and I now present the follow-
ing cases as the initiative of the treatment, without claiming that
the question is settled, as I know that cases of Hydrophobia are ex-
ceedingly rare not bearing a proportion greater than 1 to 20 of
those wounded by animals supposed to be rabid :

Case I. April, 1853. Mr. B., aged 25, painter. When three
miles from the city, was bitten by a dog supposed to be rabid, and
I believe, was so, though there was no opportunity for the proof, as
the animal was killed. The patient came immediately to my office.
On his right hand were several wounds, to which I applied the
Tincture of Iodine every five minutes for an hour, and then applied
an emollient poultice, with directions to apply the Iodine every
hour for the next ten hours, and every four hours for the twenty-
four hours succeeding, with a change of poultice every twelve
hours, till the wounds should heal. I saw the patient daily for a
week, and occasionally for six months after. No symptoms of Hy-
drophobia had appeared.

Case II. April 29, 1853. IT. S., aged twelve years. Was bit-
ten by a furious watch-dog, in the side and arm, through clothing.
There was no evidence that the dog was rabid, but I instituted the
same treatment as in the former case.

Case III. June 24. G. H., aged twenty-five. Was bitten in
the hand by a large pup, three months old. Ordered the applica-
tion of Tincture of Iodine.

Case IV. July 4. W. M., aged nine years. Was bitten (through
his clothing) by a dog running the streets. There were five wounds
in the leg and two in the side. I saw the patient twenty minutes
after, and applied Iodine and poultices, as iu Case I. The patient
is well at this date. The same dog bit an Italian in the leg, and
the surgeon in attendance cut out a large piece of the integument,
and the patient recovered from the operation, and was not attacked
with Hydrophobia. I believe the dog was mad, but as he suffered
the death penalty, there was no opportunity for proof.

Case V. September 16. Mrs. S. Bitten in the hand. I could
not determine if the dog was rabid or only worried by its pursuers.
Ordered Iodine. There was no subsequent trouble.

Case VI. December G. W. A., aged twelve. Bitten several
times in the hand. Treated as Case I.

1856.] Favus, successfully treated. 417

Case VII. H. K., aged ten. Bitten by same dog. Ordered like
treatment. No subsequent difficulty.

Case VIII. June 2G, 1854. Miss H., aged nineteen. Was bit-
ten in joint of great toe by a cat. Four days after, I was called,
and found joint inflamed, and slight tetanic spasms about the larynx
and inferior maxilla. Applied Iodine and poultices, and adminis-
tered antispasmodics. Patient recovered.

On a review of the foregoing, it will be noticed:

1. That in all cases I apply the Tincture of Iodine, as there is
some uncertainty as to the character of the wound.

2. That in cases 1, 4, 6 and 7, the animals inflicting the wounds
were probably rabid ; whilst in cases 2, 3, 5 and 8, the animals
were probably not rabid.

3. That in cases 1, 3, 5, 6. 7 and 8, the parts wounded were not
protected by clothing.

4. That dogs show no respect for the calendar, or summer ordi-
nances, but have their day whenever it suits their taste.

[Cincinnati Med. Observer.

Favus, successfully treated by Phytolacca Radix, or Poke Moot. By
H. Gatch Carey, M. D., Dayton, Ohio.

The phytolacca decandra, or poke, is indigenous to almost all parts
of North America. Its medicinal qualities have received but little
attention. Taken internally, it is an emetic, tardy in operation;
cathartic and slightly narcotic. " In over doses it produces exces-
sive vomiting and purging, attended with great prostration of
strength, and sometimes- with convulsions. In small doses it is an
alterative, and has been recommended in rheumatism. Externally
it has proved beneficial in piles, psora, and tiena capitis." (U. S. ]).)

I have cured three cases one severe and obstinate, of sycosis
with a decoction of the poke root. The action of the remedy was*
prompt and highly gratifying. The pathological resemblance'
which subsists between this disease and' favus, induced me to test
the virtues of the agent in the latter. The case was one of six
months standing, and had been under treatment during that time
by a regular, scientific physician. The disease had only been tem-
porarily benifited by the course of medication. The general health
of the child ait. eight months, was good'. No hereditary elemenfs
of disease could be traced. The eruption occupied the parietal
protuberances, extending forwards to the middle of the sagital suture,,
back as far as the centre of the occipital bone, and all the interme-
diate space. A dense light brown crust covered the above defined
region. Characteristic yellow points imbedded in the derma, could
be detected along the' line of the disease, rendering the diagnosis
clear.

418 Microscopy of the Kidney. [Juty)

I directed thorough ablution with soap and water three times per
day, and the crust to be kept constantly saturated with,
$. Carb. Potass. 3iv.
Glycerine 5ij. m.

The head to be covered with an oil silk cap. At the end of the
third day, under the use of this treatment, the scale was entirely
removed. The scalp was ulcerated in several places, and the re-
mainder which was originally covered by the crust, furnished
unmistakable evidence in a multitude of yellow points offawus
dispersus. Pruritia was almost intolerable.

The glycerine and potash only had the effect of softening t'he
crust, thereby rendering its removal easy by soap and water. The
exuberant cryptogami were not in the least, repressed by the appli-
cation. A single night was sufficient to give a coating to the
diseased surface.

After removing the hair as far as possible with scissors, I ordered
the ablutions to be continued, and the affected parts to be kept con-
stantly moist with a decoction of poke root. This was effected by
means of clothes saturated in the decoction and applied to the
diseased scalp, with the oil silk cap superimposed. The crust
ceased to be reproduced immediately upon the application of the
wash. In four days the yellow points in the scalps had disappeared,
and the ulcerations soon healed under the use of the decoction. In
a fortnight, after the first use of the poke root, the disease had
vanished, and hair in limited quantities now covers the affected
parts. [Western Lancet.

Microscopy of the Kidney.

At the April session of the Academy, Dr. Isaacs read a continua-
tion of his paper on the Microscopy of the Kidney, in which he
proved still more decidedly than at the previous meeting, the fallacy
of some of the physiological views of Bowman and other European
authorities, and demonstrated to perfection the true anatomical and
physiological relations of some important parts, especially the con-
nection between the Malpighian tufts and the uriniferous tubes.
His investigations have settled this vexed question, so that there
can no longer exist any doubt of their being an anatomical connec-
tion and a direct functional relation between these two parts. He
tied the renal artery of a cat, after putting the animal under the
influence of chloroform, and was then enabled to see the passages of
blood directly from the capilliary turft in the tube ; and he has
proved to exist, what others have denied, because they failed to see,
the presence of nucleated cells upon the surface of the tuft, as well
as upon the inner surface of the capsule of the tube, which embra-
ces and covers the tuft. The cells of the capsule he discovered to
be of a different chemical character from those of the tuft as nitric

1856.] Placenta Prcevia. 419

acid, while it destroyed the former, had no effect upon the latter.
Upon his inability to discover any cells upon the tuft, Bowman
based his theory that the office of this congeries of capillaries was
to separate water only from the blood ; a theory which is subverted
by Dr. Isaacs' discovery of a cellular formation upon them. He
furthermore demonstrated the presence of various substances in the
tube, such as bile in a jaundiced person, and various salts which
could only have got there through the Malpighian tuft.

In this, as in his former paper, Dr. Isaacs was eminently satisfac-
tory to his audience, who received his communication with fre-
quent demonstrations of their gratification. [Med. and Surg. Rep.

Placenta Prcevia. By John P. Mattaeuk, M. D., LL.D., of
Prince Edward, C. H., Virginia.

Implantation of the placenta over the os uteri may be central or
marginal, and in either case will pretty uniformly be the cause of
haemorrhage, as the uterus expands during the advancing periods
of utero-gestation. Where central implantation exists, the safety
both of mother and child will be seriously jeopardized, while a
marginal attachment chiefly endangers the life of the foetus, and
not necessarily that of the mother, though by neglect and impro-
per treatment, she too may be placed in imminent peril by it.

It is generally at or about the seventh month of gestation that
placenta praevia begins to endanger from haemorrhage ; and this
is due to the more rapid and extensive expansion of the cervix
uteri, from this period, in enlarging the uterine cavity, to accom-
modate the increasing size of the contained ovum. In some
instances, however, no serious danger threatens until labor com-
mences at the full term.

In central implantation the placenta is attached more or less
centrally over the os uteri, and is decidedly the most important
and dangerous deviation, while the danger diminishes as the at-
tachment varies from this to the marginal.

The haemorrhage attendant on placenta praevia from the seventh
month, and before labor commences at the full term, is due chiefly
to the separation of the placenta around its circumference, and the
consequent rupture of its vessels there, caused by the increasing
dilitation of the cervix uteri at this period, while that occurring
with the commencement of labor is caused by the separation of
i the placenta, and rupture of the utero-placental vessels around the
, os, as this opening dilates to give exit to the uterine contents.

In the first, the haemorrhage is less violent and menacing than
that connected with separation of the placenta from the os uteri,
because the separation is gradual in the former, and the vessels,
that are ruptured from time to time, smaller and more delicate.
Here the vessels are ruptured only as the cervix expands; and

N. s. VOL. XII. NO. VII. 27

420 Placenta Prcevia. [July,

as this dilatation is slow and gradual also, and the consequent
haemorrhage comparatively moderate.

When, however, labor commences, the os uteri dilates more or
less suddenly, and the separation of the placenta, if the case be
one of central implantation, will be propotionally sudden also, and
the consequent haemorrhage must necessarily be sudden and im-
petuous in greater or less degrees.

If the haemorrhage appears near about the seventh month, it
will in all probability result from the separation of the placenta
at its circumference, as no other portion would be likely to be
detached at this period of utero-gestation ; and it would be moder-
ate, because, as already stated, the placenta must be more or less
gradually separated, then, from the uterine surface, by reason of
the comparatively slow expansion of the corresponding wall.

But should it set in with the accession of labor, if the views
already expressed are correct, it would be both sudden and im-
petuous, from the sudden separation of the placenta, and rupture
of the utero-placental vessels at or near the os, chiefly if not ex-
clusively the result of sudden dilatation of the os uteri, as prepar-
atory to the expulsion of the foetus. And such will be the case,
also, should a border of the placenta only be connected with the
os uteri.

These divisions of placenta praevia implantation, if carefully
studied in practice, will enable us to determine at once the char-
acter of the haemorrhage, both as respects the seat of the vessels
yielding the blood, and its danger to the mother and foetus.

In many instances, uterine haemorrhage occurs during pregnan-
cy, at or after the seventh month, that causes not a little alarm
with females, and much perplexity with practitioners in determin-
ing as to its precise nature.

The discharge of blood often, in some of these examples, will
be quite free and menacing for a few moments, but will very soon
greatly abate, or cease for some hours entirely, leading the physi-
cian to believe that there will probably be no return of it.

After a while, however, and without any known cause, it
recurs, and pursues the course of the first attack ; and again abates,
or ceases entirely; and in this manner it may return and abate
after intervals until labor sets in at full term; or it will cease
altogether before that time.

This description of uterine haemorrhage must either be due to
central implantation of the placenta over the os uteri, or a margin-
al attachment may exist, with the border of the placenta extend-
ing beyond the os uteri sufficient^ to occlude it. It may also be
due to detachment of a portion of the chorion from the correspond-
ing uterine mucous lining, by an accidental blow on theabdomen,
or by a fall or severe jolt.

If it result from placenta praevia, the probabilities are against
the complete arrest of the haemorrhage until the attendant preg-

1856.] Placenta Previa. 421

nancy terminates, and in favor of the return of it in an aggravated
and menacing form when labor sets in. But should it depend on
partial separation of the ovum, in a majority of cases spontaneous
arrest of it would follow, and a cure be effected by proper treat-
ment, with little danger of recurrence, unless brought on by expo-
sure of the woman to causes similar to those that induced it at first.

A sudden and profuse discharge of blood from the vagina, as
labor commences, or as the os uteri begins to dilate, could not fail
to lead to the belief that there was implantation of the placenta
over the os uteri, and that the haemorrhage resulted from the rup-
ture of the utero-placental vessels, caused by the sudden detach-
ment of the placenta from the os as it is forced open by the
uterine contractions, constituting labor in its first or preparatory
stage.

In these cases it will invariably be the duty of the obstetrical
attendant to examine carefully into the condition of the os uteri,
per vaginam, in reference to implantation'of the placenta over it.
If the haemorrhage is profuse, little difficulty will attend the in-
troduction of the index finger of either hand into the os uteri to a
sufficient depth to ascertain if the placenta is situated upon it or
not, as that opening is always more or less dilated by the escaping
blood. The examination, however, should be conducted with
gentleness, taking care, as the finger is introduced, not to force
open the os violently, nor to employ undue force with it against
the placenta.

If the case is ascertained to be placenta praevia, the cause and
nature of the haemorrhage will be satisfactorily declared, and a
course of treatment must be adopted accordingly. But if no pla-
centa can be found to occlude the os uteri, and instead of that
structure the delicate and thin membranous envelope of the foetus
presents, it will be fair to presume that the haemorrhage is due to
accidental separation of the ovum from the uterine surface, which
we know is generally harmless and easily corrected nay, most
frequently, it subsides spontaneously, if the woman is still and
quiet in bed for a few days.

In the treatment of pregnancy and labor, complicated with im-
plantation of the placenta over the os uteri, great difficulty has
always been experienced, whether the attendant haemorrhage
commences early or at full term ; and perhaps no question in
obstetrical therapeutics has given rise to greater contrariety of
opinion or of medication. It is not the writer's intention to notice
these discrepancies, as he could not examine them fully in a paper
like this, designed chiefly to explain his individual methods of
treating placenta praevia, and through the pages of a monthly
medical journal. Having had considerable experience in the
management of this menacing and formidable obstetrical hydra,
1 he proposes merely to present a condensed transcript of that ex-
perience.

422 Placenta Prcevia. [Jutyj

In haemorrhage connected with placenta praevia, from the
seventh month to the close of the eighth, it will not generally be
necessary to do more than maintain the bowels in a soluble state
by gentle cathartics, such as the bitart. potass., Seidlitz powders,
and the like; to detract blood if the habit is plethoric, or the pulse
strong and excited ; to enjoin absolute rest in the recumbent pos-
ture; to restrict the diet; to guard against nervous excitement;
to allow free ventilation of the woman's apartment, and cold drinks
or ice; to require the person to be loosely dressed, and to be kept
cool; to use narcotics in conbination with astringents if there is
much nervousness, as internal remedies, or astringents alone if
narcotics are not demanded, especially acetis plumbi, snip, alum or
tannin ; and cold, wet cloths over the hypogastrium and vulva.

Sometimes it will be necessary to have recourse to the tampon,
especially if the woman is delicate and the haemorrhage very pro-
fuse; and when employed, it should be carefully applied to the
os tineas, and steadily and firmly pressed against it until the hae-
morrhage ceases.

Even after the external appearance of blood is no longer visible,
it will be safest to continue the pressure upon the tampon for some
hours ; and when the pressure isto be discontinued, it must inva-
riably be gradually done, and the instrument suffered to remain.

The writer has often witnessed the return of the flooding by too
suddenly removing the pressure from the tampon, and from
the premature withdrawal of the tampon also. The best tam-
pon can be made of raw cotton enveloped in fine linen or ken-
ting, so as to forma firm ball ; and the surface to be applied
to the os tincae, before the envelope is put on, should be well satur-
ated with a powder of equal parts of sulphur, alum and tannin.
By using a square piece of soft old linen of proper size for the
envelope, it can be put over the medicated cotton so as to form a
handle beyond the ball, that will be found convenient in the in-
troduction or removal of the tampon ; and to render the ball firm,
the gathers of the envelope should be tied firmly close up to the
corresponding surface of the cotton with a strong thread.

In numerous instances, the writer has succeeded in restraining
uterine haemorrhage, in cases of placenta praevia, by the energe-
tic employment of the plan of treatmnnt that has been briefly
sketched, and women have been conducted thereby, in compara-
tive safety, to the close of pregnancy. It is true, haemorrhage,
connected with malposition of the placenta, is not generally
attended with very great danger in the 7th and 8th months of
pregnancy, especially the 7th, as already slated, but it should
always be regarded with solicitude, because it is sometimes fatal.
When it complicates labor, however, it is indeed a formidable
accident, demanding decision and the most exalted skill, in many
cases, on the part of the obstetrical attendant, to advert the dan-
gers that peril the life'ofboth mother and infant; audit is the

1856.] Placenta Proevia. 423

form that this paper is designed chiefly to consider. A labor thus
complicated is distinguished by the discharge of blood from the
vagina, more or less profusely, with the commencement of uterine
pain ; but the haemorrhage is most free and impetuous as the os
uteri becomes dilated, and particularly so, if the dilatation is sud-
den ; and it is the sudden separation of the placenta from the os
and cervix uteri, and the consequent rupture of the connecting
vessels, that cause the haemorrhage, as has already been stated.
In many cases, these pregnancies are attended with occasional
discharges of blood from the 7th month down to the commence-
ment of labor, that are restrained by appropriate treatment ; but
although they are menacing in a high degree now and then, the
haemorrhage is far less impetuous than that ushered in by the
accession of labor.

In treating this complication of labor, the aim should be to save
both mother and child, if possible. But if this is impracticable,
and one must be sacrificed, every consideration of duty and hu-
manity demands that the foetus should be the victim.

When haemorrhage sets in with labor, whether impetuous or
not, the saftest and most reliable means of restraining it is the
tampon; and it should be resorted to without a moment's delay;
and formed and applied as already suggested, only that the ex-
tract of belladonna must be used with the astringents in medica-
ting it, and in quantities varying from twenty-five to forty grains.
This instrument, as already stated, should be carefully and firmly
applied to the os uteri, so as to prevent the further escape of blood
from the uterus, and to cause a coagulum to form in the os and
over the separated portions of the placenta. By the addition of
the belladonna to the alum and tannin, two important ends may
be simultaneously attained; that is, the coagulation of the blood
around and in the orifices of the ruptured vessels, and the prompt
and free dilatation of the os uteri.

Iu many cases the haemorrhage will be promptly and complete-
ly arrested by these measures; but if not completely staunched, it
will often be greatly moderated, so as to allow time for the safe
and full dilatation of the os, and spontaneous delivery of the foetus.

If, however, the haemorrhage proves obstinate, and from the
blood already lost, seriously endangers the life of the woman, it
will not be safe and proper to trust farther to the tampon alone,
but the immediate resort must be had either to delivery by intro-
ducing the hand into the uterine cavity and turning, or to forcible
separation of the placenta from the uterus with the index finger
passed between them.

If the haemorrhage has been very profuse and exhausting in
its effects, whether of long or short continuance, attempts to de-
liver would not be justifiable or safe.

But should the obstetrical attendant see the case before such
prostrating loss of blood had taken place, and the os uteri could

424 Placenta Praivia. [July,

be entered without the employment of undue force, delivery by
turning or with the forceps might be promptly resorted to. But
to attempt delivery after the woman has become greatly enfeebled
by the lioodings, would seriously endanger her life. Indeed it
would be murderous, in a majority of instances, as the process
requires more time for its completion, even when executed in the
most dexterous manner, than could be safely consumed while the
flooding continues.

In numerous instances, attempts to deliver, or even its accom-
plishment, have proved fatal under these circumstances, when life
might have been perpetuated by a different procedure. True it
is, some few women of uncommon vigor of constitution have
escaped with life ; but such examples are remarkable exceptions,
and do not in the least weigh against the plan here advocated.

If the case forbid all attempts to deliver, the second expedient
that has been suggested must be adopted, and without a moment's
delay ; that is, the separation of the placenta from the os and cer-
vix, by forcibly and quickly passing the index finger between
them, so as completely to detach the placenta from the uterine
surface.

This operation causes considerable but temporary increase of
the haemorrhage, and should be executed with the utmost des-
patch, or the woman may sink from the loss of blood before it is
accomplished. As soon as the placenta is detached, the medicated
tampon, without the belladonna, must be applied. And to save
time, that instrument should invariably be previously gotten
ready. By carefully pressing the entering surface of the tampon
against and partially mto the os uteri, and firmly holding it there
with the fingers, the haemorrhage will instantly cease; and after a
short time thus restrained, there will be very little danger of its
recurrence, even if the tampon should be removed, which howe-
ver, must not be attempted ; it must invariably be forced away by
the uterine contractions upon the renewal of labor.

When the ease is a marginal implantation of the placenta over
the os and cervix, and delivery is forbidden, by reason of the pre-
vious loss of blood, and great prostration of the woman's strength
it will be necessary also to resort to the expedients just described.
In some of these cases, however, when the placenta barely or im-
perfectly occludes the os uteri, it will only be necessary to detach
it partially ; and the writer's experience has led him to adopt and
to advise the practice of separating that organ on its occluding
border to a line a little beyond ihe opposite half of the os uteri.
This separation very often, aided by the medicated tampon, will
completely or greatly restrain the haemorrhage, and at the same
time afford a chance for the preservation of the foetus.

After the haemorrhage is restrained by the means which have
been suggested, a question arises as to the propriety of speedy
delivery by artificial means. Should there be very great prostra-

1856-] Placenta Previa. 425

tion of the system from the flooding, artificial delivery must not
be attempted until the energies recuperate, as manifested by a
well developed and equable reaction. In numerous melancholy
instances, women have perished by being delivered too soon after
the arrest of profuse haemorrhage from placenta praevia', especially
before the powers of the system had reacted sufficiently to restore
a well balanced circulation. As long as there is no haemorrhage
and absence of uterine contraction, attempts at artificial delivery
should never be made. There will be infinitely less danger in
delaying delivery in such cases several days, if reaction is no lon-
ger deferred, than from an early resort to it. Inflammation might
supervene from the detention of a dead foetus 24 or 36 hours after
the arrest of the haemorrhage, causing its death; but this possible
contingency would not bear a comparison with the almost certain
danger of death to the mother, should she be delivered before
reaction takes place to a sustaining extent.

The writer has known women to die, in several instances, al-
most at the moment of delivery, who had previously flooded most
profusely from placenta praevia, but had ceased to do so as soon
as the placenta was detached. In these cases there was great
prostration of the system, manifested by difficult respiration;
absence or alarming depression of the radial pulse ; tinnitus
aurium ; moaning; restlessness; and a tendency to swoon from
the slightest change in the posture of the body ; and though delive-
ry was not attempted or accomplished for more than ten hours
after haemorrhage had been arrested, there was not the slightest
tendency in the system to react; and the woman died the instant
the stimulus of distention was removed from the uterus and abdo-
men. In such examples of placenta praevia, the safest and most
rational mode ol procedure is, to employ such restoratives and
incitants as may be demanded to re-excite the flagging operations
of the system, and to wait patiently until reaction is fully restored,
or until spontaneous delivery takes place, which often occurs with
the re-establishment of a well-balanced circulation, and is seldom
fraught with danger, unless improperly managed or officiously
interferred with.

Should utero peritonitis threaten, even before delivery is ac-
complished, purging the bowels impressively once or twice will
effectually avert it, and not only without increasing the depression
of the vital actions, but actually re-exciting them. In some most
menacing and exceedingly perplexing cases of this kind, the
writer has resorted to purging with the happiest results in prompt-
ly exciting the uterus into vigorous and effective contractions,
speedily resulting in delivery, and in the removal of the symptoms
threatening inflammation also.

It is important after every delivery to have the abdomen sup-
portingly bandaged; but in the case now under examination it
should be done with compressing force, and continued until every

426 Pneumonia. [Julj>

menacing symptom subsides, unless contraindieated by increasing
abdominal tenderness, and when to be discontinued, it must inva-
riably be gradually done.

The views advocated in this paper, in regard to the treatment
of labor and haemorrhage, in cases of implantation of the placenta
over the cervix and os uteri, have been long entertained by the
writer, and their correctness and safety often verified in his inter-
course with cases complicated with such malpositions, or, as usual-
ly denominated, placenta praevia. In more than thirty-five cases
that have been treated by him, only two unfortunate results fol-
lowed ; and the treatment now pursued by him, and commended
through this paper to his brethren, was suggested by those two
unfortunate cases more than twenty -five years ago, while he was
a young practitioner of medicine.

These views, however, are not peculiar to the writer, although
original with him; and it is gratifying to find that they are enter-
tained, in the main, also by some of the ablest and most successful
as well as prominent obstetrical practitioners both of this country
and of Europe, with Professor Simpson generally conceded to
be the highest authority at the present time in midwifery at the
head of them. [ Virginia Med. Jour.

Pneumonia discussed in thirty-three Aphorisms. By M. BOUCHUT.

Our readers will be interested in the perusal of the admirably
condensed series of aphorisms taken from the excellent work on
Diseases of Nursing Children, by M, Bouchut. This mode of im-
pressing a subject on the memory is very effective and one often
employed by the eminent author of this treatise. We are pleased
to see that a translation of the work is announced by Dr. Bird of
New York, from the publishing house of the Messrs. Wood.

Primary pneumonia, which is also called pneumonia d'emblee, is rare
in children at the breast.

Pneumonia usually follows simple bronchitis, or bronchitis complicating
fevers, or acute febrile diseases.

Primary pneumonia is usually lobar.

Consecutive pneumonia is always lobular.

Lobular pneumonia is sometimes discrete, sometimes confluent.

The pneumonia of children at the breast is almost always double, and
usually attacks both lungs.

Lobar or lobular pneumonia is observed under two anatomical forms,
slightly differing as to structure; these are intra-vesicnlar and extra-vesicu-
lar pneumonia.

Intra-vesicnlar pneumonia, usually primary, leads to congestion and
thickening of the walls of the cells of the lung, with the formation of an
internal plastic deposit, which constitutes the character of red and gray
hepatization.

1856.] Pneumonia. 4:27

Extra-vesicular pneumonia, always consecutive, only produces conges-
tion and thickening of the walls of the pulmonary vesicles, without
fibrinous plastic secretion in the interior of these vesicles.

Chronic pneumonia, more common in the infant at the hreast than in
the adult, is always lobar.

Pneumonia often engenders the formation of fibro-plastic miliary granu-
lations in the interior of the cells of the lung, in lymphatic and scrofulous
children, or in the issue of parents tainted with scrofula.

The developement of lobular pneumonia is favored by the crowding of
children in the wards of a hospital.

Ordinary and frequent cough, accompanied by fever and anhelation,
should make us fearful of an invasion of pneumonia.

Expiratory, groaning and jerking respiration is a certain sign of the ex-
istence of confluent lobar or lobular pneumonia.

Panting respiration, accompanied by a continual movement of the nos-
trils, is a sign of pneumonia.

Dullness of the chest is generally but slightly defined in the pneumonia
of children at the breast.

When dullness of the chest exists in a young child with a very bad cold,
pneumonia should be feared.

Dullness confined to one side of the chest in a young child rather indi-
cates pleurisy than pneumonia.

The subcrepitant rale which accompanies the cough, the fever, and an-
helation, confirm the diagnosis of confluent lobular pneumonia.

Bronchial respiration, which is rare in children at the breast, always
belongs to lobar pneumonia, and sometimes to confluent lobular pneumo-
nia,

Bronchophony, that is to say, the resounding of the cry, indicates that
pneumonia has arrived at its last stage.

The exaggerated vibration of the thoracic walls at the time of the cries,
indicates pneumonia, whilst their absence, on the contrary, points out the
existence of pleurisy with considerable effusion.

The acute or moderate fever at first continued, presents numerous exacer-
bations in the course of pneumonia.

Primary pneumonia, or d'emblee, is less severe than consecutive pneu-
monia.

Pneumonia consecutive to simple pulmonary catarrh is often cured.

Pneumonia consecutive to measles, scarlet fever, small-pox, is a very
serious disease.

The pneumonia of children at the breast is, especially, a serious disease,
in consequence of the complications which precede or follow its develope-
ment.

The pneumonia of children at the breast has a great tendency to pass
into the chronic state.

The pneumonia which is consecutive to the developement of fibroplastic
miliary granulations, or to tubercular granulation, is usually fatal.

Expiratory, groaning and jerking respiration, accompanied by move-
ments of the nostrils, announces that the life of the child is in great danger.

The swelling and oedema of the hands, or of the feet, which comes on in
the course of pneumonia, indicates an approaching death. (Trousseau.)

The return of the secretion of tears, which has been suspended in the

428 Necrosis of the Inferior Maxilary Bone, dr. [Jul}-,

attack of pneumonia, is a good augury for its favorable termination.
(Trousseau.)

One or two leeches at short intervals, several blisters in front of the
chest and doses of ipecacuanha, are sufficient for the cure of simple acute
pneumonia. [ Virginia Med. Journal.

Necrosis of the Inferior Maxillary Bone from the Vapor of Phospho-
rus. Removal of the entire Lower Jaw, and Recovery. By Dr.
James E. Wood, of New York.

The very brilliant operation described in this paper, which we
find in the New York Journal of Medicine, May 1856, has many
points of interest to the reader. The victim to the deleterious
fumes of phosphorus was a " dipper" in a lucifer match factory
in New York, an occupation she had followed for two years and
a half. The first signs of mischief appeared in the form of tooth-
ache, and one tooth was extracted, but swelling" of the jaw-bone
supervened, followed by discharge of pus, and she entered Belle-
vue hospital, and came under the charge of Dr. Wood.

Necrosis of the inferior maxillary bone existed both on the right
and left side, and Dr. Wood performed his first operation on the
right and most diseased side. Finding the bone necrosed to its
articulation, he removed the whole of the right lateral half of the
inferior maxillary, and twenty-eight days afterwards he was com-
pelled to perform a like operation on the left lateral half. The
patient was discharged on the 20th of March 1856, with remarka-
ble preservation of the contour and comeliness of the face.

Necrosis, the result of the fumes of phosphorus, although a
subject of but recent investigation, is not a very rare affection, as
in tne paper before us, we find seven other instances of like charac-
ter reported by Dr. Van Buren. They have all resulted from the
exposure to tne fumes of phosphorus in "match factories," and
the vast consumption of this modern convenience has undoubt-
edly developed this sad disease. Dr. Wood remarks :

Phosphorus disease, or necrosis from exposure to the fumes of phospho-
rus in the manufacture of lucifer matches was first noticed in Germany.
Lorinscr of Vienna, published the first account of this disease in 1845, and
reported a number of of cases. Soon after, Heyfelder of Erlangen, and
Strohl of Strasburg, published cases ; and in 1847, Drs. Von Bibra and
Geist, published a separate work. In the following year, accounts of the
disease were published in England ; and in noticing a case, in the surgical
reports of Guy's hospital (1846-47) of separation an,d exfoliation or the
lower jaw, from exposure to phosphorus, in the manufacture of lucifer
matches, it is stated, that the disease was previously noticed to be not un-
commom in those working in phosphorus. Mr. Stanley alludes to this
disease in his treatise on Diseases of Bones. Cases have been occasionally
reported in English periodicals; and in the Lancet for 1850, (vol. i. p. 41,)
there is an interesting clinical lecture by Mr. Simon, on this subject, with

1856.] On the Treatment of Haemoptysis. 429

the full details of a case. Phosphorus disease does not seem to have been
frequently noticed in this country, if we may judge by reported cases ; yet
the causes exist among us in all their intensity. I am aware, indeed, of
but a single case which has been placed on record, and that was observed
by Dr. Bigelovv of Boston. That this disease is more prevalent in this
country, than might be inferred from this single case, is evident from the
several cases appended to this paper, which I have been able to collect, and
the case kindly communicated by Dr. Van Buren.

That phosphorus is the destructive agent in this disease, has been proved
by experiments upon animals. Rabbits exposed to the fumes of phospho-
rus, under circumstances similar to those which determine the disease in
man, are similarly affected. Another fact seems clearly established, viz :
the vapor of phosphorus must come into immediate contact with the per-
iosteum or bone, in order to excite the morbid process. This explains, in
the first place, why but few, comparatively, are affected who work in these
manufactories ; and in the second place, why the lower jaw is more fre-
quently the seat of the disease than any other bone. For it appears that
those only sutler who have decayed teeth the defect in the teeth allowing
the fumes of phosphorus to penetrate to the periosteum. So important is
this latter fact, that the government of Erfurt has passed a decree, that no
person having decayed teeth shall be allowed to work in lucifer match
factories. In a factory in this city, no workmen is allowed to return to
his work for a week after the extraction of a tooth.

The prognosis in these cases is very unfavorable. "When the disease
first comes .under notice, the peiiosteal inflammation has generally long
existed, and new formations already separate the bone from its covering.

More frequently the suppuration is established, exfoliations of bone are
taking place, and the whole morbid process is in active progress. The sys-
tem now hueaks down under the exhausting discharges and poisonous ema-
nations from the jaw; and the miserable subject of this destructive disease
falls a victim to its inroads upon its strength long before the completion
of the process of exfoliation. [Ibid.

On the Treatment of Haemoptysis. By M. ARAN.

M. Aran agrees with those who entirely condemn the employ-
ment of blood-letting in the treatment of haemoptysis, as it only
temporarily arrests the bleeding, while it is dangerous, owing to
the debility, and increased susceptibility, to the intercurrent affec-
tions it gives rise to. He has, for some time past, been engaged
in testing the efficacy of the various haemostatic agents employed
in haemoptysis; and in this paper he gives the results of his ob-
servations. He considers the essence of turpentine a most valua-
ble remedy, given in doses of from 10 to 80 drops every hour,
either in a spoonful of water, or mixed up with magnesia as a bolus.
Marked amendment usually occurs in a few hours, and in from
twenty-four to thirty-six hours the bleeding ceases. It is less
suitable for young or plethoric subjects with febrile action, than
in weak cachectic individuals, exhibiting atonic characteristics.
Ergot of rye and ergotine are far less efficacious ; but chloride of

430 Croup and Method of its Treatment. [July,

sodium, given in doses of 1 to 2^ drachms, proves very efficacious
in some cases, and has the advantage of being always at hand.
Among the astringents, tannin, and especially gallic acid, are to
be recommended; the latter while quite as efficacious, does not
exert the same desiccating effect upon the tissues, or induce the
obstinate constipation produced by tannin. As a mean dose, M.
Aran gives 15 centigrammes (a centigramme is \ grain) every
hour or alternative hour. He has had little experience in the use
of emetic and nauseating remedies; but in three cases in which
veratriae was employed, the bleeding ceased as if by enchantment.
This class of remedies, indeed, would deserve to stand in the first
class of haemostatic agents, were there not others possessing like
efficacy, and yet not giving rise to the painful nausea these pro-
duce. M. Aran has derived great advantage from the combined
use of digitalis and nitre. In ordinary cases, he gives in the
twenty-four hours, 30 centigrammes of digitalis, and \\ gramme
(a gramme is 15 grains) of nitre, divided into lour doses; but in
very severe cases, these doses may be very much increased, so that
the digitalis has been given to the extent of 1^ gramme, and the
nitrate to 4 grammes, without injuriously affecting the action of
the heart, while the effect produced upon the hemorrhage has
been remarkable. Its arrest, never, however, takes place so sud-
denly under the use of these medicines, as when turpentine or
gallic acid is employed.

In abundant, but not immediately dangerous hemorrhage we
can choose among any of the above-mentioned means. In ex-
tremely abundant hemorrhage, we must arrest the flow as speedily
as possible, by agents which do not depress the powers of the
economy too much, and which are not too slow in their operation.
Neither ergot, acetate of lead, nor alum is sufficient to meet the
danger. Turpentine, gallic acid, chloride of sodium, or nitre with
digitalis, can alone be trusted; but the necessity of increasing the
dose with the intensity of the hemorrhage may, perhaps, render
the chloride of sodium, and especially the nitre and digitalis, dan-
gerous, through the possibility of the production of a too great
depression of the heart's action. It is, therefore to gallic acid or
turpentine that we must chiefly trust in these severe cases ; and
we must not limit ourselves to their employment, but also endea-
vor to procure a temporary arrest of the hemorrhage by ligatures
to the limbs and the application of ice to the chest, allowing
the means employed internally to consolidate this temporary
Cure. [Med. Tunes and Gaz. from Gaz. Hop.

Croup and Method of its Treatment.

Dr. Hftnerkopff has recently published a paper, in which he
extols the administration of the sulphate of copper in this disease.
He has used this substance in 99 cases of croup, 77 of which

1856.] Croup and Method of its Treatment. 481

recovered; and the total quantity administered by him to these
patients was 2846 grains, or, on an average, 31^ grains each.
He has never seen any poisonous effects result from its use, al-
though one child got 27 grains daily for a week, or in all 216
grains; and another, 4| years old, took 150 grains in seven days,
and a third, aged 21, 120 grains in three days. No inflammation,
gangrene, or other bad symptoms took place. In 8 out of 13 cases
which proved fatal, there were either other diseases coexisting, or
the author was called to see them too late, so that he considers
that his remedy failed in only 5 out of the remaining 82 cases.
The mode in which he administered the salt was to dissolve from
6 to 8 grains in I j of water ; and, according to the age of the pa-
tient, and the severity of the vomiting induced, to administer,
more or less frequently, from a teaspoonful to a tablespoonful of
this solution, until vomiting occurred. The nature of the vomit-
ing should always regulate its administration; for the induction
of vomiting is absolutely essential for the therapeutic action of the
remedy, as it has a kind of specific influence on the disease.

Dr. J. Samter, of Posen, has also written a paper in praise of
the sulphate of copper in this disease. His remarks on its advan-
tages and mode of administration so closely resemble those of Hon-
erkopff which we have given, that it is unnecessary to quote them
here at length. He uses a solution of from 4 to 8 grains,, (and in
severe cases, 10 to 12 grains,) in ?ij of water; of this he gives
3ij repeatedly, till vomiting is induced, and thereafter 3j every
two hours.

In additin to the use of sulphate of copper, this author, at the
beginning of the disease, applies four, eight, or twelve leeches to
the larynx, and especially if there be any pain felt there,, and he
afterwards applies stimulating epithenes. He also uses the inha-
lation of powdered alum and sugar, employs warm baths, and
envelopes the feet in hot sand, etc. Gunsburg Zeitschrift, vj.r 1855.

Dr. Luzsinsky considers that there are four therapeutical indi-
cations in the treatment of croup, which must be attended to by
the physician. 1st. To change the peculiar blood crasis which
exists. 2d. To prevent the localization of the inflammatory pro-
cess in the larynx. 3d. To treat the spasm of the larynx. And,
4th. To encounter and destroy the false membranes whieh have
been formed.

For the fulfilment of the first indication, most men have recom-
mended the use of mercurials, but Luzsinsky depends more upon
alkalies, and especially on the carbonate of potass, which exercis-
es a solvent action on all the albuminous products of the organism.
Its use retards the developement of the constituents of the blood,
and greatly impairs the vital coagulability and inherent plas-
ticity of that fluid. This is the theory of the action of this salt,
which Eggert recommended as a specific in croup, after an expe-

432 Experimental Researches, &c. [J aly ,

rience of it in about 250 cases. It may be given advantageously
in doses of from 3ss to 3ij daily. Carbonate of soda may do in
mild cases, but the other alkali is alone to be relied on in more
severe ones.

The second indication may be answered by the application of
a blister, the size of a crown-piece, to the upper part of the manu-
brium of the sternum.

Spasm of the larynx is most surely treated by opium, applied
externally, in conjunction with vesicants (15 grains to 3ss of
ojjium, to 3ss of lard,) and also given in small doses internally.

To arrest the formation of the pseudo-membranes, nitrate of
silver, in a concentrated solution, may be applied to the fauces and
enterance of the larynx. Emetics may thereafter be given, and
they are only necessary in the exudative stage. Luzsinsky gives
decided preference to the use of sulphate of copper, which he-
administers by giving, every 15 minutes, a teaspoonful of a solu-
tion of two or four grains (or even more,) of the salt in 3 iiss of
some fluid. He does not look upon tracheotomy, in croupr iau a
favorable lighht.

Out of 30 cases treated thus by Dr. L. only seven died. Oester
Zeitschrift, i, 6, 8, 10, 1855 ; also Schmidts Jahrb. xi, p. 207, 1855.-

Dr. Menschel relates a case of croup in which, despite the timely
and assiduous use of all the ordinary remedies for this disease,,
difficulty of respiration and danger of suffocation increased. He
then painted the whole of the front of the neck very darkly with
a strong tincture of iodine, ( 3j of spirit,) and covered the part
with flannel, smeared with digitalis ointment. After an hour the
urgent symptoms had abated, the patient slept quietly during the-
night, and next day was convalescent. [Preuss. Verein. Zeitungr
10, 1855. Edinburgh Med. Journal.

Experimental Researches on the Production of a Convulsive Epilep-
tiform Affection, after Lesions of the Spinal Chord. By M.
Brown-Sequard.

The author by numerous investigations, has assured himself that
this convulsive affection may be produced after the following le-
sions : 1st. Complete, or nearly complete, transverse section of
one lateral half of the spinal chord. 2d. Simultaneous transverse
section of the posterior columns of the posterior grey cornua, and
of apart of the lateral columns. 3d. Transverse section of the
posterior columns alone. 4th. Transverse section of the lateral
columns. 5th. Transverse section of the anterior columns. 6th.
Transverse sections of the entire spinal chord, in the dorsal and
lumbar regions. 7th. Puncture of the spinal chord.

Lesion of the chord would appear to be less and less capable of
producing the epileptiform affection, in proportion as they are made

1856. j Relative Value of Disarticulation of the Knee, &c. 433

nearer the cliordal extremity. The time of the appearance of this
affection is almost always in the third week after the operation.

Convulsions occur sometimes without external excitement, but
in general they can be very easily provoked, either by irritating one
side of the face in those cases where the lesion exists only in a
lateral half of the chord or the two sides indifferently, when both
halves of the chord have been injured ; or again, by preventing the
animal from breathing for a very short time. This convulsive
affection much resembles epilepsy. It appears to differ from it only
in this, that the animal cries during the attack, if be is pinched.
The author has shown that the number of attacks increase consider-
ably in animals which he shut up in a narrow space, and to which
he gave much food.

On examining animals having this convulsive affection, M.
Brown Sequard found decidedly artificial lesion of the chord, a state
of congestion of the base of the brain, and of the gasterion ganglion
on both sides, when the lesion was on both sides of the spinal chord,
and only on the side of the lesion, when it was on but one lateral
half of the chord.

From the facts reported in this work, the author draws the follow-
ing conclusion?: :

1st. Various lesions of the spinal chord may produce in mammi-
ferae a convulsive affection, having much analogy to epilepsy. It
seems, consequently, that in man it is not by mere coincidence that
we find alterations of the spinal chord in epileptics.

2d. Lesions of the spinal chord may produce such a change in
the vitality of the trigeminal nerve, or of that part of the brain
where this nerve rises, that the irritation of the branches of this
nerve in the face, produces convulsions. Farther the right half of
the spinal chord has this influence on the trigeminal nerve, or the
encephalon of the right side, and the left half of the chord on one or
other of these parts on the left side. [Gaz. Heb. from Amer. Med.
Monthly.

The Relative Value of Disarticulation of the Knee, and of Amputa-
tion of the Thigh.

M. Baudens, in a paper on this subject, referred by the Academy
of Sciences, of Paris, to the section on medicine and surgery, says
that the opinion of all the chiefs of the ambulances, confirmed by
all that he saw from Marseilles and Toulon to Constantinople and
the Crimea, is that disarticulation of the knee should be preferred to
amputation of the thigh, whenever it is not possible to amputate the
leg below the patella. Disarticulation should be performed imme-
diately, that is as early as possible after the wound is received.
Consecutively, amputation of the thigh should be preferred. The
difference of success in immediate or consecutive disarticulations
is due to the fact that even in the condition of health, the size of the
bone is not in perfect harmony with the quantity of soft parts; and

434 Gallic Acid. [July,

the disproportion becomes still greater when the patient has lost his
flesh bv prolonged suffering and profuse supuration. [Gaz. Hebdom.
Ibid.

Gallic Acid.

A London Physician reports several cases in which this remedy
was successfully used as a haemostatic. The first was a case of
vesicle haemorrhage, from a polypoid growth in the bladder. Six
grains invariably checked the hemorrhage. The second a case of
scarlatinal dropsy. Urine at first albuminous and afterwards
bloody. Five grain doses three times a day greatly reduced the
amount of blood; but it was not until a drachm a day had been
continued for some time, that albumen and blood both disappeared
from the urine. If the acid was omitted for a single day, the urine
became as bloody as ever. He took more than eight ounces of
the acid, and was cured. The third was a case of ha?matemesis,
from chronic gastric ulcer. Ten grains were given every hour,
and the patient finally relieved. The fourth, a case of albuminu-
ria, in which the acid was given in doses often grains thrice a day.
Decided relief was obtained ; but the patient was not cured. Case
fifth, excessive menorrhagia, always checked by the acid in five-
grain doses. Case sixth, menorrhagia, Avith ovarian irritation,
simulating pregnancy. Every occurrence of hemorrhage effectu-
ally controlled by the acid. Case seventh, hemorrhage from the
bowels of a new-born infant, The acid given too late. The child
sank after the first dose, exsanguine. Case eighth, cerebral he-
morrhage from atheromatous deposit in the vessels of the brain.
Relieved, but not cured, by the galic acid. Case ninth, intercra-
nial hemorrhage from a fall ; relieved, but not cured, by the acid,
in ten-grain doses. Case tenth, profuse epistaxis in typhoid fever.
Two five-grain doses, and the application of the remedy to the
schneiderian membrane readily stopped the discharge. Case
eleventh, acute tonsillitis. Relieved by the following gargle: 3.
Gallic acid, 9 ij ; distilled water, hot, 3 viij. Mix. Cases twelfth
and thirteenth, tonsillitis, relieved by same gargle. Cases four-
teenth and fifteenth, polypus uteri. Hemorrhage relieved
by the acid in full doses. Case sxteenth, hemorrhage from
injury to the vagina. Relieved by two-grain doses of the acid
every half hour and cold applications. Case seventeenth, in-
ternal piles, with unusually severe hemorrhage, checked by live-
grain doses every three hours. Case eighteenth, haemoptisis, re-
lieved by three five-grain doses, and a second attack by the same.
Case nineteenth, erysipelas of the face, relieved by the application
of a lotion, 3ij of the acid dissolved in a pint of warm water.
Case twentieth, a profuse haemorrhage from a deep cut, arrested
by powdered gallic acid placed in the wound, and without pain.

1856.] Treatment of Fistula Lachrymalis. 435

He suggests that the garlic mentioned in case eleventh might
be used, in conj auction with the nitric acid treatment, in scarla-
tina.

In cases of yellow fever, we have succeeded in restraining he-
morrhages from the stomach and bowels, and other outlets of the
body, by the use of this remedy in doses of five to eight grains ; and
we have found it scarcely less effectual in restraining watery dejec-
tions from the bowels. A case of pyrosis was promptly relieved
by the same remedy, as were also, to a marked extent, the dyspep-
tic symptoms with which the disease was complicated. [New
Hampshire Jour, of Medicine.

On the Treatment of Fistula Lachrymalis. By M. TAVIGNOT.

M. Tavignot is of opinion that fistula lachrymalis is the result
of an organic disaccord between the chemical properties of the
tears and the physiological properties of the nasolachrymal
mucous membrane. This explains both the obstinacy of the
disease and the relative efficacy of that treatment which most
protects the mucous membrane from the contact of the tears.
We find the tears will not flow through the canal, even when it
has been dilated by surgical means ; while the presence of a for-
eign body in the canal causes the cessation of the accidents ; this
being better tolerated than the tears, the access of which it prevents.
These various modes of treatment only succeed after long perse-
verance has modified and transformed the characters of the
mucous membrane.

In place of occupying so long a time in obtaining this alteration
in the sac and the duct, the author recommends that the gland
itself should engage our attention. Where the affection does not
arise from scrofulous disease, when it is ameanable to appropriate
remedies, he is unaware of any means of restoring harmony to the
parts, although in the 'early stages antiphlogistics and topical
remedies do much to remove complications and procure tempora-
ry relief. The contact of the tears can only, by the various means
usually employed, be tempo rarity prevented, while obliteration
of the passages is difficult to obtain, and is attended with stillici-
dium. The lachrymal gland itself may, however, be removed
without inconvenience. It is, in fact, the orbital portion that is
alone to be removed; and the palpebral granules that remain
suffice, with the mucus of the membranes, to lubrify the surface
of the eye. The operation is inoffensive. Very soon great ame-
lioration ensues, after the immediate effects of the operation have
passed away, and this may go on to a definitive cure. When this
; is delayed, owing to the still disordered state of the passages,
iodine injections should be employed. [Moniteur des Hopitaux.
Brit, and For. Medico* Chir. Rev.

N. S. VOL. XII. NO. VII. 28

436 Editorial and Miscellaneous. [July,

The Seton before the Academy of Medicine of Paris.

A very hot discussion has just been closed before the Academy
of Medicine of Paris, on the use of the seton; and a great many
instructive facts, both in ancient and modern medicine, connected
with that powerful derivative, were brought to light, both by M.
Bouvier, the author of the paper and advocate of the practice, and
M. Malgaigne, the caustic and epigrammatic decrier of the seton.
There can be hardly any doubt but that the latter eminent sur-
geon went too far with his condemnation, and that the timely use
of the seton, especially in chronic ophthalmic cases, will continue
in favor with the great majority of practitioners. M. Bouvier
employs little cords of No. 1 bougies, and covered with a water-
proof composition, instead of the skein or tape. [London Lancet.

EDITORIAL AND MISCELLANEOUS.

Sulphur to arrest Vomiting. We are informed by Dr. J. F. Reynolds,
of Newborn, Ala., that he lias recently succeeded in arresting two cases of
vomiting, which had resisted the usual remedies, by the administration of
a tea-spoonful of the Sublimed Sulphur. The dose is to be repeated imme-
diately, if rejected.

Never having used sulphur for this purpose, we can say nothing of its
efficacy ourselves, but think it worthy of trial.

Dr. II. A. Ramsay. We take from the Augusta Chronicle and Sentinel
the following notice relating to the late notorious Editor of the "Georgia
Blister and Critic," who for some years past seemed to take peculiar plea-
sure in traducing honest men anonymously and otherwise.

" Bonn t y Land and Pension Fraud. The Pension Office at Washington
baring had suspicion of fraud being practised on account of the number of
claims for homily land and pensions for revolutionary service sent from Col-
umbia county, in this State, despatched Mr. Stephen C.Dodge, Special
Agent, toinvestigate the matter. After some interviews with Mr. Stewart,
the U.S. Marshal in Savannah, and Mr. Ross, of Macon, the Deputy U. S.
Marshal, whom he met, in this city, he returned to Savannah and obtained
warrants for the arrest of Dr. Eenry A. Ramsay and Richard W. Jones, of
Columbia county, on the charge of having fabricated testimony in support
of false pension claims. The arrests were made in this city hist Sunday,
and the prisoners W( re forwauded to Savannah. On Wednesday they were
examined before the U. S. Commissioner. Judge Henry required the pris-
oners to enter into bonds for their attendance during the examination of
$5,000, which bond was given by Ramsay, hut in default of which Jones
was lodged in jail. The examination is said to have revealed the grossest

1856.] Editorial and Miscellaneous. 437

fraud and deception which had been practiced on persons whose affidavits
had been obtained in support of false claims. Dr. Ramsay, who is thought
to have been the chief instigator of the scheme, absconded during Wednes-
day night, forfeiting his bail, and has not since been heard of. Vigilant
efforts are being made for his re-capture. Jones is still in Savannah jail."

Teeth extracted without pain. Instruments for the production of local
insensibility to pain in Dental and Surgical Operations, secured under the
Patent Laws, are now ready and for sale, with full instructions for use, at
$25, and can be had by addressing Messrs. Jones, White & McCurdy, at
their Philadelphia, New-York, or Boston Depots; or by addressing I. B.
Branch at Galena, 111.

American Dental Convention. The second annual meeting of this body
will be held in New-York, on the 6th of August next.

7 O

Death of James McCaffcrty. It is with profound regret we have to an-
nounce the death of our worthy and highly esteemed Publisher. Mr. James
McCafferty has been the printer and publisher of this Journal for nearly
twelve years, and has always discharged the duties assigned him with
punctuality and distinguished ability. The publication will be hereafter
issued by Jeremiah Morris, for the benefit of the estate.

Ninth Annual Session of the American Medical Association, at Detroit,

Michigan.

The Association met at Fireman's Hall, at 11 o'clock, A. M., and was
called to order by the President, Dr. G. B. Wood, of Pennsylvania.

Dr. Pitcher, of Michigan, in behalf of the Committee of Arrangements,
welcomed the assemblage in handsome style.

The roll was then called by Dr. Wistar, of Pennsylvania.

On motion of Dr. Thompson, of Delaware, a recess of fifteen minutes
was taken to allow the delegates from the respective States to report one
member from each State represented, as a Committee to nominate officers
for the ensuing year.

After the Nominating Committee had retired, Dr. Pitcher, of Michigan,
from the Committee of Arrangements, reported the order of proceeding
for the session.

The President announced the death of the eminent Dr. John C. Warren,
of Boston, Mass., whereupon, Drs. Childs, of Massachusetts, and Gross, of
Kentucky, having made some remarks; a committee of five was appointed
to draft resolutions expressive of the feelings of this Association at the loss
of their late associate.

AFTERNOON SESSION.

The Secretary read a letter from Dr. Grafton Tyler, of the District of
Columbia, one of the Vice-Presidents, excusing his absence.

He also read letters from the State Medical Society of Tennessee, and
from the University of Nashville, inviting the Association to hold its next

438 Miscellaneous. [July*

annual session at Nashville, Tennessee. Also, one tendering the use of
the Hall of Representatives of that State for the purposes of said session.

The following report was accepted and the nominations unanimously
confirmed :

President Dr. Zina Pitcher, of Detroit.

Vice-Presidents Drs. Thomas W. Blatchford, of New- York; "Wm. K.
Bowling, of Tennessee ; E. Geddings, of South-Carolina ; W. H. Brisbane,
of Wisconsin.

Secretaries Drs. W. Brodie, of Michigan ; R. C. Foster, of Tennessee.

Treasurer Dr. Caspar Wister, of Pennsylvania.

On motion, the President was requested to deliver his annual address.

At the close of the address, on motion of Dr. Atlee, of Pa.,

Resolved, That the thanks ol'the Association be presented lo our late President for
the able and interesting parting address he has just delivered, and that he be request-
ed to present to the Committee of Publication a copy, for preservation in our trans-
actions.

On motion of Dr. Atlee, of Pa.,

Resolved, That a Committee of three be appointed to inform tie President and
Vice-Presidents elect of their election, and conduct them to their seats.

The President appointed as such Committee, Drs. Atles, of Pa., Reeves,
of Ohio, and Sutton, of Ky.

Upon taking the chair, Dr. Pitcher returned thanks for the- honor
conferred.

Dr. Frost, of Charleston, S. O, offered the following resolution, which
was adopted :

Resolved, That the thanks of this Association are due to the retiring officers for
the zealous and efficient manner in which their duties have been performed ptn our
late President, for the courtesy and ability with which he has presided over our de-
liberations ; to all the officers, for their attention to the laborious duties of their sta-
tions not excepting our Committee on Publication, to whom we must feel indebted
for the satisfactory form in which the volume of the transactions appears.

On motion of Dr. Gunn, of Michigan,

Resolved, That the resolution passed at St. Louis, requiring a majority of the
Committee on Publication to be appointed from residents of the place where the
meeting is held, be repealed.

Dr. Palmer, of Illinois, from the Committee on Prize Essays and Volun-
teer Communications, submitted the following:

"The Committee on Prize- Essays and Volunteer Communications, report,
that some months since thy issued a card, which was extensively publish-
ed in the medical journals, setting forth the terms upon which essays in-
tended for prizes would be received ; but that the number of papers
presented has been but four.

" By referring to the past records of the Association, it is found that the
numbers received by preceding Committees have been, in 1852, sixteen ;
' in 1853', fifteen; in 1854, nine; in 1855, six ; and in 1856, four. Your
Committee beg leave to call attention to this almost rtgular and quite ra-
T>id decrease in the number of essays presented, for the purpose of having
the Association consider whether there be not danger that the number
which may hereafter be furnished, will be so small as to afford insufficient
rarr^e of comparison and* choice as to cause the preference shown to be
much valued, if, indeed, presentations do not cease altogether, and whether
any means should be dvised for preventing such a result.

1856.] Miscellaneous. 439

" The essays received by your Committee have been subjected to a care-
ful examination ; and while admitting that they all possess a degree of
merit, which would render them suggestive and useful, if given to the pro-
fession, still, in their opinion, but one manifests that evidence of careful
and laborious investigation, that wide scope and rigid accuracy of logical
reasoning, that chasteness of expression and artistic skill in the presenta-
tion -of the subject, as to furnish sufficient claim for awarding a prize by
this body.

" Bat one prize is therefore awarded. The essay selected for this honor,
bears the title ' An Essay on the Arterial Circulation.'

"It is regarded by the Committee as possessing the merits just alluded
to, and while not wishing to give an unqualified endorsement of all the
views which it contains, they regard it as possessing, not only interest in
its physiological and scientific relations, but also real value in its patholo-
gical and practical bearings.

" The production has considerable length, and by the fulness with which
the views advanced are discussed, it partakes as much of the nature of a
treatise as an essay. It has, at least, one quality which Lord ]3acon con-
sidered necessary to a treatise, as distinguished from an essay, it required
a degree of leisure on the part of the writer, and will require the same on
the part of the reader for him fully to appreciate its value.

" The essay bears the motto ' Una est Veritas?

(Signed) A. B. Palmer, Chairman.

Samuel Denton,
Silas H. Douglass,
Ab'm Sager,
E. Andrews.

" On breaking the seal of the accompanying packet, Dr. Henry Harts-
horn, of Philadelphia, Pa., was found to be th successful essayist."

The report was accepted.

Dr. Blatchford, of New York, from the Committee on " Hydrophobia,
and the connection of the season of the year with its prevalence," read a
report thereon. The Committee, in conclusion, submitted the following
resolution, which was adopted :

Resolved, That the Secretary transmit to the Governor of each State a copy of the
statistical part ot this report, with :the respectful request that he would bring the sub-
ject before the Legislature of the State over which he presides, that in iheir wisdom
they may devise and unite upon a plan by which the evil may be mitigated, if not
removed.

The Committee on Nominations reported in favor of holding the next
annual meeting of the Association at Nashville, Tenn., and the report was
adopted.

Dr. Wister, of Pa., from the Committee on Publication, made the annual
report. It states that the first copies of the transactions of the last session
of the Association were issued on the 10th of November, 1855 ; that 1000
copies were printed ; that the aggregate expense of printing, illustrating
and binding was $1,922.70 ; that the distribution of the volume was effect-
ed, in every possible instance, by express; that Drs. C. Hooker of Ct., Al-
den March of Albany, J. L. Atlee of Pa., W. Brodie of Mich., C. B. Gibson
of Richmond, E. L. Beadle of N. Y., H. W. DeSaussure of S. C, C. A.
Pope of Mo., D. H. Storer of Mass., T. G. Richardson of Ky., J. Moran of

440 Miscellaneous. [July*

B. I., T. Miller of D. C, F. E. B. Hintzc of Md., L. P. Bush of Del., Z.
Pitcher of Mich., and J. B. Lindsley of Tenn., have rendered essential ser-
vice to the Association some in procuring subscriptions to the volume,
and all by cordial co-operation in its distribution ; that it is important to
6ecure efficient co-operation in every State by the appointment of gentle-
men whose duty it shall be to aid in procuring subscriptions for, and cir-
culating the transactions; that Connecticut is especially to be commended
for her services in this particular ; that not a little embarrassment was ex-
perienced by the committee in restoring to the list of permanent members
the names of those who had been left off by order of the Association for
non-payment of assessments ; that they had endeavored, however, by care-
ful comparison of the various lists, to supply all omissions ; that the com-
mittee had been reluctantly obliged to omit from the transactions two
valuable reports on epidemic diseases by Dr. L. H. Anderson, of Ala., and
Dr. E. D. Fenner, of New Orleans, but, as they had not been presented
to the Association, and acted on by that body, there was no other alterna-
tive ; that the following resolution, passed at the last session, should be
strictly enforced :

Resolved, That, hereafter, beginning with the session of 1S5G, no report, or other
paper, shall be entitled to publication in the volume for the year in which it shall be
presented to the Association, unless it be placed in the hands of the Committee of
Publication on or before June first.

The report further states that the number of volumes of transactions now
remainino- on hand is as follows: of Vol. I. 41, of Vol. II. 9, of Vol. III.
32, of Vol. IV. 7, of Vol. V. 316, of Vol. VI. 66, of Vol. VII. 120, of Vol.
VIII. 351 ; that some of the leading journals abroad have expressed a
strong desire to complete their sets, and it rests with the Association to
determine whether the missing numbers shall be supplied ; that, as only
seven complete sets of the transactions are now in the possession of the
Association, the committee recommend that no copy of either of the eight
volumes which is necessary to the complete sets now remaining shall bo
disposed of separately, or with any number of volumes short of a com-
plete set.

Dr. "Wood, of Philadelphia, moved to refer the nominations of standing
committees to the Committee on Nominations. Carried.

The same gentleman made a request in behalf of Dr. Hamilton, that the
committee of which Dr. II. is chairman, may be continued for another
year, it not being prepared to report at present. Granted.

Dr. Pomeroy, of N. V., moved to reconsider the resolution requiring a
member, when speaking, to stand upon the platform, and not to occupy
more (ban ten minutes in his remarks. Lost.

Dr. Smith, of N. J., moved that that portion of the resolution requiring
members, when speaking, to take the stand, be rescinded. Carried.
Dr. Atlee, of Pa., moved to refer the prize essay of Dr. Hartshorn on
Arterial Circulation, and the report of Dr. Blatchford on Hydrophobia, to
the Committee on Publication. Carried.

Dr. Wist or, of Pa., the Treasurer, read his annual report. It recom-
mends that the Treasurer be requested, at an early date after the adjourn-
ment of the present meeting, to address a circular to each permanent
member, announcing the abrogation of the resolution of 1854 making a
yearly subscription to the transactions obligatory and the consequent

1856.] Miscellaneous. 441

restoration to membership of all those dropped from the published list of
that year, advertising, also, the practicability of procuring back numbers
of the transactions, with information as to the cost at which the series of
volumes may be rendered complete, or an entire set furnished by the
Association.

Dr. Gross, of Ky., stated that Dr. "Wood, of New York, who was then in
the meeting, had lately performed an operation in an extraordinary case
removing a jaw-bone and moved that a time be appointed for the Asso-
ciation to examine the part extirpated.

Dr. Wood said he had not with him the article spoken of by the preced-
ing speaker, but would lay it on the desk of the President in the morning.

The President read a communication from Dr. Stille, Chairman of the
Committee appointed last year to consider the subject of extending the
lectures of each chair in medical schools over a period of two years, stating
that the views of medical institutions had as yet been imperfectly ascer-
tained, and asking a continuance of the committee. Granted.

The President read an invitation to the Association to attend the ses-
sion of the American Association for the Advancement of Science, at Alba-
ny, in August next, at which time, also, the Dudley Observatory will be
inaugurated, and an address delivered by Hon. Edward Everett. The in-
vitation was accepted.

SECOND DAT.

The Secretary read communications from the following gentlemen ask-
ing an extension of time in which to report upon the subjects named :

Dr. A. J. Semmes, of N. Y. " Coroners' Inquests."

Dr. J. Taylor Bradford, of Ky." Treatment of Cholera:'

Dr. J. M."Reese, of N. Y " Infant Mortality."

Dr. E. R. Peaslee, of Me. " Inflammation, &c."

Dr. J. W. Corson, of N. Y. " The Causes of the Impulse of the Heart,
and the Agencies which Influence it in Health and Disease."

Dr. Mark Stephenson, of N. Y. " The Treatment best adapted to each
Variety of Cataract, with the Method of Operation, Place of Election,
Time, Age, &c."

Dr. Beech, of Mich. "Medical Topography and Epidemics."

Dr. J. C. Hutchinson, of N. Y. " The Anatomy and Histology of the
Cervix Uteri."

Referred to the Committee on Nominations.

The Secretary announced that he had received the following resolution
adopted at the last meeting of the New York State Medical Society :

Resolved, That ihe members of the American Medical Association be invited to
attend the semi-ceniennial celebration of this Society, which will occur on the first
Tuesday of February, 1857.

The invitation was accepted.

The Secretary read a communication from Dr. Hamilton, of Buffalo, N.
Y., transmitting the second part of a report upon Deformities after Frac-
ture and Dislocations, and asking for a correction of the minutes of last
.session in regard thereto. Dr. Hamilton also asked that he be permitted
to incorporate, in a volume upon the subject he is preparing for publica-
tion, that portion of the report already published by the Association.

On motion of Dr. Brodie, of Michigan, the minutes were amended.

442 Miscellaneous. [July*

Dr. Atlee, of Pa., offered a resolution that the request of Dr. H., in re-
gard to the publication of the report, be granted.

Dr. Lindsley, of Tenn., opposed the resolution. A similar request was
denied at the session of the Association held at St. Louis.

Dr. Palmer, of 111., moved to refer the matter to a special committee.
Carried.

Dr. Sutton, of Ky., offered a resolution that 1,000 copies of the address
of the late President, Dr. Wood, be published. Adopted.

On motion of Dr. J. B. Lindsley, of Tennessee,

Resolved, That a committee of three be appointed by the Chair, to prepare a suita-
ble minute in reference to the death of our lale Secretary, Dr. P. C. Gooch, of Rich-
mond, Va., who fell a martyr while contending with the pestilence in Norfolk, in
1855.

Dr. Gross, of Ky., from Committee appointed the day previous, reported
the following preamble and resolutions relative to the death of Dr. J. C.
Warren, of Boston ;

Whereas, It has pleased Almighty God to remove from the scene of his earthly la-
bors our late fellow-member, Dr. John C. Warren, of Boston, formerly President of
this Association, and for many years Professor of Anatomy and Surgery in Har-
vard University;

And whereas, It is just and proper that, when a great and good man dies, his mem-
ory should be cherished by his fellow-citizens, and transmitted unimpaired to poste-
rity for the encouragement of future ages; therefore,

Resolved, That this Association has learned with profound regret the news of an
event which has deprived the American medical profession of one of its oldest, most
useful, and most illustrious members American surgery one of its greatest orna-
mentsscience one of its best iriends and humanity one of its noblest benefactors.

Resolved, That the lile of Dr. John C. Warren, affords an example of a man who,
notwithstanding the possession of ample riches, devoted himself, heart and soul, for
upwards of half a century, to the cultivation and advancement of his profession, and
lo the good of the human race.

Resolved, That this Association deeply sympathises with the family of Dr. Warren
in their bereavement, and the Secretary be requested to transmit lo them a copy of
these proceedings.

The preamble and resolutions were adopted, and referred to the Com-
mittee on Publication.

Dr. Gross, of Ky., read a report on " The causes which impede the
progress of American Medical Literature." In conclusion, he submitted
the following resolutions :

Resolved, That this Association earnestly and respectfully recommends: 1st. The
universal adoption, whenever practicable, by our schools, of American works, as
text-books for their pupils. 3d. The discontinuance of the practice of editing foreign
writings. 3d. A more independent course of the medical periodical press towards
foreign productions, and a more liberal one towards American j and 4th- A better
and more efficient employment of the facts which are continually furnished by our
public institutions, for the elucidation of the nature of diseases and accidents, and,
indirectly, for the formation of an original, a vigorous, and an independent national
medical literature.

Resolved, That we venerate the writings of the great medical men, past and pre-
sent, of our country, and that we consider them as an important element of onr
national medical literature.

Resolved, That we shall always hail with pleasure any useful or valuable work,
emanating from the European press, and that we shall always extend to tfiem a
cordial welcome, as books of relerence, to acquaint us with the progress of legiti-
mate medicine abroad, and to enlighten us in regard to any new facts of which they
may be the repositories.

Dr. Phelps of New York, moved that the report and resolutions, as a
whole, be adopted,

1856.] Miscellaneous. 443

At the suggestion of a menber, the question was divided. The report
was adopted.

Upon the reading of the first resolution, a member proposed to substi-
tute "just" for "liberal" in line 5. Dr. Gross accepted the amendment.

Dr. Cobb, of N. Y., was opposed to the resolutions. If adopted and sent
out to the world, they savor too much of know-nothingism to make them
palatable. [Sensation.]

Dr. Leid, of Pa., was in favor of leaving to teachers of medicine the selec-
tion of their own text books.

Dr. Davis understood there was another report touching upon the subject
that upon "American Medical Literature," by Dr. Brecken ridge, ofKy.
He moved to lay the resolutions upon the table until that report was read.
Carried.

The Secretary read a communication from Dr. P. A. Jewett, of Conn.,
Chairman of the Committee to Procure Memoirs of the Eminent and Wor-
thy Dead. Referred to Committee on Nominations.

Dr. Breckenridge, of Ky., read a report upon American Medical Litera-
ture. It was accepted and referred to the Committee on Publication.

THIRD HAY MORNING SESSION.

On motion of Dr. Atlee, of Pa.,

Resolved, That the President shall be authorized annually to appoint delegates to
represent this Association, at the meetings ot the British Association, the American
Medical Society of Paris, and such other scientific bodies in Europe as maybe
affiliated with us. Adopted.

On motion of Dr. Mendenhall of Ohio,

Resolved, That the Secretary be instructed to strike the name of G. H. Cleveland
from the list of permanent members of this Association.

On motion of Dr. Atlee, of Pa.,

Resolved, That the name of James R. McClintock be striken from the list of per-
manent members.

These expelled members were accused by the movers of the resolutions
of having retrograded into quackery.

On motion of Dr. Bissell, of New York,

Resolved, That this Association has learned with deep regret of the death of one
of its members, Dr. Theodore Rotneyn Beck, of Albany, N. Y., whose whole life has
been devoted to the attainment and promotion of medicine and general science, and
that we do hereby express our high appreciation of ihe excellencies of his character,
distinguished by its simplicity, integrity, and firmness of purpose, and by the extent
and variety of his acquirements in medical as well as in almost every department
of science.

Resolved, That the above resolution be referred to the Committee to procure
memorials of the eminent and worthy dead, and that they be requested to procure a
memoir of the late Dr. Beck, to be published in the transactions of the Association.

Dr, Bloodgood, of III, offered the following :

Resolved, That the constitution of this Association be so amended as that hereaf-
ter the President shall be elected by ballot, and shall not be a resident of the State in
which he is elected.

On motion of Dr. Watson, of N. Y., laid on the table.
Dr. AVister, of Pa., offered the following, which was adopted :
Resolved, That the invitation to gentlemen of the medical professiou of Canada,
extended to them by the American Medical Association at its session in Philadel-
phia, be renewed for the meeting at Nashville, Tenn ; and that this Association may
be safe from the introduction of unsuitable persons, it is recommended that gentle-
men presenting themselves from the Province of Canada should be provided with a
letter of introduction to this Association from one of the following gentlemen : Drs,

444 Miscellaneous. [Juljt

Tarquand A Scott, Woodstock, Canada ; Drs. Hodder, Bethune, Richardson, Bon-
nell, Haswell, Widmer, Beaumont, Herrick, of Toronto; Drs. O'Reilly, Craiggie,
Dugnan, of Hamilton; Dr. Sampson, of Kingston.

Dr. Phelps, of New York, offered the following :

Wlvereas, It has pleased an All Wise, but Inscrutable Providence, to visit the city
of Norfolk, Va., and vicinity, with a desolating pestilence, equal, or surpassing, any
record in ancient or modern limes, and by which, in a few weeks, forty physicians,
either residents or those from abroad, who had promptly rushed to the rescue, among
the the number ol whom was our late Secretary and associate, Dr. Gooch. of Rich-
mond had been swept away ; therefore,

Resolved, That such an instance of signal and unflinching devotion to the cause
of science and of humanity demands at the hands of this national Association a
passing expression of their high admiration of this, another memorable instance of
the unparallelled sacrifices of the profession to the interests of the healing art and of
the race.

Resolved, That this minute be incorporated in our transactions.

Dr. Stocker, of Perm., offered the following amendments to the constitu-
tion :

Amend article 3 so that it shall read: " Article 3. The regular meetings of the
Association shall be held annually, and commence on the first Tuesday of May.

The Association shall meet biennially in the city ol . The place of meeting lor

the immediate year shall be determined by a vote of the Association."

Amend article 4 by providing for or.e permanent and two assistant secretaries,
and also specifying the duties, &c. of each.

Laid on the tahle under the rule.

Dr. Dorsey, of Ohio, offered the following :

Resolved, That in May, 185S, and every third year thereafter, this Association
meet at Washington City, and that the present officers be requested to correspond
with the Board of Managers of the Smithsonian Institute, in regard to furnishing
necessary rooms for the keeping of the archives of the Association.

Laid on the table under the rule.

On motion of Dr. Atlec, of Pa., the report and resolutions of Dr. Gross,
and the report of Dr. Breckenridge, upon "American Medical Literature,"
were referred to the Committee on Publication.

Dr. Palmer, of 111., from Special Committee to which was referred the
communication of Dr. Hamilton, reported the following resolution, which
was adopted :

Resolved, That leave be granted to Dr. F. H. Hamilton to make use of the materi-
als of his report on " Deformities alter Fractures," which is in course of publication
by this Association, in his anticipated work upon "Fractures and Dislocations."

Dr. A. B. Palmer, Professor in the Michigan University, from the Com-
mittee on Plans of Organization for State and County Medical Societies,
presented a lengthened and able report, containing numerous useful sug-
gestions, with outlines for the proper organization of local societies, and a
series of resolutions in accordance with the views enforced in the report.
Accepted, and referred to the Committee on Publication.

On motion, the resolutions were temporarily laid on the table for further
action by the Convention.

Dr. Davis, of Illinois, chairman of Special Committee, reported on "The
Changes in the Composition and Properties of the Milk of the Human
Female, Produced by Menstruation and Pregnancy," in a paper containing
numerous valuable details of much interest to the profession and the public,
obtained by careful examination and comparison, and showing conclusively
the ill effects of lactation, especially during the latter of the periods referred
to. Accepted, and referred to the Committee on Publication.

1856.] Miscellaneous. 445

Dr. Chas. Q. Chandler, of Missouri, who was to report on "Malignant
Periodic Fevers," submitted, as a substitute, through the Secretary, a pa-
per on " Sulphate of Cinchona," which was received as a " voluntary con-
tribution," and referred to a special committee.

Dr. Johnson, of Chicago, asked further time to report on "Excretions,
&c. Referred to Committee on Nominations.

Dr. J. M. Newman, of Buffalo, from Committee on the Sanitary Police
of Cities, presented an elaborate report, embracing details of the various
estimated causes of disease in cities, as compared with rural localities,
together with nemerous valuable statistics of mortality in the larger cities
of Europe and the Union, of which the Doctor, at the request of the Asso-
ciation, gave a brief, verbal abstract. The report evidently embodies a vast
mass of useful information, with deductions from it that city life is inimical
to health and longevity, and arguments enforcing the urgent necessity for
ameliorating the senitary condition of the populous localities of cities and
large towns. Of diseases arising from impure air and insufficient ventila-
tion, classed under the term "zimotic," the report stated that, in 1850, 40
per cent, of all the deaths in the various cities were of that nature. The
report also embodied details of the loss of life from cholera, small pox, &c,
giving startling expositions of clanger from these sources, and recommends
the enactment of laws for compulsory ventilation and cleanliness, as well
as for vaccination, &c. Accepted, and referred to Committee on Publica-
tion.

AFTERNOON SESSION.

Dr. A. J. Fuller, of Me., chairman of the Committee on the Best Treat-
ment of Cholera Infantum, read a report thereon, in which he stated that
the pathology of the disease was little understood, and that physicians
should interchange views on the subject. The report was accepted and
referred to the Committee on Publication.

Dr. Green, of N. Y., chairman of the Committee on the Use and Effects
of Application of Nitrate of Silver to the Throat, read a report thereon.
He asserted that great benefits had been derived from topical medication
in thoracic diseases, tuberculosis, bronchitis, &c. The report was accept-
ed and referred to the Committee on Publication.

Dr. Flint, of Louisville, chairman of the Committee on the Best Mode of
Rendering the Medical Patronage of the National Government Tributary
to the Honor and Improvement of the Profession, read a report thereon.
He denounced the granting of patents by the United States government to
" quack medicines," stating, however, that it appears, from a letter writ-
ten by the present Commissioner of Patents, that the practice of the office
has been to discourage such abuse of its functions, and that, during the
past fifteen years, but four or five such patents have been granted, although
from twenty to thirty applications therefor have been made per year. The
credit of sanitary improvements, Dr. Flint said, were not due to individu-
als, but to medical science. Such improvements are never discoveries or
revelations, but inductions. The United States government should aid the
great cause of medical science by making appropriations for the publica-
tion of the transactions of the National Association, and by paying prizes
I for the best essays on subjects selected by that Association. The report
was accepted and referred to the Committee on Publication.

The Committee on Nominations made the following report :

446 Miscellaneous. [July,

The Nominating Committee beg leave to make the following report :

For Chairmen of Special Committees for 1857 :

Dr. E. R. Peaslee, of Brunswick, Me., on Inflammation, its Pathology
and its Relation to the Recuperative Process.

Dr. J. C. Hutchinson, of Brooklyn, N. Y., and Charles E. Isaacs, of New
York city, on the Anatomy and Histology of the Cervix Uteri.

Dr. J. Taylor Bradford, of Augusta, Ky., on the Treatment of Cholera.

Dr. Mark Stephenson, of N. Y., on the Treatment Best Adapted to Each
Variety of Cataract, with the Method of Operation, Place of Election, Time,
Age, &c.

Dr. J. W. Corson, of N. Y., on the Causes of the Impulse of the Heart,
and the Agencies which Influence it in Health and Disease.

Dr. D. Meredith Reese, of N. Y., on the Causes of Infant Mortality in
Large Cities, the Source of its Increase, and the Means for its Diminution.

Dr. J. Foster Jenkins, of Yonkers, N. Y., on Spontaneous Umbilical
Hemorrhage of the Newly Born.

Dr. Henry Carpenter, of Lancaster, Pa., on the Use of Instruments in
Obstetrical Practice.

Dr. Alex. J. Semmes, of Washington, D. O, on the Measures to be
Adopted to Remedy the Evils Existing in the Present Mode of Holding
Coroners' Inquest.

Dr. J. Marion Sims, of New York city, on the Treatment of the Results
of Obstructed Labor.

Dr. J. B. Flint, of Louisville, Ky., on the True Position and Value of
Operative Surgery as a Therapeutic Agent.

Dr. G. Volney Dorsey, of Piqua, Ohio, on the Causes and Cure of Indi-
gestion, especially in relation to the Therapeutic Indications to be derived
from the Chemical Composition of the Deposits in the Urine.

Dr. C. B. Coventry, of Utica, N. Y., on the Medical Jurisprudence of In-
sanity, and the Testimony of Skilled Witnesses in Courts of Justice.

Dr. Jos. Leidy, of Philadelphia, Pa., on Human, Animal, and Vegetable
Parasities.

Dr. M. D. Darnall, of Bainbridge, Ind., on the value of a Strict Atten-
tion to Position in the Treatment of Diseases of the Abdomen.

Dr. George Sutton, of Aurora, Ind., on Milk Sickness.

Dr. Clark J. Pease, of Janesville, Wis., on the Blending and Conversion
of the Types of Fever.

Dr. B. S. Woodsworth, of Fort Wayne. Ind., on the Best Substitute for
Cinchona and its Preparations in the Treatment of Intermittent Fever and
Malarious Neuralgia.

Dr. Franklin Ilinkle, of Marietta, Pa., on the Use of Cinchona in Mala-
rious Diseases.

Dr. Henry F. Campbell, of Augusta, Ga. on the Nervous System in Feb-
, rile Diseases.

Dr. John Neill, of Philadelphia, Penn., on the Laws, Governing the De-
posit of Bone.

Dr. John W. Green, of N. Y. City, on the Intimate Effects of Certain
Toxicological Agents in the Animal Tissues and Fluids.

Dr. George Suckley, U. S. A., on the Medical Topography and Fauna of
Washington Territory.

Dr. Jas. Cooper, of Hoboken, N. J., on the Flora of Washington and
Oregon Territories.

1856.J Miscellaneous. 447

Dr. Ohas. E. Isaacs, of N. Y., on the Intimate Structure and the Patholo-
gy of the Kidney.

Dr. Israel Moses, of New York City, on the Diseases Incidental to Euro-
peans from Temperate Climates in their Transition through Central Ameri-
ca.

Dr. T. W. Gordon, of Georgetown, Brown County, 0., on the Etiology
and Pathology of Epidemic Cholera, to be continued three years, and with
power to add any other members.

Dr. H. A. Johnson, of Chicago, on the Excretions as an Index to the
Organic Changes going on in the System.

Dr. D. D. Thomson, of Louisville, on the Remedial Effects of Chloroform.

Standing Committees.

Committee on Publications. Drs. Francis G. Sroilh, of Pa.r Chairman ;
Caspard Wister, of Pa. ; Samuel L. Hollingsworth, of Pa. ; Samsel Lewis,
of Pa. ; H. F. Askew, of Del. ; Wm. Brodie, of Mich. ; R. C. Foster, of Tenn.

Committee on Prize Essays. Drs. Wm. K. Bowling, of Tenn., Chairman ;
E. B. Haskins, of Tenn. ; Thomas Lipscomb, of Term. ; A. H. Buchanan, of
Tenn. ; B. W. Avent, of Tenn. ; W. A. Cheatham, of Tenn. ; Paul F. Eve,, of
Tenn.

Committee of Arrangements. Drs. C. K. Winston, of Tenn., Chairman;
Ira Conwell. of Tenn. ; William D. Haggard, o>f Tenn. ; J. L. C. Johnson, of
Tenn.; F. A. Ramsay, of Tenn. ; Geo. Grant, of Tenn. ; J. B. Lindsley, of
Tenn.

To fill vacancies in the Committee on Medical Topography and Epidem-
ics.

New Hampshire. Dr. V. P. Fitch, of Amherst.

Colifornia. Dr. Robert Murray, of Fort Miller.

To fill vacancies in the Committee upon a Uniform System of Registra-
tion of Marriages, Births and Deaths :

Vermont. Dr. Adrian T. Woodward, of Castleton.

Connecticut. Dr. Wm. B. Casey, of Middletown.

Virginia. Dr. R. W. Haxall, of Richmond.

California. Dr. Arthur R. Stout, of San Francisco.

They recommend the continuance of the " Committee to Procure Memo-
rials of the Eminent and Worthy Dead," and that the report, as far as
prepared, be referred to the Committee on Publication.
Standing Committees.

On Medical Education. Drs. E. Geddings, of S. C, Chairman ; C. W. Le'
Boutillier, of Minnesota; G. F. Mitchell, of Ohio; S. W. Clanton, of Ala.;
S. W. Butler, of N. J.

On Medical Literature. Drs. R. Hills, of Ohio, Chairman ; D. W. Yan--
dell, of Ky. ; R. R. Porter, of Del. ; H. A, Johnson, of 111. ; Charles E. Swan,
of Maine.

The President stated that Dr. Anderson, of Ala., chairman of Committee'
on Medical Education, had sent in his report. It was accepted and referred
to the Committee on Publication.

A report from Dr. Wroth, of Md., on the- Medical Topography and Epi-
demics of the Eastern Shore of Maryland, was accepted and referred to the
Committee on Publication.

A Report from Dr. Cain, of S. O, on the Epidemic of Yellow Fever in

448 Miscellaneous. [July*

Charleston in 1854, was accepted and referred to the Committee on Publi-
cation.

A report from Dr. Fenner, of La., on the Medical Topography and Epidem-
ics of Louisiana, was accepted and referred to the Committee on Publica-
tion.

Dr. Palmer, of 111., offered the following, which was adopted.

Resolved, That the volunteer communications in the hands of the Committee of
Arrangements be referred, with all other such communications, to a special com-
mittee to be appointed by ihe Chair, residing at the place of publication of the
transactions; and if in their judgment, the papers are worthy, they be referred
by them to the Committee on Publication, to go into the transactions of the Asso-
ciation.

The President appointed as such a committee, Drs. A. Stille, S.Jackson,
and F. J. B. Biddle.

The authors and titles of the volunteer communications were announced
by Secretary Brodie as follows :

By Dr. C.J. Chandler, ofBoeheport, Mo., on Sulph. Cinchona in Period-
ic Diseases.

By Dr. Isidor Gluck, of New York, on Formation of Gun Shot Wounds,
&c.

By Dr. G. P. Hachenberg, on an Improved Method of Applying Com-
pression to the Scrotum.

The Committee on Medical Literature, for 1855, was continued for .
another year.

Dr. Neill of Philadelphia, offered a resolution that no medical prepara-
tion, account of surgical operation, or anything else designed or calculated
to give notoriety to an individual, be laid before the Association, until re-
ported upon by a special committee.

Dr. Wood of N. Y., presumed that this resolution was aimed at him.
He had come here with the description of a disease never before described
by surgeons phosphorus disease of the jaw-bone. He had felt great de-
licacy in inviting the attention of the Association to the subject, and it was
not until after consultation with many of the most prominent members of
the body, that he had permitted a friend to do so. As for the charge of
seeking notoriety, he denied it in toto. He had aimed at no such purpose,
and he felt wounded at the tone of the resolution.

Much applause followed the conclusion of Dr. Wood's remarks.

Dr. Neill disclamed the intention of personal allusion in the resolution
he had offered. That resolution embodied a principle which never should
be violated. Dr. Wood's reputation, or notoriety, might not be enhanced
by the action tinder reference, but the privilege of similarly proceeding
might be abused by other persons hereafter.

Dr. Neill's remarks were received with applause.

Dr. Wood said he had heard beforehand that such a resolution was to
, be offered ; and it was not the resolution itself that he cared so much about,
as the outside talk. He expressed a desire that the motion of Dr. Gross,
of Ky., inviting the Association to examine his (Dr. Wood's) surgical spe-
cimen, would be striken from the minutes.

Dr. Thompson, of DeL made some humerous remarks. He hoped that
New York would hold Iter jaw, and Philadelphia not stick in hers. He
trusted that Dr. Neill would withdraw his resolution, and that Dr. Grossr
motion would be striken from the minutes. If these were done, he would

1856.] Miscellaneous. 449

see that all was made right between the opposing gentlemen before they
reached home.

Dr. Gross moved to strike his motion referred to from the minutes, for
the purpose, he said, of removing the bone of contention.

Dr. Neill withdrew his resolution, and Dr. Gross' motion was striken from
the minutes.

Dr. Dorsey, of Ohio, offered the following resolution, which was adopted :

Resolved, by the American Medical Association, That the Committee of the Etio-
logy and Pathology ot Cholera be instructed to memorialize the Cor.gTess of the
United States, requesting that Honorable body to grant every necessary assistance
which can or will promote the objects for which the Committee has been appointed.

Dr. Wister, of Pa., offered the following which was adopted :

Resolved, That a committee of three be appointed by the President to correspond
with the proper officer of the Smithsonian Institute, inquiring into the possibility of
procuring a chamber in that institution for the uses of this Association.

The President appointed as such committee, Drs. Wister, of Pa., Hale, of
Washington, and J. Neill, of Pa.

Dr. Phelps of N. Y., offered the following, which were adopted :

Resolved, That the thanks of this Association are due, and are hereby tendered, to
the Fire Department of the city of Detroit, for the use of their large and commodious
hall, so amply furnishing to us accommodation for the convenient transaction of
business.

Resolved, That the urbane deportment and elegant hospitalities of the profession
and of private individuals, as well as the polite attention of citizens generally, de-
mand of this Association a high appreciation of the cultivated manners of this city
of the West, and which has tended greatly to enhance the pleasure of the session
here of the delegates from abroad.

Dr. Atlee, of Pa., offered the following, which was adopted :
Resolved, That all voluntary communications hereafter presented to the Associ-
ation shall be referred to a Special Committee, to be appointed by the President on
the first day of each annual meeting, whose duty it shall be to examine such com-
munications and report upon the propriety of their presentation and reference to the
Committee of Publication.

Dr. R. K. Smith, offered the following :

Resolved, That a special committee be appointed to report to the next meeting of
the American Medical Association a classification of those diseases which involve
a derangement of the mental manifestations.

Adopted, and Dr. Smith appointed chairman of said committee, with
power to choose his associates.

Dr. McGugin offered the following:

Resolved, That a special committee be appointed to report on the subject of
"Stomatitis Materna."

Adopted, and Dr. McGugin appointed chairman of such committee.

On motion of Dr. Bailey, of 111., Dr. Davis, of Chicago, was requested to

continue his observations on the changes produced in the composition and

qualities of milk by pregnancy and menstruation ; also the best substitute

for the mother's milk when weaning becomes necessary ; and report at the

: next meeting of the Association.

The Association then adjourned to meet in Nashville, Tenn., in \Qb*I.

A Uterus in a Man sixty-three years old. By Prof. Langer. The
case of Professor Langer is a physiological curiosity. Professor Aramij
has recently found, at the necropsy of a man sixty-three years old, a struc-
ture resembling a uterus, between the rectum and bladder. The man had

450 Miscellaneous.

had a " capon's voice," beard well grown ; he had lived thirty years in
childless wedlock. The uterus was two-horned, ending in two large open
tubes. The mesometrum (ligamentum uteri latum of the female) ended
on either side in a fine doubling of peritoneum; a true ala vespertilionis,
which embraced the testicles and epididymi ; and, at the upper border, the
end of the tube. On the left side, the uterine horn, with its tube, was
dragged over by a scrotal hernia. The distance between the two testicles
in the preparation is sixteen inches. A round ligament (uterine) is marked
by a bundle of vessels on the right side. The uterus is connected with the
upper part of the prostate. The arteries of this uterus arise, with those of
the bladder, from a common arteria vesico-uterina. The organ could be
easily inflated through the abdominal end of the tube. There were no
strong folds in the interior, even at the isthmus. Above the isthmus, the
walls of the two-horned uterus were soft, the muscular tissue loose, its
mucous membrane was easily separated as a distinct layer. On a section,
there were detected tubular crypts opening on the free surface.

In fine, there were distinguished three parts of this nterus ; An orificial
part a gland less, thickeded portion, terminating at the isthmus ; and a
part provided with the ordinary uterine glands, which end in two short
horns, which again end in tubes. The testicles were of the normal size.
The vasa deferentia ran in an obliqne direction to the isthmus uteri, to pen-
etrate the prostate. True vesiculie seminales were absent. [Med. Chir.
Review.

Quick Process for Mercurial Ointment. M. Bernier, Pharmaceutist of
Reuwez (Ardennes,) recommends the following process. Take one-third of
the lard to be used for the ointment, heat it in a skillet of copper till it com-
mences to disengage vapors and burn, and then pour it into an earthen
vessel, and place it in the cellar for ten or fifteen days. Use this lard to
extinguish the mercury, employing an iron mortar, and observing to add
the mercury gradually as each addition disappears. The mercury is soon
perfectly extinguished when the rest of the lard is incorporated thoroughly,
the whole operation requiring but an hour. [Eeportoire de PKarmacie
and Ametican Jour, of Pharmacy.

Muriate of Opium. We have met with, in looking over old files of the
Medical Times and Gazette, a new preparation of opium ; and as it is al-
ways desirable to have as many modifications as possible of a drag which
so frequently requires to be used, and which acts so differently on peculiar
idiosyncracies, we give it a place in our pages.

Take of the best powdered opium, 3i; muriatic acid, 3i ; distilled water,
3xix. Shake this mixture frequently for fourteen days, and strain. The
dose is from twenty to forty drops. [Philadelphia Med. and Surg. Jour.

Chloride of Zinc Collyrium. Mr. Critchett of the Royal ophthalmic
hospital (Moorfields) has been in the habit of using frequency a lotion of
the chloride of zinc as a lotion in thickened and vascular conditions of the
conjunctive. He regards them as in an analogous condition to the gleets
of the urethra, and calls this condition a "gleet of the eye." Its strength
is one grain to the ounce. [lb.

SOUTHERN

MEDICAL AND SURGICAL JOURNAL.

(NEW SERIES.)

Vol. XII.] AUGUSTA, GEORGIA, AUGUST, 1856. [No. 8.

ORIGINAL AND ECLECTIC.

ARTICLE XX.

LETTERS FROM SAML. D. HOLT, M. D., UPON SOME POINTS OF GENERAL PATHOLOGY.
LETTER NO. 13.

Montgomery, Ala., June 25th, 1856.

Messrs. Editors Having spoken of the periodic character of these
fevers, (intermittent and remittent,) and insisted upon the necessi-
ty of attention to that which constitutes their most important
characteristic feature' important, at least, so far as their proper
treatment is concerned, I will next examine them with reference
to the nature of their special pathology ; but before I do so, it is
necessary that I should make some general remarks respecting the
nature of that condition of the system called "fever."

Heretofore, in my remarks respecting the general pathological
conditions of excitement and depression, I have designedly neg-
lected to draw any distinctions between the febrile affections with
which they were associated, whether they were regarded as idiopa-
thic or symptomatic, for the reason, that I desired to keep the
attention fixed upon the conditions, and not upon the diseases, with
which they were associated ; and for this purpose, selected pneu-
monia, or inflammation of the lung, as the disease, and the fever
as the consequential condition, varying in character and degree
according to the nature of the individual, and general predisposing
causes, epidemic influences, &c, which I have already pointed out.

N. S. VOL. XII. NO. VIII. 29

452 Holt's Letters upon General Pathology. [August,

I come now to consider "fever" in the light of a disease, and not
a condition, symptomatic of, or depending upon, the pre-existence
of some other disease ; and the first question which presents itself
is What is fever? If we define it to be a state of general ner-
vous excitement, with increased vascular action to such a degree
or extent as to derange, interrupt, or suspend, the healthy per-
formance of the vital functions, with the characteristic signs of
such a condition, as heat and dryness of skin, with increased
strength and frequency of pulse, it may serve to convey a general
idea of fever, but does not let us into the secret of its first cause,
or the true pathology of the disease. A better definition of fever,
in my opinion, is, that it is an effort of the system to relieve some
laboring organ or impeded function, to restore some suspended
secretion, or to rid itself of the presence of some noxious and of-
fending cause. That fever, though it consists in a concatenation of
morbid actions which involve the whole system, often producing
the most dangerous and fatal results, is nevertheless a recupera-
tive process, or a sanative effort of the system to overcome some
pre-existing morbid impression under which it labors, as the result
of the operation of one or more of the thousand causes, apprecia-
ble and non-appreciable, moral, physical and chemical, which are
perpetually at war with the vital powers, and interfering with the
healthy operations of the animal econom}7. That the concatena-
tion of morbid actions constituting fever has its origin or starting
point in some part, organ, system, or function, all being subject to
the influence of the morbific agents, and capable, under circum-
stances, of originating the febrile movement. That the pre existing
morbid impression which calls the sanative effort of the system
into action, is a change in the innervation of the part, which im-
plies a departure from the line of healthy excitement, by such an
accumulation or exaltation of nervous power above, or such a
loss, destruction, or depression of nervous power below that line,
as to interrupt, suspend or destroy the healthy action of the
part, organ, system, or function involved, and consists of debility
or nervous depression the first link, irritation the second, and in-
flammation the third, in the chain of all morbid actions; upon
these depending all the changes which take place in the fluids and
solid tissues consequent upon the febrile movement. This view
of the subject assigns to all fevers a local origin, but it does
not explain how the existence of a local morbid impression,

1856.] Holt's Letters upon General Pathology. 453

either of depression, irritation or inflammation, brings about the
febrile movement. This may not be so difficult to explain, or
understand, with reference to those fevers which are recognized
as symptomatic, having inflammation or irritation as their osten-
sible cause, if we call to our aid the physiological relations which
are known to exist between all parts of the system through the
great nervous centres, and the facility and rapidity with which, by
direct and reflex nervous action, impressions are transmitted and
communicated from one part of the organ or system to another.
But it is somewhat different with those fevers which have no such
ostensible cause, and which have, in consequence, been recognized
as idiopathic fevers. Such are the fevers under consideration
(intermittents and remittents) in their essential typical character.

To explain the origin of these fevers, we must suppose, what has
generally been conceded, that the causes, which are very numer-
ous, act with a greater degree of force upon some organs than
upon others that some are directly depressing in their influence,
and others indirectly so; but that they all tend to the same result,
namely, debility and depression. Pathologists have endeavored
to assign for the seat and origin of these fevers a special location ;
some have taken the brain, others the spinal or ganglionic cen-
tres, while others have taken particular organs, as the stomach,
liver, spleen, &c. But the truth, I think is, that though some
organs are more uniformly implicated in their origin, none can be
said to be invariably or essentially concerned ; but that those or-
gans which have been most strongly impressed, or which yield
most readily to depressing influences, -will have to bear the brunt
and burden of the disease. Hence the great variety of these dis-
eases which have been described by the systematic writers, both
in this country and Europe varieties founded, not upon an}' dif-
ference in their essential pathology, but upon the organs involved.
When, then, any important organ, from the operation of the de-
pressing causes, falls into such a state of debility or depression as
to render it incapable of performing its accustomed functions, the
recuperative powers of the system are called into requisition in
aid of the laboring organ ; the sanative effort commences, and a
rally of the vital forces takes place in the organs where it accu-
mulates, at the expense of a proportional loss to other organs and
parts of the system. This process will usually be attended with a
sort of oscillatory motion in the nervous and circulatory systems

454 Holt's Letters upon General Pathology. [August,

constituting the forming stage of these fevers. At this time, the
genera], remote or systemic capillaries, sharing in the general loss
of nervous power, become relaxed, allowing the free flovvof blood
out of the arteries, while its flow is retarded in the lungs, from a
similar loss of power in the muscles of respiration. Thus, the bal-
ance between the arterial and venous portions of the circulation
becomes broken, and the blood accumulating upon the right side
of the heart, in the large venous trunks and cavities, constitutes
the congestive or cold stage or chill. Now, though an analysis
of the symptoms and phenomena which belong to, and distin-
guish this condition, shows not a single one which is character-
istic of fever, but indicates, on the contrary, a diametrically oppo-
site condition, we are bound to consider it an essential condition
in the pathology of these fevers, being generally found to appear
in the first and the last act, and frequently throughout the drama.
When this condition has reached the lowest point of depression,
and continued for a somewhat indefinite time, the recuperative
powers of the system are again called into operation, the sanative
effort and the reactionary movement commences. The accumula-
ted excitability, the nervous power, which had been rallied in
support of the laboring organ, being now no longer necessary for
its support, is redistributed to the organs whence it was taken.
The organs of respiration thus acquiring their accustomed power
of action, allow a free flow of blood through the lungs, while
the remote or systemic capillaries, having regained their lost tone
and power of action, and the blood retarded in its flow through
them, accumulates upon the left side of the heart, producing a
general arterial plethora, giving rise to the characteristic phenome-
na of, and constituting the true febrile condition. When this
reactionary movement commences, which is at first slow, import-
ant changes take place with respect both to the nervous and cir-
culatory systems. The blood which had been pent up, and become
somewhat depraved, acquires, in its passage through the lungs,
new life, which it imparts to the heart and arteries, to the brain
and other nervous centres, increasing their activity, and thus
creating a state of general nervous excitement and increased vas-
cular action, giving rise to heat and dryness of skin, and strength
and frequency of the pulse, the characteristic symptoms of fever.
This state of excitement, after continuing for a somewhat indefi-
nite period, gradually subsides, the capillaries gradually relax, the

1856.] Holt's Letters upon General Pathology. 455

balance in the circulation becomes restored, the secretions become,
re-established, and an end is put to the paroxysm.

This hasty and imperfect sketch of an intermittent, serves to
show us the existence of two distinct pathological conditions, one
consisting in a state of general nervous depression, attended as a
consequence with a broken balance in the circulation, and an un-
due accumulation of blood in the venous system ; the other con-
sisting in a state of general nervous excitement, with a consequent
broken balance in the circulation, and an accumulation of blood
in excess in the arterial system. That one, or the other, of these
conditions constitutes the essential pathology in all fevers, there
can be but little doubt; and that both are necessary and essential
to the formation and progress of intermittent fever, I think there
can be none; and I might say that there is little with respect to
remittent fever. It is true, that a paroxysm of these fevers may
be ushered in with such slight evidences of the existence of de-
pression and congestion, as to escape the attention of the patient,
and the observation of attentive and skilful observers ; but such
cases cannot be taken as exceptions to the general rule, as I have
before shown that these conditions may exist in various degrees
of development, from the lowest grades of depression below, to the
highest grades of excitement above the line of a healthy excite-
ment; and I think it would be much more fair and reasonable to
suppose that the depression really existed in such cases, though
not observable, than to suppose that it did not, because the signs
of its existence could not be observed.

My impression, therefore, with respect to these fevers, is, that
the first essential element in their pathology is nervous depression,
with more or less of general venous congestion ; and that the se-
cond essential element in their pathology is, nervous excitement,
with increased vascular action, with more or less general arterial
plethora. Whether this be the case with respect to other fevers,
must remain for further discussion, while we go back a little, and
examine into the laboring organ which has given rise to all
this mischief and disturbance. Well, in the absence of positive
proof to sustain the position, I would assume, as the most pro-
bable state of the case, that the accumulated excitability or ex-
altation of nervous power in the weak and laboring organ would
serve to relieve it from its condition for the time being, but upon
its re-distribution, and the subsidence of the general excitement,

456 Holt's Letters upon General Pathology. [August,

it would be left in near about tbe same state of debility and de-
pression as at first, and would be tbe subject for renewed or
repeated efforts of tbe system, tbrougb a succession of paroxysms,
until tbe condition was removed or overcome by tbe efforts of
nature, or art ; sucli being the character of our simple intermittents.
Or, to take another step in the morbid concatenation, we may sup-
pose that the weak and laboring organ being, in consequence,
unable to resist the force of an increased column of arterial blood,
which would accumulate iu undue quantity, and thus give rise to
irritation in the organ, would in turn Lave the effect of keeping
up for a longer time, and in a higher degree, the febrile movement
as observed in our simple remittent fevers ; or, from the oft re-
curring state of irritation of the organ from repeated paroxysms,
or a protracted state of general excitement, the local excitement or
irritation might eventually spring up into a state of inflammation,
the highest and last link in the chain of morbid actions, which we
see occurring sometimes in intermittent and remittent, and in va-
rious other forms and grades of fevers. Such being the usual
progress in the degrees of morbid action in the organs involved
in our fevers, we are not required to recognise local inflammation
as essential, either for their production or for their continuance.
Local inflammation often exists without fever : it often occurs as
the the consequence of fever; and we often have fever in which
there is no evidence of the existence of inflammation, either as
cause or effect. Besides, inflammation is not a primary but an
ultimate degree of morbid action, and even when considered as
the cause of fever, it might not be found an easy matter to estab-
lish tbe fact, that the febrile movement had been incited by the
ultimate, and not the primary morbid action. Now, I wish it to
be understood that the examples of the degrees of morbid action,
which I have stated, are not confined to the organ which created
the disturbance ; nor docs it necessarily pass through these degrees
during the progress of the fever, but that through the intimate
anatomical and physiological relations which exists among the
different organs, many of them become involved and assume one
or other of these degrees of morbid action, having had no direct
agency in the production of the fever. Ilence they should be re-
garded as non-essential, and as the result of adventitious influ-
ences. At. the character of all these fevers is determined by the
teral predisposing causes which I have elsewhere shown, so it

1856.] Holt's Letters upon General Pathology. 457

is with the different organs involved, being the result of individu-
al and general predispositions, and often of prevailing epidemic
influences.

To enable us to trace the phenomena of these fevers as near as
possible, through the order in which they arise, and to preserve
as accurately as possible their relations, one to another, we will
commence with those which result directly from the broken bal-
ance of the circulation, and the undue accumulation of the blood
in the large venous trunks and cavities, which we recognise as
General Congestion from General Nervous Depression, Having de-
signated the lungs, heart and liver, as the points for the forma-
tion and the chief seats of congestion, we are bound to suppose
that under the operation of general causes it would commence
simultaneously at all those points, and consequently all the organs
anatomically related which become involved, do so, at the same
time. Passing by the general outward signs of the condition of
nervous depression and congestion, the first organ which claims
attention is the brain. Though this organ shares alike with other
organs in the general loss of nervous power, and is often the seat
of irritation and inflammation, it is never, as I have before shewn,
the seat of congestion, except as the consequence of congestion in
the lungs or the 'heart; consequently, whatever importance may
be attached to that condition of the brain, (and I am not disposed
.to attach a great deal, from the fact that it is rather a mechanical
than a pathological effect,) for its removal, we must look to the
organs which gave rise to it. Congestion of the brain is not in
itself a very dangerous affair, for occupying a closed cavity, it is
subject neither to a very great increase or diminution of its proper
quantity of blood, either of which would be apt to produce sud-
den fatal results, in cases of great general depression. This cir-
cumstance, which I have endeavored to explain elsewhere, enables
the brain to continue in the exercise of its functions, often in a
wonderful degree, amidst the general wreck and prostration of all
other vital functions. Cases, however, often occur in these fevers,
in which the action of the heart is sufficiently strong to throw an
undue quantity of blood upon the brain, giving rise to more or
less pain or uneasiness in the head, dullness of intellect, drowsi-
ness, and not un frequently to stupor and insensibility, which
usually occurs suddenly as by an impulse. Now, these evidences
of cerebral disorder, though not devoid of danger, are generally

458 Holt's Letters upon General Pathology. [August,

more alarming than dangerous, for the reason that they imply no
seated morbid action in the brain, and generally subside and pass
away with the paroxysm. They cannot, however, be regarded
with indifference, or without apprehensions of subsequent danger,
as upon the establishment of the febrile stage of the disease, the
brain would be more apt to become a seat of morbid action, and
a state of irritation kindled up in the previously distended vessels,
which might continue, in that character, through a succession of
paroxysms, producing in each, headache, delirium, convulsions,
and other signs of cerebral irritation, and, as has been explained,
ultimately to spring up into a state of inflammation with all its
direful consequences. I feel inclined to pause here, for the pur-
pose of making some practical comments upon these different
morbid conditions or states of action in the brain, knowing as I do,
that they are too often mingled up and confounded, and that cases
have been heroically treated (to the great detriment of other or-
gans, and the system, generally,) as inflammation of the brain,
which were but slight congestion or irritation, which would have
yielded, and which did yield at once upon the arrest of the parox-
ysm. As this subject, however, must claim attention hereafter, I
will proceed to enquire into the effects produced upon other or-
gans from congestion of the liver.

"Whether the liver is the prime seat of these fevers, (which I am
inclined to believe, but which is not for us now to determine,) one
thing I think is very certain, that it is more uniformly involved
or complicated with them, than any other organ. Though it has
been maintained upon high authority, that these fevers are of
gastric origin, to which doctrine I cannot assent, much less that
inflammation is essential to their production I cannot deny that
gastric disorder is a very common (though not an invariable) at-
tendant upon them. Nor is it strange that it should be so, when
we look at the character of the organ, its size, the extent of its
mucous surfaces, the number of its bloodvessels, its extensive ner-
vous sympathies, and the readiness with which it sympathises
with other organs"; yet it is strange what it can endure without
evident disturbance, when we see it receiving large quantities of
crude, heterogeneous, and apparently indigestible substances ; be-
sides, other strong and irritating substances, such as salt, vinegar,
pepper, mustard, wine, brandy, hot tea and coffee, or ice-water,
and sometimes physic all with apparently the same degree of

1856.] Holt's Letters upon General Pathology. 459

impunity. Now, these things I will not attempt to explain, but
there is one thing which I think their existence serves to show,
namely, that the stomach is not so sensitive to first impressions, or
ready to take on morbid action from the influence of general
causes, as it is through sympathy, or direct communication with
other organs.

The liver, which may become congested from congestion in the
lungs and heart, being itself a point for the formation of conges-
tion, especially in the portal circulation, when that organ and
system is in that condition, has the effect of throwing the blood
back, or darning it back to the organs whence it came, thus ob-
structing the flow of blood through the capillaries of those organs
producing such a state of plethora, or mechanical congestion in
them as occurs in congestion of the brain. The effect of conges-
tion of the liver is, therefore, felt in all the abdominal viscera, (it-
self included,) and most of these being secreting organs, besides
the effects or consequences which are likely to result from the ob-
struction, and the accumulation and retention of an excess of
blood in their capillaries, in the establishment of irritation and in-
flammation in the manner already described, they have their func-
tions thus mechanically interrupted, without having necessarily
labored previously under any morbid action. The consequence
of this stagnation and accumulation of blood in the vessels of the
stomach, from both forward and backward pressure, is to create a
sense of fulness and distress in that organ, sometimes pain, and
often nausea and vomiting; indeed, so common are these things
to our fevers, as to have lent support to the doctrine that they are
of gastric origin. But observation has taught me that they sel-
dom occur in fevers where there is no hepatic obstruction, and
seldom or never fail to disappear when the obstruction is removed.
As a consequence of the accumulation and stagnation of blood in
the mesenteric vessels, from congestion in the liver, we frequently
have, as a concomitant of these fevers, a serous diarrhoea from the
percolation of the thinner constituents of the blood into the intes-
tines, and sometimes when these vessels are in an unusual degree
or state of atonicy, blood itself is poured out in such quantities as
to be both alarming and dangerous. Besides the spleen, which
we may suppose to suffer in the ratio with other organs, the liver
only remains to be considered among those which furnish the chief
pathological and characteristic phenomena of these fevers, and as

460 Holt's Letters upon General Pathology. [August,

I shall have occasion more than once to refer to it, I will next
examine into the effects of general congestion upon the constitution
of the blood, and the consequences resulting from the changes
thereby induced. Whatever changes may take place in the con-
stitution of the blood from excessive or defective secretions, and the
agency which such changes have in the production of these fevers,
(which we suppose to be no little.) belongs to another branch of
the subject; but, there can be no doubt that as cause or effect, the
stagnation of the blood in these organs (whereby its elaboration
and its depuration are both arrested or suspended,) acts injuriously
upon the constitution of the blood, rendering it less fit for per-
forming its offices, and sustaining the great vital functions de-
pending upon it, and thus favoring the continuance or increase of
general nervous depression. This change in the constitution of
the blood consists chiefly in its defective and imperfect oxygeni-
zation, consequent upon the feeble respiratory movement, and
pulmonary congestion, and in an increase of the carbonaceous
products from the same causes, together with the suspended func-
tions of the livei', which products are known to possess powerfully
depressing influences upon the nervous centres. Having thus
examined into the pathological condition of the principal organs
and systems, as they may be supposed to exist in the first stage,
and at the commencement of intermittent and remittent fevers, the
next step will be to examine them in connexion with the second
or febrile stage, which must necessarily be deferred until my next
letter.

Before I close, however, it may not be amiss to say, that any
cause which is capable of producing great and sudden depression
in the nervous centres, can bring about a condition similar to that
which I have described, such for instance as heavy blows upon
the head, violent injuries, strong or violent passions and emotions
of the mind, the action of deadly poisons, &c. But the depression
and congestion thus produced will generally be sudden, evanes-
cent and transitory, leaving no traces behind ; while the depression
and congestion of these fevers is generally the work of their pre-
disposing causes, which have operated for a length of time, and
though they may not be so perfect and complete, are always more
permanent <ihan when suddenly induced. The subject to be con-
tinued in my next. Yours, sincerely, &c.,

Saml. J). Holt.

1856.] Goss, on Phthisis Pulmonalis. 461

ARTICLE XXI.

Is Phthisis Pulmonalis Contagious? By I. J. M. Goss, M. D., of
Jackson county, Ga.

This is a question that has engaged my attention and observa-
tion for several years. In examining the standard works, I find
considerable discrepancy of opinion upon this, as I regard it,
important subject. Dr. Dickson, in his manual of Pathology and
Practice, says, " a large proportion of writers of the past and
present age consider this disease communicable by contagion;
and within my own observation, so many circumstances have
occurred, which seem to confirm the doctrine, that with Cullen, I
dare not assert, that consumption is not contagious."

Dr. Dunglison says, he has had no adequate evidence, that it
can be extended in this manner; yet, says he, "singular instan-
ces of the kind have been related by different writers, and if they
prove nothing more, they exhibit strange coincidences." In Italy
the contagious nature of this disease appears to be admitted by
almost all medical men. At Naples, when an individual dies of
Phthisis, his house, effects and furniture are destroyed; or if his-
house is not destroyed, the walls are scraped and whitewashed,.
and the cealings, floors and partitions removed. Similar views
are entertained at Rome, where the disease is much more frequent
than at Naples. "If," says Dunglison, "a person be constantly
breathing the deteriorated atmosphere of the rooms, which the
consumptive occupy, by sleeping perhaps in the same bed, the
health may ultimately suffer, tuberculous cachexy be induced,
and finally confirmed Phthisis." Dr. Bell does not admit that
phthisis can be communicated by contagion, but admits nearly
the same thing in substance, though not intentionally; he says,
"unhealthy air, whether from closeness, humidity, or impurities,
combined with other causes, is a common cause of the constitution-
al origin of tuberculous matter." In Spain and Portugal, the
contagious nature of this disease is so universally believed, that
the clothes of those who have died of it are burned by the civil
authorities. Morgagni, so frightened at its contagiousness, never
opened the body of one who died of it, but that he evinced great
nervousness. Morton mentions this as a contagious disease.
Elliotson says, " I do not believe that phthisis is in the slightest
degree contagious;" but just at the top of the same page he says,

462 Goss, on Phthisis Pulmonalis. [August,

" we see a family, brought up with every care in guarding against
cold, having good food, good clothing, and good lodging, and
attention paid to the slightest indisposition ; and yet, one after
another, especially if they be females, often become the victims
of this disease." This would go very far to prove the very idea,
that he so flatly contradicts at the bottom of the page. He says,
one is taken after another, and die, especially if they be females.
This, it seems to me, may, with much plausibility, be accounted
for in this way; one having a constitutional tendency to tubercu-
lous cachexy, is exposed to bad air, as Dunglison snys, or other
external causes, and takes the disease ; the others are in the room
where he lingers out weeks, perhaps months, or even years of
painful suffering; the air of the room, perhaps by close confine-
ment, is kept in a contaminated state, and very soon after, if not
before, the first dies, a second one perhaps is seen in the incipient
stage of consumption. Now, Dr. Elliotson says, especially if the
family be females; and why are females more predisposed to the
disease than males? They are not as much exposed to the vicissi-
tudes of atmosphere as the other sex, which is laid down at a
common exciting cause of the disease, not only by him, but by
most writers; but females are confined to the room to nurse, and
soothe a brother's pathway to the grave, or to palliate the sufferings
of a sister, as she slowly declines by mental gloom and decaying
lungs. Thus it is reasonable to account for the greater frequency
of the disease in females, than in males (ceteris paribus). It
seems quite plausible to me, that, if bad air has any agency in the
production of a tuberculous cachexy, or that it tends even to
excite, or call into action, hereditary or constitutional predisposi-
tions to the disease, that it, in the same way, would produce the
disease when coming fresh from the lungs of a patient with phthisis,
while it is so fully contaminated, not with the common impurities
produced by atmospheric changes, that are admitted to be causa-
tive of phthisis, but with a more concentrated virus, the exhalations
of tuberculous matter itself, imbibed from the diseased air cells
as the air passes through the lungs. What the nature of the virus
may be, I do not pretend to know, or what its modus operandi.
I can only say, that if the theory of Broussais be correct, which
is, that phthisis is disorganization, which is the product of inflam-
mation of the pulmonary parenchyma though this is denied by
some writers, others contend that irritation or hyperaemia is con-

1856.] Goss, on Phthisis Pulmonalis. 463

nected with tubercular formation and developement. I believe
irritation to be the first step in the development of phthisis, which
seems very presumptive, from the fact, that Bronchitis, or any-
other inflammatory disease of the respiratory organs, will hasten
the development, or the fatal termination of this disease.

I have frequently seen Pneumonia, Pleuritis, Typhoid fever,
and various other frebrile and inflammatory diseases engrafted
upon phthisis, which, as well as I recollect, invariably aggravated
the disease. Some writers acknowledge that a chronic inflamma-
tion of the pulmonary tissue may be developed in the absence of
any tuberculous tendency, eventuating in phthisis. It is general-
ly believed, that certain employments may excite the disease, such
for instance as stone grinding or dressing, and flint making. This
fact is noticed in Berri in France, (a village,) where almost all
the inhabitants follow the profession of making gunflints, and
all of them die of phthisis, sooner or later. It is noticed too, that
feather dressers, cotton manufacturers, needle grinders, labourers in
coal mines and other dusty employments, seldom escape consump-
tion, which cannot be attributed to any thing but to the irrita-
tion of the dust, consequent upon these employments. Climate
has been always acknowledged to have influence in producing, or
mitigating the disease, just in proportion as it was harsh and
irritating, or mild and soothing. There is no climate entirely
exempt from the disease ; but there is a vast difference in countries
in regard to the aggregate amount of cases of this disease, which
is conclusive proof that a large proportion of the cases is pro-
duced independently of hereditary predisposition. I would ask,
then, what can be the cause of so many cases among those who
are employed in dusty situations? If it be not simply irritation
of the dust, what can it be? Those thus engaged, generally are
clothed and fed as other laborers of different occupations. I
therefore conclude that irritation from dust in the air, as well as
the harshness of cold, damp air, may be causative of this disease.
I infer, then, if irritation be the first step in the development of
the disease, it is quite reasonable to conclude, that the air, loaded
with the virus exhaled from a tuberculous lung, may produce the
irritation necessary for the production of the tubercle. So much
for the plausibility, or possibility, of tuberculous contagion.

And now, I will give my reasons for my own suspicions of the
contagiousness of this dreaded scourge of humanity. In 1843,

itil Goss, on Phthisis Pulmonalis. [August,

I was reading Physic in Harris count}', Gra.; there lived a man in
the neighborhood, whose lady was laboring under phthisis pulmo-
nalis; she lingered for some considerable time, and finally died.
Her husband, a stout and apparently healthy man, was necessari-
ly confined to her bed-chamber closely in her last illness, soon
took the disease, and in despite of all remedies, soon died also.
This case, coming under my immediate observation, led me to
notice many similar cases, that have since fallen under m}r parti-
cular notice. This man had no hereditary taint that I could find
out, nor did he exhibit any scrofulous or tuberculous diathesis,
that I could perceive.

In a village near where I now reside, a gentleman was laboring
for several years under consumption, and finally died. His wife,
who was confined to his chamber in his whole illness, soon took
the same disease, and also died. She, too, was unknown to have
any hereditary predisposition, as none of her progenitors had died
with the disease, as I could learn.

Many cases, of a similar nature have been related to me, but I
only give such as have fallen under my own observation. I have
seen quite a number of families, that, one by one, would fall vic-
tims to this disease; these would not be allowed to be adduced in
evidence, as an inherited predisposition might be supposed to ex-
ist; but they followed in such quick succession to the grave, that
I have been led to doubt that hereditary transmission had more,
if as much agency, in the production of the disease than contagion.
There may have existed a tuberculous diathesis in some, or even
all the members of the families thus observed, but why they should
all appear healthy, and clear of any scrofulous tendency, until
some one of the family took phthisis, ia hard for me to account
for, only by supposing that, if they had any predisposition to tu-
berculous nature, it was, by the contagious air of the sick room,
brought into active development.

I am acquainted with a family, some members of which are now
under treatment for phthisis; some have already died of the dis-
ease ; none of them, I believe, was known to have any appearance
of the disease, until two or three years ago, one of the family took
it, and died ; another, and another, until several have gone to an
early grave they followed in quick succession, three, I think, in
one year. I know it may be, as it has always been said, that this
was only an instance of predisposition ; but why did these all en-

1856.] N eilson, on Sulphate of Bebeerine. 465

joy health until one of the family should die of consumption ;
then, in such quick succession, so many die in one family? There
appears much plausibility in the conclusion, that if there really
existed a hereditary tendency to the disease, that that tendency
was, by some exciting cause, then brought into active develop-
ment, to have produced the disease in several persons in so short
a time.

I pen these observations to elicit the testimony of others of bet-
ter opportunity. I hope that it will not be withheld on this high-
ly important subject, and that correct information may be had.

ARTICLE XXII.

Sulphate of Bebeerine. By Kobert Neilson, M.D., of Tuscaloosa
County, Ala.

Sometime since, a friend sent me a few ounces of the sulphate
of bebeerine, requesting me to test its power, and publish the result,
if I thought it proper to do so, which is my apology for placing
this communication at your disposal.

The adulteration of quinine and its increasing scarcity, strongly
demand the development of some other article to supply, if possi-
ble, its place. Occasionally an agent possessing some merit is
brought forward, and with little trial, and still less accuracy ob-
served, is discarded or placed under ban.

Such has been in part the history of the sulphate of bebeerine
mankind being ever prone to search for precedent, rather than
endure the patient toil to discover things new and untried, prefer to
take the views of the old world, than to call forth the energies of
our native intellect.

I have experimented with several indigenous plants, but have
found them inferior to the sulphates of quinine and bebeerine.
The latter is inferior to the former in general application, but su-
perior in some special conditions of the system. In cases of inter-
mittent, prone to relapses, Fowler's solution is not more effective
than bebeerine; or if diarrhoea attends them, its astringency and
anti-periodicity are happily combined to arrest it. We do not
intend, while now in its infancy, to place it side by side with qui-
nine, but trust that whatever of merit it may possess, will be sub-
mitted to the closest investigation.

466 Neilsox, on Sulphate of Bebeerine. [August,

It is my opinion, that one reason why it has not been more ap-
provingly noticed, is because its therapeutical application is not
well understood. To succeed with any medicine requires a nice
adaptation of its peculiar power to the diseased condition.

No skilful physician would think of giving opium in active in-
flammation of the brain, yet after depletion it may be highly use-
ful. Thus, while the bebeerine possesses strong anti-periodic
power, it is also astringent and slightly stimulant, I am satisfied
from reason and actual experiment, that it cannot be exhibited
successfully where inflammation or a tendency to it obtains. Nor
can it be given during the paroxysm of fever without increasing
vascular action ; also, if exhibited in this stage it produces emesis,
or nausea, to which it is more prone than quinine. It is more
effective when used in the distinct remissions or intermissions of
fevers, aud hardly admissible during any other stage. It some-
times has an emetic effect, best obviated by combining with it
some one of the tinctures of opium. Being soluble in water, I
am accustomed to exhibit it in a solution of twenty grains to the
ounce of water.

During the summer and autumn of the years 18545, 1 used the
bebeerine occasionally in intermittents when relapsing, after qui-
nine seemed to have lost its action, and generally with success.
Pleased as far as I tried it, I determined to test its relative value
as compared with other anti-periodics. Accordingly, twenty cases
were treated with it, and the usual preparatory adjuvants,
seventeen of whom were cured, one (a case of tertian,) ran into
the quotidian type, cured by quinine; the two remaining cases
being threatened with gastritis, the remedy was abandoned, and
they were cured in the usual way ; but I am satisfied the bad
symptoms were occasioned by over-eating. The case of quotidi-
an type was a perfect failure under apparently favorable circum-
stances for its use.

1856.] Periodical and Continued Fevers. 467

Remarks on the blending of Periodical and Continued Fevers. By
Austin Flint, M. D.

I shall preface some remarks on an interesting and important
subject, viz: the blending of periodical and continued fevers, by
the report of a case of disputed type by W. J. Chenoweth, M. D.,
of Decatur, Illinois. This report was received some months since
by my esteemed friend and colleague in the University of Louis-
ville, Professor Rogers, and was accompanied by a request that it
be also submitted to my examination. It was designed for publi-
cation if deemed advisable. The writer is a young practitioner
of much promise. I may add that its publication, with remarks,
is at the suggestion of Professor R. The reader will perceive that
the case was the occasion of a difference of opinion among a num-
ber of physicians who visited the patient during the progress of
the disease. The difference was purely one of opinion, and Dr.
Chenoweth states in a postscript, that having read the report to Dr.
Trowbridge, who saw the patient in consultation oftener than the
other medical gentlemen, he expressed satisfaction with it as giving
a fair history of the case, although differing from Dr. C. as regards
the nature of the febrile affection.

A Case of Fever of Disputed Type.

" The following is one of a class of cases which have occurred
in this town and neighborhood, and which have been called re-
mittent fever by some of our physicians, and. by others, typhoid.
Those of us who believe the disease to be remitting fever treat it
with quinine, while those calling it typhoid fever prescribe opiates
and stimulants. And inasmuch as the name of the disease carries
with it different views of its pathology, and will almost necessari-
ly govern the treatment, however guarded we may be, it may be
useful to report a single case, so that physicians living in mias-
matic districts may be led to give an opinion as to the disease and
its treatment. We believe that the importance of being able to
diagnose like cases is a sufficient excuse for laying it before the
profession.

Sept. 23d, 1855, Rev. Mr. C. was attacked with a chill, followed
by a fever. The chill and fever returned on the following day,
and for three or four nights following he had " night sweats."

Sept, 30th he again had a chill. The next day he took ten
grains of quinine, by the advice of a physician, and in a few days
a dose of purgative pills. He had no return of the chill but did
not feel well.

Oct. 7th. I was called to see him. I found him (in the fore-
noon) with a pulse 80 per minute; cool skin ; eyes and surface of
the body without capillary congestion; mind clear; bowels moved
once the day before without medicine.

N. S. VOL. XII. NO. VIII, 30

468 Periodical and Continued Fevers. [August,

I ordered 12 grains of quinine to be divided into three doses,
one to be given every three hours.

5 o'clock, P. M. Pulse 90 ; surfuce of body hot ; eheeks flushed ;
restless and wakeful.

Directed to wash him in cool water.

Oct. 8th, A, M. Learned that he was awake until after twelve
o'clock, when he fell asleep and rested until about seven. Pulse
78 ; much the same appearance as on preceeding morning.

Ordered quinine as on yesterday.

P. M. Xo apparent change since the same hour on the previ-
ous day.

Oct. 9th, 9 o'clock, A, M. Has been up for half an hour and
has just got to bed. His breathing is a little more labored, but
otherwise symptoms as on yesterday. His tongue in the fore-
noon has been moist, in the afternoon dry. It has been, covered
with a white fur, and has had a red spot at the tip. He has had
liquid stools once or twice daily.

I did not see him in the afternoon of the 9th, but learned that
although the paroxysm returned as usual at one o'clock, he was not
quite as restless.

Oct. 10th. Very little difference in the symptoms from those
present on previous days in the forenoon.

No treatment.

6 o'clock, P. M. Pulse 90 ; quite restless, (throwing his arms
about and changing his position in bed;) skin hot; had been
dozing a little and imagined he had a body of sohliers at his com-
mand, and gave them orders.

Oct. 11th. I called in my partner, Dr. Trowbridge. Pulse 84 ;
breathing regular, but labored ; tongue coated and dry ; eyes clear :
a slight defined redness on both cheeks; skin cool; has had as
many as three or four brown colored evacuations during twenty-
four hours.

Dr. T. thought the case was probably typhoid fever, but agreed
to let him take 15 grains of quinine, divided into three doses. The
medicine was left, but as the patient refused to take it, he had no
treatment.

P.M. Pulse 96; skin hot and dry; stupid and restless; face
sallow ; tongue red in the middle.

At Dr. T.'s request we gave him brandy in small quantity, with
orders to discontinue it if he was more restless, and substitute Do-
ver's powder, three grains every two hours.

Oct. 12th, A.M. We learned that he had taken the three Do-
ver's powders before he obtained sleep; but as this was at mid-
night, and he generally fell asleep and rested until morning, we
did not know what credit to give to*the medicine.

Dr. King was called in consultation, Oct. 13th, and advised to
give quinine, but it was not given on account of difference of
opinion, until the next day. The symptoms were about the same

1856.] Periodical and Continued Fevers. 469

as on the 12th, except that about daylight he is reported to have
sweat.

Oct. 14th. Drs. King and Kellar saw him with Dr. T. and my-
self. Little, if any, difference in symptoms.

Dr. Kellar proposed to give him valerianate of quinine, which
was agreed to by Dr. King and myself, thinking that the differ-
ence between that and the sulphate would not warrant us in de-
clining to concur in the proposal. We ordered five grains three
times a day.

Oct. 15th, 5 o'clock, P. M. Pulse 80 ; skin hotter than natural;
somewhat deaf ; drowsy; talking in his sleep; tongue red in spots,
where the coating has fallen off; vomited once, water and bilious
matter.

Oct. 16th, 9\ o'clock. Pulse 72 ; has been sweating for half an
hour; two rhubarb colored motions since yesterday.

6 o'clock, P. M. Pulse 84; skin dry and hot; paroxysm of
fever returned at four instead of one o'clock as previously.

Oct, 17th, 85 o'clock. Pulse 78 ; eyes look well, no disposition
to stupor; bowels moved once; a slight appearance ofsordes on
the teeth.

No medicine.

10 h o'clock, A. M. We were sent for under the impression that
he had a chill. Mrs. C. had found his hands and feet cold, finger
nails blue, and said that he was shivering; when Ave arrived his
skin was rather hot, but he drew the bed clothes around him, and
was evidently cold. This chill (or as Dr. T. preferred to think,
nervous tremor,) lasted three-quarters of an honr. He then threw
off part of the bed clothes, and appeared to be quite warm.

6 o'clock, P. M. Pulse 72 ; mind clear.

In consultation I declined to give brandy, and persisted in
giving him 20 grains of the sulphate of quinine (divided into three
doses) between twelve o'clock at night and daylight. He had
taken on the 14th, 15th and 16th, fifteen grains of the valerianate
each day.

Oct 18th, 9 o'clock, A. M. In a profuse perspirstion ; pulse 72;
mind clear; bowels moved once since yesterday; tongue dry; (he
has kept his mouth open, asleep and awake, during his illness.)

3 o'clock, P. M. Not sweating ; otherwise as in the forenoon.

Oct. 19th, A.M. Pulse 72; mind clear; bowels not moved
since yesterday ; tongue moist, covered with a light fur; says he
is a good deal better.

Oct. 20th, P. M. Had a slight paroxysm of fever at one o'clock.

Nov. 1st. Has been convalescent since I last saw him, and is
now able to be up half of the day ; wishes food, and complains
only of muscular debilitv.

He has had a small red pimple on the neck, elevated above the
surface, and disappearing under pressure; another under the right
nipple ; a third a little to the right of the median line over the

470 Periodical and Continued Fevers. [August,

stomach; and between these last, two or three not so well defined.
His wife says that mosquitoes have been abundant, and also that
there have been fleas about his bed. I could not say that they
were not the characteristic rose spots of typhoid fever.

We have been looking at the case from different stand-points,
and have called-in other counsel, (as the minutes will show.) One
of them, Dr. King, saw him several times. He has practiced in
this town and neighborhood for sixteen years. He agrees with
me. Dr. Kellar, who has practiced here for three years, and Dr.
McBride, just here from Ohio, (neither of them saw the ease but
once,) unite with Dr. Trowbridge in calling it a case of typhoid
fever. As the case was under my care, and as Dr. King concur-
red with me in opinion, I persisted, as the notes show, in giving
quinine in liberal doses. Dr. Keller preferred the valerianate, and
we therefore gave it. Drs. Towbridge and McBride declined giving
the treatment their approbation.

The grounds for calling the disease typhoid fever were

1st. Its continuance after the use of quinine, on the 7th and 8th
assuredly not an uncommon thing in remitting or even intermit-
ting fever.

2d. The tongue was coated and dry in the middle. Dr. Flint
does not think that the tongue furnishes any positive criterion of
the disease.

3d. He had diarrhoea. This is not an uncommon event in
ague, and is common in remittent fever, after the use of purgative
medicine.

4th. On the 17th there was a slight appearance ofsordes, a
symptom acknowledged to exist in the typhoid condition occur-
ring in remitting fever.

5th. There was capillary congestion. This was- more intense
in the afternoon, and presented a dull but defined appearance.
His eyes were always clear, until convalescence was established,
and then never congested except after sleep.

6th. He was stupid. This was not noticed until on the forenoon
of the 12th ; he had then been in bed for six or seven days, and
the disease had evidently increased, and we may easily account for
the stupor by congestion of the brain.

7th. He was deaf. He had taken a good deal of quinine.

8th. He had red spots on his neck and abdomen. My reason
for not believing they were the characteristic spots of typhoid
fever are hinted at in the report of the case.

The reasons for believing the case to be remittent fever are the
following:

1st. The attack was preceded by intermittent paroxysms, recur-
ring regularly on the seventh day after it was arrested, as is com-
mon in ague.

2d. There was a regular exacerbation, commencing at noon and

1856.] Periodical and Continued Fevers. 471

lasting until midnight. Oct. 7th, 8th and 9th, there was almost,
if not quite, an intermission in the forenoon.

3d. The fever ended with a chill.

4th. There was no epistaxis.

5th. There was no tympanites."

Decatur, 111., Nov. 5th, 1855. W. J. Chenoweth.

The following note, written subsequently to the following re-
port, has an obvious bcaringoii the question as to the diagnosis:

"Dear Dr: The person whose case I recently reported to you,
moved on Saturday last, Nov. 10th, to a new house, freshly plas-
tered, (the room in which he slept was dry, but the next room
was quite wet.) On Sunday he ate a small quantity of milk, (his
appetite was good,) and in about half an hour he was seized with
considerable pain, which he referred to the head of the colon.
Injections were given, and two motions produced. He was then
given opiates, but the pain continued. On Tuesday evening his
bowels were tympanitic, and on Wednesday he died.

I suppose his death was not connected with his first attack as a
sequence, but I think it necessary to mention the fact. He was able
to walk about, had an excellent appetite, and bid fair to be entirely
healthy, but was cut off at a time when hope had well nigh result-
ed in certainty. Respectfully,

Decatur, Nov. 15, 1856. W. J. Chenoweth."

Remarks. Having introduced the foregoing report, an opinion
respecting the diagnosis will be expected by the reader as well as
the reporter.

I need not say that, in discriminating between diseases which
may have many points in common, the data contained in a written
description, however complete this may be, are much less satisfac-
tory than the evidence afforded by personal observation. The
account of the case, as given by Dr. Chenoweth, was undoubtedly
prepared with a disposition to state the facts fairly, and in a truth-
seeking spirit.

The circumstances, however, under which the phenomena were
observed, and the history related, are such as to render it extreme-
ly difficult to divest the mind altogether of bias, and therefore the
confidence of the author in the correctness of the position which
he was led to take early in the progress of the disease, must not
be taken into account in forming an impartial judgment concern-
ing it There are certain points on which it were to be desired
that the report had been more full and explicit, viz: the condition
of the abdomen as respects meteorism, tenderness, and gurgling;
the state of the mind; the presence or absence of cough, and the
bronchial rales; the period when the spots were observed, and a
more minute description of their physical characters.

Judging from the symptoms detailed, and taking into view the
occurrence of fatal peritonitis, probably from intestinal perfora-

472 Periodical and Continued Fevers. [August,

tion, during convalescence, I must think that the evidence decided-
ly preponderates in favor of the conclusion that the disease was
typhoid fever. It is much to be regretted that the autopsical ap-
pearances could not have been ascertained. These, in all proba-
bility, would have sufficed, in connection with the ante-mortem
history, to determine positively the diagnosis.

Occurring, however, in a malarious district, the case presented
certain symptomatic events which belong to periodical fever, and
which rarely enter into the symptomatology of typhoid fever as
observed in parts of the country where intermitting fevers do not
prevail. I refer more especially to the recurring febrile paroxysms
preceded by chills, which characterised the early part of thehistory
of the case, and the occurrence of a single paroxysm at the termi-
nation of the disease. We have then, in this case, apparently an
intermingling of the events pertaining to both typhoid and remit-
tent fever; and Dr. Chenoweth states that the case was one of a
class of cases observed in that town and neighborhood, which
were regarded by some of the physicians as cases of remitting, and
by others typhoid fever. Now, is it not probable that there, and
in other situations where periodical fevers prevail to a greater or
less extent, the two forms of fever, viz., periodical and continued,
may be blended, giving rise to a hybride affection, the phenomena
of either species being manifested in different cases in varying pro-
portions? It is with reference mainly to this question that I have
introduced this case of disputed type of fever, and to this question
the remainder of my remarks will be devoted.

With the present amount of positive knowledge bearing upon
it, this is a speculative question. We have not data on which to
base a definite answer. The question can only be answered defi-
nitely by historical facts, which it will require not a little time and
labor to collect. We are not to prejudge the result of analytical
investigation by conclusions which may be hypothetically ration-
al. Nevertheless, here, as in other instances, a discussion profess-
edly on rational or speculative grounds is legitimate, and may be
useful by exciting and guiding the researches which will cither
confirm or disprove the suppositions.

Let us clearly xinderstand what is involved in the hypothesis of
the blending of periodical and continued fevers. It is a matter of
common observation, that in remitting fevers the occurrence of
remissions frequently ceases after a time, and the febrile move-
ment becomes continuous. It is not, however, on this account
regarded as nosologically transformed into continued fever.
Practitioners, it is true, often speak of remitting terminating
in typhoid fever. But this is a loose mode of expression,
which has given rise to not a little confusion. The remittent
fever puts on more or less of the external characters which
belong to typhoid fever; or, in other words, the patient lapses
into a typhoid condition common to a variety of affections.

1856.] Periodical and Continued Fevers. 473

This is all that can with propriety be said, and yet the pertinacity
with which many who are not over nice in pathological distinc-
tions, insist on the conversion of the one form of fever into the
other, is a significant fact to which I shall have occasion presently
to refer.* The two forms of fever are, in fact, reckoned distinct
genera of the pyrexias. It may be logically, although not demon-
stratively proved that each proceeds from the introduction into
the system of a special cause; that this morbific agent, or poison,
in either instance, is capable of producing a certain definite series
of morbid results, which, in the one case, give rise to the charac-
teristic symptomatic phenomena of periodical, and, in the other
ease, to those of continued fever. The two genera are, therefore,
considered as essentially distinct from each other. The poison
improperly called marsh miasmata is capable of producing the
species of fever called intermitting and remitting, and these only;
while the special cause of typhoid fever, be it the matter of conta-
gion, or not, will give rise to the species of fever last named, and
none other. Now the question is, may these two different
morbific agencies act m conjunction within the organism, the
processes peculiar to each going on simultaneously, and conse-
quently givirtg rise to an union of the sjTmptomatic phenomena
peculiar to each ?

The affirmative answer to this inquiry by no means involves a
pathological absurdity. The old doctrine that two diseases cannot
co-exist in the same place and time within the body, is now obso-
lete. Observation has abundantly established that two essentially
distinct fevers may run their respective courses simultaneously.
Scarlet fever has repeatedly been known to be thus associated with
measles and with small pox.f The supposition, then, that periodi-
cal and continued fevers are capable of being blended, is sustained
by analogy.

The special cause of periodical and continued fevers are alike
impalpable, inappreciable. In the present state of medical science
we can only study their pathological effects. We argue for the
distinct specific character of these causes from the uniformity and
peculiarity of the effects. This being so, the evidence in behalf of
the blending of the two diseases must consist in the union, under

* The conversion, as distinguished from the blending of fevers, is a point which I
shall not discuss. The reader is referred to an able article entitled the "blending
and conversion of tyres in fever," from the pen of Frof. Dickson, of Charleston, S.
C, contained in the Transactions of the American Medical Association, Vol. V.,
1852. Prof. D. shows very clearly the improbability of a conversion of one species
of fever into another, in the literal sense of that term. Two diseases, so special in
their character, and so distinct as regards their phenomena and their causation as
different species of esential fevers, in a certain sense become merged into each other
by being blended, but it is not likely that either in reality parts with its individual-
ity, or, in other words, that an actual metamorphosis occurs of the one into the other.

f For a collection of facts, from difi'eient sources, in support of this statement, the
reader is referred to a note in Gregory on the Eruptive Fevers, by the American
editor, Dr. Buckley, page 344.

474 Periodical and Continued Fevers. [August,

certain circumstances, of the symptomatic characters of the two
kinds of fever. 1 have already alluded to the fact so well known
to physicians who reside in districts termed malarious, that cases of
remitting fever frequently not only fail to preserve during the
career of the disease remissions, but present many of the distinc-
tive traits of typhoid fever; and, hence, it appears to the medical
observer to be a matter of common sense that the former under-
goes a conversion into the latter. Is it not reasonable to suppose
that in these cases there is actually a combination or blending of
the two diseases, albeit the diagnostic criteria by which they are
discriminated from each other are sufficiently constant and relia-
ble to enable the practitioner to make the distinction practically in
the vast majority of cases?

I am disposed to advance a step beyond an affirmative answer to
this question, and to ask whether it be not a rational view of re-
mitting fever to regard it as always involving a blending of the
intermittent and the continued. Why do we have in malarious
districts, in certain instances, remitting instead of intermitting fe-
ver? It is not owing to the greater abundance of the so-called
malarious poison, or its greater virulence, as was imagined by Dr.
Eberle, for intermitting fever may be as pernicious, in other words,
as severe and fatal as remitting fever, and it is fair, other things
being equal, to measure the quantity and potency of the special
cause by the degree of the specific effects. The specific effects of
the malarious poison are intermittent febrile paroxysms, more or
less complete and intense recurring at regular intervals. In remit-
ting fever an additional pathological element appears to be involved
- two separate affections, viz, a continued and a paroxysmal fever,
are united. The disease is a hybrid.

This theory is favored by an inference from a well known fact,
which I do not recollect to have ever seen cited for that purpose.
The fact to which I allude is the indigenous deveiopement of
typhoid fever, more or less abundantly, in different portions of our
country, directly intermitting fever disappears, and the infrequen-
cy or absence of well marked cases of the former so long as the
latter form of fever prevails. This fact has been observed in the
locality in which I now write by those who have resided here for
the last twenty or more years, and it is a fact which has arrested
the attention of observing practitioners in various sections.* Now
is it probable that the special cause producing typhoid fever is not
developed, or is deficient, in miasmatic districts precisely so long as
periodical fever prevails, and that, as a rule, it starts into existence
or becomes move abundant just as the latter form of lever disap-
pears? Essentially distinct as are the two poisons, why should the
one, in this way, supplant ihe other? Is it not almost absurd to
suppose that the typhoid poison, as it were, obsequiously stands

* For a collection of testimony relative to this point, the reader is referred to
Bartlett's Treatise on Fever. Edition of 1847, page 108 et sey.

1856.] Periodical and Continued Fevers. 475

aside for marsh miasmata, and patiently wails the departure of the
latter before presuming to fake its place, and assert its rank among
the grand morbific agencies of nature! On the other hand, is it
not more reasonable to suppose that in districts atone time abound-
ing in periodical fevers, in which subsequently typhoid fever be-
comes the prevalent form of febrile disease, the special causes of
both were at the same time indigenous, and that the association of
the two poisons in different relative proportions, gives rise to an
union of intermittent and typhoid fever, the phenomena of either
predominating according to the relative quantitative proportion of
the efficient causes ?

The speculative character of these remarks was conceded at the
outset. The blending of periodical and continued fevers, either
occasionally in cases of the former, which exhibit in a marked de-
gree more or less of the characters belonging to the latter, or uni-
formly in cases of remitting as distinguished from intermitting
fever, is to be established, or otherwise, by evidence more solid than
that pertaining to the considerations just adduced, and others of a
kindred character. These considerations claim attention only as
suggestive of an interesting and important subject for scientific in-
vestigation. What are the requisites for an investigation directed
to the points which have been raised? A few words with refer-
ence to this inquiry.

Bearing in mind our ignorance of the special causes involved in
the production of both forms of fever, of their nature and origin
as well as the primary and essential morbid processes to which they
give rise when they are introduced within the organism-, it is plain
that the supposition of their conjunctive operation is to be proved
or disproved by the analytical study and comparison of their appre-
ciable phenomena, that is, the symptomatic characters of the two
kinds of fever. The data for this method of investigation are yet
to be acquired. The natural history of continued fever, so far as
concerns the species now known as typhus and typhoid, is pretty
well ascertained. These fevers have been carefully studied by
means of the analysis of recorded cases in different countries. As
much cannot be said of periodical fever, especially the species or
variety called remitting. The natural history of this fever cannot
be considered as satisfactorily settled on the basis of that of the two
species of continued fever just mentioned, Great as are the oppor-
tunities in various parts of this country, and in other countries, to
collect recorded cases of remitting fever for analysis, it remains to
accomplish for this disease what the labors of Louis, Gerhard and
others, have done for typhus and typhoid fever. Something has
been contributed toward an end so desirable by Stewardson* and
Alfred Stille.f but the materials gathered by these distinguished

* Analysis of twenty cases of remitting fever in the Amer. Jour, of Med. Sciences,
April, 1841, and April, 1842.

f Analysis of ten cases of remitting fever recorded by Dr. , of Baltimore,

by Alfred Stille, M.D., of Philadelphia, April, 1846.

176 Periodical and Continued Fevers. [August,

physicians, although valuable, are not sufficient. What a tempting
field is here open to the clinical observer and historian ! But of
how many diseases may this be said? " Truly the harvest is great,

The results of the analysis of different collections of recorded
cases of remitting fever in different situations, including districts in
which typhoid lever is seldom or never seen, and those in which it
has become more or less prevalent, will establish the points pertain-
ing to its natural history which distinguish the former from the
latter; and by bringing these results together and comparing
them with each other, it will be seen whether remitting fever main-
tains uniformly certain characters essentially distinct, or whether
in proportion as cases of periodical fever disappear, and cases of
continued fever succeed, the symptomatic phenomena of remitting
fever manifest a transition to typhoid, showing a gradual predom-
inance of the characters of the latter until those of the former are
finally lost.

According to the general impressions of observing practitioners
who have seen more or less of the disease, the descriptions by various
authors, based on unrecorded experience, together with the results
of analytical investigation (as yet far too limited) of recorded cases,
certain diffeivntial characters of remitting and typhoid fever are
generally sufficiently marked to serve as diagnostic criteria. It
is, however, admitted that in a certain proportion of instances a
positive discrimination is not easily made, especially in cases not
observed from the commencement of the disease ; and it is perhaps
not incorrect to say that in certain situations it is oftener difficult
to determine whether the disease be typhoid or remitting fever than
to distinguish typhoid from typhus fever, in places where the two
latter diseases prevail. As already stated, it is a matter of com-
mon observation that the symptoms generally characterised as
typhoid, such as low, muttering delirium, a dry furred tongue, rordes,
etc., are not infrequently developed in the course of remitting fever.
The poinls to be settled are, to what extent are the characters con-
sidered as distinctive of each form really entitled to be regarded in
this light, and of the characters which are truly distinctive, what
significance or importance do they possess as representatives of the
essential nature of the disease. Take for example the abdominal
symptoms which belong to the natural history of typhoid fever, viz.,
diarrhoea, meteorism, tenderness, gurgling. These are undoubted-
ly wanting, as a rule, in cases of remitting fever; but are they not
present in a certain proportion of cases, and if so, in what propor-
tion? Again, complementarity to the inquiry just made, are the
intestinal lesions supposed to be characteristic of typhoid fever,
ever found in cases which, irrespective of their existence and of the
presence of the symptomatic phenomena associated with them,
would be entitled to be called cases of remitting fever? A
statement to that effect is positively made by a distinguished

1856.] Periodical and Continued Fevers. 477

teacher and writer;* can it be substantiated by evidence adduced
by the analyses of recorded cases? The same interrogatories may
be applied to the eruption, and to other diagnostic events which
are of more or less significance and importance in their relations to
the essential o? special nature of the disease. When these points
are settled, as they may be, and as they alone can be by the accu-
mulated results of numerous analyses of recorded cases, then we
shall be prepared to bring logical proof for or against the doctrine
that remitting fever, either occasionally or habitually, involves a
blending of the special causes and essential pathological processes
pertaining to the periodical and continued fevers.

In the mean time indulging, as we may do, theoretical views,
(provided they are not permitted to engender pre-conceptions which
will blind the perception of truth.) this doctrine is sustained by co-
gent considerations, and explains satisfactorily well known facts.
Variation in the relative proportion of the periodical and the contin-
ued causative and pathological elements, serves to account for
certain palpable differences in cases of remitting fever. We can
understand that in proportion as the former elements predominate,
the character of the disease will approximate to that of intermit-
tents; the febrile exacerbations will approach to paroxyms, and the
career of the disease will be arrested by anti-periodic remedies.
On theother hand, the predominance of the latter elements will pro-
portionately give rise to ihe phenomena which are characteristic of
typhoid fever, in addition to continuity in the febrile movement.
These are the cases which resist the sulphate of quinia in large
doses, and which sometimes perplex even the accomplished diagnos-
tician.

In the same way we may account for a fact which might be
cited as tending strongly to sustain the doctrine. I refer to the
prevalence of remitting fever in malarous districts during seasons
when cases of intermitting fever are comparatively unfrequent, and
vice versa. It is well known that the two forms of periodical fever
(intermitting and remitting) do not observe any law of relative pro-
portion in their concurrence. In one year intermitting fever may
be rite, and remitting fever be rarely observed, while in another
year remitting fever is abundant and intermittents not usually prev-
alent. Now, is this fact consistent with the notion that remitting
fever involves the same special cause, and that only, which produ-
ces intermitting fever? Is it not, on the other hand, more consist-
ent with the supposition that two special causes are conjoined, viz.,
that which is called marsh miasma and the typhoid poison? Adopt-
ing this supposition, when remitting fever preponderates, the
typhoid poison has the ascendency. Under these circumstances,
were the district not malarious, there would be an endemic of pure
typhoid fever. But when intermitting fever is the prevailing form,

*Prof. Dickson, in his paper on the " Blending and Conversion of Types in Fever,"
Already referred to.

478 Form of Metamorphosis of Nerve and Muscle. [August,

the special cause of a purely periodical fever abounds, unattended
by the typhoid poison.

In conclusion, the doctrine in behalf of which these few discur-
sive remarks are offered, simply assumes that ihe special cause of
typhoid fever* is not restricted, geographically, to territory free
from periodical fevers, but existing in miasmatic districts, is asso-
ciated in its morbid manifestations to a greater or less extent, with
the phenomena due to the special cause of periodical fever, and,
thus associated, gives rise to remitting fever, which is therefore a
hybride affection. This, in reality, is only an extension to con-
tinued fever of a fact to which the experience of all practitioners
residing in malarious districts will testify, viz: that, in general, the
various affections originating in these districts are liable to receive
important modifications from the conjunction of the malarious
poison. [Buffalo Med. Journal.

Form of Metamorphosis of Nerve and Muscle into Areolar Tissue.

A paper with this title appears, by Dr. Billroth. f After allu-
ding to the observations of Blunnette and. Schroder van der Kolk,
on the changes which muscle and nerve undergo in the neighbor-
hood of carcinoma, he goes on to speak of this change occurring,
not as a specific carcinomatous degeneration, but essentially as a
transformation of the muscles and nerves into areolar tissue. In
hard carcinoma of the breast it unites intimately with the fascia
of the pectoral muscles, and this again with the muscular sub-
stance itself, so that the muscle is drawn into the mass, and from
the first point of growing together is arranged in a radical direc-
tion. One still distinguishes the fascia a long time after this
growing together has taken place ; but at a later period the tissues
form such a firm cicatrix that one can, neither by the naked eye
nor microscope, distinguish an}- of the original elements. The
muscle passes right into the tumour, loses its dark red colour, and
at last assumes a white glittering colour, but often the bundle-like
arrangement is preserved. The like occurs in cancer of the lip.
In investigating microscopically these spots of transition, a very
careful tearing is required. First of all, a number of small cells
and nuclei come into sight, and the muscular fibre is found to be
very brittle, easily tearing transversely where the fibres immedi-
ately pass into the carcinomatous cicatrix, but one seldom can
follow a free fibre very far. The muscular fibre first becomes less
cross-striped in places assuming a more homogeneous and stringy
appearance, ami at the same time a new formation of tolerably
dark oval nuclei arises in or under the sareolemma of the fibres,
which takes on a completely homogeneous glittering look. Whilst

* I limit this statement to typhoid fever, inasmuch as this is the species of coutin-
lied fever chiefly indigenous in this country,
f Virchow's Archiv., p. 260. July, 1855.

1856.] Form of Metamorphosis of Nerve and Muscle. 479

this change is progressing, new cells are formed between the fibres,
and the tissue becomes so coherent that single fibres can only sel-
dom be recognised, and the substance thus formed is no longer
cleavable like muscle, but friable. The newly-formed nuclei com-
press the muscular substance, and afterwards appear to dwindle
as the substance arising from the metamorphosis becomes much
less nucleated than it was during developement. The fore-men-
tioned process is the one most frequently met with, but yet there
are many variations ; for instance, the fibres may maintain their
breadth, losing their cross-stripes, they may assume a fine punc-
tuate bright appearance, with only a scanty formation of nuclei.
Iu other cases the covering is filled with such a mass of nuclei that
it appears as if the muscular substance passed into the new forma-
tion, and perhaps itself served as material for new formation.
But these forms are seldom proportional-, and may possibly
be a deception, as this material does not correspond to single fibres,
but only depends upon the coherence of the nucleated and cellu-
lar material deposited between the muscular fibres, which on
mechanical grounds also assumes a cylindrical form. Along with
these nuclei one sees a good number of fine spindle-cells, unaffect-
ted by acetic acid, which must be regarded as proceeding out 'of
the cells deposited between the muscular bundles. This meta-
morphosis of muscular fibre is not peculiar to the neighborhood of
cancer. The author relates a case of a boy, part of whose lip was
excised in the Berlin Hospital, for the removal of a tumour, and
the labial muscles adhering, the rete was found to be metamor-
phosed into strong nucleus-holding areolar tissue and elastic fibres.
In other cases, such as the diffuse cavernous tumours, the trans-
formation of muscle into areolar tissue may be seen.

Just as it is with musculnr fibre, so do nerve fibres pass into a
kind of matrix, whilst elongated nuclei form in their sheaths. A
firm cancer was removed from the mamma. It had grown into
the pectoral muscle, which was removed with it. At the place of
transition of the sound muscle into the tumor, in a portion kept
in acetic acid for twenty-four hours, an abundance of nerves more
clear and numerous than usual Avas seen. In a thick nervous
trunk, raylike extensions of the primitive fibres in a lateral direc-
tion were seen which, partly single7 and partly united with small
secondary branches, proceeded into the muscie. Here and there
the bright-dark contours of the primitive fibres were seen, but for
the most part the nerve substance had passed into a kind of ma-
trix, and only a row of nuclei placed alongside each other indica-
ted the original eourse of the fibre. One clearly sees in single
places that the nuclei were imbedded in the sheaths of the nerve
fibres, which were also in great part destroyed by reagents. This
degeneration was advanced also in the neurilemma of the larger
nerve branches. Our author considers that the pain often felt in
cancer of the mamma? arises from the above-described new for-

4:80 Progressive Atrophy of Muscular Fibre. [August,

mation of nuclei in tbe sheaths of the primitive nerve fibres by
which the nerves are manifestly exposed to great pressure; and
this the more likely, as the cancerous growths are almost free from
nerves themselves. Probably something of this kind occurs in the
fibroids of the skin and periosteum. The substance resulting from
the above degeneration of the muscles and nerves become brittle,
and swells up on maceration in weak acetic acid, as also in weak
alkalies, being therefore not completely analogous to ordinary
areolar tissue. [British and Foreign Med. Chir. Review.

Progressive Atrophy of Muscular Fihre.

Virchow * relates at length a case of a man, aged forty-four,
who was affected by progressive muscular atrophy. He had been
affected, when aged twenty-one, with almost complete lameness-
of the extremities, supposed to be of rheumatic origin. His father
had been similarly affected when aged forty. In this case the
lameness began in the leg and spread upwards. The intestines
and urinary bladder remained natural until his death. The mus-
cles of the extremities were very emaciated, and of a pale reddish-
yellow colour, some being entirely degenerated. Under the
microscope they exhibited areolar tissue and fat-cells containing
granular material, partly corresponding to the old muscular bun-
dles in an uninterrupted way, partly not so. In some muscles the
microscope also showed the presence of slender vesicles of 0,000
0,01 millimetres broad, containing very small fat corpuscles.
Here and there were elongated nuclei, and in some places small
round nuclei, showing a double contouron addition of acetic acid.
These were partly single and partly heaped together from 2 to 7
in number, partly in files. These vesicles at times appeared quite
isolated, with round extremities, and many had a more caudate
character. In other places, where the muscle was redder in colour,
the vesicles were broader, containing more numerous granules,
mostly oval, and of 0,075 millimetres in length. The signification
of these structures was difficult to decipher. Often there were
evident fat-cells, surrounded by a membrane entirely uplifted from
the fat drops, and with an oval nucleus. Areolar tissue bundles
existed, with spindle-shaped very delicate corpuscles, which were
mostly connected at their extremities; also spindle cells, broader,
and filled with fine fat granules, which gradually became larger,
and finally pass into large oval cells, containing large fat drops as
well as the fine granules.

Finally, there were decided fat cells, only differing from ordina-
ry ones in that along with a large fat drop they contained many
smaller ones. Hence it appeared to Virchow that a new forma-
tion of fat-cells had taken place out of areolar tissue corpuscles.

* Virchow's Archiv., p. 537. Oct. 1855.

1856.] Jugular Venesection in Asphyxia, <kc. 481

Where the muscle was still more unaltered, the primitive bundles
were delicately pale, with finely granular contents and incomplete
striae The arteries of the diseased muscles had fine granular fat
in their walls. The nerves contained less fibres than usual, and
on longitudinal as well as transverse section very broad intervening
spaces were seen occupied by a very richly nucleated tissue; the
nuclei were long, delicate, something pointed, almost like nuclei
oforganic muscle fibre, and in every direction much finely-granu-
lated fat existed. The various nerves did not appear atrophied to
the naked eye.

The spinal marrow, as well as the roots of the nerves, were
healthy in look, but on section, even to the naked eye, a remark-
able variation was seen, beginning at the upper cervical region
and proceeding downwards, becoming gradually more marked,
and most remarkable about the lumbar swelling. In all these
places one saw in the posterior fibres of the chord, and more
decidedly, near the posterior longitudinal fissure, a clearish grey,
somewhat translucent mass, instead of the white nerve substance,
which so extended into the under part of the medulla as to reach
the posterior horn of grey substance. Here it so united with the
grey matter that an obvious limit could not be seen. In general
the degeneration began at the posterior longitudinal fissure, and
proceeded thence into the substance of the posterior fibres. As
seen by the microscope, only the posterior fibres, and not the
horns, were affected. The change was of the same nature as that in
the peripheric nerves, only that some broader nerve-fibres existed
grouped together, which on transverse section were separated
from each other by a distance of 0,005 to 0,012 millimetres. Be-
tween them existed a very soft friable granular material, contain-
ing thickly-strewed corpora amylacea, and also many granulated
nuclei, chiefly oval, and here and there enclosed in round elonga-
ted cell membrane. No fat was visible, and the bloodvessels had
a natural look. On the addition of chromic acid, instead of finely
granular substance, much shreddy firm and fine fibrillated mate-
rial was seen. [Ibid.

On Jugular Venesection in Asphyxia, Anatomically and Expert-
mentally Considered.

A paper on this subject was read before the Medico-Chirttrgical
Society of Edinburgh (March 19th, 1856,) by Dr. Struthers, The
object of the paper, which was illustrated by preparations and
drawings of the valves in the cervical veins of the human subject,
was to ascertain whether distension of the right side of the heart
could be relieved by opening the external jugular vein in the hu-
man subject. The experiments of Drs. John Reid, Cormack, and
Lonsdale, had satisfactorily shown that, in the lower animals
(dogs, cats, and rabbits,) the right side of the heart could be thus

482 Jugular Venesection in Asphyxia, dx. [August,

disgorged so as to restore its action, which had been arrested by
a simple mechanical cause, over distension. He considered that
the indication of restoring the heart's action by jugular regurgita-
tion, had not received that attention which Dr. lieid's suggestive
paper demanded for it. Dr. Struthers described the anatomy of
valves which he had found in the cervical veins, as well as those
usually alluded to as present in the external jugular. A pair of
valves at or within the mouth of the internal jugular vein; a pair
in the subclavian vein immediately external to the point of uuion
with the external jugular ; a pair at or within the mouth of the
externa] jugular ; a second pair in the course of the external jug-
ular, at the upper end of its sinus, or large portion, about H inch
above the clavicle, and various lesser valves at the mouths or within
the tributaries of the external jugular. The varieties, and relative
position of the two portions of each pair of valves was described, as
he had found them in numerous careful examinations. With the
view of ascertaining whether regurgitation could take place not-
withstanding these valves, Dr. S. performed a series of experi-
ments on the dead subject. A pipe was fixed in the femoral
vein, and tepid water thrown freely upwards. The general result
was, that the external and other jugular veins very soon became
distended, and that when the lancet opening was made, at about
an inch above the clavicle, the fluid regurgitated freely. At first
a jet came, emptying the distended sinus, and then it continued to
flow, never in a jet, but in an active stream across the neck, escap-
ing by the wound with a wriggling motion, evidently due to the
obstruction offered by the valve which it had overcome. Care
was taken to ascertain that the fluid came by regurgitation, not
from above; but, if allowed, it also came freely from above, having
ascended by the internal jugular. The introduction of a probe so
as to hold aside the guardian valve of the external jugular did
not much accelerate the regurgitating flow. When the catheter
was introduced, however, the fluid came very freely by it as
freely as from a distended bladder. It is easy to introduce a
common male catheter to the vena cava or right auricle, by direct-
ing it backwards and inwards, as well as downwards, from the
point of venesection. But as soon as the catheter has entered the
subclavian vein, the fluid comes as freely as when it is pushed
farther. As soon as the point of the catheter is withdrawn into
the external jugular, the fluid ceases to come by it. In one sub-
ject the fluid could not be made to regurgitate. This was at the
time attributed to the circumstance that the cranium had been
opened for the removal of the brain, the fluid pouring out by the
cranial sinuses; but, on dissection, two pairs of valves were found
in the external jugular below the lancet opening, besides the pair
above it, as usual. Regurgitation seems to be prevented by two
pairs of valves, though one may be overcome. In these experi-
ments the veins of the arm did not become distended, and no re-

1856. j Sun Stroke. 483

gurgitation took place from a lancet-opening in the axillary vein,
although afterwards it was seen that only two pairs of valves had
stood in the way, between the heart and the opening. By "pair,"
Dr. S. meant the two separate portions which act together as one
valve. He (Dr. S.) drew the following conclusions : 1. No vene-
section can be of any use in asphyxia, except in the neck, on the
principle of regurgitation ; which, however, may also relieve con-
gestion of the head. 2. That, besides warmth and friction, and
(the most simple and effectual of all means,) continued artificial
respiration by alternate compression and relaxation of the sides of
the chest, jugular venesection should be tried. 3. With reference
to Dr. M. Hall's recent recommendation of the prone position, to
prevent the tongue falling back and closing the glottis, the ques-
tion occurred Does the tongue fall back, under passive circum-
stances, in the supine position ? Is not the closing of the superior
glottis, under all circumstances, a muscular act both the carry-
ing down and back of the tongue and epiglottis, and the lifting
upwards and forwards of the larynx? The mouth, however,
should be cleared of frothy mucus. 4. That to obviate the evi-
dent risk of entrance of air into the veins, the wound should be
closed as soon as regurgitation is about to cease, and artificial res-
piration be then commenced; the jugular venesection having been
performed as early as possible. \_Edinburg Med. Journal.

Observations on the Cause of the Disease known as Sun Stroke. By
Sanford B. Hunt, M. D.

As the season is now approaching in which we may not unrea-
sonably expect to witness occasional cases of this sudden and
terrible malady, it may be useful to recur to it now as a subject,
in itself interesting, and especially so to those who have made its
causation and pathology a subject of study.

The name "sun-stroke," or coup-de-soliel, implies that it is pro-
duced by the direct rays of the sun, and its pathology has been
almost universally conceded to be a sudden and intense conges-
tion of the brain sufficiently severe to cause immediate death.
Based on this view of the pathology, the treatment has consisted
almost entirely of heroic blood-letting, and the application of cold
to the head.

Unfortunately no one of these propositions or theories is proven,
and perhaps it is not too much to state that no one of them is
correct. It is the object of this article to consider briefly the
questions involved in them, and taking them one by one, to bring
to bear upon them such light as is afforded by the copious statisti-
cal tables which emanate from the health -offices of our principal
cities. In conclusion, I shall endeavor to reconcile the facts of
the disease so far as known, and suggest another theory of causa-

N. S. VOL. XII. NO. VIII. 81

484 Sun Stroke. [August,

lion one which I have already incidentally advanced on two or
three occasions, but in which I have no especial claim to originali-
ty- . ...
The first question for consideration is,

Are the direct rays of the sun necessary to the production of the
disease known as sun-stroke?

Undoubtedly the larger number of cases occur in the open air,
and in unshaded locations. But a very large number, so great
as not to be considered exceptional, occur within doors or on
cloudy days.

During the great epidemic of sun-stroke in New York, in
August, 1854, of 235 deaths in that city from this cause, 49 were
females. The argument here would be that as females do not
live much out of doors, that some, at least, of these occurred under
shelter. This supposition is confirmed by the fact that Dr. H. D.
Swift, in his valuable paper on "Exhaustion from the Effects of
Heat" a monograph remarkable for the intelligence of its path-
ological views mentions that "Eleven patients were attacked
one morning in the laundry of one of our principal hotels ~r several
were brought to us from a sugar refinery, where, after working
several hours in a close and over-heated apartment,, they fell down
suddenly in a state of insensibility; and we had an opportunity
of comparing their symptoms and lesions with those who became
exhausted after laboring in the sun, but was unable to satisfy our-
selves of any distinction."

Again, Dr. Reyburn, of St. Louis, in his "Report on the Dis-
eases of Missouri and Iowa," made to the American Medical Asso-
ciation at its meeting for 1855, furnishes the following statement:

" The cases of the disease that occurred in the last summer were
not all traceable to direct insolation ; the furnace-tenders in engine
rooms, and bakers unexposed to the sun, were sometimes attacked.
One case is reported to us of a female who had not been out of
the house during the entire of a very hot day, being attacked."

It is evident, then, that insolation is not essential to the creation
of this disease, but that it may occur in shaded localities, and even
on cloudy days, for Dr. Reyburn Ts statistics show that four deaths
by "sun-stroke" occurred in St. Louis on the 5th of July; and on
reference to Dr. Engleman's meteorological tables, I find that this
day there was a very cloudy sky, with rain and thunder. More-
over this was not a very warm day, the mean temperature being
only 79?. I shall have occasion to refer to this day again, with
reference to another meteorological condition.

Secondly. Is congestion of the brain the special pathological
condition present in this disease?

It is only recently that the fact has been fully recognized, that
in the great majority of instances of sun-stroke, the symptoms have
been those of syncope or exhaustion. Dr. Swift, in the paper be-
fore alluded to, proves from both symptoms and post-mortem

1856.] Sun Stroke. 486

appearances that the latter is generally the true condition. In-
deed, he says distinctly, that he has seen "a few, a very few cases,
of insolation verified by a post-mortem examination, certainly not
one during the past year, although examinations were made in all
the cases in which we suspected any cerebral lesion." And he
gives one case where a hot head, suffused and injected eyes, con-
tracted pupils, swollen countenance, coma and stertorous respira-
tion, with " fair strength" of pulse, all seemed to indicate intense
cerebral congestion ; but after death none was found.

So far as we know, the question of congestion of the brain rests
rather upon the symptoms than the patholigical evidence. In a
case which we witnessed a few years since, all the symptoms of
intense congestion were present. We bled the patient freely from
both arms. Soon after the flow of blood commenced he passed
into the most violent convulsions, which were only discontinued
on the production of profound syncope. Yet the symptoms
next day did not indicate that congestion had been present. His
recovery was rapid, and we have always felt some doubt as to
whether congestion were really present in that apparently well-
marked case.

At any rate enough is known to prove that contracted pupils
and convulsions are not to be accepted as sufficient proof of con-
gestion, and we must wait for actual post-mortem evidence of it to
verify its existence. It is already plain that only a very limited
number of cases are congestive, and it is quite probable that that
limited number will be much decreased on careful study.

Dr. Swift has more correctly given the name of " Nervous Ex-
haustion from the Effects of Heat" to the disease. The nervous
exhaustion is proven, and it is also proven that the brain is rather
anaemic than congested. But the cause assigned by Dr. Swift is
not satisfactory to me, and I expect to prove that heat is not alone
sufficient to act as a cause.

Wliat are the facts in relation to heat as a cause of coup-de-soliel ?

During the period of greatest mortality from sun-stroke in 1853,
in New York, the temperature was, according to the register kept
at the New York Hospital, not very high. During August, as
we have already mentioned, 235 deaths occurred from this cause.
It will be interesting to examine the weather record of this period.
We find from it that the temperature at 3, P. M., the hottest hour
in the day, was above 90 on three days only ; on which it stood
respectively at 92, 91 and 90. There were two days only on
which it stood between 85 and 90. There were five days on
which it stood between 80 and 85, leaving twenty-one days in
this month of "excessive heat," on which the temperature ranged
lower than 80. With reference to insolation we may also note
that twelve da}rs were cloudy, and that it rained on eleven of
them, the total amount of rain falling being large, viz : 6.04 inches.

Turning to St. Louis we find that in the summer of 1854,

486 Sun Stroke. [August,

during a period of nine days, (the last four of June and first five
of July) fifty-three deaths occurred from sun-stroke. The mean
daily temperature of this period was 86. Subsequently in July,
another period of nine days occurred, the mean temperature of
which was 83, during which only seventeen deaths occurred.
If temperature is the cause, why this disparity ? Again four
deaths occurred on the 5th of Jul}-, with a very cloudy sky, with
rain and thunder, and a mean temperature of only 79.

Here we leave the question of temperature. The facts adduced
are conclusive that, though a certain temperature is necessary,
neither the frequency or the fatality of the disease increase with a
further rise of the themometer. Heat then is not the essential
cause ; neither are the direct rays of the sun necessary.

What, then, is the essential condition for the production of eoup-
de-soliel, or rather exhaustion from the effects of heat?

I have been led to believe, from a careful survey of the premi-
ses, that a high humidity is the essential condition. This opinion
is based upon weather records and upon analogv.

In the first place the condition of nervous exhaustion is never
produced by a high, yet dry heat. The various experiments
going to prove that a person may live and breathe without evil
effects in a temperature high enough to cook a steak, or an egg7
are too well known to need comment. Experimenters have borne
for half an hour a temperature of L35* without great discomfort.

No person, however, could live that time in a vapor-bath of
that heat. The effect of surplus moisture in prostrating the
nervous system, impairing the vigor of the heart's action and
producing syncoj>e, is as well known as the vapor-bath, and needs
no comment. The symptoms of coup-de-soliel, in its ordinary form,
are precisely similar to prolonged syncope. The exhausting in-
fluence of a sultry day, or of a hot sun directly after a shower, are
familiar instances of the effect of high humidity upon the system.
But the proposition remains to be proven by hygrometrical obser-
vation, and not by the uncertain perceptions of the senses. I
purposely omitted to mention the hygrometrical condition of New
York and St. Louis in the epidemics cited, because it was desired
that the relation of heat in their causation should be tested by
itself.

We may now, however return to it.

Mr. Blodget(then of the Smithsonian Institution) said of it (New
York Journal of Medicine, Oct., 1853,) that "the temperature of
evaporation at New York, at the time of greatest mortality in
August, was from 80 to 84, being higher than the maximum
temperature of evaporation at New Orleans at any time in 1852,
by 2. Commenting on this point on another occasion, we made
the following remarks:

" This implies, necessarily, a high fraction of saturation, and
placing all the evidence together the fact that the temperature

1856.] Sun Stroke. 487

at 2 P. M., was only 90 to 92 (not an unusual heat for the season,)
that the cases were mostly among foreigners, that Dr. Swift des-
cribes the symptoms as indicative of ' nervous debility,' and not
of 'cerebral congestion,' that the dew-point reached a tropical
maximum, and the conclusion is irresistable that, not dry heat,
but along-continued bath of aqueous vapor was the true cause of
this unparalleled mortality. But, as if to make the evidence irre-
fragable, we are told that ' eleven patients were attacked one
morning in the laundry of one of our principal . hotels ;' and
' several were brought to us from a sugar refinery, where, after
working several hours in a close and over-heated apartment, they
fell down suddenly in a state of insensibility.' I regard these last
mentioned facts as of the last importance. Here, in a laundry, or
in a sugar-refinery, unaffected by solar rays, filled with vapor
artificially produced, having an excessive humidity, unventilated
(for on these fatal days there was no wind.) men fell by dozens in
sudden death. The experience of all time contradicts the idea
that dry heat can produce these effects, and I regard them as con-
clusive upon the question, whether or no the combination of high
heat and humidity is of itself a cause of disease.''

Turning again to St. Louis, we ascertain from Dr. Engleman's
tables, that during the period of nine days before alluded to, the
mean temperature of evaporation was 78, against a dry bulb tem-
perature of 86. The fraction of saturation is high enough to
prove the presence of an immense amount of aqueous vapor,
nearly as much, in fact, as could be forced into the air without
having it in the form of steam.

Without multiplying statistics, I may state that the examinations
of such weather records, corresponding with periods of mortality
from sun-stroke, as have fallen under my notice, has uni ormly
resulted in fixing a high temperature of evaporation as the efficient
condition of the cause of the disease, and that without dtfinite
relations to the dry bulb temperature.

A question of much interest connected with this theorv of cau-
sation, is as to what power a humid atmosphere exerts on the
absorption of the solar rays. I made last summer, some experi-
ments, with a view to ascertain this point. So far as thev went
they seemed to prove that the difference between a thermometer
in the sun and one in the shade, is greater on days of least humid-
ity. The observations were, however, made without sufficient
precaution against reflected heat, and will be repeated during the
present summer with care. The method of making them is to
use four thermometers : 1st, one with a dry bulb: 2d, one with
a wet bulb these two to be in the open air. shaded. A third
thermometer should be exposed with a naked bulb to the sun's
rays, while a fourth should be similarly exposed and wrapped
around with black wool. Only clear days should be noted. In
this way we hope to establish some relation between humidity and

488 Carbonic Acid in Premature Labor. [August,

radiation, corresponding with that which is evident to the senses
in the chill produced on going into the shade on a humid day.

Buffalo Medical Journal.

Carbonic Acid as a means of artificially producing Premature Labor.
By M. Scanzoni, Professor to the Faculty of Wiirzburg.

Two years since M. Scanzoni proposed to provoke premature
labor artificially by exciting the breasts by means of cupping
glasses, and by reflex action to produce contractions of the muscu-
lar fibres of the uterus. This process, made use of on several
occasions, often promptly induced labor, at other times it succeed-
ed better as an adjuvant, while in many cases its effect was incom-
plete, or failed almost entirely. The application of the glasses
frequently produced excoriation of the mamella?, inflammation,
abscesses, and more or less severe pain. Generally, the result of
the mammary excitation was particularly evident, when the irrita-
tion of the nerves of the mamellae was accompanied with local
excitation of the womb, and when besides the cups, the uterine
douche, the colpeurynta of Brown, the tampon, &c, were used.
Desirous of finding a certain means of provoking uterine contrac-
tions without inconvenience to the mother, and without danger to
the infant, and persuaded that artificial premature labor is one of
the most useful and valuable resources of obstetrics, the professor
of Wiirzburg continued his researches, and in the interesting prac-
tice which the maternity of Wiirzburg furnished, occasion soon
offered upon which to experiment. Taking the observation of M.
Brovvn-Sequard as a starting point, which shows that carbonic
acid provokes the contractions of the muscles of organic life; that
the genital organs for a long time exposed to the action of this
acid become the seat of very severe congestion ; and that it is even
a sure means of curing amenorrhcea, M. Scanzoni resolved to em-
ploy this acid to arouse the contractile power of the uterus, and to
excite it so as to bring about labor.

The apparatus employed was as follows : A flask holding about
a. quart, hermetically sealed, with a stopper having two openings,
by one of which a tube penetrated to the bottom of the flask, to
the other orifice was fitted a horn pipe which connected with a
caoutchouc tube about a foot long, ending in acaniilaof an ordin-
ary injecting syringe. Bicarbonate of soda, and then some acetic
acid is introduced by the first tube, a conical glass speculum is
placed in the vagina. The caoutchouc tube inserted in a cork is
introduced into the speculum, which it exactly fits. The carboniG
acid is increased or diminished at will by the addition or not of
acetic acid.

The following is the report of the case in which it was first em'
ployed :

1856.] Carbonic Acid in Premature Labor. 489

D. S , 26 years old, primapara, menstruated for the last time

May 26, 1855; entered the Maternite of Wiirzburg Jan. 29, 1856.
Pelvis low and narrow. The antero-posterior diameter, ordinarily
from 4 to 4 inches, is only 3 to 3 inches. The vaginal portion
of the neck is from five to six lines in length, and the external
orifice firmly closed. The head of the foetus was felt above the
anterior portion of the vaginal arch, the beatings of the heart were
heard to the left, and the extremities of the foetus were felt to the
right and high up, near to the bottom of the womb. The mother
thought she was in the thirty-second or thirty-fourth week of ges-
tation, and the examination of the genital organs confirmed this
opinion. The narrowness of the pelvis preventing natural labor
from taking place, and furnishing the indication for the induction
of premature labor, M. Sea nzoni resolved to try carbonic acid.

Feb. 2. At eight o'clock in the evening, the apparatus was ap-
plied for twenty minutes for the first time, without provoking any
notable modifications.

Feb. 3. At eight A. M., application for twenty minutes, and at
eight P. M. for half an hour. The mother felt while the gas pene-
trated into the vagina adisagreeable sensation of painful prickings,
and during the day darting pains about the umbilicus. Evening
The vaginal portion of the neck was slightly softened. After a
good and tranquil night the pains about the umbilicus recurred.

Feb. 4. The apparatus was used half an hour morning and night.
The same pricking sensations during the application. The neck
became dilated during the day so as to permit the finger to feel the
inferior segment of the membranes. During the night, severe and
darting pains in the groins and back; towards evening the hand
placed upon the abdomen followed the evident contractions of the
uterus, which, to tell the truth, soon after ceased.

Feb. 5. In the morning another application for half an hour,
followed by the ordinary pricking sensations. The orifice was of
the size of a two franc piece, yielded easily, and was readily dila-
ted by the finger. The vaginal secretion is very much increased.
In the afternoon the painful contractions of the uterus appeared,
which increased in intensity by degrees. At half-past six in the
evening the membrane broke, and an hour after a living child
was expelled, which weighed 1350 grammes. During delivery
a slight hemorrhage appeared, which necessitated the removal
of the placenta a quarter of an hour after the birth of the child.
The sequelae of labor were not at all troublesome.

Mefteotions. With the exception of the vaginal prickings,
which seemed to continue only during the application of the cur-
rent of gas, the employment of carbonic acid is followed by no
serious inconveniences, and acts with sufficient energy, since its
application during 3^ hours was sufficient to provoke the expulsion
f the foetus. Unfortunately there is but one case, and it may be
that this process may have some unpleasant results in nervous

490 Amputation in Sjyhacelus. [August,

women, and cause uterine spasms rather than normal contractions.
The vagina may hecome irritated, and it is not clearly proved
that the increased vaginal secretion was not caused by a com-
mencement of vaginitis. To decide upon the value of this me-
thod, the author himself calls for further experiments, and it is
desirable that the demand of the distinguished physician of Wiirz-
burg should meet with some replies. [ Weiner Medicinishe Wochen-
schrift, from Amer. Med. Monthly.

Is it always necessary to resort to Amputation when a Limb is at-
tacked with Sp)hacelus f

Prof. Bardinet, of Limoges, has brought this important question
before the Academy of Medicine of la Haute Vienne, and has an-
swered it in the negative.

We are too ardent partisans of conservative surgery, having
ourselves sufficiently often protested against the excessive tenden-
cy to operate everywhere and at all times, not to hasten to sub-
mit to our readers the reasons adduced by M. Bardinet in support
of his opinion.

The following is the resume of his memoir:

1st. In this memoir I report eight new cases of sphacelus (two
of the fmger, three of the forearm, and three of the leg,) in none
of which amputation was performed. The task of eliminating the
dead parts was intrusted to nature, except that her operations
have been actively aided by the employment of the ordinary dis-
infectants, and especially by the early resection of the dead parts
near the eliminatory circle.

In these eight cases recovery took place.

Had amputation been performed, it is, on the one hand, ex-
tremely probable that a certain number of patients would have
died; on the other, several of them would have been deprived, in
consequence of the necessity of amputating above the eliminatory
circle, of a portion of their limbs (the knee, for example, or the
upper part of the forearm,) which they are fortunate in having
been able to preserve.

It is, therefore, not alwaj^s necessary to amputate in cases of
sphacelus.

* 2d. We should, above all, be extremely cautious in having re-
course to amputation in cases of spontaneous gangrene first,
because in such coses, whatever we do, and even after the estab-
lishment of the eliminatory circle, we can never be sure that the
gangrene will not reappear, and that we shall not thus needlessly
add the pain and dangers of a serious operation to those of the
original disease.

3d. Because the fear of amputating in parts whose vessels are
diseased, obliges us to carry the section up to a considerable

1856.] On Liquidambar Styracifiua. 491

height, and thus involves, sometimes very uselessly, the sacrifices
of parts which might have been preserved, and the loss of which
is to be lamented.

4th. Because the gangrene may attack several limbs in succes-
sion, and even all the limbs, of which I have quoted two exam-
ples, and we should then find ourselves compelled to perform a
series of sad mutilations.

5th. Because, on the contrary, in confining ourselves to cutting
away the dead parts near the circle of elimination, we perform an
operation which is always practicable and always useful, as it lib-
erates the patient from a focus of infection.

6th. Because we avoid the risk of performing an amputation,
all the benefits of which will be lost if the gangrene makes fresh
advances.

7th. Because, in adopting the new mode, we do not unnecessa-
rily remove parts which the patient is much interested in pre-
serving.

8th. Because we have still the power of performing amputation,
if it should become necessary. [Dublin Medical Press from Presse
Medicale Beige.

On Liquidambar Styracifiua. By Charles W. Wright, M. D.,

Professor of Chemistry in the Kentucky School of Medicine.

Liquidambar Styracifiua, commonly called sweet-gum, is indige-
nous to nearly every part of the United States, and constitutes one
of our largest forest trees. When an incision is made through the
bark of this tree, a resinous juice exudes, which possesses an agree-
able balsamic odour. When this substance first exudes, it is of the
consistence of turpentine, and possesses a stronger smell in that
condition than it does after it has become resinified. Contrary to
the statements made by Wood and Bache, in their Dispensatory,
this tree furnishes a considerable quantity of resin in the Middle
States, particularly in the States of Ohio, Indiana, and Kentucky,
bordering on the Ohio River. It is annually collected in those
States, and sold under the name of gum-wax. It is a much more
agreeable masticatory than the spruce-gum, and is chewed in the
West by nearly all classes. By proper incisions, one tree will
yield annually about, three pounds of the resin.

The chemical composition of the specimens collected in this lat-
itude correspond with that given by M. Bonastre, of specimens
gathered elsewhere, viz : benzoic acid, a volatile oil, a semiconcrete
substance separated by distillation and ether, an oleo resin, a prin-
ciple insoluble in water and cold alcohol, termed styracine. The
bark of the tree contains tannic and gallic acids, to which its as-
tringency is due.

What I wish more particularly to call attention to is the employ-
ment of a syrup of the bark, of this tree, in diarrhoea and dysentery,

492 Quinated Cod-liver Oil. [August,

and more especially the diarrhoea which is so prevalent among
children during the summer months in the Middle States, and which
frequently terminates in cholera infantum.

The best formula for the preparation of this svrup is that given
in the United /States Pharmacopoeia, for the preparation of the syrup
of wild-cherry bark, of which the following is a copy, the sweet-
gum bark being substituted for the. wild-cherry bark.

"Take of sweet gum bark, in coarse powder. Jive ounces; sugar
(refined) two pounds ; water a sufficient quantity. Moisten the bark
thoroughly with water, let it stand for twenty-four hours in a close
vessel, then transfer it to a percolator, and pour water upon it gra-
dually until a pint of filtered liquor is obtained. To this add the
sugar in a bottle, and agitate occasionally until it is dissolved."

The dose of this syrup for an adult is about one fluidounce, to be
given at every operation, as long as the operations continue to re-
cur too frequently.

One advantage which this medicine possesses over most astrin-
gent preparations is that of having an exceeding pleasant taste, and
of being retained by an irritable stomach when almost every other
substance is rejected. Children never object to it on the score of
bad taste. The resinous and volatile bodies which it contains, no
doubt enhances its value. My brother. Dr. J. F. Wright, ol" Co-
lumbus, Indiana, has employed this preparation for the last three
years in a great number of cases, with the most satisfactory results.
He prefers it to any other article where there is an indication for
astringent medication in the class of diseases before referred to.
In the bowel complaints of children it has a decided advantage
over all preparations containing opium, and I am always pleased
with the happv results which follow its employment in that class of
patients. \_Amer. Jour, of Med. Sciences.

Quinated Cod-Liver Oil. By M. Donovan.

A preparation of cod-liver oil, called oleum aselli cum quina, has
been lately introduced into medical practice, and is favorably no-
ticed by some practitioners. It is probable that the tonic effects of
quinine, conjoined with the restorative powers of the oil, may afford
a combination of greater efficacy than is possessed by either sepa-
rately. To many persons, the mawkish taste of the oil modified
into the decided bitter of the quinine is an improvement. I have
been informed that the combination of sulphate of quinine with
cod-liver oil is effected by exposing them in a state of mixture to a
certain temperature: if the heat be too high or too low, the combi-
nation, it is said, will either not take place or it will be subverted.
I have made some trials with very unsatisfactory results, the quan-
tity of sulphate which dissolved being very small, as might be ex-
pected from the character of sulphates in general.

Aware that the alkaline basis of sulphate of quinine possesses

1856.] New Method of Treating Phagedena. 493

some of the properties of a resin, it seemed probable that it might
dissolve in oil ; and, on making the experiment, I found that this is
actually the case.

The alkaloid quinine is known to possess little efficacy as a me-
dicine on account of its insolubility in aqueous liquids ; hence, it is
always administered in the state of acidulated disulphate, or, in
other words, in the state of sulphate. Oil, by rendering quinine
soluble, develops the medicinal virtues of that alkaloid, and thus,
for every useful purpose, acts the part of sulphuric acid.

A few trials convinced me that quinine may be dissolved in cold
cod-liver oil in even greater ratio than it is ever necessary for the
purposes of the physician A solution of eight grains to the ounce
is intensely and persistently bitter. When the mixture is first
made, a very disagreeable and peculiar smell is developed; but by
exposure to the air for an hour or two, or better by filtering, the
smell exhales and is dissipated. The colour of the oil is deepened
by the combination.

This compound, which may be briefly named oleum aselli quina-
turn, has this advantage, that two active medicines, of coinciding
effects, may thus be administered at one dose. To some, it is a
severe trial to swallow either of them; and to such persons it would
be a relief, instead of taking two separate disagreeable doses at dif-
ferent times, to swallow both at once, and have done with them.

There are constitutions which will not tolerate the free exhibi-
tion of cod-liver oil, and patients of this class are precluded from
availing themselves of advantages which might have been of the
utmost value to them. Perhaps the quinated od would agree bet-
ter with such stomachs. [Dublin Med. Press.

New Method of Treating Phagedena.

Mr. Cock has recently been trying, in Guy's Hospital, a plan of
treating phagedenic ulcers by constant irrigation. The method
is, to have the sore well exposed, and the affected limb placed on
some water-proof material ; a reservoir above the bed is then fill-
ed with lukewarm water, and, by means of an elastic tube, a
stream is kept continually flowing over the surface of the sore.
By this means all particles of discharge, etc., are washed away as
soon as formed, and the ulcer assumes the clean, pale appearance
of a piece of meat which has been long soaked. In all the cases
in which it has been practicable to employ the irrigation efficient-
ly, a speedy arrest of morbid action has been secured, and the
number has included several in which the disease was extensive
and severe. The theory cf the treatment is, that phagedenic action
is a process of local contagion the materies morhi by which the
ulcer spreads being its own pus. Admitting this supposition
which there is every reason for doing to be true, the object to be
kept in view in curative measures is either to decompose or to re-

494 Chloroform in Cynanche Trachealis. [August,

move the local virus. This end is accomplished somewhat clum-
sily by such remedies as the nitric acid, which, unless so freely
used as not only to char up all the fluid matters, but to destroy
the whole surface of the ulcer to some depth, fails to prevent a
recurrence. Mr. Cock's plan of subjecting the ulcer to a perpetu-
al washing attempts the accomplishment of the same end by a
more simple and direct method. It involves no pain to the pa-
tient, and does not destroy any healthy tissues. Its one advan-
tage seems to be. that, excepting on the extremities, its use would
be attended with some inconvenience, from the difficulty of pre-
venting the water from running into the patient's bed. Should,
however, further trials confirm the very favorable opinion which
has been formed at Guy's as to its value, these difficulties might,
no doubt, be surmounted by the contrivance of suitable apparatus.
The directions as to temperature of the water are that it should
be as warm as comfortable to the feelings of the patient : and, as
preventive of smell, Mr. Cock advises the addition of a small
quantity of the chloride of lime or of soda. [Med. Times and Gaz.

Chloroform in Cynanche Trachealis. By J. JEFFERY, M. D., of
Southfield.

As much has been written on the disease called Cynanche
Trachealis, or Croup, and a variety of favorite remedies presented
to the medical profession, which have excited the most ardent
hopes for a short time, that something reliable had been discover-
ed, which would not only inspire confidence in the physician, but
remove the anguish of the sufferer, and dispel the terror and dis-
may that weighs down many an anxious parent; which hopes
have mostly perished in embryo, it is with some diffidence that I
present any thing on the subject fearing it may not sustain the
confidence it has excited in my mind. I wish to report a recent
case that came under my care, the treatment of which was entirely
new to me, (but perhaps, not to others,) and so perfectly agreeable
to the patient and satisfactory to myself, that the merits of the
remedy may be duly tested by the medical profession. The pa-
tient, a lad between four and five years of age, had what the
parents called whooping-cough, (but from their account rather a
peculiar type or form, as also many cases that I have witnessed
during the past winter.) while they lived in Redford. The family
came here about the first of April, two of the children exhibiting
some symptoms of the remaining disease. On the evening of the
23d ult., the patient came in from play, with a severe cough
which alarmed the parents. I was absent from here. They got
at my office a composition, prepared with Lobelia Sem., Ant.
Tart., Lard and Licorice, administered it through the night with
no benefit. On the A. M. of the 24th, I saw him and found him

1856.] Chloroform in Cynanche Trachealis. 495

with all the symptoms of severe croup, could only speak in a par-
tial whisper; nervous system very irritable. Skin dry, consider-
able thirst, no cough of importance. The patient suppressing the
effort to cough as much as possible. The shrill whistling sound
of breathing could be heard for two or three rods from the house.
Bowels had not moved for twenty-four hours ; tongue with brown-
ish coating. Gave him about 15 or 20 grs. of Ilyd. Sub. Mur.,
followed with a teaspoonful of Sal Epsom. In the evening, bow-
els moved freely, and he appeared some better for a short time.
Advised inhalation of vinegar and water, with the ordinary rem-
edies. 25th, at 3 o'clock, A. M., was called to see the patient, as
they thought he was dying. Found him unconscious, with the
eyes half open and turned upwards, head thrown back, respira-
tion feeble and exceedingly difficult, trachea apparently nearly
closed up, pulse scarcely perceptible at the wrist, heart violently
agitated, as if making its last struggle, extremities cold, &c. Un-
der these discouraging circumstances, I concluded to try the effect
of chloroform, in order to palliate the distressing symptoms and
ease the patient through the portal of death. I put it on a hand-
kerchief and placed myself by his side, allowing access to the air,
holding it under the chin. In about ten minutes, the breathing
was much relieved, the pulse became moderate and of fair strength
at the wrist. The heart quite calm. I continued this about two
hours, regulating the strength of the chloroform to the urgency of
the symptoms. The patient seemed to fall into an easy slumber,
the eyes closed ; still the breathing was not natural, but so much
improved that I began to feel some hopes of recovery. I left the
chloroform in the care of the nurse, with instructions to use it suf-
ficent to keep the patient quiet. Saw him again in the afternoon,
found him with skin moist, and very much improved in strength,
and all the urgent symptoms relieved, but coughing and raising
his mouth full of tough phlegm, quite often, having the appear-
ance of a pseudo-membranous substance, which continued for
about twenty-four hours. The patient walking about the room
part of the time. At the end of about thirty-six hours from the
time of the commencement of the chloroform, he was able to eat
nearly a full meal, and play around the house ; a slight wheezing
continued for about three days, since which he has been well. All
the medicine I gave after the evening of the 25tb, was a solution
of Muriate Ammonia, half 3 to half pint of water and molasses,
dose one to two teaspoon sful every two or three hours.

If you deem this of any importance, you can publish such part
of it as you choose in your worthy journal, or dispose of it as you
see fit. My only object is to aid the profession in their endeavors
to benefit suffering humanity, and secure the confidence of com-
munity in medical science. [Peninsular Jour, of Med.

496 On Detection of Strychnia. [August

On Detection of Strychnia. By Marshall Hall, M. D.

The detection of strychnia as a poison is, at this moment, of
deep public interest.

When the chemical test fails, there remains, I think, another
the physiological. Having long studied the effects of strychnia
on the animal economy, (I have sent two papers on this subject
to the Institute of France,*) I am persuaded that these effects on
the most excitable of the-animal species are at once the most deli-
cate and specific tests of this poison.

I have just performed two experiments, and only two, for want
of materials for more.

I requested Mr. Lloyd Bullock, of Hanover street, to dissolve
one part of the acetate of strychnia in one thousand parts of
distilled water, adding a drop or two of acetic acid.

I then took a frog, and having added to one ounce of water
l-100th part of a grain of the acetate of strychnia, placed the frog
in this dilute solution. No effect having been produced, 1- 100th
of a grain of the acetate was carefully added. This having produ-
ced no effect, in another hour 1-I00th of a grain of the acetate-
was again added, making the 3-100th, or about the thirty-third
part of a grain. In a few minutes, the frog became violently te-
tanic, and though taken out and washed, died in the course of the
night.

I thus detected, in the most indubitable manner, one thirty-third
part of a grain of the acetate of strychnia. It appeared to me that,
had more time been given to the experiment, a much minuter
quantity would be detectable.

I placed the second frogf in one ounce of distilled water, to
which I had added the l-200th part of a grain of the acetate of
strychnia. At the end of the first, the second and the third hours,
other similar additions were made, no symptoms of strychnism
having appeared. At the "end of the fifth hour, the frog having
been exposed to the action of l-50th part of a grain of the acetate
of strychnia, tetanus came on, and under the same circumstances
of removal and washing, as in the former experiment proved fatal
in its turn.

I thus detected l-50th part of a grain of the poisonous salt by
phenomena too vivid to admit of a moment's doubt; the animal,
on the slightest touch, became seized with the most rigid general
spasmodic, or, rather, tetanoid rigidity. And this phenomenon,
alternating with perfect relaxation, was repeated again and again.

As the nerve and muscles of the frog's leg, properly prepared,
have been very aptly designated as galvanoscopic, so the whole
frog, properly employed, becomes strychnoscopic.

* See the Comptes Rendu* for June 1847, and February 1853.
f These frogs were not fresh from the pools.

1856.] Astringent Application. 497

In cases of suspected poison from strychnia, the contents of the
stomach and intestines, and the contents of the heart, blood-ves-
sels, &c., must be severally and carefully evaporoted, and made to
act on lively frogs just taken from the ponds or mud. I need
scarcely say that, taken in winter, the frog will prove more
strychnoscopic than in summer, in the early morning than in the
evening.

The best mode of performing the experiment also remains to
be discovered, with all its details and .precautions, an inquiry
into which I propose to enter shortly. Meantime, this note may
not be without its utility.

P. S.. I have repeated my experiment. I placed one frog,
fresh from the pools, in an ounce of water, containing the l-50th part
of a grain of the acetate of strychnia ; a second in the same quanti-
ty of water containing the l-66th, a third containing l-100th, and
a fourth containing l-200th. All became tetanic in two or three
hours, except the third which was a female, (the other being males,)
which required a longer time.

The 1 -200th part of a grain of the acetate of strychnia is, there-
fore, detectable by means of this test conferred by physiology.

We now placed a male frog in l-400th part of a grain of the
acetate of strychnia, dissolved in six drachms of water. In three
hours and a half it became violently tetanic.

The fresh frog is, therefore, at this season, strychnoscopic of
l-400th part of a grain of the acetate of strychnia, and probably
to a much minuter quantity, which ulterior experiment must show.

In two other experiments the l-500th and the l-1000th of a
grain of the acetate of strychnia were detected. [Lancet.

Neiv Form of Astringent Application. By Dr. William Bayes,
Brighton.

Pure glycerine dissolves nearly its own weight of tannin, afford-
ing a very powerful local astringent application.

The solution of tannin in pure glycerine appears to me to sup-
ply a desideratum long felt, and capable of a great variety of
useful applications.

The solvent property of glycerine over tannin, allows us to form
a lotion of any desirable strength, as the solution is readily misci-
ble with water.

The solution of tannin in glycerine, in one or other of its
strengths, is peculiarly applicable to many disorders of the mu-
cus membrane, readily combining with mucus, and forming a
non-evaporizable coating over dry membranes ; hence it may with
benefit be applied to the mucus membranes of the eye and ear in
many of its diseased conditions. It forms a most conveniet appli-
cation to the vaginal, uterine, urethral, or rectal membranes, where
a strong and non -irritant astringent lotion is desired.

H)S Radical Cure of Hydrocele. [August,

In local haemorrhage?, where the bleeding surface can easily be
reached, it will prove very convenient, and may be applied either
with a sponge or small brush.

The solution must be kept in the dark, and should not be pre-
pared for any great length of time before used, or decomposition
will occur.

It is singular that glycerine does not possess the same property
towards gallic acid. [Association Med. Jour.

Radical Cure of Hydrocele.

A man, aged 31, has recently been under Mr. Lloyd's care, in
St. Bartholomew's, on account of a hydrocele, which had been
several times tapped, and on one occasion treated by the injection
of iodine, with the hope of permanent cure. The latter expedi-
ent, however, had failed, the sac having re-filled. Mr. Lloyd
adopted a plan which has long been a favorite with him, of intro-
ducing a little of the red precipitate into the sac. The fluid hav-
ing been drawn off by a canula, large enough to allow a director
to enter it, the latter instrument, oiled, and then dipped in the
powder so a to carry a few grains adhering to it, was introduced
and moved about in the cavity. The introduction was repeated
two or three times ; some inflammation followed, and a perfect
cure ensued. The practice has the advantage over that by injec-
tion of not requiring any special apparatus. Mr. Lloyd believes
it also to be more uniformly successful. [Med. Times and Gazette.

Observations and Remarks on Diseases of the Brain. By H. Bam-
berger. Verhandlungender Physicalisch-Medicinischen Ges-
ellschaft in Wurzburg.

Although we are not informed with regard to the number of
the cases upon which Dr. Bamberger's remarks are founded, it is
manifest that his experience is extensive, and his opinions there-
fore carry considerable weight. The cases which he does record
are of much interest, and embrace almost the whole field of cere-
bral pathology. The following arc the prominent points of his
investigations to which we would draw the reader's attention.

Apoplexia Nervosa. Pathological anatomy has so much narrow-
ed the limits within which it is possible to apply the term nervous
apoplexy, that we now rarely meet with cases to which it may be
fairly given viz., those in which sudden death occurs with cere-
bral symptoms, and in which no palpable lesion is discoverable
after death. It is probable that the microscope and pathological
chemistry may reveal minute changes that have hitherto escaped
detection, and that the term, in its present sense, may have to be
entirely eliminated from nosology. Dr. Bamberger is of opinion
that sudden death resulting from violent emotions, electricity, and

1856.] Diseases of the Brain. 499

concussion, must be classed in this category. He quotes one case
that fell under his observation. A girl, aged twenty, previously
in perfect health, was admitted into the Prague Hospital in Janua-
ry, 1850, having the evening before been seized with vomiting,
followed by universal convulsions and unconsciousness, brought
on by the information received in the morning of the same day
that her lover had proved faithless. The temperature of the sur-
face was elevated, the pupils unaltered, the eyes closed, the face
pale, respiration stertorous, and the pulse intermittent. There was
occasional spasm of the extensors of the upper and lower extremi-
ties, and also of the abdominal muscles. The extremities, when
raised and allowed to fall, descended as if lifeless, though not
actually paralytic. There was no return of consciousness, and she
died twenty-eight hours after the seizure.

Necropsy. The brain was pale and anasmic, the walls of the
left ventricle of the heart were slightly hypetrophied, the aorta
very narrow and its coats thin, the heart and large vessels were
full of loose coagula. All other organs were perfectly healthy.
There was no suspicion nor any evidence of poisoning.

Apoplexia Serosa. We are still on debatable ground; for

although the occurrence of sudden death, with symptoms of apo-

I plexy, and exhibiting serous effusion into the ventricles, the sub-

; stance of the brain, or the meninges, is undoubted, the majority

of observers (as Abercrombie, Dietl, Wunderlich, Leubuscher) are

* of opinion that these cases are rarely, if ever, idiopathic. Dr.

Bamberger has frequently met with the varieties of acute serous

j effusion alluded to, but is of opinion that they are always the

i secondary result either of cerebral diseases and abnormal state of

} the cerebral circulation, or of an altered state of the blood induced

I by some other acute or chronic disease, as granular kidney, typhus,

i acute exanthemata, tubercular, cardiac, and other maladies.

Meningitis. Dr. Bamberger adverts briefly to a few points con-
nected with this subject, one of which is the occurrence of inflam-
mation limited to the ventricular lining membrane; he is of opin-
ion that where the post-mortem appearances indicate such a condi-
tion, a previous inflammatory exudation on the surface has been
reabsorbed, or overlooked as an unessential concomitant.

Cerebral Hemorrhage. -The author refers all cases of haemor-
rhage to increased pressure in the vascular system, or to an altered
condition of the blood, but from the alterations previously induced
in the coats of the vessels. He admits that the latter lesion has not
yet been demonstrated. As but few authentic cases of passive
; haemorrhage within the cranium are on record, he relates some
that have fallen under his own observation in typhus (typhus pe-
1 techialis,) scurvy, and chlorosis. The rarity of the occurrence in
typus is shown by the fact that Dr. Bamberger has only met with
it once in above a thousand cases of the disease. In that case,
after death, which had ensued on the thirteenth day of the typhus,

N. S. VOL. XII. NO. VIII. 32

500 Diseases of the Brain. [August,

in a boy, aged fifteen, a cavity of the size of an egg, containing
blood that was slightly coagulated, was found in the right corpus
striatum.. This was also the site of the apoplectic spot found in a
girl, aged twenty-five, who died suddenly while under treatment
for intense chlorosis. In scurvy, which the author has repeatedly
found almost epidemic, he has also met with apoplexy in a girl,
aged twenty-three, in whom numerous small apoplectic spots were
found closely aggregated in the right anterior cerebral lobe, be-
sides another large extravasation on the convexity of the left
posterior lobe.

"We must pass.over the author's observations on the uniform
occurrence of the crucial paralysis shown with reference to the
facial, fifth, oculomotor, optic, and acoustic nerves; on the rapid
return of sensibility, compared with that of motility, in the para-
lysed half of the body; on haemorrhage into the pons, the sac of
the arachnoid, into the tissue of the pia mater, and the grey matter
of the brain.

Red softening occurs in three forms; it may be latent and ac-
companied with such trifling symptoms as not to induce a suspi-
cion of a cerebral affection; it may be accompanied by symptoms
of apoplexy ; or it may manifest a very chronic form, in which
we meet with the most varied symptoms of cerebral irritation and
compression. It is only in the last variety that a diagnosis is pos-
sible, though even here there are numerous sources of error. A
very peculiar case is detailed, in which the author assumes the con-
versionof the ordinary products of normal inflammation into tuber-
cle a view which iscertainly at variance with the prevailing opin-
ions on tubercle and the tubercular diathesis. The case is briefly
this. A female, aged thirty-five, wasseized in the fifth month of her
seventh pregnancy with pneumonia, which lasted three weeks;
about three weeks later severe headache was followed by sadden
rigidity of the left extremities, the fore-arm and leg being flexed ; se-
vere convulsive movements of the same extremities ensued lasting a
few minutes. There was no unconsciousness, though she was slight-
ly giddy during the attacks. The rigidity and the temporary spasms
continued for a week, when she was admitted into the hospital
(November, 1851.) She was able to answer questions, but her
memory was somewhat impaired. There was occipital headache,
paralysis of the left side of the face, violent contraction of the right
trapezius, of the left arm and leg; attempts to overcome the
flexion caused severe pain. Sensibility of the parts unimpared,
total loss of motility ; some improvement took place in the paraly-
tic condition, but in December an epileptic seizure supervened;
delivery followed in the same month; further epileptic attacks
ensued, with pleurisy in the right side, and advancing tubercular
disease of the lungs. Death on the 27th January. The state of
the brain was as follows: On the inner and upper surface of the
right hemisphere, a portion of the size of a desert plate exhibited

1856.] Diseases of the Brain. 501

intimate adhesion between the membrane to the brain by means
of a greyish-red cellular tissue, and a yellow cheesy friable mass;
the subjacent gyrr were converted into a similar substance to an
extent of 9 to 10 lines, not circumscribed as cerebral tubercle gen-
erally is; the cerebral tissue in the immediate vicinity was redden-'
ed and softened, the more distant portions almost pulpy. Old
and recent tubercles were found in the apices of both lungs; the
liver and spleen also showed tubercular deposit. Dr. Bamberger
argues that the symptoms showed that the cerebral disease commen-
ced with inflammation, and that therefore the deposit in the brain
was the result of a conversion of plastic exudation into tubercle;
but it necessarily suggests itself that the tubercular deposit may
have been lon; dormant in the brain, and that the inflammation
was a secondary affection. Until such cases are multiplied, it ap-
pears illogical to adopt a theory which is opposed to the common
experience of pathologists. Two interesting cases are given of
encephalitis, resulting from plugging of the arteries by fibrine
carried from other portions of the circulating apparatus.

With regard to cerebral abscesses, Dr. Bamberger only confirms
the known fact of their remarkable latency. The details of three
cases are introduced in evidence.

Paralysis Agitans. In one necrospy of a female, aged forty-five
who had been subject to constant tremors of both upper extremi-
ties and the head from her childhood, the meninges were found
opaque, and infiltrated with serum of which two ounces were
found in the ventricles; the brain was otherwise normal. The
characteristic feature was found in the spinal cord, which was
white and moist, and exhibited throughout the white matter
numerous grey, gelatinous spots; from the middle of the cervical
to the middle of the dorsal portion there was a central canal,
admitting of the passage of a probe. Dr. Bamberger regards the
gelatinous spots as the residue of previous inflammation, and the
formation of the canal as the result of atrophy of the cord.

Encephalic Tumours. The diagnosis of encephalic tumours still
remains, to a great extent, a matter of guesswork, the symptoms
being mainly those of compression, which they share equally with
other affections. Of 17 cases observed by Dr. Bamberger, 11
occurred in men, 6 in females ratio established by Lebert
and Friderich. They were distributed over the different periods
of life as follows: Under ten years, 1; ten to twenty, 3 ; twenty
to thirty, 4 ; thirty to forty, 4 ; forty to fifty, 2 ; fifty to sixty, 2 ;
sixty to seventy, 1. Six were large tubercular or tuberculoid
masses; 2, cancerous; 2, fibrous tumours; 2, simple cysts (not
appoplectic ;) 1, echinococcus; 1, extended hard masses, of an un-
defined character; 2, osseous tumors in the cerebral tissue; and 1,
cholesteatoma. In 10 cases the cerebrum, in 5 the cerebellum,
and in 2, both were affected.

The most uniform symptom was cephalalgia: this was absent

502 Obliteration of the Thoracic Aorta. [August,

only in two cases; it was severe and paroxysmal in 6. Paralytic
affections occurred next in order of frequency viz., 10 times; in
5 gradually, in 5 suddenly. Convulsive attacks were met with 8
times ; 7 in the form of epilepsy (6 of these with cerebral, 1 with
cerebellar, tumours;) 1 in the form of convtilsive affections of one
side of the face. Derangement of the intellectual functions occur-
red in 8 cases.

The details of 3 cases of encephalic tumours, for which, howev-
er, we cannot make room, conclude Dr. Bamberger's interesting
communication. [Brit, and For. Med. Chir. Review.

Obliteration of the Thoracic Aorta. Wochenblatt der Zeitschrift
der k. k. Gesellshaft der Aerzte zu Wien.

At a meeting of the Medical Society of VienDa, held on the 19th
October, 1855, Professor Skoda introduced a man affected with
obliteration of the thoracic aorta. In illustration of the lesion,
the Professor exhibited preparations of a five-months' foetus and
of a new born child, in which he indicated the point at which
alone this anomaly can take place or has hitherto been observed.
It is the point at which the ductus botalli communicates with the
aorta and the short space intervening between this point and the
origin of the left subclavian artery. During foetal life, this por-
tion is commonly narrower than the remainder of the aorta, and
only acquires the same calibre after birth.

The individual in question was a man, aged forty -seven ; a
jeweller; of normal complexion, and throughout well nourished.
On the whole, he enjoys good health, and has only come under
clinical observation owing to his having, for three years past,
suffered from some dyspnoea in making violent exertion. This is
due to an insufficiency of the tricuspid valve, which has only been
established for three years.

The following are the grounds upon which Professor Skoda has
diagnosed a co-existing obliteration of the aorta: In addition to
the blowing murmer coincident with the impulse, and which in-
dicates the above-mentioned insufficiency, a "peculiar vibration
or whirring (schwirren) is to be..perceived over the greater part
of the thorax, partly by palpation, partly, as in the course of the
intercostal arteries, by auscultation ; it follows the impulse, and
for that reason has its seat in the arteries. The vibration of the
arteries of the thorax is due to their dilatation, as may be shown
by touching the superficial epigastric arteries, which are much di-
lated and very tortuous. The beat of the crural arteries at the
groin is very feeble, and no pulsation can be felt in the abdominal
aorta."

These are the indications characteristic of obliteration of the
thoracic aorta ; the collateral circulation is carried on by the bran-
ches of the subclavian arteries, which must therefore be dilated.

1856.] Punctured Fracture of the Cranium, &c. 503

A large volume of blood passes from the anterior intercostals to
the posterior intercostal, and by centripetal movement reaches the
descending aorta, which is thus filled with blood sufficient to sup-
ply the arteries of the intestines, but not sufficient to produce
distinct pulsations. The inferior extremities probably also receive
a supply by the the anastomosis of the superior and inferior
epigastric arteries. No cyanosis is observed, because nowhere
venous blood is introduced into the arterial system.

In connection with this case, Professor Skoda made the follow-
ing remarks : 1. That in examining the heart, we occasionally
perceive murmurs which give rise to the assumption of valvular
disease, while the heart is afterwards found healthy ; and that the
murmur was produced in the coronary arteries or in other arteries,
in the vicinity of the heart. Such errors can only be avoided by
carefully attending as in the case detailed, to the coincidence or
non-coincidence of the murmur with the movements of the heart.
2. The circumstance that the nutrition of the individual was un-
impaired, although the circulation in most of the organs must be,
doubtless, slackened, proves that the deranged nutrition, so fre-
quently coinciding with impediments in the circulation, does not
depend solely upon the latter.

Professor Skoda was of opinion that the obliteration of the aorta
was due either to a complete obliteration or absence of the corres-
ponding portion of aorta in the foetus, or to the contraction of the
latter ccineidently with the ductus botalli, owing to the exception-
al extension of the tissue of this channel into the coats of the aorta.
Porfessor Skoda maintained that the obliteration could not be set
down to inflammation, as arteritis led, not to obliteration, but to
aneurism. He referred to an analogous case which had occurred
in his wards some years previously, where no disturbance of func-
tion was manifested until, accidentally, endocarditis supervened.
Death occurred later from pneumonia; and the obliterated aorta
has been preserved in the anatomical museum of Vienna. [Ibid.

Case of Punctured Fracture of the Cranium, and Wound of the Brain,
with loss of Cerebral Matter, without the occurrence of corresponding
serious symptoms. By M. Morton Dowler, M. D., of New
Orleans.

Instances of recovery after the most formidable injuries of
the brain are not frequently recorded, and hive, in some cases,
not a little contributed to overthrow the theories of physiologists
and psychologists, demolishing, at once, as with a "knock-down
argument," the skullbump psychology. The crowning case of
Gage, related in the July, 1850, numberofthe " American Journal
of the Medical Sciences,1'1 affords an exemplification, which coming
from a less reliable source, would be regarded as almost incredible.

504 Punctured Fracture of the Cranium, dec. [August,

It has been seen in this case that a tapering iron bar, of the length
of three feet seven inches, and of the diameter of one inch and a
quarter, ma}7 enter beneath the zygoma, and pass out at the junc-
tion of the sagittal with the corona! suture, passing through the
anterior lobe of the left cerebral hemisphere, and that the subse-
quent report may be, as in this case, that "the patient has qu'te
recovered his faculties of body and mind, with the loss only of the
sight of the injured eye." Nevertheless, whatever may be the
deductions afforded by exceptional and extraordinary cases such
as this, all surgery gives us emphatic warning that in cases attend-
ed with any manner of lesion of the brain, its blood-vessels, its
meninges, or its bony protection, the gravest and most serious
results should always be apprehended and guarded against, on
the part of the attendant. A patient whose brain has been laid
open, and the proper substance of the same wounded, should be
considered as being in both immediate and ultimate peril, and
should no urgent or alarming symptoms whatever occur during
the treatment of such case, it may be considered as a remarkable
exception, and the more especially where the patient -is of tender
age, and has received a severe punctured wound. Of such excep-
tional kind is the following case, which is not like the case of
Gage, given as an extraordinary case of mere recovery, but as ex-
emplifying recovery without any symptom corresponding to the
gravity of the injury sustained, being in this respect the most re-
markable I have ever witnessed.

On the 8d day of September last, a little boy, Louis, son of Mr.
R. D. Maclin, of the Fourth District of this city, received a punc-
tured fracture of the skull, and penetrating wound of the brain,
under the following circumstances: a negro servant girl ascended
a shed, about 12 feet from the ground, for the purpose of driving
a nail, using, in place of a hammer, a large male hinge, weighing
nearly two pounds, which had been drawn from the post of a wide
gateway ; and after effecting her object, without taking the pre-
caution to look downwards, she threw forcibly from her hand the
hinge, which descending, struck the child on the parietal bone of
the left side, an inch and three- fourths from the coronal, and one
inch from the sagittal suture, the post-spike of the hinge present-
ing, and entering the brain. The child was at the time sitting
with the head erect, and the iron entered in nearly a perpendicu-
lar direction. The spike of this formidable iron is a four-sided
body, six inches long, gradually tapering on all sides, but so flat-
tened latterally as to tripple the width of the horizontal surfaces,
thus terminating in a wedge, the edge of which is half an inch long,
and which is dull and battered. The iron penetrated about an
inch, passing into the medullary matter of the brain, making by
the tapering spike, an external opening three-fourths of an inch
long, and one-fourth of an inch wide. The great weight of the
butt end of the hinge, and its slight deviation from the perpendicu-

1856.] Punctured Fracture of the Cranium, &c. 505

lar direction of the spike, caused it to be swayed over across the
sagittal suture, the thin parietal bone affording no other resistance
than as a fulcrum on which the whole iron became a lever of the
first kind, to injure the brain in the direction of the parietal pro-
tuberance, and the child's body was thereby drawn over to the
right, and- he was found with the right side of his head on the
ground. Mrs. Maclin ran to the child's relief, and drew out the
huge spike from his head, and she saw particles of cerebral matter
adhering to the rough, rusty iron, and also escape from the wound.
The blood at first escaped pretty freely, but soon ceased to flow.
The force and weight of the iron was such, that it produced a sim-
ple oblong opening the exact shape of the spike, without there
occurring any surrounding depression, or radiating fracture, the
displaced bone being comminuted into small particles, as is believ-
ed. But few of these latter were ever found, and must have
cleared the wound during suppuration, otherwise they involve a
mystery. After the transient primary shock had subsided, none
of the symptoms of concussion or compression of the brain mani-
fested themselves; nor did they subsequently, the child relating to
his father, in an hour afterwards, how the accident happened, and
inquiring "if he must die" from the injury.

Dr. W. P. Sunderland, the family physician, was sent for, and
was soon in attendance. Very reasonably regarding the case as
one likely to be attended with the gravest consequences, it resulted
that I met him in consultation, and was fully impressed with the
justice of his apprehensions. He had sponged the wound, and
made the only topical application subsequently resorted to a
simple compress saturated with cold water. We engaged to
meet twice a day and watch the progress of the case. The patient
never at any time labored under any apparent urgent symptoms,
excepting during the second and third days; nor was any medical
treatment found neeessary, or resorted to, excepting the adminis-
tration of an occasional saline aperient. Excepting during
these two days, there was but little febrile irritation or pain : there
was freedom from delirium, from coma, and the intellectual mani-
festations were unchanged, the wound soon beginning to suppur-
ate, and to rapidly heal.

During the second and third days there was considerable nausea
and uneasiness of the stomach. The patient was kept for many
days strictly in the recumbent position. I discontinued visiting
him at the end often days, and he was subsequently under the
care of Dr. Sunderland. Towards the close of December the
wound completely healed, and a firm membranous cicatrix now
shows the seat of the injury. The patient is a child of great intelli-
gence, and his faculties have in no way suffered from a wound in
which there has been a loss of cerebral matter amounting, as Dr.
Sunderland and myself both estimate, to at least a drachm in
weight.

506 Simple Ulcer of the /Stomach. [August,

In neither the effects of injuries nor from the effects of remedies
can we calculate on uniform results. The most inexplicable pe-
culiarities and individualities interpose themselves, so as to render
an ordinarily salutary remedy pernicious and an ordinarily fatal
injury a thing of ready cure. Much here remains to be elucida-
ted before the depths of pathology and therapeutics can be con-
sidered as explored. [iV. 0. Med. and Surg. Journal.

On Simple Ulcer of the Stomach. By M. Cruveilhier.

M. Cruveilhier has recently presented two papers to the Aca-
demie des Sciences upon this subject, and the following are the
general conclusions : 1. There exists a disease of the stomach
that may be anatomically characterised as simple ulcer of the sto-
mach, usually chronic. 2. This lesion, which is far more common
than is usually supposed, differs from cancerous ulcer, with which
it is generally confounded, in its curability. 3. It is susceptible
of complete cicatrization, this being accomplished by means of
very firm fibrous tissue, differing essentially from scirrhus, with
which it has been confounded. 4. When the ulcer penetrates
through the whole of the coats of the stomach, the loss of sub-
stance is repaired by surrounding organs, which also sometimes
participate in the ulceration. 5. Danger may continue even after
the cure of the ulcer, as the cicatrix often becomes the seat of
consecutive ulceration, with all its attendant accidents. 6. It is
one of the most frequent causes of blackish vomiting and dejec-
tions, and the most frequent one of haemorrhage of the stomach
whether accompanied by hsematemesis or not. 7. Simple ulcer
is the most frequent cause of perforation of the stomach. 8. The
two principal accidents are haemorrhage and perforation, which
take place more commonly consecutively, i. e., by the erosion of
the cicatrix, than primarily, or during the period of formation of
the ulcer. 9. This ulcer, or ulcerative gastritis, may be always
suspected, and almost always positively diagnosed. 10. It is
distinguished from idiopathic gastralgia by the permanence of the
symptoms it gives rise to, although these have alternations of ex-
asperation and remission. Gastralgia is only temporary, comes
and goes sudden^, leaving no traces of its presence, and may be
suddenly relieved by opiates. 11. It is distinguished from non-
ulcerative gastritis and gastralgia by black vomit and stools. It
is very probable, however, that simple ulcer may exist without
these discharges, and then its diagnosis from gastritis would be
difficult. These black discharges are not characteristic of cancer;
and, to some extent, are more inherent to simple ulcer than to it,
for they belong to all periods of simple ulcer, of which they con-
stitute the first symptom, while cancerous ulcer is not attended
with them until the last stage, and sometimes not at all. 12. The

1856.] Treatment of Typhoid Fever with Tar Water. 507

distinctions between simple and cancerous ulcer are founded on,
first, the physical signs, there being no tumor in the former; and,
next, on the pain which is often absent in cancer but never in
ulcer. The pain in the latter is like that of an open wound or
burn, opposite the xyphoid appendix, striking through to the
spine. In cancer there are cramps or spasmodic contractions,
with induration of the stomach. 13. The true touchstone is the
effect of alimentary regimen, which completely fails in cancer,
but succeeds surprisingly in ulcer. 14. The great object in treat-
ing the disease is to find an aliment that is tolerated by the sto-
mach without pain, for then the cure may soon be effected. In
the immense majority of cases, milk diet induces improvement
from the very first day, and sometimes operates like magic ; but
when it ceases to be agreeable to the patient, or fatigues the sto-
mach, we must unite it with other substances, in the choice of
which the instincts of the stomach must be consulted. Alimenta-
ry regimen, in fact, constitutes the entire treatment, but nothing
can be more difficult than the direction of this, according to quan-
tity, quality, repetition, preparation, and temperature. 15. Medi-
cinal substances^ whether general or topical, are quite secondary
in importance. Iron and bitters are quite contra-indicated; and
opium only succeeds when gastralgiais associated with the inflam-
matory action. Gaseous waters, ice, alkalis, and especially phos-
phate of lime prepared by the calcination of bone, alkaline and
gelatinous baths, cold ablution of the entire surface, (in some cases
very hot ablutions,) cold baths, and, in some cases, very hot sit-
ting baths, stimulant frictions, with shampooing of the entire
surface, derivatives or revulsives applied to the epigastrium are
the means which have seemed to exert most influence on the pro-
gress of the disease. 16. It must never be forgotten, that this
ulcer is very liable to relapse, such relapse sometimes going on to
haemorrhage or perforation. Such relapse may be certainly pre-
vented by a good alimentary hygeine, and avoiding medicinal
6timuli. [Comjptes Hendus. Med. Times and Gazette.

Treatment of Typhoid Fever with Tar Water. By Dr. Chapelle,
of Angouleme. (Translated for the Charleston Medical Journal
and Review.)

Having observed the favorable effect of tar in a certain case of
Typhoid fever, Dr. C. was induced to pay particular attention to
this remedy, in a series of cases occurring during the typhoid epi-
demic of 1854, 1855. His conclusion is, that liquid tar, if not an
absolute specific, is yet incontestable the most efficacious agent yet
discovered for the treatment of the above mentioned disease. The
tar should be administered internally, as a drink, and in the form
of an injection.

508 Fungus Hvematodes aired by Chloride of Zinc. [August,

The drink is prepared in the following manner: About Sij. of
liquid tar are put into a vessel, containing nearly a quart of hot
water; after it has stood a few hours, the patient commences to
drink it, filling up with ordinary water after each draught, so that
the same dose of tar will last during the whole treatment. The
injection is prepared by rubbing up the yellow of one or two eggs
with a table-spoonful of liquid tar, and diluting with a little more
than a pint of warm water; this serves for two injections.

The patient should drink as much of the draught as he can ; as
to the injection, that should be insisted on in proportion as the
drink disgusts, for the intestines should be always kept supplied
with a certain quantity. Sometimes six, eight, and even ten ene-
mata should be administered in twenty-four hours. Should the
patient be taken with diarrhoea, these injections check it promptly.

This treatment, if continued for two or three days, generally
triumphs over the typhoid state. Typhoid fever of ordinary in-
tensity, called usually mucous fever, needs double that time; but
typhoid fever, property so-ca41ed, of whatever form, is vanquished
in its essential phenomena in eight to ten days. Each day the
skin loses its dryness and heat, the tongue becomes clearer, the
abdomen presents less tension and susceptibility, the sleep is calm-
er, the fecal matter acquires a more normal odor, and the digestive
functions recover strength. When there exists only a simple ty-
phoid state, the tar draught alone is. commonly sufficient; but
when the general perturbation augments, the febrile re-action in-
creases, and the functional disorder is excessive, a much stronger
dose of the tar is required, and the injections are then indispensa-
ble. In all cases where the breast or the head has been affected
with violent perturbation, the disappearance of the ordinary ty-
phoid phenomena does not immediately produce a cessation of
these complications. These functional disorders either disappear
gradually of themselves, or need the application of treatment ap-
propriate to the morbid state. [Rev. Med. Chirurg.

Fungus Ilaimatodes, cured by Chloride of Zinc. By F. J. CoGLEY,
Madison, Indiana.

In February, 1856, I excised from Mr. P. M., aged twenty-four,
an enormously enlarged testicle, wdiich on examination proved to
be, unequivocally, medullary sarcoma. There is not a larger, or
purer specimen, of medullary cancer in the British or French mu-
seums. About the middle of January, the wound being nearly
healed, he returned to his home; but soon found it would not en-
tirely close. lie returned to me the first of March, with a bleed-
ing fungus, the size of a hen's egg, protruding from the small
portion of the wound, which had refused to heal. It was, beyond
doubt, fungus hcematodes.

1 transfixed the base of the tumor, with two sharp pointed

1856.] Detection of Phosjihorus in Poisoning. 509

probes, crossing each other at right angles, and involving consid-
erable sound tissue: then applied a strong ligature below the
probes, in order to prevent haemorrhage; afterwords I protected
tlie scrotum from the zinc, by muslin strips passed round under
the probes. After removing a portion of the fungus with the
scissors, I applied the chloride of zinc in its p,urity, and continued
its application until the fungus was entirely destroyed. In a few
days, a very deep eschar came away, and the ulcer healed very
rapidly, so that in twenty days, he again went home with the
wound entirely closed. It is my decided opinion, that if I had
excised this fungus, it would have been rapidly reproduced ; nor
do I believe that any "combination" of u chlorides"* could have
enhanced the value of the application.

This patient has had a slight cough, with bloody expectoration
for more than a year; his general appearance cachectic; and it
seems more than probable he has fungi in his lungs, but is enjoy-
ing tolerable health. [Lancet.

Chloric Ether in Diarrhoea.

Diarrhoea of a painful character, and attended by spasmodic
action, has been relieved in England by the use of chloric ether,
after having resisted opium and a multitude of other remedies.
"The effect of ether in every case was marvelous. The spasms
and pains were relieved as by a charm; the diarrhoea ceased;
warmth returned to the extremities; the pulse, before perhaps
flagging, increased in force and volume. The relapses were un-
frequent, and were generally checked at once by a single dose.",
The same treatment was found efficacious in an epidemic diarrh,cea,
which was supposed to be premonitory of cholera. "Hundreds
of cases in which alarming cramps existed, were cured like mag-
ic. [New Hampshire Jour.

Antidote to Strychnia.

M. Guiboust lately stated to the Academy of Medicine that,
having observed a dog in violent convulsions, in consequence of
eating one of the compound balls containing strychnia, he forci-
bly made it swallow powdered gall-nuts, when the convulsions
ceased immediately. Ipecacuana was then given to the animal,
but the latter could not vomit. The next day milk was given to
it and manna, after which the dog recovered. M. Caventon said
that the infusion of gall was a very effectual opponent to vomiting,
and that he had observed it destroy the power of Tartar Emetic.
M. Orrila had already advised the administration of this infusion
in cases of poisoning by opium and salts of morphia. [Bulletin
Universe. Boston Med. and Surg. Journal.

* Lancet, June, 1855.

510 Editorial, [August,

EDITORIAL AND MISCELLANEOUS.

A Practical Treatise on the Diseases of the Testis, and of the Spermatic
Cord and Scrotum. With numerous wood engravings. By T. B. Cur-
ling, F.R.S., &c, <fec. 2d American from the 2d revised and enlarged
English edition. Philadelphia: Blanehard & Lea. 1856. 8vo. pp.
420. (For sale by T. Richards & Son.)

The work before us has so generally received the approbation of the
profession, that a new edition cannot be otherwise than welcome. Although
treating of but one organ, a glance at the table of contents will show that
the volume is not too large for the subject. After devoting some space to
anatomical considerations, the author studies the congenital malformations,
atrophy, and injuries of the testicle. lie then devotes special chapters to
hydrocele, hematocele, orchitis, tubercular disease of the testicle, carcino-
ma of the testicle, cystic disease of the testicle; to fibrous, cartilaginous,
calcareous and other tumors of the testicles ; foeta! remains and entozoa in
the testicle and scrotum ; spermatocele. The nervous affections are com-
prehended under the. heads of irritable testicle and neuralgia; the sympa-
thetic and functional under those of impotency and spermatorrhoea. The
affections peculiar to the cord are varicocele, tumors, and spasms of the
eremaster. The work closes with a full review of the diseases of the scro-
tum ; as injuries, prurigo, varicose veins, pneumatocele, oedema, diffuse
inflammation, mortification, elephantiasis, tumors, cancers, &c.

This volume is essentially practical, and treats of diseases of every day
occurrence. It should be in the hands of all physicians.

Digestion and its Deranc/ements. The principles of rational medicine ap-
plied to the disorders of the Alimentary Canal. By Thos. K. Chambers,
M.D., F.C.P., &c, Ac. N. York : S. S. k W. Wood. 1856. 8vo. pp.
440. (For sale by Geo. A. Oates.)

The publication of a new monograph on Digestion is rendered necessary
by the developments of experimental and chemical physiology ; and al-
though we have not yet been able to study the work before us, we have
seen enough to induce a desire to know more of it, and to advise others to
read it attentively. We have no doubt that it is a very valuable addition
to our stock of practical monographs.

The Causes and Curative Treatment of Sterility ; with a preliminary state-
ment of the Physioloyy of Generation. With colored lithographs and
numerous wood-cut illustrations. By Auck K. Gardner, A.M., M.D.,

- &c, &c. N. York : De Witt & Davenport. 1856. 8vo. pp. 175.

The very interesting subject of this work, as well as the creditable man-
ner in which it is treated, will command for it a ready acceptance by the
profession. It does great credit to American medical authorship, and

1856.] Editorial. 511

proves that good books may be made in this, as well as in any other
country.

Clinical Lectures on the Diseases af Women and Children. By Gunning
S. Bedford, M.D., Prof. &c. in the University of N. York. 3d edition,
carefully revised and enlarged. S. S. & W. Wood. New-York: 1856.
8vo. pp" 600. (For sale by Geo. A. Oates.)

We are happy to find that the favorable opinion of tliis work, advanced
by us upon the reception of the first edition, is fully sustained by the pro-
fession, as is evinced by the demand in so short a time for a third edition.
The present volume contains much new matter of interest. We cheerfully
reiterate our former commendation.

Obstetric Tables. By Dr. Pajot, agrege Professor, <fec, Paris. Transla-
ted from the French, and arranged by 0. A Crenshaw, M.D, and G. B.
McCaw, M.D., of Richmond, Va. With three additional tables on the
mechanism of natural, unnatural, and complex labor. By N. P. Rice,
M.D., of N. York. Richmond Enquirer Press. 1856. 4to.

These tables will prove exceedingly valuable helps to the student, and
may be consulted with advantage by practitioners who desire to refresh
the memory, in the midst of professional engagements.

Headaches their Causes and their Cure. By H. F. G. Wright, M.D., &c,
Ac. N. York: S. S. & W. Wood. 1856. 12mo. pp. 122.

This little volume treats of " Headaches in childhood and youth," of
"Headaches in adult life," including such as are dependant upon the circu-
lating, the digestive and the nervous systems; and finally, of headaches in
old age. We would advise its careful perusal, for these affections are yery
little understood in general, and often wofully misunderstood.

The Medical Profession in Ancient Times. By John Watson, M.Pa, Sur-
geon to the New-York Hospital. N. York : Baker & Godwin, printers.
1856.

This interesting contribution to the history of medicine, was made in
the form of an anniversary discourse, delivered before the New-York Aca-
demy of Medicine, in November last. It is indicative of great erudition;
on the part of the learned author, and will be read with pleasure- by the
profession.

Pronouncing Medical Lexicon, containing the correct pronunciation and de-
finition of most of the terms nsed by speakers and writers on Medicine
and the Collateral Sciences ; with addenda. By C. H. Cleaveland, M.
D., &c. 2d edition. Cincinnati : Longby Brothers. 1856. I8mo. pp. 300.

The use of a phonetic alphabet in illustrating the pronunciation of wordr
renders it necessary to learn that in order to understand this. We have
not, therefore, yet had leisure to enable ourselves to judge correctly of the

512 Miscellaneous. [August,

merits of the little lexicon. This is the Work, sometime ago, stigmatized
as a plagiarism. We know nothing about the correctness of the charge,
but it would seem to be difficult to make a dictionary, especially a con-
densed one, that would be materially different from its predecessors.

Two pieces of Heed le removed from the Thigh after a sojourn of forty-
five years On the 9th of February, 1856, Mr. Ebenezer Byram, aged 53
years, presented himself at my office for the purpose of having his thigh
examined, which, he said, was swollen, as his physician told him, from the
"fever settling in it," lie having had a spell of typhoid fever some twelve
months previous. On exposing the limb, I found the thigh, on its external
side, much swollen, red and inflamed ; the surrounding parts being quite
hard, and about the centre of the thigh, on its external side, was a small
soft space about the size of a silver dollar, which fluctuated on percussion,
showing that a quantity of matter was contained within. I plunged a
large abscess lancet into this soft space, and discharged about a gill of thin
yellowish fluid. I then introduced the probe, and after searching for some
time, felt the probe grate against some foreign body. I immediately with-
drew the probe and introduced a small pair of forceps, and laid hold of the
substance, and withdrew two .bits of what appeared to have been a large
sewing needle ; each piece was near three-fourths of an inch in length.
After introducing a tent, and dressing the wound, I made enquiry concern-
ing his previous history. He informed me, that when about eight years
of age, he had what his parents called white swelling; the symptoms then
were great swelling, pain, and redness of the thigh, which continued to
trouble and pain him for twelve months; but at no time did it ever dis-
charge matter, but gradually subsided, and at the end of twelve months he
suffered little or no inconvenience from it, except on sitting in "a certain
manner" in a chair, or in riding on horse-back, if he pressed the parts "a
certain way," they would feel as though something were sticking in him ;
these continued to be his symptoms up to September, 1855, when the pain,
redness, and swelling increased and gave him so much trouble, as to in-
duce him to seek advice; and the above is the history and the result.

[JV. 0. Med. and Surg. Journal.

Hydrophobia. -Dr. T. W. Blatehford, of Troy, in his paper on hydro-
phobia, read before the American Medical Association at its late meeting
in Detroit, reports the following curious facts, as having taken place in
Prussia :

In 1810 there were in that kingdom 104- deaths from hydrophobia; in
1811, 117; in '12, 101 ; in '13, 85; in '14, 127; in '15, 79; in '16, 201 ;
in '17, 228; in '18, 260; in '19, 356, making a total of 1,658 deaths in 10
years in Prussia alone. It is mentioned also as a curious fact, that in Cy-
prus and Egypt hydrophobia never has been known to occur. It is believ-
ed also that the disease is incident to no particular month in the year, as
statistics show on the whole as many deaths at. one month in the year as
any other there being no real difference between summer and winter.
Dr. P. believed that the constitutional irascibility of the dog was the true
etiology of canine madness, and that excision is the only means now known
which affords any reasonable hope of successful prevention. The report

1856.] Miscellaneous. 513

pronounced as an utter fallacy the general idea that the dog-star has any-
thing to do with the origin of virus in the dog, or that summer has any
special preponderance over winter in the existence of cases of hydropho-
bia. The facts submitted, and which had been collected by the Commit-
tee, show the following facts:

Out of 72 cases, 54 were bitten by dogs, 0 by cats, 1 by a raccoon, and
1 by a cow. Out of 62 cases, 4 died the first day, 9 the second, 6 the
third, 18 the fourth, 4 the fifth, 2 on each the sixth, seventh, and tenth
days, and one on the twenty-first. That 22 cases occurred in March,
April and May; 17 the next quarter; 18 the next; and 22 the last. The
average of the time of sickness was 66 days; but this lengthy average was
enhanced by two strongly marked cases, lasting 365 and 360 days re-
spectively. The usual average is 41 days. [N. Y. Med. Times.

A New Instrument for Indicating the Movement of the Heart. Dr. Scott,
Alison has exhibited an instrument to the Royal Society which lie calls a
sphyginoscope, and employs it to indicate the movements of the heart and
bloodvessels. The construction is simple: a small glass tube, about a foot
in length, open at the upper end, and with a graduated ivory scale affixed,
terminates below in a hemispherical or trumpet-mouth, bent to a right
angle with a tube. This mouth is covered with a water-proof membrane,
and, being filled with colored water, is to be pressed against the ribs where
the movement of the heart is most sensible. At once the water starts up
the tube, in which it is seen to rise and fall with every beat; and thus all
the movements of the vital organ, whether regular or irregular, may be
distinctly viewed and measured by means of the scale. A smaller instru-
ment of the same kind will show the beating of the pulse or of any other
bloodvessel, however small ; and the beats may be compared with those of
the heart. They are perceptible even at the end of an India rubber tube
two feet in length. Already some new physiological conclusions have been
arrived at with regard to the circulation of the blood, and a further insight
into vital action is hoped for from the general use of the sphygmoscope
among medical practitioners. [Boston Med, and Surg. Journal.

Liquid Caoutchouc. This is said to be of the color and consistency of milk,
and is preserved in the fluid state by the addition of free ammonia. As
an external application, it has many advantages over both collodion, and
guta percha dissolved in chloroform. It is not stimulating and painful, as
are both the others in certain cases; it does not contract, like collodion ;
and on account of its elasticity, it allows entire freedom of motion. Water
does not act upon or remove it; and it adheres closely to the skin. In
the treatment of burns, erysipelas, and many other surgical diseases which
require exclusion of the atmosphere, it answers the purpose so perfectly,
as to render any other preparation scarcely desirable. [Ibid.

After Pains and Hemorrhage. These difficulties, which so often follow
delivery, and are so little under the control of remedies, have been forestall-
ed and prevented by a French accoucheur, by the exhibition of ergot
during delivery, and injecting cold water into the umbilical vein imme-
diately after delivery. The object is to produce such tonic contractions of
the uterus, as will prevent the accumulation of blood or other fluids in the

514 Miscellaneous.

uterine cavity, the expulsion of which causes pain. Even cases in which
ergot had not been used, it was found that the injection of five or six ounces
of cold water into the umbilical vein, caused an immediate expulsion o\ the
placenta; and the usual suffering of the woman from after-pains was avoid-
ed. The cord is cut to the length of some twelve or fifteen inches ; and
then a small nozzle of a syringe holding five or six ounces, or a small eanula,
can be inserted into the vein, and the injection made without difficulty [lb.

Consumption of Quinine. The Philadelphia Medical and Surgical Jour-
nal says that 300,000 ounces of Quinine are annually consumed in the
United States, meaning, it is presumed, imported, as there are two very
large manufacturing establishments in this country which prepare it on an
extensive scale, and which are not included in the computation of the Se-
cretary of the Treasury, from which the above estimate is derived. It is
worth, at the present time, from $3 to $4 the ounce. [Peninsular Jour,
of Medicine.

New Hcemostatic. Dr. Butler, of Ohio, recommends a scruple of tannic
acid to be dissolved in an ounce of elixir of vitriol, and 15 drops to be given
as a dose in menorrhagia, etc. [American Jour, of Pharmacy.

On a Composition for Attaching Labels. By Frederick Stearks, Phar-
maceutist Having noticed in the March number, the present year, of the
American Journal of Pharmacy, an article upon "Unalterable Labels for the
Cellar," it occurred to me that the method I have employed for soms years,
in giving adhesiveness to dispensing and other labels, might be of some
service to the readers of the Journal. It is as follows :

Take of white glue (Cooper's best) three ounces, (avoir.); refined sugar
one and a half ounces ; water ten fluid ounces, or a sufficient quantity.
Dissolve by the aid of a water-bath, and use while warm, applying it by
means of a suitable brush to the reverse side of the labels while uncut or
in sheets. After being dried and moderately pressed they are ready for
cutting. A little experience will show the propriety of increasing or les-
sening the amount of water used ; for instance, if the paper is thin and well
sized, more may be added; on the contrary, if the paper be thick and with-
out sizing, less is required ; in all cases it should be quickly and evenly
spread upon the paper.

It is not applicable to the purpose of a common paste, as it can only be
used while warm.

I have found the use of it to possess these advantages : Labels prepared
with it adhere more fimly than when any other adhesive substance is used ;
it does not penetrate, and thus disfigure the label, and when applied to
glass they never become loose, as is often the case when acacia and traga-
canth are used, when moistened with saliva. No disagreeable impression
is left in the mouth, as with dextrine, and it would well supply the place of
that material upon Post Office stamps, gum tickets, etc. [American Jour,
of Pharmacy.

ERRATA. In Dr. Kollock's article, June No., on page 333, seventh line from bottom, for " anus,"
read arms. On page 83T, fourteenth line from bottom, for " anus," read arms.

SOUTHERN

MEDICAL AND SURGICAL JOURNAL.

(NEW SERIES.)

Vol. XII.] AUGUST,!, GEORGIA, SEPTEMBER, 1SSG. [No. 9.

ORIGINAL AND ECLECTIC.

ARTICLE XXIII.

An Essay upon the Relation of Bilious and Yellow Fever' prepared
at the request of, and read before, the Medical Society of the /State of
Georcjia, at ite session held at Macon on the 9th April, 1856. By
Richard D. Arnold, M. D., Professor of the Theory and
Practice of Medicine in the Savannah Medical College.

The subject about to be discussed by me, in compliance with
the appointment of the Society, is The Relation of Bilious
and Yellow Fever.

At first sight, this may appear to be a question of very little
practical utility, and one upon which there is little contrariety of
opinion. But when I recollect the change which years and expe-
rience have wrought in my own opinions, and when I see taught
in medical text-books views so totally dissimilar to those I now
entertain on the subject, I have not been unwilling to endeavor
to convey to the society what I conceive to be the true relations
between Bilious and Yellow fever. In doing so, I shall not pre-
tend to give a history of either Bilious or Yellow fever, nor shall
I bring any bibliographical array to support my views: not that I
underrate the value of books, for without a proper knowledge of
what has been learned and taught before our day, Ave would be
little better than blind mill-horses, constantly pursuing one narrow

N. 8. VOL. XII. NO. IX. 33

516 Arnold. Essay upon the Relation of [September,

circuit; but, because the subject is a strictly practical one, which
must be decided by the weight of testimony.

Each observer must bring in his mite of observation, add his
grain to the mound of true knowledge ; "-and, as the laborious ant

Trahit quodcnnquc potest, aique addit acervo

Quern struit, haud ipiara at non incauta futuri."

"While Yellow fever has never been known to prevail in cli-
mates and localities where Bilious fever was not endemic Bilious
fever, in its most malignant form, is known to prevail where Yel-
low fever has never been seen. Having practised for more than
twent}7-five years in one of those localities where Bilious fever is
annually endemic, and Yellow fever only an occasional visitor, I
feel that I have been placed in a position which has given me some
advantages in treating of this subject. Two opinions have pre-
vailed amongst those who have judged from this fact: first, that
Yellow fever, occurring as it does where Bilious fever is endemic,
is but a higher grade of the same disease, produced by the same
causes, acting in greater intensity; second, that Yellow fever is a
disease sui generis, having no analogy nor connection with Bilious
fever, not produced by any local causes, but invariably imported
from abroad, therefore to be kept away by quarantines and all
their inhuman vexations and costly consequences. I shall pro-
ceed to consider these two opinions in their order.

1st. Is Yelloiv Fever only a higher grade of Bilious Fever T The
first time I ever saw a case of Yellow fever was, while a pupil of
the late Dr. m. R. Waring, in the summer of 1827. No man
in the southern country was better acquainted with our fevers than
he was. He had seen them in various localities while a surgeon
in the army; he had seen them in all their violence in our own
city before the dry culture system,, by removing the culture of
rice, with its concomitant evils, from under our very door sills,
had so favorably modified the type of Bilious fever as met with in
the city proper; he had been through our then recent epidemic of
Yellow fever of 1820, from the beginning to the end; in compa-
ny with the distinguished Chervin, he had conducted a series of
po.-t-mortem examinations of Yellow fever subjects, and he could
thus "speak by the card." During the fall of 1827, Yellow fever
broke out in our city : it did not prevail very extensively ; for,
occurring late in the season, its mighty destroyer, frost, put an
end to it before it had time to spread extensively.

1856.J Bilioui and Yellow Fever. 517

It was my privilege to conduct all the post-mortem examina-
tions made by my preceptor during that season. Is it any wonder
that I should have considered him my medical Gamaliel, and have
sat reverently at his footstool? Among the opinions held by my
distinguished preceptor was this identical one, that Yellow fever
was but a higher grade of Bilious fever. He had imbibed this
from his preceptor, the celebrated Rush ; it descended in a straight
line to me, and many years rolled by before I dared to question
its accuracy ; and I did not do so, until repeated observations had
given me data on which to base my belief. Such is the power of
authority, which too often trammels us in our researches. In fact,
in our views of general affairs in this world, of politics, of reli-
gion, &c, there are very few who can truly apply as a motto >

" Nulius addict us jurare in verba magistri."

If Yellow fever were only a higher grade of Bilious fever, we
ought to see it " cropping out," whenever there was any unusual
intensity, or any greater prevalence of the latter.

I have witnessed every epidemic in the city of Savannah, from
the year 1830 up to the present time; I have often known and
2 seen Bilious fever of a malignant congestive type ; for fifteen
consecutive summers I was the attending physician of the city
hospital, whither the worst cases of our ordinary climate fever are
conveyed.

When year after year, I met with malignant and fatal cases of
Bilious fever, and yet with not a single one of Yellow fever, I
began to doubt whether or not I was right in my opinion. Occa-
sional]}'' a few cases of Yellow fever would occur, at intervals of
years; these I studied with intense interest. From 1830 up to
1839, I never saw a case of Yellow fever in the city. Its charac-
ters were indelibly imprinted on mj* memory from the experience
of 1827. In 1839, the city of Augusta was ravaged by this
scourge : it was denied at the time that Yellow fever prevailed
there. In the last of August, a patient, fresh from Augusta, en-
tered the city hospital, and died in a couple of days. My then
colleague, Dr. P. M. Kollock, and myself examined the body, and
found the unmistakable post-mortem appearances of genuine Yel-
low fever. A short time afterwards, a patient from Charleston
entered, and died, and after death presented the same appearances.
It is worthy of recollection, that although these cases were placed
in the wards of a hospital filled with Bilious fever patients, there

518 Arnold. Essay vpon (he delation of [September,

was no propagation of the disease. I still look back upon the year
1839, as the sickliest season I have ever experienced in Savannah,
with the exception of our terrible epidemic of 1854. Old inhab-
itants will recollect it as the driest summer on record, when turnips
were planted in the bed of the Savannah river opposite Augusta.
It was also a hot summer. Bilious fever prevailed over the whole
country, and in a malignant form. Contrary to what would seem
the fact at first view, such a season was peculiarly calculated to
generate the malaria which is the generally acknowledged cause
of Bilious fever. It is conceded that mere moisture will not pro-
duce malaria; but mix vegetable matter with water, and subject
it to heat, and the most malignant malaria will be generated.
That year, swamps and ponds which had been covered with water
since they had been known to the white man, were dried up, and
the vegetable debris which had been precipitating to their bottom
for years and years, were exposed to the action of the sun and air,
and consequently were decomposed, and generated malaria. Now,
Bilious fever prevailed with great violence in our city from early
in July. I cannot imagine more favorable circumstances for the
spread of Yellow fever than accompanied the introduction of those
two cases in our city. Later in the season, I did meet with seve-
ral cases of Yellow fever, but they were so few in number that I
did not consider them as entitled to be considered epidemic. They
were isolated, occurred in different parts of the cityr and had not
the slightest connection with the cases of the hospital. I consid-
ered them sporadic, and they most undoubtedly originated on the
spot.

I met with one solitary case of Yellow fever, with black vomit,
in the fall of 1840. She was an unacclimated foreign lady, who
had not stirred out of the city during the whole summer, nor had
she even peeled a banana from Havana.

In March, 1841, a case was brought to the hospital from Deme-
rara, and in October of the same year a case occurred in my private
practice, both of which were reported by me in the American
Journal of the Medical Sciences for October, 1842.

A few cases occurred at the hospital late in the fall of that year.
I found the post-mortem appearances so similar in all the cases I
had examined, from 1827 up to this time, that I was convinced
that Yellow fever must be a disease sui generis. It was with in-
creased interest, that during the summers of 1843, 4, 5, 6, 7, 8, 9,

1856.] Bilious and Yellow Fever. 519

I examined every case of fever which died at the hospital. Neither
during life, while attending them, nor after death, did I find any
signs to make me ever suspect that Yellow fever had existed.
With the exception of a sporadic case in June, 1852, I met
with no Yellow fever until the fall of 1852. Late in September,
an utiacclimated painter was attacked with it in the north-eastern
portion of the city: he had been working here all summer,
and had had no connection with Charleston or Havana. He was
removed to the hospital after he had thrown up black vomit, and
he died. I had resigned my post as physician there in 1850. and

,i was not attending. An autopsy was made, at which I was pre-
sent. Before it was done, I stated to the attendants what morbid
appearances I expected to see; and they turned out exactly as
described beforehand. The fever began to show itself in several
places about the middle of October; but, fortunately, a frost early
in November cut it short. I examined several subjects who died
of it, and found the same peculiar morbid appearances. In 1854,
it was my lot again, as in 1852, to have the first Yellow fever pa-

,] tient. I was called in on the night of the 3d August, and he died
on the morning of the 5th, after having discharged quarts of genu-
ine black vomit. My last case of Yellow fever, with black vomit,
died on the 27th November. In the intermediate time, I had seen

J hundreds of cases of genuine Yellow fever.

I had made post-mortem examinations in the beginning, the
middle, and the end of our epidemic, under the broiling sun of
August, the more temperate atmosphere of the latter end of Sep-
tember and October, and the almost cool temperature of Novem-
ber, and I found nothhig new. From the beginning to the end,

,j I found the same morbid appearances. Of course I do not mean
that each case was an exact copy of the other; but just as all cases
of genuine Typhoid fever present the same morbid appearances,

\\ although the patches of Peyer may be more ulcerated in one case

j than in the other, or in some cases they may be enlarged without
being ulcerated.

Now, the morbid appearances after Bilious fever have never, in
my experience, approximated those after Yellow fever; and the
symptoms during life have presented wide and marked differences.
Let us devote a little attention to these two conditions.

It is well known that all fevers have many symptoms in com-
mon in their beginning, such as headache, lassitude, pain in the

520 Arnold. Essay upon the Relation of [September,

limbs, &c. ; and that merely from such symptoms it would be im-
possible for the most experienced and skilful practitioner to diag-
nosticate the particular kind of fever presented to him. He must
wait the progress of the case, and the development of the charac-
teristic S3rmptoms, before he can decide. Of course I speak of the
inception of the disease. Certain fevers come on, as a general rule,
more suddenly than others; bnt the rule is not invariable, and
we would be at a loss to make a correct decision if we depended
merely on the first phenomena of febrile disturbance.

Moreover, some cases of well-known specific exanthematous dis-
eases are developed so imperfectly that we are at a loss to decide,
positively, whether or not the patient has had the genuine disease.
Every practitioner of any experience must have met with such
cases of Scarlet fever and Measles. Yet no one has ever, in latter
days, denied that they are distinct and peculiar diseases, although
a little more than a century ago Measles was confounded with
Small-pox.

I do not deny that, when no suspicion is aroused, sometimes the
first notice the physician has that he is treating a case of Yellow
fever, is the appearance of the fatal black vomit. But even in
epidemics of Yellow fever, black vomit often supervenes when the
patient has apparently passed the point of danger and offered no
untoward symptoms.

Nor must it be supposed that all cases of genuine Yellow fever
appeared in one stereotyped edition. There was every variety of
grade and intensity, from the ephemeral attack of twelve hours of
fever, followed by speedy convalescence, to the more prolonged
paroxysm of seventy-two hours, ushering in a malignant or a fatal
case. Yellow fever is essentially a fever of one paroxysm; but
that paroxysm is of very unequal duration, as just intimated.
Now, if the access of fever should not be very marked, it could
not be distinguished at first. Again: there are some cases which
are ushered in with such marked symptoms that }rour suspicions
would be at once aroused. The first case with which I met, in
1854, was one of this nature. There had been no unusual severi-
ty in the fevers which had occurred up to that time. The summer
had been the very hottest I had ever experienced, and what is very
rare many fatal cases of coup desoleil had occurred. I was called
to see my patient at night (3d of August) ; he had taken comp.
blue pill : he offered the usual symptoms of fever pain in the

1856.] Bilious and Yellow Fever. 521

head, in the loins, over the upper part of the sacrum, down the
thighs ; a hot, dry skin, and accelerated pulse. I directed a de-
mulcent drink, and that a dose of castor oil should be administered
the next morning early. On my visit the next morning, I found
him with a raging fever; intense headache; blood-shot, shining,
watery, smoke affected eyes; a full, bounding, but not very fre-
quent pulse; a constant retching, and quite delirious. The land-
lady said to me, "Doctor, what kind of a fever is this ?" I replied,
" It is first-cousin to Yellow fever." I bled him, and applied a
blister to the epigastrium, and directed cold demulcent drinks.
The fever continued unabated all that day and the ensuing night.
On the morning of the 5th of August, on my visit, they showed
me a large wash-hand basin filled with matter, which I pronounced
black vomit. He continued to eject large quantities of it, and at
noon he died. This man was a carpenter by trade, a northerner;
it was his first summer south ; he had been working on the roof
of a house which was just finishing, and before he had moved to
the place where he was then boarding, had lived in Curry town,
the extreme south-western portion of the city, and had walked
nearly a mile two or three times daily to and from his work, which
was in the north-eastern portion of the city, through the broiling sun.
It is again to be noticed that not a single other death occurred in
that house during the season. After the epidemic became a fixed
fact, and cases had occurred all over that section of the city, two
of the inmates had the fever, but it was in a mild form. There
was not any loop-hole whereon to hang even a suspicion that this
man's disease had been contracted any where out of the limits of
the city no "low, long, black-hulled schooner" had just arrived
from the West Indies to afford an easy solution of how Yellow
fever had attacked a denizen of Savannah. The house was a
mechanics' boarding-house. A great panic ensued ; but I am yet
to learn that any boarder contracted the disease from this case.

The next afternoon, the 6th August, I was called by Dr. Jas.
B. Read to see a case on the extreme eastern edge of the city,
many squares distant from the first case. The patient was a
young German girl, entirely unacclimated; the house where she
lay was on the eastern bluff of the city, overlooking the low
swampy grounds in that direction; it was amply ventilated,
standing isolated in a large lot. She had been engaged sewing-
decorations at the theatre, distant about three-quarters of a mile

522 Arnold. Essay upon the Relation of [September,

and had walked to and from it in the hot sun, during the whole
season. Unfortunately there was no doubt about the case ; she was
moribund, with black vomit thrown up all about her.

On the afternoon of the 5th, 1 was called to see a patient in
Congress-street, about a hundred yards to the north-east of my
first patient, but in a different street. His fever did not attract my
attention particularly. He was of a lymphatic temperament, a
northerner who had resided several years in the city, and whom
I had attended some summers before in a very severe attack of
bilious fever. His fever was not very high ; he complained of
pain and languor. I gave a dose of blue pill, and directed oil
the ensuing morning. On the 6th his medicine purged him and
he was better. On the 7th, when I called to see him, he had left
the house and gone to his business. On the evening of the 8th I
was called to him: I found him with a slow pulse, a cool skin,
and a constant retching, ejecting glairy matter, and no bile.

For ths first time, I suspected Yellow fever, and that the cessa-
tion of the fever had been the calm which follows the single
paroxysm of that fever. I ordered a blister to epigastrium, ice
to suck, and iced gum water for a drink, and my alterative pow-
ders, (two grains of calomel, and one sixth of a grain of opium,)
every two hours. On the 9th, he was much the same, except that
the prostration was greater, so as to seem to threaten death from
sheer exhaustion. Towards night, I discovered flocculi of black
vomit in his vomit. He continued to throw up the black vomit
mixed with a good deal of mucus, all that night, and all the next
day, and died on the night of the eleventh. The quantity eject-
ed was not very great, and it was thrown up with a great deal
of straining and mixed .with mucus. He sank away gradually
and gently, like one yielding to the effects of a depressing poison,
without the power of reaction.

Let us contrast the first case and this: The first case occurred
in an unacclimated subject it was violent from beginning to end.
The last occurred in an acclimated subject it was slow in its
progress, ^e?s maiked in the first stage, but running its stage of
calm and secondary fever as is most generally seen where death
does not occur during or just after the paroxysm of the fever.

Now no fact is more notorious than that acclimation to a warm
latitude diminishes the susceptibility to yellow fever, and that it is
far milder in those who have constantly resided south, summer

1856.] Bilious and Yellow Fever. 523

and winter, than in those who have not; and who are consequent-
ly unacclimated. By this time, the eleventh of August, I had been
called to many cases, all in the north-eastern part of the city, but
in separate houses and different streets not in any ways con-
nected with each other, and I could not doubt that we had a
different fever to contend with than a bilious remittent fever,
and I will now proceed to state the symptoms which brought
me to that conclusion. Of course I will state what was the gen-
eral type.

The invasion of fever was more sudden than in ordinary
Bilious fever, and although all fevers will be found to have a cold
stage of some kind, it was not well marked in these. There was
intense pain in the back, over the last lumbar vertebra and upper
part of the sacrum and extending down the thighs along the sciatic
nerve. The pain over the eyes, in the frontal region, was excru-
ciating; the eyes were watery, shining, sometimes injected, some-
times not, with the upper lid partially drooping, like one whose
eyes were watering from a quantity of smoke. The skin was in-
tensely hot and very dry; the stomach was very irritable; the
ejecta were either a serous fluid, bluish green, as if blue vitriol
had been dissolved in water; or a glairy, viscid, tenacious mucus.
But the pulse was not disturbed in accordance with the general
perturbation, it seldom being over a hundred beats to the
minute, and very often not more than eighty or ninety. This
6ymptom I have been disposed to look upon as very characteristic.
This febrile state lasted from twelve to seventy-two hours, on an
average about thirty-six hours, and was succeeded by a cessation
of these symptoms, and an apyrexia, but without any critical eva-
cuation whatsoever. After this, in fatal cases, black vomit came
on immediately, or it was ushered in by increased irritability of
the stomach, it becoming intolerant of the mildest ingesta, by a
constant empty straining, and by the most acute sensibility of the
epigastrium to any pressure. With this, in most cases, there was
the most remarkable depression of strength ; in some cases, several
hours of a most perfect calm succeeded the paroxj^sm, and there
was nothing to rouse suspicion of danger but a slow pulse, it gen-
erally sinking to forty or sixty beats in the minute. When black
vomit supervened, a few hours terminated the case. With all this
manifest affection of the stomach, the brain, as a general rule, did
not sympathise. The intellect was not affected, untd the last

524 Arnold. Essay ujjon the Relation of [September,

closing scenes of life, when the brain gave away in common with
the rest of the organism.

This, considering the violence of the febrile paroxysm, must be
considered one of the characteristics of Yellow fever. The thirst
was great, but the tongue was not generally parched. At this
period of the epidemic, the fatal cases terminated quickly ; black
vomit came on within three or four days, and the patient seldom
survived beyond the fifth day. When he did so, the chances
were greatly in his favor.

I have sketched only the prominent symptoms. Do they differ
from those presented in a case of Bilious fever? Let us take a
well developed, well marked case, with which to make our com-
parison.

A Bilious fever is almost always ushered in with a pretty dis-
tinctly marked chill. There are certain symptoms, as stated before,
which are common to the various forms of fever, such as weari-
ness, head ache, back ache, &c; but the invasion of these pains is
not so sudden in a Bilious fever. After the cold stage, there is an
evident reaction of the system, and a hot stage ensues. This,
again, is followed by a third stage, viz., one of sweating; the fever
then abates, with a distinct critical evacuation, either by urine or
by perspiration ; and in a few hours it again begins to increase,
and having attained its height a sweating stage again follows; and
so the fever goes on, the remissions becoming shorter, the stages
less marked, until the system sinks under it; or the paroxysms
becomes lighter, the remissions so marked and distinct that they
slide into intermissions, and the patient recovers.

Marked Periodicity is the distinctive characteristic of Bilious
fever, as far as it has come under my observation.

But there are certain symptoms attending the paroxysms which
are quite distinctive. The pulse becomes more accelerated in Bil-
ious fever, ranging far above one hundred, increasing as the fever
increases, becoming slower as it abates, presenting, as verified by
me, in scores of cases, a variation of forty beats to the minute be-
tween my morning and evening visit.

There is headache in Bilious fever, but is not of that intense
supra-orbital character as in Yellow fever, and is more diffused
over the anterior portions of the brain. There is very frequently
great irritability of the stomach in Bilious fevers, and the stomach
ejects great quantities of bile. Sometimes the bile may assume a

1856,] Bilious and Yellow Fever. 525

greenish color. Very often, a severe attack of Bilious fever may
present its paroxysms so marked, and the remissions so distinct,
that you could with propriety class it in the intermittent variety ;
still the three stages, of cold, heat, and sweating, can be easily
traced and marked in the form of Bilious fever. Now, if Yellow
fever was but the highest grade of Bilious or Climate fever, we
ought to find the worst cases of the latter closely approximating,
if not running into the former. But what are the facts? The
congestive type of Bilious fever (as witnessed by me in hundreds
of cases) is unquestionably the very worst type of that fever.
Every year, however healthy, affords cases of it in those individu-
als who have been exposed to swamp miasma in their avocations.
Watchmen are required at the wharves under the bluff of the
city. Savannah lies on a high bluff, forty feet above the level of
the tide, and fronts to the north. Northward is a low alluvium
extending in a direct line due north, for fully four miles before
the high ground of South-Carolina is reached. Hutchinson's Isl-
and, immediately opposite to, and north of the city, is under the
dry culture contract, which prohibits the planting of rice within a
mile of the Exchange ; but beyond the back river and on the Ca-
rolina side, are vast bodies of land, fully from two to four miles
through in a northward direction, and extending east and west
for about twelve miles, which are cultivated in rice with all its
concomitant moisture. To the northeast of the city, these lands
extend to the limit where the water becomes brackish and unfit
for the culture of rice. To the direct east of the city, and beyond
the limits of the dry culture contract, and on the Georgia mainland
are many hundreds of acres of land cultivated in rice. To the
north-west of the city, the alluvium takes a bend to the north,
affording in that quarter some of the finest rice plantations in
South-Carolina. What constitutes the defence of Savannah against
the malaria of these low grounds? I answer; that, fortunately,
almost the whole northern front of the city is defended by a high
row of brick storehouses rising some twenty or thirty feet above
the level of the plain on which Savannah stands ; which store-
houses are not inhabited, and thus afford a material bulwark
against the introduction of malaria into the city. To the north-
east of the city, this protection is not afforded, because the store-
houses have not been built up in compact mass above the level of
the plain of the city, as they have been at the portion of the front

526 Arnold. Essay upon the Relation of [September,

more westwardly. In this portion of the city there are many
dwelling houses on Bay-street which are not protected; whenever
the winds prevail from the north or north-east, those houses have
invariably, and I speak advisedly from many years' experience,
afforded the first cases of Bilious fever, and the most malignant
types of it every year. I have a patient who lives in this locality.
About six years since he moved into his house, and he and his
whole family (a wife and three children,) were desperately ill of
Bilious fever. I advised him, nay, insisted upon it, giving my
reasons, that in the sickly season, when malaria was generated,
(say from the first of June until a frost in the fall,) he should keep
all the windows on the north side of his house closely shut by the
sashes, from early in the evening until the sun was high up in the
morning. He has done so, to the exemption of his family from
fever, and the great curtailment of my professional fees. Such
has been my advice to all persons inhabiting houses exposed in a
similar manner, and I distinctly aver, that where the advice has
been followed, the same result has obtained.

Those individuals whose liberty is the practical one so much
sighed after by the pseudo-philanthropists of the North, of work-
ing or starving, are the ones who take the perilous occupation of
watching at night under the bluff, and who are thus exposed to
the malaria which may be blown from the north-east, the north,
or the north-west, just as the wind may set.

The summer of 1855, was the healthiest I have ever known in
the city. Fevers did not rise above the grade of intermittent, as a
general rule, yet I met with two cases of congestive fever, both of
which were fatal within four days from my first visit, and each
individual had contracted his fever, from exposure at night and
early in the morning, in the very locality 1 have pointed out.
They were the fac simile of cases occurring more or less frequent-
ly every year; they were malignant, and they were fatal ; but they
offered not the slightest resemblance to Yellow fever. The fever
was high, the pulse was accelerated up to 120 to 140 iu the min-
ute ; while the skin was hot to the touch, it was covered at times
with moisture, standing out in great beads of sweat. The brain
%was affected with stupor from the very commencement. When the
fever remitted, which it did in the morning, and notably on the
morning of the alternate day, the brain would become relieved in
a measure, but as the fever exacerbated it would again become op-

1856.] Bilious and Yellow Fever. 527

pressed. These cases terminated in a stupor many hours before
death. Perspiration in the very heighth of the fever, I consider
as a very common symptom of the congestive form of Bilious fever,
and I always consider those cases most dangerous which show this
symptom, while there are stupor, an accelerated pulse, and an in-
tensely hot skin. Whilst the cases which terminated favorably
have the paroxysm of fever resolved by a critical sweat, with an
abatement or cessation of the other febrile symptoms; I have time
and again seen a man in articulo mortis, with a pulse so accelera-
ted that it could not well be timed ; in a profound stupor, and with
the sweat standing out on his skin in great drops ; and this condi-
tion of affairs had not supervened just before the patient became
in extremis, but had gradually come on in the last exacerbation of
fever. There are other cases which come under the category of
pernicious or malignant intermittents, or congestive chills. I
have known a patient in a state of perfect apyrexia in the morn-
ing, to die in the afternoon. These are the most malignant forms
of climate fever met with in this city. I may fail to convey an
idea of their real character, but it is from want of power in my
pen, not from want of their total dissimilarity to Yellow fever.

Late last fall, but before a frost, a watchman on the Charleston
wharf, at the northwestern portion of the city, was found early in
the morning lying in a state of complete insensibility. The night
had been a stormy one; he had had intermittent fever, but had
persisted in going to his work in spite of the remonstrances of his
wife. He was carried to his house on the brow of the bluff, and I
was sent for. I found him in a complete stupor, with his pulse
nearly gone, his extremities icy 6old, his whole periphery cool,
skin mottled, purplish, or rather in some parts bluish, with a clam-
my sweat, hurried respiration, and in short, in what I considered
a dying condition. I had him stripped and rubbed dry, had dry
heat applied to the surface, sinapisms to every available point, and
a large blister to the epigastrium and one to each leg. Friction
was applied continuously for some hours; after awhile he was en-
abled to swallow: I gave him hot brandy toddy every half hourr
and calomel two grains, and opium one-sixth every two hours.
Eeaction gradually took place and the next day, about twenty-
four hours after he had been brought home, he spoke. From that
time he began to mend, and is now at this present writing "earn-
ing his bread by the sweat of his brow."

528 Arnold. Essay upon the Relation of [September,

The rationale of this case is simple. The exposure to cold and
moisture in an undue degree, converted what would have been,
without such exposure, a mild paroxysm of simple intermittent
into a malignant congestive chill, oppressing and depressing all
the vital powers so as to prevent proper reaction, thus giving a
fair representation of the congestive form of Bilious fever. If it
were not so, I am at a loss to comprehend what that type of fever
is, and must come down from the witness stand as never having
seen a genuine case of it. One more prominent symptom remains
to be noticed. While a jaundiced hue often follows an attack of
bilious fever, another colour is its most frequent concomitant.
There is in the worst types of it, a peculiar pallid anemic hue. This
hue can be seen in those cases which have not fully recovered
from attacks of intermittent fever, or where, as is often the case, a
severe attack of bilious remittent fever has been succeeded by
attacks of irregular intermittent fever prolonged late in the fall or
even after a frost.

In my clinical lectures at the Savannah Hospital, I have
frequently diagnosticated malarial fever subjects from merely
seeing them, before, I had asked a single question of the patient.
In enumerating the peculiar signs of Yellow fever, I did not speak
of the yellow colour of the skin because I wished to reserve that
point up to this period. Now, as a general rule, fatal cases of that
disease presented that discoloration ; and an unfavorable prognosis
was almost always to be formed when the skin began to assume
that colour; yet in the commencement of the epidemic, during our
intensely hot and dry weather, when the cases were more acute
and terminated more rapidly, I saw many dead bodies whose
skin could not have afforded any index to the disease of which
they had died, although black vomit had been freely thrown up
before death. Of the cases which did recover, although many had
been very severe, very few presented airy morbid discoloration of
the skin, and it was a subject of frequent remark by those who
returned to us after the pestilence had left us, that they were
astonished to see the survivors looking so well and free from any
marks of previous diseases. A gentleman, his wife and child, had
all had very severe attacks of the fever in September 1854. He
Visited the north late in October for a change. He has often told
me that persons there would hardly believe that they had just
come from what was then an infected city, and that they had been

1856.] Bilious and Yellow Fever. 529

sufferers from the scourge, so little did they bear any traces of it
with them. Let me then sum up what are the prominent symp-
toms during life of each disease, before I go into the signs presen-
ted after death. I speak of the average of symptoms without
noticing the varieties which occur in this, as in every other disease.
In Yellow fever, the access of the disease is generally sudden ; a
person may be about in the morning and quite ill in the evening,
or may be well in the evening and attending to business and be
prostrated in the morning following. The sympathetic pains are
much greater ; the pain is over frontal region, over sacrum and
down the thighs ; the skin is hot and dry, and does not pour out
perspiration as in Bilious fever ; the pulse, never mind how high
the febrile symptoms, seldom ranges over a hundred ; the tongue
is not coated, on the contrary offers no index of the state of the
stomach. The paroxysm of fever subsides without any critical
evacuation and a state of calm succeeds which lasts from a few
hours to forty eight hours. The pulse at this stage generally falls
as low as fifty or sixty. In bad cases, the stomach invariably
shows great tenderness upon pressure, or there is an uneasy sensa-
tion in the epigastrium, and an intolerance of food. With this,
there is also a remarkable prostration of strength. Many cases
seem to be threatened with death from sheer exhaustion; nor is
this at all dependent on any previous evacuations from the system,
nor is it always in a direct ratio to the severity of the febrile parox-
ysm, for it would occur where there had been no evacuation, and
would follow a very slight paroxysm. If the case continued to
grow worse, the retching is followed by the vomiting of the black
vomit, the occurrence of which at the season of the year when
alone Yellow fever prevails in this climate, leaves no doubt as to the
nature of the disease or the fate of the case; or hemorrhage would
occur from the mouth, the lips, the tougue, the gums, a scorbutic
oozing. In an epidemic of Bilious fever, many of the cases have
their periodicity so well marked that no one could doubt as to
their true nature. Other cases have their remissions more ob-
scurely marked, and without close watching, would seem to be
continued fever, but a close observation will generally detect marked
remissions, and decided exacerbations. The remissions almost
always occur in the forenoon, the exacerbation in the latter part of
the day and at night. Bilious fever seldom attains its height at
one bound as does Yellow fever. Questioning will frequently

530 Arnold. Essay upon the Relation of [September,

reveal the fact that there has been a distinct intermission between
the first and second paroxysm. The pulse is most certainly more
accelerated in Bilious fever, reaching often in a parox}Tsm up to
120 to 140. It will also vary many beats in the course of the day.
A paroxysm seldom lasts longer than twenty-four hours when it
either terminates, or there is a marked remission accompanied by
sweats more or less profuse, and a sensible abatement of all the
febrile symptoms. After this the fever again rises, again runs the
same round. If the case is to terminate favorably, the paroxysms
become lighter and lighter, the remissions more marked; very fre-
quently they may be considered perfect intermissions, and you
will see that the great peculiarity of Bilious fever is its periodicity.
In the paroxysms there are headache, and backache, and pain
down the sciatic nerve, but they are not so marked, as a general
rule ; not of such a neuralgic character as is so often seen in Yellow
fever. There are nausea and vomiting, but bile continues to be
thrown up to the last stage of Bilious fever, should it be a case
marked by great irritability of the stomach. Now when a person
is attacked by Yellow fever, of course there is some bile in the
system, and it may sometimes be thrown up at the very commence-
ment of the attack, but certainly it is never seen in the advanced
stages of the disease.

In October 1842, I published the article on Black Vomit in the
American Journal of the Medical Sciences alluded to before. My
experience was then limited, but I adhere without qualification to
the opinion then announced by me, viz: "Perhaps there may be
bile in the incipiency of the attack, before a physician is called,
but in every case that has ever come under my notice, that has
terminated in black vomit, the absence of bile in the excretions has
been the distinctive characteristic of the disease." The head is decided-
ly more affected in Bilious fever, than in Yellow fever. It
is a common thing for patients to remain in their senses long
after they have reached the stage of black vomit. Just before
death, the brain gives way as the other organs do. But in a
bad case of Bilious fever there is almost always oppression of
the brain, and cases lie in a stupor for two or three days before
death. I think the anatomical lesions discovered in Bilious
fever after death, which, I will detail further on, sufficiently ac-
count for this.

I think I have furnished sufficient points of contrast for the

1856.] Bilious and Yellow Fever. 531

symptoms during life. Let us follow out the diseases, and see
what anatomical lesions are left on the dead body by them.

In Bilious fever we find marks of disease on the mucous coat
of the stomach, the upper part of the duodenum and the liver.
These I may state as invariable. In a large number of cases, and
particularly in the worst types of Bilious fever, there are traces of
the disease on and under the meninges of the brain.

In Yellow fever we find the same organs affected, except that,
as the brain is involved during life in but comparatively few
cases, it does not exhibit the same uniform alteration as do the
stomach and liver. Now here is a point of relation, and to what
does it amount?' to no more than does the relation of scarlet
fever to measles, in each of which the skin and air passages are
affected. In Bilious fever we find what I consider undoubted
marks of an inflamed stomach.

The mucous membrane is often red and injected, either puncta-
ted or arborescent, it is often softened, so as it can be easily
scraped off with the handle of the scalpel ; it is very often of a
slate colour in protracted cases, but invariably traces of bile can
be detected in the stomach or in the intestines. In Yellow fever,
we also find the mucous membrane injected, but certainly much
more generally and much more intensely than in Bilious fever.
You do not always find black vomit in the stomach, because it may
have been ejected just before death, but most generally you will.
I have opened, in my day, several subjects dead from Yellow fever,
in whose stomach black vomit was found, although not a particle
had been thrown up. The patient, from Augusta, who entered
the hospital in 1839, alluded to before, was one of these cases.
Without a post-mortem examination, it might have remained in
doubt as to what his fever was. Another case, amongst the very
last of 1854, was examined after death by Dr. J. B. Read and
myself, and black vomit was found in the stomach, although none
had been ejected during life.

Black vomit is however generally found in the stomach ; but
it is found free in almost all instances, lying on the surface of the
mucous membrane ; but there are cases in which the peculiar
flocculi of black vomit can be detected in the very mouths of the
patulous vessels of the mucous membrane ; and in some cases, I
have seen a dark black arborescent injection running under or in
the mucous membrane, exactly like the red arborescent injection so

N. S. VOL. XII. NO. IX. 34

532 Arnold. Essay upon the Relation of [September,

frequently met with. Now black vomit is a Hemorrhage. I express-
ed in 1842, (loc. cit.) my belief, that it was blood altered ; in 1852r I
detected blood corpuscles existing in it; I exhibited them under the
microscope to Dr. Wragg, Dr. West, Dr. Read, Dr. Bulloch, and
the late Dr. Ladd. Here is proof positive that the mucous mem-
brane is the seat of a peculiar hemorrhage. Dr. Copland has
some grounds in wishing to designate Yellow fever as the hasma-
gastric pestilence. Whatever may be the real poison, it undoubt-
edly has a peculiar tendency to produce hemorrhage from the
stomach ; but there is a great deal of acid in the stomach, and it
produces a peculiar effect on the blood, coagulating it into the
flocculi of black vomit. The ejecta in Yellow fever, tested by
litmus paper, always show strong acidity ; it is the acid which turns
the blood, and prevents the haemorrhage from being a mere
hematemesis. Occasionally the hemorrhagic tendency of the
disease is shown by its action on the bowels, and blood is passed
downwards. Such cases, as far as my experience goes, are always
fatal, are genuine Yellow fever ; but must be distinguished from
those in which the black vomit is passed per anum ; in the latter
case, recovery is more apt to follow than when the unaltered
blood is passed. Now, if Yellow fever were but the highest grade
of Bilious fever, we ought every season to meet with occasional
cases in which black vomit would be found in the stomach after
death, even if it were not ejected during life. Such cases have
never occurred in my experience. But it is when we examine the
liver that we find unmistakable evidences of the peculiar nature
of Yellow fever. In Bilious fever we find the liver of various
shades, dark brown, umber, bronze, but always gorged with blood.
In Yellow fever it is always altered in colour, being pale and
destitute of blood. The best colour to which I can compare it is
boxwood. Some boxwood is of a dirty yellow, some of a brighter
yellow ; so of the liver, some arc of a light pale boxwood, almost a
dirty ash white, some of a more pronounced yellow color. In a
Bilious fcver liver, by pressing a piece of white paper on the cut
acini, you will stain it yellow, showing the secretion of bile still
having existed up to the time of death ; but this cannot be done
with a Yellow fever liver. It sometimes contains a thin bloody
serum, most generally it is almost dry. In 1827, Dr. Waring
pointed out to me this state of the liver as the exact state present-
ed in our fatal epidemic of 1820. In every case that I have had

1856.] Bilious and Yellow Fever. 533

the opportunity of examining from that time to the present, I
have found the identical appearances. I examined cases at all
times of our epidemic of 1854, and I found no variation of any
account. I consider this conclusive proof of the identity of the
disease, from 1820 to 1854.

One case early in the season, presented a mottled liver, that is,
there were spots in it which had undergone the peculiar change
incident to Yellow fever, and there were other spots in which the
liver presented the natural Spanish brown color. I attribute this
to the patient having died before the change in the circulating
fluids had been sufficiently great to effect the alteration of the en-
tire parenchyma. In some cases of Yellow fever, I have seen the
gall bladder contain only a dirty, thick, viscid bile. In Bilious
fever, it is always filled with bile.

In Yellow fever, the absence of bile is not confined to the sto-
mach : you may search from the cardiac orifice to the anus with-
out finding a trace of it ; often have I done so, and never have I
succeeded. I do not say, that a person who has the opportunity
of examining every fatal case which may occur in a large hospital
may not succeed better, but when a man is harrassed with constant
demands on his time, as a physician in full private practice will
be in great epidemics, he cannot examine every case. It was my
object in 1854, to procure a record of the post-mortem appear-
ances during the various periods of the epidemic, and I examined
cases which died in August, September, October, and November,
and I found a great uniformity in all of them the discolored liver
and the total absence of biliary secretion in the prima? vise.

I was the attending physician of the Savannah Hospital for ev-
ery summer, from that of 1835 to that of 1849, inclusive. I rarely
allowed a fatal case of Bilious fever to escape without an autopsy.
I state most distinctly, that in every case I found an abundance of
bile in the intestines, if I did not find it in the stomach.

My examinations of the head in Yellow fever have been very
few. In the great majority of cases, the cerebral symptoms did
not induce me to do so. I have seen cases in which the head was
involved from the commencement, and, doubtless, those cases
would have furnished evidences of cerebral engorgement ; but, as
a, general rule, the local manifestations of Yellow fever are in the
stomach and liver. The existence of long continued stupor in
Bilious fever made me examine the brain very frequently ; indeed,

534 Arnold. Essay upon the Relation of [September,

in the great majority of cases, and as I stated before, enough was
found to account satisfactorily for the stupor; serum was gene-
rally effused under the coverings of the brain, in the ventricles,
and under the arachnoid, and the latter membrane was frequently
opalescent. I have always considered the brain as a special organ
for the local manifestation of Bilious fever, both from the decided
symptoms presented during life, and from the post-mortem ap-
pearances.

I present for the inspection of the Society, drawings in oil colors
taken from nature, of the appearances of the liver in the two dis-
eases. An inspection will be better than any description. The
Society cannot fail to see, at a glance, the vast difference from the
brown and bronze of the four copies of the Bilious fever livers,
and the light yellow boxwood color of the Yellow fever liver. It
has been my object to sketch the prominent characteristics of the
two diseases, presented during life and after death. If they be so
widely and so uniformly different, how can we class them as the
same disease, modified only by intensity?

The second opinion entertained, that Yellow fever is a disease,
sui generis, special, distinct, has been sufficiently discussed in the
consideration devoted to the opinion, whether it is only a higher
grade of Bilious fever. It will be seen that I entertain this belief.

The question of its origin and propagation would, itself, afford
scope for an essay ; and mine has already occupied so much time,
that I could not go into it now. I can bear my decided testimony
that in no instance has there ever been the shadow of the shade of
proof, that it ever was imported into Savannah from abroad. On
the contrary, the proof is positive that its first victims had had no
communication, direct or indirect, with any source of infection.
Moreover, when the British steamer Conway, which ran to the
West-Indies, touched at this port, I attended two cases of Yellow
fever from her, both of which died in the city, and yet no disease
was propagated from them. In March, 1841, (as will be seen by
my article quoted before,) I brought a case from a ship from De-
merara, and placed it in the hospital where the patient died. It
is said that it can be propagated from abroad in a city, although
most give up the point as to its contagion in the country. The
whole experience of 1820 and 1854, when our citizens fled by
nundreds into the country, and into neighboring villages, towns,
and cities, does not afford a single instance where the disease was

1856.] Bilious and Yellow Fever. 535

spread by the fugitives. If then, it is not propagated into the
country, and into other cities by land routes, why is it supposed
to be so fatal when it comes by sea? If one case can originate in
a place, why not ten or twenty ? Case upon case occurred in
1854, in which the patients had not been near a deceased subject.
Isolation was no protection. The poison, whatever it may be,
spread like a pall over the whole city, and covered in its embrace
all who staid, or entered its precincts ; but a quarter of a mile be-
yond its limits the poison became innocuous. Such is fact. Let
those who appeal to fancy, disprove it, or theorise upon it.

Again : facts prove that Yellow fever is a city disease. Expo-
sure to swamp malaria, staying on a rice plantation in the summer,
and in the fall before a frost, will produce a malignant and most
fatal Congestive-bilious fever ; but never, no never Yellow fever.
Such cases of Bilious fever, as I stated before, I meet with every
year; but, thank God, very seldom have I encountered cases of
Yellow fever.

Yellow fever, in this locality, has this in common with Bilious
fever, it never prevails except in the summer and fall months, and
is most effectually cut short by a frost. As a general epidemic, it
ceased to prevail in Savannah about the second week in October
in 1854 ; yet the poison continued in the atmosphere until a frost,
! and attacked those strangers who imprudently returned into the
j city. The last resident whom I attended was attacked on the
1 25th of October. The cases which occurred afterwards were, with-
out exception, strangers and unacclimated.
,- Since my connexion with the Savannah Medical College, I again
:i attend "the hospital, and it was there, and amongst seamen that I
: met with my last cases. They lay promiscuously amongst patients
i with other diseases, but in no single instance did any body catch
i the disease. I stated towards the close of that ever memorable
;i season, that I would expect to meet with Yellow fever for a fort-
' night after a frost. I had taken up the belief that ten days, or a
fortnight, was the period of incubation of the poison. My last
case died at the hospital on the 27th of November ; frost had oc-
1 curred on the 13th of that month. The unfortunate subject had
reached our city before the mighty destroyer of the poison had
withered and destroyed its noxious powers.

Such, gentlemen, is my experience of the relation of Yellow and
Bilious fever.
Savannah, April, 1856.

536 Holt's Letters upon General Pathology. [September,

ARTICLE XXIV.
LETTERS FROU SAUL. D. HOLT, M. D., UPON SOKE POINTS OF GENERAL PATHOLOGY.

LETTER NO. 14.

Montgomery, Ala., July 22nd, 1856.

Messrs. Editors Having expressed the belief, that the liver is
primarily affected, and largely concerned in the production of these
fevers, (intermittents and remittents,) it is but proper that I should
give some of the reasons which induce that belief.

The liver is a large central organ, having more intimate and
extensive anatomical relations with other important organs and
systems, and a greater number of offices and functions to per-
form, than any other organ in the body. It receives the blood
from other organs, which is distributed through its substance, from
which the bile is secreted ; it receives and elaborates a large por-
tion of nutritious matter furnished by the process of digestion, to
which the bile largely contributes ; it prepares the carbonaceous
products for more easy and rapid combustion in the lungs, and
thus aids in the production and evolution of animal heat ; it elimi-
nates the impure and effete matters from the blood which it re-
ceives, and thus acts the part of one of the principal depurating
organs of the system. The liver, being an excitable organ, is liable
to frequent interruptions in the performance of its functions, by
causes which tend to increase or diminish its activity, either of
which results must be felt in a greater or less degree throughout
the system, but more particularly by those organs in immediate
connection with, and dependent upon it. To say nothing of other
causes, the stimulant effects of atmospheric heat (which, by-the-by,
is essential to the production of these fevers) upon the liver, which
it highly excites, often causes an increased, and sometimes very
excessive, secretion of bile ; and the bile thus secreted is generally
imperfectly formed and depraved in its character, and in place of
subserving its natural purposes, it acts as an irritant to the stom-
ach and intestines, giving rise to bilious vomiting and purging,
(than which nothing more rapidly prostrates the nervous or vital
powers,) suspends the function of digestion, interrupts the process
of elimination, and depuration, and, in a word, suspends or de-
ranges all its functions, as well as those of dependent organs. But
if these effects follow excessive action, from over excitement, let

1856.] Holt's Letters upon General Pathology. 537

us see some of those which result from, deficient action, from de-
pression. The non-secretion of bile, which is essential to the
digestive process the non-elaboration of the materials of nutri-
tion the non-elimination of the impure and noxious substances
from the blood, and all the consequences which grow out of these
suspended functions, to say nothing of the effects resulting from
bilious and sanguineous congestion of the organ, are the legitimate
and natural results of torpor and acidity of the liver.

The question then arises what cause is most likely to produce
this condition of the liver ? Without calling in the aid of other
causes, which no doubt exert an influence in the production of
these fevers malaria, for instance which may have the effect of
increasing the bile matter in the blood, and thus increasing work
for the liver, or which may have the effect of impairing the pro-
cess of digestion and nutrition, thus impoverishing the blood and
rendering it more difficult of depuration, we can find a cause (and
the true one in my opinion) for this condition of the liver, in the
loss of excitabilitg from over action, consequent upon long continued
and high ranges of atmospheric heat. While atmospheric heat is
thus employed in the production of these fevers, at least so far as
the liver is concerned, it exerts a large influence in determining
their general character, with respect to the degrees of excitement, as
it tends in the same manner to impair the tone and vigour of the
! whole nervous system, as it does the liver. When the febrile or
i reactionary movement commences in these fevers, in the manner
which has been indicated, by the redistribution of the accumulated
( excitability to the organs whence it was derived in the formation
i1! -of the cold stage, or stage of nervous depression, it will proceed
Li with a rapidity, and progress, to an extent or degree of excitement
a proportioned ahvays to the condition of the general system, in re-
& spect to the amount of vigour and excitability which it possesses,
I as determined by the operation of the individual and general pre-
| disposing causes, and by the presence, or not, of epidemic influ-
- ences thus giving rise to the modifications which these fevers
assume with respect to the degrees of excitement, which I have
attempted, accordingly, to classify. So far, then, as the febrile
movement, and the essential type and character of these fevers are
concerned, it matters not whether the excitability of the system is
plus, or minus, or whether the excitement rises above, or falls below
the fine of a healthy excitement. If the system possess vigour

538 Holt's Letters upon General Pathology. [September,

and tonicity, the depression will generally be slight and of short
duration, and the reaction will be prompt, rapid and complete. If
the system possess less vigour, and more elasticity and mobility,
the reaction may be rapid, but will be less certain, complete, or
permanent ; and if the system is enfeebled and depressed, the re-
action will be proportionately slow, feeble and imperfect, or incom-
plete thus furnishing us 'with the inflammatory, the irritant, and
the congestive forms or grades of these fevers, with such intermedi-
ate grades or degrees as have already been noticed.

Before I attempt an explanation of the pathological condition
of the principal organs, as they exist in the second or febrile stage
of these fevers, it is proper that I should first notice the condition
of the skin, and the remote systematic capillaries, as they not only
play an important part in the production of these opposite condi-
tions of the system, but furnish the most prominent signs of the
actual condition Avith respect to the degrees of excitement or de-
pression. I have stated that in the formation of the cold stage,
these vessels became deprived of their accustomed or proportionate
share of excitability, and in consequence became relaxed, allowing
of the free escape of the blood sent to them by the heart, which
continues its action to some extent independent of the general loss of
excitability; and the flow of blood being retarded in the pulmo-
nary extremity, from a feeble respiratory movement, necessarily
accumulates upon the right side of the heart, including the pulmo-
nary artery and its ramifications. While this state of congestion
gives rise to plethora, or engorgement in the organic capillaries, in
the manner which has been described, the remote capillaries re-
main free from such engorgement, except in very extreme cases of
depression, as in collapse and asphyxia, and this is owing to the
valvular structure of the veins, and the remoteness of their radi-
cles in the extremities from the seat of congestion, which has been
shown to be in the lungs and heart, (congestion of the liver hav-
ing no agency, so far as the remote capillaries are concerned). The
cold, flaccid and shrunken condition of the skin and extremities,
and the feeble action of the heart, indicate the feebleness of the
respiratory movement, and the sluggishness of the pulmonary
circulation, which is sometimes so great, that not only do the ex-
tremities become cold, but the whole surface of the body, and even
the tongue and breath become so. This condition may exist in
various degrees, from the slightest chill perceptible, to a complete

1856.] Holt's Letters upon General Pathology. 539

collapse, depending of course upon the degrees of nervous depres-
sion ; and so may the febrile or hot stage vary in degrees of excite-
ment, from a simple flush to the most intense febrile action. Now,
as it is our duty to enquire what takes place in these conditions, it
is equally our duty to enquire into their why and wherefore. It
would seem, then, that the two extremities of the circulation were
mainly employed in the formation of the cold and hot stages of
intermittent and remittent fevers; that while nervous depression
retards the flow of blood through the pulmonary extremity, the
same cause, by relaxing, allows it to flow readily and freely through
the remote capillaries, and the natural consequence must be an
accumulation of blood on the right side of the circulation, as it
exists in the cold, or congestive stage, and which must continue
to exist, with the attendant phenomena, as long as the depression
continues; and that, while excitement accelerates the flow of blood
through the pulmonary extremity, it retards it in the remote ca-
pillaries, and the accumulation necessarily takes place on the left
side of the circulation, as it exists in the hot or febrile stage. It
is true, that the circulation of the blood depends upon the action
of the heart, but the heart has not as much agency in the produc-
tion of these conditions as we might be disposed to believe from
first sight. The retardation of the blood in the lungs cannot be
charged to a want of action in the heart, for in fact, the blood is
thrown in excess upon the pulmonary capillaries by the heart's
action : nor is the emptiness of the remote capillaries, in the cold
stage, to be laid to the feeble action of the heart, as we see that the
, action of the heart is always sufficient to empty the arteries.
With this explanation of the manner in which the cold stage of
an intermittent is formed, from a want of nervous power and action
in the two capillary extremities of the circulation, in consequence
of its accumulation in the liver, or other weak and laboring organ,
which I have shown to be the first step or link, in the chain of
morbid actions which follows, with the blood accumulated upon
the right side of the circulation, with its attendant consequences
and its phenomena, I will proceed to examine the consequences
of a return or restoration of nervous power to the capillaries of the
two extremities, being the commencement of the reactionary or
febrile movement.

Upon an increase of the respiratory movement, and a freer flow
of blood through the pulmonary extremity, the heart, in conse-

54:0 Holt's Letters upon General Pathology. [September,

quence of an increased supply of blood, which has been revivified
in its passage through the lungs, becomes increased in action and
sends the blood out to all parts, as fast as it is received from the
lungs. If the heart failed in this, and was not responsive to the
stimulus of the fresh arterial blood, an increased flow of blood
through the pulmonary capillaries would necessarily produce con-
gestion in the pulmonary veins a thing, I dare say, which rarely
occurs. So far, the action of the heart is instrumental in carrying
on the febrile movement, though not instrumental in starting it.
The next event in the regular sequence is an increase of the gen-
eral excitement, from the stimulus of the blood upon the nervous
centres, and an increase in the activity or power of action, in all
parts which share in the general excitement. If the remote or
systematic capillaries receive their full share of excitement, and
regain their contractile power, they will be enabled to retain their
blood sufficiently long for the arteries to become refilled, which
will be the sooner, in proportion to the flow of blood through the
pulmonary extremity of the circulation. In this condition of
things, we have a full development of the febrile stage, with all
the phenomena dependent upon it, such as a hot, dry skin full,
strong pulse, &c, &c. But this prompt reaction, and high excite-
ment, presupposes or indicates a full share of vigour and excita-
bility in the system, which does not always exist in our latitude.

From the influence of causes, which have been sufficiently
pointed out, it is generally the case in our climate that owing to
less vigour, and greater elasticity and mobility of the system, independ-
ent of the immediate depressing influences which would retard .
reaction, notwithstanding there may be a free flow of blood
through the pulmonary extremity, duly exciting the heart to ac-
tion, and* the nervous centres respond to the stimulant influence
of the blood, promising a full and uniform, or perfect, reaction, the
unequal distribution of nervous excitement is almost always certain
to prevent it. Thus, if the remote capillaries fail to receive their
due share of the nervous power, or excitability in its re-dis-
tribution, or of the new excitement kindled up by the reaction,
through the nervous centres, the consequence will be that they
will allow the blood to pass so rapidly out of them as to prevent
the perfect filling up of the arteries, which is the case in the irri-
tant forms of these fevers, and which are characterized by a hot,
but generally moist skin, and a frequent pulse the action of the

1856.] Holt's Letters upon General Pathology. 541

heart being spent in frequency of action on account of a dimin-
ished column of arterial blood, the nervous centres, in such cases,
being often the seat of accumulated excitement, giving rise to de-
lirium, convulsions, &c. A greater degree of depression, or less
of reactionary power, with loss of tone and contractility in the
Systemic or remote capillaries, generally determines the grade of
these fevors, which will be known by *the feebleness of and fre-
quency of the pulse, and the coldness and fiaccidity of the skin,
during the reactionary or febrile stage of the disease, or paroxysm.
In all the grades of these fevers below the irritant, the febrile ex-
citement, though generally manifest, never rises so high as to
create or establish a general arterial plethora, or a preponderance
of the blood upon the left side of the circulation, except in organs
which have been engorged by previous congestion, as the brain,
stomach, liver, &c, in the manner which has been described, or in
such parts as may become the point of accumulated excitability,
giving rise to irritation or inflammation, which conditions are usu-
ally manifested by increased heat of the head and body, while the
extremities remain cold, or pre tern aturally cool during the parox-
ysm, indicating a want of tone or power of action in the remote
capillaries.

Having given what I conceive to be the "rationale," or the
physiological and pathological process by which the cold and hot
stages of intermittent and remittent fevers are produced, which, so
far as the two extremities of the general circulation are concerned,
is applicable to the production of every other form, grade, or type
. of fever, whether the attack be preceded by depression and
congestion, or whether (if such a thing be possible,) the sys-
tem rise into a state of general febrile excitement without it, I
feel it due to myself in order to prevent misunderstanding, to re-
peat, that the capillaries of the pulmonary extremity of the general
circulation, under the influeuce of general nervous depression, fails
to transmit the blood through them as fast as it is sent to them by
the heart, and consequently the blood accumulates behind them ;
and that the remote capillaries, under the same influence, transmit
the blood faster through them (except where it is opposed by phy-
sical obstruction,) than it is sent to them by the heart ; and that a
reversed condition and result occurs when these vessels are under
the influence of general nervous excitement, the heart in the mean-
time performing its part in the circulation of the blood, but not

542 Holt's Letters upon General Pathology. [September,

controling the action of the capillaries* It may be asked, why re-
sort to a local origin, and to the doctrine of accumulated excita-
bility for the production of the cold stage, and its diffusion or
redistribution for the production of the hot stage of these fevers,
when an easier and shorter way would have been to assign their
production at once, to the direct influence of the causes of depres-
sion and excitement upon these vessels ? In my opinion, I have
given the true method of their production. In my last letter, I
stated that a condition of general depression and congestion could
be produced from a sudden and violent shock to the great nervous
centres ; and so may a high state of general excitement be pro-
duced from some powerful cause, but in each case they would be
but ephemeral and transitory, while in these fevers these conditions
are permanent, or of frequent occurrence according to their type,
form, or modification.

The importance of these points of pathology, respecting the degrees
of nervous excitement, and the consequent unequal and irregular dis-
tribution of the blood, involving, as they do, the most serious conse-
quences, attendant upon these and, indeed, all other fevers, is my
apology for dwelling upon them with so much earnestness and per-
tinacity ; for I candidly believe, that if they were looked to more

* I would not, question the fact that the circulation in the capillaries is assisted,
as has been maintained by the influence of affinities, that is, that the arterial blood
in exchanging oxygen for carbon in the remote or systemic capillaries produces a
forward movement, and that a deficiency of oxygen in the blood, has the effect to
retard its movement in the remote capillaries, while in the pulmonary extremity
the affinity of venous or carbonized blood for oxygen produces the same result, and
that an excess of carbon retards it in the pulmonary capillaries. But this doctrine
does not serve to account for the broken balance which sometimes suddenly takes
place in the formation of the cold and hot, stages of the fevers in question, and cer-
tainly does not serve to explain the causes of their production, if we leave out of
view the condition of the capillaries, with respect to the degrees of nervous excite-
ment and depression, upon which I maintain these disturbances in the circulation
mainly depend. And if we attempt to explain the production of these phenomena,
According to the doctrine of affinity, we will find that the condition of the capilla-
ries have no agency in their production, but that they depend upon the condition
of the blood with respect to its amount of carbon and oxygen ; and, we will be com-
pelled to look further for the causes which produce that condition, which will be
found as I have maintained, in defective and imperfect ecration from an enfeebled res-
piratory movement, whereby the quantity of oxygen is diminished; or from defec-
tive and imperfect depuration from suspended functions of the liver, whereby the
quantity of carbon is increased in the blood, which after all are but the effects or
results of deficient nervous excitability. H.

1856.] Holt's Letters upon General Pathology. 548

closely by the profession at large, our cardinal remedies would receive
the credit of their true " behest," and these diseases would be treat-
ed with more uniformity and success than they generally have been.
It is not in the spirit of arrogance, but of self-gratulation, (which,
by-the-by, is about my only reward) that I say, that the principles
which I am endeavoring to advocate have carried me through a
practice of nearly thirty years, with, perhaps, as few disappoint-
ments, or causes of regret, as the most favoured of my cotempora-
ries. It is not very delicate, I know, for a professional man to
blazon his success, even in the ears of his colleagues ; but, as an
argument in support of this principle which I advocate, I will state
that, in the management of certain formidable diseases, scarlet
fever, for instance, though I have encountered it in all its forms and
varieties, through several epidemics, besides many individual or
sporadic cases, I have had the good fortune never to lose a case.
It is but justice, however, to myself and the profession, to say, that
I have pursued no plan, and used no remedies, which are not recog-
nized and prescribed by the best authors, with this exception, that
viewing the disease as self-limiting, having a definite course to run,
according to its essential and specific nature, I have generally avoid-
ed as much medication as the books prescribe, but have left it to its
course, watching, however, for such symptoms as did not belong to
it in its essential character, and treating such upon the general prin-
ciples which I am now advocating, to which, next to peculiar good
fortune, I must ascribe my success.

In the management of yellow fever my success has been little less
than in scarlet fever; and so of typhoid fever, and various forms of
congestive diseases, the details of which will hereafter be given
among others, a severe epidemic congestive pneumonia, over sixty
cases of which I treated one season, without the loss of a patient.
It is not my privilege to say as much of some other epidemics which
I have encountered, such as cholera, and cerebrospinal meningitis.
But in these, the want of equal success depended rather upon the
want of a timely and proper application of the principles of which I
speak, than from error or defect in the principles themselves, as,
after all, I have not been able to ascertain that any other plan of
treatment was more successful. I am not so vain and arrogant as
to suppose that all case3 of those malignant diseases which I have
named are amenable to treatment, and that a great many of them
would not terminate fatally under any known plan or system of

544 Holt's Letters upon General Pathology. [September,

treatment ; but I do say, that hundreds and thousands of cases ter-
minate fatally, which under a timely and proper course of treatment
would recover ; and that in all such cases, where the physician has
been called in time, the responsibility is upon him, and he cannot,
upon the plea of their malignancy, or the impotency of the remedies
at his command, evade, or shrink from it. Nor should he be too
ready to claim the honor of success, as there are hundreds and
thousands of cases which would recover without his aid or assist-
ance. Such, no doubt, was the case with the largest number of the
cases of scarlatina and typhoid fever which have fallen into my
hands, which (" an honest confession being good for the soul") I am
willing to confess, though I could not say so much with respect to
the other diseases named.

Upon a redistribution of nervous power, or excitability, those
organs will receive the largest share, whose capillary vessels have
been the seat of engorgement from venous congestion. These have
been shown to be, the brain, stomach and intestines the liver and
spleen; and these, in consequence of irritation thus kindled up in
them, become the points of determination and accumulation of blood,
as it finds its way, more or less rapidly, through the pulmonary ex- '
tremity of the circulation. From the direct action of the causes of
irritation, the capillaries of these and other organs may become the
seat of engorgement, (which may or may not excite a febrile move-
ment in the system.) which is the antecedent condition to inflamma-
tion in these organs. Thus, we see that the capillaries of these
organs are doubly liable to engorgement, and, liable to double en-
gorgement ; for, if the reactionary powers of the system are insuffi-
cient to effect a full and complete reaction, and entirely remove the
congestion, which is generally the case in our worse forms of fever,
these organs, especially those which are connected with, and are
dependent upon, the liver, (which often remains in a state of con-
gestion after the lungs have been set free,) must necessarily remain
to a greater or less extent, in a state of engorgement, to be increased
from an increase of blood thrown upon them in consequence of the
febrile reaction; and whether the reaction be partial or complete,
these organs will always claim, and will generally receive, more
than their full share of the circulating fluid. Hence it is that so
many of these fevers are characterised during the febrile stage or
exacerbation, by heat of the body and head, but preternatural, cool
extremities, with a variable, but generally a feeble or frequent

1856.] Holt's Letters upon General Pathology. 545

pulse ; and this is the class of fevers which I have designated as
congesto-infiarnmatory and congesto-irritant. Should there exist a
greater amount of excitability in the system, with an active pulmo-
nary circulation, the degrees of animal heat will be proportionably
exalted, and the action of the heart increased, giving great celerity
to the blood which is in active circulation, and diffusing heat
throughout the system. In this form of fever, which we recognize
as the irritant, and by far the most common in young subjects
notwithstanding the reaction is often violent, as evinced by the in-
creased action of the heart, and the great increase of heat which
extends to the whole surface and the extremities the reaction is
never complete or permanent, for the reason that the enfeebled and
relaxed condition of the remote capillaries permits such a free escape
of the blood, that the arteries fail to be filled up, in consequence of
which the pulse never requires much strength, but is always fre-
quent, and the skin, though hot, is generally moist, a state of things
peculiarly characteristic of this form of fever. Now, while the re-
mote capillaries participate for a short time, and to a limited extent,
in the general febrile excitement, the organic capillaries always
come in for their full share, if not more, as evinced by the delirium
and convulsions, and the copious bilious vomiting and purging
which are almost the constant attendants upon the exacerbations of
this form of fever, abundant secretion being one of the diagnostics
between this and the inflammatory form. The irritation excited in
the brain by the stimulus of highly oxygenized blood, consequent upon
the active pulmonary circulation, constitutes a new and altogether
different morbid action from that which existed in consequence of
mere physical obstruction and engorgement of its capillaries from
congestion in the lungs, manifested by a change of the dull, inactive
and comatose state of the brain into a state of delirium, or phrenzy,
and convulsions. This condition is sometimes the result of sympa-
thetic action, in which case, though the manifestation may be nearly
the same, the irritation will be more transitory and evanescent, and
seldom passes into a higher or inflammatory grade of action, which
a long-continued or frequent renewal of the condition, from the re-
currence of paroxysms, is apt to do.

Another source of disturbance in the functions of the brain, and
other nervous centres, is to be found in the changed character and
depraved condition of the blood ; but cerebral disturbance from this
cause seldom takes place in the early stages, or in the milder forms

546 Holt's Letters upon General Pathology. [September,

of these fevers, and is only found in the protracted and violent case?,
in which the excitement has been so high as to suspend for a length
of time the functions of secretion and excretion, allowing of the ac-
cumulation of poisonous matters in the blood, which should have
been thrown out by the liver and other depurating organs ; and the
blood thus depraved, being thrown upon the brain and other nervous
centres, unlike the freshly oxygenized blood, instead of excitement,
produces depression, with low delirium and coma, the characteris-
tics of the typhoid condition. It seems to be scarcely necessary to
say that the inflammatory form of these fevers is distinguished from
the irritant, by the more equally diffused and permanent character
of the excitement by the greater strength and less frequency of the
pulse by the more uniform and often less intense heat by the
dryness of the skin, and the suspension of the secretion generally
by the more protracted febrile exacerbation, and generally by less
cerebral disturbance in the earlier stages of the disease.

Notwithstanding the frequent occurrence, and the important con"
sequences of disturbance in the functions of the brain and other
nervous centres in these fevers, there are other organs not less fre-
quently involved the derangement of whose functions are no less
important and serious in their consequences than those of the brain
these are the liver, stomach and intestines. The condition of the
latter, in connection with congestion of the former, in the cold
stage of these fevers, I have already considered, and as these organs
are all subject to the same states of morbid action, and the same
consequences and results, from exalted excitement, it will be unne-
cessary to notice them separately, and I shall therefore confine my
remarks, chiefly, to the functional derangements of the liver. These
fevers have generally been called bilious, but whether they are en-
titled to the appellation from an excess, or deficient secretion of bile
would be a difficult matter to determine. A certain degree of ex-
citement is necessary for the performance of the functions of secre-
tion, and whether it is too high, or too low, it becomes alike suspend-
ed ; hence we notice that in the cold stage of these fevers, and
particularly in those more decidedly congestive in their character,
the vomiting and purging, which is a common occurrence, consists
in the discharge of a glareous, mucus, or serous matter, having
more or less acrimony, without any of the properties of bile. But
upon the return of excitement, and the establishment of a febrile
reaction, large quantities of bile are often poured out, giving rise to

1856.] Holt's Letters upon General Pathology. 647

violent and obstinate bilious vomiting and purging. This excited,
and active secretory function of the liver, often occurs as an idio-
pathic affection, but when it occurs as one of the phenomena, or as
a concomitant of these fevers, it is usually in connection with the
milder and more simple forms of intermittents, attended with a
lively reaction, or with the earlier stages of remittents having the
irritant form or character, of which it may almost be said to consti-
tute a characteristic feature. But in the more advanced stages of
these fevers, and in those of higher grades of excitement, as well as
those of a lower, the suspension of the biliary secretion is one of the
most common occurrences, and constitutes one of the most serious
difficulties with which we have to contend. It is important, there-
fore, to enquire into the causes, and then into the consequences,
of the suppression or suspension of the secretion. We have stated
that over action from excessive stimulus, induced debility and ex-
haustion in the nervous tissues and have ascribed to this condition
of the liver, (a state of depression from excessive action from the
stimulus of atmospheric heat,) the origin of these fevers, and have
shown the consequences which resulted, not merely in the suspension
of the biliary secretion, but the formation of a portal congestion,
and the consequent obstruction and interruption of the functions of
other organs, and the changes thereby effected in the constitution
of the blood. Now it must be borne in mind that the liver is lia-
ble to congestion and engorgement from several different causes
one from congestion of the lungs, from local debility or depression
in its vessels from excessive excitementor arterial and capillary
engorgement and engorgement of the biliary ducts. The first, re-
sults from the general causes of depression ; the second, from general
or local causes of depression in the capillaries of the portal veins ;
the third, from excitement and the stimulus of freshly oxygenized
blood accumulated in the hepatic artery and its capillaries mani-
festing the signs of irritation, and perchance, the signs of inflamma-
tion but I must say, that in my whole practice, I never met with
a case which I could recognize as inflammation of the liver; the
fourth, engorgement of the biliary ducts and gall bladder, from the
accumulation of bile consequent upon its previously abundant or
excessive secretion, which, from its retention in these vessels, and
having parted with its thinner portions, it often becomes black and
inspissated. Hence, it is, that we often see harrassing vomiting,
and purging of thin bilious matter of various color and consistence,
N. S. VOL. XII. NO. IX. 35

548 On Scarlatina. [September,

followed by the discharge of large quantities of black or deep green
and consistent bilious matter, which is always hailed as the harbin-
ger of safety to the patient, especially, if it has been the work of a
substantial dose of calomel.

Being admonished that I am transcending the usual limits allot-
ted to my letters, I must close for the present, and resume the sub-
ject in my next letter. Hoping that you will not tire from reading,
before I do from writing about these things, I remain, as usual,
Your friend, &c. Saml. D. Holt.

On Scarlatina, audits Relations to Rheumatism, Carditis, and Al-
buminuria. By Dr. W. Hughes Willshire, Assistant Physician
to the Charing-Cross Hospital.

[The complications of scarlet fever are very numerous, and will
be found amply treated of in works on the subject ; but rheumatism
is one of those which, though common, has been but very cursorily
noticed, excepting within the last few years. In 1851, Betz, of
Heilbronn, drew particular attention to it, and went so far as to
hint at an essential relation between acute rheumatism in the child
and scarlet fever.]

He implies, at least, that an arthritic affection in young children
often could not be told from the exanthem in question. That he
had seen albuminuria and desquamation of the skin in acute rheu-
matism in children who had shown no exanthematous eruption ; and,
on the other hand, that the eruption was not an essential symptom
of scarlet fever, leaving it, therefore, a very difficult, if not impossi-
ble, case in which to arrive at a differential diagnosis. In 1853,
M. Trousseau stated that he had very frequently met with the com-
plication we are speaking of; that the arthritic disorder sometimes,
though but rarely, became generalised, and attained a high degree
of intensity, accompanied by delirium and other nervous symptoms
terminating in death. In 1854, I myself read a paper before the
Medical Society in London on Rheumatism in Children, in which
I adverted to its union with scarlatina (reported in 'The Lancet,'
1854, vol. i., p. 138) ; and a few months afterwards, Mr. Haydon.of
Bovey Tracy, communicated some very interesting facts in ' The
Lancet," in reply to a commentary, as it were, upon my paper. You
"will find Mr. Haydon's communication in the first volume of that
journal for last year. This gentleman has had some very corrobo-
rative experience, and states, that although he cannot coincide in
the views I have detailed of Betz, he admits there is a remarkable
analogy between the phenomena, especially the secondary ones of
the two diseases; and that so closely does he consider the two rela-
ted that he makes it a rule, on the decline of the rash in scarlet

1856.] On Scarlatina. 549

fever, to administer lemon juice. I strongly advise you to read Mr.
Haydon's remarks, and then to turn to Betz's paper, which you
will find in the eighteenth volume of the 'Journal fur Kinderkrank-
heiten.' In both essays you will find how easily certain cases of
the two affections I say certain cases, mind might be confound-
ed together.

If we were to take extreme forms of the two diseases viz., on
the one hand, an almost universally bright-red child, with sore
throat, strawberry tongue, who had been known to have been with
other children similarly affected, and on the other hand, a pallid,
scrofulous child, without any cynanche, with a white-coated, moist
tongue, and swollen and painful joints, there would certainly arise,
I should say, no difficulty about the matter. But you must recol-
lect scarlet fever is not always of this characteristic appearance ;
the sore-throat may be next to nothing, or absent; the rash only
evident about the joints, which may be a little puffy and painful ;
the tongue but moderately and simply coated, and the child not
known to have been directly exposed to the zymotic virus. On the
other hand, if what is stated be true, albuminuria may be tempora-
rilv present in rheumatism, as also, according to Betz, desquamation
of the cuticle. Now, in a case presenting such equivocal signs as I
have hinted at as possible, I do not know that from these signs
alone, and from these only, the differential diagnosis could be per-
fected. But this I must believe, from my own experience up to the
present, that the further course of the malady, together with the
commemorative history of the patient, would not fully help me out
of the difficulty. The difficulty, in truth, has not yet occurred to
me; but let me tell you that in India and in America a somewhat
analogous one has happened to others, and from this, and what you
will glean from Dr. Betz and Mr. Haydon, it is not impossible we
might hereafter have a case occur amongst us, or an epidemic dis-
order, which should have such a mixture of the symptoms of rheu-
matism and scarlatina that we should be much puzzled to give it a
satisfactory name.

A late patient of mine had been surrounded by the scarlatinal
poison; she had sore-throat, diffused red efflorescence ; the tongue
and even breath were those of scarlet fever. The rash subsided,
desquamation just began around the neck, when pains of the ankle
and wrist joints came on ; the parts were swollen and shining, and
a kind of secondary fever was lighted up. Now, whatever might
be thought of this latter affection, the former was clearly not rheu-
matism. That there is some obscurity about the exact nature of a
disease occasionally attacking not only children, but adults, and
marked by arthritic pain and tension often of a severe character,
accompanied by a scarlet rash, is plain from the accounts given by
some American and East and West India practitioners. For in-
stance, in 1824, 1825, and 1847, outbreaks of a disease like the one
I have just mentioned occurred in the East Indies. In the summer

550 On Scarlatina. [September,

of 1828, the malady appeared epidemically in some of the southern
cities of the American Union, after having previously prevailed in
some of the islands of the Gulf of Mexico. In Charleston it spread
with great rapidity, ultimately attacking almost the entire popula-
tion. In this latter city the last occurrence of it that I have found
recorded was in 1850, and is alluded to by Dr. Dickson, of South
Carolina. In Calcutta, again, during the hot and rainy season of
1853, a variety of the same affection prevailed, and has been well
discussed by Dr. Goodeve in the first volume of the ' Indian Annals
of Medical Science' for that year, and to which I must refer you.
Now, this disease has been called scarlatina rheumatica by Cocke
and Copland, exanfhesis o.rthrosia by Nicholson, and the strange cog-
nomen of dengue has been popularly bestowed upon it. I have said
that the first account of this disease goes not further back than
1824 ; but it is proper I should mention that Dr. Dickson, of Charles-
ton, writes as follows: "I recognize Rush's "break-bone fever' of
1780 in Philadelphia as the first notice of a malady such as I have
called dengue ;" and Dr. Waring, of Savannah, alludes also to
dengue under the title of " eruptive breakbone."

I cannot go into the details of this peculiar disorder : indeed, I
have only alluded to it to show you that there occurs a fever, ac-
companied by arthritic pains and a red exanthem, whose true rela-
tions to scarlet fever yet require clearing up. However, I may just
remark, that Dr. Dickson regards dengue as a distinct contagious-
disease, giving immunity from second attacks, and that it is not
scarlatina ; whilst Mr. Goodeve states that most of the symptoms
characteristic of the latter affection found expression in some of the
cases occurring in Calcutta. He says, "the fever eruption, red-
dened mucous membrane and tonsils, desquamation of cuticle, swell-
ing of hands and feet, state of the tongue, albuminous urine, and all
such as go to make up scarlatina ; but it would be premature to as-
sert that the cause is identical with that of scarlatina. I should say
that it would require a longer series of observations of several epi-
demics, with careful examination of all the attendant circumstances,,
before we could pronounce the diseases to be identical." Again.
Dr. Copland affirms, that the disease called dengue "Was not a form
of scarlatina is shown by the severity of the rheumatic or neuralgic
symptoms," &c. ; and "that it was not a rheumatic fever was shown
by the undoubted propagation of it by infection," &c. I see that
in some later observations by Dr. Mackinnon, in the third number
of the 'Indian Annals,' he doubts whether any of the epidemics of
India described as attended by red efflorescence of the skin can
be identified with any of the varieties of the scarlatina of Europe,
denies the disease we have referred to to be contagious, and for
which, he says, the name of " the red fever " is as good a name as
any other.

On reviewing the different accounts given by Indian and Ameri-
can writers of this puzzling affection, the disease appears in certain

1856.] On Scarlatina. 551

places, and epidemics, to have had more the characters of rheuma-
tism ; whilst in others it has had more those of scarlatina. The
case mentioned may be said to illustrate, so far as my own experi-
ence extends in respect to the relations between scarlatina and
rheumatism, one form of the arthritic complication namely, that
occurring early in the course of the exanthematous disease. When
it so occurs, the specific inflammation about the joints terminates,
like primary or idiopathic rheumatism, in resolution or delitescence.
But it may take place at a later period of the disease, when all has
been thought to be over. It occurs after desquamation has made
some progress, and then may terminate in the suppurative crisis.
Now, this is peculiar about the rheumatic inflammation generally
of young children ; unlike in adults or older children, it may lead to
purulent effusions into joints, and also about them. I have known
this to occur in several instances, and it is more liable, I believe, to
ensue in the secondary rheumatism of scarlatina. This is a fact
well known to authors. If I recollect aright, Dr. Kennedy, of Dublin,
has published something upon it, and Trousseau, I know, states that
scarlatinal rheumatism is often more dangerous when localized to a
single joint, than when attacking several articulations at one time,
as it is then more inclined to terminate in suppuration, and even
eventually to result in caries of the articulating surfaces. This cir-
cumstance, however, of the arthritic inflammations of infants and
young children, not unfrequently terminating in the formation of
matter, has led some pathologists to deny the true rheumatic nature
of the disease in question. I must confess, too, it does seem to me
not improbable that the results of pyohaemia, or purulent infection,
of phlebitis, umbilical or otherwise, may, along with other forms of
abnormal action, have been occasionally placed to the credit of ordi-
nary rheumatic inflammation. But Mr. Henry Lee, who has paid
great attention to the subject of purulent infection, states that he
has seen, as the result of the absorption of sero-purulent fluid from
an ill-conditioned abscess, very severe rheumatism, affecting, in
some instances, the pericardium and dura mater. In these cases
there was occasionally more fluid secreted than in ordinary rheu-
matism, but in milder examples there was no such distinctive mark;
they are said to have been " in every sign and symptom apparently
identical."

I have undoubtedly seen cases in children, which I should not
have known from rheumatism, terminate in the suppurative crisis.
If it be said, then such cases therefore could not have been rheuma-
tism, the argument is of course settled ; but it appears to me only
so by apetitio principii. In adults, again, rheumatism does occa-
sionally, however rarely, terminate in the formation of matter. In
this case of mine some mischief ensued certainly to the mitral, if
not also to the aortic valves. It may be but slight, still there it is,
and may lay the foundation for changes in after years connected
with the walls of the heart's chambers. The abnormal sound (which

552 On Scarlatina. [September,

some of you have listened to) at the apex is very loud, but this is
not proof of the amount of structural mischief at the mitral, for there
may be much noise and slight change, and but little noise and great
alterations. The former, I hope, is the case here ; but from the
pulse being so small at the wrists, my hope is not to be too much
trusted too. A German pathologist affirms it to be a general thing
in scarlatina for the first sound of the heart to be aspirated or blow-
ing, which is a result of the altered state of the blood, and not of the
valves, and is a proof that scarlatina and all its complications arise
from one common blood disorder. I presume he must mean to re-
fer only to the sound at the base, and not at the apex (where our
worst one is), of the cardiac region. Sounds at the base may be of
haemic origin, but at the apex they are, I believe, always of struc-
tural derivation.

The liability of the heart to become affected during scarlatina has
been known for some time. Roux in 1819, and Krukenbergius in
1820, are said by Rilliet and Barthez to have referred to the occur-
rence of pericarditis in connection with scarlatina and measles.
Trousseau says Bouillaud pointed it out ; but certain it is Mr. O'Fer-
rall, in 1835, detailed to Dr. Graves, of Dublin, how he was obliged
to have recourse to leeching, calomel, and James' powder, to over-
come acute pericarditis in connexion with scarlatina. Several
later writers, as Burrows, Willis, Joy, &c, have noticed this com-
plication ; and not long ago, M. Trousseau stated it as his belief,
that " many cases of organic disease of the heart, which only
become evident at an after period, have had their origin in scarlet
fever." But, so far as I know, we are most indebted to Dr. Scott
Alison for prominently bringing this matter before our notice, though
it has been said that the frequency of the complication has Deen
somewhat exaggerated. You will find Dr. Allison's original paper
in the 'Medical Gazette' for 1845. The case I have mentioned
makes the third one of heart complication during scarlatina that I
have seen, and here it has occurred in connexion with an arthritic
affection. One might d priori, suppose the sequences of the phe-
nomena would always thus present themselves, but it seems that it
is not so, as the involvement of the cardiac organ is alluded to by
writers, as well as seen by myself, without the arthritic affection
having preceded or accompanied it. I find it remarked that in the
tStuttgard collection of papers on "Children's Diseases," the occur-
rence of purulent collections in the pericardium during scarlet fever
is mentioned by Von Amnion, whilst effusion of pus beneath the
periosteum and in the substance of muscles has been recorded by
others. It is, therefore, possible that the rheumatism in this case
had, in one sense, nothing in itself to do with the cardiac affection,
but that both were the effects of one same and common cause, and
that this cause was the same condition of the blood which gave rise
jo every other manifestation of the scarlet fever,

But it is said that the rheumatism occurs, like the dropsy, from

1856.] Dilution as a Principle in Therapeutics. 553

unnecessary or incautious exposure of the child to cold ; whereas,
in the latter case, we find the disease will come on where no such
exposure was known to have taken place. We frequently find this
secondary rheumatism occur without any cardiac involvement
arising, while the primary form, in children, is very far more apt to
include the central organ of the circulation within its grasp than at
other periods. Had it been my intention to treat of scarlatina or
rheumatism substantively, I must, when speaking of the nature of
these maladies and their complications, have said much about uric
and lactic acids, of urea in the blood, ot a specific poison, of the ne-
cessity of that poison being eliminated from the system, of the pecu-
liar irritative action of the urea or some other poison in the blood
upon the serous membranes, of an elective affinity in scarlatina for
the kidneys, and many other topics of the like nature. But I should
have felt it my duty to have impressed upon you at the same time,
that these would but have helped us to hypothetical and very obscure
explanations of points which it must be confessed an exact and va-
lid pathalogy is not as yet able to include within its grasp. All that
I now lay stress upon, therefore, is a certain observed sequence of
phenomena Scarlatina, Rheumatism, and Heart-disease; a sequence
observed sufficiently often, and under such intimate relations of time
and place, to warrant us in associating these phenomena in casual
connexion, however the true relations of this connexion may be af-
terwards definitely fixed. I would also, in conclusion, recall to your
memory, that whilst we have had recorded experiments on animals,
in which the kidneys have been removed, or the ureters tied, &c,
and cases related where the secretion of urine has been suppressed
from stoppage of the ureters by calculi and new formations, and
which cases and experiments have been followed by vomiting, dry-
ness of the tongue and mouth, &c, intense thirst, altered or husky
voice, serous profluvia, great perspiration, convulsions, deep stupor,
and death. I am not aware that dropsy, affections of the synovial
membranes, of the pleura, or of the pericardium have followed, as in
scarlet fever. [Lancet.

On Dilution as a Principle in Therapeutics. By Benj. Bell, Esq.,
Edinburgh. (Read before the Medico-Chirurgical Society.)

[In the administration of remedies of a metallic nature, we may
err in not having them sufficiently diluted. Our purpose should be
to gain ready entrance for them into the blood : take for example
iron. We know that the entire blood of an adult does not contain
more than 30 grains, and that this is deficient in.anaemia. But what
use can there be in giving such large quantities when so little is re-
quired ? Our doses, then, ought to be small in quantity, and amply
diluted. We may learn the same lesson by examination of medi-
cines prepared for our use in the great laboratories of Nature. The

554 Dilution as a Principle in Therapeutics. [September,

famous spring at Pyrmont contains about half a grain in the pint
of water ; that at Tunbridge Wells only about one- third of a grain;
the same also in the bromine and iodine springs of Kreuznach;
they exist under the same condition of remarkable dilution. But
we cannot doubt their virtue in glandular swellings and scrofulous
diseases. May we not, then, take a hint from nature, and prescribe
our metallic preparations in smaller doses, and largely diluted?]

Of late years, I have seen reason to believe that all the benefit
derivable from certain metals, as remedial agents, may be secured
by comparatively small doses, provided that they are sufficiently
diluted. I have seldom trusted to what could be called very minute
doses; but so far as my observations go, I have a strong impression
that, within certain limits, we do not increase the efficacy of such
medicines by adding to the quantity prescribed. For example,
eight or ten drops of the muriated tincture of iron in a large glassful
of water, will, if useful at all, do as much good to our patient, as
double or treble the quantity. And a similar remark applies, in my
opinion, to the iodide or bromide of potassium, a single grain, or at
most two of either, in a glass of water, being capable of effecting all
the benefit of larger doses. We have already seen that the natural
springs of world-wide celebrity present these ingredients in the pro-
portion of one-third of a grain to sixteen ounces, and therefore we
shall probably find, upon more extended trial, that corresponding
doses of our pharmaceutical preparations, similarly diluted, will an-
swer every purpose.

It may be observed in passing, that although no strictly analogous
argument, furnished by the chemical composition of natural springs,
can be urged in regard to the administration of antimony, the prin-
ciple of dilution is probably no less applicable to that important
remedy. Without venturing to speak very dogmatically on the
subject, I have a pretty strong conviction that we both increase its
remedial power and lessen its tendency to cause sickness by diluting
our antimonial solution. Many practitioners suppose, that without
the production of nausea, we miss our object in subduing pulmona-
ry inflammation, the principal disease for which that metal is pre-
scribed ; but I doubt the soundness of this view, and am inclined to
think that every object may be gained without sickening our pa-
tient, just as iron and mercury can produce their curative effects
without (he former causing headache, or the latter salivation. Our
aim should be to bring the antimonial into contact with the capilla-
ries of the inflamed part, and this, probably, will be best promoted
by presenting it in a form fit for immediate absorption into the cir-
culating fluid. When this is attended to I find it seldom necessary
to give more than the sixteenth or twenty-fourth part of a grain of
tartrate of antimony in successive doses.

Another dpriori argument, in favor of this practice, may be ad-
duced. Unless a metallic medicine be administered in a state of
proper dilution, that condition will be secured by the secretion of

1856.] Dilution as a Principle in Therapeutics. 555

more or less fluid within the stomach itself, in order that the for-
eign matter may be in a fit state for being taken up and appropria-
ted by the blood. But it is evidently desirable that this secreting
process should be kept within as narrow bounds as possible, in every
case standing in need of tonic remedies, and therefore, if it can be
rendered unnecessary, even in part, by previous dilution ab extra,
we secure an advantage for our patient. If, however, we still ad-
here to large doses of the active ingredients, it is obvious that, in
order to effect the necessary dilution, we must increase the entire
quantity of liquid so enormously as to oppress the stomach, and de-
range the digestive process.

Other advantages of moderate doses, largely diluted, taking their
efficacy for granted, will be readily admitted ; for besides being less
hurtful, it may be, to the teeth, they are also less unpalatable and
better adapted on that very account for being taken and digested
with the food, a point, the importance of which has been long fully
recognised by practical men. That this last advantage is not ima-
ginary, may be gathered from our familiar experience regarding the
chloride of sodium. Mixed with the food at meals, although useful
in helping digestion, it has no aperient action ; but the same quan-
tity dissolved in water, and swallowed when the stomach is empty,
before breakfast, will almost certainly open the bowels. In the
former case, it is absorbed gradually in company with the food ; in
the latter, being presented too abruptly and strongly to the fastidi-
ous capillaries of the portal system, it is rejected by them, and hur-
ried onwards through the canal, from convolution to convolution,
and hence its qualifications as a purgative. But, if the solution be
a concentrated one, it will probably never reach the bowels, but act
as an emetic, and be rejected at once from the stomach. And cases
are met with, in the annals of toxicology, where death itself was
occasioned by large and irritating doses of common salt. Supposing
it, however, to act as a purgative, the explanation of its action given
seems preferable to the endosmosis theory, which appears to be too
mechanical, and ignores entirely the vital affinities and endowments
so conspicuous in the living body. We have supposed the solution
of the chloride of sodium to be moderately concentrated, like sea-
water, or in the proportion of about a drachm to four ounces ; but,
if we double the allowance of water, we shall probably find that the
action is no longer purgative, but diuretic. The salt has entered
the circulation and will be eliminated by the kidney.

It may be objected, perhaps, to the principle we are advocating,
that it takes for granted that the whole of the medicine swallowed
is absorbed and received into the blood, whereas, allowance should
be made for a great part of it passing through the alimentary canal
unchanged, and more, therefore, ought to be administered than we
can expect the system to appropriate. That this superfluity does
exist, when large doses are given, we have already suggested, and
also that it is probably a source ot injury to the patient; but the

556 Dilution as a Principle in Therapeutics. [September,

likelihood of such being the case, is obviously much less when the
dose is small and well diluted. Moreover, we are very apt, I sus-
pect, to over-estimate the quantity of any foreign substance which
is needed, in order to act upon the human body.

I have repeatedly seen so small a dose as the eighth of a grain of
extract of belladonna taken into the stomach of a young person,
cause full dilation of the pupil. Now, if we only consider how ex-
tremely minute must be the portion even of this very small dose,
when circulating through the blood-vessels, which could come into
contact with the nerves of the iris, we may form some conception
of the susceptibility and delicacy of our frame. To take another
illustration, let us consider the remarkable efficacy of the muriated
tincture ot iron in erysipelas, or in acute desquamation of the tubuli
uriniferi following scarlet fever. An adult is labouring under the
former of these complaints, with much febrile disturbance, as indi-
cated both by the hot dry skin and the frequent bounding pulse ;
we administer ten drops of the tincture every two hours, and after
two or three doses, as I have often seen, the symptoms give way, the
skin becoming moist and cool, and the pulse slow and soft. A few
grains of iron, at the very most, have mingled with the circulating
blood, and of these a mere fractional portion has reached,the congest-
ed capillaries of the inflamed region, and occasioned the favourable
change, and in this way, a comparatively small dos:e of a substance
confessedly foreign to the system, comes to fulfil the purpose we
have in view with all the efficiency of a larger quantity.

A boy of ten years, we shall suppose, who has recently passed
through an attack of scarlet fever, is observed to have oedema of the
eyelids, a furred tongue, and a full, febrile pulse. His urine is of a
dingy colour ; it deposits a dark sediment, and is scanty and albu-
minous. Five drops of the tincture of iron in a glass of water, are
administered every four hours; a speedy improvement commences,
and in two or perhaps three days, the symptoms are entirely gone.

Such facts, besides enforcing the principle we have been incul-
cating, should leach us to deal tenderly at all times with an organ-
ization so finely constituted, and to administer our remedies under
a more settled conviction that, if potent for good at the right time,
they may also be potent for evil, when the case and the occasion
are not favourable.

One mav express himself in this manner, without verging in the
very least towards the credulity of those persons who profess their
faith in the power of infinitesimal doses. It is one thing to recom-
mend half a grain in preference to five, and a very different thing to
stand up, with unabashed countenance, for the millionth or billionth
of a grain. The human mind is baffled in forming even a concep-
tion of such infinitesimal quantities ; and, therefore, they may be
placed in a category by themselves, for the use of those who take
pleasure in believing everything that ordinary people are compelled
to doubt. But is there no truth in the allegation, that some of our

1856.] Dilution as a Principle in Therapeutics. 557

large doses of remedies, inteneed to enter the circulation and mingle
with the blood, must startle and stagger many reverential students
of the human frame and functions, and so create, it may be, a hurt-
ful reaction in favour of homoeopathy, and other kindred eccentri-
cities?

I would venture to suggest, that some topical appliances those
especially of a discutient nature may be rendered more efficacious
and useful, by attending to the same principle of ample dilution.
For example, the most efficient mode by far in my experience, of
employing iodine locally, is a solution consisting of two grains of
iodide of potassium and one of iodine, in an English pint of water.
It must be used warm, as a fomentation to the affected part, by means
of a sponge, twice or thrice a day, for five or ten minutes at a time.
In cases of glandular tumour and of fibrinous exudation into the cel-
lular tissue; in chronic enlargement of the testicle or epididymis;
in short, in all that class of disorders where iodine or mercurial
ointment would seem to be indicated, I have often found it remark-
ably efficacious. The warmth of the application renders it more
agreeable to most patients than if it were cold or unctuous, and at
the same time probably increases its power by relaxing the pores,
and so favouring absorption. It seems to be much preferable to the
tincture of iodine painted upon the surface a favourite remedy
with many. The latter certainly does good in some cases, but we
may doubt, I think, if it produces its beneficial effects in the manner
usually attributed to iodine and its compounds. It is a strong stimu-
lating fluid, and sometimes occasions a good deal of local suffering;
so that, when attended by favourable results, it probably resembles
in its action a common blister, or the croton-oil ointment, and re-
lieves inward congestion or chronic inflammation indirectly, by its
power as a counter-irritant, and not directly, by hastening the pro-
cess of absorption. The distinction is not unimportant; because
some swellings, of inflammatory origin, may reasonably be expected
to give way under a sysem of counter-irritation ; while other growths,
of a slower and colder constitution, will be more amenable to a
treatment less active and heroic.

Another illustration of the same principle seems to be afforded by
the outward uses of croton oil. When employed in a form tolera-
bly concentrated, it induces, as we all know, an eruption of minute
vesicles ; but when mixed with a large proportion of olive oil, and
rubbed over an extensive surface, such as the abdomen, it some-
times shows its power as a purgative, in the most unequivocal man-
ner. One case in particular, that I attended with the late Dr.
Thatcher, occurs to me, in which this treatment was eminently
successful. A young gentleman seemed to be dying of obstruction
in the bowels. As all the ordinary means of relief had been ex-
hausted, and circumstances forbade the farther use of internal rem-
edies, a liniment, composed of one part of croton oil and twenty-
four oi mingled olive and camphorated oil, was used in an embroca-

558 Management of Placenta Prvevia. [September,

tion to the belly ; and very speedily, and in consequence, as I
believed at the time, the peristaltic action downwards was restored,
and the obstruction overcome. Of course, we may have mistaken
in this, as in other cases, the 'post for the propter hoc; but such facts
seem to suggest the propriety and desirableness of new experiments
in the same direction.

The spiritus terebinthinae is another local remedy which we may
probably employ with advantage, in a less stimulating shape than
we are in the habit of doing. This has been suggested to my mind
by witnessing the effects of small doses of turpentine in certain
forms of iritis, and in rheumatic ophthalmia. In exercising these
curative effects upon textures so remote from the stomach, the me-
dicine must be supposed to enter the vascular system, and to modify
the blood by stimulating one or more of the organs of excretion;
and it is reasonable to infer, therefore, that the well-known remedi-
al power and efficacy of terebinthinate embrocations in certain
chronic forms of muscular rheumatism and neuralgia, may depend
very much upon a simular therapeutic action. And on this suppo-
sition, we should take care that the local remedy is not presented
in a form too stimulating, our object being, not so much to cause
counter-irritation by it, as to secure its absorption by the integu-
ments covering the seat of pain. [Edinburg. Med. Journal.

On the Management of Placenta Prcevia. By Dr. Robert Barnes.

The author passed in review the actual state of obstetric science
and practice in relation to the pathology and treatment of placenta
previa. He showed that the prevailing belief was, that so long
as the delivery of the child was not effected there was no security
against haemorrhage, and that hence the rule in practice of pro-
ceeding to forced delivery as early as practicable was almost uni-
versally inculcated, the 011I3* exception consisting in the more or
less general substitution of the plan of totally detaching the pla-
centa. The author thus showed that, while the practitioner was
anxiously waiting for the moment when the dilatibility of the
cervix uteri would permit the passage of the hand, for the purpose
of turning, the patient might perish of flooding; and that, there-
fore, in the most severe class of cases, those of central placenta,
some other resource, some means of placing the patient in security
against renewed flooding, before the full dilatation of the os, was
eminently desirable. Dr. Barnes then explained the physiological
course of a labour with placenta praevia, and the mode in which
Nature sometimes arrests the haemorrhage before the expulsion of
the child. He illustrated, by the help of an ingenious and inter-
esting diagram, that a stage of labour arrives when the recurrent
contractions of the womb do not entail an}' further flooding ; that
the pains return in their usual course, with the usual effect of fur-

1856.] Management of Placenta Previa. 559

ther dilating the os uteri, and forwarding the labour, but without
causing any further flooding ; that the labour was in fact resolved
into a natural one, and would be safely concluded by the natural
powers. Reflection upon these cases had led Dr. Barnes to doubt
the truth of the obstetric dogma, which declares that there is no
security against haemorrhage, so long as the presence of the liquor
amnii or the child in the womb prevents full contraction. Dr.
Barnes then unfolded the anatomical, physiological, and clinical
facts which led him to the conclusion that, under proper restric-
tions, Nature might in many cases be trusted with more confidence
than was generally believed. The clinical facts, he said, had come
to him first, and led him to examine into the anatomical and
physiological bearings of the case. He related cases in illustra-
tion, and quoted a commentary upon one of these cases from the
memoir he had published ('Lancet,' 1847), in order to establish his
priority in the enunciation of the views he now laid before the
society ; and adverted to the fact, that he had since the publication
of that memoir, constantly taught, in his lectures on Midwifery,
the same doctrine ; and stated that even the original of the dia-
gram now exhibited, rudely sketched, was also figured in the
memoir referred to. He had, therefore, believed his views to be
original, and was surprised to find, in several numbers of the
'Berlin Monatschrift fur Guburtskunde ' for the present year, a
controversy between Dr. Cohen, Dr. Crede, and Professor Hohl,
in which Dr. Cohen for the first time expounded similar views to
his own, whilst Dr. Crede, referring to writings of 1853-54, also
claimed them ; and Professor Hohl assigned them to Dr. Zeitfuchs
so far back as 1843. Dr. Barnes acknowledged, with pleasure,
that Dr. Cohen's views of 1855 fully confirm those put forth by
himself in 1847 ; but he found, in the writings of Crede and Zeit-
fuchs, nothing whatever to show that either had, in the remotest
degree, possessed himself of the points in question. But Cohen
had gone beyond the author in proposing a new operation based
upon the physiological and clinical facts expounded. This opera-
tion consists in 1st. Determining the side of the uterus to which
the smaller flap of the placenta is attached; 2. In rupturing the
membranes and detaching the placenta from this half of its cir-
cumference; 3. Exciting uterine contraction; 4. Hooking finger
over edge of placenta, tearing membranes from the freed border
of the placenta ; and 5. In separating the placenta in a circumfer-
ence of 190 to 200. The greater half of the placenta, now freed
from the dragging of the lesser half and membranes, is now drawn-
back, just as in placenta lateralis, with the uterus. From this mo-
ment there is no further danger. Cohen insists, like the author,
on the impropriety of hastening labour unless urgent complications
arise. Dr. Cohen refers to his experience to prove the efficay of
this method, but does not recite any cases in illustration. Dr.
Barnes pointed out that the difference between his memoir and

560 Management of Placenta Prcevia. [September,

that of Dr. Cohen consisted simply in this : Cohen had, in 1855,
carried forward the principle Dr. Barnes had enunciated, in 1847,
by proposing the artificial partial detachment of the placenta, in-
stead of trusting, as Dr. Barnes had recommended in certain cases,
the execution of this operation to the powers of Nature. The au-
thor then quoted from Sir Charles Bell passages showing that the
anatomical distribution and physiological action of the muscles of
the uterus accorded with and explained the clinical facts observed
in the course of intermissions and cessations of ha3morrhage from
placenta prasvia as set forth by Dr. Barnes. The author then ex-
plained the mode and mechanism by which the haemorrhage in
placenta prama is arrested. The opening of the mouth of the
womb, and the detachment of the placenta adhering to this part,
are effected by the active contraction of the longitudinal mus-
cles of the uterus; this active contraction shortens the cervix,
when it intermits a passive contraction goes on, which main-
tains or even increases the shortening of the cervix. This short-
ening necessarily compresses the torn mouths of the vessels,
and checks the flooding caused by each successive detachment of
fresh placenta, until the detachment has gone to the boundary line,
beyond which point the further expansion of the cervix has no
effect, and when all fear of flooding is at an end. It was not there-
fore necessary that the uterus should be empty in order to arrest
the flooding. The arrest depended upon the contraction of the
cervix, which went on, although the fundus and walls were pre-
vented from contracting. Dr. Barnes submitted the following as
some of the conclusions dcducible from his researches :

1. In cases of placenta prasvia, the hemorrhage is sometimes
arrested spontaneously before the complete detachment of the pla-
centa, before the discharge of the liquor amnii, and consequently
before the expulsion of the child or the pressure of its head against
the cervix.

2. That this spontaneous arrest of the flooding is owing to the
scaling up of the vessels torn by successive detachments of placen-
ta, and the attainment of a stage of labour when no further de-
tachment can take place until after delivery.

3. That dangerous and even fatal flooding sometimes occurs
while the os uteri is still closed, and so undilatable as to render it
impossible or expedient to have recourse to forced delivery.

i 4. That in such cases it is eminently desirable to possess some
means of diminishing the hemorrhage until the hand can be pass-
ed through the os uteri.

5. The spontaneous or artificial detachment of the cervical por-
tion of the placenta competes with two most formidable operations,
dangerous to mother and child forced delivery, and the total
separation of the placenta. The new principle of treatment may,
in many cases, supersede forced delivery altogether ; since the pa-
tient being secured against farther flooding to resort to turning

1856.] Medical Properties of Charcoal. 561

when the flood has ceased is an unnecessary proceeding, although
the os uteri may admit of it. In many more cases this principle
will be the means of gaining the necessary time to admit of turn-
ing or other modes of forced delivery being performed with safety.
In almost every case it may supersede the practice of wholly de-
taching the placenta, since the end in view being the arrest of the
flooding, it is better to detach only just so much of the placenta as
will effect this end, than by detaching all, to destroy the child.

%\_Medical Times and Gazette.

Medical Properties of Charcoal. By JAMES BlKD, Esq.

Pure charcoal is known to possess two singular properties, first,
the power of absorbing gases to an almost incredible extent, and
secondly, the capability of rapidly oxydizing any dead animal or
vegetable substance placed in contact with it, as explained by the
experiments of Dr. Stenhouse and others. As charcoal is not
chemically affected by either acids or alkalies, and is quite insolu-
ble, its admixture with other substances is not incompatible, so
that it may be combined with any other kind of medicine, ad libi-
tum.

It is a powerful absorbent of fluids, whether aqueous or aeriform ;
and as it ungergoes no change in the human stomach, it may with
great truth be described as the only pure absorbent Ave possess, for
the same cannot be said of aether, lime, magnesia, bismuth, or any
other mineral absorbent, all of which form Salts with the acids
they meet with, sometimes to the complete subversion of all their
original properties, while the vegetable or farinaceous absorbents,
such as flour starch, gum, &c, are changed by digestion, giving
off frequently offensive gaseous emanations as the results of mal-
assimilation.

Charcoal is, therefore, recommended as a pure and effective ab-
sorbent, applicable either alone, or in combination with other
remedies, to a cure of a large number of the acute disorders of the
mucous surfaces of the alimentary canal, and also of those of the
uterine passages, and particularly in those instances where the
secretions are inordinate in quantity, or offensive in condition.

It may, perhaps, induce a more extended trial of charcoal pow-
ders if a few instances were named in which the remedy has proved
eminently serviceable. In the exquisitely painful small ulcers
within the mouth, on the inner surface of the lips or cheeks, which,
at irregular intervals prevail to some extent, and are extremely
troublesome, the following wash will be found an excellent reme-
dy:

3. Pulv. carb. ligni pur. ij.; mel. rosaa l\. - decoc. cydonh
1 iij. ; aq. dest. I iv. M. Ft. lotio saspe adhibenda.

This lotion is also useful in excessive ptyalism ; it speedily mod-
erates the discharge, and instantly corrects its fetor, and its appli-

562 Chronic Ulcer of the Leg. [September,

cation is extremely soothing and agreeable. The same may be
said of it when used as a gargle in ulcerated sore-throat, the
sloughs separating rapidly and easily, leaving a healthy surface
underneath.

In the earlier stages of diarrhoea, a mixture composed somewhat
as follows speedily gives relief:

ty. Pulv. carb. ligni pur. 3j. ad 9iv. ; mucil. acacias 3 ij - ;
syr. aurantii, tr. cardam. co. aa. 3iv.; aq. dest. 3iij. M.
Sumat 4 drachms 3tia.vel 4ta q.q. hora.

In the bowel affections of children, accompanied with worms,
powdered charcoal, in doses of 10 to 15 grains, with one grain of
ipecacuanha powder, and from 3 to 5 grains of rhubarb, taken at
bed-time, acts like a charm, correcting disordered secretions with
certainty and comfort, and promoting a healthy tone and action.
In gastralgia and gastrodynia, charcoal powder, in doses of 30 or
40 grains, three times a day, in water, seldom fails to give relief;
and in cases of severe tenesmus, accompanied by bloody or mu-
cous stools, an injection into the lower bowel of one drachm of
charcoal powder in a small quantity of thin arrow-root or gruel
has been found to give almost instant relief. [Ibid.

On Chronic Ulcers of the Legs. By F. C. Skey, Esq., F.RS.

Abundant have been the examples of treatment of chronic ulcers
of the legs by means of the internal administration of opium. I
know of no treatment at all comparable to this, so rapid or so
efficient. These cases have had many observers, who can bear
testimony to its value. Exactly in proportion to the amount ad-
ministered is the regeneration of the defective structure. Years
will probably yet elapse before this principle will be universally
acknowledged, before the medical community will admit that in
opium we have an agent far more valuable than that derived from
its comparatively worthless power as a sedative. It is notorious,
that the chronic ulcer the disease of ten or even of twenty yearsT
duration is unattended with pain. To suppose that opium effects
its local marvels by any sedative property in the drug, appears to
me worthy only the advocacy of a senile -female, or of an unin-
structed youth. If we administer five grains of the soap and opium
pill, night and morning, to a man advancing in life, who has been
carrying about with him for ten years a large callous ulcer, with
an ash-coloured base, surrounded by high walls of organized
lymph, and in which there remains not a vestige of activity, good
or bad, advancing or receding, the moisture from which is a hot
ichor, becoming sanious under provocation, if we examine care-
fully this surface at the expiration of forty-eight hours, we shall
Jin < t it speckled with red points; these are future granulations, and,
in ten days, the whole of the base of the wound will be carpeted
with them. [Lancet.

1856.] Strangulated Femoral Hernia, 563

Practical Deductions from a Clinical Record of Twenty-six Cases of
Strangulated Femoral Hernia.

Mr. Birkett, in a paper read before the Medical Society of Lon-
don, (April 26th, 1856,) commenced by stating that the object
of the paper was, first, to bring prominently into the foreground
the causes of death ; 2d, The circumstances by which those causea
are brought about; and, 3d, The means by which they may be
avoided. It was shown, by means of a table of the cases, that a
certain number of unfavorable circumstances occurred in each
case, and that, in proportion to the aggregate, as a general rule,
the case was cured, or terminated fatally. But in some of the
cases only two, three, or four unfavorable circumstances existed,
and yet the patients died; and in these, as well as others with a
larger number, the causes of death were sought for and demon-
strated. Of the twenty-six cases, all of which were operated upon
by the author, one-half terminated fatally. In the fatal cases,
death resulted from causes over which the operation could have
but little influence ; and it was undertaken only with the view to
place the patient in a condition more favourable to recovery.
The causes inducing the fatal result may be thus enumerated:

1. The consequences of a journey performed while the patient
was suffering with strangulated femoral hernia.

2. The defective constitutional nutrition of the patients generally.

3. Irrecoverable prostration, the result of long continued vomit-
ing and strangulation of the bowel in aged women.

4. Violence inflicted on the hernia. To this cause, the death df
not less than five out of the thirteen is to be attributed.

5. The administration of purgatives before the operation.

The author unhesitatingly preferred to reduce the hernia with-
out opening the peritoneal sac in those cases in which the surgeon
would be justified in returning the protrusion by the taxis, if it
could be accomplished.

In the twenty-six cases, the peritoneal sac was opened in twelve,
and the causes which prevented the reduction of the hernia with-
out so operating were the three following :

1. The contents of the sac.

2. The morbid condition of the contents of the sac.

3. The dimensions of the neck of the sac, and the unyielding
state of its tissues.

Six cases were related in which the author had reduced the her-
nia by a simple division of the fibrous tissues about the neck of
the sac, and external to that covering of the hernia known as the
fascia propria. To this simple method of relieving the constriction
around the bowel the author gave the name of the "Minimum
Operation." The causes of death in the fatal cases were shown,
hj post-mortem examination, to be referable to peritonitis, injury
of the bowel inflicted in the taxis, exhaustion after fecal fistula,

N. S. VOL. XII. NO. IX. 36

564 Myeloid and Myelo- Cystic Tumors of Bones. [September,

phlegmonous inflammation, collapse, acute bronchitis, and perfo-
ration of the bowel. Of the cured cases, the minimum of hours
during which the bowel was strangulated was three hours; the
maximum was seventy-seven hours. Of the fatal cases, the min-
imum period of strangulation of the bowel was eleven hours, the
maximum seventy-nine hours. Of the cured cases, the average
number of hours during which the bowel was strangulated amount-
ed to twenty-three. Of the fatal cases, the average period of stran-
gulation of the bowel was forty-six hours. The causes of death
were primary and secondary: 1. Prostration; peritonitis; gan-
grene of the intestine ; perforation. 2. Bronchitis ; abscess behind
the peritoneum ; phlegmonous inflammation and suppuration.
The circumstances by which they were brought about : Age ; a
journey; the defective constitutional nutrition of the patient; the
morbid state of the canal above the strangulated piece of bowel \
injury of the hernia caused by the constriction of the ring, and by
manual violence inflicted on it; the duration of the sufferings; the
intensity of the constitutional sympathies ; fecal fistula ; neglect of
the tumour ; the administration of purgatives ; the warm bath.
The means by which they may be avoided are : By care in mani-
pulation ; the early relief of the bowel from constriction ; the re-
duction of the hernia without opening the peritoneal sac; the
exhibition of opium, and the avoidance of all causes likely to in-
duce exhaustion. [Med. Times and Gazette.

On Myeloid and Myelo- Cystic Tumors of Bones: their Structure, Pa-
thology, and Mode of Diagnosis. By Henry Gray, F.B.S.

The author detailed the history of nine cases of tumors of this
form removed during life, with a minute description of the results
of his own microscopical examination of six of the tumors.
The results at which he arrived were as follows : That these tu-
mors were not of a malignant nature, although in several of the
instances given they have been so regarded both previous to and
after removal by operation ; that on the contrary, their minute
structure bore the closest analogy with the normal constituents of
the marrow and other elements of bone in the early periods of
life: that their growth is confined to the osseous texture, or its
investing membranes, the periosteum and dura mater ; that they
, occur at a period of life when the normal constituents of the me-
dulla exist in the greatest amount, and are developed in those
parts of the osseous system in which those structures exist in a
most distinct and well-marked form, (all the cases given took their
origin in the epiphysial ends of long bones ;) that they are occa-
sionally mixed with the other elements of bone in a rudimentary
state, as fibrous tissue and cartilage, and even with bone itself;
that they may probably occur in any bone; that since they are
thus found to consist of an abnormal amount of some of the nor-

1856.] On the Dropsy of Pregnancy. 565

mal constituents of the medulla cells, the name "myeloid" given
to them by Mr. Paget is most appropriate (the author proposes to
add the term "cystic" to such of them as present a mixture of
cysts with the structure above described, and regards their fibrous
element as most probably derived from the organization of lymph
effused as the result of chronic inflammatory action, or from some
abnormity in the development and growth of the fibrous element
of bone :) that they occur in all the cases at present recorded at an
early period of life, and that their growth is generally much less
rapid than malignant disease, both which facts afford important
diagnostic marks to distinguish them from malignant growths ;
that the absence of the malignant cachexia, of glandular lymphatic
enlargements, and of diseased internal organs, combined with the
facts that, although these tumors attain occasionally a considerable
size, yet they present no tendency to ulcerate or obtrude exter-
nally, and generally retain some surrounding shell of bone within
which they have grown, serve as additional aids to the surgeon in
forming a diagnosis between myeloid and malignant growths; that
they do not return when entirely removed ; and that for all these
reasons they are to be regarded as innocent tumors. [Association
Med. Journal. New York Med. Journal.

On the Dropsy of Pregnancy. By M. Becquekel.

Four forms of dropsy are observed in pregnant women, which
are far from being of the same importance.

1. Mechanical Dropsies, perhaps the most common, are due to
the pressure exerted by the gravid uterus, their production being
favored by the lesser density of the blood in pregnant women, and
the slight diminution of albumen that exists in its serum. These
dropsies are confined to the lower extremities, are of no import-
ance beyond their inconvenience, and disappear after delivery.

2. Dropsies due to changes in the Blood, but unaccompanied by
Albuminuria. The change in the blood which induces these
dropsies, consists in a diminution in the amount of the albumen
of the serum, a diminution that is sometimes considerable, and for
which we can assign no other cause than the fact of the pregnan-
cy, and its influence on the various immediate principles of the
blood. This description of dropsy, like the two next, tends to
become general. It is of importance to distinguish it from the
two others, and especially the 4th, for it does not predispose to
eclampsia. It is by analysis of the blood alone that we can estab-
lish its existence. It disappears also after pregnancy, but far
more slowly. It has been observed that women suffering from it
remain feeble for a long period, their "getting up" being slow and
difficult.

3. Dropsies with Changes in the Blood, and Albuminuria, but
without Brighi's Disease, properly so called. These dropsies are the

566 Operation for Pharaphimosis. [September,

consequence of the diminution of the albumen of the blood, pro-
duced by its deperdition through the kidney. Until lately it was
supposed that such loss might take place without material lesion
of the kidney ; but from the investigations made by M. Robin and
the author, it results that this albuminuria is due to a special mo-
dification taking place in the epithelial cells of the tubuli, a modi-
fication consisting in the infiltration of the cells and tubuli by
numerous granules of a proteric nature. This infiltration is ana-
logous to that which M. Eobin had already found in choleraic
albuminuria, and like it is susceptible of cure. The absolute di-
agnosis during life of this disease from Bright's affection is very
difficult, and yet it is highly important, as the prognosis must be
entirely based upon it. It is in women who are the subjects of
these dropsies that we have to fear eclampsia, and the predisposi-
tion to puerperal peritonitis. Eclampsia is not, however, a ne-
cessary consequence ; and when we find general dropsy, change
in the blood, and albuminuria co-existing, we still cannot affirm
that this terrible accident will follow. On the other hand, when-
ever we find eclampsia we are certain of finding, not only dropsy,
but albuminous urine, and change in the blood. In respect to
the termination of this form of dropsy it may be observed, that if
eclampsia does not supervene, a cure is almost certain, while, in
the case of its occurring the result is dependent upon that of the
eclampsia.

4. Dropsies due to Bright's Disease. It is very important to
establish the diagnosis of this form. We may lay stress upon the
somewhat larger quantity of albumen, the presence of fragments
of tubuli, of fibrinous filaments, and fatty globules. When
eclampsia complicates this form it is invariably fatal ; and even
when aclampsia does not occur, the disease is not arrested after
delivery. The dropsy continues to increase, the termination
proving, after a certain period, fatal. [London Med. Times, from
Medico- Ghirurgicale.

Operation for Pharaphimosis.

At the session of the Academy of Sciences (Paris,) on the 21st
of April, the following extract was read from a letter of M. Mal-
gaigne:

" With this strangulation, as with strangulated hernia, we at-
tempt at first to accomplish reduction, and usually succeed. But
when reduction is impossible, it is advised, as with strangulated
hernia, to divide the bridle which strangulates it, even if it is ne-
cessary to repeat this section at two or three points. The danger
of strangulation is thus diminished, but the reduction still conti-
nues to be impossible. At least I have never seen it accomplished
after such an operation. What is the reason of this want of suc-
cess? It is that the preputial ring, in producing inflammation,

1856.] Action of Digitalis upon the Uterus. 567

^ulceration, sometimes even gangrene, of the parts strangulated,
commences by thickening the subjacent cellular tissue, and by
producing extensive adhesions between the integument and the
cavernous bodies. Dividing the stricture, though repeated, does
not destroy these adhesions, and does not suffice for the reduction,
while destruction of these adhesions, even without division of the
stricture, is sufficient to allow the return of the parts to their
place.

" Thus the study of this affection has led me to distinguish a
new element, hitherto left in the shade. The establishment of
this element gave a new indication, and this is the way in which I
have met this indication.

" A young man came under my care the 11th of this month,
for a paraphimosis of five days' duration, and already there was
seen upon the back of the penis a superficial ulceration, embracing
more than half of the circumference of the organ. The internes
tried to reduce it without success. The next day, at the visit, I
was no more fortunate; the adhesions of the integument to the
cavernous bodies presented an insurmountable obstacle to it. I
slipped a narrow bistoury flatways between the integuments and
the cavernous bodies, by means of which I divided those adhesions
to the extent of one centimetre (four-tenths of an inch). This did
not suffice. I carried a probe-pointed bistoury into the incision,
to complete the division of the adhesions throughout their whole
extent, and the reduction was accomplished with the greatest fa-
cility. The next day, the engorgement of the prepuce had dimin-
ished, the third day the ulcerated surface had cicatrized, and the
patient went out the 20th of April, having been well several days,
and without experiencing any kind of accident." Am. Med. Mon.

On the Action of Digitalis upon the Uterus. By W. EL DlCKERSON.

The writer commences his paper by stating that during the
month of October, 1854, a patient in St. George's hospital, laboring
under most severe menorrhagia, was cured by the infusion of digi-
talis, exhibited for the relief of cardiac affection, from which she
also suffered. In consequence of this he had been induced to try
the remedy, by the permission of Dr. Lee, in a series of cases of
uterine hemorrhage which had occurred in the hospital. These
cases, of which a table is given, were seventeen in number, and
the general results of their treatment were as follows : In every
case of uterine hemorrhage, unconnected with organic disease, re-
quiring the employment of active remedies, admitted into the
hospital after October, 1854, the administration of digitalis was
had recourse to as the sole treatment, and the discharge was inva-
riably arrested by it. The time which elapsed before the hemor-
rhage subsided varied with the dose in which the digitalis was
exhibited. When large doses were given, as an ounce to an ounce

568 Eneuresis. [September,

and a half of the infusion, the discharge never appeared after the
second day; when smaller doses, it never continued beyond the
fourth day. In uterine hemorrhage connected with organic dis-
ease, the remedy acted with less certainty ; its exhibition was re-
quired for a longer time, and the effect was sometimes transient.
The author then spoke of the mode in which the digitalis operated
in controlling uterine hemorrhage ; and after concluding that its
effect could not depend on the sedative influence of the drug in the
heart and arteries, he showed, by various experiments and obser-
vations, that the arrest of the hemorrhage was due to the action
of the digitalis on the ganglia of the uterus, by which the organ
was stimulated, and the muscular substance powerfully contract-
ed. [Dublin Hospital Gazette.

Eneuresis.

Two methods for treating this troublesome affection having been
given in our May number, we present the following, which we
adopted in our practice long ago, from the Medico-Chirurgical Be-
view, of January, 1849. Memphis Med. Recorder.
ty. Ex. Belladonna.

Ex. Hyoscyami, aa. gr. xvj.

Sacchari albi, 3i.

Aq. Camphorae, 1 iss. Take a teaspoonful at bed- time.
In obstinate cases we have sometimes repeated the dose two or
three times in the same night. We have rarely failed of success,
though in one case we were obliged to give up the remedy before
the cure was complete, in consequence of the excessive dilatation
of the iris. We remember one case, where the disease had con-
tinued from early childhood till the age of seventeen, which was
permanently cured by a week's use of the above prescription.
The young man was unable to recollect a period at which he had
not been constantly troubled with an attack on retiring to sleep.
Where remedies so diverse cure the same disease, we arc naturally
led to the hypothesis that, though the symptoms are identical, the
pathology is different ; for example, we are disposed to think that
where Dr. Merrill's remedy the Iodine was successful, irritation
of the mucous lining of the bladder, was the cause of mischief,
, while in cases where the present treatment effected a cure, (Bella-
donna having a special tendency to the muscles of organic life.)
the sphincter vesicas, had been the seat of the disease. D. F. W.

On the Detection of Phosphorus in Cases of Poisoning.

Mitscherlich has published a very simple and satisfactory me-
thod of detecting phosphorus in forensic investigations. The
matter to be tested for phosphorus is to be distilled in a flask with
water and sulphuric acid, and the vapors conveyed through a

1856.] Bloodletting in Young Subjects. 569

glass tube into a vertical glass condenser. This condenser is sim-
ply a glass tube which passes through the bottom of a wide glass
cylinder filled with cold water, which is constantly renewed by a
funnel. A vessel to receive the distillate is placed under the end
of the condensing tube. (The arrangement resembles Liebig's
condenser placed vertically.) If there be phosphorus in the sub-
stance in the flask, its vapor passes over with the stream into the
condenser, and a distinct light is seen in the dark where the va-
pors meet the cooled portion of the tube. This light lasts for a
very long time, and a luminous ring is usually observed. More
than three ounces of fluid could be distilled from substances which
contained only the Too'ooo f phosphorus without a cessation of
the light. Even after fourteen days the effect was observable.
An addition of oil of turpentine prevents the light, but alcohol
and ether distil over, and then the light appears. In the distillate,
globules of phosphorus may be detected and are easily recognized.
These were observed even in a mass which contained but one-
third of a grain of phosphorus in five ounces of matter. When
the mass contains much phosphorus, the distillate contains phos-
phorous acid, which is easily oxydized and detected. The author
found that phosphoric and phosphorous acids do not pass over
when distilled carefully with water. A fresh human stomach
boiled with water gives no soluble phosphates ; on the other hand,
a stomach in a state of decay yields to water phosphoric acid,
which can easily be detected by ammonia and magnesia. \_Chem-
isches Central Blatt, from Amer. Jour. Arts, &c. '

Bloodletting in Young Subjects.

Dr. Beck justly remarks that young subjects do not bear the
loss of blood as well as adults. They fall into syncope more readi-
ly, and their lives arc almost endangered by it That their nervous
systems are more powerfully affected, is considered by the fact that
convulsions and coma more frequently occur after the loss of blood
in children, than in adults. ISTor will a repetition of the remedy
be so well borne by the child as the adult, and if carried only a
little too far, children sink under the loss of blood irretrievably.
Leeching exerts greater power over children than adults, because
of the greater vascularity of the skin, the effect resembling more
nearly that produced by general bloodletting. Hence the so fre-
quently fatal effects of leeching, the difficulties of which are further
increased by the uncertainty as to the quantity of blood drawn.
Too great caution cannot be exercised, therefore, in leeching chil-
dren. The operation should be performed with the child in an
erect posture, and as soon as paleness of the lips or face appears,
the bleeding should be arrested, and the patient should be closely
watched to prevent hemorrhage, which may prove quickly fatal.
Dr. B. recommends matico as the best astringent remedy for ar-

570 Sulphate of Cinchonia in Intermittent Fever. [September,

resting this and other hemorrhages. The leaf is to be applied to
the leech-bite and pressed upon it for a short time with the finger.
For the cure of epistaxis, the powdered leaf is snuffed up the nose.
Dr. B. thinks excessive bloodletting has been encouraged by the
writings of Eush, who says, in his " Defence of Blood-letting,"
that " bleeding should be continued while the symptoms which
first indicated it continue, should it be until four-fifths of the blood
contained in the body are drawn away." The whole quantity of
blood being estimated at 32 lbs., four-fifths is over 24 lbs. ! [Mem-
p>his Medical Reporter.

On Sulphate of Cinchonia in Intermittent Fever. By Dr. Jisro. S.
Dukate, of Fredericsburgh, Ind.

In the "Medical Observer," for January, 1856, 1 find an article
entitled, "Report of fifty-seven cases of Intermittent Fever treated
at the City Dispensary by the Sulphate of Cinchonia, by Dr. J. C.
Welles." I have always held, that in order to test the therapeuti-
cal virtues of any article of the Materia Medica, especially of the
so-called specifics, we should administer it alone, if tolerated by the
stomach without combination ; for who can tell, for instance, whe-
ther cinchonia or quinia cured the patient, when both are given
together or alternately ? Dr. Welles' article is not quite satisfac-
tory, although very nearly so. In the account of case first, he
states that the patient had taken ten grains of quinia combined
with opium and pipeline. He had a chill on the 7th and 8th
took cinchonia and had no chill on the 9th and 10th ; he was then
put upon sub-carbonate of iron. On the 26th of September he had
a severe chill, and was again put upon cinchonia, and convalesced.
So far as this case is concerned the treatment was too complicated
to be entirely satisfactory, but it is not so with nearly all the other
cases.

My object, however, in communicating this article, is to call the
attention of the profession to the remedial virtues of cinchonia in
intermittent fever, and to offer to them my experience with the
medicine. Perhaps I may not have used the article so extensively
as some others, but still my experience will, contribute something
to the common stock, and assist in judging of the value of the
remedy.

I had never administered a grain of cinchonia until I saw Dr.
Welles' article, when I determined to give it a fair trial in inter-
mittent fever which I have had a fair opportunity to do, as it
has prevailed extensively in my locality during the past spring.
In order to test its remedial value I administered it alone in every
case, or at least using no other antiperiodic. I preceded its exhi-
bition, however, always by an active cathartic. I have noAv used
three ounces of this article in intermittent fever, and have come to

1856.] Sulphate of Cinchonia in Intermittent Fever. 571

the conclusion, from what I have observed in using the above
amount, that it is superior to the sulphate of quinine in the treat-
ment of this peculiar and tenacious disease. Patients, also, seem
to take it more readily than they will quinine, having, most of
them, from frequent use become tired of its repetition.
The following cases may possess some interest :
1st. Mrs. B., aged 24, contracted an intermittent fever last au-
tumn, which was promptly arrested by quinine, but relapsed again
and again; paroxysms continuing at intervals during the fall,
winter and spring. She became anemic, with a tendency to drop-
sical effusions. On the 1st of March I put her on the use of cin-
chonia ordering her twenty grains divided into five grain doses,
exhibited every four hours. It was of the tertian type, and on the
day for the paroxysm she had some unpleasant coldness of the
extremities, followed by slight febrile excitement.

After this was over she took eight grains more, and has not had
another chill to this date, (June 15th,) and is in the enjoyment of
tolerably good health. She is now using, for enlargement of the
spleen, the proto-iodide of mercury internally, and iodine ointment
externally.

2nd. Mr. S. was attacked last fall with intermittent fever, which
became chronic. All the so-called specifics were used, but to no
purpose, except to arrest the disease for a short time. He was
put, by me, on the cinchonia without combination with any other
medicine; after using thirty grains his disease was arrested, and
has not since returned. A period of two months has now elapsed
since he has taken any of the medicine, and previous to this his
ague had returned about every two weeks.

3rd. This was a case of chronic ague, which had resisted quin-
ine, and nearly all other remedies. He was put upon the cinchonia,
and has now been free from the disease about one month.

This article might be extended by relating special cases, but it
is unnecessary. It is sufficient to say that in every case of inter-
mittent fever, whether recent or chronic, the sulphate of cinchonia
has completely arrested the disease, and in but rare cases have
there been any relapses. It may be thought by some that I have
given the remedy more credit than it deserves, but I am of a dif-
ferent.opinion. In every case I have given it alone for the pur-
pose of testing its antiperiodic powers. No complication of effect
has been produced by using quinine, piperine, salicine, strychnine,
arsenic, or any other potent remedy. It is very clear that it is to
the sulphate of cinchonia alone that the cures are to be attributed.
I therefore feel justified in using it in all cases of simple intermit-
tent in preference to quinine. I do not yet know enough of it to
place that reliance upon it that I would on quinine in pernicious
fevers, malarial neuralgia, &c, &c.

Effects on the system. This article does not produce the same dis-
agreeable effects upon the nervous system that quinine does. In

572 Treatment of Typhoid Fever. [September,

no case has my patient complained of tinnitus-aurium, vertigo,
cephalalgia or gastric disturbance. In short, patient's feel no in-
convenience from its administration.

Doses. I think from twenty to thirty grains of cinchonia are
required to completely arrest an attack of intermittent fever. My
mode of prescribing it is to weigh out twenty grains and divide it
into five doses, one to be taken every three or four hours, between
the paroxysms, and in the absence of fever. If this quantity does
not completely arrest the disease, I then give from eight to ten
more, and the object is certainly accomplished. The cinchonia I
have used is prepared by Powers & Weightman, and costs me one
dollar per ounce.

[In a letter to one of the editors, from E. C. "Woolley, M. D., of
Butler county, in this State, the following language is used:
"I have used the sulphate of cinchonia exclusively, with very
happy effects ; succeeding in every case but one, in arresting the
paroxysms of ague by the first administration of the medicine. I
think it not at all inferior to quinine as an antiperiodic." Eds.]

[Cincinnati Med. Observer.

Treatment of Typhus Fever. By Edwin B. Maxon, M. D., of
Geneva, N". Y.

What, then, are the indications in the treatment of Typhus ?
Shall we bleed, purge, and starve our patients, and thus increase
the debility which the morbific agent has produced? Or shall we
strive to support the sinking energies of the system, and thus ena-
ble it to bear up under and throw off, with its various excretions,
the debilitating morbific agent it has so unfortunately imbibed.

From my experience in the treatment of typhus fever, for the
past few years, I am compelled to believe, that with a proper sus-
taining course of treatment, nearly every case of typhus may be
arrested, and the patient convalescent, by the fifth or sixth day;
and that very few need be kept in longer than the ninth day, if
attended to in season, and before any serious local inflammation
has taken place.

The indications then are, to remove from the alimentary canal,
any irritating matter which it may contain; to equalize the circu-
lation ; to promote perspiration ; and to support the sinking pow-
ers of the system by tonics and a due amount of proper nourish-
ment.

I therefore usually give, at first, two or three blue pills, and
follow with half an ounce of castor oil; use warm pediluvia, morn-
ing and evening, the first day or two ; also, rubbing the whole
length of the back with a tepid infusion of capsicum in vinegar;
and, generally, give the sulphate of quinine and Dover's powders,
of each, grs. jv, every six hours, at first, for a day or two. I then

1856.] Mode of Reducing Strangulated Hernia. 673

discontinue the Dover's and give pulv. camp. gr. j, with quinine
sulp., grs. iij, every six hours, and continue till the fever is arrest-
ed, giving crust coffee, with milk, at first freely, as nourishment,
and as soon as the stomach will retain it, toast every six hours ;
and, by degrees, other nourishing and digestible food, as the ap-
petite generally returns and calls for it.

Such are the means which I have found most effectual in ar-
resting typhus fever ; and even in cases in which, through neglect,
or maltreatment, local inflammation has supervened, I have found
this course to do well, in conjunction with sinapisms, dry cupping,
or blistering, as the case may require. [Buffalo Med. Journal.

Mode of Reducing Strangulated Hernia, after failure of the Taxis, by
a Bloodless Operation.

M. Seutin, the eminent surgeon of Brussels, is endeavoring to
establish, in a Belgian Medical Journal, the superiority of tearing
either the inguinal or crural ring, over incising the same, for the
reduction of strangulated hernia. He quotes experiments on the
dead body, and several successful cases; and is confident that his
method will soon supersede the operative measures generally re-
sorted to. He places, first, great reliance on graduated taxis con-
tinued with due precautions for a considerable period; and when
this fails, he endeavors to hook his index-finger round the margin
of the ring, by passing it between the tumour and the abdomen ;
and by using a certain force, he causes the fibres of the external
oblique to give way and crack to an extent sufficient for the re-
duction of the hernia. M. Seutin defends his practice with con-
siderable ability, and hopes trials will be made. [Lancet.

Alkaline Treatment of Rheumatism.

The (Burlington) Medical and Surgical Beporter gives a table
of twenty six cases of acute rheumatism treated by the alkaline
method, in New York Hospital, under the care of Dr. John H.
Griscom. The average time that the patients were under treat-
ment was about thirteen days, and the whole duration of the attack
twenty-one days. The treatment consisted in the administration
of the supertartrate of potassa and soda, every hour, and the appli-
cation of an alkaline and opiate lotion to the swelled joints. As
the urine became less acid, corresponding improvement in the
symptoms was noticed. [Boston Medical and Surgical Journal.

Danger of Employing Iodine Injections for the Cure of Hydrocele.

M. Gosselin made an interesting communication to the Societe
de Biologie, on the 24th of May. He has ascertained that in three
cases where, after the death of patients, he has examined the testi-

574 Congenital Deafness. [September,

cles, there is a peculiar danger in employing iodine injections in
the vaginal cavity as a means of curing hydrocele. This danger
consists in the absence of the secretion of a sperma fit for fecunda-
tion. In these three cases, no spermatozoa were found in the
seminal vesicle of the side, where a hydrocele had been treated by
iodine injections. In experiments upon dogs, M. Gosselin has
found, also, that after such injections, the production of spermato-
zoa does not take place, and that the testicle becomes pale and
smaller than before. \_Med. Times and Gaz.

Etiology of Congenital Deafness.

In a paper read before the French Academy of Medicine, M.
Meniere states that the intermarriage of relations has more effect
than any other cause in producing deaf-mutism. This is shown
by the fact that the disease is nowhere so common as in those iso-
lated comunities where almost all the inhabitants are related to
each other, as the Canton of Berne, in Switzerland, where the de-
generacy of the race is seen in all its deformity cretinism, idiocy
and congenital deaf-mutism. [Gaz. desHop., and Boston Med. Jl.

EDITORIAL AND MISCELLANEOUS.

American Contributions to Medical Knowledge. The multiplicity of
medical periodicals in the United States evinces a degree of activity in the
medical mind of our countrymen that has no parallel elsewhere ; for while
we have between thirty-five and forty regular medical journals, besides the
periodical issue of the transactions of a large number of Societies, to say
nothing of the publications by the Eclectic, Botanic, Homeopathic, Hydro-
pathic, and other quondam brethren, we believe that the British and
French have only about a dozen each, and that the whole of Europe does
not furnish as many as we do. And yet it is very questionable whether
this state of things will ultimately prove beneficial to the profession at
large, or even to its American branch.

Under existing circumstances, no one can become acquainted with the
workings of the American medical mind without reading a number of pe-
riodicals well calculated to stagger any but an editor, and even editors are
not always proof against the accumulated load of their table. It cannot
be denied that by increasing the number of journals we correspondingly
multiply that of contributors. Many a physician, the result of whose ob-
servations might be useful, will feel himself stimulated to write and to
impart his experience to others, if a journal be started in his neighborhood,
who would otherwise have remained silent. Others will be disposed to
imitate his example, and unexpectedly, perhaps, realize the fact that they

1856.] Editorial. 575

also have views that ought to be made known, and that writing is not so
difficult as they thought, nor the exclusive privilege of the favored few.
Men are thus accidentally trained to the art of composition, and often be-
come accomplished writers. In this way journals are eminently useful
within the sphere of their influence, and we would be the last to approve
of any diminution of their number. We would, on the contrary, like to
see as many published as the profession can or will support. But we must
repeat that, in the present state of things, much of most valuable matter
intended to reach the general eye through such channels is never heard of
beyond the more or less restricted limits of their own circulation.

It cannot be expected that any practitioner in the United States will
subscribe to all the American medical periodicals, besides those from
abroad ; and if any were found so liberally inclined, it is not presumable
that he would or could give them all even a hasty perusal. With the ex-
ception of the copies we send to Europe in exchange for their publications,
we may say that our periodicals are entirely unknown in foreign countries
whereas several of their journals are reprinted in this country, and exten-
sively patronized. The writings of Europeans are not only brought direct-
ly to us, but our own journals cull most assiduously from them every para-
graph supposed to possess the least interest. While our local periodicals
are thus actively engaged in heralding the achievements of Europe, those
of domestic origin remain unnoticed. In additidn to the extensive circula-
tion among us of European journals and reprints, the publications of Braith-
waite and Ranking give a degree of permanency to their papers which is
denied our own. I say, denied our own, because it is quite notorious that
these "retrospects" and "abstracts" are devoted to the propagation of
European views, and almost entirely silent with regard to what is said or
done in America. Take up these semi-annuals, number after number, and
you will look in vain for any evidence of the mental activity to which we
have referred. Can it be that we do or say nothing worthy of permanent
record ? Foreigners are perhaps not so much to blame in this matter,
when some of our leading periodicals make an equally meagre showing for
us under their heads of " Domestic Summary," " American Intelligence,"
&c. There is indeed no journal issued in our country which contains even
the slightest notice of one-fourth of the valuable contributions to medical
knowledge by American writers. The petty jealousies of rival schools and
cities, and the more significant evil of sectionalism, tend materially to fetter
periodicals sustained by antagonistic interests, and consequently to restrict
their sphere of usefulness. We might mention some important discoveries
in diagnosis, and in the treatment of particular diseases, which have never
been alluded to in rival cities and sections of the Union, while some of the
verriest puerilities of foreign prints will be found going the round in every
journal of the land.

576 Editorial and Miscellaneous. [September,

Now, we need a remedy for the evils pointed out, and the object of these
remarks is, to urge upon the profession the adoption of one that may be
effectual, without interfering with the interests already involved in local
journalism. Let a work be published by subscription, semi-annually, bear-
ing the title at the head of this article, or any other of similar import.
Let it consist of three parts : the first, to be made up exclusively of such
papers contained in the original departments of American Medical Jour-
nals, as may be deemed by competent supervisors, worthy of permanent
record ; the second, to be devoted to the review of American books on
medicine and its collateral branches ; and the third part, to contain ab-
stracts of the contents of our medical journals, general medical intelligence,
&c. Let the conductors of such a journal be men of industrious habits as
well as of competent abilities, whose sole object will be to furnish us a com-
plete and impartial reflex of the workings of the American medical mind
during the six preceding months. Such a work, if well conducted, would
enable us to become acquainted with the views of men of ability in every
section of the country, and would at once become a standard book of refer-
ence in Europe, as well as in America. "Writers might then enjoy the
satisfaction of contributing to the literature of their own immediate neigh-
borhood, and still feel that by so doing, their labor was not necessarily
restricted to the limits of their local periodical. With the consciousness
that merit would entitle their papers to a place in the proposed national
work, they would be actuated by an incentive which they do not now ex-
perience, and would strive to do themselves credit abroad, as well as at
home. Such a work would not conflict with the interest of existing peri-
odicals, because it would publish no paper that had not already appeared
in a local journal, with the exception of reviews. Physicians would natu-
rally continue to support the journal of their own neighborhood, and take
also the national work for more extended knowledge, as they do now the
reprints of European retrospects.

We have no doubt that such a work, as we propose, would meet with
the approbation and patronage of the American Medical Association, if
the subject were brought before that enlightened body at their next meet-
ing. We appeal to our editorial brethren, throughout the length and
breadth of our great confederacy, to aid us in bringing about so desirable
-an undertaking. Surely there are many men in our large cities who have
the requisite qualifications for such a task ; and who, living where the faci-
lities for printing and general dissemination are abundant, might find it
advantageous to embark in the enterprise.

Escape of Great Vessels by their Elasticity, from Balls. By G. H B.
Macleod. There is no circumstance in gunshot wounds wdiich is more
striking than the wonderful way in which the great vessels, by their elasti-

1856.] Miscellaneous. 577

city, escape from the ball in its transit. Thus bullets innocuously traversed
parts where one would suppose a pin's head could not be placed, without
wounding a vessel. True, the fact that such cases remain to be seen, re-
sults from the vessel not having been opened, and we do not know in how
many cases the result was not so fortunate, but still, viewed merely as hap-
py escapes, they are curious and interesting. In the course of the femoral
vessels, this phenomenon is particularly common. Through the axilla,
through the neck, out and in behind the angles of the jaw, between the
bones of the forearm and leg, balls of every size often take their passage
without harm to the vessels. Take the following cases as examples : A
soldier was wounded at Inkerman, by a ball which entered through the
right cheek and escaped behind the angle of the left jaw, so tearing the
parts that the great vessels were plainly visible in the wound. Three
weeks after he was discharged without having had a bad symptom. A
soldier of the Buffs was struck in June last, when in the trenches, by a rifle
ball, in the nape of the neck. It passed forwards round the right side of
the neck, up under the angle of the inferior maxilla, fractured the superior
maxillary and malar bones, destroyed the eye, and, escaping, killed ano-
ther man who was sitting beside him. This man made a recovery without
a bad symptom.

A French soldier at the Alma was struck obliquely by a rifle ball, near,
but external to the right nipple; the ball passed seemingly right through
the vessels and nerves in the axilla, and escaped behind. His cure was
rapid and uninterrupted. Endless numbers of similar cases may be seen
in any military hospital. [Edinburgh Med. Jour.

Treatment of Erysipelas. M. Velpeau gives the results of his treatment
of 1000 cases of Erysipelas. He places the greatest reliance in iron. He
employs the proto-sulphate of iron in solution, about twelve grains to the
ounce of water or as an ointment, eight parts to thirty of lard. In forty
cases in which this was exclusively used, the erysipelas yielded in from
twenty-four to forty-eight hours. The ointment is more easily applied to
some parts than the lotion, but is somewhat less efficacious. It should be
used about three times a day. The lotion should be applied by soft com-
presses or cloths kept constantly moist. [Bull, de Therap. Boston Jour.

Removal of Milk in the Breast. Mr. Gibbon states in the Lancet, that
the application of belladonna to the mamma is an excellent means of
checking the secretion of milk. With a lotion consisting of half a drachm
of the extract of belladonna to half a pint of water, he has succeeded in ar-
resting the secretion in three protracted cases, where a variety of expedi-
ents had failed. [Boston Med. Journal.

Formula for the Internal Use of Chloroform. M. Dannecy, pharmacien,
of 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. [Lancet.

578 Miscellaneous.

Rapid Detection of Sugar. M. Botte lias several times employed the
method suggested by Liebig of quickly detecting sugar. A small quantity
of ox-gall is dissolved in the suspected fluid in a test-glass, and a quantity
of concentrated sulphuric acid equal in amount to that of the fluid in the
glass is rapidly added, care being taken to pour it along the side of the
glass. If sugar is present a beautiful purpurine is immediately produced.

[Rev. Medicate Med. Times and Gazette.

Vaccination in Relation to Blindness. Statistical researches show us
that, prior to Jenner's discovery, of 100 cases of blindness, 55 were due to
small-pox ; and Dr. Dumont, physician to the Hospice for the Blind, has
recently supplied an interesting account of the progressive decrease of that
proportion. Among the blind of sixty years of age, he finds this variety of
cause in 12 per cent. ; in adults, it only exists as 8 per cent. ; and, in chil-
dren, only as 5 per cent. We may take as a mean, counting all ages,
about 7 per cent., which, as at the commencement of the present century,
the proportion was 35 per cent., exhibits a diminution of 28 per cent.

[Med. Temes and Gazette.

Solution of Gutta Percha. Mr. Maisch, of New York, advises the fol-
lowing method : Oue part of the best commercial gutta percha is cut into
small pieces, and by agitation is dissolved iu twelve parts of chloroform.
On standing for a day, all the coloring matter rises like a scum to the sur-
face, leaving the solution clear. This may then be easily drawn off to the
last drop. A wide glass tube, narrower at the bottom, and so arranged
that both ends may be closed with corks, is the only instrument necessary.
After the separation is complete, the upper cork must be removed, and the
lower one loosened, so as to allow the fluid to run out slowly. The advan-
tages of this solution over collodion consist in the absence of contractile
power and gloss, and in its elasticity and greater resemblance to the skin
in appearance. [Memphis Med. Recorder.

Pectoral Sijrup. Take of ipecacuanha, one ounce ; seneka, three ounces ;
refined sugar, two pounds ; sulphate of muriate of morphia, sixteen grains ;
oil of sassafras, ten minims ; make two pints of syrup. Macerate the ipe-
cacuanha in coarse powder, for fourteen days, in one pint of diluted alcohol,
express, filter, and evaporate to six fluid ounces. Next digest the seneka
in coarse powder, with ten fluid ounces of water, and two fluid ounces of
alcohol, at a heat not exceeding 104 F., for six hours, strain, express and
filter, adding, if necessary, enough water to make ten fluid ounces. Mix
with this the tincture first obtained, and dissolve in it the sugar, at a gentle
heat; strain, and while yet warm, add the morphine and oil of sassafras,
dissolved in a very little warm alcohol. The dose is from one to two tea-
spoonfuls. This is Jackson's formula as prepared by Stevens. (See Amer.
Journal of Pharmacy, May, 1850.) The prescription is a favorite one with
many Northern physicians, ;is an anodyne expectorant; and is, doubtless,
a better remedy than any of the numerous compounds sold in the shops,
all which have opium for their basis. Great mischief is undoubtedly done
in pulmonary diseases, by the injudicious and extra-professional use of all
these anodyne cough mixtures. It is far from being true that every case
of COUgh requires or admits the use of anodyne remedies. [Poid.

SOUTHERN

MEDICAL AND SUBGICAL JOURNAL.

(NEW SERIES.)

Vol. XII.] AUGUSTA, GEORGIA, OCTOBER, 18ft. [No. 10.

ORIGINAL AND ECLECTIC.

ARTICLE XXV.

An Essay Historical, Theoretical and Practical on Hydro- Thera'
peutics. By Jno, Stainback Wilson, M. D., of Muscogee
county, Ga.

In writing an article designed to invite attention to the varied
applications of waters the numerous indications it is so well
calculated to fulfil -its great, and in many cases, transcendant re-
medial virtues, we trust that our antecedents will be sufficient to
relieve us from the charge of "giving aid and comfort" to a class
of modern pseudo-reformers, who claim for this agent exclusive,
universal, and almost omnipotent powers. And in order to remind
regular physicians that they may speak and write of the remedial
application of water, and use it too, ad libitum, in all its forms
solid, fluid, or gaseous ; at all temperatures hot, cold, tepid, or
warm ; to every part, generally or locally ; in every way by
aspersion, by affusion, by submersion, by detersion and perfusion ;
by wet sheets or shirts, cloths, blankets, or rags, without justly
subjecting themselves to the humiliating imputation of being mis-
led by the New Lights, we will give a very brief history of bath-
ing, which will show that water has been used in most or all these
forms, from the most remote antiquity, and sanctioned by the
greatest medical writers of ancient and modern times.

Iff. S. VOL. XII. NO. X. 37

580 Wilson, on Hydro- Therapeutics. [October,

History of Bathing.

As it would be foreign to our purpose to dwell on the remedial
and religious uses of water, by the Hebrews, Egyptians, Greeks,,
and Romans, we will only remark that it has thus been used by
all nations, in all ages, and by all denominations Jewish, Chris-
tian, Mahometan, and Pagan. We will now briefly refer to some
of the ancient medical authors who advocate the use of "Nature's
own remedy," of which we hear so much in these modern days.
Hippocrates recommended bathing in pneumonia ; and cold affu-
sions in inflamed joints, in gout and rheumatism, and in spasms,
dislocations and fractures. Galen says: "Cold water quickens^
the action of the bowels; cold drink stops hemorrhages, and
sometimes brings back heat * cold drinks are good in continued
and ardent fevers they discharge the redundant and peccant
humors by stool, by vomiting, or by sweat." He also commends-
the internal and external use of water, warm and cold, in bilious-
ness, spasms, headache, fever of the stomach, hiccough, cholera
morbus, ophthalmia, and plethora, Celsus directs bathing in af-
fections of the head, in fulness of the stomach, weak vision, deaf-
ness, tremors, sinking, pains in the joints, diarrhoea, piles, hysteria,
hypochondriasis, low fevers, digestive disorders, diseased kidneys,
skin diseases, and hydrophobia. In addition to this strong testi-
mony from the "fathers" in medicine, we can only mention),
among the ancients, the names of Asclepiades, Oribassius, iEtiuSj
Rhuzes> and Avicenna; and among the moderns, the names of
Hoffman, Boerhaave, Haller, Floyer, Gregory, Cheyne, Lanzani,
Harvey, Ambrose Pare, Larry, Macartney, Percy, Wright, Carrie-,.
Jackson, Forbes, and John Bell ; and we might add the names of
Sir Charles Scudamore, Drs. Johnson, Adair and Crawford, Mr.
Mayo, Mr. Courtney, and the celebrated Liebig, several of whom
have gone so far as to give their sanction to the " Water-cure
processes.

But it may be said by our modern reformers, this is all true \
the external and internal use of water has been recommended by
.all the most distinguished physicians in the world, ancient and
modern, in every variety of disease ; yet the immortal Priessnitz
certainly did discover the wet sheet. We will see.

" Dr. Cole gives an account of a stout young man in a delirium,
who, escaping from his nurse, ran into a pond, where, standing
up to his chin, he swore he would drown who ever came in after

1856.] Wilson, on Hydro- Therapeutics. 581

him. At his own time he came out of the pond and sat for many
hours in his wet shirt by the bed-side. A physician was sent for
four miles distant, who found him, upon his arrival, still in his wet
sheet, or shirt, pertinaciously refusing to go to bed until, as he said,
'he took a notion.' This man recovered kindly.

" Dr. Floyer, 150 years ago, tells us that the people of Stafford-
shire, England, go into the water in their shirts, and when they
come out they dress themselves over their wet linen, which they
wear all day, and much commend."*

But be this as it may, whether the idea of the wet-sheet pack
originated with Priessnitz or not, it is doubtless a very valuable
and convenient application, and we should not fail to avail our-
selves of it, or any of the " water-cure processes," because they
may have been abused and over-rated by a set of empirical hydro-
maniacs : on the contrary, guided by a Catholic spirit of scientific
eclecticism, we should, without hesitation, levy contributions from
every quarter, remembering always that the difference between
the scientific physician and the quack consists, not so much in the
remedy used, as in the mode of using it.

Having shown that Hydropathy (like Thompsonianism) has
nothing really new about it, except its extravagant pretensions,
we will next adduce some theoretical considerations as an essential
preliminary to a rational exposition of the therapeutic application
of water. For the sake of brevity and perspicuity, we will pre-
sent this part of our subject in an aphoristic form, promising that
we shall advance nothing but axiomatic truths, or facts well
established by the researches of Liebig and other modern chemists
and physiologists.

Physiological, Pathological, and Therapeutic Aphorisms.

Aphorism I. Animal life, in its ultimate analysis, is nothing
more nor less than a continued transformation of matter an
uninterrupted decay and restoration of the body the ceaseless
operations of two opposing processes of supply and waste of de-
composition and recomposition of vital and chemical affinity.

Aph. II. These two grand processes comprise the functions of
digestion, absorption, circulation, assimilation, respiration, and
excretion.

Aph. III. The above transformations and functions are render-

*Prof. Bowling, in Nashville Journal, Jan. 1854.

582 Wilson, on Hydro-Therapeutics. [October,

ed more active by exercise, and by cold, through the agency of
the Vis Medicatrix Naturae, in her efforts to maintain an uniform
standard of temperature.

Aph. IV. The direct effect of water, of a lower temperature
than the human body, is sedative.

Aph. V. In its indirect or re-active effect, it is stimulant; and
it possesses in addition the following properties, according to tem-
perature and mode of administration, viz : Kefrigerant, anodyne,
derivative, diaphoretic, diuretic, anti-spasmodic, astringent, (coun-
ter irritant) and tonic.

Aph. VI. The first impression produced by the application of
cold water to the surface is, a vivid shock to the nervous system,
with a simultaneous repulsion of the fluids upon the internal or-
gans. The second effect (the result of the conservative powers of
the organism,) is re-action, attended with a strong determination
to the superficial cutaneous vessels, and perhaps to the capillary
vessels of every part of the system.

Aph. VII. Derangement or impairment of the nervous power
is the primary link in the chain of morbid action.

Aph. VIII. Derangement of the capillary system of vessels
the organs of chemical and vital transformations (Aph. I.) is
the second link in the chain of diseased action.

Aph. IX. As a general rule, decidedly eold water should not
be used on the surface of the body, in active internal inflamma-
tions, and high fevers ; or in acute diseases generally, unless it
could be continuously applied so as to avoid injurious re-action.

Aph. X. The degree of re-action, after the cold bath is, in gen-
eral, cceteris jxiribus, proportioned to the coldness of the water to
the suddeness and force of the immersion to the vigor of the cir-
culation in general, and more particulary that of the surface to
the muscular movements in the bath to the friction and exercise
after the bath ; and, finally, within certain limits, to the period of
stay in it.

Aph. XI. The cold bath is not positively contra-indicated in
acute internal inflammations; on the contrary, its use in such ca-
ses is correct, according to the modus operandi of the remedy ; the
objection to it being the practical difficulty of keeping up uninter-
rupted sedation. (Aph. IX.) Hence the following corollary, which
demands our special attention, viz : Most of our medical writers,
confounding the effects of water of different temperatures, or being mis-

1856.] Wilson, on Hydro- Therapeutics. 583

led by theoretical fears, are over cautious and restrictive in its use.
The terms hot, cold, warm, &c, being entirely relative and not
absolute, great confusion and misapprehension are almost inevita-
ble, in estimating the effects of different kinds of baths. We will,
therefore, in discussing this subject, venture to make the following
innovation in our present nomenclature, which we think will ob-
viate, to some extent, this difficulty. We will call all baths which
act primarily as stimulants to the general system all bath above
the active or relative temperature of the body, plus baths ; while all
baths of primary sedative action all baths below the actual or rela-
tive temperature of the body, will be designated as minus baths ; or,
to be more specific all baths above 98, or above any other num-
ber of degrees to which the body may be accidentally elevated
all caloric baths will be comprehended under the former division ;
and all baths positively or relatively lower than the above points,
will be classed under the latter head ; while at the same time, the
terms in ordinary use may be prefixed, or affixed, as convenience
may dictate.

Dr. Forbes, in his very comprehensive article in the Cyclopce-
dia of Practical Medicine, has fallen into the difficulties above
mentioned, if we are not much mistaken ; and as he may be con-
sidered a fair expositor and representative of the views of the
profession generally, his article on "Bathing" will receive special
attention.

He tells us, first, that the cold bath (33 to 60 according to his
division,) is less applicable in infancy and old age, than in youth
and middle life. This may be true as a general rule, still we are
fully satisfied that it may be safely and beneficially used in tender
infancy, and in trembling senility ; and even in great general de-
bility of all kinds, if the temperature of the water be duly proportion-
ed to the re-active powers, and if the proper means (Aph. X.) be
used to ensure vigorous re-action. His second contra-indications
to the cold bath are menstruation and pregnancy ; in the former
positive, and to be used with great caution in the latter. The
objections to the use of very cold baths during menstruation are
no doubt well founded, still we think it possible, on theoretical
grounds, that minus cool, or even cold baths might be resorted to
with safety and advantage in some forms of dismenorrhcea and
menorrhagia. As to pregnancy, although all violent perturbating
remedies are inadmissible, we cannot see why this state should.

584 Wilson, on Hydro- Therapeutics. [October,

in itself, be a contra-indication to the judicious use of the cold
bath, either generally or locally. Our author, in speaking of the
warm bath, says : "It may be stated generally that pregnancy, in
relation to the warm bath, is to be viewed as a state of excitement,
if not as an inflammatory disease. Admitting this to be true, cer-
tainly nothing would more safely and effectually subdue the ner-
vous and vascular excitement incident to pregnancy, than the
local and general use of minus cool, or even cold baths of the
higher temperatures; by the abstraction of excessive heat; by
equalizing the circulation ; by removing internal congestions; by
corroborating the whole system ; and thus preparing it to furnish
suitable elements for the development of the new being, and to
pass safely through the critical period of parturition. In short,
we think that this is one of the cases in which regular physicians
might, with much advantage to their patients, disregard the sug-
gestions of pride and false theories, and follow the example of the
Hydropaths, who use their wet bandages, general and sitz-batbs,
in the cases under consideration, not onby with safety, but with
great reputed success. And while on this subject, we would ap-
ply the above remarks to the treatment of women after parturition.
All physicians agree in the use of cold applications in post-partu-
rient uterine hemorrhage ; and we are convinced that all the more
reflecting are fully satisfied that the popular fear of " catching
cold," so prevalent, is unfounded. They are also taught by daily
experience and observation, that the throes of parturition leave
the system in an irritated and excited condition bordering on fe-
ver, which constitutes a strong pre-disposition to inflammatory
disease. This being true, then, could anything be more safe, more
agreeable, and more prophylactic than a general tepid, or even a
cold ablution soon after delivery ? Far be it from us to advocate
the rash and indiscriminate practice of many empirics of the pre-
sent day ; but in order to show that cold water is not so dangerous
in childbed, as some imagine, we will give the practice of the Hy-
dropaths in such cases. As soon as the child is born, a pint or
more of water is thrown up the vagina, which they say (with rea-
son too,) causes the womb to contract immediately, and prevents
after-pains. The patient is then washed all over in cold water,
and a cold wet bandage is placed around the abdomen. When
the patient awakes she goes into a cold sitz-bath fifteen minutes,
the wet bandage is re-applied and continued a month, together

1856.] Wilson, on Hydro- Therapeutics. 585

with two sitz-baths, and three vaginal injections, daily. We must
say that we consider this rather too much of a good thing, yet it
serves to sustain us in the position we have taken, and should go
far to encourage and confirm physicians in the judicious and sci-
entific use of cold water, even within the very domain of ignor-
ance, prejudice, and oldwomandom the lying-in-chamber.

Dr. Forbes' third contra-indieation embraces great plethora ; a
predisposition to active hemorrhages ; to local congestions in the
more important viscera; in apoplectic subjects, and in tendency to
haemoptysis, &c. As the plethoric contra-indieation will be dis-
cussed under the head of the warm bath, we will only remark
here, that the wet-sheet pack (which combines the stimulant and
sedative effects of cold water,) is highly recommended by the Hy-
dropaths in such a condition.

The action of cold in hemorrhages and in internal congestions
will now engage our attention. If we are correct in our views
with regard to the action of cold water ; if it be a direct sedative
and refrigerant; and if (as is admitted by Dr. Forbes and others,)
parts not in contact with a refrigerating medium, contract through
sympathy, then is the local, continuous (Aph. IX.) sedative appli-
cation of this remedy strongly indicated in active hemorrhages of
all kinds, haemoptysis not excepted ; the only cautions necessary
being, to avoid carrying sedation too far, and yet to keep it up contin-
uously, so as to prevent re-action. In passive hemorrhages, the
same potent agent is at our service still ; but in cases of this kind,
its stimulant, re-active, derivative, and equalizing effects are desired:
it should therefore he briefly and suddenly applied ; while all the means
already indicated as proper to ensure these results should he duly re-
garded. (Aph. X.)

As to the local congestion of internal viscera, we must be per-
mitted to say that we could not possibly imagine anything better
calculated to remove these congestions than the stimulant and de-
rivative action of cold water properly adapted, in temperature, to
the re-active powers of the system, and regulated according to the
principles already annunciated. And we will add, even at the
risk of being considered heterodox, that we know of nothing bet-
ter suited to fulfil these indications, in the cases in question, and
in passive hemorrhages, haemoptysis included, than the wet-
sheet pack. Passing the fourth division of contra-indications,
which does not require special attention, we will give the fifth

586 Wilson, on Hydro- Therajieutics. [October,

verbatim : "It is generally inadmissible (the cold bath) in indura-
tions, obstructions, or chronic inflammations of the internal parts
of the body, more particularly of the principal viscera; likewise
in all acute inflammations of the same parts, and also in chronic
inflammations of the mucous membranes of the bronchi and in-
testinal canal, except when these are very slight." Our views as
to the principles which should govern us in the treatment of acute
diseases, with cold water, having been sufficiently indicated,
(Aph. IX. and XI.) we pass on to the consideration of one of the
most interesting subjects within the whole domain of therapeutics,
namely, its application in chronic diseases. This is a theme of ex-
traordinary interest, on account of the well known obstinacy of
such affections, their extensive prevalence, the inefficiency of our
ordinary remedies in their treatment, and because, in our opinion
our orthodox dogmas on this subject, need a thorough and radical
revision. While it is admitted, even by the ultra Hydropaths,
that cold water is not so useful in organic, as in functional dis-
eases, we must dissent from the conclusion of Dr. Forbes, that " it
is generally inadmissible in indurations, obstructions, or chronic
inflammations of internal parts," for the following reasons: In
chronic diseases, generally, there is a want of proper activity in
all the organic processes; all the powers of life are below par, and
consequently all the functions are more or less tardily and imper-
fectly performed ; and this is true equally of the diseased organ
itself, for though there may be a determination of blood to the
affected part, this is rather a morbid than a vital stimulant, for it
flows languidly through the hypenemic vessels of the suffering
organ, and producing in short, all the pathological phenomena
characteristic of passive congestion, rather than of active inflam-
mation. If these premises be admitted, then are the stimulant and
re-activc effects (Aph. V.) of the cold bath most desirable in almost
every form of chronic disease to derive to the surface, to equal-
ize the circulation, to eliminate morbid matters, to arouse the ex-
crctorics, to quicken the chemical and vital processes of the capil-
lary circulation, (Aph. I. and VIII.) to send the vivifying current
through the stagnating vessels of the affected organ with a healthy
impulse ; and in short, to re-animate the sluggish powers of the
whole organism. We will even go farther than this, and say, if
the premises be true, then the more chronic the disease, the more
permanent the inflammation ; the greater the congestion or obstruc-

1856.] "Wilson, on Hydro- Therapeutics. 587

tion, the colder should be die water: provided always, that all the at-
tendant circumstances of tiie case receive proper consideration ; and
provided everything necessary be done to ensure vigorous re-action.
(Aph. X.) The above observations are applicable to chronic dis-
eases generally ; and a fortiori, to chronic inflammations of the
gastro-intestinal and pulmonary mucous membranes, because of
the well known sympathy existing between those membranes and
the skin. Yet while this intimate sympathy tends to strengthen
the indication for the cold bath, it at the same time requires cor-
responding caution in using this remedy ; and this is the reason,
no doubt, why it has been deemed wholly inadmissible in inflam-
mations of the chest, by Dr. Bache, (IT. S. Dispens.) and almost all
regular physicians ; while the same consideration, doubtless, in-
duced Dr. Forbes to restrict its use only to ''very slight" chronic
inflammations of the intestinal and pulmonary mucous membrane.
From this we draw the following practical deduction, viz : While
cold water is not by an}r means inadmissible, either locally or
generally, in the affections under consideration, it will, as a gene-
ral rule, be safer and equally as effectual to use it in accordance
with the principles which would govern us in the treatment of
acute diseases ; (Aph. IX.) for ceteris paribus a higher temperature
will produce as great an effect in these affections, as a lower would
in other diseases. We have thus given our views on the use of
the cold bath in several morbid conditions, and endeavoured to
establish correct principles for its administration ; we have felt
much diffidence in expressing opinions adverse to the most autho-
ritative writers in our profession, but we are prompted to the disa-
greeable task, by the firm conviction, that the doctrines advocated
(although to some extent theoretical,) will bear the test of the most
rigid examination. We proceed next to another form of bath,
concerning which greater errors are entertained, if possible, than
those we have first been discussing.

The Warm Bath.
It has been seen that this bath, according to our division, in its
primary, and we might say in its exclusive effects, is a minus or
sedative bath ; being lower than the normal temperature of the
body, its action is identical with the sedative action of the cold
bath, differing in degree only from the latter, and not in kind: yet,
with this important difference there being little or no reaction or

588 Wilson, on Hydro- Therapeutics. [October,

shock to perplex us in investigating its modus operandi its phenome-
na are less complex and more easily understood. This is undoubtedly
a correct view of the subject; yet, as strange as it may appear,
Drs. Bache, Forbes, and indeed most our medical writers, while
they prescribe the warm bath in diseases of excitement, neverthe-
less trammel its use with cautions, restrictions, and contra-indica-
tions, which plainly show that they have confounded the effects
of the hot and warm bath. The former writer says: "the warm
bath cannot be deemed, strictly speaking, a stimulant." And he
tells us again, that it has a soothing influence in certain states of
morbid irritability ; and that it is proper in febrile and exanthe-
matous diseases in which the pulse is frequent and the skin hot
and dry. Yet "it is contra-indicated in diseases of the head and
chest," according to Dr. Bache. (IT. S. Dispen., 115.)

Now, the fact is the warm bath is not in any sense a stimulant,
as we might be led to believe from the cautious language of this
writer : for though, as he says, its temperature may be above that
of the surface communicating to it a sensation of warmth, it is nev-
ertheless below the normal standard of animal heat ; it abstracts
caloric, soothes the nervous system, allays vascular excitement,
restores the equilibrium of the circulation, and is, therefore, " strict-
ly speaking" a minus or sedative bath and nothing else. And
yet, notwithstanding all this, we are told that it is contra-indicated
in diseases of the head and chest: in inflammatory diseases of
these parts, we presume. But with what propriety such declara-
tions are made we cannot possibly see, for we cannot imagine any
way in which the warm bath could act injuriously, in such cases,
unless it were by the retro-pulsion of the fluids, by the density of
the medium surrounding the body ; but, admitting the possibility
of this, we think that this result would be fully counteracted by
the increased capacity of the cutaneous vessels, in accordance with
well known physical laws. And apart from all theory, we feel
Confident that we may safely appeal to the experience of every
physician to answer the question as to whether he has ever seen
any injurious effects from the warm bath, in the diseases under
consideration, when the temperature of the water and all the at-
tendant circumstances of the case were duly regarded in its admin-
istration.

The position we have taken is so rational and obvious that it
would appear to be a work of supererogation to multiply argu-

1856.] Wilson, on Hydro- Therapeutics. 589

merits in its support, were it not that our most authoritative wri-
ters, our preceptors in theory arid our guides in practice, advocate
adverse (and we must say erroneous) views on this vitally import-
ant practical point. For instance, the author to whom we have
already given so much attention, (Dr. Forbes,) prescribes the warm
bath (92 to 98) in chronic nervous diseases of a spasmodic kind;
in cramps, spasms, and convulsions of various kinds, unaccompa-
nied by a plethoric state of the system, or by fever. He prescribes it
also in various painful nervous and spasmodic affections, such as
neuralgia, sciatica, &c, in spare habits, and without inflammation ;
also, in acute inflammations of the mucous membranes of the ab-
dominal and pelvic viscera, with the loss of blood generally and
locally, in all cases, or with very rare exceptions, in order to ren-
der the bath a useful, or even a safe remedy. With these precautions
it may be useful, if not contra-indicated by plethora, &c. Similar
directions are given as to the use of the warm bath in chronic
inflammations of the same parts. And lastly, he informs us that
it has been used, more particularly on the continent, in the cold
stages of severe fevers, and in the retrocession of cutaneous dis-
eases. Certainly rather a strange remedy, according to our ideas,
unless the temperature of the bath was above that of the body.

We have italicised some of the contra-indications made by him
in prescribing this remedy ; and we find by glancing over his ar-
ticle, that five, out of the nine indications, contain cautions and
restrictions plainly showing that he considers the warm bath a
dangerous stimulant and excitant. He positively contra-indicates
it,1 or enjoins great caution in its use in full habits, in plethora,
in predisposition to apoplexy and hemorrhage, in organic diseases
of the heart, in great relaxation of the system, in extreme sensi-
tiveness of the surface, and " in all febrile diseases, whether accom-
panied by visceral inflammation or not, where there is an active circu-
lation and a hot dry skin." (Cyclo. Prac. Med., p. 277-279.)

As we remarked, when treating of the cold bath, we feel great
diffidence in opposing the views of one so distinguished as Dr.
Forbes ; yet we must be permitted to say, that we can see but one
proper contra-indication in all the above list, and that is in cases
of " great relaxation."

And we must say, in conclusion, that we cannot expect physi-
cians to realize the extraordinary benefits to be derived from the
warm bath, or to use it judiciously, when they follow, without

590 Howard, on Pneumonia. [October,

investigation, the dicta of writers who make an " active circulation
and a hot, dry skin," a positive contra-indication to it.

The Temperate, Tepid, Vapor, and Hot Baths.

As the cold and warm baths are the terminal and governing
links in the chain of minus or sedative applications, and as the
general principles established in reference to them may be readily
applied to all the intermediate links of the same chain, above men-
tioned as these differ in degree of action, and not in kind of action,
from the warm and cold baths, it will be unnecessary to enter into
any general discussion as to their modus operandi: we will only
remark, then, that any peculiarity in the action of each, and par-
ticularly of the vapor bath, will be noticed when treating of speci-
fic diseases. The effects of the hot bath being obvious and well
understood, it is equally unnecessary to multiply remarks con-
cerning it.

But the length of our article warns us that we must here dismiss
this interesting subject, for the present; Ave will therefore defer, to
some future time, that part of our " Essay " which we intended to
devote to special Hydro-therapeutics, or the practical application of
the principles advocated to specific diseases. In the mean time, we
trust that our humble effort will tend to the establishment of more
definite and philosophic views as to the modus operandi of the agent
we have been considering ; and we hope that physicians will re-
member, amid the intricate mazes of fallacious theories, and the
uncertainties of a redundant Materia Medica, that Nature has pro-
vided in the greatest profusion, a remedy of wonderful, varied,
manifest, and in many cases, transcendant remedial powers IN

PUKE SIMPLE WATER.

ARTICLE XXVI.

Treatment of Pneumonia. By C. C. Howard, Lowndesboro', Ala.

The attention of the profession has been prominently directed,
for the last few years, to the treatment of pneumonia ; and, inas-
much, as I have some reason to be satisfied with the plan pursued
by myself, it is here briefly given.

The treatment of nearly every case of this disease, coming under
my management, is begun and continued with calomel, quinine

1856.] Howard, on Pneumonia. 591

and ipecac, aided by other remedies to be hereafter mentioned.
These medicines are usually commenced with in combination in
something like the following proportions for an adult:
^ Calomel, grs. xvj.
Quinine, grs. xxiv.

Ipecac, grs. iv. Divide into eight powders.
One to be taken every three hours until the bowels are moved
two or three times. Should these medicines fail to operate in
twenty-four hours from the time of commencing to administer
them, give oleum ricini, ss, or a seidlitz powder, or some other
simple cathartic ; and, if necessary, in two or three hours thereaf-
ter, enemata.

It will frequently happen, however, that the patient will have
taken a cathartic before the physician is called, then the calomel
should be given in smaller doses, with a view to its specific action
only ; for, although a soluble condition of the bowels is desirable
throughout the attack, purgation is to be avoided.

According to the writer's observation, a great majority of pa-
tients will be brought under the peculiar influence of quinine, in
from twelve to twenty -four hours, if the medicine be administered
in doses of two or three grains, every two or three hours. But in
the more violent cases of the disease, I occasionally give five
grains, at intervals of three or four hours. A little experience
with still larger doses of this drug, i. e. ten or twenty grains, has
fully satisfied me that in any of the diseases I am called to treat,
(provided there is time to repeat the smaller doses,) there is no
necessity for the very large quantities of this medicine sanctioned
and recommended by some others.

As has been already indicated, the calomel is given with a view
to its cathartic or constitutional effect, or both ; the quinine and
ipecac with a view to their action especially on the nervous sys-
tem and skin. In the course of the treatment, therefore, one or
another of these medicines may be left out, or the whole suspend-
ed for a time, as the effect and existing symptoms dictate.

Warm poultices, powdered with a little mustard, if there is
much pain, are to be applied over the diseased lung or lungs.

If the fever has not subsided by the second day's visit, the pain
greatly decreased, and the patient improved generally, I apply a
blister sufficiently large to cover the entire thoracic disease. In-
deed, the maxim with me is, in every case of pneumonia when

592 Howard, on Pneumonia. [October,

the inflammation is such as to make a blister tolerable, or when
there is the probability that a blister will be required in the treat-
ment at all, to apply it without delay, and re-apply it if necessary,
that is to say, if the disease does not give way during the contin-
uance of the first vesication.

The calomel, quinine and ipecac, generally act well as an ex-
pectorant, and some cases are treated without any other ; but fre-
quently something like the brown mixture (IL S. Ph.) is given,
preferring, however, flax-seed to the gum arabic, less liquorice,
with some sugar, and in most cases wine of ipecac, to the antimo-
nial wine. The flax-seed are decidedly preferable to the gum
arabic, probably on account of the oil they contain. Indeed, oily
substances generally will allay cough, and I suspeet cod-liver oil
owes much of its efficacy in lung disease (if it has much,) to its
oily nature. Latterly, I have frequently used the following oil
mixture as an expectorant, and have been much pleased with its
action :

$. 01. ricini, . .
Tr. opii., . .
Loaf Sugar,
Gum arabic,
Aq. pip. ment.,

?5S.

3i.

3i.

5 vss. M. secundum artem.

One tablespoonful every one, two, or four hours, as occasion re-
quires.

If the patient has thirst he may allay it with water, which it is
submitted is the most reasonable, natural, efficient and satisfactory
means. When he wishes nourishment, the direction is to give
him a little plain food, nicely prepared. Here let it be said, out
upon those heathenish preparations of arrow-root, sago, tapioca,
pulv. elm, barley, beef tea, and a hundred vile dietic compounds
which ninety-nine cooks out of a hundred know nothing about,
and which no sane man would ever select as food for himself in
health.

Though expressed somewhat in detail, such is the general plan
of treatment pursued for several years, with some success, by the
writer, and which he desires to recommend to those of his breth-
ren, especially in the malarial districts of the South, who are
dissatisfied with the result of the methods of treatment they now
pursue. It may be added that, by a judicious application of these
means the symptoms resulting from the nervous disturbance

1856.] Holt's Letters upon General Pathology. 593

will be removed ; the skin induced to act healthily ; the bowels
with the viscera of the abdomen brought to the performance of
their natural functions ; the cough kept in due bounds ; the in-
flammation subdued ; the strength reasonably sustained, and the
patient very satisfactorily cured. Usually, no other remedies have
been found necessary to condtct my cases to a favorable issue.
When these, however, have failed promptly to promise success,
(as has occasionally happened,) then others have been selected and
applied on general principles.

"But do you never bleed your pneumonia patients?" I have
not bled one in several years, but should not hesitate to do so if
the grade of fever accompanying the disease was synochal ; but
hereabouts it is nearly constantly of a lower or typhoid type.

"Don't you give aconite and phosphorus?" Never a drop
never saw but one patient who took them, and he died in two or
three days with his pneumonia, marked by head symptoms, the
result, however, I believed, of morphine with which the aconite
and phosphorus had been aided. Hence it may be said that al-
though opiates have been brought into the treatment suggested in
this paper, still it has been found necessary to observe caution in
their use ; even teaspoonful doses of paregoric were observed to
produce decided effects in cases occurring in adults on the same
plantation.

But what of the veratrum viride ? I have seen a little of the
action of this medicine and consider it, both from what has been
seen and from its prominent impression on the system, as insuffi-
cient to the cure of this and most other diseases ; and with due
respect for its introducer and approvers, venture to assert that it
has received its crown, which time and future experience will
greatly fade.

ARTICLE XXVII,
LETTERS FMS SAIL. D. HOLT, M. D., UPON SOME POINTS Of GENERAL PATHOLOGY.

LETTER NO. 15.

Montgomery, Ala., August 28th, 1856.
Messrs. Editors It is not so strange a matter, that derangement
in the functions of the liver should constitute an important feature
in the character of these, and indeed, of all other fevers in our cli-
mate, if we examine into the causes which tend to interrupt the

594 Holt's Letters upon General Pathology. [October,

secretion of bile, and to suspend its other important functions; as
it is, that there should be in the present day, eminent men in the
profession, who affect to believe that disordered functions of the
liver constitute no very important or essential part in their char-
acter. How they have arrived at such a conclusion can be imag-
ined, only by supposing, that while the scalpel and dissecting
knife has failed to reveal the work of inflammation, upon which
they supposed the malignant forms of these fevers to depend, they
have overlooked the important fact, that nineteen-twentieths of
the deaths which occur from these diseases, are the direct result of
functional disorder, consequent upon nervous depression, or a change
in the healthy constitution of the blood, with which inflammation has
no necessary connection. Or it may be that they have looked at
them through glasses, adapted to the focus of popular prejudice
against certain remedies, which, Old Fogyism was once simple
enough to believe, had power to regulate their disturbances.
However that may be, we will first notice some of the prominent
causes which give rise to disturbance in the functions of the liver,
and then show the consequences which result from such disturb-
ance in connection with these (intermittent and remittent), and
other fevers in our climate, and I design to be as brief as possible.
The functions of the liver may be deranged and suspended from
a loss of power in the secreting vessels, or from excess of excitabil-
ity and irritation in the vessels of the liver. It may depend upon
an excess or a deficient quantity of blood, upon its too slow or too
rapid movement, and upon the character or constitution of the
blood itself, as when, from excessive secretion and a loss of its thin
or watery constituents, it becomes too thick for easy circulation ;
or when, from a loss of its solid constituents, it becomes too thin
and too much impoverished to sustain the functions of gecretion,
or even its own vitality. The most common source of deranged
and suspended functions of the liver is to be found in venous con-
gestion, consequent upon an enfeebled condition of the capillaries
of the portal vein, and usually attended with engorgement of the
bile ducts, with thick inspissated bile, while its deranged and sus-
pended functions, from excess of excitability or irritation in those
vessels, depend neither upon venous congestion or bilious engorge-
ment, though these conditions often attend upon it the former
being the usual attendants upon the congestion, and the lattter
upon the irritant and inflammatory forms of fever. Now, the dis-

1856.] Holt's Letters upon General Pathology, 595

turbance in the functions of the liver, which consists in an ex-
cessive or defective secretion of bile, in defective or suspended
elaboration of the nutritive materials brought to it by the portal
veins, and in the defective or suspended depuration of blood con-
sequent upon these, may, with the causes which give rise to it, be
regarded as a chain of cause and effect, having the first link in
such a loss of nervous power in particular parts, or of the whole
system, as to interrupt and disturb the circulation and to cause an
unequal distribution of blood, whereby it accumulates in certain
organs and becomes so deficient in others, as seriously to interrupt
the healthy performance of their functions, some of which, are
employed in the office of supplying material to the blood for the
support of the system, while others are employed in removing
from the blood the noxious and septic matters which are the natu-
ral product of disintegration and decay. The particular constitu-
tion of the blood most favorable for an excessive secretion of bile
is not an easy matter to determine ; but the general condition of
the system which appears most favorable is a moderate degree of
excitement, such as exists in the ordinary irritant forms of disease,
the conditions of depression and congestion and of high excitement or
inflammation, being alike unfavorable. In speaking of the exces-
sive secretion of bile, I do not mean such a normal increase as
often occurs under the influence of temporary and partial excite-
ment, but when it occurs as one of the morbid phenomena usually
attendant upon particlar forms of the fevers under consideration,
the effects of which are to excite excessive and obstinate vomiting
and purging, (the bile, itself, being under such circumstances acrid
and irritating,) and thus to interrupt or suspend the process of di-
gestion, assimilation and nutrition. Another effect of the exces-
sive secretion of bile is to weaken the secretory powers of the
liver, and thus to render it subsequently torpid and inactive ; but
the most important effects of excessive secretion, in a pathological
view, are those which relate to the changes thus effected upon the
constitution of the blood; and for the better illustration of my
views upon this subject, I will offer a few extracts from Dr. Wil-
liams' Principles of Medicine: " Excessive secretions, if abounding
in animal matter, may not only reduce the mass of the blood, but
also affect its composition." " Urine contains a great preponder-
ance of azote, and its excessive formation from the principles of
the blood would have a predominance of hydrogen and carbon in

N. S. VOL. XII. NO. X. 38

596 Holt's Letters upon General Pathology. [October,

this fluid. The bile again abounds in hydro-carbon, the copious

removal of which would leave a superfluity of azote The

secretions of the liver and of the kidneys are intended to balance
one another, and the removal of carbon from the lungsr and whe-
ther the materials from which these eliminating processes are sup-
plied, be the principles of the blood itself, or the decayed constitu-
ents of tissues, or matters derived from the foodr the co-operation
of all these processes will generally be required to maintain an
uniformity in the composition of the circulating fluid: so, too, if
one of these processes is more active than the others, the blood
must suffer by the excess of those matters which the less active
processes allow to accumulate in it."

"We come next to consider the effects of a deficient or suspended
secretion of bile, which being an important agent in the work of
digestion, its deficiency necessarily enfeebles that process, and im-
pairs the function of assimilation and nutrition. Thus, the blood
to an extent becomes impoverished, which tends to diminish the
tone and vigor of the whole system. Another effect of a deficient
secretion of bile is to interrupt the regular peristaltic action of the
intestines, which to some extent depends upon the stimulus of the
bile, but being deficient in quantity gives rise to torpor of the bow-
els, whereby the excrementitious matters are retained for too long
a time, subjected to the action of the absorbents, and thus effete
and noxious matters which ought to be thrown off, are taken again
into the circulation along with the new materials of supply, which
the liver in its deranged condition fails properly to elaborate, and
which in their unprepared state are thrown into the general circu-
lation, thus further impairing the healthy constitution of the blood'
and unfitting it for the proper and healthy performance of its va-
rious and respective offices. But by far the most important effect
of the suspended secretory function of the liver is, the retention
and accumulation in the blood of the elementary principles for
secretion, and the effete, septic and noxious matters of excretion,
" which are the product of disintegration and decay, whereby from
a want of depuration the blood often becomes so depraved as not
only to be unfit for sustaining the vital functions in their integri-
ty, which depend upon its healthy constitution, but to exert a di-
rect influence in the establishment of a still greater depravity, by
depressing the power of the great nervous centres ; and thus, the
liver, lungs, kidneys, &c., failing further in their work of elimin-

1856.] Holt's Letters upon General Pathology. 697

ation and depuration, the blood, in a great measure, loses its vital'
ity, giving rise to those malignant symptoms which are character-
istic of the highest grades, or most malignant forms of the fevers
of hot climates. To show that these remarks are not mere as-
sumption, I will quote again from Dr. Williams, who says" The
concomitance of congestion with defective secretion, in the case of
the liver, the kidneys and the mucous membrane, is well known,
but either may be viewed in the light of both cause and effect.
The most remarkable of the backward effects of defective secretion
are instanced in case of the secretions (before treated of). The
distinctive materials of the secretions of urine and bile appear to
be positively noxious, and poison the system if not separated from the
blood. Thus, the sudden suppression of urine or bile causes ty-
phoid symptoms, extreme depression, and coma, which speedily
end in death; and in such cases urea, or the coloring matter of the
bile has been found in various organs Where the suppression is
incomplete, the poisoning process is more tardy : various functional
and visceral derangements are produced, such as delirium or le-
thargy, dyspnoea, palpitation, vomiting, diarrhoea, dropsical effu-
sions, structural degenerations, &c, which always proved fatal sooner
or later, if the defective excretion be not restored.'1'1 Again " The^o-
sitively noxious properties which excrementitious matter retained
in the blood is known to possess, must be taken into account
when we attempt to explain the states of constitutional irritation
and depression with perversion of functions, which fevers so gen-
erally present." Dr. W. continues his remarks concerning the
effects of defective secretions, to which I find a note appended,
which conveys my ideas so fully, respecting a condition frequently
to be seen in some of our more malignant forms of fever, particu-
larly the typhoid, that though somewhat out of place, I cannot let
it pass : " Purpura, I have found to be often connected with he-
patic congestion, and imperfect excretion of bile, and to be most
effectually removed by remedies which promote the restoration of
the proper secretions."

I propose now, (and there can be no more appropriate occasion,)
to examine the relation which these derangements in the functions
of the liver sustains in the different forms and modifications of
those fevers, which have their origin in a change of the organic
nerve power, to which class we consider the fevers in question
(intermittents and remittents) to belong, taking, first, those which

598 Holt's Letters upon General Pathology. [October,

are characterized by nervous depression and congestion, (accord-
ing to our classification,) and secondly, those characterised by
excitement with irritation or inflammation, and lastly, those which
approach to, and assimilate the typhoid character, I have already
pointed out the manner in which general causes, acting with un-
equal force upon different portions of the nervous system, increas-
ing or diminishing the excitability of particular organs, thus de-
ranging the currents and disturbing the balance between the
venous and arterial portions of the circulation, causing determina-
tions, and undue accumulations of blood, and thus interrupting
the healthy performance of the functions of those organs, in conse-
quence of which, the quality of the blood often becomes so chang-
ed as to effect further and important changes in the nerve power,
and in some cases, and in some forms of these fevers to destroy, in
a great measure, the vitality of the blood. But it must be remem-
bered that the changes thus effected in the condition and quality
of the blood, in the first named or congestive forms of fever, do
not so much affect its vitality, as they do, for a time at least, and
to a certain extent, destroy its properties as a stimulant to the
nervous centres and important vital organs, such as the heart,.
lungs, &c, upon which their proper and healthy action depends.
These changes, which consist chiefly in an accumulation of car-
bon, or the hydro-carbonaceous products in the blood, are usually
effected in this form of fever, in the manner described by Dr.
Williams, or upon the same principles, namely, that while the
liver, from congestion or loss of power in the secreting vessels or
both, fails to separate these products from the bloodr heavy drafts
are often made upon its albuminous and animal principles through
the skin, hidneys and the intestinal mucous surfaces. Indeed, so
uniformly is this the case, as to have induced the remark on a
former occasion, that I had never met with a case of congestion
and collapse which was not the result of some heavy draft upon
the circulating fluids, or of some strong heavy epidemic influence.
Hence it isr that when death ensues in this form of fever, it is
from the loss or destruction of the organic nerve power, from a
want of the stimulus of a sufficient quantity of oxygenized blood,
and not from necrremia or loss of vitality in the blood, which
often occurs in some of the more malignant forms of fever. It is
thus, that thousands of cases of fever, pneumonia, and other dis-
eases, not necessarily fatal in their character, have been brought to

1856.] Holt's Letters upon General Pathology. 599

a fatal termination from a rash and injudicious use of the lancet,
emetics, cathartics, diuretics, and diaphoretics, all of which tend to
destroy the nerve power, and none of them, under the circum-
stances, to restore the secretions of the liver. The rational indica-
tions for the treatment of all such cases are, to increase and sustain
the nerve power, to arrest all excessive drains upon the circulat-
ing fluids, and to restore and maintain an equilibrium to the
circulation, and last, though not least, to secure the secretory
functions of the liver. The fulfilment of one of these indications
will go a great way towards the fulfilment of the others, and the
remediable means required will generally be few, simple and effi-
cient, if properly applied. Keeping in view the trite adage, that
" an ounce of prevention is worth a pound of cure," the periodic
character of the disease can never, with safety, be overlooked. To
increase the power of the nervous system, the moderate use of dif-
fusible stimuli, such as ether, ammonia, camphor, opium, and
brandy, will be found the best. As a sinrple stimulant, the bran-
dy is generally to be preferred, but for the additional purpose of
allaying irritation in the stomach and bowels, I have found cam-
phor and opium, as they are combined in paregoric, to answer
better than any other combination of these remedies ; but to get
their best effects the dose should be larger than that usually pre-
scribed. I am in the habit of giving a tablespoonful, or half an
ounce, and repeating it every hour or oftener, as long as there is a
necessity for its use, and to children a proportionate dose. If the
type of the disease is not positively known, it will be the safest
practice to combine quinine with these remedies in proper doses,
if the condition of the stomach is such as to retain it

To restore a balance to the circulation, and to arouse the action
of the remote capillaries, no means are so effectual as the steady
and persistent application of dry heat. For this purpose, the pa-
tient should be confined to bed, be well invested with blankets, or
bed-clothes, and surrounded with bottles filled with hot water.
If, from the internal use of stimuli, and the external application of
heat, a profuse perspiration should be induced before the eviden-
ces of reaction should be sufficiently manifest, it should be prompt-
ly arrested, as its continuance will have the effect of retarding, and
may prevent reaction. This may readily be accomplished by re-
moving the bottles and blankets, and sponging the whole body
and limbs with ice water, which will, generally in a few minutes,

600 Holt's Letters upon General Pathology. [October,

establish a reaction. If it fail, the blankets and bottles should be
re-applied. In the meantime, and as soon as circumstances will
admit, calomel in the dose of 25 or 30 grs. with 10 grs. of Dover's
powder, should be administered ; the best mode of administering
which, is to rub it up with a little brown sugar, put into the
mouth dry, and carried down with a swallow of water. If it
should be thrown up, it should be immediately followed by an
other dose of the same sort ; or if the stomach should be irritable
with vomiting, it will generally be the best plan to increase the
dose to 35 or 40 grs. and make it into a bolus which will be easily
swallowed, but difficult to throw up. This dose will generally
operate in 8, 10, 12 or 15 hours, and sometimes longer, and gen-
erally the longer the better, for it will seldom fail to relieve the
liver of its sanguineous and bilious engorgement and restore its
secretions, and seldom requires to be repeated. That this is the
most effective and safest manner of using calomel in this form of
fevers, and in a like condition in other diseases, I am prepared
from ample experience to testify. The liver having been thus re-
lieved of its engorgement and congestion, the next important step
is, to fortify the system against the recurrence of a similar condi-
tion of things, and this will be effected by bringing it under the
influence of quinine, in -anticipation of the period of depression
according to the type of the disease, and its action may always be
favorably assisted by confining the patient to the application of
the blankets and bottles of hot water. In this manner the sweat-
ing may be substituted for the cold stage, and whenever this is
done, and the secretory function of the liver is re-established, the
victory will be complete.

The foregoing embraces all the principles of practice, with some
slight modifications, (and most of the remedies, with the exception
of some which served rather to add to the comfort of the patient,)
with which I have successfully combated some of the most formi-
dable congestive forms of disease, among which, besides the fevers
under consideration, may be enumerated cholera, and dysentery,
pneumonia, and other symptomatic fevers, some of which were of
the most grave, and others of the most trivial character ; among
the latter was the case of a gentleman in this city, who laid
eighteen hours in a state of collapse, or asphyxia, in conscquenco
of excessive purging with Epsom salts for a common bile.

The next forms of these fevers which we shall notice are those

1856.] Holt's Letters upon General Pathology. 601

of the intermediate grades, as the irritant, congesto-irritant, and
congesto-infiamviaiory. These are characterized by higher degrees
of excitement, and generally have their type and periods of ex-
acerbation well defined, whether intermittent or remittent. In
these forms of fever, particularly the irritant and congesto-irritant,
when the febrile movement becomes established, the lungs allow
of such a free circulation as to furnish the nervous centres, and
other vital organs, with an exuberance of oxygenized blood, giv-
ing life and activity to those organs which have not suffered from
previous debility or depression, and giving rise to irritation in
those which have. In these fevers, the liver being measurably
freed from engorgement, and being excited by a supply of well
oxygenized blood, pours out quantities of bile, which, finding its
way into the stomach and bowels, gives rise to the bilious vomit-
ing and purging which, Avitli the delirium, and hot and moist skin
and rapid pulse, are their characteristic symptoms.

The indications of treatment and the details of practice are some-
what different, in these fevers, from the congestive form, and as
their tendency is to relapse into that form, when they do so, the
principles of practice will be the same: they sometimes, too,
spring up into inflammation, under which circumstances the prac-
tice must be modified accordingly. In these forms of fever, during
the exacerbation, if the skin be hot and dry, as is often the case
for a short time during its height, refrigerative drinks, and spong-
ing the body with cold Avater, will generally be sufficient to re-
duce the excitement. Narcotic medicines and diffusible stimulants
are generally required ; but there is no disease, or form of fever,
in which quinine is more required, or in which its best effects are
more manifest, than in this dangerous form of fever, and should
be used with reference both to its stimulant or antiperiodic and
its tonic effects : it may, in fact, be regarded as the shed-anchor in
their treatment. Should there be (which is sometimes the case)
engorgement of the liver, in consequence of a feeble and imperfect
febrile reaction, calomel will be both necessary and proper; or if
the flow of bile has been excessive, its use will generally be ne
cessary, as torpor of the liver is apt to follow such action. In these
cases, so Large doses will not be required to affect the liver 20 gr.
doses will generally be found sufficient; but if the stomach and
bowels are much irritable, large doses will be found to act better,
for reasons already given. If the secretion and flow of bile have

602 Holt's Letters upon General Pathology. [October,

been excessive, the use of saline diaphoretics and diuretics will be
proper, and necessary to carry off the excess of azotic compounds
left in the blood, by the withdrawal of the hydro-carbon through the
liver. If, as there is good reason to believe, the character of these
fevers depend upon a loss of tone in the nervous system, with a too
highly annualized condition of the blood, the rational indications of
treatment would certainly be to raise the tone of the nervous sys-
tem, and reduce the animal constituents of the blood. Upon these
principles has our practice in such cases been founded ; but in the
use of remedies for fulfilling these indications, care must be taken
not to excite too highly the circulation, by the use of stimuli, for
fear of producing inflammation, nor to draw too heavily upon the
circulating fluids, by bleeding or otherwise, for fear of producing
debility, depression and congestion. These being the fevers in
which, in times past, the lancet, emetics, and drastic cathartics have
displayed their prettiest work of destruction.

The next form of these fevers which claims attention, having,
like the preceding, their origin in a change of organic nerve pow-
er, are characterized by higher degrees of excitement, rangingfrom
irritation to inflammation. These fevers, which are usually re-
mittent in their character, are generally sustained or kept up by a
greater amount of vigor and tonicity of the system, and a richer
and denser constitution of the blood.

We have maintained that fever is a sanative effort of the sys-
tem to overcome some obstruction, to relieve some laboring organ,
to restore some suspended function, &c. ; and we have advanced
the opinion, that the liver was the seat of the origin of these fevers;
and it now remains for us to examine the relations which the dis-
ordered functions of that organ sustains to the particular form of
fever in question.

The torpor and inactivity of the liver, which we suppse, and
know to exist in most fevers of this character, we have ascribed
to the cause of long continued over-action, and this opinion is sus-
tained, as well by the season or period when they mostly prevail,
as by the character of the fever itself. The fact of their having
slight cold stages, or stages of nervous depression, and prompt re-
action, with a free pulmonary circulation, and a preponderance of
blood upon the left side of the heart, manifested by a full, strong
pulse and a hot, dry skin, which are characteristic features of this
form of fever, arc sufficient evidences of the general condition of

1856.] Holt's Letters upon General Pathology. 603

the nervous system, and that the blood is not so loaded with
hydro-carbon as to cause nervous depression. From the long con-
tinued and excessive drain from the liver, which induces its debili-
ty, we might suppose that the azotic compounds would be left in
excess in the blood ; but the skin, if not the kidneys, (as these
often perform vicarious offices for each other,) under the same
influence as the liver, (atmospheric heat,) tends to preserve the
proper condition of the blood, by throwing out the azote, while
the liver is separating carbon. Though suspending secretions are
among the characteristic symptoms of this fever, the termination
of each paroxysm is usually attended with a restoration of some
one or more of the secretions, generally the skin or kidneys, or
both, and sometimes the liver; and thus the integrity of the blood
is often preserved through many successive paroxysms.

Although I have ascribed the suspended or interrupted func-
tions of the liver, among other causes, to excess of excitement, to
which we must assign the suspension of other secretions in this
fever; yet it does not follow that the suppression of the biliary
secretion in these fevers depends upon that cause. The fact that
this secretion is performed by venous capillaries, from venous
blood, while other secretions are performed by arterial capillaries,
from arterial blood : and the further fact, that the means employ-
ed to restore other secretions, by the reduction of excitement, has
little or no effect in restoring the suspended secretions of the liver ;
but that it requires the action of a specific excitement to do it, may
be taken as prima facia evidence that the liver is inactive and tor-
pid, in these fevers, from debility. This, we believe and it is an
important matter to be kept in view that using the proper means
for the reduction of excitement, care must be taken that too heavy
draughts be not made upon the blood, by bleeding, purging,
sweating, &c, until other measures have been resorted to for the
restoration of the biliary secretion, lest such an excess of carbon
be left in the blood as to cause depression in the nervous centres.
How often has it been the case, that for the want of this precau-
tion, and acting under the belief that reduction of excitement was
the great object to be obtained, patients having strength sufficient
to sustain them through a series of paroxysms, have in this way
been suddenly precipitated into states of extreme depression, con-
gestion and collapse? Where there has been no such drains upon
the circulation, and these fevers have pursued their course through

601 Holt's Letters upon General Pathology. [October,

a succession of paroxysms, the consequence of the suspended se-
cretions will be, such an accumulation of effete, noxious and septic
matters in the blood as not only to depress the organic nervous
power, but to prostrate the animal powers also, and to a consider-
able extent to destroy the vital properties of the blood itself, aud
giving rise to a train of typhoid s3'mptoms, such as, a loss of mus-
cular strength, a feeble pulse, low delirium, or coma, showing the
poisonous influence of the blood upon the brain and other nervous
centres; a dry, brown and cracked tongue; a sallow, icteric, or
cadaverous appearance of the skin, with sudamina, petechias, hem-
orrhage, offensive excretions, &c. showing, from the deranged
condition and depraved character of the secretions and excretions,
an evident tendency to putrescence of the fluids, from a loss of
vitality in the blood. Hence it is, that it is not uncommon in
localities where this form of fever prevails to find cases bearing a
striking similarity to typhoid and yellow fever, in the low deliri-
um, coma, sudamina, hemorrhage, jaundice, and even, in extreme
cases, black vomit. But similarity must not be confounded with
identity; and it must be remembered that this typhoid condition
and necrajmic state of the blood, in bilious fevers, are consequential
upon deranged functions, the result of organic nervous depression,
and of poisons generated in the system during their progress while
the fevers which they assimilate have their origin in causes or
poisons which have been generated out of the system, and which,
being taken into the circulation, tend from the first to destroy the
vitality of the blood, and to prostrate the animal nervous power.
The similarity between these fevers, which has given rise'to the
doctrine and arguments in support of their essential identity, belongs
rather to their termination than to their origin and progress, in
which my own observation has satisfied me that they are essentially
different. As this subject will constitute the theme of my next
letter, I will make a few therapeutic remarks, in addition to the
suggestions which I have already made, and leave the subject to
the reflection of the reader.

It seems almost a matter of supererogation to say, that the indi-
cations of treatment, in this form of fever, are to reduce the general
excitement, and restore the secretions, by raising the tone and
excitement in organs in which it is too low, and reducing it where it
is too high, and thus preserve the integrity and vitality of the
blood. Another equally important indication is, to arrest the

1856.] Lecture on Impotence. 605

progress of the disease, by interrupting its periodicity by estab-
lishing a state of excitement in substitution for the stage of nervous
depression. These indications will be best fulfilled by a judicious
use of the lancet, and saline diaphoretics and diuretics; by calomel
in full purgative doses; by opium, to allay pain and check exces-
sive secretions; and by quinine, to break up their periodicity and
arrest their progress. Local inflammations, either as cause or con-
sequence, must be treated upon their own merits, but with respect
to the general condition of the system. The treatment suited for
the typhoid condition in these fevers will be noticed in another
connection.

I have thus examined the character of intermittent and remittent
fevers, according to the plan and classification which I at first
proposed, which I think will cover all the forms and varieties (so far
as their pathology is concerned) which have been noticed by Eu-
ropean and American writers. It may be, that some of my read-
ers may complain that I have given but a meagre account of these
fevers, and a still more meagre plan of treatment. To such I will
say, that it was never my purpose to enter into a minute detail of
the causes, the symptoms, or the treatment of these diseases, but
to consider them in the light of a general pathology, upon which
their treatment was to be founded; and I regret it, if their expec-
tations have been disappointed. It is my intention, however, to
give, more minutely, the treatment in particular cases which I
shall furnish in support, and in proof, of the principles which I
advocate. As ever, yours truly,

Saml. D. Holt.

Lecture on Impotence. By Prof. Trousseau.

In considering, to-day, the subject of impotence, I design to sub-
mit for your examination a question as delicate as it is important.
The disease about to be treated is but recently known ; it may,
whatever be its nature, present itself every day to the practitioner;
you will therefore understand how necssary it is to have all possi-
ble information on this point, since for the patient it concerns an
entire loss of health for years, and even death, and for the physi-
cian cruel misapprehension, or, on the other hand, the complete
cure of a disease apparently unconquerable.

I shall, however, call things by their true names; the expose of
facts will be conceived as far as possible in irreproachable terms,

606 Lecture on Impotence. [October,

yet clinical instruction has its indelicate side, and I am speaking
only to the professional, I will not disguise my ideas for the slen-
der satisfaction of rendering my words a little more delicate.

A seminal loss is an involuntary flow of semen, a passing out
sperm without any erotic provocation, or at least without sufficient
erotic provocation. An individual has an excremental mass of a
certain volume accumulated in the large intestine ; he makes vio-
lent efforts to eject it, and finally succeeds in overcoming the
resistance of the sphincter. This mass pressed on the prostrate
and ejaculatory conduits, it bore considerably upon the seminal
vesicules, and at the moment of its ejection, it caused an emission
of sperm. This comes under the cognizance of pathology for in
the normal state, and even with those who are affected with obsti-
nate constipation, these parts, by their elasticity, resist the difficult
passage of hard faeces, without producing any such result.

Another individual passes, in the first jet of urine, but especial-
ly with the last drops, a thick, glairy, viscous fluid, which adheres
sometimes to the meatus urinarius ; the consistence is characteristic,
the odor sui generis, and microscopic observation reveals well
formed and vivacious animalcule. These are two examples of
seminal flow without erotic provocation.

To produce ejaculation, there must be a previous act of greater
or less duration ; for however strong be the desire of a continent
young man, there ensues no seminal evacuation even when he is
near the person who excites the desire. Voluptuous handling of
the penis, and lascivious caresses, may occasion seminal issue, but
there is not in that case sufficient erotic provocation.

With men who are very reserved in the pleasures of love, noc-
turnal pollution, the ordinary result of lascivious dreams, are,
when they occur at long intervals, and when they leave after them
no great feeling of weakness or discomforting symptom, a sign of
health and virile power, and not of feebleness or disease. But if
they succeed rapidly, several times a week for instance ; if the
subject is left in a decided state of langor; if he has less ability for
work ; in short, if he presents to a certain degree the general symp-
toms which we are about to mention, health exists no longer, and
disease has commenced. There also is there no sufficient erotic
provocation.

On introducing the virile member into the female genital organs,
sume individuals ejaculate immediately, and very soon the erection
ceases. Here again is an involuntary seminal flow, because there
has not been due and sufficient excitement; the intromission of
the penis ought to continue for a certain length of time. When-
ever you know such a state of affairs, question and observe well
the patient.

Of these spermal issues during micturition and defecation, what
may be the consequences ? Professor Lallemand, although some-
what exaggerating the effects of these seminal losses, has not failed

1856.] Lecture on Impotence. 607

to throw much light upon the question. He regards involuntary
flows of sperm as favoring the development of various nervous
affections and mental alienations, and he is right; but his error
consists in having singularly amplified the importance of this
cause ; indeed he attributes to it the origin of a host of maladies.

There is an aphorism which says, Omne animal post coitum triste.
The same idea, more poetically expressed is found in the follow-
ing line : Loeta venire Venus, tristis abire solet. It is a fact, that
after coition man is generally fatigued and sad. If he repeat often
the generative act, his body becomes weakened, his understanding
more obtuse, and all his intellectual faculties less active. Almost
immediately after copulation, the genital organ loses its rigidity,
and it needs new excitement and a certain interval to reproduce
an erection: there is then frigidity, but relative frigidity, since a
quarter of an hour previous vir erat potens. From this point to
impotence there is but a single step, for impotence is but contin-
ued frigidity.

Even when the seminal losses are not accompanied by the cynic
spasm, they are not the less an active cause of exhaustion and lan-
gor. With the woman, who experiences the spasm quite as
strongly, or even more so than the man, it may be felt an almost
unlimited number of times a day without any appreciable effect
upon the general condition. It is not that, then, but the involun-
tary emission itself, which produces the emaciating effect. An
additional proof is that in nocturnal pollutions there is no cynic
spasms ; and yet, when often repeated, they end by depriving the
individual of reproductive power.

Let us now examine what constitutes the difference between fri-
gidity and infecundity. And first, listen to the relation of this
authentic fact:

At the beginning of the reign of Louis XIV., a certain lady
sued her husband for a divorce, accusing him of being unable to
cohabit. In the presence of matrons, congressus juridicus, the cou-
ple attempted the conjugal act, and the husband experienced the
shame of a defeat. They were divorced. The same man, accused
and convicted of impotence, married again, and had seven chil-
dren. This anecdote may, I know, give rise to various pleasant-
ries, and yet there may be deduced from it a very serious fact,
namely, that an individual reputed impotent may have more pow-
er than he himself thinks, if in spite of an incomplete erection and
precipitate emission at the moment of introducing the penis, his
sperm possesses fecundating power.

Now, the matrons declared this husband impotent because of
his apparent slight physical readiness for coition ; nevertheless, as
circumstances afterwards proved, he was sufficiently puissant to
increase his family. Other individuals, on the contrary, very
amorous and very excitable with women, showing themselves ex-
ceedingly vigorous, often have no children at all,.

608 Lecture on Impotence. [October,

Patients affected by seminal losses have a sad and morose clis-
position ; they suffer from headaches, vertigo, weakness of sight,
and often fall into a habitual state of hypochondriacal melancho-
ly. Besides, they are often affected with paralysis, and especially
with paraplegia and various nervous disorders, but less frequently
indeed, than M. Lallemand has asserted.

Which is the organ that secretes the seminal fluid ? The testi-
cle, you answer, and you may think the question a singular one.
But it is not the testicle. Tie up the deferent canal of the ramr
that most amorous of animals, and you isolate the testicle complete-
ly ; and yet the sexual connection takes place with the same ener-
gy, and the emission is as abundant as before. Should a Menor-
rhagia affect the testicle of a man, the epididymus becomes indu-
rated, the origin of the deferent canal is closed, the same desires
and venereal aptitudes exist, the emission takes place in equal
quantity, but the individual remains unfruitful, and the ram just
mentioned is no less so. Hence we conclude that the seminal
vesicles secrete the spermatic liquid, and the testicles secrete the
animalcuhe. The labors of M. Gosselin have perfectly elucidated
this important point of physiological anatomy. We may now
comprehend how young and strong men, athletic and vigorous in
the duties of love, often accuse their wives of sterility ; most of the
latter are so fruitful, that should they burden their conscience
with a breach of conjugal faith, they would readily conceive.
The husbands are affected with indurated epididymis; they are
unfruitful, and thus are the cause of the sterility of their wives.

Although the failing old man, who bows beneath the weight of
years, and who has almost reached his century, may not have
experienced a rigidity of the penis, nor have ejaculated for say
forty years, yet he has still the deep voice of a man, and the an-
gular feature of a male form. On the contrary, had he suffered
castration at seventy years, his beard and hair would fall, his-
voice would change and assume the tone of that of an old woman.
The testicle was certainly of no service to him, yet it shows that
organ marks and constitutes virility even with those who make
no use of the virile attribute. Take one of the fowls castrated for
the table, if one testicle should by accident be left in the abdomin-
al cavity it will graft itself on the contiguous tissues, and the
animal will remain a cock ; but the eggs of the hen will be unfer-
tilized.

In stomatitis the salivary glands secrete abundantly ; in an irri-
tation of the neck of the bladder the kidneys do the same, and the
quantity of urine expelled is notably increased ; in an intestinal
inflammation the liver and the pancreas produce a more consider-
able flow of bile and pancreatic fluid; in certain catarrhal affec-
tions, the action of the nasal and ocular mucous membranes is
manifestly stimulated. Well, in the irritation of the veru monta-
num, of the prostrate mucous membrane, and of the entrance of

1856.] Lecture on Impotence. 609

the ejaculatory vessels, the same thing takes place ; there is an in-
crease of secretion, and an abundant flow of the spermatic fluid.
Professor Lallemand was of the opinion that in a given case of
involuntary loss of semen there was always irritation of the veru
montanuvi and of the prostatic mucous membrane. This explain-
ed the spermatic flow.

When urine escapes during the night from the bladder of a
child, without the participation of the will, it is an evidence of
what M. Bretonneau has noticed : that is, that the contractility of
the bladder is more exalted than during the day, when the nrine
was retained, and the child urinates in a continuous stream.

In sleep there is a state of erethism of the bladder, a sort of te-
nesmus of the vesical muscle, which contracts against the little
liquid contained; hence the incontinence of urine. This takes
place in the early part of the night, generally an hour or two after
lying down. The same thing may occur with the seminal vesi-
cles; an individual experiences in this region what the child does
in the bladder: incontinence of the semen is analogous to inconti-
nence of urine ; and where, in the one case, there is a sphincter
and a bladder inert, in the other are inert seminal vesicles and
ejaculatory vessels.

Seminal losses, strangely misunderstood before the time of
Lallemand, were empirically treated ; but in our day when this
disease has assumed a position in the domain of pathology, it
has been conscientiously studied. The following positions have
been established :

1st. Seminal losses resulting from a chronic irritation of the
prostate or of the prostatic portion of the urethra.

2dnly. Spasmodic seminal losses analogous to the nocturnal
losses of urine.

3rdly. Passive seminal losses corresponding with the diurnal
losses of urine in children.

These divisions have been established because they appeared to
be the expression of the facts observed, and also because they con-
duct to therapeutic consequences of some importance. Lallemand
from his point of view, thought that any medicament modifying
the urethral irritation was capable of preventing the involuntary
spermatic flows. He remarked that in a great number of cases
the seminal loss followed a badly cured Menorrhagia, and that
many men ended thus by becoming frigid and impuissant; and
he believed that chronic phlegmasia of the urethral mucous mem-
brane was the occasional cause of the affection under considera-
tion. Notwithstanding the exaggerations contained in Lalle-
mand's work, we must acknowledge that he could derive useful
results from his treatment which consisted in cauterising by the
aid of the consealed sound. When the cauterisation was ineffect-
ive he had recourse to anti-blenorrhagic preparations, turpentine,
copaiva, cubebs, and to tar injections into the bladder, &c; by

610 Lecture on Impotence. [October,

these means the seminal losses were often cured, and nearly al-
ways considerably modified.

Lallemand, although not ignoring the fact that the involuntary
seminal emission could be excited by other causes besides chronic
urethral phlegmasia, was yet wrong in according to the latter a
disproportionate degree of" influence. He did nothing for the
spasms of the seminal vesicles, while it is necessary to act upon
them either by internal medicated preparations or by interna) phy-
sical means. Belladonna administered before going to bed, in
doses of from one-sixth of a grain to one grain, constitutes a pow-
erful and ever useful medicine in nocturnal urinary flows, and as
the latter have a certain analogy with involuntary spermatic eva-
cuations, it follows that the same remedy succeeds in a great
number of cases. So far as mechanical means are concerned, their
object should be to counteract the exaggerated contractility of the
seminal vesicles, and to aid the resistance of the ejaculatory vessels.

In 1825, at which time I was interne at the Maison Royale of
Charenton, Dr. Bleynie, adjunct physician of the establishment,
spoke to me of one of his patients affected with impotence, who,
seduced by the deceptive advertisements on the fourth page of the
newspapers, had consulted a quack who cured him by introducing
into the anus a sort of plug of box-wood which he made him wear.
It struck me to be some trumpery manoeuvre to excite the ex-
hausted sense, or some lascivious resort like those of worn-out
libertines in certain circumstances, and I took no more notice of
it. Ten years later, in 1835, I had some little business with a
young man twenty -six years of age, troubled with decided frigid-
ity, and yet having an irresistible desire to marry. Seeing him
plunged in profound melancholy, and learning that he seriously
contemplated suicide, I sought in every possible way to relieve
him. Then was recalled the remarkable cure mentioned by Dr.
Bleynie. Immediately I contrived a kind of plug, and prescribed
it to be worn in the anus, keeping it in position by means of ban-
dages. Scarcely a fortnight had elapsed before several erections
had appeared, and the seminal losses had become less frequent.
My patient got married, and was fully competent to the discharge
of the conjugal duty; he is living yet, and is by no means im-
potent.

I sought to understand the rationale of this remedy, and was
soon convinced that the charlatan had employed a means, the true
scope of which he was far from comprehending, like M. Jourdain,
who made prose without knowing it. In fact the plug, pressing
necessarily and immediately upon the prostrate and the ejaculato-
ry vessels, hindered the spasmodic seminal losses.

Since that time I have witnessed many patients affected in the
same manner, and as I grow older I witness more of them, for one
does not generally go to a young physician with a complaint re-
garded as disgraceful, but rather to an old practitioner who is sup-

1856.] Lecture on Impotence. 611

posed to be more indulgent towards these cases. The same rem-
edy has often been by me successfully used.

Something after the fashion of the apparatus used to sustain
hemorrhoids, I had prepared, an elastic band furnished with a
metallic branch, very slight and elastic, at the end of which was
fixed a truncated cone of ivory penetrating into the rectum and
supported in front by two attached pieces connected with the band.
This cone was arranged in a very solid manner : it did not incom-
mode the wearer much because of the great elasticity of all its
parts. Besides, if the anus became chafed, I covered the ivory
with caoutchouc.

Subsequently, I endeavored to improve the apparatus and to
modify in some manner the form of the cone. M. Mathieu, a sur-
gical instrument maker, then conceived a sort of plug shaped like
a lengthened olive: this was a considerable improvement, but af-
terwards M. Mathieu thought it possible to do without the band-
age around the body, and to fix the plug or stopper without the
assistance of bands. Hence he gave to the plug a sort of hour
glass contraction, around which the sphincter ani closed strongly,
and the large portion without kept the instrument in the proper
position. An opening was made through its longest diameter
which allowed the free exit of gas. The plug, retained in this
manner in the rectum, presses upon the prostrate and on the sem-
inal vesicles, and this very often suffices, after a week or two, to
check involuntary spermatic discharges, to restore to an impotent
man his former virile aptitudes, and to prevent uncomfortable
accidents to the moral and intellectual faculties.

I would recommend this little apparatus, not only in cases of
involuntary seminal losses, but also for nocturnal incontinence of
urine. By employing these means, I have often seen the bladder
restored to its normal tone, and have witnessed the cure of one of
the most inconvenient and unclean diseases. It is scarcely neces-
sary to observe that this plug cannot be applied to girls. In their
case, in incontinence of urine, it might perhaps be introduced into
the vagina at the same time that a small plug was adjusted in the
urinary meatus ; but you will readily perceive that you must re-
sort to that only in the last extremity, when belladonna, and all
other available therapeutic resources have failed ; for the deflora-
tion of a young girl is always a serious thing, and a physician
should assume that responsibility only when he has exhausted all
other scientific means.

I have frequently known my colleagues in consultations pre-
scribe cold hip baths, but I always prescribed myself very hot
ones. I tell my patients besides, " heat, to a temperature which
the hand can scarcely bear, four or five pounds of fine sand in a
dish ; tie it up tightly in a napkin and apply it to the anus, the
perineum, the scrotum, and the penis ; keep it there a half an hour
or so until cool, and do the same to-morrow on getting up." I do

N. S. VOL. XII. NO. X. 39

612 Lecture on Impotence. [October,,

not know a more energetic anti-phlogistic than caloric, nor a more
severe irritant than cold. Put your left hand into warm water,
and your right into cold water, the former will be chilly all day.
while the latter will be warm. When heat is applied for any
length of time to a particular part of the body it gives rise to a
reaction.

Thus sea-bathing is a powerful means of producing derivation
towards the skin, and continued warm baths are potent agents in
extinguishing its exaggerated sensibility. Physicians devoted ex-
clusively to cutaneous affection, attack an eczema of the face by
warm shower-baths repeated for two months. They put caloric
in contact with the face, cold water causing eczema, which hydro-
pathy proves conclusively.

The action of caloric is coercive, an ti -phlogistic," the action of
cold is phlogistic and fluxionary. This fact is conspicuously in-
scribed on the records of hygiene. Have the cook, the pastry-
cook, and the baker who pass several hours a day before ovens-
heated to 160, red faces? While actually before the fire they
may have, but do they afterwards ? Have the workmen who pour
out melted ore, or who hammer red-hot iron a very high color?
On the contrary, when away from the heat they are pale and sal-
low. Fluxion succeeds defluction.

Observe then that it is not in a contradictory spirit that I would
substitute warm for cold, but because there are really strong mo-
tives for so doing. In general, whenever I hear of any remedy,.
I trouble myself very little as to the source whence it comes, I re-
volve it about in my mind and endeavor to comprehend it. If it
appears to me good and useful I apply it, and should it succeed, I
recommend it. It matters little whether it comes from a quack or
not if it is really worth anything. I may have for the originator
the most profound contempt, but nevertheless I apply the idea for
the good of my fellow-men.

A very worthy physician, Dr. Lebatard, was very much sur-
prised some time ago, to see all his patients troubled with sprains
getting well under the treatment of a certain individual. He ob-
tained information of the process used, and accordingly, putting it
into practice, he kneaded or compressed the foot until the swelling
entirely disappeared, and the patient was cured. M. Lebatard,
being an honest practitioner, published the fact. This I call doing
1 a useful thing.

Returning then to the use of caloric in the treatment of seminal
losses,. I repeat that when this agent is applied for any length of
time on a part of the body, it gives rise to a reaction. The sper-
matic emissions may perhaps, under its influence, be augmented
for the first and second night, but they afterwards rapidly dimin-
ish and the erections become more and more firm. The compress-
ing apparatus and caloric are then to be used conjointly with the
means recommended by Professor Lallemand.

1856.] Suppurative Arthritis. 613

When the seminal losses are produced by relaxation, and you
are assured that there exists no calculous affection, you must have
recourse to cold baths and to a hydro4herapeutic regime. Thia
state is diametrically opposed to the preceding, and it is not aston-
ishing that an entirely different treatment should succeed. You
may prescribe nux vomica internally, and apply the little com-
pressing apparatus, etc. After very frequent spermatic losses,
there may occur nervous disorders so serious as to endure even
after the cure of the local affection, their proximate cause, Thia
is an unfortunate complication, and you will have to consult those
who have made these diseases these monomanias with hypocon-
dria, and inclination to suicide, these paraplegias and general
paralysis their special study.

Should you devote your whole attention to the treatment of
seminal losses, you would soon find yourself able to relieve nearly
all, and even to cure the majority of cases. But be on your guard
against those patients who are very rapidly cured, who set up too
soon the cry of victory, and who entertain you about their recov-
ered energies and their well tested prowess: for those who have
once suffered from involuntary seminal discharges, alwa}rs run
great risks, and if they are not careful, sooner or later may come
the renewal of the infirmities which I have mentioned. In such
case you will do well to make your patients take preventively the
same medicine which may have succeeded at first, and to continue
it for a fortnight two or three times a year. " Prudence" says the
proverb, " is the mother of safety. [Charleston Med. Journal.

Of the Possible Cure of Suppurative Arthritis with the Preservation
of Mobility. By Dr. Hyppolite Blot, Chief of the Obstetric
Clinic of the Faculty of Medicine of Paris.

The object which I have proposed to myself to accomplish, is
sufficiently indicated by the title of this essay. I wish to adduce
facts, to prove what I have not seen mentioned in any, either of
our classical treatises, or in monographs on the diseases of articu-
lations, viz: that a termination of suppurative arthritis with the
preservation of motion in the joints is, if not a common, yet at
least a possible event.

To demonstrate the correctness of what I have stated in relation
to the opinion of surgeons upon the different modes of termination
of suppurative arthritis, it will be sufficient to adduce a few passa-'
ges from the principal authors that I have been able to consult in
relation to this subject.

Boyer and the surgeons who preceded him, do not describe at
all the inflammations of the joints as distinct diseases; they include
their history in that of white tumors, and in relation to these, they
agree in stating that, when these affections are complicated with

614 Suppurative Arthritis. [October,

purulent effusion into the joints, anchylosis is the most fortunate
issue that can take place. To find these diseases separately
considered, it is necessary to refer to treatises that are altogether
modern.

In the Dictionary of Medicine we find Velpeau stating that "the
least that can happen, when suppuration occurs in such cases, is
an irremediable anchylosis. In other cases he may be so fortunate
as to find the discharge to cease, at least in part ; the general sym-
pathies become quiet, the affection becomes purely local, permit-
ting to the surgeon the possibilit}' of a complete removal f the
disease by amputation, or resection of the articulation."

In relation to articular ostitis, Sanson thus expresses himself:
"Difficult to arrest, even in its incipient stage, it becomes almost
impossible to check the disease when suppuration is established.
We may then but very rarely hope for a cure, and that generally
with an anchylosis of the bones."

In the same work, (El. de Path. Med. Chirur., 4th Edit.,) in re-
ference to traumatic arthritis, we read again : " When pus is formed
in the interior of an articulation, the disease becomes much more'
serious. Imprisoned in a capsule, the pus effects a change in the
synovial sac, the cartilages become eroded, and terminates by
evolving the spongy extremeties in destructive caries. Sometimes
a point of the articular capsule is destroyed, and the pus burrow-
ing in the cellular tissue forms often extensive sinuses in which it
accumulates and becomes decomposed. The life of the patient is
then doubly compromised, by the abundant suppuration and by
the effect of its resorption; anchylosis is inevitable."

M. Bonnet, in treating of the prognosis of arthritis, concludes
by saying: "The gravity of those cases in which pus is generated
in the articulations, is much greater than when it results simply in
the formation of false membranes. The necessity of an amputation
is then always to be apprehended ; and under the most favorable
circumstances, if a large joint is affected, a year or two may be
required to complete a cure, and then only at the expense of an an-
chylosis.1,1

M. Begin, in treating of traumatic arthritis, concludes his article
relative to the prognosis and termination of the disease, as follows:
"In the rarest and most fortunate cases, the secretion of pus grad-
ually abates; from all the parts surrounding the joint, from the
synovial membrane as well as the cartilages, cellular and vascular
granulations arise, which, coalescing, obliterate the cavity of the
joint and cause a firm and solid adhesion of all the contiguous
parts. The joint of the patient is then irremediably anchylosed.'1'1
. In the same work, (Diet, de Med. et de Chir. Prat.,) in speaking
of rheumatismal arthritis, M. Roche says: "In some cases the
synovial becomes inflamed and suppurates, the cartilages become
eroded and ulcerated, the bones become softened and carious, and
there is no resource but in amputation or in resection of the joint."

1856.] Suppurative Arthritis. 615

M. Vidal is no less explicit. " In all cases in which it becomes
necessary to make a prognosis," says this author, "it should be
given with much caution and reserve, for it is either due to an
internal cause when it is complicated and will recur, or it is of a
traumatic origin, in which case it becomes extremely grave; for if
the patient is cured, it will only be at the expense of the functions
of the joint."

As to M. Nelaton, occupying a purely surgical point of view,
and not having devoted a special article to the consideration of
arthritis, he has not found it necessary to express an opinion upon
the diverse modes of termination of this affection.

In the Compendium of Surgery the following occurs relative to
acute arthritis : " When it terminates by suppuration and the
formation of an abscess in the joint, we have every thing to fear,
and amputation may become necessary to save the life of the pa-
tient."

From all the citations that have been adduced, it is evident that
authors are unanimous in the opinion that suppurative arthritis
always presents an unhappy mode of termination, the patient
sometimes succumbing from purulent infection, in others, amputa-
tion above the joint or resection becomes necessary; and again, in
others, more rare and perhaps more fortunate anchylosis occurs,
and the patient is cured with loss of motion of the articulation. I
will only add that, having interrogated most of our masters of
surgery in reference to their having observed any other mode of
termination than those above indicated, I have uniformly received
a negative response.

Besides, I have searched in vain for facts analogous to those
which I shall report, iu the rich collection of cases published by
Brodie upon this subject as well as in most of the leading French
periodicals.

It seems to me, therefore, interesting to report certain observa-
tions made already some time since, which conclusively establish
the fact that another and more fortunate mode of termination of
suppurative arthritis than those before indicated, is possible ; a
cure with preservation oftlie motion of the joint.

These observations, although but three in number in the human
species, added to analogous ones related by our colleague, M. H.
Bouley, at the Society of Biology, as occurring in the equine spe-
cies, will suffice to prove the possibility of the mode of termination
we have designated. Future researches will determine in what
proportion of cases of suppurative arthritis we may venture to
hope for so happy an issue.

One of these observations I owe to the kindness of M. Monod,
who communicated to me the principal details of the case in 1848,
during a conversation in reference to what I had myself seen.
The second case was observed by myself in a patient introduced
into the infimary of the Maternity of Paris, to which I was then

616 Suppurative ArOiritis. [October,

attached in the capacity of intern. Both cases occurred in females
soon after parturition. I will hereafter state what importance
should be attached to this peculiarity. It is moreover to be well
understood that we do not here treat of those multiple articular
abscesses which are observed to occur in puerperal lever, but of
mono-articular arthritis, freely developed and uncomplicated with
any grave constitutional condition.

In regard to the third case, it is borrowed from the clinics of
Prof. Nelaton, who has kindly permitted me to treat of it in con-
nection with the two preceding cases. This was a case of trauma-
tic arthrisis of the knee, developed in a young man of eighteen
years.

Case 1. The female P., aged eighteen }^ears, a laborer, of good
constitution and sanguine temperament, was born of healthy pa-
rents and had herself never been sick. Menstruation commenced
at sixteen years of age, and continued regularly until she became
pregnant. During her entire pregnancy she suffered not the least
illness.

The 20th Feb., 1848, without appreciable cause, she gave birth
to a male child weighing 2500 grammes,* at the eighth month of

her pregnancy. A vertex presentation in the . The birth

was natural after a labor of eighteen hours. No accident occurred
during the day, but during the night a violent attack of colic oc-
curred, for which she was conveyed to the Infirmary.

Feb. 21st. Simple cataplasms with laudanum were sufficient to
calm the pains.

Feb. 23d. The abdominal pains had entirely ceased. She how-
ever complained of pain in the right foot, which she compared to
spasmodic pain. No marked local affection, however, could be
detected by the most careful examination. Slight redness and
tumefaction on a level with the internal malleolus was all that
was observed ; but all movement of the tibio-tarsal articulation
was very painful. Six leeches to the part tumefied; a bath, fol-
lowed with a large linseed cataplasm. To secure the influence of
position, the limb was elevated upon a cushion, and to avoid the
pain of motion, the foot was fixed by bandages to a hoop that
sustained the covering. General condition good; no appreciable
fever.

Feb. 24th. The patient was much relieved ; she suffers now but
very slightly, when the limb is moved. Poultice renewed twice
a day.

Feb. 26th. The amelioration is not continued ; the tumefaction
has increased, especially in the malleolar region ; fluctuation, how-
ever, is not distinctly perceived. Treatment continued.

March 3d. Since the 26th Feb. the tumefaction has continually

* The gramme is about equal to 15 grains Troy.

1856.J Suppurative Arthritis. 617

augmented notwithstanding the means employed, and fluctuation
in the malleolar region has become quite distinct. An incision,
about an inch in length, was made on both sides of the joint, from
which flowed a considerable quantity of laudable pus, mixed with
strings of synovia, easily recognized by its yellowish color and
syrupy consistence permitting it to be drawn out in long filaments.
A soft probe introduced into the internal incision, penetrated more
than two inches in depth, and passed without difficulty into the
tibio-tarsal articulation. On withdrawing it, it was readily made
to pass into several of the other tarsal joints by changing its direc-
tion. "Without the joint the probe was arrested by fibrous bands.
When the foot was moved, upon the leg it caused a sharp pain,
and a rough friction sound, a sort of crepitation, could be distinctly
heard and felt. This fact was confirmed by all the persons present
at the time. Same position of the limb maintained, and the same
treatment continued.

March 4th. Very evident improvement; pain of the joint less
severe; suppuration more abundant; proportion of synovia great-
er than yesterday. Treatment continued.

March 9th. Suppuration diminishes from day to day, the pus
becoming more liquid and the proportion of synovia increasing.
Pains none when the foot is not moved. Same treatment con-
tinued.

March 15th. Suppuration is completely arrested, and the pain
has quite ceased. Even slight movements of the foot excite no
pain. Same treatment continued.

March 18th. the incisions are nearly closed; the tumefaction
having ceased, the joint is restored to its normal volume; the pa-
tient is able to move the foot without pain ; the friction sound
and crepitation have also ceased. The cataplasm was replaced by
a simple unguent.

March 26th. The incisions being healed, and the movements
painless, the joint may be considered as completely cured.

March 29th. The articulation again, and without assignable
cause swollen and painful, and the surface somewhat red. Cata-
plasms. Elevation,

March 30th. All the symptoms augmented, and apparently a
slight fluctuation felt about the malleolus internus. An incision
gives issue to nothing but blood. Treatment as before.

March 31st. Patient improved ; suffers but slightly ; incision
uniting.

April 2d. Symptoms all disappeared. Treatment discontinued.
Rest in bed.

April 5th to 17th. During this period the patient gradually ac-
quired the power of using the limb without inconvenience, and left
the maternity without the slightest trace of anchylosis or rigidity.

Case 2. Madame X., thirty -five years of age, of a nervous

618 Suppurative Arthritis. [October,

temperament and good constitution, had a very fortunate first ac-
couchment, with the exception of an unusual nervous prostration
which lasted five or six hours. Lactation was quite normal.

She became pregnant a second time, and now suffered much
more than during her former pregnancy. A removal and the
cares of a large household caused her during the last months to
undergo great fatigue. Her accouchment, however, took place at
term without accident, but shortly after that, singular nervous
phenomena again occurred, accompanied this time with anguish
and insomnia. The mammary secretion was but slight, and to-
wards the fourth or fifth day after accouchment, simultaneously
with the cessation of the nervous symptoms, a serous effusion oc-
curred in both knee joints, which continued to increase notwith-
standing every effort. At the end of a month, the effusion in
the right knee was entirely absorbed, but the distention of the
ligaments had been so great that the tibia was partially luxated
outwards, and the motion of the articulation was considerably im-
paired.

In the left knee resorption of the fluid could not be obtained,
and the joint remained greatly distended. Perfect rest with cau-
terization were quite ineffectual. During the second month, an
acute inflammation supervened without appreciable cause, termin-
ating in suppuration ; a spontaneous and abundant discharge of
pus soon occurred from the inferior and external part of the arti-
culation. No serious constitutional symptoms occurred; several
counter-openings were made at different points, and the healthy
suppuration gradually diminished. About a month after the
opening of the purulent abscess of the joint, the knee was cured.
From that moment, the motion of the joint was gradually restored,
but the power of flexion could never be carried beyond a right
angle.

'o'

CASE 3. Traumatic suppurative arthritis cured ivithout loss of mo-
tion of the joint. A shawl-maker, eighteen years of age, punctured
the left knee joint with the point of the scissors employed for
shearing the shawls. At first he gave very little attention to the
injury, bu1 after the eighth and tenth day, a considerable swelling
of the joint occurred, and the patient solicited and obtained per-
, mission to enter the Hospital St. Louis.

The case presented all the signs of a penetrating wound of the
knee. A very extensive, white, cedematous tumefaction had ta-
ken place resembling that of phlegmasia alba dolens. The lips of
the wound were flabby, whitish and cedematous. A sero-purulent
liquid issued from the wound, increased by pressure upon differ-
ent points of the articulation. Adopting the treatment extolled
by M. Kleury, the entire joint was enveloped in a vesicating
plaster.

Notwithstanding this measure, the tumefaction remained unaba-

1856.] Suppurative Arthritis. 619

ted. The liquid flowing from the wound became more and more
purulent, until it no longer contained any serum, and every day
a considerable discharge from the original wound and from the
counter-openings took place. Perfect rest in a wadded splint.

Somewhat later, the discharge again became mure serous, which
character augmented until it finally ceased. In six weeks the
Wound was completely closed. The power of motion in a slight
degree still existed. The difficulty at first existing became less
and less, and at the end of three months, the patient presented
himself to M. Nelaton, having completely recovered the motion of
the joint. He now returned to nis former occupation of shawl-
making.

To the preceding cases I will add another, addressed to the So-
ciety of Biology, by Prof. H. Bouley, of Alfort. Our colleague
presented the t<mporo-maxillary articulation of a horse, in which
suppurative arthritis had existed for some time. A considerable
quantity of pus flowed from the diseased joint, especialty during
mastication to which the animal was urged, notwithstanding the
pain it produced, by the intensitj^ of hunger. Desiring to ascer-
tain the state of articulation, M. Bouley sacrificed the animal, and
on examination found that the cartilages from both the temporal
and the inferior maxillary surfaces had completely disappeared,
and were replaced by red and vascular vegetations, densely crowd-
ed together, covered in spots with smooth osseous plates. The
synovial membrane had entirely disappeared.

M. Bouley is of the opinion that the joint which, at the death
of the animal, was suppurating but little, was in process of heal-
ing, and founds this opinion upon observations in a considerable
number of other cases in the same species of animal. It appears,
indeed, that suppurative arthritis of the temporo-maxillary articu-
lation is not rare in the horse, and it is often observed that the
animal, urged by hunger, maintains the freedom of the joint by use,
and a complete cure is effected after a longer or a shorter period.
It is scarcely to be expected that similar observations should be
made upon other joints, especially upon those of the legs; for, as
is well known, when a horse has received so serious an injury as
to be incapable of any service, he is not deemed worthy of pre-
servation.

Such are the facts to which I desire to call the attention of sur-
geons.

I will endeavor now in a few words to present the reflections
that flow very naturally from them.

When we seek to account for the happy exceptions which I have
presented, two interpretations present themselves prominently to
the mind, one having reference to the special conditions in which
the first two patients were placed ; the other may be applied to
the mode of treatment which one of them received. The two cases
referred to, presented themselves in fact during the puerperal pe-

620 Suppurative Arthritis. [October,

riod. May not this condition itself furnish or suggest an explana-
tion of the cause of the fortunate issue of these cases? I am
inclined to adopt that opinion.

The facility, and especially the rapidity with which pus is form-
ed in the puerperal state, may furnish an explanation of the effu-
sion and accumulation of pus in joints, without the occurrence of
such profound lesions of the synovial membranes and cartilages as
to render anchylosis inevitable ; the transformations have not had
time to become so grave as to prevent the articular surfaces from
returning to their normal condition and a consequent restoration
of their function of motion. This view of the subject, yet hypo-
thetic, may hereafter acquire the value of a demonstration, if
opportunities occur of examining the elements of the joints affect-
ed with suppurative arthritis in puerperal females, who may have
succumbed from intercurrent diseases.

But until direct proof can be adduced, the hypothesis here put
forth may apparently derive support from the peculiar facts ob-
served in our second case, to wit, the presence of a distinct quanti- '
ty of pure synovia mingled with the laudable pus furnished by the
joint; the relative quantity of the former always increasing as the
arthritis progressed towards a cure. How, indeed, can the con-
tinued secretion of synovia be explained without admitting that
the synovial membraue has preserved its integrity, at least to some
extent? This observation seems moreover to possess some direct
practical utility. From the light of this observation, the surgeon
should, if I am not mistaken, be capable of making a clearer diag-
nosis in a given case. The prognosis being as much less serious,
and the prospect of cure the greater as the proportion of synovia
in the fluid that issues from the joint when opened, is augmented.
This hopeful anticipation being moreover enhanced, if, while from
day to day the synovia increases, the purulent secretion suffers a
corresponding diminution.

The preceding reflections are especially applicable to the first
two cases, and might seem to cast a doubt upon the possibility of
obtaining similar success in ordinary cases. But the third case is
quite differet In this, we find a genuine suppurative arthritis not
occurring in a puerperal female, but in a young man of eighteen
years. Taken in connection with the case of comparative patholo-
gy above cited, this case seems to compel the admission that sup-
purative arthritis is susceptible of cure without loss of motion of
the articulation.

As to the treatment, perhaps, that was not entirely foreign to
the success obtained. It will be recollected that, as soon as sup-
puration became manifest, free incisions were made on both sides
of the joint.

By thus avoiding the serious accidents indicated by all writers
on this subject, as the separation and infiltration of muscles, denu-
dation of bones, &c., &c, perhaps, also by thus diminishing the

1856.] New Method of Inducing Premature Labor. 621

granulations of the synovial membranes, the wasting of the carti-
lages, the inflammation, suppuration, and sometimes the necrosis
of the osseous extremities of the articulation, we shall augment
the chances of curiug the diseased joints and preserving, if not the
complete, yet the greater part of the mobility of the articulation.

I am well aware that, at first sight, these views seem to be con-
tradicted by what daily experience teaches in regard to the gravity
of wounds communicating with joints; indeed, it is well known
that such lesions are the more serious and more frequently follow-
ed by suppuration in proportion to the size of the wound and the
greater facility of admission of air into the cavity of the articula-
tion. These objections, however, are believed to be more specious
than well founded, for the two elements of the comparison are not
analogous. In one case, we dread to see suppuration supervene;
in the other, it has already occurred, and measures are not indica-
ted to avoid it, but to render it as harmless as possible. The best
means for attaining this object will probably be to avoid the pro-
longed contact of the pus with the synovial surfaces, by giving it
a free and early exit.

It is hardly necessary to add that these reflections are submitted
to the mature judgment of our distinguished surgeons with great
reserve and hesitation.

Whatever may be the influence of treatment, the cases of which
we have given the principal details prove that in suppurative ar-
thritis the surgeon ought not to despair of curing the patient, and
preserving the functional integrity of the limb. Archives Generates,
and Peninsular Journal of Medicine.

On a New Method of Inducing Premature Labor. By E. NOEGGE-
rath, M. D., of New York.

In the following communication, I desire to give an account of
a new method of inducing premature labor, which was practised,
for the first time, as far as I know, in New York, on Monday 2d
June, 1856. I wish to draw the particular attention of my pro-
fessional colleagues to this method, because I am thoroughly con-
vinced that it is superior to other methods, and will hereafter
surpass all the different modes resorted to up to the present time.

The question of the induction of premature labor has not been
discussed to the same extent in this country as on the European
continent. This is readily explained by the fact, that deformities
of the pelvis are much more rarely met with in this part of the
globe. But the time will come, and is rapidly drawing near, in
this country, that the average number of labors ending naturally,
without operative assistance, will lessen in a remarkable degree.
The immense immigration of a far from wealthy and well-shaped
people on the one hand, and the strong tendency to high city life

622 New J fethod of Inducing Premature Labor. [October,

on the other, must show their influence upon the coming genera-
tions. How different is the experience of the practitioner of to-
day from that of the late Dr. Dewees, of Philadelphia, who enjoyed
so large an obstetrical practice ! In his " System of Midwifery" he
states, that he observed only three cases of deformed pelvis during
his professional career, while during eight weeks' residence in this
city, I have met with the same number of contracted pelves.
These three occurred in ten obstetrical cases, which I had partly
under rny own care, during the absence of Dr. G. C. E. AVeber,
partly in consultation with him. In one of them a difficult for-
ceps' operation was required ; the second one was terminated by
application of the craniotomy forceps; the third one gave origin to
the present report.

While in this country but two ways of inducing premature la-
bor are generally followed, viz: tapping of the foetal membranes
and the exhibition of ergot in German}', France, and England,
there are no less than nine methods for accomplishing the same
purpose.

They are as follows :

1. The opening of the membranes.* Macaulay, Kelly, Schcd.

2. Dilatation of the os uteri, by the application of compressed
sponge. Briinninghausen, Kluge, Simpson.

3. Partial separation of the Chorion from the internal wall of
the womb by lingers or instruments introduced into the orifice.
Uamilton.

4. Administration of internal remedies, such as secale cornutum,
etc. Ramsbotham, Bongiovanni.

5. Plugging of the vagina with lint or an india-rubber bag filled
with water. Schaeller, Iluter, Braun, (Colpeurynter).

6. Injections of warm water into the vagina by the ascendant
douche or the irrigator. Kiwiseh von Eotterau.

7. Injections of warm water into the cavity of the uterus.
Schweighauser, Cohen.

8. Application of electro-galvanism to the uterus. Schreiber,
Mikscluk, Dorrington, Simpson.

9. Application of sucking-glasses to the breasts.

The great number of methods for inducing premature labor,
shows that the older ones had to be ameliorated a great deal, as
well in regard to promptness as to the safety of the mother and
the child. But it would exceed my proposed limits should I en-
deavor to discuss the value of the different methods. I will con-
line myself to the report of the case, and some remarks necessary
to present our proceedings in its true light.

Case. Mrs. G. M., born in German}'', living now in New York,
presents, in her external appearance, the form of a healthy, well-

* We give a chronological succession of the methods; the names adjoined belong
partially to the inventors, partially to the chief advocates of the single operations.

1856.] New Method of Inducing Premature Labor. 623

shaped female, though she is of a rather short stature, and exhibits
on a closer examination, the well-known form of knock-kneed ra-
chitic lower extremities.

In her first confinement, which took place about fourteen
months ago, she was attended by Dr. Gr. C. E. Weber. This
eminent practitioner was compelled, in this labor, to perform the
operation of craniotomy, in consequence of the malformation of
the pelvis. He advised her then to be delivered artificially, before
the full term, in case of a second pregnancy, not only for her own
safety, but because it would afford a chance of her having a living
child. The latter circumstance being of considerable importance,
induced the lady to follow the advice of her physician. Concep-
tion again took place at the end of October, or the beginning of
November, 1855, for at that period, her courses, always regular,
ceased. She expected, therefore, to be confined during the first
week of August, 1856, with which statement we could thoroughly
agree upon a first examination made towards the end of May.
The superior margin of the fundus uteri was then found between
the umbilicus and the processus xiphoides, the womb being equal-
ly developed on both sides. The foetal pulsations we could easily
observe on the right side, at a level with the umbilicus, while the
feet were distinctly felt near the left upper portion of the uterus.
Corresponding results were obtained by a vaginal exploration.
The pregnancy was decided to have advanced to the end of the
eighth lunar month, with a large-sized living child, having a cra-
nial presentation.

The pelvis was a model of rachitic deformity. The promontory
of the sacrum protruding forward and towards the left side of the
pelvic cavity, diminished the antero-posterior diameter to 2| 2f
inches, while the lateral diameter remained unchanged in extent ;
the outlet of the small pelvis was rather enlarged in consequence
of the widely open pubic arch and the flattening of the sacral cur-
vature. The whole basin presented but a very small degree of
inclination. The general state of health of the patient was satis-
factory. On Monday, 2d June, about 11 o'clock in the morning,
Dr. G. C. E. Weber and myself proceeded to perform the operation
of inducing labor after the method of Schweighauser, Cohen. The
woman was placed upon her back with the nates projecting some-
what over the edge of the bed, and the feet supported by two
chairs ; an elastic catheter, of the ordinary size, was introduced
into the mouth of the uterus and pushed upwards, with the inten-
tion of bringing the instrument between the anterior wall of the
uterus, au*d the foetal membranes ; the point of it entered the womb
to the extent of about four inches, then, with a syringe adjusted
to it, we injected about 7 ounces of water, heated to 90 or 100
Fahrenheit. As soon as the fluid touched the internal surface of
the uterus, the woman complained of uneasy feeling in the abdo-
men, and we distinctly felt the uterus in a state of rigidity, which

624 New Method of Inducing Premature Labor. [October,

lasted for several minutes. After a time, the finger was removed
from the external opening of the catheter, when a portion of the
water was rejected through the instrument with considerable force.
The withdrawal of the tube was followed by another escape of
some water. During the following thirty minutes the uterus was
in an almost continual state of contraction with but very few and
short intermissions of flaccidity. Besides a slight degree of excite-
ment and little headache, the woman's state of health, as well as
her pulse, proved to be unchanged. Towards noon the pains
grew stronger, but less in frequency, with long intervals.

At about 7 o'clock in the night, the pain lessened in a degree
that we thought it proper to make another injection. This was
applied in the same way with the exception that we did not
change the ordinary position of the patient in her bed, because
the lips of the os uteri were already so much retracted by the pre-
vious pains, that the introduction of the catheter would meet with
no difficulty at all. Whether the water was injected with a some-
what greater force than at the first time we cannot decide, but it
all remained in the uterus, and the operation was followed by a
sudden enlargement of the womb. Mrs. M. experienced a very
distressing pain in her abdomen ; much more so than she did at
the former injections. It made such an impression upon her sys-
tem, that she fell into an almost unconscious state; the pulse sunk
suddenly, so as to be scarcely perceptible ; her face instantly be-
came purple, and her breathing very much embarrassed. Half an
hour later, when she recovered from these symptoms, she was
seized with a violent chill, which lasted for nearly two hours.
This was followed by a feverish condition, general heat, and a
pulse of 130 in a minute. This alarming state gradually subsided,
and a renewed succession of strong uterine contractions commenc-
ed. At 7 o'clock, A. M., of the following day, we were told that
she endured almost incessant labor pains during the last night.
At this time we found that the vagiual cervix had disappeared
completely, the os uteri was opened to the size of a silver dollar,
the well-filled bag protruded into the vagina with every recurring
pain. Now we could ascertain, beyond question, a vertex pre-
sentation. At 9 o'clock, A. M., the os uteri dilated to its full ex-
tent, and the membranous cyst broke, while it was protruded
almost to the external orifice. At that time, the vertex was just
""engaged in the entrance of the pelvis. Passing over the very in-
teresting peculiarities of this cranial parturition, it will be sufficient
to say, that it required a full hour of time to bring the head down
through the brim of the small pelvis, notwithstanding "those tre-
mendous pains, which are only witnessed with rachitic females.
But when the greatest circumference of the cranium had passed
the upper part of the pelvis, then, one of these violent pains was
sufficient to drive the head through the whole cavity, and at once
out of the labia externa up to the shoulders. The entire parturi-

1856.] New Method of Inducing Premature Labor. 625

tion, from the time of the first injection, was achieved in less than
twenty-four hours.

The child, though born in a weak condition, was soon brought
to the most satisfactory state of breathing and crying. After the
placenta was removed by the ordinary manipulations, the uterus
proved to be well contracted. The mother's condition was satis-
factory, and has continued favorable.

The first man who conceived the idea of inducing premature
labor by injection of water into the uterus was Dr. Tac. Fried.
Schweighauser, of Strassburg. In his excellent work, " Das' Oe-
baren nach der beobachteten Natur" etc, Strassburg and Leipzig,
1825 ; he recommends to throw a quantity of warm water into the
womb for that purpose. But, as he never seems to have practised
it, we must attribute the whole merit to Dr. JJ. M. Cohen, of Ham-
burg, who first of all introduced this proceeding into practice.
He called the attention of the profession to this method in a thesis
written in the year 1846. After this we received by the way of
different medical journals, accounts of upwards of 80 cases in
which Dr. Cohen's directions were imitated, all of which speak in
the highest terms in its favor. The operations did not fail, in one
instance, to have the expected result. The expulsion of the child
followed from the time of the first injection of water, to an aver-
age, in three days, the shortest instance being six hours, the long-
est six days; the number of injections required was from 2 to 13.
Not one case is reported where there were any bad consequences
to the mother, while the life of the child proved to be less threat-
ened by this proceeding, than by any of the others. The sjnnp-
toms of general nervous excitement, witnessed in our case imme-
diately following the injection, have been mentioned by all the
different authors, though in a less conspicuous degree. All agree
as to their subsiding without any further injury to the patients.
The quantity of water to be injected at once was, in almost all the
cases, no more than two ounces; the quantity recommended by
Dr. Cohen. He also prescribed the use of tar-water, as being
somewhat irritating, and, therefore, more prompt in its effect; but
afterwards only common water was used, and' if heated from 90
to 100 Fahrenheit it will answer all purposes. Instead of the 2
ounces we took 7 or 8 ounces, in order to have a more decided
effect, and we introduced the instrument as far as 4 inches into the
uterus. The principle requisite for obtaining complete success is,
to push forward the tube behind the internal orifice of the uterus,
so that the point of the instrument, being in the womb, enters a
distance of at least 2 inches from the edge of the os, in order to-
bring the fluid in contact -with the internal wall of the body of the
uterus itself. The instrument to be used may be any tube that is
at hand ; an elastic or a metallic, male or female, catheter will an-
swer the purpose. Experience has proved, that the operation
worked much slower, or even not at all, when the full quantity of

626 Llandolfis Treatment of Cancer. [October,

the water is poured out again. Therefore, it is advisable to keep
the cylinder closed at its lower end for some time until the con-
traction of the uterus, which immediately follows the injection is
subdued. If, after withdrawing the instrument, water begins to
be discharged in considerable quantity, it will be necessary to plug
the vagina.

The interpretation of the fact, that premature labor can be in-
duced in this way, is not very difficult. By the contact of the
internal surface of the womb with a heterogeneous body, (water)
the 'organ must be excited from its previous inactivity, and, there-
fore, we see that the injection is immediately followed by a state
of uterine rigor ; this soon gives way, and genuine contractions
set in, in order to remove the fluid. If this is really accomplished
in a short time, we see that the pains die away again ; but if the
water has been injected high enough, and is retained, the contrac-
tion will continue. Still, it cannot be doubted that, after a while,
the liquid is absorbed, and uterine action would perhaps subside
once more, were it not that the separation of the foetal membranes
from the uterus, induced already by the act of injection itself,
and advanced by the previous contractions stimulated the uterus
to activity.

A case like this is sufficiently intelligible of itself, and the de-
tails of this method are so obvious, that a further exposition of
them would be unnecessary. It did not in a single instance fail
of immediate success, neither injuring the mother nor jeopardizing
the life of the child, it presents all the advantages connected with
a labor where the membranes remained entire. [X. Y. Jour. Med.

Llandolfis Treatment of Cancer.

M. Llandolfi's mode of treating cancer having gained considera-
ble notoriety in Austria, he repaired some time since to Paris, in
order to induce the surgeons of that capital to endorse the favora-
ble opinions expressed by some of the Vienna practitioners. The
French hospital surgeons accordingly appointed a committee of
their body to examine into the stability of their claim, and this
was done by assigning to M. Llandolii a certain number of pa-
tients at the Salpetriere. The committee, after watching the re-
sults of his treatment of these cases, has just made its report, and
the following arc the conclusions arrived at. From these it would
seem that the remedy is destined to fall into the oblivion that has
engulphed so many of its predecessors.

1. M. Llandolfi's method is made up of both local and internal
treatment. 2. The latter, which consists in the administration of
chloride of bromine, does not possess the slightest special thera-
peutical value in the treatment of cancer. 3. The local treatment
consists in the application of the following caustic : Chloride of

1856.] Ltandolfts Treatment of Cancer. 627

bromine, three parts ; chloride of zinc, two parts ; chloride of an-
timony, one part; liquorice powder, one part. 4. Of these sub-
stances, the chloride of zinc and chloride of antimony have been
long known and employed as caustics. These two chlorides com-
bined in the same proportions as in Canquoin's caustic, form the
only portion of M. Llandolfi's preparation that is really active.
5. The chloride of bromine only acts by raising the epidermis, and
exposing the denuded part to the action of the other two chlorides,
a result easily obtained by a vesicatory applied just before em-
ploying Canquoin's paste. 6. M. Llandolfi's preparation is, in
fact, only this caustic masked by a coloring and odorous body,
which, although it leaves the causticity unimpaired, destroys the
precision of application. The chloride of bromine has only spoil-
ed the mixture by rendering it fusible, much more difficult to
manage, and much more uncertain in its results. 7. As the caustic
so modified does not secure the patient from erysipelas or consecu-
tive haemorrhage, it can be no longer affirmed that its employment
is exempt from danger. 8. Infinitely more painful than most
others, this caustic induces most severe suffering, which in general
lasts for six or eight hours, and may be prolonged for more than
twenty-four hours. Opium and other narcotics are powerless
against these pains, while their duration forbids our even thinking
of employing anaesthetics. 9. the mode of application is quite
vicious, and opposed to the rules of art. In place of attempting
to at once destroy the cancerous tumor, M. Llandolfi attacks it by
partial and successive applications a necessary consequence of
employing a caustic, the extent of the action of which cannot be
calculated. 10. These successive applications, repeated on some
patients fifteen or twenty times, induce a total amount of suffering
hitherto unheard of. 11. They prolong the treatment indefinitely,
and infinitely delay cicatrization. 12. The incessant irritation
thus induced is of nature to favor relapse, as experience has only
too well shown, and as all know who are imbued with sound sur-
gical knowledge. 13. This method, applied by the inventor him-
self to nine cases of cancer of the breast and three cases of cancroid,
has given the following results: Of the nine cases of cancer of the
breast, two have died, four have suffered a notable aggravation of
the disease, while in three cases in which cicatrization took place,
the disease immediately after re-appeared; that is to say, in no
case did a cure result. Of the three cases of cancroid, a cure took
place in one ; in another there was cicatrization, with reappearance
of the disease, and in the other an exacerbation took place that
necessitated the amputation of the limb.

To sum up, M. Llandolfi's method can only be applied to certain
cancers ; it is more painful and more uncertain than several other
modes of cauterization ; and it is in particular, inferior to Can-
quoin's method, of which it is only an altered copy. Like all the
other methods of treatment, it may succeed in destroying certain

N. S. VOL. XII. NO. X. 40

628 Paralysis from Muscular Atrophy. [October,

tumors and cicatrization may follow ; but it is quite powerless for
the prevention of relapse, which it would seem rather to provoke,
and so far from forming a step in advance, it adds but another to
the illusions that so abound in the history of cancer. [Bulletin de
Therap. Med. Times and Gazette.

On Paralysis from Muscular Atrophy. By M. Cruveilhier. (Ar-
chives Generales de Medecine, Jan. 1856.)

In this paper, Cruveilhier claims the priority of the observation
of muscular paralysis* apart from any lesion of the nervous cen-
tres. He gives a brief account of the first cases which came under
his notice, in 1832 and 1848, and describes the surprise he felt
when after, in the first instance, having diagnosed disease of the
spinal cord, he found no trace of any affection of that part. He
details two later cases which satisfied him that the anterior roots of
the spinal nerves exhibited a degree of atrophy closely correspond-
ing to the amount of muscular degeneration upon which the para-
lysis depends. We must content ourselves with directing our
readers' attention to these cases, f and giving an abridged summa-
ry of the author's views on the subject. They are as follows:

1. There is a species of paralysis, partial or general, which gra-
dually affects the voluntary muscles, without involving the gene-
ral or special sensibility, the intellectual or emotional powers, or
any function of nutrition, except that bearing upon the muscles.

2. This muscular paralysis is the result of the progressive atro-
phy of the anterior roots of the spinal nerves, together with the
progressive atrophy of the muscles; the posterior roots of the
nerves, the spinal cord, and the encephalon remaining sound.

3. This form of paralysis is analogous to that resulting from
section of a nerve.

4. This form of paralysis fully confirms the doctrine of Sir C.
Bell, relative to the functions of the anterior and posterior roots-
of the nerves.

5. These observations establish the fact, previously not suspect-
ed, that the anterior roots of the nerves exercise a definite influ-
ence over nutrition.

6. These observations establish an independence of the anterior
spinal roots, from the antcro-lateral tracts of the cord, in which
not the slightest disorganization was traceable. From this the
author concludes,

7. That the anterior roots of the spinal nerves do not spring

* It is but just to Dr. Edward Mcryon (who- published some interesting cases of
granular and fatty degeneration of the voluntary muscles in the Medico-Chirurgical
Transactions for 1852,) to state, that he was the first to observe the disease in Eng-
land, and apparently without any knowledge of Cruvcilhier's discovery.

\ See,, also, British and Foreign Medico-Chirurgical Review, Oct 1855, p. 410.

1856.] Temperature of the Body in Intermittent Fever. 629

from the anterior-lateral tracts of the cord, but necessarily from
the central gray matter.

Those interested in the whole history of symptomatology and
therapeutics of progressive muscular atrophy, we would refer to a
very complete memoir on the subject in all its bearings, by Dr.
Adolph Wachsmuth.* He does full justice both to Cruveilhier
and Dr. Meryon's claims, but points out that the ' Medical Gazette'
of 1831, f contains an article by Dr. Darwall, in which that Writer
describes several instances of muscular atrophy with paralysis of
the upper extremities, but attributes them to previous disease of
the peripheral nerves. Dr. Wachsmuth has collected altogether
sixty cases of the affection. [British and For. Med. Review.

Observations on the Temperature of the Body in Intermittent Fever.
By Dr. S. A. Michael. (Archiv fur Phyliologische Heilkunde
von Vierordt. Jahrg., 1856. Heft. i. p. 39.)

This paper contains two series of observations on the tempera-
ture of the surface in persons suffering under intermittent fever.
The first contains eleven cases of intermittents of different types,
in which the observations were taken every hour, or at least fre-
quently in the course of the day ; the second comprises three cases,
in which the observations were made during the paroxysms them-
selves, and generally every five minutes. The state of the pulse
and the respiration were generally noted at the same time. The
number of thermometric observations amounted to about 260.
They were taken by placing the thermometer in the armpit. The
following are the general conclusions arrived at by Dr. Michael :

1. An increase of temperature from the normal state or the low-
est apyretic condition, at first slow, shortly before or at the com-
mencement of the rigor, rapidly and continuously advances, and
then attains its maximum by successive intermittent advances.

2. The temperature remains at its maximum height for a period
never exceeding two hours, but generally much less.

3. The diminution always takes place less rapidly than the ele-
vation. It is affected in a graduated manner, each depression of
the temperature being followed by an arrest.

4. The sensations of the patient are not in the ratio of the
changes of temperature. The temperature is above that of the
normal condition, both at the commencement of the rigor and at
the termination of the sweating stage. The maximum tempera-
tures occur either during the hot stage, towards the termination of
the cold, or at the commencement of the sweating stage. These
remarks apply to the various forms of intermittent fever.

* Henle und Pfeufer's Zeitschrift, Band vii. Hefte 1 & 2, pp. 128.
f Cases of a Peculiar Species of Paralysis. By John Darwall, M.D. Medical Ga-
zette, vol. vii. p. 201.

630 Dislocation of Tendons. [October,

5. In most of the cases, the maximum lay between 32 and 33
E. (104 106 j F.) The highest maximum was 33 ! R.

6. The duration of the paroxysms varies considerably in the
cases presenting a tertian type. The limits are sixteen and thirty-
two hours ; in the quotidian forms they are nine and eighteen
hours.

7. The duration of the period of increase is always shorter than
the period of decrease in the quotidian forms ; in the tertian it is
sometimes shorter, sometimes longer.

8. During the free intervals, the temperature generally falls be-
low the normal temperature, still, the instances especially of the
quotidian fevers are not rare in which it is at least several de-
grees (Reaumur) above the normal temperature.

9. After the exhibition of sulphate of chinidine (the salt com-
monly employed in Dr. Michael's cases) in doses of from ten to
fifteen grains, there is either no recurrence of an increase of tem-
perature, or a single increase of almost the same intensity, but
with less violent subjective symptoms ; or again, the temperature
rises, though to a lower degree, and the symptoms are scarcely
perceptible ; or, finally, there is a feeble increase of temperature
without any subjective symptoms. Only one case occurred in
which there were two increases of temperature.

10. During convalescence, the temperature is generally under
the normal elevation, but may occasionally rise a few tenths of a
degree above it. At times there are evening exacerbations or
evening remissions, or it is the same morning and evening. [/&,

On Dislocation of Tendons. By Dr. Sebregondi.

Dr. Sebregondi, judging from his own observations, believes
this accident to be far more frequent than, judging from the little
notice of it taken in the manuals, it is supposed to be, it being, in-
deed, often confounded with partial or complete dislocation or
sprain ; and at other times explanatory of the success occasionally
obtained by empirics by their manipulation of injured limbs.

The dislocation of the tendon may be either simple or complica-
ted with rupture of the sheath ; the consequences in the latter
case, especially in diseased subjects, being sometimes very serious.
The tendons especially liable to be dislocated are those which run
a long course from the muscular belly prior to their attachment,
lying, for the most part, in a groove, and either surrounded by a
sheath, or protected by the adjoining cellular tissue. To these
especially belong the tendons of the long head of the biceps
brachii, as also the tendons of the teres major and minor. A case
of each of these dislocations is narrated by the author, as also ano-
ther occurring at the elbow-joint, though this is of much rarer
occurrence. The accident is often met with in the vicinity of the
wrist-joint, especially at the posterior surface; and is frequently

1856.] New Rules for the Treatment of Asphyxia. 631

there accompanied by rupture of the sheath, and not unfrequently
gives rise to ganglionary formations. The knee-joint is also not
unfrequently the seat of these dislocations, the accident not only
occurring to the tendon of the sartorius, but also to that of the
biceps cruris, in the vicinity of the head of the fibula. The same
accident often happens near the ankle-joint, and is frequently mis-
taken; but ganglionary formation is a far less common result than
at the wrist-joint. The author relates an interesting case of dislo-
cation of the tendon of the plantar muscle occurring in a child.
\Berlin Med. Zeit. Virginia Med. Jour.

New Rules for the Treatment of Asphyxia. By Dr. MARSHALL HALL.

I. Send with all speed for medical aid, for articles of clothing,
blankets, etc.

II. Treat the patient on the spot, in the open air, exposing the
face and chest freely to the breeze, except in too cold weather.

I. To excite Respiration

III. Place the patient gently on the face (to allow any fluids to
flow from the mouth).

IV. Then raise the patient into the sitting posture, and endea-
vor to excite respiration,

1. By snuff, hartshorn, etc., applied to the nostrils ;

2. By irritating the throat by a feather, or the finger;

3. By dashing hot and cold water alternately on the face and chest.
If there be no success, lose no time, but

II. To imitate Respiration.

V. Beplace the patient on his face, his arms under his head, that
the tongue may fall forward, and leave the entrance into the wind-
pipe free, and that any fluids may flow out of the mouth; then

1. Turn the body gradually but completely on the side, and a
little more, and then again on the face, alternately (to induce inspi-
ration and expiration);

2. When replaced, apply pressure along the back and ribs, and
then remove it (to induce further expiration and inspiration) and
proceed as before ;

3. Let these measures be repeated gently, deliberately, but effi-
ciently and perseveringly, sixteen times in the minute only.

III. To induce Circulation and Warmth

1. Continuing these measures, rub all the limbs and the trunk
upward with the warm hands, making firm pressure energetically;

2. Replace the wet clothes by such other covering, etc., as can
be procured.

IV. Omit tJie Warm-bath until respiration be re-established.
To recapitulate, I observe that
1. If there be one fact more self-evident than another, it is that

632 Treatment of Ncevus by Vaccination. [October,

artificial respiration is the sine qua non in the treatment of as-
phyxia, apncea, or suspended respiration.

2. If there be one fact more established in physiology than ano-
ther, it is that within just limits, a lotv temperature conduces to the
protraction of life, in cases of suspended respiration, and that a
more elevated temperature destroys life. This is the result of the
admirable, the incomparable, work of Edwards.

3. Now, the only mode of inducing efficient respiration, artifi-
cially, at all times and under all circumstances, by the hands alone,
is that of the postural manoeuvres described in this paper.

This measure must be adopted.

4. The next measure is, I have stated, to restore the circulation
and warmth by means of pressure firmly and simultaneously ap-
plied in the course of the veins, therefore upward.

5. And the measure not to be adopted, because it tends to extin-
guish life, is the warm bath, icithout artificial respiration.

This measure must be relinquished.

These conclusions are at once the conclusions of common sense
and of physiological experiment. On these views human life may,
nay, must sometimes depend. [Lancet.

On the Treatment of Nxvus by Vaccination. By M. LEGENDRE.
(Archives Generates.)

M. Legendre believes that the ill success which has attended
this practice in the hands of some, is chiefly due to the defective
mode adopted. He sums up his observations as follows :

1. Choice of the Lymph.- It is of the greatest importance that all
the vaccinated spots should take, as it is from their multiplicity
and confluence the inflammatory process results sufficing to trans-
form the erectile tissue into non-vascular cicatricial tissue. When
but two or three from among seven or eight punctures succeed,
the number is usually insufficient for the production of the requi-
site amount of inflammation, while it prevents the repetition of the
operation. The lymph should be therefore taken directly from
the arm of the child that supplies it, the lancet being charged
afresh after each puncture, and the operation performed slowly, so
as to involve only the superficial lymphatic net- work of the skin.

2. Number of Punctures. < There is nothing fixed with regard to
this, depending as it does upon the size of the naevus; and while
one nsevus may require seven or eight insertions, double this
"humbcr may be necessary for a very extensive one. It may be
laid down as a general rule, that a sufficient number of punctures
must be made to admit of the edges of the pustules, after their
complete development, running into each other. M. Pigeaux
States that this end will be attained by making the punctures at
the distance of a centimetre from each other.

3. Place of Vaccination.^ -Most authors direct the inoculations

1856.] Vitis Vinifera Radix, as a Diuretic. 633

to be made in the erectile tumour itself and not at its circumfer-
ence ; but this practice not infrequently gives rise to haemorrhage,
which alarms the friends. It is generally very difficult to make
several punctures in the excessively thinned skin of an erectile
tumour, without piercing the erectile tissue, especially as it is im-
possible so to control the movements of the child, as to be certain
that the lancet will not penetrate farther than we desire. Not-
withstanding this inconvenience, direct inoculation must be resort-
ed to whenever the naevus is situated on the face; for if we vacci-
nated around its circumference, the ensuing cicatrix would be
larger than the tumour itself. When the naevus is out of sight
we need not mind this, and by vaccinating near to, without im-
plicating the erectile tissue, we avoid all danger of haemorrhage,
while we can produce a circle of pustules that entirely surrounds
the tumour. The erectile tissue more and more invaded by the
increasing pustules, diminishes in size, inflames, and becomes con-
nected together with the pustules into a large, dry, blackish crust.
When this falls off, the place of the naevus is found to be occupied
by a smooth cicatrix, which is either quite white or scattered over
with a few red isolated spots, the size of a small pin's head, and
devoid of elevation, the further development of which is prevented
by the surrounding cicatricial tissue.

M. Legendre points out the desirableness, before vaccinating
infants, of inquiring whether any erectile tumour exists, in order
that the opportunity of so treating it may not be passed over.

[Brit, and For. Med. Review.

Vitis Vinifera Radix, as a Diuretic. By A. J. SlMMONS, M. D., of
Eankston, Monroe county, Ga.

From a considerable experience, I have found the Grape-vine
root to be one of the best diuretics known to me. Scarlet fever
has been in my section for some length of time ; having many
cases of genuine Anasarca to treat as a sequel of that disease, I
have given the Grape-vine root a fair trial. In a number of cases
nothing else prescribed, the water moving off rapidly.

I have the root procured, and then placed upon a heated oven-
lid and there burnt into ashes.

fy. Two table-spoonsful of the ashes, pour on a pint of boiling
water. The patient drinks it ad libitum.

Another prescription often used ^. Two table-spoonsful of the
ashes, I ii. bitartrate potss., pour on a pint of boiling water. Ta-
ken ad libitum.

Case. A case of Anasarca of the lower extremities. The subj ect
was a stout negro woman, enciente some months, plethoric, robust,
hearty woman. Her legs, thighs and left labia much enlarged.
#. Grape-vine root, two table-spoonsful; bitartrate potass., 5 ii.
Pour on a pint of boiling water. Patient taken the above pre-

634 Conclusions on Antimonial Poisoning. [October,

scription, ad libitum, consuming about a pint a day, in less than
five days the swelling had completely subsided.

I mention this case for the benefit of the young practitioner, as
he is often at a loss how to treat such eases. [Atlanta Medical and
Surgical Journal.

Conclusions on Antimonial Poisoning. By B. W. RICHARDSON, M.D.

1. That antimony, both as regards the symptoms it induces, and
the pathological results arising from its administration, excites ef-
fects in the dog identical with those it excites in man ; and that
experiments on dogs thus afford a fair basis of comparative research.

2. That the skin, peritoneum, cellular tissue, lungs, all absorb
antimony in its soluble form with as much certainty as the stom-
ach ; and that, whether introduced by any of these channels, or
by direct transfusion into the blood through the veins, the diffu-
sion of the poison is equally complete, and its effects specifically
the same. (Absolute.)

3. That, after such mode of introduction, antimony may be de-
tected in the vomited and purged matters, in the stomach and in
the contents of the stomach, in the intestines and their contents,
and in the lungs, liver, kidneys, blood, urine, heart, and even in
serum infused into cavities, if such be present. (Absolute.)

4. That consequently, the detection of antimony in vomited or
purged matters, in the stomach or the contents of the stomach, or
m the intestines or in their contents, can no longer be considered
as any judicial scientific proof that the poison was introduced into
the system by the alimentary canal at any part, as has been as-
sumed. (Absolute.)

5. That antimony being absorbed with great rapidity wherever
introduced, the point of surface at which it is taken into the sys-
tem may afford slighter indication of the presence of the poison
than any other parts of the organism : ergo, that the point of in-
troduction can never be proved by mere chemical analysis.
(Absolute.)

6. That antimony applied localty, so as to admit of being rapid-
ly absorbed, seems to excite but little amount of local injury, al-
though it exerts marked local effects when brought by the blood
to any surface for elimination : ergo, that the appearance of intense
redness or inflammation in the stomach or other part of the ali-
mentary canal, in supposed cases of death from antimony, is no
Scientific proof, nor yet indirect evidence, that the poison was re-
ceived into the system by this canal. (Absolute.)

7. That the symptoms of poisoning by antimony by large doses
are, as a general rule, those of vomiting, purging, and rapid col-
lapse; and that the same symptoms, somewhat modified in their
course, result from small doses repeated frequently during a pro-
longed period.

1856.] Treatment of Hydrocele of Children. 635

8. That to this rule exceptions occur; to-wit, that antimony,
when thrown into the system in a ]arge dose, and in such a way
as to prevent its digestion, as by direct injections into the veins,
may destroy the muscular power so suddenly that the symptoms
of vomiting and purging may not present themselves. And,
again, that when introduced very slowly, as by application to a
small wound, it may also destroy by producing simple exhaustion,
without the specific symptoms of purgation or vomiting.

9. That in all forms of antimonial poisoning, death occurs mainly
from failure of the circulation ; the respirations being continued
after the cessation of the heart's beat.

10. That the pathological appearances incident to antimonial
poisoning are (a) general congestion ; (b) marked fluidity of the
blood ; (c) intense vascularity of the stomach in the course of the
greater curvature, and, in some cases, of the rectum and other
parts of the canal, but without ulceration ; (d) a peculiarly pale
yellow or occasional dark glairy secretion on the alimentary sur-
face. Lastly, and contrary to the statements of Magendie, anti-
mony seems to excite no other pulmonary lesion than simple con-
gestion.

11. That the election of antimony by different parts of the body
is as yet an open question ; that the liver, however, would appear
to be the structure in which it is most collected when the adminis-
tration is slow and in small doses ; and that the elimination of the
poison is attempted by all the secreting surfaces.

12. That, in rapid poisoning, the fatal effect seems due to direct
chemical change in the blood, and to indirect effect therefrom on
the heart ; while, in slow poisoning, there is superadded an inter-
ference with the assimilative powers, the result of the lesions ex-
cited in the stomach and other parts of the alimentary canal.

[Association Med. Journal.

On the Treatment of the Hydrocele of Children. Fty Dr. LlNHART.
(Froriep's Notizen, 1856, vol. ii. No. 4.)

In hydrocele, met with immediately after birth, there is usually
a wide communication with the abdominal cavity ; and as there is
frequently a fold of gut at the upper part of the tumour, it some-
times occurs that hernia and hydrocele alternate so that two
practitioners, called at different times, may give different opinions
respecting the case. This form scarcely requires any special treat-
ment, since the serum returns, during the horizontal position, into
the cavity of the abdomen, where it is easily resorbed. The only
treatment likely to be of any use would be the keeping the neck
of the processus vaginalis compressed by a bandage.

It is otherwise when the hernia occurs later after birth, when it
is tense, and the communication with the abdomen is either very
small or absent, the processus vaginalis being closed above. In

636 Arrangement of the Muscular Substance. [October,

the first case, the fluid will often return slowly into the abdomen,
although it may occupy six or eight days in so doing ; and such
cases deceive the attendants of the child into the belief that the
means employed have produced the resorption of the fluid. The
deception is the more likely, as in very great narrowing of the
upper mouth of the processus vaginalis, which is often more than
an inch long, re-position cannot be induced by the taxis. This
difficulty of returning the fluid is often mistaken for an impossibi-
lity, and unnecessary operations resorted to. Indeed, the diagno-
sis of complete closure is very difficult. When such closure does
exist, the case does not differ from one of ordinary hydrocele of
the tunica vaginalis.

The indications of treatment are, the removal of the fluid and
the closure of the processus vaginalis. With regard to the first,
resorption frequently occurs spontaneously, but it can rarely be
influenced by the practitioner. The various stimulants employed
for this purpose are inoperative, or may be even hurtful by irri-
tating the scrotal skin. When they seem to have been of avail,
an aperture has, in fact, existed. The resorption, however, is re-
markably facilitated by a subcutaneous incision of the processus
vaginalis, which allows the fluid to become effused into the scro-
tum, where it is rapidly absorbed. A fold of the scrotum should
be raised, and a concave tenotomy knife passed in flat between
the scrotal skin and the serous sac, so as to make an incision of
from one to one and a half inches in length in the processus vagi-
nalis. Dr. Linhart prefers this to seeking to obliterate the vaginal
process by means of pressure applied to its neck, which is either
ineffectual or cannot be borne, or to the employment of injections,
which at this age are not without danger. [Brit. <& For. Med. Rev.

An Account of the Arrangement of the Muscular Substance in the
Urinary and Certain of the Generative Organs of the Human Body.
By George Vineb Ellis, Esq., F.R.C.S., Professor of Anato-
my in University College, London.

It would be vain to attempt to represent this important commu-
nication by an abstract; all that can be done is to draw attention
to some of the most striking points in it. After a minnte descrip-
tion of the three more or less perfect strata of involuntary muscu-
lar fibres which constitute the muscular substance of the bladder,
viz: an external or longitudinal, a middle or circular, and an
internal longitudinal or submucous, stratum the author proceeds
to trace them through the rest of the genito-urinary apparatus.
With respect to the prostate, after a minute description of its struc-
ture, the author deduces that it is less of a glandular than of a
muscular body, and is only a largely developed portion of the
circular muscular layer that invests all the urethra behind the bulb
or spongy portion, and which is continuous, without interruption,

1856.] Diagnostic Peculiarities of True and False Croup. 637

with the circular fibres of the bladder. As the prostatic enlarge-
ment includes only part of that muscular stratum of the urethra,
the author proposes the name orbicularis, vet sphincter urethral, for
both the prostate and the prolongation around the membranous
portion of the urethra; while he would confine the old term pros-
tate (without the word gland) to the thickened and more powerful
part near the neck of the bladder. The submucous layer of the
bladder is traced throughout the whole length of the urethra. A
muscular covering of the vesicuke and vasa deferentia, consisting
of two layers of fibres, (one longitudinal, the other transverse,) is
next described; and the paper concludes with a very elaborate
description of the sheaths surrounding the spongy structure of the
penis.

Mr. Quain was very glad that Mr. Ellis, of whose accuracy the
profession might be assured, had given so good a description
(which had long been wanted) of the muscular structure of the
prostate gland, and he should be glad to see, from the same pen,
or from some other, an account of the glandular structure.

[London Med. Times and Gazette.

Comparative Diagnostic Peculiarities of True and False Croup.

TRUE CROUP

Comes on slowly and insidiously,
the paroxysms occurring during the
day or night.

Voice, hoarse, soon becoming weak
and reduced to a whisper.

Cough, hoarse and frequent in the
beginning, but becomes short and
smothered.

The xymjJtoms do not remit, but
gradually grow worse and worse.

Can, in a majority of cases, see
false membrane on tonsils.

Duration, from four to eight days.

Fatal, in a majority of cases.

FALSE CROUP

Comes on suddenly, and almost
always after the subject has been for
some time asleep.

Voice, hoarse, but does not become
whispering.

Cough, boisterous and hoarse.

Occurs in paroxysms. After the
paroxysms are over the child feels
well.

Fauces slightly red no false mem-
brane.

Duration, seldom more than two
days.

Seldom fatal.

[N. Y. Jour. Med.

Ingrowing Toe-Nails. By J. H. Beech.

I have seen, within a few months, in different journals, several
articles on the subject of " ingrowing toe-nails," but none, I think,
answering just the indications and going no farther.

A simple and effectual operation may be commenced by an in-
cision made by inserting a strong narrow knife nearly over the
joint, extending to the end of the toe, deep by the side of the
bone traversing the diseased side of the nail.

638 Editorial. [October,

Next, an eliptical incision just within the skin, uniting with the
two ends of the first cut; thus excising the " hypertrophied flesh"
(which nearly always exists) with the offending portion of nail.

It is desirable to remove the "matrix" of that side, but not es-
sential, for a more proper direction will be given to the subsequent
growth. Excising one side generally will cure both, as the nail
has room to push over. If the disease is entirely removed, the
wound heals by first intention, making a less painful and more
perfect cure than removal of the whole nail in the usual manner.

[Peninsular Jour, of Medicine.

EDITORIAL AND MISCELLANEOUS.

Prevention of Yellow Fever. The following communications were writ-
ten for the Augusta newspapers, by the senior Editor of this journal, with
the view of directing public opinion to certain measures for preventing the
importation of yellow fever into this city. Inasmuch, however, as the ar-
guments used for this locality are equally applicable to others in the inte-
rior, we transfer them to our pages, in the hope that they may be useful
at some future time, if not for this season :

The announcement that yellow fever has made its appearance in Charles-
ton, is well calculated to create the apprehension that this pestilence may
again be carried into the interior. It therefore becomes the duty of every
community, thus threatened, to take such steps as may be deemed most ef-
fectual for the prevention of such a calamity, as well as for allaying the
fears of the people. In determining the measures to be adopted for this
purpose, we need not lose time in discussing the question, whether yellow
fever be contagious or infectious, in the technical application of these terms.
Let us keep within the limits of the simplest observation, and we shall find
it to be now well established, that it can be carried about from place to
place, by ships, steamboats, closed railroad cars, and indeed by any con-
veyance in which a certain quantity of the pestilential air may be trans-
ported. Before steamers were in common use, yellow fever was confined
to seaports. Steamboats extended its ravages to the towns along the shores
of the Mississippi ; and railroads have now taken it into our inland towns,
and otherwise secure villages. In 1854, when the disease prevailed in
Doth our seaports, it was conveyed by railroad, not only to this city, but
also to Macon and Union Point in this State, and to Blackville and Colum-
bia, in South-Carolina. There is no reason why the same may not be done
again, unless the people resolve to protect themselves, cost what it may.

The course to be adopted by Augusta, under existing circumstances,
seems to me very simple. Let our authorities, forthwith prohibit and pre-

1856.] Editorial. 689

vent from entering the city, any box-car, or closed car of any kind, whether
containing merchandize, baggage, or the mails, which may come from an
infected district. It will be with the railroad companies to determine
whether they will put their freight upon open trucks in Charleston, or do
so at a point nearer Augusta but this should not be less than three miles.
Should the disease show itself in Savannah, measures should be adopted
with regard to our river boats. Inasmuch as their freight is usually stored
upon deck, where no air can be confined, it might be sufficient to cause
their hatchway, or other communications with the interior of the boat, to
be closed and sealed by an officer some miles below the city, and not al-
lowed to be re-opened until they return to the same place. It would be
safer, however, to prohibit their nearer approach to the city than two or
three miles, from whence the cargo might be brought up by open boats.

In again referring to the subject of yellow fever, I beg leave to
premise that my object is not to excite, but, on the contrary, to quiet
the fears of the timid. When the first cases of yellow fever in Charleston
were announced, the writer, in common with many others, apprehended
that the disease would assume the character of an epidemic, and thus show
the whole atmosphere of that city to be contaminated. In such event it
was deemed possible, at least, that portions of the infected air, by being
conveyed in close vehicles, might occasion the disease in other places. It
was, therefore, thought to be the duty of communities thus exposed, to
take some steps to protect themselves from so dreadful a scourge. But
communities of men are wonderfully prone to extremes of apathy and pan-
ic; so, that the very people who would not close a door to keep out an
enemy, would leap out of the windows at the first sight of his grim visage.
They who are most indifferent to the means of prevention, would, probably,
be the very first to fly and to spread terror in their path, if it were even
whispered that a case of yellow fever had occurred in their town. To
persons thus constituted, it is, perhaps, useless to offer any argument; but,
there are some who assign specific reasons for inaction under existing cir-
cumstances. The object of this paper is, therefore, to examine their positions.

1st. It is said to be inexpedient or unnecessary to adopt measures of
prevention before the disease has become decidedly epidemic in the sea-
port, because, until it has assumed this character we have no evidence that
the atmosphere is contaminated. I must confess that this is the strongest
ground upon which I have heard our present inaction predicated, and if
the measures of prevention I have recommended involved any serious incon-
venience to the community, it might perhaps be well to consider whether
we should submit to it or incur the risk, however slight, of importing
the poison before we had acquired the positive certainty that it lurked
about the streets of Charleston. When cars are daily, and almost hourly,

640 Editorial. [October,

leaving the seaport, it would be a nice question to decide, on which day, or
at what hour it would be safe or otherwise, to take in a cargo of air for
diffusion in our midst. This might be done with impunity on one day,
and yet be fraught with fatality on the next. Inasmuch, therefore, as the
proposed remedy is simple, and would not subject the people to any seri-
ous inconvenience, prudence certainly dictates its adoption, upon the first
appearance of a disease, which experience teaches us will almost invariably
assume the epidemic form, sooner or later, after its introduction into a
southern seaport. Yellow fever usually commences its work insidiously,
and spreads from point to point, without any such premonition as might
be available for escape. Hence it is, that many take it in portions of the
city previously supposed to be exempted from its influence. The first inti-
mation we have of the extension of the poisoned area is, the loss of human
life.

2d. Some urge in extenuation of their inaction, the fact, that yellow fever
has often been in our seaports without being brought here, and that, inas-
much as it has visited us but twice, and with an interval of fifteen years, we
have but little cause of apprehension now. I would certainly be the last
to exaggerate the degree of our liability to this pestilence, and am free to
acknowledge that I do not now, and have never entertained the belief,
that yellow fever could often prevail epidemically in Augusta, however
sadly it might decimate the seaports. It is not necessary here to give my
reasons for this conviction ; but I should say that I am well satisfied that
yellow fever cannot originate here, and consequently that our only danger
is from importation. That it is not always brought to us when existing
in our seaports is certainly no reason why we should not endeavor to
keep it away entirely.

3d. Again : It is objected that the measures of prevention proposed are
insufficient, because, while they provide against the importation of pestifer-
ous air, they do not prevent the introduction of the disease by persons, or
in other words, by contagion. Now, I do not believe that the yellow
fever can be communicated by man to man, and it must be obvious to
all that contagious diseases can be restricted to no particular locality or
section of country, but must and do invade every part of the habitable
earth, whereas yellow fever has never done so. But it would lead me farther
than the limits of this paper will permit, to discuss the question of conta-
gion, and I prefer to admit for the present all that is claimed on this subject
by the most decided contagionists, to-wit : that while yellow fever is usually
propagated by atmospheric influence, it may sometimes, under peculiar cir-
cumstances, which rarely present themselves, be transmitted by contagion.
Even, according to them, therefore, its contagiousness is exceptional, whereas
atmospheric importation is the general rule. If the disease, in localities
in which it does not originate, owes its existence to atmospheric importa-

1856.] Editorial and Miscellaneous. 641

tion in 99 out of 100 cases, and to contagion but once in a hundred, will we
not have accomplished a great deal by getting rid of the atmospheric
cause ? It would indeed be a narrow policy that would not avert one evil,
because it could not ward off all others.

4th. I have heard it intimated that Ave have no legal right to carry out
the proposed measures ; that we cannot dictate to the rail-road companies
the kind of cars upon which they may bring freight into the city. I am
not sufficiently well versed in the law to answer this objection ; but the
right of self-protection is a very high one, which I doubt not would be at
once recognized by the officers of all rail-roads. They would unquestiona-
bly acquiesce in any measure proposed by the city authorities for the pro-
tection of human life.

Lastly: there are some who, mornus-like, with their fingers upon their
lips, object to our saying anything upon the subject, lest a panic be pro-
duced and the trade of the place injured. I repeat what I said at the onset :
that my object is to quiet and not to excite apprehensions. The people
already know their danger. Let them now also know that we are doing
all in our power to make them safe, and that we have full confidence in
the efficacy of our exertions, and their fears will be allayed. The people
know very well that what has happened may happen again unless meas-
ures of prevention be adopted. Adopt these, then, and you will do more
to restore confidence than by the observance of any mystical silence. True
manliness looks the enemy in the face and quietly prepares for defence.

American Contributions to Medical Knoioledye. "We are happy to lay
before our readers the following communication received from a highly
respectable source. We sincerely hope that the subject may be duly
weighed, and that our project may be speedily realized-

Messrs. Editors :

I am much pleased with your views in relation to the establishment of a
common medium for the collection and diffusion of " American Contribu-
tions to Medical Knowledge," as expressed in the last No. of your Journal.
I have long felt the want of something of the kind, and doubt not that
many others have experienced the same feeling. There is surely no reason
why we should not have and sustain such a semi-annual as you propose,
to be devoted exclusively, if I understand you correctly, to American con-
tributions culled from all the medical journals of our country. Such a
publication would be of incalculable advantage to us all, and be- the means
of securing us an honorable position abroad, w7here we are now compara-
tively unheard and consequently unknown. Keep the ball in motion, and
your views will find a hearty response from one end of the union to the
other. Medicus..

642 Miscellaneous.

On the Use of a new Solution of Iodine in various Skin Diseases. By '
Dr. Max Richter. The solution is made thus : Half an ounce of iodine
is to be dissolved in an ounce of glycerine, and subsequently half an ounce
of iodine is to be added, which completely dissolves in a few hours. In the
experiments made with this solution, it was applied to the surface by means
of a hair pencil ; the part was then covered by gutta percha paper, fixed at
the edges with strips of plaster, so as to prevent the volatilization of the
iodine. This was removed after twenty-four hours ; and for a similar time
cold pledgets were applied. Burning pain, more or less intense, but rarely
of more than two hours' duration was produced. The repetition of the
painting depends on the appearance of the part and the amount of disease.
The conclusions of the author are 1. That the iodine thus employed acts
as a caustic ; 2. That while it possesses considerable curative powers in
respect of scrofulous and syphilitic affections, it is especially useful in lupus;
3. That the solution dissipates even deeply-seated tubercles of lupus; and
may be applied for this purpose to the most tender surface without fear of
eroding it; 4. That when the solution was applied only to the part of a
diseased surface, the remainder was, nevertheless, influenced; 5. That it is
particularly serviceable to large and superficial sores ; 6. That after a series
of paintings, and when the sore was almost healed, the local pains greatly
increased in intensity. [ Wochcnblatt der Zeitschrift der k. k. Gesellsch. der
Aerzte zu Wien. Brit, and For. Med. Chir. Rev.

Anaphmdisiac Property of Bromide of Potassium. Thielmann, recom-
mends this remedy as an excellent anaphrodisiac, in satyriasis, nymphomania,
spermatorrhoea, and in the frequent and painful erections experienced du-
ring gonorrhoea. He has given it in the dose of two to three grains, every
two or three hours : with this is joined a vegetable and milt diet, and all
acids are forbidden. [Med. zeit. Russ., in Gaz. des Hop. Boston Med. Jl.

Acid Beef-Tea. The following is the formula for an acid beef-tea, 'which
Mr. Paget has recently introduced into use in St. Bartholomew's Hospital.
It was originally suggested by Liebig, and is intended, in cases of great
debility, to supply the stomach with fluid nutriment, which, containing its
own acid, will task the digestive powers in the least possible degree.
Take of beef, veal, or chicken, chopped fine, half-a-pound,

" of hydrochloric acid (strong), four drops,

" of water (cold), eighteen ounces,

" of common salt, a pinch.
After macerating for an hour, strain off the fluid, using no pressure. The
remaining meat may be treated with half-a-pint of water, and a second
solution obtained. If the fluid be not clear a second straining will be need-
ed. The solution does not taste acid, and is very palatable. Pepper, or
-other spice may be added, according to the patient's taste. [Med. Times
and Gazette.

Chilblains. Professor Berth old {Archives Generates) employs decoction
of nutgalls as a bath, or applied by means of pledgets. The itching and
burning disappear in two or three days, but in old cases the remedy
must be continued longer. Oak bark (1 lb. to 2 lbs. of water) may be
employed as a poultice. These remedies are not applicable to broken chil-
1 tains. [British and Foreign Med. Chir. Rev.

SOUTHERN

MEDICAL AND SURGICAL JOURNAL

(NEW SERIES.)

Vol. XII.] AUGUSTA, GEORGIA, NOVEMBER, 1856. [No. II.

ORIGINAL AND ECLECTIC.

ARTICLE XXVIII.

Typhoid Fever. By S. W, Burney, M. D., of Forsyth, Ga,

For fifteen years, or more, I have been solicited by many physi-
cians in our State, as well as some who reside without her limits,
to submit my views of the pathology and treatment of Typhoid
fever to the public at large. Besides, many other persons who
have sustained me throughout my professional career, with a devo-
tion that knew neither "variation or shadow of turning/' have,
through their confidence and partiality, urged upon me the same
task. These considerations, rather than a desire to come uninvi'
ted before a reading and censorious community, have given rise
to this article. I am not unmindful of the fact, that, he who often
comes voluntarily before the readers of a public journal, though
he may discourse and analyze wholesome truths, often, very often,
fails to win golden opinions from either friends or foes. Hence
the origin of that trite adage " 0 that mine enemy would write
a book." "With this explanation, I throw myself, with confidence,
upon the kindness and indulgence of my professional brethren,
believing that the errors of style and opinion will be generously
and forbearingly overlooked. While, on the other hand, the same
commendable spirit will give me credit for candor and honesty of
purpose, in submitting this communication to your pages. Let
me remark, right here, that I expect to say but little in relation

N. S. VOL. XII. NO. XL 41

644 Burney, on Typhoid Fever. [November,

to the symptoms of Typhoid fever. For every man who has skill'
enough to conduct a patient safely through an attack of this dis-
ease, will seldom or ever fail to recognize it, by reference to its-
peculiar pathognomonic symptoms. What I may say, shall be
said mainly in relation to the pathology and treatment of this
fever.

Again : much has been said about the difference (if any) be-
tween typhoid and typhus fevers. Some of our best physicians
and pathologists, as well as those who reside in England and on
the continent of Europe, assert, with great confidence, that there
is but little, if any, similarity between typhoid and typhus fever;
whilst others, of equal celebrity and skill, claim that they are
synonims, differing only as to grade and dissimilarity of constitu-
tion. For my own part I agree, most fully, with the latter. Ever
since typhoid fever made its appearance in Monroe county, I have
narrowly scanned the symptoms of every case to which I have
been called, and the result has been to satisfy myself, beyond all
eavil, that there are no good reasons why any material difference
should be made between the two diseases. Abler pens than mine
have discussed this matter without setting the question at rest,
and, for that reason alone, I shall refrain from entering upon a
labored argumentation to establish their identity. Let it suffice
for the present to say, that,. I have seen in various parts of the
country typhoid fever, and another form of disease, every symp-
tom of which corresponded in the aggregate with the fever clept
by Dr. Armstrong, and other able and experienced physicians,.
typhus gravior. The symptoms were so very prominently devel-
oped as to place this proposition beyond all doubt. In some of
those cases the adynamic symptoms were never more plainly de-
pictured in any of the New England States or Great Britain : the
low muttering delirium, a frequent compressible pulse, the sordes
about the teethy the dry black and fissured tongue, the copious
secretion of foetid and unheal tjr urine, the frequent discharges from
the bowels, the great prostration of strength and disgusting foetid
' breath, together with all the other indications mentioned by the
above writers, were plainly to be seen in the cases occurring in
my practice, and upon which I confidently rely to prove their
identity differing only as to grade. It will not do to say the
differences of symptoms, generally occurring in typhoid and ty-
phus fever, prove the diseases to be unlike in pathology; this

1856.] BurStey, on Typhoid Fever. 645

argument is certainly fallacious. Who is prepared to say that the
symptoms of bilious fever, pneumonia, pleurisy, and other affec-
tions, present the same train of symptoms in every case? They
are always modified by peculiarity of constitution, difference of
exciting cause, &c. We must rely mainly upon the predisposing
cause, as well as the pathological indications thereby produced,
to point out the true character of every case.

If the constitutions of all mankind were alike, and the predis^
posing and existing causes were the same, in every instance, then
diseases would be a unit. The poison giving rise to typhoid and
typhus fever is, in my opinion, whatever may be its trUe charac-
ter, essentially the same; and this poison is what I call the pre-
disposing cause. It acts upon the recuperative powers of the
system for a longer or shorter time, gradually, but surely, under-
mining their energies, and nothing is wanting to develop the
aggregation of symptoms save some slight cause, often overlooked,
which we term the exciting cause. We repeat it, there can be
little doubt as to the predisposing cause being the same in both
diseases, and if their pathology differs essentially, that difference
has not, in my opinion, been shown to the profession.

Typhoid fever was a stranger to the profession in Middle Georj
gia, and probably to the whole Southern States, previons to the
year 1836. During the winter of that year, it made its appearance
in Monroe county, and prevailed with increased violence and
fatality until the spring of '37. From that date down to the pre-
sent, the disease has been of frequent occurrence, having for the
last five or six years acted as an Aaron's rod, swallowing up, ex-
cept in certain localities, bilious remittent and bilious continued
fever. So complete has been the change in this respect, that we
are now rarely called to any disease of malarious origin, and
quinine and mercury have given place to leeches, blisters, &c.
Typhoid fever and the different forms and grades of pneumonia,
are now the diseases of this climate, and such has been the violence
of their onset, in some communities, as to decimate our population.
It has been our fortune to encounter a great many cases of this
fever, at the bed-side, and when We assure the professional breth-
ren that we have studied its rise, progress, and the various phe-
nomena presented by its symptoms, with anxious thought we
speak the words of soberness and truth and whatever reputation
we may have acquired by meeting and battling with this recent

646 Burney, on Typhoid Fever. [November,

scourge of the South, we repeat, if we can boast of any professional
character thus acquired, we obtained it through much tribulation
of matter and spirit.

Twenty years' experience with typhoid fever has forced upon
our mind the following convictions in relation to its predisposing
cause : First, that it is a poison originating from an accumulation
of filth under and around houses of long standing. Second, the
primary impression of this poison is upon the great sympathetic
nerves, and the diseased state of the mucous membrane of the
smaller bowels; and the evidences of disease of the brain the
first of which is almost invariably present, and the latter often
seen together with the other morbid phenomena characterizing
the disease, occur as the effect of the debilitating influences of this
poison upon the nerves controling digestion, etc. This view has
been entertained ever since Ave became acquainted with the pecu-
liar modifications of the nervous system, existing in every well
developed case, and it was found that opiates exert a controling
influence in every case, when prudently used; but more of this
anon. The most obstinate and fatal cases of this disease it has
been our lot to treat originated in cabins of long standing, so con-
structed as to allow of no circulation of air under them, and under
the puncheon floors of which the sweepings of half a century had
accumulated. If one desires to see this fell destroyer developed
in all its frightfnl beauties and realities, let one manage to crowd
these ancient buildings with sleeping inmates, and bis desire will
be gratified to its fullest extent. This combination of circum-
stances does not only originate the gravest and best marked cases
of typhoid fever, but it many times becomes indispensably neces-
sary to scatter these crowded sacrifices to the God of Sleep, before
any diminution takes place in the many-times daily and hourly
advent of the disease. Besides, it occasionally becomes necessary
to perform various rakings and burnings, and the erection of new
cabins, with a sufficient altitude to allow and secure a free circula-
tion of air under the building, before the owners and friends of the
sufferers may claim exemption from the disease. Who is it that
has had any experience in watching, and tracing the rise, progress
and termination of typhoid fever, will deny these facts? We do
not claim to be exempt from errors or mistakes, but nothing is
hazarded by the assertion, that whatever may be the true nature
and character of the specific, remote, or rather the predisposing

1856.] Burney, on Typhoid Fever. 647

cause of this disease of adynamia, it is not marsh effluvia. This
miasma invariably gives rise to a form of disease of certain lead-
ing characteristics, among the most prominent of which is their
periodicity. JMo one who values his reputation a baubee will dare
attempt to gainsay this proposition. Well, this being admitted,
as all will admit, and as it is equally plain that the disease does
not rise and spread from contagious influences, the question again
presents itself Whence comes the poison of typhoid fever ? It
cannot arise from that peculiar constitution of the atmosphere in
which influenza and some other affections seem to originate and
spread themselves many times from continent to continent.

Beflection, observation and experience have fixed the above
expressed opinion upon our mind, and we most respectfully direct
the minds, the master minds of this our day and age, to the eluci-
dation of the matter. As has been already remarked, the first
link in the chain of morbid action in typhoid fever is the great
system of sympathetic nerves, and the pathology developed by
post obit examinations are the results of this primary impression
upon the nerves. It has long been an opinion of ours that when
this impression reacts upon the parenchyma of the lungs, we have
a case of typhoid pneumonia ; when the first impressions are upon
the smaller bowels and kidneys, etc., we then have what is termed
typhoid fever ; and when the poison arising either from the filth
under, or about old buildings, or the badly ventilated air of ships
or jails, inhaled in a concentrated form,, we have presented to our
observation the typfius gravior of writers. Being, however, wholly
unacquainted with this disease as it prevails north, we feel we
should subject ourselves to the charge of arrogance, and perad-
venture ridicule, were we to insist upon the correctness of our
theory. The fact is, we have long since ceased to spend our time
and labor in the vain endeavor to divest of mystery the charming
theory of some charming writer. At the outset of our professional
career, nothing gave us more pleasure, or engaged our time more,
than the examination of the writings of these men. Then we
could spend our leisure in drinking down the arguments of the
sympathist and solidist. But we have lived long enough to dis-
cover that all were right, and all wrong, to a greater or less extent ;
and as age creeps upon us, and the hand of time begins to press
heavily upon us, we are better satisfied with one practical fact
than a thousand theories. Hence, if we are taught by experience

64:8 Bueney, on Typhoid Fever. [November,

that certain leading symptoms obtain in typhoid fever, and that
certain remedies, when employed by us, invariably alleviate, if
they do not cure these symptoms, we consider that time, always
valuable to the physician, would be unprofitably employed in the
endeavor to satisfy the world why these symptoms exist, or, how
it is the remedies employed effect a cure.

Let the writers of the present age, whose seeming province it is
to give tone and direction to public sentiment among the mem-
bers of the healing art, deal more in fixed practical facts, and less
in theory, and the cause of suffering humanity will thereby be
greatly blessed. Theory may do something towards diverting the
mind of the medical student to wholesome channels ; but after he
has it in his power to study symptoms at the bed-side, and by
bringing the appliances of the science to bear towards alleviation
of the "ills to which flesh is heir," he must, to be successful, reason
inductively. Some men, of splendid mind and rare opportunities,
who theorize so very eloquently and learnedly, as to astonish their
friends, and provoke the jealousy and envy of others, are notori-
ously unsuccessful in the treatment of every disease of formidable
character ; whilst, on the other hand, we sometimes see practi-
tioners of limited opportunities, having been educated in some
cabin in an old field, by some teacher hardly able to conjugate a
verb we repeat, some of these men have been known to build up
for themselves, unaided by fortune or the influence of friends,
and that too in enlightened communities, a reputation of which
any man should feel proud. Now, why is this so ? It is mainly
attributable to the fact, that the uneducated man has a more logi-
cal head, with more tact than the other. Hence, place him at the
bed-side, and, by reasoning from cause to effect, he is enabled to
form a correct diagnosis, which is often overlooked by the eloquent
theorist. But let us not be misunderstood. It is not our inten-
tion to assert, or even intimate, that a good education is not ne-
cessary to make a good Doctor: because some men have succeeded
^ well in the healing art, unaided by a collegiate course, it does not
follow as a corollary that a sound and thorough education is un-
necessary. No man can be over-educated. Had these men of
limited education enjoyed, in early life, the instructions of a
Gamaliel, it would have added greatly to their usefulness.

Such are the facilities now enjoyed for making M. D?s that any
child of nature, for a few hundred dollars, may enjoy the soubri-

1856.] Bueney, on Typhoid Fever. 649

quet of Doctor. Hence our objections to the rapid multiplication
of Medical Colleges in Georgia and Southern States. It is neither
our province nor wish to draw invidious distinctions, but we con-
fidently predict that unless our lawgivers shall apply the corrective
upon this furor for chartering medical colleges, the cause of hu-
manity must bleed at every pore, and the science of medicine be
turned into ridicule and contempt. But having already digressed
more than we intended, we must return to our subject.

We come now to speak of the proximate cause, or, in other
words, the morbid pathology of typhoid fever. The proximate
cause of any disease is nothing more nor less than the disease it-
self. The effect of the poison generating this disease is, after
making its specific impression upon the nervous system, to react
upon the mucous membranes most generally of the stomach and
small bowels. Should the question be asked, why this membrane
should be implicated in preference to others, the reply is, we do
not know, nor will we dare assert. The whole matter is shrouded
in mystery. There is nothing more mysterious, however, about
this primary reflexed action in typhoid fever, than the phenomena
attending every disease, of whatever character. Why it is that
cold should act upon certain organs and tissues, and marsh efflu-
via upon other tissues, and so on through the whole catalogue of
diseases, is for others to determine. It is enough for the sound
practitioner to know that the morbific influences of the poison
giving rise to typhoid fever is most generally exerted upon the
mucous membrane of the stomach and smaller bowels. This pro-
position is based upon the post-mortem examination of Louis, and
many others. Out of the several hundred cases treated by us,
from its first visit to this county, up to the present time, we do
not remember the first one in which there were not unmistakable
evidences of inflammation or irritation of the lining membrane of
the ileum, and in all severe cases there were like evidences about
the lining membrane of the stomach. Let this fact be borne in
mind, and then remember the pathognomonic symptoms of ileitis,
viz., fever, diarrhoea, and tenderness over the left ileac region, and
it will account for the contrarieties of opinion entertained in some
communities upon the treatment of typhoid fever. Some practi-
tioners, without taking the pains necessary to form a correct
diagnosis, seeing the symptoms of ileitis present, all of which
usually obtain in typhoid fever, arrive at the erroneous conclusion

650 Bueney, on Typhoid Fever. [November,

that the disease is of the latter character, when in fact it is wholly
different, originating, it may be, in a surfeit at a dinner party the
day before. It should ever be remembered, that ileitis is an idio-
pathic disease, usually superinduced upon some irregularity in
eating and drinking, and that typhoid fever arises, invariably,
from the morbific influences of a poison, specific in its character
and influence upon the system. This poison is also adynamic in
its effects, the recuperative energies of the system, therefore, re-
quiring a wholly different plan of treatment from ileitis We
repeat, let this be never forgotten, and it will serve to lessen the
difference of opinion urged upon the symptoms and treatment of
typhoid fever. Again : we have seen cases of bronchitis super-
vening upon attacks of this fever treated as idiopathic bronchitis.
Now every practitioner is certainly very much to blame for these
mistakes. The usual effect of the irritation in the ileum is to en-
large and ulcerate the glands of Peyer and Brunei-. Kit be safe to
rely upon external evidences, ulceration always takes place in
fatal cases as well as those which run beyond the second week.

There being strong prejudices entertained here against post-
mortem examinations, we have nothing to offer upon this division
of our subject, except the facts of other morbid pathologists, and
those predicated upon external data. There can be but little, if
any, doubt that many cases recover after ulceration has superven-
ed. Everything depends, however, in these cases, upon the plan
of treatment employed. A mild, soothing, and coaxing plan will,
in every instance, accomplish much; but let purgatives, nay, laxa-
tives be employed, to the neglect or mal- adroit use of stimulants
and refreshing diet, and there would be no way of computing the
injurious consequences. But more of this anon.

Let the pathology of typhoid fever ever be kept in view ; for any
plan of treatment, to be rational or successful, must be based upon
the morbid condition of the tissues and organs implicated. Never
forget that the disease progressing in the bowels, lungs and brain,
,is the result of a debilitating poison reacting upon these parts.
These facts being overlooked and forgotten, and the practitioner
goes groping about in the dark, as liable to injure as to benefit. It
were like placing a club in the hands of a blind man, and direct-
ing him to hit therewith a certain person standing in a crowd.
The object in view might be accomplished eventually, but it would
be to the injury of many not aimed at, or directed to be struck.

1856.] Bukney, on Typhoid Fever. 651

Having now said as much as we deem necessary by way of
elucidating our opinion of things to be considered in typhoid fe-
ver, we come to the most important part of our task. Before we
enter upon the discharge of it, however, we would once more
repeat, that no man ought to be allowed the exclusive manage-
ment of this disease who could not, from the various symptoms
presented to the senses, diagnosticate it correctly. For the practi-
tioner who could not perform properly and correctly this part of
his duty, would be like the mariner at sea without mast or rudder,
all left to his care liable to destruction.

TREATMENT.

Emetics. Whenever there are evidences of biliary derangement,
at the commencement of the fever, or soon after, indicated by
constant nausea, loathing of nourishment, together with an occa-
sional vomiting of thick mucus, mixed more or less with bile, it
has been our constant practice to administer a puke of ipecac, with
much benefit. If it be managed so as to secure a thorough action
upon the system, the result is to emulge the liver, cleans the stom-
ach of its morbid secretions thus relieving nausea, equalizing the
excitement, and preparing the way for other remedies. But emet-
ics have never yet cured a case of typhoid fever, and nothing is
hazarded in saying they never will : indeed we are distrustful of
their influence, except in the first stages of the disease.

Venesection. In the winter of 1836, we used the lancet in a
sufficient number of cases to satisfy us of its non-efficacy and dan-
ger. We are aware of the fact, that we tread upon dangerous
ground in making this avowal the very highest authority being
in favor of the remedy. This, however, proves nothing, as the
disease is always modified by climate and constitution, this not
admitting of the same plan of treatment in all hemispheres. What
is the condition of the blood in this fever? Let it be remembered
that the blood is very black, and in a dissolved state in every
case. If coagulation takes place at all, it does so only to a partial
extent. General bloodletting never does good in any disease when
this condition of the blood obtains; for it cannot be denied, that
the vis vitce is thereby already greatly prostrated, and the only
effect the general abstraction of blood can produce, is to lessen
very much what we wish to preserve the recuperative powers of
the system. It seems to us no man can be successful in the man-

652 Burney, on Typhoid Fever. [November,

agement of this disease who neglects to nurse the vis viae. But
while general bleeding should never be employed, topical bleeding
is strongly indicated, and in most cases indispensably necessary.
Let twenty (20) leeches be applied over the right ileac region, and
repeated daily, and in severe cases twice a day, so long as the heat
of skin, abdominal tenderness, and the strength of the pulse, shall
indicate their use. The good effect of the leeching, when not con-
traindicated by the symptoms present, is plainly pointed out by
the reduction of the heat of skin, the diminished velocity of the
pulse, and the alleviation of abdominal tenderness. It should
constantly be borne in mind, that the ulceration in the ileum is
the result of the preexisting inflammation. Then cure the inflam-
mation of the stomach and bowels, b}f the local abstraction of
blood, and other means, and you thereby prevent ulceration and
death. We prefer leeching to cupping in this disease, because we
have satisfied ourselves of this important fact, viz., that in all in-
flammations implicating mucous tissues, leeching is far preferable
to cupping; but where the irritation is situated in the nervous or
parenchymatous structures, the application of the cups is prefera-
ble to leeches. Now this is not a figment of a disordered fancy,
as all may determine by using these means as here indicated.

Purging.- This class of remedies should be wholly reprobated
in the treatment of typhoid fever. Dr. Graves says, in his clini-
cal lectures, and we fully concur with him, "the idea of curing
fever with purging is absurd." What is the condition of the or-
gans to be disturbed by using purgatives, or even laxatives ? The
mucous coat of the stomach and bowels is either greatly irritated
or highly inflamed. The effect of the action of the purge must be
to increase this inflammation, by inviting the blood to the parts
upon which it exerts its influence. But, says the advocate for
purging in this disease, " the secretions of the stomach and bowels
are diseased, and unless they are removed, they superadd to the
already existing irritation." They are certainly diseased ; but what
js the cause thereof? Is it not owing wholly to the fact, that in-
flammation is going on in these organs? Nothing is plainer than
the fact, that the secretions of all organs must per se be diseased,
so long as their parts are inflamed. In a majority of cases a per-
sistent diarrhoea is present from the first, instituted by nature to
deplete mildly the parts diseased. Then why increase it, with
even the mildest means ? It should not be interfered with, unless

1856.] BUENEY, on Typhoid Fever. - 655

there be danger of prostration, as there generally is after the first
week ; then the bowels ought to be locked up, and allowed to re-
main in this condition throughout the remainder of the attack.
Never shall we forget the importunities of the parents of two
young men, whose bowels, after running freely during the first
week of their attack, were arrested at the commencement of the
second. After the expiration of eight days, in one ca6e, and ten
in the other, their kind mother, supposing that no one could get
well of fever, who was allowed to go this length of time without an
action on the bowels, began to intercede with us, to give a mild
laxative. Bat being well satisfied with the state of affairs, we re-
sisted every influence she and others could bring to bear upon the
matter. One of these young men was without an action upon his
bowels for twenty-one (21) days, and the other seventeen. We
thought then, as we believe now, that the administration of the
mildest laxatives would have resulted in death. Where constipa-
tion is present from the beginning, the plan employed by us is to
give an enema of cold water, from two to three times a day. It
generally serves to keep the bowels in a soluble condition, and is
also refreshing to the patient. Nothing is more valuable than the
daily use of cold water enemas toward the winding up of the case,
when there is a slight rise of fever of evenings, attended with a
flushing of the cheeks, occasioned by the persistence of a slight
irritation of the bowels ; used under these circumstances, it cools
the head and bowels, brings down the fever, and relieves the red-
ness of the cheeks.

An extensive experience of twenty-five years, has forced upon
us the conviction, that he who uses purgatives freely in the treat-
ment of this fever will never have much cause for self-gratulation,
as the effect must be, to hurry to the grave many a poor fellow-
creature, whose fate would have been different, had his case been
left to the providence of God. Then away with your purgatives
and laxatives study the pathology of this disease, and follow the
unerring indications of nature.

Mercury. There are many advocates for the mercurial plan of
treating typhoid fever. There are certainly many serious objec-
tions to it. In the first place, such is the inactivity of the absorbent
system and the irritability of the bowels, that it is impossible to
secure its specific influence upon the system.

In the second place, any dose of this article, given with the

L

654 Burney, on Typhoid Fever. [November,

view of producing ptyalism, would, from the very nature of cir-
cumstances, aggravate the attack; for it certainly would pass off
by the bowels, thus increasing the disease going on in these parts.

Thirdly: Such is the peculiar nature of typhoid fever, that the
specific effect of mercury would not cure the disease, even if we
could secure it. This declaration is not made " curiente calame."
In two of the first half dozen we ever had, we succeeded by mix-
ing cayenne pepper with the calomel in suitable doses, in bringing
about ptyalyism ; but still both cases spread themselves out to an
almost interminable length. The only effect of the salivation,
leaving out of the question its usual sequiter, was an increase of
the hitherto existing nervous symptoms.

Fourthly: Two of the worst cases of the disease we have ever
witnessed, supervened upon salivation, which had been employed
to cure a preexisting diseased state of the system. The subject
of one of the cases was a negro girl aged 18 years, our own pro-
perty ; she was severely salivated to cure an attack of syphilis,
which she had unfortunately contracted three weeks previously.
Several of our slaves were then prostrate with typhoid fever.
Albeit, the chancres and bubos had disappeared ; we thought it
best to keep her a few weeks longer under the influence of mercu-
ry, and supposing she might have been predisposed to an attack
of the fever several inmates of the cabin she lived in having
been already attacked we directed her to take moderate exercise
in the open air, but not to get wet under any circumstances. The
directions were disobeyed, for she got very wet a few days after-
wards, and a severer case of typhoid fever has never fallen under
our care and management. The nervous symptoms were peculiarly
severe and perplexing, and after running for forty-one da}Ts, the
fever left her with two bed sores, the worst I ever saw the mere
wreck of her former self. The subject of the other case was a ne-
gro woman twenty-one years old; she had been salivated a few
writs before for the cure of a cutaneous disease. The existing
cause of the fever, in this instance, was not so apparent as in the
other; it was hidden in obscurity, unless the ptyalism itself was
the existing cause. Iler owner had between fifteen and twenty
cases of typhoid fever on his plantation at the time the mercury
was used in this case.

Whatever opinion may be entertained with reference to the
matter, there is nothing preposterous in the opinion, that the spe-

1856.] Burney, on Typhoid Fever. 655

cific effect of mercury may, under favorable circumstances, prove
the exciting cause of typhoid fever. But, however much the use
of mercury Math the view of securing its specific effect should
be deprecated, it is highly necessary that it shonld be administered
cautiously and prudently in most cases, narrowly watching its ef-
fect upon the bowels. The plan pursued by us has been to use
hyd. cum. creta in preference to all other preparations, in those
cases unattended with looseness of the bowels. Two grains of this
article with three or four grains of Dover's powder, given every
four hours, has a soothing and beneficial influence ; besides, the
alterative effect of mercury desirable in most cases, is secured with-
out much danger. But if diarrhoea be present, or if there be great
irritability of the bowels every thing passing off as soon as
given the hyd. cum. creta, if given at all, should be administered
in much smaller doses. In these cases, it were preferable to give
the blue pill in doses of the quarter of a grain, morning, noon and
night; use this cautiously, and there is little danger of irritating the
bowels, and its constitutional or functional influence on the liver,
is sure, first or last to be attained. This is of the last importance
in all those cases in which the vis vitce is mostly prostrated. In
much the larger portion of the cases occurring in the winter of
1837, the symptoms were so very closely allied to those depicted
by the writers of the past and present day, as distinguishing ty-
phus fever, the most experienced and best practitioners in this
county were unable to draw the distinction.

Blue pill, in doses as above advised, was given by us in con-
junction with proper doses of opium or Dover's powder, in every
case that came to our hands. Every case, to the best of our re-
collection, that recovered, was attended in the last stages with the
frequent discharge of a thick tarry, sort of bilious matter. So very
constant were these operations towards the termination of our
cases, that we remember with what anxiety the secretions were
watched, for the passing off the black tenacious bile gave presage
of a favorable termination. The crisis, however, seldom takes
place in this way, unless the disease is strongly adynamic in its
character.

Cold Water. It has already been remarked under what circum-
stances we feel ourselves bound to use cold water enemas. There
are still other symptoms requiring the use of cold water in a dif-
ferent manner. Should the " ealor mordax" be strongly developed,-

656 Burney, on Typhoid Fever. [November,

the patient ought to be sponged nearly all over with cold water,
frequently repeated, according to circumstances. In some violent
cases, we have ventured to envelope the whole body in a cold wet
sheet, with the very best results. Whenever this is resorted to,
however, blankets should be thrown over the sheet, so as to bring
about perspiration. Eemove them as soon as the sweating takes-
place, and should the fever rise again as high as ever, repeat the
cold sheet. "We have thus repeated it several times, before we
were satisfied with the results. Again, the abdominal region is
very hot, in all cases attended with severe inflammation of the
ileum. When this is found to be the case, there is a strong rea-
son why every appliance should be brought to bear, so as to les-
sen the inflammation, thereby preventing ulceration, present in all
protracted cases, and abridging the stages of the attack, which is
a matter of no mean importance. To attain this end, let towels
be folded, dipped in cold water, and laid over the abdomen, re-
newing every fifteen or twenty minutes, till the heat is overcome.
Nothing exerts a more potent influence over the circulation, and
we have seen the patient collapsed, in this very way, in a few
hours ; hence, it must be evident to all, the remedy is not admis-
sible, provided the attack is of long standing, and even when pro-
perly used must be closely watched the attending physician
using it himself, narrowly watching the pulse, and always stopping
it as soon as the temperature of the skin over the bowels is pro-
perly reduced.

Blisters. After leeehing, and using other remedies called for by
the disease, and the blistering grade of the disease has made its
appearance, cover the whole abdominal surface with a vesicating
plaster, and repeat often enough to keep up a constant discharge.
We have applied a blister to the bowels as often as six times in
the same attack. It was discoverable to all, that every time the
blister was used, the patient, after passing through the nervous
derangement thereby produced, underwent a desirable change.
This is certainly a valuable adjuvant in the treatment of typhoid
fever, and if prudently and cautiously used, will never disappoint
the attending physician. It should never be forgotten, however,
that blisters make a strong impression on the nervous system, and
as they are generally used in the last stages of the disease, when
the energies of the system are on the wane, and the nerves always
more or less affected, the first influence is decidedly deleterious.

1856.] Burney, on Typhoid Fever. 657

They frequently -when thus used, produce a nervous rigor, attend-
ed with a great and sudden diminution of the pulse. A dose of
opium or camphor, or musk and valerian, promptly relieve these
untoward symptoms.

Opium. We come now to what we consider the most import-
ant and valuable remedy among the whole range of medical sci-
ence, in the treatment of typhoid fever. Deprived of the privilege
of using it, we would not consent to attack a case characterized
by prominent nervous symptoms. If there is a single remedy
calculated to cut short an attack, it is opium; we use it in all cases
freely, relying upon its conservative influence. Dr. T. Fort, of
Milledgeville, Ga., is probably the only physician in the State,
who uses this article as boldly and as confidently as we do, in the
treatment of this disease. We have conducted a great many per-
sons safely through an attack of some length, by the single use of
tine. opii. Our favorite mode of administering it from forty to
sixty drops given every six hours, or eight, does more towards
relieving every urgent symptom of the disease than anything else
with which we are acquainted. When the brain becomes impli-
cated, producing great jactitation and wakefulness, the patient can
be saved, only by the bold use of opium. The following case will
show the effect of this practice ;

December 10th, 1849. Called to Mr. B.r who had been ailing
of the worst grade of typhoid fever for ten days. The physician
in attendance informed us that his patient, three days before, ma-
nifested the strangest symptoms of diseased brain, since which
time he had not slept a moment. We found him with a hot scalp,
cool feet, redness of the adnata, which was secreting a tenacious
mucus; sordes about the teeth; throbbing of the carotids; a con-
stant raging delirium, making frequent efforts to get out of bed.
To cure these symptoms, which portended a speedy dissolution,
the patient was ordered to take sixty drops of laudanum every
four hours, until he fell into a sound sleep ; apply mustard to the
feet, and then cold water upon the much heated scalp, every half
hour,, until it became comfortably cool. The third portion of
laudanum brought on a sound sleeps out of which he awoke
twelve hours after with his mind fully restored. The after treat-
ment gave but little trouble, the patient fully recovering in a few
days. If time and space allowed, we could detail many such
cases, in all of which the afflicted were snatched from the jaws of

658 Burney, on Typhoid Fever. [November,

death, by the fearless use of this remedy. In some cases we have
conjoined tartar emetic with the tine, opii, with signal benefit.
This is Dr. Graves' plan of treating this brain fever, and when
properly used is attended with signal advantage, Some persons
condemn opium in these cases, because', say they, it invites the
blood to an already highly inflamed organ. All admit the pro-
priety, nay the necessity, of keeping all other inflamed organs in
a perfectly quiescent state, but from some cause or other, hitherto
unexplained, the brain, when inflamed, must be permitted to re-
main in a state of preternatural activity. The truth is, opium in-
stead of inviting the blood to the brain in these cases, takes it from
it, by equalizing the nervous energy, and the circulation generally.
Those who may hereafter encounter these brain cases of typhoid
fever, may be assured, that their patients will never undergo any
amendment, until they are brought under the wholesome influences of
a sound sleep ; and he who shall attempt to save his patient in a
different way, will be sadly deceived.

"We repeat, we could fill several sheets by the detail of interest-
ing cases, in all of which, this valuable article more than sustained
the opinion we entertain of it ; but prudence forbids this course.

Stimulants. There is a time, in all cases, running beyond the
twelfth or fourteenth day, when stimulants are not only required,
but indispensably necessary. The physician who purges least,
and eschews general bleeding, pursuing a temporising and sooth-
ing plan of treatment, and who shall soonest detect the time when
nature calls for the use of such means as are required to keep up
the energies of the system, thus supporting the vis vitoz, will,
.ceteris paribus, always be the most fortunate and successful in the
treatment of typhoid fever. Sometimes, if six hours are allowed to
pass off unemployed, after this stage has arrived, the doom of the pa-
tient is sealed. The most skilful is much troubled in determining
when his patient ought to be sustained. Whenever there is doubt
resting upon his mind, let the practitioner try such restoratives as-
would in his own judgment best suit the exigencies of the case,
narrowly watching the effect, thus feeling his way, as it were.
When they reduce the frequency of the pulse increasing the vol-
ume of the artery, let him persevere ; on the other hand, if the
first effect is to increase the frequency and quickness of the pulse,
and augmenting the heat of the skin, take it for granted the stage
called the stimulating, has not yet made its appearance, and they

1856.] Burney, on Typhoid Fever. 659

must for the time being, be discontinued. Well, the practitioner
being satisfied as to the necessity of stimulating, which of this
whole class of remedies is best calculated to subserve the end in
view ? We have in the course of our career used many, but of
late years have settled down upon grain musk, gum camphor and
the oil of valerian, as the very best belonging to the materia medi-
ca. From two to four grains of the former, and four grains of the
latter, should be made into a pill and given every two or four
hours, according to the urgency of the symptoms. Six drops of
the oil of valerian mixed in a tablespoonful of mucilage gum ara-
bic should be given every six hours. These medicines are not
only diffusible stimulants, but are also strongly anti-spasmodic in
their character and influence : they all, when properly used, dimin-
ish the frequency of the pulse, while they enlarge the volume of
the arterial system, and very often invite sleep when it is much
needed. The whole train of nervous symptoms generally attend-
ing, are often by them promptly arrested. Quinine is strongly
recommended and extensively used in some quarters in the treat-
ment of the disease ; we have often tried it, though without bene*
. fit ; there is only one symptom, in our opinion, which would au-
thorise its use, and it is this: In the last stage of some cases of
long standing, after the disease has formed a crisis, the patient,
from the long hitherto nervous derangement, is attacked very un-
expectedly with a periodical nervous rigor or shake, unattended
with much, if any, arterial excitement. For the relief of these at-
tacks quinine may be used with much confidence. There is yet
another medicine which, although not a stimulant, is used by some
gentlemen, (who seem to be easily captivated with new things,) not
only in almost every stage of this disease, but in almost every at-
tack of disease attended with arterial excitements : we allude to
the veratrum viride. From the universality of its employment, it
has, in our opinion, done more harm than good. It possesses no
curative properties, as all admit, and as it generally affects the
stomach and bowels before its specific influence is exerted upon
the system, we have seen this disturbance produce much harm.
Whatever may be the opinion of others, we shall never, so long
as we entertain our present notions, dare use it to any great extent
in the treatment of typhoid fever. Indeed, it has so very frequently
disappointed us in typhoid fever and pneumonia, that we have
been forced, reluctantly we confess, to the conviction, that Dr.

N. S. VOL. XII. NO. XI. 42

Bueney, on Typhoid Fever. [November,

Norwood's great physic is pretty considerably overrated, and that
the time will soon come when sound thinking men will pronounce
it to be a humbug. But to return : wine should be freely used in
conjunction with the other stimulants mentioned, and the patient
nourished with chicken broth.

There is yet another remedy classed with stimulants, though
possessing many other curative properties in the latter stage of the
disease, to which we invite attention : we allude to spirits of tur-
pentine. It possesses, and many times produces the most aston-
ishing sanative influences, not only in the latter stages of this dis-
ease, but in all others depending upon inflammation of the mucus
surfaces. Whatever of credit has accrued from the introduction
of this remedy into the treatment of this class of diseases, belongs
exclusively to us. As early as 1834, we were in the habit of
using it in all cases of bilious remittent fever, spinning themselves
out to great length, in consequence of the mucous membrane of
the ileum taking on disease, as the result of the unwise use of pur-
gatives in the first stage. Besides, in all cases of diarrhoea among
children, where the disease seemed to be perpetuated by an in-
flamed state of the living membrane of the small bowels, we were
constantly in the habit of using this article in small and frequent-
ly repeated doses, with astonishing good results. It is very com-
monly the case, that remittent fever is converted into a modifica-
tion of disease, termed by some " slow fever." This change in the
type of the fever is generally the sequence of an unthinking, un-
wise persistence in purgatives. It was for the cure of a case like
this we first ventured to use spirits of turpentine, and its success in
this case led us and others to administer it in the treatment of
genuine typhoid fever. The subject of this case was a lady twen-
ty-five years of age; she was attacked thirty-one days before we
saw her, with remittent fever ; she had been treated by Dr. J. our
then partner, a gentleman of much skill, and enviable celebrity.
When first called to her by her husband, in the absence of our
partner, there were unerring evidences of inflammation in the
- mucous membrane of the ileum ; the tongue was very red and dry,
the cheeks flushed every evening, the abdominal region tender
and slightly swollen ; there was also borborygmus, a strong pre-
disposition to diarrhcx^a the mildest laxative exciting action in a
few minutes strong pulsation in the bowels ; a sparseness of uriner
which was very red, and much dryness about the throat, with a

1856.] BuRney, on Typhoid Fever. 661

pulse ranging from 110 to 120 in the minute. "We recommended
ten drops spts. terebinthem, morning, noon and night, in a little
sweetened water ; a mush poultice to the region of the bowels, to
be renewed every six hours ; mucilaginous drinks; forty 'five drops
tinct. opii, every night at bed-time, and boiled milk to nourish
her. It was astonishing to witness the prompt relief following
this treatment. The fever began to abate after the second dose of
turpentine was given, the patient remarking at the time, " I feel
the spirits of turpentine taking hold of the disease in my bowels,
and I believe now, for the first time since the supervention of my
illness, I shall get well." Well, she did recover, and that too with
such rapidity as to astonish all friends, as well as physician. This
case gave me much eclat in our community, besides imparting a
celebrity to the chief remedy employed, which it has ever since
deservedly enjoyed. It were a task of supererogation to point out
minutely the symptoms which call for the use of spirits of turpen-
tine in typhoid fever ; let it suffice to say, that in the last stage,
where there are evidences of inflammation as, well as ulceration of
the ileum, the remedy may be administered with confident assur-
ance of speedy benefit. The practitioner who is ignorant of these
symptoms, would do well to transfer his cases to those who are
wiser and better qualified to discharge their duty. Our usual plan
is to give from six to ten drops, morning, noon and night, in a
little sweetened water. When it manifests a tendency to increase
the peristaltic motion of the bowels, amounting to looseness, ten
drops of tinct. opii ought to be conjoined with each dose. Such
is the confidence we have in the curative properties of this article
that we would not undertake the management of the fever were
we deprived of its use.

It is, however, occasionally necessary to assist the spirits of tur-
pentine by the use of astringents, especially when there are evi^
dences of ulceration of the bowels. Those preferred by us are
nitrate silver and alum. Nothing is sometimes better calculated
to arrest the troublesome diarrhoea superinduced by ulceration,
than half grain doses of nitrate silver given in the form of a pill,
three or four times every twenty-four hours ; it probably has a
wholesome influence in a two-fold sense, acting directly and spe-
cifically upon the ulcerated and inflamed surfaces, and secondarily
benefiting the ulcers, &c, by arresting the peristaltic motion of the
bowels ; for nothing can be plainer, in our view, than that the

662 Buhney, on Typhoid Fever. [November,

ulcers and inflammation will never be arrested so long as this state
of things shall continue. Then lock up the bowels, if it be possi-
ble, and give nature as well as art some chance to effect a cure ;
and he that understands best the art of controling the bowels, will
be most successful in curing the disease. Should the nitrate silver
fail to attain the end in view, try alum in doses suited to the age
and condition of the patient : an adult will usually bear four grains
every four or six hours. This article, like nitrate silver, acts in
more than one way ; it certainly produces a direct influence upon
the ulcers and inflamed surface, and has also an indirect action, by
controling the bowels. It sometimes acts like a charm, lessening
the fever and diarrhoea, and cleansing the tongue in a few hours.
Then never fail to give it a fair and impartial trial. In every
case of the fever, mucilaginous drinks made cold with ice, ought
to be used in every stage of the disease; it many times does much
toward curing the disease, and such is the confidence some have
in it, they believe a severe attack could not be cured without a
constant persistence in the use of the ice. The diet should be
wholesome and nourishing throughout the attack : boiled milk, tea
and coffee, etc., are preferable to all other articles in the first, or
non-stimulating stage ; but after the patient reaches that stage,
when stimulants prove to be antiphlogistic, chicken broth and
beef-tea are preferable. Let him be nourished at proper intervals
and in proper quantities in the day time ; but never wake him up
of nights to take either drink or nourishment. This rule should
be constantly borne in mind, for more depends on it than meets
the eye at first. He who is allowed to sleep on without disturb-
ance, stands a much better chance for his life, than one who is
annoyed by officious and ignorant nurses and attendants, every
now and then waking him up, with the vain endeavor to get him
to feed.

There is yet another important item in the treatment, to which
attention must be called ; it is this : The patient must always have
the attention of the nurses directed to his clothing, and prompt
removal of the secretions from the room. Nothing contributes so
much. to the comfort of the sick, in cases of long standing, as the
frequent change of clothing ; and it is to the neglect of this, as well
as the prompt removal of the secretions from the sick apartment,
we must attribute the notion so prevalent in some latitudes, to-wit,
that this disease is contagious. There can be no evidence adduced

1856.] Holt's Letters upon General Pathology. 663

: in support of its contagiousness, but there is no doubt the disease
may become infectious, by the neglect of the highly important
rules above mentioned. Never forget the indubitable necessity
there exists for scattering the families of those who suffer, to any

\ great extent from the disease. The attending physician many
times does more good by insisting upon this desideratum, than in
any other way.

Having already said more than we intended at the outset, we
must bring this article to a close. If we have been fortunate
enough to make a single suggestion which shall prove beneficial

i to our professional brethren, in their efforts to relieve suffering
humanity, we shall consider ourselves amply remunerated for the
trouble we may have undergone, in preparing this essay for the
press. And, in conclusion we would remark, once for all, that
we were not constrained, either by motives of vanity or egotism,
in submitting these views to a censorious public.

ARTICLE XXIX.

I LETTERS FR01T SAUL. D. HOLT, M. D., UPON SOME POINTS OF GENERAL PATHOLOGY.

LETTER NO. 16.

Montgomery, Ala., September 25th, 1856.
Messrs. Editors Up to the summers of 1853, '54 and '55, I had
considered myself an incompetent witness to testify as to the char-
acter of yellow fever, as, until that time, all that I knew about it
was from "hear say" evidence, and I should have been unwilling,
; previous to that time, to have been put upon the stand for the
| purpose of giving even parole evidence. But, having during those
j periods formed somewhat a familiar acquaintance with its charac-
! ter, I feel willing, whether competent or not, to submit my testi-
mony in writing, which shall, according to the rules of law, be
1 confined to the facts of the case, claiming, at the same time, the
\ privilege of "experts" of forming and expressing opinions from the
| testimony of other witnesses, as well as from observation and ex-
perience, of which I must confess, in this disease, I have had
C comparatively little. I cannot testify as to its paternity, or its
genealogy ; whether it is a native American, or a naturalized for-
| eigner whether it is a creole, or a foreigner, making occasional
[) summer and autumnal visits to our southern sea-ports, and now

664 Holt's Letters upon General Pathology. [November,

and then extending them to the interior river towns. Upon these
points, and many others in relation to it, the testimony is abund-
ant, but contradictory, and in many instances unsatisfactory.
Some have testified, very positively, that it is a native American;
and others, as confidently, that it is a, foreigner. My own opinion
is, from the evidence, that it is a creole, and belongs to the typhoid
family, and is decidedly democratic, from the great love it has at
times for the people, and the wonderful fondness and partiality
which it always shows for foreigners. But seriously : There is no
disease concerning which so much has been written, and such a
mass of testimony has been collected, as yellow fever ; and yet,
strange as it may appear, there is none concerning which there is
such a conflict of opinion, and concernining the nature and treat-
ment of which the profession are less agreed. This is certainly
not owing to a want of facts regarding its history and character;
for any one who will examine the work which Dr. La Eoche has
recently furnished to the profession, (which is an ingenuous embo-
diment of the opinions of every observer, of any note or distinction,
upon every important point relating to its history and character,
from the earliest records of its existence to the present time, con-
stituting a perfect encyclopedia of yellow fever,) will be satisfied
that there are but few facts which remain to be established, which
can be expected to be done by observation of the disease. I do not
know that I shall be able to add a single fact, worthy of record,
derived from my own observation and experience, which is not
already known to the profession; nor do I expect to be able, nor
shall I undertake to reconcile the conflict of opinions upon points
which always have, and must always continue to divide the pro-
fession. But I do hope to be able, from the great mass of testimo-
ny which has been collected, and which we must regard as truthful,
to show that the causes of disagreement, as to the character of the
disease, are not as numerous as well founded, and as irreconcilable
as they seem to be. As an apt illustration of these causes of disa-
greement, and of my views of the subject, I will cite the fable of
the "Travellers and the Chameleon." Each one saw the same
animal, and each described it accurately in its proportions; but
each one saw it in a different light, and a different shade of color,
to which each was willing to swear; yet no two were agreed as to
the color of the animal. So it is with yellow fever. The great
chroniclers who have furnished us with an account df the disease,

1856.] Holt's Letters upon General Pathology. 665

have each done so with an honest conviction, no doubt, that the
light in which they have observed it, and the character in which
they have represented it, was the true and natural character of the
disease. Some of these who have had an opportunity of observing
it, in different parts of the world, at different periods, and under
different circumstances, in the same localities, have found the dis-
ease so changed and modified in its character, from their first
impressions, as to raise a doubt in their mind as to its identity, or,
to use our metaphor, whether it is the same animal which they
had seen under different colors and aspects, or not.

I have on a former occasion, though on a different subject, ex-
pressed the belief, that yellow fever is a disease " sui generis" and
that in its essential typical character it is universally the same.
This opinion is sustained by the greatest weight of testimony, and
it is in this light and character that I shall examine the disease,
with respect to its pathology, considering the chameleon hues and
complexions of the disease to depend upon extrinsic and adventi-
tious influences, and not upon those which are inherent either in
the disease or the cause which produces it. To be still more expli-
cit : What I mean, is that yellow fever has one essential and specific
cause, which, in operation, produces a certain and determinate set
of phenomena and results, which no other cause can produce ; and
that the causes which so often combine to produce diversity in the
character of the disease are non-essential to its production, but ne-
cessary for a change or modification of its character. One cause
produces the chameleon the other its colors. But it would be a
difficult matter to determine who, or whether any one has ever
seen it in its pristine color, or character ; for, as I have before
stated, the combination of influences which are necessary for the
generation or production of tlie cause of yellow fever, if not iden-
tical, are nearly allied to those which determine its modifications,
and these are found so universally to co-exist, and so generally to
co-operate, that it is doubtful whether the disejase ever exists in its
pristine character, fully divested of the non-essential and modify-
ing influences. It is in this character, however, that I shall con-
sider it, observing the same classification which I have adopted
with respect to other fevers, believing that it will fully cover all
the forms and modifications to which the disease is liable. My
object for thus considering it, is to endeavor to fix the pathology
of the disease in its essential typical character, so far as it is known,

666 Holt's Letters upon General Pathology. [November,

upon which, a general and uniform system of practice may be
founded. For so long as the pathology remains unsettled, or is
made to rest upon the modified forms of the disease to which it is
continually liable so long will it be a subject of dispute, and the
practice little better than a system of empirical experimentation.

With regard to the pathology of yelloAV fever, Dr. LaEoche says:
"Painful as the avowal may be, it is a fact, the truth of which
cannot be denied, that, notwithstanding all that has been written
on the subject of the yellow fever in this and other countries all
the labor that has been bestowed on an investigation of its causes,
characters, and anatomical phenomena, little progress has, so far,
been made in a knowledge of the pathology of that disease."
Now, I am not prepared to admit the truth of this avowal, in its
full import, or to admit that the profession are as much in the dark,
or as much behind hand, with respect to the pathology of yellow
fever, as they are with some other diseases, of which they profess
to know more. Of what advantage to us is the great store of in-
formation which has been collected upon every important point
connected with the history of the disease, or where shall we go for
more reliable testimony, if from this we cannot form correct views
with regard to its pathology? The truth is, in my opinion, that
there is not so much a lack of knowledge with respect to its patholo-
gy, as there is a want of agreement as to the special pathology of the
disease, in its essential, unmodified, and uncomplicated form; the
pathology having, unfortunately, too often been founded upon
groups of symptoms, and conditions of the system which may be-
long to, and are often observed in connection with other diseases
besides yellow fever, and are consequently non-essential. I have
founded my classification of fevers upon the general pathological
conditions of the system, and have maintained, and shown, that the
causes which produce and determine these general pathological con-
ditions, were non-essential to the production of any particular type
or form of fever, but that all fevers under their influence were de-
, termined in their character by the general pathological condition
of the system, and that the particular cause of the fever, of what-
ever type or form, had no necessary or essential agency in deter-
mining the general pathological condition which determines their
character,

If this matter requires any further elucidation, I will take exam-
ples from the disease in question yellow fever which appears

1856.] Holt's Letters upon General Pathology. 667

sometimes in an inflammatory garb, sometimes an irritant, and
sometimes congsstive, with the intermediate grades, not generally
recognized, as the congesto-infiammatory and congesto-irritant, and
alioays the typhoid, which I consider the true type of the disease.
Now, the point which I particularly desire to impress upon the
mind of the reader is, that the specific cause which is essential to the
production of yellow fever, has no necessary or essential agency in
determining the general character of the disease, except so far as
the latter, or typhoid character, is concerned; and that fever from
any other cause will assume the same garb, or character, under a
like general pathological condition of the system, illustrations and
examples of which I have given in pneumonia, and intermittent
and remittent fever. Hence it follows that no pathology of yellow
fever can be perfect, and free from objections, which is based upon
a general condition of the system, which the cause of yellow fever
has no agency in determining, and which determines alike the
general pathological character of all fevers. And though the
treatment must necessarily conform to the general pathological
character of the disease, which is constantly liable to change, yet,
in its essential character, the principles of practice founded upon
its special pathology, which is universally the same, admits of no
change.

As the views and opinions which I entertain with regard to the
pathology of yellow fever, have been derived chiefly from the
great mass of testimony which has been collected concerning the
disease, and which is open to, and now the common property of
the profession, I do not deem it necessary that I should resort to
argument and proof to establish every position which I may as-
sume, at least, not until they are assailed, or called in question,
particularly as I shall be careful to assume none which is not sus-
tained by at least respectable weight of authority. The position
which I have taken, with respect to the pathology of intermittent
and remittent, and other 'periodic or miasmatic fevers is, that they
belong to the dynamic class, having their origin in such a change
of nervous power, as to disturb to a morbid extent the balance of
the circulation, causing unequal distributions and accumulations
of blood, without necessarily affecting materially its healthy or
normal condition ; and that in all such diseases in which the blood
becomes depraved, and its vitality impaired, it is the consequence
of pre-existing morbid actions in certain organs, which the condi-

668 Holt's Letters upon General Pathology. [November,

Hon of Uie blood has no necessary agency in exciting. That which.
I asssume with respect to the disease in question (yellow fever,) is,
that it belongs to the zymotic class and is a necrwmic disease, hav-
ing its origin in an altered and depraved condition of the blood
from the action of a specific poison, which, in addition to its direct
tendency to destroy the vitality of the blood by a destruction of its
fibrin, produces by its sedative action upon the nervous centres, a
shock or state of nervous depression, followed by a febrile reaction,
being a single effort of the system, more or less prolonged, to over-
come or relieve itself of the morbid impression, which so far
as the febrile movement alone is concerned, differs little from other
fevers of the same class, being limited in its duration to the term
of the zymotic action of the poison, which seldom or never con-
tinues longer than the longest interval, or quartan type of inter-
mittents, (seventy-two hours,) and often terminates with the short-
est interval of those fevers, (twelve hours,) during which time such
molecular changes are effected in the general capillaries, (which
system of vessels I believe to be the seat of the disease,) as to dim-
inish their tone and vitality, giving rise to irritation and conse-
quent engorgement in those vessels, which in connection with the
previously altered, attenuated, and depraved condition of the blood
from the direct influence of the specific cause, gives rise to a gen-
eral hemorrhagic diathesis, and a putrescent tendency of the sys-
tem, which constitutes the essential pathology of the disease, under
whatever form or modification it may appear. Whatever changes
may have been effected in the condition or constitution of the
blood from the action of the poison anterior to the actual invasion
of the disease, which should date from the commencement of the
febrile movement, at which time it begins to localize itself, not only
with respect to the capillaries generally but to particular organs,
which as one or more become permanently involved, during the
progress of the first or febrile stage of the disease, have their func-
tions so deranged and even suspended, as not only to prevent the
elimination of the specific poison from the system, but to cause
the blood to become overloaded with noxious matters, even more
deleterious than the specific poison itself. Now, if by the efforts
of nature or art, these organs, the lungs, the liver, the skin and the
kidneys can be kept in the exercise and performance of their res-
pective depurative functions, so as to prevent the retention and
accumulation in the blood of the septic and noxious matters which

1856.] Holt's Letters upon General Pathology. 669

are generated in the system, during the progress of the febrile
stage of the disease, I am strongly inclined to the belief that there
would seldom be more than one stage to it. This opinion is sus-
tained by the fact, that the disease can be aborted, that is, prevent-
ed from manifesting any other signs of morbid action than those
which belong properly to the febrile stage of the disease : in other
words, that it can be arrested in that stage from which the process
of reparation will commence and go on to convalescence. I would
not pretend to say that all cases could be so aborted or arrested in
their progress, however judiciously managed, but I must say,
that judging from my own observation, the larger number may
be, as during the prevalence of the disease with us, during the
summers of 1853, '54 and '55, I had the management of about fif-
ty cases, all of which, after a single paroxysm of fever of about
thirty -six hours duration passed into a state of convalescence, with
the exception of two, one of which died on the third day with black
vomit, and the other, after a paroxysm of fever of seventy-two
hours, had black vomit, but recovered. Such a result jnstines me
in the belief, that the disease is not so much an " opprobrium me-
dicorum," as certain learned and experienced members of the pro-
fession would induce us to believe. But one thing is certain, that
there is no point more clearly established in the history of the dis-
ease, than that it is amenable to treatment only in its first stage,
and that subsequently, all heroic measures are rather injuri-
ous than beneficial. This matter it is necessary we should ex-
amine into a little : The fever, which is always one of a single
paroxysm, is unquestionably, in my opinion, a fever of irritation
of the general capillaries from the direct action of the specific cause
upon those vessels, and the uniform consequence and effect of that
irritation is, to keep them in a state of active engorgement during
the febrile stage, whatever may be the general pathological condi-
tion of the system with respect to its amount of vigor and excita-
bility, that is, whether the condition of the system favors the con-
gestion, the inflammatory, or the irritant form or modification of
the disease, which (the latter) I consider as its true and essential
form, and to leave them in a state of passive engorgement when the
febrile action subsides. Although general capillary irritation
throughout the system is characteristic of the disease, its tendency
is always to localize itself by falling with much more force upon
some organs, tissues and systems, than upon others ; and these are

670 Holt's Letters upon General Pathology. [November,

unfortunately the organs which are chiefly employed in elaborat-
ing tho materials for supply and reparation, or in the elimination
and excretion of the products of disintegration and deca}^. Hence,
the stomach is so uniformly found to be a point of attack, as to
give plausibility to the idea, that it is the " Throne" of the disease,
(but this I cannot admit, if for no other" reason than that I had al-
ready pronounced the disease " Democratic" which renders it in-
compatible with any Throne except the general capillaries, the seat
of its poiver,) this may be ascribed, however, rather to the greater
vascularity and extent of the mucous membranes, in the stomach,
than to any particular elective affinity for this, over other organs ;
for, though next to the nervous symptoms which arise from capil-
lary irritation in the nervous centres, the stomach is usually the
first organ to manifest disturbance of function, it by no means follows
as a consequence, that the stomach should be considered as the
prime seat of the disease, or that other organs are not as deeply in-
volved, though they may not show it as early. On the contrary,
the disordered condition and suspended function of the stomach,
bears no proportion in its direful consequences, to the disordered
condition and suspended functions of the liver, kidneys and other
depurating organs ; and there is no good reason for supposing that
the cause of the gastric disturbance, and the nature of the morbid
action which exists in the stomach, is at all different from that
which exists in, and interrupts and suspends the functions of the
liver, kidneys, etc., all of which alike owe their disturbance to
irritation and engorgement of their respective capillaries. But it is
not to be inferred that all the vital organs are invaded simultane-
ously, or that each one suffers in the same degree, or that indeed,
they should all become subject to the process of localization at
least, to such a degree, as to cause a suspension of their functions.
This process, which is generally progressive, commences, as I have
stated, with the febrile movement and continues through, but
ceases with the febrile stage, though many of the symptoms which
ar^e consequent upon its localization, and which are considered
characteristic of the disease, do not become manifest until that
stage of the disease has passed by ; indeed, during that stage, there
are but few symptoms characteristic of the disease, except its gen-
eral irritative character, and its type, or term of continuance of its
hot or febrile stage. Although from the want of plasticity in the
blood, and from the general capillary irritation and engorgement

1856.] Holt's Letters upon General Pathology. 671

there exists from the commencement, a hemorrhagic tendency,
which is sometimes manifested by active hemorrhage during the
febrile stage ; yet, ordinarily, it is not until the subsidence of the
fever, when the whole vital forces of the system are left in a state
of prostration, and the capillary system in a state of passive en-
gorgement, that the characteristic hemorrhages occur. The same
may be said with regard to the liver, kidneys, etc., that though the
functions of the liver may be suspended early in the disease, from
the influence of the specific cause, or from adventitious influences,
causing an accumulation of bile matter in the blood, or of the
lungs causing an excess of hydro-carbonaceous products, or
of the kidneys, causing an accumulation of the azotic com-
pounds, it is not until the subsidence of the febrile stage, or rather
not until its decline, that the symptoms resulting from the disturb-
ed and suspended functions of these organs, manifest themselves,
and when once manifest, it is evidence, irrefragable of the localiza-
tion of the disease in those organs, and of a failure, (if the attempt
may have been made,) to abort the disease. Although I do not
much admire the term abort as applied to an arrest of the progress
of yellow fever, yet from its having been sanctioned by high au-
thority, and for the want of a better, I shall adopt it, and proceed
to examine in what the process consists, and by what means it may
be accomplished. What I understand by aborting the disease is,
to prevent it from becoming localized, or prevent it from falling upon
certain important organs with such force as seriously to disturb or
suspend their functions, which is to be accomplished in great part,
by directing such remedies to those organs as will maintain them
in the exercise of their respective functions during the continuance
of the febrile stage ; and by directing such remedies to the general
capillaries, as to elevate their tone and activity, and fortify them
against collapse, upon the decline of the fever. It is not to be un-
derstood, that the aborting process means a cutting off of the fever;
for, being a fever of a single paroxysm and self limited, it will run
its course, though, that the crisis of the fever may be hastened by
the means used for its abortion I have no doubt. To abort the
disease then, is to arrest it in its febrile stage, and thus prevent the
consequences and the manifestation of the phenomena, which are
characteristic of other and subsequent stages of the disease. Can
this be done; and have we the means for doing it? If not always
with unerring certainty, at least, so often, as to render an effort

672 Holt's Letters upon General Pathology. [Novemberf

always necessary and proper, as the abortable stage of the disease
is the only curable one.

In corroboration of my views, and of my observation and ex-
perience, I will make a few extracts from a "Report on Yellow
fever," by Dr. Daniel Blair, Surgeon-general of British Guiana,
which, without disparagement to other1 writers, is one of the best
articles on yellow fever which I have read. He says: "When
the epidemic poison was in moderate intensity, or quantity, the
results of treatment were highly gratifying. At such times, when
the disease was recognized and treated early, the chances of aborting
the seizure were very favorable and decisive." . . . "But at
times, when the system seemed thoroughly saturated with the
poison when every mucous tissue was more or less irritated by
it when no auxiliary or exciting cause was required when the
attack was violent on many points, and spontaneous when, in
fact, the exacerbations of the epidemic became 2^stilential, medica-
tion was powerless, and the morbid processes terminating in death
were scarcely, if at all, modified or interrupted. The prime ob-
ject, however, was to abort the attack. If that failed,, after one, two,
or three doses, although still much could be done in putting the
patient in the best condition for sustaining the struggle, and keep-
ing off intruding complications, there was little room for active
interference on the part of the medical attendant. Early attention
to first symptoms among the susceptible was of priceless value in saving
human life.'''' Among other instances, Dr. Blair relates, that often
cases which occurred on a vessel, and received prompt medical
attention, all were aborted; while three out of four died on another
vessel, where treatment had been delayed. " One of the earliest
and most uniform effects of the dose in the treatment of aborted
cases is the removal of the headache symptom. It is likely that
this symptom properly belongs only to the early stages of yellow
fever, and that its tendency is to subside spontaneously, but its
departure is unquestionably hurried by the agency of the medi-
cine, and the first or second dose is generally adequate to its remo-
val. While the same amount of the compound, gives in small
and frequently repeated doses, would infallibly cause salivation,
such an effect is of the rarest occurrence in the large doses, and
when it has happened, never, that I have seen, but mildly. I
have prescribed it, without injury, to females far advanced in
pregnancy, and to my own infant three and a half months old, in

1856.] Holt's Letters upon General Pathology. 673

a similar dose, proportioned to the age, and found it attended with
no practical inconvenience of any consequence. The modus oper-
andi of the dose in aborting yellow fever, probably, is not by the
constitutional effects of mercurialization. Calwell, while acci-
dentally salivated for another malady, got a violent attack, which
was aborted by the usuad method. Three doses were in this case
required, and found sufficient, and without any increase of salivation.
The aborting dose should be used as early as possible. When a
state of apyrexia is induced, it may be relinquished the end is
attained; but if the urine has become coagulable, or the epithelium
of the tongue has begun to peel, it is of no use pushing it further,
the time for its administration is past, and subsequent to this it
will be a noxious irritant."

" From information which we received through the Surgeons of
the West India mail steamers, we could see that the use of calomel
and quinine in the treatment of the epidemic was not understood,
or rather was completely misunderstood, among the West India
Islands. We were told that it was pushed on, in various doses
and proportions, through all stages, and whether the stomach re-
tained it or not. Nothing could be more injudicious. Its benefits
are confined to the first and early stage, and though, if the case
run on, some mitigating effects may flow from its previous use,
still it is for aborting the attack completely and at once that it is pre-
scribed, and is suitable."

The apology which I have to offer for so long an extract, (if
inded any apology is necessary,) is that it comes from one of much
larger experience than myself, and tallies with my own views and
opinions, not only with regard to the character of yellow fever,
and the power which we possess of aborting it, but also with re-
gard to the means by which it is to be accomplished, and confirms
what I have previously written with respect to the action of calo-
mel, namely, that large doses are usually safer and more efficient
than small repeated doses. Now, the dose of which Dr. Blair
speaks as the aborting dose was 20 grs. of calomel and 24 grs. of
quinine. As to which of these articles, or whether to the joint ac-
tion of both, the credit of aborting the disease is due, we are left
in. some doubt. Dr. Fenner, and others,, have succeeded in abort-
ing the disease with quinine alone. I, and others, have succeded
in aborting it with calomel alone at least without the use of
quinine; though I must confess, that notwithstanding my greatest

674 Holt's Letters upon General Pathology. [November,

confidence is in the powers of calomel, I would always, when cir-
cumstances would permit, call to its aid the powers of quinine.
The objects and purposes for the administration of calomel are
manifold: To relieve irritability of the stomach; to excite the
liver, and relieve it of bilious engorgement and venous congestion,
and thus to diminish its capillary engorgement, as well as that of
the stomach, and other organs whose blood passes through the
liver ; to re-establish or keep up the secretory function of the liv-
er; and last, though not least, by its purgative effect, to aid mate-
rially in the removal of the excrementitious and noxious matters
from the system. Will calomel do this in yellow fever? My
limited experience in three epidemics assures me that it will
though in " pestilential epidemics" in which I have had no experi-
ence, upon the testimony of others, and particularly of Dr. Blair,
I am compelled to believe that it would fail. Its failure, however,
would never deter me from its use, until something more reliable
in such cases is found out; for though in ninety- nine cases it should
fail, in the one-hundredth it might succeed.

The object and purpose for the administration of quinine is, to
impart tone to the capillaries, which it unquestionably has the pow-
er of doing, and thus it aids the laboring organs in keeping up
their secreting, eliminating and depurating functions, and to that
extent prevents the localization of the disease ; or what is probable
with regard to its action is, that the tone which quinine imparts to
the capillaries, enables them better to resist the irritative action of
the specific poison, and to rid themselves more easily of the con-
sequent engorgement. At all events, it exerts in most cases a de-
cided salutary effect in sustaining the sinking energies of the whole
system, upon the decline of the fever, whether the case has been
aborted or not. These two remedies, first calomel, then quinine,
or both conjoined, I consider as the cardinal remedies in yellow fe-
ver, and all others as auxiliary. They are alike applicable (one
or the other,) to all forms or modifications of the disease, being ap-
plicable to its essential or sui-generic character', and whether the
disease assume an inflammatory character, requiring the use of the
lancet, and other antiphlogistic remedies, or congestive, requiring
the use of stimulants and tonics, these remedies will be alike ne-
cessary and efficacious ; for, while the modifications which render
the use of auxiliary remedies necessary, depend upon extrinsic or
adventitious influences which would determine the same modifi-

1856.] Holt's Letters upon General Pathology. 675

cations in other diseases, and which are consequently non-essential;
these cardinal remedies are reliable, not from the control which
they are capable of exercising over any particular modification of the
disease, but of the disease itself under every modification ; these regu-
late the chameleon, while the auxiliary remedies regulate its colors.
I will now, in a few words, state the plan which I adopted for the
abortive treatment of yellow fever, reserving the more minute de-
tails of practice for the report of some cases, which I expect subse-
quently to make of this and other diseases ; and reserving, also,
what little I may have to say, concerning the latter stage of yellow
fever, for consideration, in connection with some other forms of
typhoid fever.

If called to a patient in the chill, or before the febrile reaction
was established, it was my custom to treat them entirely upon gen-
eral principles, by enveloping them with blankets and bottles of
hot water, or a mustard foot-bath, and if the stomach was irritable,
or if I suspected it to be loaded, or containing irritating matter, I
washed it out with warm water, or a mustard emetic, and as soon
as it became quiet, or as soon as the action of the emetic had
ceased, I gave from thirty to forty grains of calomel, "with from
six to eight grains of Dover's powder, mixed in a little brown su-
gar, as I have described. This dose, if retained, (and it generally
will be,) will usually operate upon the bowels in eight, ten or
twelve hours, producing one, two, or three large offensive fcecal
and bilious discharges. If it operated much earlier than this, I
immediately repeated the dose, or if it did not operate within that
time, (twelve hours,) I gave twenty grains of calomel additional,
and in four or five hours a bottle of congress water, a seidlitz pow-
der, or some other saline and magnesian aperient. As soon as
the purgative action of the medicine ceases, which large doses will
do, (for several hours,) after two or three large discharges, I com-
mence the administration of calomel and quinine, in doses of
two grains of the former and three grains of the latter, made
into pills and given every two hours, and continue them until the
purging recommences, at which time, if the discharges are such as
to give evidence of the action of the medicine upon the liver, and
the general system is under the influence of quinine, further medi-
cation will be unnecessary, at least so far as any efforts to abort
the disease are concerned, for by this time at least twenty-four
hours will have gone by, and the case will either have been abort-

N. S. VOL. XII. NO. XI, 43

676 Holt's Letters upon General Pathology. [November,

ed, or from the lapse of time will have become non-abortable.
About this time, or twenty -four hours from the commencement of
the attack, sometimes sooner, sometimes later, the fever begins to
decline," at which time I have been in the habit of giving a few
grains of quinine, and continue to give it at intervals, until the
febrile stage has gone by. During the first twenty -four hours, and
the first hours of the twenty -four, the condition of the skin requires
particularly to be observed and attended to, for the reason that it
is an index to the character of the disease, and is an important de-
purating organ, capable of performing vicarious offices for other
more vital depurating organs. Hence, the proper action of the
skin has the effect of keeping up a determination to the surface,
and thus preventing the localization of the disease, (which in fact
is but another term for aborting it,) by diminishing capillary irri-
tation and engorgement, and perhaps, to some extent, by eliminat-
ing the active poison. I found no difficulty in exciting, or keep-
ing up a perspirable condition of the skin, by the means which
were necessary to establish the febrile reaction, by keeping the
patient within blankets, and an occasional plain, or mustard foot-
bath, (warm of course,) by the action of the calomel, Dover's pow-
der, and quinine, by some warm agreeable beverage, as balm, sage
or orange leaf tea, and by an occasional cool or cold and acidulat-
ed drink. Much is to be gained, in my opinion, in the abortive
treatment of yellow fever, by inspiring the patient Avith confidence
in the efficacy of the remedies, as he not only submits to them
with greater alacrity, but their action is more certain and favora-
ble under a cheerful and sprightly, than a sorrowful and dejected
state of mind, which of itself has a tendency to localize the disease
upon internal organs. I should have remarked before, with re-
spect to the kidneys, that in the abortive treatment they seem to-
require little attention, for though they are the chief excreting and
depurating organs in all acute febrile affections, so long as other
organs can be kept in the .performance of their work, the kidneys
will perform theirs. The result of this abortive plan of treatment
Vith me has been, that of fifty cases, as I have before stated, two
only failed of being aborted. Two of the aborted cases had cpistax-
is, which I ascribed to idiosyncracy, which I knew they possessed,
one of them being my son, and with these exceptions, in every
case, upon the purgative action of the medicine, the headache,
pain in the back and legs, and other nervous symptoms subsided,,

1856.] Wilson's Case of Cholera Infantum. 677

or began to subside, and soon left no symptoms characteristic of
the disease, save a single paroxysm of fever prolonged beyond the lim-
its allotted to ordinary intermittent and remittent or periodic fever.
Yours, as usual, Sam'l D. Holt.

article xxx.

A Case of Cholera Infantum and Convulsions^ Treated principally
by Water. By Jno. Stainback Wilson, M. D., of Muscogee
county, Ga., (near Columbus.)

On the 27th of June, my little boy, a delicate child, six months
old, and cutting his first two teeth, was attacked with diarrhoea.
This did not receive any attention until Tuesday, 1st July, when
the following symptoms presented themselves : Frequent vomit-
ing of yellow bile, with very profuse serous evacuations from the
bowels, intense fever and great heat of head and abdomen. About
midnight he was attacked with violent general convulsions, with
opisthotonos, which continned at intervals of from three to sis
hours, until the evening of the 2d. While the convulsions were
at their height, and for some moments immediately preceding the
muscular contractions, respiration seemed to be entirely suspended,
and the little fellow appeared to be in articulo mortis.

Treatment. 1st morning. A tepid bath ; the temperature to be
gradually raised to a hot bath, after the excitement has been some-
what reduced by the tepid bath ; the object being to stimulate the
whole skin, and to produce a strong determination to the cutane-
ous capillaries. Apply sinapism to epigastrium, to be followed
by a wet bandage wrung out of cold water, to the whole abdomen ;
bandage to be renewed whenever it becomes dry or very warm ;
cold cloths to head, to be changed frequently. Under this treat-
ment the nausea and vomiting subsided, and the intestinal dis-
charges were diminished in frequency, but they were still profuse
and watery.

Evening. Fever has increased ; restless tossing from side to
side, and biting at the fingers. Scarified gums ; used warm, or ra-
ther a tepid hath, and cold applications to head and abdomen as
before. No medicine yet.

After the bath, the restlessness and fever subsided, and he
seemed to be doing so well, that we ventured to retire to rest,

678 Brandon's Case of Stone in the Bladder. [November,

when we were aroused about midnight by his convulsive strug-
gles. Tepid bath immediately, with copious cold affusions to head
while in the bath. Cold applications to head and abdomen con-
tinued, and bath repeated whenever a convulsion comes on, or
before the seizure, if there were sufficient premonition. By this
treatment the convulsions were gradually diminished both in
frequency and severity; and at five o'clock on the evening of the
2d, they took their final departure. The cold cloths were contin-
ued about twenty -four hours longer, when the fever also yielded.
The only medicine given during the whole attack was, three or
four doses of a powder, composed of two grains hyd. cum creta,
and about the same quantity of chalk and ginger, with two half
grains doses of quinine, on the mornings of 2d and 3d.

Remarks. It is to be feared that physicians, like the Syrian
captain,* in their desire to do " some great thing," too often over-
look the simpler, safer, and even more effective remedies which
can be so readily obtained at all times, and under all circumstan-
ces; my object, therefore, in publishing this case is, simply to call
attention to the fact, that the most formidable diseases may be
speedily subdued by water alone; for I am convinced that the
medicine had but little, if any agency in bringing about a result
so satisfactory.

ARTICLE XXXI.

Case of Stone in the Bladder Operation Difficulty Recovery. By
D. S. Brandon, M. D., of Thomasville, Ga.

On the 5th day of August, 1853, "W. B. B., a strong able-bodied

farmer, of Thomas county, aged about forty, presented himself at

my office for the purpose of having a stone removed from his blad-

, der. The patient's health being sufficiently good to authorize the

operation, it was determined upon at once.

The bilateral opening was made into the bladder in about thirty
seconds. The stone was seized and an effort made to extract, but
without success. Finding the stone a large one, I enlarged the
opening with a bistoury, and again attempted to extract. Consid-

* 2 Kings v. 1-1'4

1856.] Brandon's Case of Stone in the Bladder. 679

erable force was being used when the stone crumbled into frag-
ments. At this I was a little disconcerted, for it was my first
operation of the kind. With forceps, fingers and syringe, alter-
nately, for more than two hours, I labored with two of my profes-
sional brothers in removing the fragments. At last, to my great
gratification and to the infinite joy of my patient, I announced
the operation over.

My patient did well until the 12th some days after the opera-
tion when he got up from his bed, shaved himself, walked over
the room once or twice, and returned to bed. I called to see him
soon after, and found him suffering with pain in the right testicle.
It continued painful through the night and next day. By the
14th, it was swollen three times the ordinary size and still painful ;
patient had considerable fever. Treated him with calomel and
opium, and cold local applications. On the 18th, the other testicle
became involved in the inflammation ; fever considerable. The
urine, which had begun to pass the natural way, returned through
the artificial opening again. Calomel and opium in small doses,
with cold to the inflamed organs, was continued until the 23d,
with no abatement of fever, nor of inflammation pulse ranging
from 95 to 110 ; tongue coated ; great thirst. Having improved
but little, if any, by the above treatment, I determined to put him
upon the use of veratrum viride. The tincture was used sufficient-
ly often to keep the pulse at about 75 to the minute. It caused
vomiting but once or twice. The fever and inflammation gave
way under its use, with a Dover's powder at night and cold appli-
cations; so that on the 27th, my patient was altogether comforta-
ble, the urine passing the natural way, and the wound healing
kindly. I discharged him two days afterwards, the wound having
healed up tp a scab, and his strength being greatly improved.

For two years after the operation he suffered occasionally from
inflamed testicles, induced by wet or cold, but at this time I think
he enjoys uninterrupted health.

The fragments of stone, (principally phos. lime,) weighed a frac-
tion over three ounces.

680

On the Remote Causes of Deafness. [November,

On the Remote Causes of Deafness.
of New York.

By Dudley Peet, A.M., M.D.,

I propose to treat, as briefly as I can, of the Remote and Prox-
imate Causes of Deafness, understanding by the former, those
conditions of the atmosphere, country, condition of parents and
offspring, etc., etc., which predispose to deafness, and by the latter,
those local affections which mechanically or otherwise cause deaf-
ness.

Several attempts have been made by different individuals, to
collate statistics in relation to the causes of deafness, but from the
ignorance of the guardians of the patients, these statistics have
proved but very imperfect. An abstract of seven hundred and
eighty-seven cases, collected from the institutions for mutes at Pa-
ris, Copenhagen, Leipzig, Prague, Cologne, St. Petersburg, Dres-
den, Hamburg, and Modena, in Europe ; and Hartford, New York,
Philadelphia and Columbus, in the United States, I will here in-
sert. It is as correct as any that have as yet been published. It
may be found in the Eighteenth Eeport of the New York Institu-
tion for the Deaf and Dumb.

CAUSES OF ACCIDENTAL DEAFNESS:

Scarlet Fever 44

Typhus Fever 3

Spotted Fever 33

Inflammatory Fever. 1

Nervous Fever 5

Nervous Fever and gathering in ears . 1

Brain Fever 4

Brain Fever, from dentition 1

Brain Fever, from coup de soleil 1

Fever and Fits 1

Convulsions 24

Epileptic Fits 6

Colds 26

Measles 35

Gatherings in the head 15

Inflammation in the head 20

Falls 19

Scrofula 12

Whooping cough 12

Hydrocephalus 9

Hydrocephalus and Whooping cough

Bilious Fever

Catarrhal Fever

Epidemic Fever

, Intermittent Fever

Arthritic Fever

Fever (not named) 38

Foreign substances in the ear 2

Itch 2

Dentition 2

Humors in the head 2

Scrofulous Opthalmia 1

Quinsy 1

Peripneumonia 1

St. Vitus' Dance 1

Palsy 1

Paralysis 1

Syphilis 1

Mumps 1

Croup 1

Measles and Mumps 1

Small Pox 8

Injuries of the head 9

Disease in head (not named) 4

Disease in ears (not named) 4

Disease in throat and head (not named) 1

Ulcers 2

Falling in the water 3

Use of calomel 1

Report of a cannon 1

Loss of hearing without manifestcause 4

Inflammation of a limb 1

Swelling in neck and gathering in ear,

with convulsions 1

Injury of the ear 1

Bite of a mad cat 1

Swallowing tobacco 1

Swallowing poison laurel I

Disease caused by vermin 1

Injurious medical treatment 1

Gradual decay of hearing 2

Diseases and accidents unknown 398

Total 787

This abstract shows the prominent causes to be fevers, the exan-
themata, pertussis, convulsions, hydrocephalus, and inflammation

1856.] On the Remote Cannes of Deafness. 681

in the head. In regard to the ages at which deafness is most like-
ly to commence, the same authority gives the following abstract
of 284 cases :

From birth till 1 year of age, 94 cases of deaf mutes.
i a 2 73

u 2 " 3 " " 41 "
" 3 " 4 " " 19 "

<< ^ UK U U 27

" 5 and upward, 30 "

Total, 284

One singular fact, established by statistics, is, that there are more
deaf males than females. This cannot arise from the fact, that
they are more exposed, for at the age (under five) when they are
most liable to become deaf, male children receive the same degree
of care as female. The probability is, that more males survive the
diseases of youth than females. Of congenital cases of deafness,
however, there are more females than males, in the proportion of
nine to seven.

There are not sufficient instances known on which to form defi-
nite conclusions as to the amount of the hereditary transmission
of deafness when one or both of the parents are mutes. There
can be no doubt that there is a certain degree of danger. I per-
sonally know of only two families, both the parents in each being
mutes, in which there is any direct transmission. In each family
there are seven deaf and dumb children. I have heard of several
other instances, however. Marriages between deaf mutes are,
however, not very uncommon occurrences, the children resulting
from which possess perfect audition. There seems to be in some
families, the heads of which are possessed of all their faculties, a
marked predisposition to deafness. Sometimes this is owing to
dissipation of one or both of the parents, at the time just preceding
gestation, thereby debilitating the vital powers. In other cases,
dissipation in youth has been the cause. But of all known causes
intermarriage is the most prolific cause of predisposition to deaf-
ness. It has been settled beyond a shadow of doubt, that inter-
marriages of first cousins, and even some of second cousins, give
rise to offspring which are generally either of small size, imperfect
health, or of imperfect development in some part; they are either
idiots, blind, club-footed, or deaf and dumb. And those offspring
of first cousins who are not, are rather the exceptions than the rule.
A curious but not very frequent mode in which hereditary pre-
disposition manifests itself is seen in alternation. A single case
will suffice. In a family of fourteen children, the second, fourth,
sixth, eighth, tenth, twelfth, and fourteenth born, were deaf mutes
congenitally, while the others could hear and speak. Another
case has been recorded, in which the line was only broken by the
birth of twins, both deaf mutes. Among other facts shown by the

682 On the Remote Causes of Deafness. [November,

late census of the United States is, that deaf mutes are more fre-
quently found among white than colored people, while blind per-
sons are more common among the blacks than whites. Mulattoes
are more subject to both blindness and deafness than the full-
blooded individuals of either race.

That the scrofulous diathesis should be assigned as one of the
predisposing causes of deafness, will cause no surprise to any one
in the least acquainted with pathology. The deposition of tubercles
being one of the results of scrofula, the latter term has at length
become, in the minds of many, so associated with the former, as
to be understood as almost s}monymous with tuberculosis. Tu-
bercular matter may be deposited in different parts of the ear, it is
true, but yet it is so unusual, that to regard it as a curiosity, would
be strictly correct. The scrofulous diathesis, however, so affects
the whole body that inflammation is easily excited in any organ ;
this inflammation is of an unhealthy kind, slow to heal, producing
an abnormal pus, and exceedingly liable to take on a chronic sub-
acute character.

When the ear of a strumous patient becomes inflamed, deafness
is almost certain to result, unless proper medical treatment be at
once resorted to. The mucous membrane becomes thickened, red,
pulpy, a purulent effusion is poured forth, constituting what I shall
hereafter speak of as strumous otitis, and, if the membrana tympani
be at the same time perforated strumous otorrhcea. The mucous
membrane of the membrana tympani is thickened, thus greatly im-
pairing its functions, as is also that of the Eustachian tube, thus pre-
venting the free access of air to the middle ear. When we examine
the delicacy of the apparatus of hearing, it is truly wonderful that
even in grave cases of inflammation, the hearing is not immediately
and totally lost. And yet the mucous lining of the cavitas tympani
is often so thickened, that it would seem impossible for the mem-
branes of the fenestra ovalis and fenestra rotunda to be of the slight-
est use in conveying the vibrations to the internal ear, the degree of
deafness resulting therefrom, being at the same time, by no means
commensurate with what we should have good cause to expect.
Scrofula, as a predisposing cause of deafness, acts then, almost al-
ways, merely as a predisposing cause of inflammation in general,
which inflammation, being excited in the ear, produces changes
resulting in deafness. These strumous inflammations are not
rare. They are very common among children, almost as much so
as strumous affections of the eye. Those of the deaf and dumb
who are scrofulous, form a large proportion of the whole number,
and the proportion is not much less among those who are deaf,
but who have lost their hearing so late in life as not materially to
affect their speech. It is evident, then, that whatever is calculated
to engender the scrofulous habit, is indirectly a cause of deafness.
Among these causes may be mentioned, living in imperfectly ven-
tilated, poorly lighted, and damp habitations; living in wet locali-

1856.] On tJie Remote Causes of Deafness. 683

ties or in a climate subject to great or sudden variations of heat
and cold, dryness and humidity. In mountainous countries, a
great deal depends on the altitude of the habitation ; thus in Swit-
zerland it has been ascertained that those who live in the valleys
are far less healthy than those who live high up on the mountains;
the disproportion of cretins between the two mentioned classes of
localities being exceedingly great. The number of deaf persons
in Switzerland is much greater in proportion to the number of
inhabitants than in any other country in the world where statisti-
cal knowledge has been obtained. In Belgium, Holland, and
Saxony, the proportion is much less; these latter countries are
level and dry. In the South of Europe, the number of deaf per-
sons is less than in the colder countries of the North. A case has
been recorded in the Paris Institution for the Deaf and Dumb, of
a family of eight children, five of whom were congenitally deaf
and dumb. These five had been born in a very damp dwelling.
A family which previously had resided in the house, had three
children, two of whom were deaf and dumb.

It has been a disputed question since the days of Hippocrates,
whether the pregnant is able to transmit to her offspring peculiar
traits of mind or conditions of body, as the result of a persistent
melancholy mood, or mental anguish, or as the consequence of a
sudden fright or disgust during any period of her pregnancy. The
affirmation of this problem has been, and ever will be, considered
by the vulgar of every nation as indubitable, no superstition or
tenet being more universally believed ; so much so, that Shaks-
peare, in many places, alludes to this belief. But whether, or no,
deafness has ever been the child's misfortune through the mother's
fright, I leave others to judge after the perusal of the following
statements, which I have collected from files of " Questions to Pa-
rents and Guardians of Deaf Mutes." These questions were issued
from the office of the Secretary of the State of New York, and are
preserved in the New York Institution for the Instruction of the
Deaf and Dumb. The facts I am about to state, are to be found in
answer to the second of the "questions," which is as follows:
" Was your child born deaf? If so, was there any cause which is
supposed to have operated before birth ?"

First Case. A. Si., the daughter of L. M., a physician in this
state, is a fine, sprightly girl, in excellent health, having no bodily
infirmity with the exception of deafness and the dumbness conse-
quent on the loss of hearing. There has never been in any ef the
collateral branches of the family, a single case of deafness. She,
however, is congenitally deaf, and her deafness is ascribed to the
fact that her mother while pregnant with her, was frightened by a
deaf and dumb man, who boarded in her family.

Second Case. C. P. E., is a boy of perfect health, and no phys-
ical defect except his deafness. The cause of this deafness is
ascribed by his parents to the fact, that a few months before the

684 i On the Remote Causes of Deafness. [November,

mother was delivered, she saw a deaf and dumb child. It must
be acknowledged, however, that this is not a sufficient cause of
deafness, as the mother was afterwards delivered of a boy, who
was also deaf and dumb, and who died at the age of ten. One of
the great-aunts and great-uncles of this boy were deaf and dumb.
The parents were second-cousins. That these additional facts
establish the existence of other causes than the one assigned,
sufficient of themselves, to account for the deafness, there is no
question.

Third Case. M. Gr., is the duaghter of an intelligent tanner and
currier, who gives the following statement : " She was born deaf.
I (the father) do not know of any other cause than the following:
My wife is a Catholic, and while in pregnancy with Melissa, wished
to go to confession ; I refused to let her do so, at which she was
offended, and would not speak to me for nearly a week, which
time was about five or six months before the birth of Melissa. I
was ignorant at the time of my wife's pregnancy, else I should
have avoided any opposition to her wishes." There are two other
children in the family, both of whom are in possession of all their
faculties. The father has "tried to remove her deafness, by the use
of refined sweet-oil, which caused extreme pain, without any appa-
rent benefit to hearing." Dew- water was also tried, "which caused
no pain, and seemed to relieve the head-ache she was formerly
troubled with." The trial of refined sweet-oil, has thus added to
medical lore the important fact, that the not going to confession,
is apt to leave considerable inflammation in the ears of the proge-
ny. Verily, the sins of the parent are visited upon the children,
(unless confession is duly made,) as is abundantly shown by this
instance of the hereditary transmission of moral turpitude.

Fourth Case. S. A., is a healthy girl, of a family in which there
is no hereditary taint. Her mother, sometime before the birth of
the infant, saw a little foolish child, the vision of which is supposed
by the parents to be the sole cause of deafness.

Fifth Case. J. S., was born deaf, and there has been no appa-
rent cause assigned, except that his mother while enciente "saw a
deaf and dumb man acting." There is no other cause of deafness
in any of the collateral branches of the family. There are seven
other children, all of whom are perfect in body and mind.

Sixth Case. E. S. Y., was deaf from birth. The family is free
from any taint likely to produce deafness. None of the exanthe-
mata have attacked him, with the exception of the kine-pox. The
mother, during the early part of her pregnancy, became very much
excited, so as to be unable to speak, and ascribes the deafness of
her child to this cause.

Seventh Case. I. M. The only reason assigned for the deafness
of this boy, is contained in the following account given by the
mother : " I lost a son three weeks previous to the birth of this
deaf son. The dying child kept calling for me. The friends pre-

1856.] On the Remote Causes of Deafness. 685

sent thought it riot proper for me to witness its struggles. To
prevent me from hearing the cries of the child, I put my fingers
in my ears, and, so far as I could, stopped my hearing. Three
weeks thereafter my child was born deaf and dumb, and has re-
mained so ever since." This woman has had four children by her
husband, (a convict in the state prison, and who has, since his re-
lease, deserted his wife,) and two by another man with whom she
is at present living. All these children can hear and speak, and
there is no other case of deafness known in any collateral branch-
es of the family. There is no relationship between the parents.

Eighth Case. This is a boy by the name of L. McK. H., who
was born deaf and dumb. During the days allotted to his mother,
one of the older children in the family hurt his shoulder, and it
became necessary to lance it. The mother, fearing to see the
operation, went some distance from the house, and in order that
she might not hear the screams of her child, placed her fingers in
her ears, and she says, "immediately experienced sensations which
she could not describe." This is the cause assigned by the mother
for her son's deafness. It may not be improper to add, however,
that an uncle of the father of this lad was born deaf and dumb,
and also a cousin of the mother, thus showing an hereditary dis-
position to deafness, which, much more likely than the above
incident, was the cause of this infirmity. Six other children are
in the family, none of whom are deaf and dumb.

Ninth Case. J. W. P., was born deaf, and the mother assigns as
a reason, that while with James, a child was placed in her arms to
be fondled. The infant very suddenly expired, and she became
so exceedingly frightened, that she believes the deafness of her
child was induced. There are no other causes known by me for
his deafness.

Tenth Case. This is a case of congenital deafness in a bright,
sprightly lass, perfect in all her faculties except hearing and speak-
ing. The only cause for her deafness that I can find assigned, is
contained in the following sad, yet interesting, narrative : The
father of this child had seduced the mother, under the promise of
marriage. The situation of the mother being known, he promised
to perform his duty, and legitimate the offspring. For some rea-
son or other, the marriage was not immediately consummated, but
the time for it was definitely settled a few weeks before the birth
of the child. A few days before the wedding was to have taken
place, the father went to work in a neighboring field, and while
engaged in cutting down a tree, was instantly killed by the fall of
it. The unfortunate mother on hearing the sad tidings, was ren-
dered distracted with grief at the loss of her lover, and shame at
her miserable condition. Hastening to the side of the dead man,
she called upon him to speak to her once, if only once, more.
This she did constantly in her frenzy, until torn away from him
by her friends. Being confined shortly afterwards, she was de-

686 Strangulated Hernia. [November,

livered of a female infant, which has since its birth neither heard
or spoken. And she ascribes its deafness to the efforts she made
to hear the voice of her intended husband.

A case is mentioned in a report printed in the year 1837, of a
boy, which at the time attracted considerable attention. The mea-
tus auditorius externus was entirely wanting, and the auricle
reduced to a mere projecting cartilage. The face and head were
also deformed, but intellectually he did not appear to be deficient.
The occasion of his deafness and deformity, " is supposed to have
been fright on the part of the mother during the period of gesta-
tion, from a piercing shriek uttered by a servant. The distressing
effect upon the ears of the parent, is believed to have caused those
of the child to be closed up. This individual hears imperfectly,
on opening his mouth, through the Eustachian tubes ; and by this
means he has, to a trifling extent, learned to articulate." The re-
port suggests the practicability of opening the external orifice of
the ear. I believe the operation was never performed. \N. York
Journal of Medicine.

On a new mode of Reducing Strangulated Hernia. By BARON Seutin.

Baron Seutin declares, that with his mode of reducing strangu-
lated hernia, which he has now practiced for twenty years, he
hardly ever in his large practice finds it necessary to have recourse
to an operation.

The patient is laid upon his back, with the pelvis raised much
higher than the shoulders, in order that the intestinal mass may
exert traction upon the herniated portion. The knees are flexed,
and the body is slightly turned to the opposite side to that on
which the hernia exists. The surgeon ascertains that the hernia,
habitually reducible, cannot be returned by continuous and mod-
erate taxis. He next seeks with his index finger for the aperture
that has given issue to the hernia, pushing up the skin sufficiently
from below, in order not to be arrested by its resistance. The
extremity of the finger is passed slowly in between the viscera and
the herniary orifice, depressing the intestine or omentum with the
pulp of the finger. This stage of the procedure demands perse-
verance, for at first it seems impossible to succeed. The finger is
next to be curved as a hook, and sufficient traction exerted on the
ring to rupture some of the fibres, giving rise to a cracking very
sensible to the finger, and sometimes to the ear. When this char-
acteristic crack is not produced, the fibres must be submitted to a
continuous forced extension, which, by extending them beyond
the agency of their natural elasticity, generally terminates the
strangulation. This mode of procedure is more applicable to Gim-
bernat's ligament, the hooking and tearing of which are more diffi-
cult than in the case of the inguinal ring. Considerable strength
has sometimes to be exerted, and the index finger becomes much

1856.] Strangulated Hernia. 687

fatigued. When, in consequence of the narrowness of the ring,
the finger does not at once penetrate, it is to be pressed firmly
against the fibrous edge, and inclined toward the hernia. After a
time the fibres yield and the finger passes. When the finger be-
comes fatigued it is not to be withdrawn, but it should be support-
ed by the fingers of an intelligent assistant, who seconds the action
it is desired to produce. In inguinal hernia, the traction should
not be exerted with the finger upon Poupart's ligament, but in a
direction from within outwards, and from below upwards, by which
the aponeurotic layers between the two ligamentous pillars consti-
tuting the inguinal aperture are easily torn through.

The ring is then enlarged by this tearing, just as if it had been
divided by a cutting instrument, or largely dilated, and reduction
takes place easily, by performing the taxis in a suitable direction.
The mobility of the skin, its laxity in parts where hernia prevails,
and its extensibility, greater in proportion to its thinness and to
the absence of a lining of fatty cellular tissue by allowing the
sliding and thrusting of this membrane in front of the finger it
cushions, affords protection to the intestine from all immediate
contusion. When the strangulation is induced by the issue of a
considerable mass of intestine, or an accumulation of faecal
matters, it is desirable first to disengage one of the extremities
of the noose, and to seek to expel the gas or faecal matters
by moderate pressure, in order to facilitate the reduction of the
tumor. In the few cases in which the finger cannot be intro-
duced, a small incision may be practiced in the skin, and the
handle of a spatula or any blunt instrument may be passed in by
separating the cellular tissue. Pressing this against the border of
the ring, while avoiding the intestine, this orifice may be eroded
or dilated without danger. The greater the resistance offered by
the aponeurotic fibres, the greater will be their tension,, and the
more easily will their laceration be produced.

As a general conclusion, it may be laid down, that the facility
and promptitude of this procedure, and the immunity that attends
it, ought to diminish the gravity of the prognosis of strangulated
hernia, by rendering the circumstances under which recourse need
be had to an operation quite exceptional. Such exceptional cases
will be found (1) in old irreducible hernias. (2.) When the stran-
gulation in inguinal hernia occurs at the internal ring. Generally
the external ring and inguinal canal are large, and allow of the
easy penetration of the finger : and then the new method is appli-
cable, and the rupturing or dilatation of the internal ring should
be attempted, and the manoeuvre is rendered the easier by the fact,,
that in these cases the canal is much shortened, and the two rings
much approximated. If, however, the external ring is too narrow
to admit the finger, an operation is required. (3.) When there are
general symptoms- of a gangrenous state of theintestine. [Bull, de
Therap. British and For. Med. Chir^Rev.

688 Local Ancesthesia by Cougelation. [November,

Local Ancesthesia by Congelation.

Dr. H. L. Burpee, in the April number of the Dental Kecorderf
thinks that direct application of cold causes too much pain to a
vital tooth or one in an inflamed condition, to be adopted into
general use. He states that he has adopted into his practice an
apparatus with which he extracts teeth without pain, but that it
requires a longer time to effect the object than the one invented
by Dr. Branch, "by commencing with warm water, and graduat-
ing the cold at will, by which process the patient suffers nothing
actually in the application, and seldom any pain is felt in remov-
ing the tooth." The time required is from one and a half to two
and a half minutes. " This apparatus consists of a combination
force pump, by which two fluids (warm and cold) can be thrown
together or separately, through a flexible tube, into a mouth-piece-
covering the tooth and surrounding the gum, (the muscles of the
face and tongue being protected by a non-conductor,) and passing
off through a flexible tube leading to a vessel placed in a conve-
nient position to receive the waste fluid." Dr. Burpee thinks that
there are cases where different applications of cold may be used,
to those teeth or roots which have lost their vitality. He remarks,
that the danger to be incurred in anaesthesia by congelation, is as
nothing compared to ether and chloroform, and that the results
are quite as satisfactory, "and that it leaves none of the ill ef-
fects ;" " that the patient is relieved from much dreaded pain and
anxiety of mind." [Am. Jour, of Dental Science.

On the Influence of Phosphate of Lime in the Production of Callus.
By M. A. Milne-Edwards.

The question of aiding the formation of callus by the adminis-
tration of phosphate of lime has recently been revived in Paris,
and the author of this paper alludes to some experiments tried by
M. Gosselin at the Hopital Cochin, especially in cases of fracture
of the arm, which are sometimes so long in uniting. In the six
cases observed by him the result seemed satisfactory, inasmuch as
the apparatus could be removed in from twenty-seven to thirty
days, the fracture appearing quite consolidated. As, however, in
these cases, the condition of the callus could not be verified, M.
Edwards undertook a series of comparative experiments on ani-
mals. Fractures as nearly as possible alike were executed upon
clogs and rabbits of the same size and strength, to some only of
which the lime was administered. The phosphate employed was
prepared by the calcination of bones, and consequently was com-
bined with carbonate. The results were decidedly favorable ; and
the author believes that the phosphate may be usefully employed
as an adjuvant, expediting the union in ordinary fractures, and
tending to prevent the non -consolidation of others.

From another communication, (Gaz. des Hop.,) it appears that

1856.] New Operation for Paracentesis in Dropsy. 689

in one o M. Gosselin's cases of fracture of the lower third of the
humerus, complete consolidation occurred in thirty days. He ad-
ministers as a minimum dose half a gramme per diem. [Comptes
Rendus. British and For. Med. Chir. Rev.

New Operation for Paracentesis in Dropsy.

A new mode of "tapping," or performing the ordinary opera-
tion of paracentesis abdominis, recently adopted by Mr. Birkett,
deserves a word of notice. Every surgical practitioner must be
aware how commonplace and uninteresting this operation has be-
come, and how very like the analogous process as regards a beer
barrel; thus justifying in some measure the association of ideas
with which the literal acceptation of the term, the process of " tap-
ping," has come to be regarded by students and surgeons in oper-
ating theatres. Mr. Birkett proposes that the fluid should flow
away by a piece of vulcanized India-rubber tube being slipped
over a sort ot flange on the canula, through which the trocar is
passed ; this piece of India-rubber tube fitted on to the further
piece of tube of any convenient length, so as to carry the fluid
away from the patient's bed. The finger and thumb are applied
to the smaller piece of India-rubber tube, which is compressed
firmly as the trocar is withdrawn, and this tube, then fitted on to
the longer piece of tube. The very unpleasant sound of a flowing
stream of fluid is thus done away with ; and where patients are
not able to sit up to have the operation performed, it suits most
admirably. It prevents air also, as in paracentesis of the chest,
entering into the cavity. [N. Y. Jour, of Medicine.

Chorea. Inhalation of Chloroform.

According to Dr. Gery,* chloroform inhalations have been used
with advantage at the Hop. des Enfans in severe cases, where the
violence of the movements have been beyond the control of opium
or belladonna. It has been found at once to calm the movements
and produce sleep, and in this way time has been gained for the
employment of other remedies. On the first application of the
vapour, the intensity of the movements is often greatly increased,
but a calm succeeds as the inhalation is continued. Sound sleep
thus induced lasts in children for ten or fifteen minutes, or even
half an hour, and no ill effects have been observed to follow. The
usual precautions, however, which are taken in the instance of
adults, are necessary to be observed, such as ensuring that the
stomach be empty, removing all obstacles to the respiratory move-
ments, and watching the respiration and pulse, &c. The usual
quantity administered has been ten to twenty grammes.

Dr. Bouchardf relates a case of a girl, in which severe chorea

* Bull. Gen. de Therap. March, 1855.. \ Ibid. July, 1855.

690 On the Use of the Oil of Turpentine, &c. [November,.

had lasted twenty-one days. She was subjected to the kifluence
of chloroform twenty seven times in fourteen days, at first twice,
then three times, and lastly once a day, at the end of which time
she was cured.

Chorea. The gymnastic treatment of chorea has already been
discussed in this journal, and we now subjoin the conclusions
drawn from an extended experience of its use in the Hopital des
Enfans by M. Blacke.* 1st. No other method of treatment ap-
plied to chorea has produced so large a number of cures as the
gymnastic treatment either alone or associated with sulphurous
baths. 2d. It may be employed in almost all cases, without being
arrested by the various contra-indications which present them-
selves at each step in the use of the other remedies for the disease.
3d. The cure is obtained in a mean number of days about equal
to that which the sulphurous baths require, but it seems to be
more lasting, and the diminution of the affection is exibited from
the first. 4th. At the same time that the disorder of the move-
ments disappears, the general health of the children sensibly im-
proves, and the patients depart not only cured of the chorea, but
also of the anosmia which most frequently accompanies it. 5th,
The gymnastic exercises, which might be regarded as perilous,
especially in the instance of the children who are submitted to
them, present no danger at all, and may be put in practice without
inconvenience in all seasons, an advantage which the baths do
not possess. 6th. It is important to divide the exercises into two
categories a, the passive exercises, which can alone be employed
in that period of the affection where the will has no influence
over the muscular powers ; and b, the active exercises, which the
children execute themselves, either with or without the aid of ap-
paratus. [Brit, and For. Med. Review.

On the use of the Oil of Turpentine, with God-liver Oil in Ophthalmias..
(Translated from Rev. Therapeutique by the Editor.)

Some years since, Uolbert, in his department of the Hospital at
Hambourg, tested the value of oil of turpentine in sjphilitie iritis.
M. Becker had already used it in rheumatic iritis, in which he
found it exceedingly useful. Since then he has used it in other
obstinate ophthalmias, and recently, in order to facilitate its use,
he prescribes it in combination with cod-liver oil. He has given
a spoonful dose every hour of the following mixture: 4 grammes
of pure oil of turpentine (rectified) with 30 grammes of cod-liver
oil, in a very bad case of catarrhal ophthalmia. He has used the
same mixture for a contagious ophthalmia, which had resisted
medical treatment for six weeks; afterwards, at the end of six days,
he substituted camphine, which is made by distilling the oil of
turpentine from the hydrate of lime. At the end of two weeks,

* Rev. MeA Chir. August, 1855.

1856.] Pneumonia. 691

the left eye was clear, the conjunctiva slightly red, and at the right
there was slight opacity of the cornea, with the granulations much
diminished. After four weeks the eye was well. During this
time the patient had taken 20 grammes of the essence of turpen-
tine, and a mixture of 80 grammes of camphine, with 100 grammes
of cod-liver oil. [Annates d? Oculistique. Phila. Med. & Sur. Jour.

Pneumonia, Asthenic or Passive form of; Treatment by Quinine.

Dr. Corrigan, in an interesting clinical lecture, {Dublin Hospital
Gazette, July 15, 1856,) makes the following practical remarks :

I have two objects in view in this lecture ; first, to impress on
your minds, gentlemen, this position, which you ought never to
forget, viz., that the name of a disease is not a sufficient guide
either as to the nature or treatment of a case; and, secondly, to
draw your attention to the treatment of certain forms and stages
of pneumonia by quinine, both on account of the importance of
this treatment, and of the cases before us forming a good illustra-
tion of the first point.

Medical students are very apt to fall into the same mistake as
is occasionally fallen into by botanists, florists, and conchologists,
viz., fancying that when they have acquired a knowledge of names
they have acquired a knowledge of the nature of the objects of
their studies ; but the mere knowledge of the name of a plant, or
a shell, or a flower, gives no more acquaintance with their respect-
ive natures than was possessed previously. You must avoid such
a mistake in medicine, for its consequences would be too serious ;
and yet I am sorry to say that this error prevails very generally
among our students, and it is because I see it prevail so generally
that I feel myself called upon, even in the middle of a session, to
notice it, and to warn you against it. I know it prevails, because
I see the great tendency there is to substitute book-reading and
knowledge of names of diseases merely, for the more troublesome
task of reading disease in nature's book at the bed-side. The mere
acquaintance with names, and the rules for treatment, will enable
you to pass a very creditable examination, and even to win exam-
ination prizes, but it will not make you practitioners ; and you
should ever bear in mind that the passing of an examination with
credit, and the obtaining a degree, are not to be your main objects.
They are only the means to an end; that end is station in your
profession, and its result competency ; and believe me the only
way to acquire both is to acquire a knowledge, not of the names,
but of the intimate nature of the objects of your study.

Let us now proceed with the illustration of our first point, that
the name of a disease is not an index to its nature or its treatment.
With the name of "pneumonia" you generally and properly asso-
ciate the ideas of sthenic vascular action of the capillaries, of throb-

N. S. VOL. XII. NO. XI. 44

692 Pneumonia. [November,

bing of the arteries, increased action in frequency and strength of
the heart, and with the accompanying symptoms of flushed face,
pink lips, hot breath, burning heat of skin, high-colored and scan-
ty urine, and orange-colored viscid sputa. With these there will
be naturally associated, as to treatment, bleeding and tartar emetic,
those remedies that possess such power over high inflammatory
action and over pneumonia, as we have sketched it ; but if you
were to imagine that the name " pneumonia" always indicated the
same, nature in the disease going under its name, you would fall
into a very grievous error in knowledge and in practice. Pneu-
monia occasionally means a state of disease the very opposite in
character to the picture first drawn, and requiring a very opposite
treatment. It is this knowledge, so as to recognize the altered
character of the disease, which you can only learn in clinical study.

To make my observations as simple and as easily intelligible as
possible to you, I will confine my observations to what is usually
called the first stage of pneumonia, that is the state in which, if a
patient die, the lung will be found dark-colored, from the great
quantity of blood contained in it, its capillaries congested, distend-
ed frequently beyond their natural calibre, its smaller air-tubes
loaded with effused fluid, and the whole lung pitting on pressure
and much heavier than natural. Bear in mind next, the peculiar
structure of the lung, resembling, as it were, two large sponges,
made up nearly altogether of a great congeries of vascular capilla-
ries, the capillaries of the pulmonary artery, loaded with venous
blood, and those of the pulmonary veins with arterial blood.

Now let me recall to your mind one of your earliest physiologi-
cal lessons. If the capillary vessels of the web of a frog's foot be
stimulated, the effect of the stimulation is very soon to cause a dis-
tension of the capillary, and a more rapid movement in the con-
tained blood. This, along with the momentary preceding contrac-
tion is its sthenic state, for all that is necessary to enable it to
return to its healthy state, is to. withdraw the stimulant, and the
capillary contracts of itself. But if the distension and stimulation
be continued another phase occurs: the blood becomes darker, the
circulation becomes slower, the capillary has lost its power of con-
tracting, and, to enable it to return to its healthy contractile state,
the application of some stimulant is required, when under its influ-
ence the capillary regains its lost power, and it again returns to
its previously healthy state.

Now, this simple experiment is really the key to the sthenic and
asthenic states of the vascular system, and is the foundation on
which Ave rest our principles as to the treatment of pneumouia,
which I bring before you in this lecture.

Carry your mind's eye from the experiment on the frog's foot to
what goes on in some forms and types of pneumonia, and you can
no more doubt of what is taking place in the lung within the in-
terior of the chest, than you can doubt your occular evidence of

1856.] Pneumonia. 693

what you see in the experiment. In the first stage of an attack
of pneumonia, in a healthy constitution, with the whole capillary
system, including, of course, that of the lungs in possession of its
ordinary vigor, the capillaries become distended, but still preserve
their sthenic state. In such a case the line of treatment is at once
indicated: venesection, to relieve their over-distension, and tartar
emetic, to act upon them and upon the whole vascular system, in-
cluding heart and arterial and capillary system, are the great
means of treatment upon which we rely. But if, from the state of
constitution, or from the epidemic type of disease at the time, the
capillaries do not retain their sthenic tone, they pass into the state
exemplified in the experiment on the frog's foot, they lose their
contractile power, and we have then to deal with quite a different
state with an immense mesh of pulmonic tissue, formed nearly
altogether of capillaries that have lost their contractile power, and
in which further depletion will be not only useless but injurious,
for while its effect in lessening the distension would at best be
doubtful, it would tend still further to aggravate that asthenic
character which they now present ; and extension of the disease,
increasing debility, exhaustion, and death will follow. It is to
meet the supervention of this second or asthenic stage that you
have seen me exhibit quinine in large doses; the result has been
satisfactory, and it is the more satisfactory to know that its em-
ployment has not been a mere empirical experiment, but has arisen
from considering the physiological state of the capillaries in the
lungs, as illustrated by a physiological experiment, and revealed
to us by an analysis of the symptoms. I will now shortly notice
some of the cases.

The first case that suggested the treatment occurred in private
practice. The patient was a man of about thirt}r-five years of age.
He was attacked by pneumonia of the right lung; he was a man of
rather full habit, and flabby texture. The physical signs were
the ordinary ones of the first stage. The constitutional symptoms
did not indicate any very high degree of vascular action, and the
treatment was of the usual kind, cupping, blistering, and calomel
and opium. About the fifth day there was every symptom dis-
couraging in this case. He became slightly jaundiced, or rather
assumed a yellowish, sallow cast of countenance, the pulse became
very full, very soft, and very yielding, and the expectoration pre-
sented the appearance of softened down dissolved blood. The
lung had not passed into the second stage of the disease. He ap-
peared now to be rapidly sinking, and it then occurred to me to
administer quinine, guided by the principles that I have already
explained. He got five grains of quinine every three hours, and
the alteration in twenty-four hours was very marked indeed. The
same treatment was continued for the next day, and within three
days more he was out of danger. I never treated a case in which
I was more satisfied of the efficacy of the medicine.

694 Pneumonia. [November

In this case the disease set in presenting a moderate degree of
the sthenic form, but the capillaries speedily lost their contractile
power, and then the asthenic form rapidly succeeded. Quinine
appears to possess the same power in giving contractile action to
the capillaries of the lungs, which we know it possesses in so
marked a degree over the capillaries and venous radicles in the
spleen, and it may further support this view to recollect that both
in lungs and spleen the capillaries are in a very large proportion
venous.

This asthenic form of pneumonia may, however, exist from the
very commencement of the attack, that is, either from type of dis-
ease, from nature of constitution, or from long-continued action of
depressing influence, the capillaries of the lungs may lose their
sthenic power from the very onset, and thus we may have asthen-
ic pneumonia either as the second stage of sthenic pneumonia, or
we may have it as the primary disease.

James Hays, setat. 21, previously a healthy man, was admitted
into the Hardwicke Hospital on the 24th of March, 1856, com-
plaining of pain in the right side, and of great dyspnoea. On ex-
amination, double pneumonia was discovered, both lungs were
extensively engaged, but the disease had not gone beyond the
first stase ; there was extensive crepitation with bronchial respira-
tion. The pulse was extremely rapid and small. The debility
was extreme, and the surface of the body was pale and rather
cool. He presented very much the appearance of a dying man.
He was a boatman, constantly exposed to wet and cold, and for
four days had been suffering under his illness, and all this time
had lain in a canal luggage boat, on its way to Dublin, in extreme-
ly inclement and cold weather.

In the night the dyspnoea became so urgent that he seemed on
the point of suffocating ; from this he was somewhat relieved by
draughts of ether and by wine. A blister was applied to his
chest. The next day he was ordered five grains of sulphate of
quinine every three hours, and the quinine was continued. On
the 29th he was so much improved that the quinine was dimin-
ished to a dose three times a day, and his convalescence then set
in. I merely give you these cases in illustration of the disease and
of its treatment; you have seen a great many cases of a similar
kind treated here on the same principle during the past winter
and spring, and I will now briefly sum up in propositions what I
wish to impress on you in this lecture.

1. That the name of a disease is not an index to its treatment;
but that on the contrary, under the one name, the pathological
conditions of the organ affected may change so much,, as to require
the most varying or even opposite mode of treatment.

2. That pneumonia presents an illustration of this principle, as
it may be of a sthenic or an asthenic form.

3. That the asthenic form may be consequent on, or be the se-

1856.] Gangrene from Arteritis. 695

cond stage of the sthenic form ; or that the primary attack of
pneumonia may be of the asthenic form from the commencement.

4. That quinine in large doses is a remedy of great power over
the asthenic form of pneumonia, whether it be primary or second-
ary.

I have only to add, that these observations as to the pathology
and treatment of this form of pneumonia have reference to the dis-
ease in the stage of extreme congestion, or what is commonly
called the first stage of pneumonia. [Am. Jour. Med. Sciences.

On Gangrene from Arteritis. By Professor Poeta.

The following are some of the conclusions arrived at by Profes-
sor Porta, from the observation of thirty-one cases of his own, and
the consideration of those published by others:

Although the tunics of arteries consist of tissues little disposed
to inflammation, yet they are not exempt from liability to it; and
external violence, the extension of phlegmasia from other tissues,
rheumatism or metastasis, may induce an arteritis that may lead
to gangrene of subjacent parts. Among all these causes, metasta-
sis is pre-eminent, so that eighteen out of the thirty-one cases are
referable to it. Not infrequently on the decline or disappearance
of some serious internal malady, a reverberation is directed to the
arteries of the limbs, the original disease either then disappearing,
or remaining as a complication of the newly developed arteritis.
The large external arteries, such as the axiliary, humeral, femoral,
or popliteal, are usually the subjects of such reverberation, but it
has not as yet been met with in the carotid. Exceptionally small-
er arteries, are attacked, such as the radial, ulnar, or tibial.

The end to which arteritis tends is the closure of the artery, all
the manifestations observed subsequent to the cessation of its pulsa-
tion being but the sequela? of that. Strictly speaking, however,
such cessation of pulsation is not pathognomic of obliteration, as
sometimes a minute stream continues to pass, which excites so
feeble an oscillation of the vessel as not to be perceptible to the
touch. The obstruction of the artery does not necessarily give
rise to gangrene, for not only may it be incomplete, but even when
complete it may have been formed with sufficient slowness to allow
the development of the lateral anastomoses; the amount of the
obliteration, indeed, exerting less influence than the rapidity with
which the coagulum is formed. This local condition is not the sole
cause of the gangrene, for the production of this may be favored
by a disordered state of the general circulation, or a temporary
enfeeblement of the cardiac impulse. There is, however, no lesion
of the function of the capillaries operating, as the minute vessels
are found healthy and empty in the midst of the gangrened parts,
just as they are in mortifications that supervene upon ligature.

696 Gangrene from Arteritis. [November,

Gangrene from arteritis presents a great analogy to senile gangrene,
which may take place slowly or rapidly, according to the amount
of ossific deposit, and the other conditions of the subject.

There is nothing constant observed as regards the form, exten-
sion, or duration of this result of arteritis. Sometimes the patient
dies during the prodromic stage, in consequence of the rapid ex-
haustion of his powers before the limb has mortified. In other
cases there are eschars, limited to the skin ; or the gangrene may
attack only one or more toes. Frequently, however, it extends to
the foot and leg, or the hand and fore-arm, until the power of the
lateral circulation restores the equilibrium, if it succeed in so do-
ing. If even it is arrested, there is a disposition to relapse; and
a paresis, and temporary or permanent atrophy of the limb, re-
mains. Danger to life, however, is not alone dependent upon the
degree of extension of the gangrene, but also upon the general
state; this allowing us sometimes to hope for recovery in even ex-
tensive gangrene, while at others it renders a limited gangrene a
most grave circumstance. So dangerous an affection is it, that
few succeed in escaping from its effects.

Besides the internal changes that may exist as the effects of the
malady which has also caused the arteritis, we often find in the
artery supposed to be affected but slight traces of lesions. In bad
cases, however, a sero-gelatinous fluid is found external to the ar-
tery, the cellular coat is finely injected, and the proper tunics are
adherent to each other, and fragile. Sometimes there is thickening
of the cellular tunic, and exudation of puriform matter or plastic
lymph, externally to the vessel, affixing it to neighboring parts.
All these lesions are not of frequent occurrence in arteritis ; and
except in the case of violence, all the coats of the vessel may pre-
sent a normal appearance, and they would be so pronounced, were
it not for the obstruction caused by the product of inflammation.
This consists of a solid coagulum of plastic lymph, varying in size,
length, and degree of adhesion to the vessel. Sometimes small
coagula are observed obstructing the artery at intervals ; but more
commonly it is a single coagulum, one or more inches in length,
converting the vessel into a cord. Sometimes, however, the co-
agulum assumes the form of a canal, or presents here and there
small lacunas, containing a milky or semi-fluid reddish matter,
which may also cover the whole surface of the coagulum, or almost
* constitute its entire substance. Maisonneuve and Cruveilhier have
found even the smallest vessels corresponding to the gangrened
part obliterated ; but, for the most part, the closure will be found
only in the vessels above the gangrened part, those corresponding
to this remaining open showing that the coagulum has preceded
the gangrene.

The principal veins of the limb sometimes participate in the in-
flammatory conditiou, and exhibit the signs of this more plainly
than do the arteries, Their coats become thickened, and rich in

1856.] Comparative Value of Amputation. 697

vasa vasorum: while their cavity is filled with lymph, or, oftener
still, by puriform matter combined with cruor. In ordinary cases,
however, the principal veins remain free, contain a small quantity
of blood, in part fluid, and in part coagulated, or, without exhibit-
ing any signs of phlegmasia, are obstructed by a sanguineous
coagulum.

As the arteritis is unpreceded by any prodrome, no prophylac-
tic can be employed; but in order to prevent or circumscribe the
formation of coagula, the arteritis itself must be actively combated
by antiphlogistic means, general or local, according to the amount
of reaction and the condition of the patient. These must, however,
be employed with due caution ; for while we combat the inflam-
matory action, we have to favor the lateral circulation. As soon
as the more urgent symptoms are mitigated, aromatic fomentations
or warm applications should be made to the part, improving the
patient's diet, and even exhibiting stimuli, if not specially contra-
indicated. If the pain is violent, opium is here, too, of great use.
These means are, however, often of no avail ; for the arteritis, es-
pecially when metastatic, appears suddenly, gives rise to the exu-
dation, and at once disappears ; gangrene following if the lateral
circulation cannot resist, and leaving to the practitioner only the
office of administering palliatives. So, too, all attempts at dissi-
pating the coagulum are useless, this remaining even in the case
of recovery ; and all that can be done is to endeavor to limit it by
favoring the lateral circulation. Even in the case of recovery, un-
til the circulation is completely re-established, there is great danger
of relapse. {Brit. & For. Med. Chir. Rev. and Omodei An. di Med.

On the Comparative Value of Amputation at the Knee-joint and of the
Thigh. By M. Baudens.

M. Baudens states, in a recent communication to the Academie
des Sciences, that the above question is one of those that have
engaged his attention during his directorship of the French army
in the East. He found that the opinions of all the medical officers
whom he consulted, whether in the Crimea, at Constantinople, or
the military hospitals at Marseilles and Toulon, were in favor of
disarticulation of the knee whenever the amputation of the ex-
tremity could not be performed below the patella. And, in fact,
the disarticulation of the knee has succeeded in a given number of
cases oftener than the amputation of the thigh, even when per-
formed at the lower third. But the disarticulation is only to be
preferred upon one express condition viz., that it be performed
immediately after the receipt of the injury. Consecutively, ampu-
tation of the thigh should be preferred. This second statement
agrees in every respect with all that he has observed, written and
taught during the ten years he has been at the head of the Val-de-
Grace. The excellent results of disarticulation of the knee, espe-

698 Citrate of Caffein in Neuralgia. [November,

cially recorded in his Clinical Observations upon Gun-shot Woun ds,
were obtained in soldiers who had just been wounded on the field
of battle. This difference in the results derivable from immediate
and secondary amputation at the knee-joint, depends upon the
fact that even in a state of health the size of the bones is not in
complete accord with the amount of soft parts a disproportion
that becomes still greater when the patient has lost flesh during
prolonged suffering and abundant suppuration.

In another communication, M. Baudens observes that, although
the surgeons of the Sardinian army in the Crimea hesitated to em-
ploy chloroform, those of the French army have used it in twenty-
five thousand cases without any accident resulting. It was always
administered with great care, so as not to go beyond the produc-
tion of insensibility. [Comptes Rendus. Med. Chir. Rev.

Citrate of Caffein in Neuralgia. By G. W. Arnett, of Bossier
Parish, Louisiana.

I see in the May number of your Journal p. 414 Muriate of
Morphia and Coffee recommended in Neuralgia by M. Boileau.

I have used in the same disease the Citrate of Caffein and the
Sulphate of Morphia with more success than with all the remedies
that I have seen tried. I have used the same remedy with more
relief to my patients in nervous headache, hysteria, and a few
other diseases of a similar character, than any other one remedy.
My prescription varies in amount to suit the case; but the average
would be about

grs. | sul. morphia, grs. iij caffein, grs. iij citric acid,
to be given in some warm coffee, or which is better, in a decoction
of rad. senega. The caffein and citric acid will, in the majority of
cases, relieve nervous irritation without the addition of the mor-
phia ; which is a desideratum when the bowels are constipated. It
acts powerfully on the skin ; equalizes the circulation, and thereby
removes local congestion. [Charleston Med. Journal.

On the Treatment of Ranula. By M. GOSSELIN.

M. Gosselin, after alluding to the various modes of treating ranula
..that have been adopted, and the relapses that are so common after
them, describes the plan he has himself found beneficial. lie first
of all performs excision, as recommended by Boyer, and then cau-
turizes with the nitrate of silver. Next day he introduces a probe
into the wound, owing to its tendency to close, and repeats the
cauterization the day after that. On the third or fourth day he
enlarges, by means of the scissors, the aperture, which has become
too narrow, and on the following day cauterizes again. After ten
or twelve days of this assiduous attention, if on the introduction

1.856.] Editorial. 699

of a probe he finds the cavity is obliterated, he leaves the opening
to itself. If, however, a track of a certain extent still exists, he
again enlarges the orifice with the scissors. This attention to the
case is rarely required beyond fifteen days, when the external
opening becomes closed, and the cavity being obliterated, there is
no fear of relapse. M. Grosselin has operated in this way in several
cases, and in three of these, which he has watched for several
years, no relapse has ensued, the opening remaining closed. This
plan of procedure has also been extended to various analogous
cases, in which there is a cavity with secreting walls, having no
spontaneous tendency to approach each other. \L? Union Med.
Brit, and For. Med. Chir. Rev.

EDITORIAL AND MISCELLANEOUS.

BIBLIOGRAPHICAL.

A Treatise on Therapeutics and Pharmacology or Materia Medica. By
George B. Wood, M. D., late President of the American Medical Asso-
ciation, &c, &c. Philadelphia: J. B. Lippincott & Co. 1856. 2 vols.
8vo. (For sale by T. Richards & Son.)

The work bofore us is from the pen of one who " for a period of about
thirty years, before 1850, when he was transferred to the Professorship he
now occupies, was engaged in teaching Materia Medica, first as a private
lecturer, and afterwards, successively, in the Philadelphia College of Phar-
macy, and the University of Pennsylvania ;" one than whom no man in our
country can be supposed better qualified in every respect for the produc-
tion of a first-rate treatise on Therapeutics. These volumes, comprising
upwards of 1700 pages, are divided into two parts, the 1st treating of Gen-
eral, and the 2d of Special Therapeutics and Pharmacology. In the first
part we find chapters upon the operation, the effects, the application, and
the classification of medicines. The second part comprehends the general
remedies, as astringents, tonics, stimulants, sedatives, and alteratives ; the
local remedies, as emetics, cathartics, diuretics, diaphoretics, expectorants,
cholagogues, emmenagogues, &c. ; local remedies affecting the organiza-
tion ; local remedies acting mechanically ; and lastly, the non-systemic
remedies, as antacids and anthelmintics.

We have given the above synopsis of the contents of the work as better
adapted to convey some idea of its scope than could be done in any other
way with the space allotted us. We cheerfully commend this great Ameri-
can production to the profession, believing that no one will regret having
bought it, after perusing it.

700 Editorial. [November,

On the Diseases of Infants and Children. By Fleetwood Churchill,
M.D., &c, &c. 2d American edition, enlarged and revised by the author.
Edited with additions by Wm. V. Keating, M. D., &c, &c. Philadel-
phia: Blanchard & Lea. 185G. 8vo., pp. 735. (For sale by T. Richards
& Son.)

The author of this treatise is one of the most prolific and successful
medical writers of Great Britain, and the American profession will doubt-
less appreciate the value of this enlarged edition. The first seventy pages
are devoted to the management of infancy and childhood ; after which the
author passes to the consideration of special diseases under the heads of
diseases of the Cerebro-spinal system, diseases of the Respiratory system,
diseases of the Heart, diseases of the Digestive system, diseases of the Skin,
febrile affections, &c. The book is fully posted up, and will be found a
valuable addition to the practitioner's library.

Medical Jurisprudence. By Alfred L. Taylor, M. D., F. R. S., &c, &c.
4th American, from the 5th and improved London edition. Edited with
additions by Edward Hartshorne, M. D. Philadelphia : Blanchard &
Lea. 1856. 8vo., pp. 700. (For sale by T. Richards & Son.)

We have here a work treating of poisoning, in general, and by particu-
lar agents ; of wounds, infanticide, pregnancy, delivery, concealment of
birth, criminal abortion, birth inheritance, legitimacy, paternity, herma-
phrodism, impotency, sterility, rape, asphyxia, drowning, hanging, strangu-
lation, suffocation, lightning, cold, starvation, and insanity.

Taylor's Medical Jurisprudence has long been a standard work of refer-
ence in England and in this country, and very deservedly so. The author
is a clear, concise and judicious writer.

Human Physiology, Statical and Dynamical, or the conditions and course
of the life of man. By John Wm. Draper, M. D., LL. D., Professor of
Chemistry and Physiology in the University of New York. Illustrated
with nearly 300 wood engravings. New York: Harper & brothers.
185G. 8vo., pp. G50. (For sale by T. Richards & Son.)

Prof. Draper has been long known to the profession as one of the most
happy and successful teachers in our country. His finely cultivated mind
and peculiar mode of treating physiological subjects, have given to his
work a degree of freshness that will win for it the good will of the reader.
Bpok 1st, on "Statical Physiology" comprises the study of the various func-
tions of the body, whilst the 2d Book, or that on "Dynamical Physiology,"
is devoted to the examination of the principle of organization, the influence
of physical agents on the organic series, the organic cell, reproduction,
growth, sleep, and death. The author dwells, lastly, upon the influence
of physical agents on the aspect and form of man, and on his intellectual
qualities, and upon what he styles " social mechanics," or the history of
society, comparative and human. We regret that our limits do not at

1856.] Editorial 701

present permit us to do more than simply to advise those who wish to read
an interesting and instructive work on physiology to provide themselves
with a copy of the one before us.

The Microscope and its revelations. By Wm, B. Carpenter, M. D., F.R. S.,
&c, &c. With an appendix containing the applications of the micro-
scope to clinical medicine, &c, by F. G. Smith, M. D., &c, &c. Illustra-
ted by 434 engravings on wood. Philadelphia : Blanchard & Lea. 1856.
8vo., pp. 725. (For sale by T. Richards & Son.)

No one can be better qualified for giving a correct and full report of the
present state of microscopy than the learned and indefatigable author of
the work before us. After studying the history, construction, and manage-
ment of the microscope, he directs the student to the microscopic structures
of the various forms of vegetable and animal life, and finally to the animal
kingdom. The appendix, by Prof. Smith, occupies about 75 pages, and
will be found highly useful. The work as a whole is an exceedingly inter-
esting contribution to medical literature, and will add to the well earned
reputation of the author.

Human Physiology. By Robley Dunglison, M. D., LL. D., &c, &c.
With 532 illustrations. 8th edition; revised, modified and enlarged; in
2 vols., 8vo. Philadelphia : Blanchard & Lea. 1856. (For sale by T.
Richards & Son.)

The call for an eighth edition of this work shows the high estimation in
which it is held by the profession. Like Carpenter, of England, Professor
Dunglison has done much and good service to the cause of science by his
laborious and able compilations diligently collecting and placing before
the reader, in a happy style, the facts and opinions of others scattered over
the broad expanse of medical literature. While neither the English nor
the American author may lay much claim to originality of research, they
are, we repeat, eminently entitled to the gratitude of the profession. The
work before us is an excellent, well arranged, system of Physiology an
admirable text-book for students, and book of reference for practitioners.

An Introduction to Physiology, designed for the use of Students and of the
general reader. By M. La Borde, M. D., Professor in the South Carolina
College. New York : R. B. Collins. 1855. 8vo., pp. 400.

The author announces in his Preface that, " it is not his purpose to write
a detailed and professional treatise on physiology, but to present the sub-
ject in such a manner as to engage the attention of the general reader."
We fully agree with him with regard to the importance of familiarizing
men with their own structure and functions; and the little volume
before us is well calculated to please as well as to instruct. It is not
adapted to the student of medicine, but cannot fail to be useful in our lit-
erary institutions.

702 Editorial. [November,

New Remedies : with Formulae for their preparation and administration.
By Robley Dunglison, M. D., LL. D., <fec, &c. 7th edition, with nu-
merous additions. Philadelphia : Blanchard & Lea. 1856, 8vo., pp. 775.
(For sale by T. Richards & Son.)

This is another of Prof. Dunglison's excellent compilations of useful
matter, which has reached a seventh edition. New articles are being con-
tinually brought to the notice of the profession, through the periodical
press which have not yet obtained a place in the systematic works on
materia medica. This work, as its title implies, relates principally to agents
of this class, and will save the practitioner the trouble of seeking in many
places what he may here find collected for him.

The Dissector's Manual of Practical and Surgical Anatomy. By Erasmus
Wilson, F. R. S., &c, &c. 3d American, from the last revised London
edition, illustrated with 154 wood engravings. Edited by Wm. Hunt,
M.D., &c. Philadelphia : Blanchard & Lea. 1856. 12mo., pp. 580.
(For sale by T. Richards & Son.)

This is one of the most generally approved assistants for the dissecting
rooms of our medical colleges. It is well adapted to the purpose for which
it is designed.

A Review of the present state of Uterine Pathology. By Jas. H. Bennet,
M. D., M. R. C. P., &c, &c. Philadelphia: Blanchard & Lea. 1856.
8vo., pp. 75.

The object of this little work is an analysis of the facts and doctrines of
those who differ from the author upon the interesting subject to which he
has bestowed so much of his attention. His arguments are very plausible,
but we still think him too much under the influence of one idea to be blind-
ly followed. The uterine mania, if we may so call it, has done much good ;
but a vast deal of mischief also.

Clinical Lectures on the Diseases of Women and Children. By G. S.
Bedford, A.M., M.D., &c, &c. 4th edition, carefully revised and en-
larged. New York : Samuel S. & Wm. Wood. 1856. 8vo., pp. 602.
(For sale by T. Richards & Son.)

We have just received a new edition of the above work, making the fourth
in the short space of fifteen months. It must be highly gratifying to the
author to find his work so generally and favorably received. Having al-
ready repeatedly directed attention to it, we will now confine ourselves to
this simple announcement.

Albinos. Having seen it stated in the newspapers sometime ago that a
negress in Alabama had given birth to three children, two of whom were
white and the other black, we addressed a note to Dr. John H. Hundley,
of Mooresville, the attending physician, requesting a statement of the facts.

1856.] Editorial and Miscellaneous. 703

We have been favored with a rejjly from the Doctor, who informs us that
it has been ascertained by microscopic examination of the hair of these
children that the two white ones were albinos, their hair presenting the
negro peculiarity as strongly as that of the black child. Our informant
adds, that both parents are full-blooded negroes that the mother has had
fourteen children, five albinos and nine blacks, and that the albinos are as
white as any of the Caucasian race.

The conjectures about double paternity and superfetation are therefore,
in this case at least, set at rest. The advantages of the microscopic test
are also here clearly set forth.

Professorial Changes. Professorships appear to be at a discount, if we
are to judge from the numerous resignations and changes that have taken
place since the close of the last winter sessions. As all is not gold that
glitters, so it is with medical colleges. Professorships are not necessarily
profitable, nor is the sum of their remuneration always indicated by the
" catalogue of students in attendance." The competition for numbers seems
to be greater, in some places, than that for money, and two " dead-heads "
are there preferred to one paying student. It is not to be wondered at
that men of sense will get tired of such empty honors as are to be met in
many of the colleges of our country.

Dr. H. W. Desaussure Ford, of this city, has been appointed Demon-
strator of Anatomy in the Medical Department of Pennsylvania College,
Philadelphia. Our young friend will, we feel assured, sustain himself
creditably in the position thus assigned him.

The New York Medical Times has merged its identity in that of its
cotemporary the New York Journal of Medicine. The editors of both will
unite their exertions in behalf of the latter.

An Easy Mode of Constructing Bougies. Dr. P. H. Cabell, of Selma
Ala., calls {Virginia Med. Journal, April, 1856) attention to an easy and
rapid mode of constructing bougies, which he thinks presents some advan-
tages, both as to the qualities possessed, and the facility and cheapness with
which they may be made. Reflecting upon the advantages the bougies
made of elm bark possessed, from the ease with which they are introduced
and the expansion they undergo while in the urethra ; and then thinking
of the danger of breaking, the difficulty of treating deep-seated strictures,
and the grave accidents which sometimes occur, Dr. C. determined to-
seek some substitute, which would possess its good qualities, aud be free
from all risk.

" The substance I finally selected was untanned cowhide, which may be
obtained sometimes of great thickness. It is first to be well soaked in wa-
ter, then cut into strips of suitable length and width, and tacked by the

704 Miscellaneous. [November,

extremities over a block of wood of the proper curve. When wished
straight, no form is necessary, they being merely stretched on a plane sur-
face till dry. When dry, they are found very tough, unyielding, and of
sufficient elasticity. They may be brought to the proper size by the knife,
rasp, sandpaper, &c., and will be found to have a fine polish, which allows
them to be introduced with ease ; they are much more rigid than either
the wax or gum instruments, but they are sufficiently yielding to be per-
fectly safe unless great violence is used, and even then I do not conceive
that there could be much if any risk of making a false passage.

" There are two ways of preparing them for use one by oiling as usual,
and (he other by dipping for a few moments in warm water. The point
may be previously well softened by a longer immersion in water. It thus
becomes almost jelly-like, and glides easily and painlessly along the ure-
thra. If the surgeon does not wish to avail himself of their expansiveness
in dilating the stricture, he may cover them with a solution of gutta peivha,
in chloroform, which will protect them from the action of the urethral mu-
cus, and render them beautifully polished." [Atn. Jour, of Med. Sci.

Ergot and Borax, their special indications. We take froin the Union
Medicale the following comparison of these two agents, in their effects upon
the uterus, by Dr. Spengler, of Ems. Each promotes uterine contractions,
but are indicated under different circumstances. Borax is preferable when
the woman is laboring under an exaltation of sensation, or when there are
spasmodic symptoms, cramps, and pain ; or gastric symptoms, dyspepsia,
acidity of the stomach, or a bilious condition. Ergot answers better with
soft, leuco-phlegmatic women, whose fibres are relaxed. When the woman
is greatly exhausted, physically and morally, when the pains are very se-
vere and insupportable, the addition of ether to the ergot is the best means
of procuring relief. Chloroform would probably answer equally well, since
it is the anaesthetic effect which is desirable. M. Spengler prefers the infu-
sion, made with two to four parts of ergot to one hundred of water. About
two parts of ether may be added. The dose is a large spoonful every fifteen
minutes. If there be gastric derangement, or constipation, castor oil is
often sufficient to provoke uterine contractions. [Boston Medical and Sur-
gical Journal.

The Medical Association. The American Medical Association, at its an-
nual meeting in the year 1852, resolved to contribute a marble block to
the Washington Monument. The following letter has been written by the
Chairman of the Committee, announcing the gift and describing the block,
which is said to be beautiful in design and execution :

To the President of the

Washington National Monument Society :

Sir At the meeting of the " American Medical Association," in the city
of Richmond, in May, 1852, the following preamble and resolution were
unanimously adopted :

"Whereas it is the duty of patriotism to do homage to those who have
been benefactors to their country ; and whereas the medical profession in
the United States, heretofore not wanting in patriotic feeling or action, de-
sire to co-operate with the other public bodies and institutions of the coun-

1856.] Miscellaneous. 705

try in rendering their profound reverence to the memory of him who was
' first in peace, first in war, and first in the hearts of his countrymen :' Be
it, therefore,

" Resolved, That a committee of five be appointed, whose duty it shall be
to solicit subscriptions from members of the American Medical Association
for the purpose of procuring a suitable stone, with an appropriate inscrip-
tion, for insertion, in the name of this association, into the national monu-
ment to the memory of Washington, now in progress of erection at Wash-
ington City.

In compliance with the above resolution, the committee contracted with
Mr. Lewis Haldy, marble mason of the city of Lancaster, to execute the
work. A block of Vermont statuary marble was procured, and there was
at that time in the employment of Mr. Haldy a young artist, Mr. J. Augustus
Beck, a native of Litiz, Lancaster county, Pennsylvania, who, after seeing
the design, undertook to execute it. The design, recommended to the
committee by the lamented Dr. A. L. Pearson, of Salem, Massachusetts,
represents the interview between Hippocrates, the father of medicine, and
the ambassadors of Artaxerxes, King of Persia, who brought him costly
presents and money to induce him to leave his native country and enter the
king's service; and as in the act of saying, "tell your master that I am
rich enough ; that honor will not permit me to accept his gifts nor to go
into Asia to succor the enemies of Greece."

Animated by the same spirit of devotion to their country which influ-
enced the greatest medical mind of Greece, the Physicians of the United
States now tender to you this tribute of their love and veneration of him,
who, whether possessed of civil or military power, had no other ambition
than to serve well his country. In claiming this privilege they would point
you to their country's history, which records among her purest patriots the
names of such medical men as Warren, Rush, and a host of others who
perilled their lives and fortunes in the cause of liberty. Whether in the
field or in the council, they have ever manifested their devotion. And
whenever perils from within or dangers from without threaten to weaken
the strength, to mar the beauty, or to assail the integrity of our glorious
Union, they offer this as a pledge through you to our common country
that they will ever be ready to follow the example of their fathers in
making a similar sacrifice.

In behalf of the committee of the American Medical Association.

JNO. L. AtLEE, Chairman.

Lancaster, (Penn.) Sept. 8, 1856.

Safety during Thunder Storms. Tbe records we are now making of the
freaks of lightning in varions sections of the country, both far and near,
prompt this communication.

First: Many persons suffer greatly from fear of lightning during the
thunder storms. To such we say that thus far, since steamboats have been
in use, no case of loss of life by lightning has occurred in a steamboat or
ocean steamer in a period of fifty years or more ; and since railroads have
been in use, now about thirty or more years, no case of loss of life by light-
ning has been known in a railroad car. This wonderful exemption, when
it is considered that tens of millions of passengers have been conveyed by
these two facilities, is extraordinary, and should calm the feelings of the

706 Miscellaneous.

timid during thunder storms, while in steamboats, ocean, steamers or rail-
road cars.

Second: No case of loss of life by lightning has been known in an iron
ship of iron building. This fact, with those stated in the next preceding
paragraph, should effectually dispel the too prevalent belief that metals are
dangerous, from an erroneously supposed attraction for lightning ; metals
attract lightning, but the attractive power probably does not extend over a
great surface.

Third : Vessels provided with lightning conductors have never suffered
injury from lightning, if the conductors were up and the continuity unin-
terrupted to the water ; nor has death by lightning been ever known on
board of a vessel thus furnished.

Fourth : We have never known of but one death from lightning in a
building furnished with metallic conductors, reared for the purpose of pro-
tection, and that occurred in the summer of 1855, at Little Prairie, Wis.
In relation to this death we have had considerable correspondence with the
person who put up the conductor.

Iron wire, costing less than one cent per foot, and less than one dollar
per hundred feet, in one single piece, is sufficiently large for a lightning
conductor. Any mechanic of ordinary capacity can put up a rod. Glass
insulators with screw fastenings can be had of some of the hardware and
glassware stores in New York for about twelve shillings per dozen. Per-
sons who want ornamented rods can substitute copper wire of the same
size.

One register of thirteen years states the deaths by lightning at 750 per-
sons ; the wounded we have not counted they number many hundred.

Persons struck down by lightning should be freely drenched with cold
water, and if necessary the drenching should be continued for hours.

We have no pecuniary interest, direct or indirect, in the furnishing or
putting up lightning conductors; our only object in making this notice is
to give information.

We have printed a sheet giving directions for putting up conductors that
will be sent to any person, postage free, who may desire a copy.

Brooklyn Heights, June 9th, 1866. E. MERIAM.

Injection of Balsam Copaiba in Gonorrhoea. By M. Dallas. M. Dal-
las, of Odessa, states, in confirmation of the observations already published
by Taddei, Marchal, and others, that the injection of the balsam of copai-
ba is the most efficacious mode of treating gonorrhoea. In sixteen cases
he has so employed it, using no internal remedy, either in recent or old
gonorrhoea, with complete success. His formula is copaib. five drachms;
one yolk of egg ; gummy extract of opium, one grain ; water seven ounces.
The injection should be used several times a day. Brit, and For. Med.
Chir. Review, from Gaz. des Hop.

Tincture of Iodine as a Collyrium in Ihjpopyon. M. Rivaud-Laudran
recommends (L'Union Medicale, April 6) the tincture of iodine, four or five
drops to six drachms of water as a collyrium to produce absorption in
hypopyon. [American Jour, of Med. Sci.

SOUTHERN

MEDICAL AND SUBGICAL JOURNAL,

(tiEW SERIES.)

Vol. III.] AUGUSTA, GEORGIA, DECEMBER, 1896. [No. 12,

ORIGINAL AID ECLECTIC,

ARTICLE XXXII,

An Essay Historical, Theoretical, and Practical ^on Hydro- Thera-
peutics. By Jno. Stainback Wilson, M. D., of Muscogee
county, Ga. (Continued from Oct. No., page 690.)

In accordance with the intimation previously given, we flow
proceed to the practical application of principles to the treatment
of specific diseases ; but before engaging in this part of ottr task,
it may not be amiss to make a brief abstract of the general princi-
ples already advanced, with the design of making them ihe basis
of our therapeutical superstructure.

The main points assumed by us a3 axiomatic, or susceptible of
demonstration, were these viz :

That animal life, in its ultimate analysis, is nothing more' nor less
than a continued transformation of matter, (Aph. I.) ; that these
transformations comprise all the physiological functions diges-
tion, absorption, &c, &c., (Aph. II.) ; that the above changes are
rendered more active by exercise, and by cold, through the agency
of the Yis Medicatrix Naturae, (Aph. III.) ; that the direct effect of
water, of a lower temperature than the human body, is sedative,
(Aph. IY.) ; that its indirect or reactive effect is that of a stimu-
lant, (Aph. V.) ; that the first impression produced by the applica-
tion of cold water to the surface, is a vivid shock to the nervous
system, with a simultaneous repulsion of the fluids upon the inter-

N. S. VOL. XII. NO. XII. 45

708 "Wilson, on Hydro- Therapeutics. [December,

nal organs ; and that re-action, with determination to the capillary
system of vessels, general and cutaneous, follows as a sequence,
(Aph. VI.) ; that derangement or impairment of the nervous
power is the primary link in the chain of morbid action, (Aph.
VII.) ; that the second link in this chain, is derangement of the
capillary system of vessels, (Aph. VIII.) ; that, as a general
rule, decidedly cold water should not be used on the surface of the
body, in active internal inflammations, high fevers, and acute dis-
eases, unless it be continuously applied, (Aph. IX.) ; that the degree
of re-action, after the cold bath, is, in general, cceteris paribus, pro-
portioned to the coldness of the water to the suddenness and
force of the immersion, &c, &c, (Aph. X.); that the cold bath is
not positively contra-indicated in acute internal inflammations, &c;
but on the contrary it is correct in principle ; the only objection
being the practical difficulty of keeping up uninterrupted sedation,
so as to avoid injurious re-action, (Aph. XL); that most of our
medical writers, being misled by erroneous theoretical fears, or
confounding the effects of water of different temperatures, are
over-cautious and restrictive in its use, (vide Corll.) ; that confu-
sion and misconception might be avoided by dividing all baths
into two classes plus and minus including under the one head,
all stimulant baths, and under the other, all sedative baths ; that
infancy and old age do not, in themselves, constitute an objection
to the use of the cold bath ; that menstruation and pregnancy are
not necessarily contra-indications to its use ; but, on the contrary,.
that minus baths of the higher temperatures, are positively indica-
ted in the latter condition ; that the popular fear of cold, after par-
turition, is unfounded, as is proved by the impunity with which
hydropaths practice their excesses; that the warm bath is a minus
or sedative bath exclusively ; and that it is a great error to con-
found the effects of this with those of the hot bath, as has been
done : and therefore, that the warm bath is not contra-indicated in
inflammatory affections of the head and chest in general pletho-
, ra in fevers or in any state of general excitement accompanied
by an "active circulation and a hot dry skin."

Such is a brief summary of the general principles, which, we-
think, should govern us in external hydro-therapeutics : it is true,
they have not been elaborated with a formidable array of argu-
mentation ; still, if we are not mistaken, they are either self-
evident, or capable of demonstration, and we stand prepared to

1856.] Wilson, on Hydro- Therapeutics. 709

defend them if attacked, or to retract any one of them, if refuted ;
truth and the advancement of science being our only objects.
We therefore sincerely invite discussion, should any of our posi-
tions be considered erroneous. It may be proper to remark, just
here, that we have confined ourself to the external applications of
water, because this department, in our opinion, most abounded
with error; but in treating of the practical part of our subject,
(which we now proceed to do,) we will allude to the internal use
of this remedy wherever it seems to be necessary.

Special Hydro-Therapeutics.

What we have to say on this subject, will be ranged under the
the following heads: 1st. Some of the more important diseases of
the three great cavities the Head, the Chest, and the Abdomen.
2d. General and Unclassified Diseases, And 3d, Some of the
more important Diseases of Women and Children,

As affections of the eye belong most appropriately to the first
sub-division, we will make a few remarks on Ophthalmia, before we
notice the diseases which belong strictly to the encephalon. Most
writers recommend the local application of water, cold and warm,
in this disease; and cold water is doubtless one of our most valua-
ble remedies; still we are satisfied that it often proves nugatory,
and even injurious, for want of proper attention to its modus
operandi. It should never be forgotten, that cold water, while it
is a direct sedative, nevertheless excites a certain degree of irrita-
tion, when it is applied immediately to a highly inflamed and
sensitive organ. And we have this frequently exemplified in the
treatment of acute ophthalmia : still we think the great difficulty,
after all, is, that the water is not changed sufficiently often ; that
the sedative impression is not continuous; and therefore that the
inflamed organ is subjected to the injurious stimulating and re-
active effects of the remedy, instead of the desired sedative effects.
In illustration of this position we will allude to a case, without
stopping to give any details.

A physician, finding all salves and medicinal applications of no
avail, in a case of acute ophthalmia, ordered the patient to im-
merse his face and eyes daily, in cold water, for a half hour or
more. As might have been expected, this treatment gave rise to
a succession of stimulating reactions which only aggravated the
pain and inflammation. The result was that a quack, or an ultra

710 Wilson, on Hydro-Therapeutics. [December,

hydropath (there is not much difference between the two, we
think) was called upon ; he taking a common sense view of the
case, discontinued the cold water, prescribed a tepid bath (sedative)
twice daily, with a warming or non-evaporating cold water com-
press, to be worn over the eye, day and night, and thus cured the
patient ; adding another to the list of triumphs obtained by em-
piricism, through neglect of the plain principles of science.

The rule for the local application of cold water in acute ophthal-
mia is manifestly this to use it tepid at first, where the sensibility
is great, reducing the temperature gradually as the eye becomes'
accustomed to it, and keeping up the sedative impression continu-
ously, by frequently changing the water. "We are aware that there
is some difficulty in this, still it is not insurmountable ; and we are
satisfied that the superiority and success of this practice will be
sufficiently great to induce us to persevere in it, in spite of any
difficulty in having it faithfully followed by the patient.

But in purulent, catarrhal, and other forms of chronic and sub-
acute ophthalmia, a different practice is indicated : in these cases
we desire the detergent, tonic and stimulating effects of cold wa-
ter ; it should therefore be used either cold, or very cold,, according
to the degree of excitability -T and it should also be applied sud-
denly, intermittently and forcibly, as by the douche \ or by in-
jecting a very fine stream into the eye. We are strongly of the
opinion that such a course as this, judiciously pursued, would be
more safe, if not far more effectual and "elegant" than the multi-
plied hash of salves, ointments, washes and powders, so much
used. And we make this remark advisedly, for we place a very
high estimate on the nitrate of silver in such cases.

With a word on the constitutional hydro- therapia of ophthalmia,
we conclude this division of our subject.

It is well known that many ophthalmic disorders are only mani-
festations of a general cachexia, such as rheumatism, scrofula,
syphilis, &c. ; this being true then, of course the constitutional
treatment becomes a matter of primary importance: we would
therefore, in addition to the means ordinarily employed in such
cases, suggest the free use of water internally as a diluent, diapho-
retic, solvent, diuretic, and eliminator of morbid matters ; together
with partial and general baths, warm, cold, or hot, according to
the circumstances of the case, as tonics and derivatives. And
even in simple ophthalmia, the wet-sheet packs and prolonged de-

1856.] Wilson, on Hydro-Therapeutics. 711

rivative sitz-baths of the hjdropaths, might be well worthy of our
attention as auxiliaries to the means above indicated.

A case to illustrate the importance of general water treatment:
A patient affected with chronic strumous ophthalmia, with corneal
opacity, faithfully tried the usual remedies, without success. Par-
tial and general cold bathing, with active exercise, free water
drinking, and the eye douche were then prescribed, which remov-
ed both the inflammation and the opacity, and restored the general
health.

What we have to say on affections of the head, will be embraced

- under two divisions congestion of the brain; and encephalitis;
including under the latter every variety of inter-cranial inflamma-
tion. Cold affusions and cold lotions are prescribed by almost all
of our writers, in congestion of the brain : still, as there are three
distinct pathological conditions in this affection, and as the action
of water is equally variant, according to its mode of application,
we think that the directions for its use are not sufficiently definite
and discriminating. We will therefore be excused for enlarging

i somewhat on the nature and treatment of this common and im-
portant disorder ; and more especially, as the principles of treat-

I ment applicable to it, may be applied, mutatis mutandis, to similar
affections of other organs.

Congestion is generally divided into three classes : active, pas-

I sive, and mechanical ; but we will confine ourself entirely to the

i first two.

In active congestion, it seems that there is an increased afflux of

(i blood to the affected part, with a rapid circulation, and distension
of all the vessels, venous, arterial, and capillary. While in passive
congestion the blood flows languidly through the hypersemic ves-

I sels, without any necessary increase of arterial excitement, and

1 its seat seems to be chiefly in the veins, and in the capillary ves-

sels intermediate between these and the arteries.* Now, if these
definitions be correct, and they certainly are, as to the essential

' differences between active and passive congestion, then it follows

: as a necessary consequence that there must be a corresponding
difference in the treatment.

We have already sufficiently indicated the two grand, distinct,
and opposite modes in which water acts viz : as a direct sedative,
and as an indirect stimulant. It follows, then, from what has been
* Vide Watson's Practice, p. 47.

712 Wilson, on Hydro- Therapeutics. [December,

said, that the mode of using it in different cases of congestion, is a
matter of vital importance. We have not space to dwell on the
diagnostic symptoms of the two forms of congestion under con-
sideration ; we can only indicate the treatment which we consider
consonant with the principles advocated. Let us take first a
case of active congestion of the brain, with its characteristic
pathology an increased afflux to that organ, with distension
of all its vessels, by a rapid and overwhelming current of blood.
The indications, in such a case as this, are, evidently, to allay
the excitement, to diminish the afflux, and to promote the con-
traction of the over-charged and distended vessels. To accomplish
these desirable ends, the direct, continuous, sedative action of cold
water is highly demanded; and we may add that its efficacy,
when properly applied, is generally equal to the emergency. But
it is obvious that it will disappoint us, if it be poured on the head,
a short time, every two, three, or four hours; or if a thick cloth
be wet with water and applied at corresponding intervals, as is
too often done ; for the affusions will produce only a transient
sedation, to be followed by consequent re-action, and an aggrava-
tion of the mischief: while the thick cloths will be followed by
like results, with the additional disadvantage of acting as a warm
fomentation, by the prevention of evaporation. To obviate such
serious difficulties as these, the modus operandi of the remedy
should be kept clearly in mind: the affusions should he frequently
repeated ; or what would be better, cold should be constantly ap-
plied to the scalp by means of an ice cap ; or by water falling on
the head, guttatim from a funnel ; or by means of light evapor-
ating cloths renewed every few minutes. In addition to this local
treatment, we would venture to suggest the wet-sheet pack, as
most potent means of subduing vascular excitement of equalizing
the circulation, and of producing a strong derivative determina-
tion to the general cutaneous surface. But we must pass on to
passive congestion.

This form consists, as we have seen, principally in a languid
circulation through the veins and the capillary vessels. What
then are the indications of treatment in a case of passive conges-
tion of the brain ? Manifestly, to quicken the flow of blood
through the stagnant vessels, to restore the tone and contrac-
tility of those vessels, and to divert the circulation into other
channels, AH this can be accomplished by availing ourselves

1856.] Wilson, on Hydro- Therapeutics. 713

of the re-active, stimulating, tonic and derivative action of wa-
ter. (Aph. V.) But instead of using it continuously, as in the
other case, it should be as cold as possible, and should be applied
suddenly, forcibly and intermittently, while the vigor of the circula-
tion should be increased before, and after each affusion, by active
friction ; and, in short, by all the means already indicated as pro-
per to secure full re-action. (Aph. X.) With a case, by way of
illustration, we conclude this part of our subject.

A negro girl had congestion of the brain, in the cold stage of
an intermittent: the physician poured cold water freely on the
head, used cold cloths, &c, without success. After he had failed,
her owner, seeing that cold water had not succeeded, and conclud-
ing from the practice of the Dr. that water in some form must be
the remedy, determined that he would try what virtue there might
be in warm affusions to the head. He did so. And lo ! re-action
ensued soon, consciousness returned, and she was entirely restored
in due time. This was, in all probability, a case of passive con-
gestion, or nervous coma, which was only aggravated by the
continuous sedative action of cold water, while the warm affusion
excited the vessels of the scalp, and relieved the brain of its pres-
sure, or aroused it from its stupor ; and thus saved the patient.

Having thus merely glanced at the more important points in
the general pathology of congestion, and having indicated the
correspondent treatment in congestions of the brain, we next pass
by a natural transition to another affection of the same organ
inflammation; which may, in the majority of cases, be considered
only the second stage of active congestion. It has been seen that
we have, in active congestion, increased afflux of blood, a quick-
ened circulation, and distension of all the vessels of the suffering
organ : this, as before intimated, is the initiative of inflammation ;
for if this state of things be allowed to continue unchecked, we
have the following additional phenomena: Loss of contractility
and paralysis of the vessels, from over-distension; remora and
stagnation of the circulating fluid; change in its composition;
disease and rupture of the containing vessels; extravasation of
blood ; effusion of lymph or serum ; and structural or organic
change, constituting the main features in flue pathology and termin-
ation of inflammation. It would appear, then, from the preceding
pathological and therapeutical principles, that the local sedative
application of cold is more especially indicated in active local con-

714 Wilson, on Hydro- Therapeutics. [December,

gestion, or the first stage of inflammation. But, as there is no
strongly marked line of demarkation between active congestion
and positive inflammation as we have no infallible diagnostic
symptoms by which they can be distinguished during life, not-
withstanding the essential difference in their pathology ; and, above
all, as inflammation, of the brain and other vital organs, is accom-
panied by constitutional sthenic disturbance, it follows that water,
cold or tepid, is still indicated as a general or constitutional reme-
dy, to allay excitement ; to subdue the morbid action of the heart;
to diminish the vis a tergo, and thus to afford opportunity for the
distended and paralyzed vessels to recover their tone and contrac-
tility. The conclusion to which we come, thejl, is this : That, in
the first stage of inflammation, or active congestion, without mark-
ed constitutional disturbance, the local sedative action of cold
water is of primary importance ; while its general sedative effects
are more especially demanded in acute inflammation of the brain
attended with constitutional excitement. But in inflammation of
the brain or its membranes, as in active congestion, the water
should be 30 managed as to avoid injurious re-action ; and as this
can be done only by keeping the patient almost constantly sub-
jected to its sedative action, which would be difficult, and even
unsafe where very cold water is applied to the whole surface, for
a length of time, it should be used either warm or tepid. In such
cases as these, the general warm bath, as a means of sedation with-
out redaction ; or the tepid sponge bath, with the local treatment
indicated in speaking of active congestion, would seem to be the
proper practice, But the warm bath, although correct in theory,
is nevertheless obnoxious to many grave objections ; among which
we will only mention the difficulty of obtaining suitable vessels
for bathing adults the trouble and delay in making the necessary
preparations the difficulty and inconvenience, if not the impos-
sibility of getting a delirious patient into the bath, and the una-
voidable excitement to which he would be subjected. As to the
sponging, while it is not liable to the same objections, we think it
Jess effectual and convenient than the application which we ven-
ture again to recommend the wet-sheet envelopment : an appli-
ance which embraces all, and more than all the advantages of the
warm bath, or the sponging, without any of the disadvantages.
For while this application combines, to some extent, the stimulant
with the sedative action of water, we are fully satisfied, both from

1856.] WILSON, on Hydro- Therapeutics. 715

theory and experience, that its stimulating effects are so very-
slight and transient that they are scarcely worthy of notice in esti-
mating the action of the remedy. It is true, that the first impres-
sion produced is that of a vivid shock, followed by intro-pulsion
of the fluids ; and that these phenomena give rise to consequent
re-action ; but this re-active excitement is of very short duration,
for the equilibrium of the circulation is soon re-established by the
equalization of temperature of the envelopment to that of the
body ; and then the abstraction of caloric necessary to vaporize
the water not only effectually cools the surface, but also subdues
the general nervous and vascular excitement, which is manifested
by a softer and slower pulse ; by a moist skin ; by subsidence of
restlessness and delirium, and by quiet sleep. Such are the happy
effects to be anticipated from this remedy : effects resulting from
the maceration of the skin from the expansion of the whole
superficial capillary system, and the consequent diversion of an
immense mass of the circulating fluid, from the vital and over-
charged internal organs. And while it promises these delightful
results, it can be applied in a moment, without subjecting the pa-
tient to a removal from bed, and when he is too weak to be placed
in a bath ; and above all, there is no difficulty about regulating
the temperature as in the warm bath, for the cooling is only pro-
portioned to the vaporizing power of the body : in other words, if
caloric is generated rapidly, it is rapidly liberated by vaporization,
and vice versa. Shall we be condemned then for recommending
this remedy, regardless of a hydrophobic popular mania engender-
ed by u old wives fables," and false professional theories ? Shall
we be deterred from using a remedy so potent because it is claim-
ed as the exclusive property of a set of hydro-maniacs who use it
empirically? Should we fear the jeers and taunts of the ignorant
rabble who cherish the idea that regular physicians are sworn to use
the remedies prescribed by old Hippocrates, and none others? .
that calomel, opium, the lancet and the warm bath, are the sum-'
mum bonum and the ne plus ultra with the "faculty" ? Nay ! let
us rise superior to all such influences as these ; let us unhesitating-
ly avail ourselves of a good remedy wherever we find it, whether
it come to us legitimately or illegitimately whether it be the off-
spring of an old woman, or of a German peasant. By pursuing
this course, and by tempering the weapons we may thus obtain, in
the crucible of science, we will not only be more likely to succeed

716 Wilson, on Hydro-Therapeutics. [December,

in practice, but we will have the additional satisfaction of know-
ing that we could not possibly devise a better plan to mortify and
defeat our irregular opponents : for it is a principal part of their
tactics to foster the notion assiduously that we are confined to a
certain set of remedies, and that they are in possession of a number
of agents of wonderful potency, from which we are debarred either
by prejudice, or by the dogmas of our schools ; it is therefore much
more mortifying to them for us to adopt the remedies claimed by
them, than it is for us to oppose them; for by appropriating them,
we effectually silence the ad captandum appeals of their noisy and
dishonest advocates. But admitting that some, though convinced
of the correctness of the practice, may be unwilling to hazard
their professional reputation, by using cold water contrary to the
established rules, it will be gratifying to such to know that all the
most desirable ends may be obtained, in the cases under consid-
eration, by using the water warm or tepid. And in cases where
the more heroic " hydropathic " appliances are plainly indicated,
it would be highly culpable to debar a patient from them, through
fear of popular clamor. Under such circumstances as these, we
think that it would be justifiable to have the water a little aired;
or, in other words, to pretend to warm it a little ; for, while we are
willing to admit that " honesty is the best policy," as a pecuniary
maxim, we have such an amount of ignorance and prejudice to
contend with in medicine that we cannot aspire to anything high-
er, in our dealings with patients, than to he as honest as circumstan-
ces will permit. Such is our hydropathic code of ethics ; and we
confess that we have acted accordingly, in some cases, with much
benefit, as we thought, to the patient. For instance, in treating a
grave case of typhoid pneumonia, we determined to avail ourself
of the wet bandage to the chest; but knowing if any untoward
event occurred, that it would in all probability be charged to the
bandage, and wishing to avoid re-action, we had the water a little
warmed ; and then we reduced the temperature still lower, by liolding
the cloth in the air some time before applying it.

Although the remedial uses of water is the subject of this essay,
we may be permitted, in concluding what we have to say on affec-
tions of the head, to make a few remarks on venesection. There
is no class of diseases in which this remedy is more universally
prescribed ; and while we willingly admit that the benefit is often
prompt and manifest, where it is demanded, we must say that it

1856.] Wilson, on Hydro-Therapeutics. 717

is too often resorted to under the idea that coma, headache, deliri-
um, and some other forms of cerebral disorder are necessarily con-
nected with inflammation or pressure. And we are, moreover,
inclined to the opinion, that patients are sometimes bled to subdue
the very re-active excitement caused by previous bleedings ; and
that bleeding is not unfrequently resorted to, improperly, in the
shock of a stroke of apoplexy, and in some forms of vertigo and
paralysis. For even admitting that there is an undue determina-
tion to the brain in all these cases, (which we are far from doing,)
it does not follow by any means that there is a general plethora or
excess of blood demanding depletion ; but, on the contrary, it is
much more reasonable to suppose that these symptoms, in the ma-
jority of instances, spring from a loss of balance in the circulation,
from an irregular distribution of blood, rather than a general ex-
cess. And we are satisfied that those symptoms sometimes origin-
ate in the want of a proper quantum of blood in the brain, and
failure of the vis nervosa; and farther, that, while such cases are
not unfrequent, and cases of irregular distribution are very com-
mon, instances of general plethora and hyperemia are compara-
tively rare. This being admitted, then, it becomes us to consider
whether we can devise any means which will spare an unnecessa-
ry, if not injurious effusion of the vital fluid. With this view, we
recommend, in addition to the hydro-therapeutic measures above
indicated, the plan proposed by Dr. Buckler, of Baltimore, and
advised, in another affection, by Prof. Ford.- By ligating the
limbs, as directed by them, and by thus retaining a large mass of
venous blood in the extremities, we would give the surcharged
vessels an opportunity of contracting on their diminished con-
tents, while their power of contraction would be increased by the
local and general use of water, as above prescribed. By pursuing
this plan, we would not only avoid the inevitable debilitating
effects of depletion, in cases where it is actually indicated, but also
the irremediable evils resulting from the improper abstraction of
blood in cases of nervous coma, paralysis, &c, before alluded to.
Besides these important advantages, this practice has the addition-
al recommendation that it still leaves the way open for the lancet,
in case it should still be needed. And we would anticipate any
objection to this delay in resorting to venesection, by taking the
position that we are fully justified in doing so, while we are using
remedies so potent as haamostasis, combined with the refrigerating,

718 Wilson, on Hydro-Therapeutics. [December,

sedative, derivative and equalizing action of water an agent, but
little, if at all, inferior to the lancet.

As our subject is too comprehensive for us to dwell on details,
and as it is more desirable to establish general principles of treat-
ment which may be applied according to the judgment of the
practitioner,, we will, in treating of diseases of the chest and abdo-
men, occupy ourself mostly in advocating the position that the
same general principles of treatment are alike applicable in similar
or identical pathological conditions, whether these are found in
the head, chest, or abdomen.

We have already shown that the use of minus baths, duly tem-
pered, in accordance with the intimate sympathy existing between
the skin and mucous membranes, is correct in principle, in chronic
inflammations of the gastro-intestinal and pulmonary mucous
membranes. It will be remembered, also, that decided cold to the
surface, unless continuously applied, has been proscribed, as a gen-
eral rule, in acute internal inflammations, &c., of every kind, on
account of practical difficulties. (Aph. IX. and XI.) We now
contend that acute inflammations of the chest, pneumonia, pleu-
ritis, &c, are no exceptions to the application of the above princi-
ples ; and consequently that sedation by external cooling appliances
is admissible in these affections. Let us take a case of pneumonia,
or pleuro-pneumonia, as the representative of parenchymatous
inflammations of the thoracic viscera. And first, in order to anti-
cipate theoretical difficulties, we will endeavor to show that there
is no direct sympathy between the skin, the substance of the lungs
and the pleura, such as we find existing between the skin and the
mucous membranes.

Dr. C. J. B. Williams, in speaking of cold as a cause of pneu-
monia, says: "It is certain that cold winds or cooling influences,
long applied, are more sure to produce the disease than mere
changes of temperature. (Cyclo. Prac. Med. Art. Pneumonia.)

Dr. Jno. Bell says that the immediate and exciting cause of
pneumonia is represented to be sudden transitions, &c. And then
he adds: "Facts justify this explanation in many cases; but in
many more, perhaps in the majority, it does not apply. (Bell &
Stokes' Prac, p. 194.)

These authorities are considered sufficient to establish our posi-
tion that there is no direct sympathy concerned in the production
of pneumonia and pleurisy ; and consequently that cold acts as a

1866.] Wilson, on Hydro- Therapeuica. 719

cause, in these diseases, (where they are not intercurrent or con-
secutive,) as it does in other diseases that is by intro-pulsion of
the fluids, resulting in congestion and inflammation. This being
true, then, it follows that the theoretical fears predicated on the
relationship existing between the skin and mucous membrane of
the respiratory apparatus are wholly unfounded. But we would
not be understood as advocating the external use of very cold wa-
ter in these affections, for it has been seen that we consider this an
objectionable practice even in acute inflammations of other inter-
nal organs; what we wish to establish is simply this : that pleurisy
and pneumonia are no exceptions to the general principles which
should govern us in the treatment of other acute internal inflam-
mations, and therefore that sedation by external cooling means is
proper in these affectionsjust as proper as it is in inflammation
of the brain and its membranes. In accordance with these princi-
ples, then, we think that we might, with safety and advantage, in
many cases of pleurisy and pneumonia, resort to sponging, mod-
erately cold or tepid evaporating and non-evaporating water
bandages to the chest, and wet sheet packs, just as though the res-
piratory organs were not involved. And we may add, that we
have tried this practice partially and cautiously, and have not had
the least cause to regret it. Anterior to the "'blistering point," the
wet bandage has several advantages: it is cleanly ;. it is conveni-
ent; it is agreeable to the patient ; and it relieves internal inflam-
mation and congestion by causing a determination to the cutaneous
capillaries, and by gradual sedation without injurious re-action, if
evaporation be permitted. As to the merits of the wet-sheet pack,
(which is only an extension of the wet bandage over the whole
body,) we have already spoken sufficiently when treating of ano-
ther disease. We know that there are almost insuperable objec-
tions, originating in the prejudices of education, and in theoretical
notions, in the minds of many, to the course we are advocating.
But why should sedation by means of water be contra-indicated
in pleurisy or pneumonia any more than in cerebri tis or meningi-
tis ? We think that it would be difficult for the most strenuous
objectors to give a rational answer to thi3 question. For we have
shown that there is no direct sympathy existing between the skin,
the pleura and the pulmonary parenchyma. If so, ivhy, we ask
again, should not inflammation and congestion of the lungs and
pleura be treated on the same general principles universally sane-

720 "Wilson, on Hydro- Therapeutics. [Decmber,

tioned in corresponding states of the brain? Surely it will not be
contended that the lungs and pleura are more vital and delicate
organs than the brain and its investments. But even admitting
that we have failed to establish our point, admitting that the sym-
pathy does exist, which we have denied, we still contend that this
sympathy would be no valid objection to the cautious and proper
use of cold as an external sedative. On the contrary, as we said
when speaking of chronic inflammations of the gastro-intestinal
mucous membrane, this direct sympathy would only make the
indication stronger to approach the disease through the skin, while
it would much increase our power of thus acting upon it. The
conclusions to which we are inevitably led are these then : That
there is no direct sympathy between the skin and the pleura,
and the substance of the lungs (the seat of pneumonia): That
such sympathy, even admitting its existence, would only render
it more imperative to avail ourselves of the sedative action of wa-
ter : That our powers would thereby be increased ; and therefore,
that the remedy should be regulated and tempered accordingly, so
as to accomplish the end desired, and no more.

It will readily be inferred, from what has been saidr that we
would even favor the refrigerating use of water in some cases of
croup, sore throat, bronchitis, &c. But let it be distinctly under-
stood, that we would, in all such cases, keep the sympathetic rela-
tionship between the skin and mucous membranes clearly in view,
and that we would modify our applications accordingly. And lest
our arguments should have failed to carry conviction, and lest we
should be considered as having strayed entirely beyond the pale
of orthodoxy, in advocating the doctrines we have, we will fortify
ourself behind the opinions of a few distinguished regular authori-
ties.

Dr. Whiting says : " This practice (the use of cold in inflamma-
tions of the chest and abdomen) has, however, of late, been recom-
mended by some physicians whose opinions ought to have weight,
and especially as the recommendation seems to be grounded on
the result of experience." And then he goes on to say that he
has used cold evaporating lotions to the chest in some cases of
phthisis pulmonalis, accompanied with inflammation of the chest,
with considerable advantage. (Cyclo. Prac. Med. Art. Cold.)

Dr. Twecdic informs us that the local application of cold, in the
sub-acute and chronic inflammation attending the formation or

1856.] Wilson, on Hydro- Therapeutics. 721

progress of tubercles, tends materially to check the disease. He
also advises frequent cold sponging of the chest as the best protec-
tion against cold in such cases. (Op. cit. Art. Infiam.) And here
we would remark, that we are fully satisfied that this sponging of
the chest, followed by friction, is far preferable to flannel as a pro-
phylactic, not only in phthisis, but in almost all other cases where-
we wish to guard against atmospheric vicissitudes. In this opin-
ion we are sustained by Dr. Watson, who recommends the shower
bath highly as a preventative to catarrh, bronchitis, &c. (Prac.
p. 534.) With two cases by way of illustration, we conclude this
part of our subject.

Case I. The writer contracted a pulmonary disease in Au-
gust, 1849, from taking a glass of ice-cream ; the cough and unea-
siness in the chest continued so long as to excite fears that a latent
predisposition to phthisis might have been developed by the ex-
citing cause mentioned ; he, therefore, had Professors Ford and
Dugas to make a physical examination, but they gave no counten-
ance to such fears. Still, the cough continued very troublesome
until March, 1850, when he was, on a very cold day, accidentally
thrown into a river ; this relieved the symptoms very much ; but
yet they returned in a few weeks, and have never been absent
any length of time since, except for the last four months ; and pre-
sent exemption is plainly attributable to the use of shower baths and
frictions; for as the subject of this report had much rather admin-
ister medicine than to take it himself, none has been taken this
year.

Case II. Gr. P. B. .had a chronic bronchitis of three or four
years standing; he had tried a number of physicians, and many
remedies, without avail. When he came under our treatment we
used tartar emetic externally and internally, and various other
remedies with only partial and temporary success. He then re-
moved, carrying his old disease with him, but much to our surprise
we heard from him not long after this, and he had relieved himself
entirely by using a wet bandage to the chest, in accordance with
our suggestions. ^

We next proceed to make a few general remarks on the treat-
ment of some of the more important diseases of the abdomen, viz :
Peritonitis, dyspepsia, diarrhoea and dysentery. If we have been
successful in demolishing the stronghold of professional and popu-
lar prejudice if we have not failed in demonstrating the safety

722 Wilson, on Hydro-Therapeutics. [December,

and efficiency of water as a sedative and refrigerant in affections of
the chest, it is needless for us to multiply arguments to show that
the same principles of treatment are applicable in diseases of the
abdomen. Taking this for granted, then, we will now endeavor
to show that water, in some of its modes of action, is not only ad-
missible in abdominal affections, but that it is superior in some
cases to the remedies considered strictly medicinal. This would
seem to be the case in peritonitis, on account of the close proximo
ity of the abdominal serous membrane to the skin. We cannot
speak from experience on this point, but we are fully satisfied from
our knowledge of the action of water, that the use of wet bandages
to the abdomen, evaporating or non-evaporating, according to the
degree of local and general excitement, together with the wet-
sheet fomentation, sponging, etc., would be attended with the best
effects. And we are pleased to find that we are sustained in this
opinion by Dr. Sutton. (Cyclo. Prac, Med. p. 797.) But it is in
affections of the gastro-intestinal mucous membrane that we are to
expect the most brilliant triumphs of hydro-therapeutics. Dys-
pepsia, in its protean forms, is justly regarded as the terror of
physicians j the reproach of medicine, and the most fiendish of all
diseases, preying alike upon the mental, moral, and physical con-
stitution of its hapless victims. This is one of the spirits which
will not be exorcised, in many cases, by drug incantations ; how
fortunate then that water treatment, externally and internally,
promises more in these deplorable cases than in any other class of
diseases, perhaps I In treating of the remedial application of wa-
ter in this disease, we cannot think of noticing all the minute divi-
sions and subdivisions made by systematic writers, like Dr. Todd,
who gives us some eighteen or twenty different genera and species,
and reserves a niche for more. It will be sufficient for our pur-
pose to make only two divisions of the disease : 1st. Inflammatory
Dyspepsia, including all cases of morbid vascular excitement, and
active hyperemia of the digestive mucous membrane; and 2d.
Atonic Dyspepsia, including such cases as are attended with local
debility, deficient secretions, impaired innervation, and passive
congestion.

We .are fully persuaded that a large majority of cases of
dyspepsia belong to the first division ; that the pain, burning,
excessive and depraved secretions, and all the multiform symp-
toms which characterize this disorder are generally indications of

t856<] Wilson, on Hydro- Therapeutics. 723

subacute or chronic inflammation, or active congestion of the di-
gestive mucous membrane. And we are equally satisfied that two
grave errors are often committed in the management of this dis-
ease. The first of these is a false diagnosis which attributes the
dyspeptic symptoms to local debility or want of tone. And the
second difficulty is that no diagnosis whatever is made, the symp-
toms being treated empirically without any regard to the patholo-
gical condition from which they originate. Is it a matter of sur-
prise, then, that the treatment of indigestion is so often unsuccess-
ful? And especially when we call to mind the fact that almost
all internal medicines, even those belonging to the antiphlogistic
class, act as direct irritants to the gastro-intestinal mucous mem-
brane? This is strikingly exemplified in acute gastritis, for it is
well known that our hands are tied in this disease, and that our
internal medical treatment amounts to almost nothing. In sub-
acute and chronic gastritis we have a similar pathological condi-
tion, with the same increase of sensibility, differing only in degree;
and, therefore, identical results must ensue from the action of me-
dicines. We readily admit that the local stimulus of drugs is
sometimes beneficial in such cases, but we fear they are oftener in-
jurious on account of the difficulty, not to say impossibility of
proportioning the degree of excitation to the excitability of the
affected parts. While we would not wholly proscribe internal re-
medies, then, in inflammatory indigestion, we consider external
remedies addressed to the skin and assisted by proper hygienic
and dietetic regulations far more safe and effectual. Indeed it is
hardly necessary to reiterate the opinion expressed by all authors,
and confirmed by all observers, that the regimen is a matter of
primary importance in any plan of treating dyspepsia. What
then are the best remedies for this disease? They are local and
general baths cold, tepid, or warm according to the circumstan-
ces of the case. What are the circumstances which should princi-
pally engage our attention ? They are, first, to diagnosticate the
true pathological condition of the case, and then to temper our wa-
ter accordingly. If the symptoms originate in subacute inflamma-
tion or active congestion of the mucous membrane, or in chronic
inflammation accompanied with accidental or extraordinary excite-
ment, then is the warm bath peculiarly indicated, to allay the local
and general nervous and vascular excitement; to equalize the cir-
culation ; to derive to the surface, and to restore the functions of
N. S. VOL. XII. HO. XII. 46

724 "Wilson, on Hydro-Therapeutics. [December,

the skin so often disordered, and so intimately associated with the
digestive membrane. And we are happy in finding that Dr.
Forbes gives his unqualified assent to this practice; for he says:
"In no class of cases is the warm bath more strikingly beneficial,
than in those affections of the stomach and bowels which are com-
monly ranged under the head of dyspepsia." And he quotes with
approbation a remark of M. Eapou, corresponding with the views
expressed by us, viz : " That chronic inflammations of the mucous
membrane of the stomach and bowels, are frequently confounded
with nervous dyspepsia, gastralgia," etc. And consequently, that
tonics and antispasmodics are used, to the injury of the patient,
instead of the vapor and warm bath. (Op. cit. Art. Bathing.)
But while the warm bath is such an excellent remedy, it is almost
impossible in many places to get a suitable vessel for bathing
grown persons : how fortunate then, that we have a remedy, (the
wet sheet,) which can be procured at all times and in all places ; a
remedy which enjoys all the advantages over the warm bath, al-
ready noticed under the head of inflammation of the brain, together
with another not before noticed ; it is a species of vapor bath, and
it is well known that this bath, cazteris paribus, is more derivative
than the warm water bath, on account of the greater rarity of a
vapory medium. And we might just here whisper in the ear of
some of our timid brethren, that they might thus get all the bene-
fit of the vapor bath, without being considered a " vegetable steam
doctor." In addition to the general wet-sheet fomentation, the
same remedy may be used with the best effects, locally, in the form
of the wet bandage to the abdomen. We can speak from actual
experience of this latter remedy in dyspeptic affections, and we
think that it is worthy of all praise. And what is remarkable, the
use of pure simple water in this way, excites a severe cutaneous
eruption ; thus, making water, as strange as it may appear, a pow-
erful counter-irritant. This is no doubt a part of the " Crisis"
about which the hydropaths make such a parade, and which they
attribute to the extraction of our poisonous drugs. We may say
Tnore of this hereafter.

AVe next notice Atonic Dyspepsia. In dyspepsia caused by de-
bility and want of tone in the digestive organs, and even in some
cases of chronic inflammation, the treatment already indicated
would be appropriate to restore the skin to its normal functions.
But here we need stimulation rather than sedation ; we need some-

1856.] Wilson, on Hydro- Therapeutics. 725

thing to re-invigorate the whole system ; something to excite the
activity of all the organic processes, and the nutritive functions in
particular. These ends may be partially accomplished by the in-
ternal use of stimulants, but much more safely and effectually by
the external use of tepid and cold water; by air; by exercise; and
by rigid attention to diet. As there are but few cases of pure de-
bility unconnected with chronic inflammation or passive conges-
tion of the mucous membrane, the water should, as a general rule,
be used as in other similar states, that is, with a view to its re-active
stimulating effects. It should, therefore, be used in the form of
cold affusions and cold sponging to the abdomen, and to the whole
surface, according to the circumstances of the case ; and these re-
medies should be preceded by exercise, and followed by exercise
and friction. (Aph. X.) The cold hip bath with hard friction of
the abdomen and loins is also a valuable addition to our revulsive
measures in many of these cases. The wet bandage will also be
appropriate still, provided the symptoms do not originate in pure
debility, which, as before intimated, is rarely the case. With a
few general remarks on the treatment of some symptoms common
to almost all forms of indigestion, we dismiss this affection.

Constipation. This is a common and troublesome symptom of
indigestion of all kinds, and is best relieved by cold and tepid in-
jections; for we fully concur in the directions given by some of
our best writers, viz : That purgatives and even laxatives shottld
be eschewed as much as possible. Indeed, we fear that this is a
point not sufficiently insisted upon even now ; for we are satisfied
that the two frequent use of cathartics, both by physicians and
people, is an evil of enormous magnitude. We have the incon-
trovertible evidence of experience, that the large majority of cases
of constipation of all kinds, may be relieved by the persevering
use of cold water enemata. How inexcusable then the practice of
keeping the sensitive mucous membrane continually teased and
excited by irritating medicines, when those who prescribe them
know, or should know, that such a course as this will almost in-
evitably aggravate existing disease of this membrane ; that it will,
in all probability, superinduce disease where it does not exist ; and
as the very least of evils, that it will result in a habit requiring
the daily use of cathartics, which must be increased in strength and
continued through life !

As to the diarrhoea, which sometimes is a prominent symptom,

72(5 Wilson, on Hydro-Therapeutics. [December,

and sometimes alternates with constipation, we believe that in most
cases it will yield to the warm bath, the wet-sheet pack, or the wet
bandage ; and we are glad to find that we are sustained in this
opinion by the distinguished writer last quoted.

In cases of dyspepsia, accompanied by depraved secretions and
deficient excretions, the free use of water internally as a diluent,
solvent, diuretic and diaphoretic is strongly indicated. And in
cases of active congestion, inflammation or high irritation of the
stomach, the best effects may be anticipated from its direct and im-
mediate sedative action on the inflamed membrane. It should be
taken early in the morning, on an empty stomach, and should be
followed by exercise in the open air.

A Case, Mrs. , set. 22, of delicate and leuco-phlegmatic

habit, had an attack of phlegmasia dolens, in Jannary last, from
exposure to the bitter cold weather after her confinement. This
was followed by dyspepsia, characterized by the following symp-
toms: "burning" in the stomach and bowels, slight nausea, se-
vere paroxysms of gastralgia, constipation, white furred tongue,,
palpitation, with great irregularity in the action of the heart;
pulse intermittent at times ; at times too slow, at other times too-
fast, etc.

Treatment. Opiates and antispasmodics for the gastralgia and
palpitation, which did little or no good. We then resorted to'
general cold affusions every morning, followed by copious cold
water drinking, and exercise, with an occasional pro-renata wet-
sheet pack and hip bath, cold. In addition to these means, the
wet bandage was worn over the abdomen day and night, until its
discontinuance was demanded by a severe herpetic eruption which
appeared under it. Soon after this eruption, another " crisis " ap-
peared on the back in the form of angry boils ; but simultaneously
with the eruptions, all the disagreeable symptoms, the " burning,"
the gastralgia, and the palpitation disappeared. The only symp-
toms now remaining are a nervous headache and flatulence, which
may originate in debility, or may be connected with pregnancy.
These symptoms we hope to relieve, by frictions along the spine,
with a cold wet cloth, and by the use of small doses of gum assa-
foetida, three times a day. It will be noticed that scarcely any
medicine has been used in this case. It may be interesting to add,
that the palpitation has returned slightly at times, but has always
been promptly relieved by the application of a cold wet bandage

1856.] Wilson, on Hydro- Therapeutics. 727

over the region of the heart. Cold water enemata always have
the desired effect in removing the constipation.

With a very cursory notice of diarrhcea and dysentery we must
close this article, leaving the two remaining divisions of our essay
for some future occasion. And in the remarks that we may make
on these diseases, we will confine ourself mostly to the internal
use of cold water, because we have already enlarged sufficiently
on the principles of treatment which should govern us in the
external application of this remedy in diseases of the mucous
membranes ; and because we are convinced, both from theory and
experience, that it possesses most valuable therapeutic properties
when used in this way ; but the principal reason why we wish to
insist on the internal use of water is, the fact, (for it certainly is a
fact,) that there is a strong prejudice among many against this
practice. We cannot well see the grounds of objection to the in-
ternal use of even cold water in diarrhoea and dysentery ; and we
cannot resist the conclusion, that it originates in erroneous physi-
ological views. The fact is, many seem to be impressed with the
idea, that fluids taken into the stomach, pass directly through the
pylorus, and come in immediate contact with the lining mem-
brane of the intestines ; when physiology teaches us that nutritive
matters in a state of perfect solution and water pass, by endosmose,
through the venous radicles of the stomach, and thus into the gen-
eral circulation. (Carpenter 279.) And we are moreover inform-
ed, (by the celebrated Beaumont, we think,) that fluids taken into
the stomach are absorbed like ivater when poured on sand. How
absurd then the notion that water passes down from the stomach
and irritates the intestines ! Yes, as strange as it may appear
Dr. Joseph Brown is guilty of this great absurdity ; for he says,
distinctly, that liquid freely taken u passes rapidly through the how-
els" exciting griping, and that it must tend to disturb the repara-
tory process. (Cyclo. Prac. Med. Art. Dysen.) But another ob-
jection, more specious, if not more solid may be urged, viz: that
the ingestion of cold fluids may check cutaneous transpiration,
and, therefore, that the surcharged vessels must necessarily relieve
themselves by increased intestinal exudation ; or in other words,
by increase of the diarrhoea. To this we would reply that it is in
our power, in most cases, to remove the intestinal determination
by diverting the circulation to external parts, and by exciting the
action of the skin and kidneys; thus compelling these organs to

728 "WlLSOX, on Hydro- Therapeutics. [December,

share in the onus thrown upon the intestines. But even admitting
that these organs should prove rebellious ; admitting that we could
not make them perform their part, and that the intestinal discharg-
es would be increased for a time, we would still contend for the
use of diluents, for these reasons : the demands for fluids to replen-
ish the serous losses of the blood, and to prevent too great inspis-
sation of this fluid, would be in a direct ratio to the loss of serum
by intestinal exudation ; and, secondly, if the fluid exuded were
introduced by us, there would be no draught, by the increased
exudation, on the serum contained in the blood, prior to the inges-
tion of our diluents. Again, admitting that our physiology is in-
correct admitting that water does actually pass directly through
the stomach into the intestines, it does not follow by any means
that it would be contra-indicated in intestinal diseases ; for the
second of the above positions would still hold good; and even, the
much dreaded cold water in contact with the diseased membrane,
would certainly be much less irritating than the undiluted and
vitiated secretions and fcecal contents of the intestines. Indeed,
so far from water being either positively or comparatively irritat-
ing, it is exactly the reverse ; and we would consider it a fortunate
circumstance, if by any means we could bring cold water in con-
tact with all parts of the intestinal canal. And as a proof of the
happy effects of dilution, we would refer to the delightful action
of saline cathartics in dysentery, as prescribed by Professor Dugas.
It is probable that the relief in these cases is partly due to the ac-
tion of the salts on the upper part of the intestinal canal, and the
consequent diminution of vascular turgescence, &c, but we are
persuaded that the remarkable relief is mainly due to the diluting
flood of serum which is poured from the small upon the inflamed
surface of the large intestine. The point on which we have been
insisting we consider one of the most important embraced in this
essay, and believing that our reasoning on this subject is perfectly
conclusive, we do hope that physicians will no longer be deterred
by groundless fears, from using not only a safe remedy, but one
of the most valuable and jwtent in intestinal affections.

The next question for us to consider is the best means of avail-
ing ourselves of the benefits of water in diarrhoea and dysentery.
This is to be done by its external application, in accordance with
the principles laid down in speaking of dyspepsia ; and by its use
as a diluent, sedative, diaphoretic, &c., per orein et per rectum.

1856.] Wilson, on Hydro- Therapeutics. 729

We will only add a few practical remarks concerning the last
two modes. When the skin is hot and dry, and the thirst for cold
drinks great, we would allow cold water both in diarrhoea and in
dysentery ; still, we would endeavor to avoid giving it in excess,
especially in cases attended with great debility and relaxation of
the intestines, or in what might be called cases of passive diarrhoea;
in short, we would aim to proportion the supply to the serous loss
of the blood, without overloading the vascular system. And this
we consider a point of vast practical importance, and one too little
regarded ; for it is evident, if the fluid portion of the blood be not
replenished, that it will become so inspissated by the continued
serous drain as to be incapable of passing through the minute ca-
pillary vessels of the system, thus producing stagnation, suspended
functions, and death. And even when the skin is moist and per-
spiring, this should not cause us obstinately to resist the demands
of nature for cooling drinks, provided we keep up a determination
to the skin by frictions, baths, &c. For it should be remember-
ed, that we do not so much desire profuse perspiration in these
cases, as we do a centrifugal determination of the fluids, and equal-
ization of the circulation. Cold injections in dysentery, we have
found to be a most valuable remedy; indeed, we think more high-
ly of simple cold water in this way than any thing else, unless it
be the nitrate of silver in some cases of ulcerated rectum, etc.
They should be used after each evacuation. And finally, we will
in conclusion, express two opinions which some may consider wild
and Utopian; they are these:

1st. If water be used externally and internally, in accordance
with the principles advocated in this article, in diarrhoea and dy-
sentery together with saline cathartics, in the latter disease, we
will have but little use for calomel and the lancet.

And, 2d. If we judiciously avail ourselves of all the remedial
virtues of water, together with hsemostasis and veratrum, in cases
of excessive vascular excitement, they will be found sufficient even
for the most formidable inflammatory diseases which we may be
called upon to combat.

Note. In Dr. Wilson's article, contained in our October number,
On page 579, second line, for "waters," read tenter.
" " 581, 14th line from bottom, for " promising," read premising.
" " 583, 9th. " " top, for " active," read actual.
" " 587, 8th " " bottom, for " first," read just.

730 Casey, on Traumatic Tetanus. [December,

ARTICLE XXXIII.

A Case of Eccentric Traumatic Tetanus. Eeported by H. R. Casey,
M, D,, Appling, Ga.

Dear Doctor Thinking the case I am about to relate to you,
may be not without interest to the profession particularly to the
junior members I send it to you in a form, which if you think
deserving a place in your valuable Journal, you are at liberty to
place there,

Some ten days since, I was called in great haste to see a negro
man belonging to Messrs. Kirkpatrick & Leitner, at Berzelia, on
the line of the Georgia Railroad. On arriving there, and inquiring
of Mr. L, the condition of the patient, he gave me the following
short history of the case ;

Early on the morning of the day previous the boy came in com-
plaining of a severe "pain in his belly." Mr. K. thinking from
his actions and his apparent great suffering that it was a case of
cramp colic, and believing that active catharsis would be most
likely to relieve him, gave him a dose of ol, ricini. During the
course of the day there were slight manifestations of the effect of
the medicine, but with no alleviation of the symptoms. Mr. L.
did not see the boy until night, when he took charge of the case.
He was at once satisfied that it was not cramp colic, but could not
liken it to any disease he had ever met with : such violent spasm he
had never before seen the boy in the interval seeming to be well.
He gavehim a dose of oil and turpentine, antispasmodics, cups to
the nuchas. The spasms continued even on throughout the entire
night. On the next morning, finding the case increasing in inten-
sity, he dispatched a messenger for me.

Living some twelve miles distant, I did not see the case until 3
o'clock P.M., which was some thirty-two hours from the incipiency
of the attack. I entered the cabin and found the boy lying on a
pallet on the floor. Taking my seat by his side, I commenced to
catechise him as to his feelings, etc. There was no febrile heat;
the pulse frequent, small, irregular and feeble; the respiration
short, hurried and anxious; profuse perspiration on the face ; tongue
slightly coated, with marks of violence on its surface. There
was no mental disturbance; and up to the time of the examina-
tion there was nothing to mark the character of the disease, by
which a true diagnosis could be formed. As the only complaint

1856.] Casey, on Traumatic Tetanus. 731

of pain the boy had made was located in the abdominal region,
I threw off the cover to sound the condition of things there when,
from the effects of a fresh current of air upon his body, a most
awful and violently painful spasm seized the patient, followed by
some three or four " more of the same sort," in rapid succession,
producing complete rigidity of all the muscles, from the occiput to
the insertion of the tendo achillis, the body forming from those
two points a perfect arch. Synchronous with these violent spasms
there was most excruciating pain ; the corrugator supercillii, orbic-
ularis, and other muscles of the face were so drawn as to give to the
countenance a most agonizing expression the true Risus Sardoni-
cus. The recti abdominis muscles were prominent, and as hard as
aboard. There could be now no mistaking the disease: Tetanus,
of the opisthotonos variety.

Belieying true idiopathic tetanus to be of very rare occurrence
in this country, I enquired of his owners, if the boy had received
any injury of late. They thought not; but one of the servants
spoke up, and said he had " run a splinter in his hand." Mr. L.
then informed me, that "some fourteen days back he had a
splinter extracted from his hand; but that after that he had
heard but little complaint, and he really could not think that so
slight an injury could be productive of such a result." I examin-
ed the hand, and saw by a slight swelling and scar where the splin-
ter had penetrated. I stated to the owners of the boy, candidly,
my opinion of the case. That it wase a case of tetanus ; that it
proceeded, in my judgment, from the hand ; and that the disease
was a mortal one.

My prognosis was based upon the very great mortality of trau-
matic tetanus, under every variety, and all kinds of treatment.

Hippocrates affirms that tetanus supervening upon a wound is
mortal ; and the experience and observation of the modern fathers
do not set aside or gainsay this aphorism. Besides the length of
time, the increasing intensity of the paroxysm, I looked upon as
but the harbinger of death. I felt it, however, to be my duty to
grapple with the fell destroyer ; and armed with the weapons used
upon such occasions, I made fight as best I could. I applied a
long blister down the spine; gave him 50 drops of tr. opii., with
a half tea-spoonful of chloroform, to be repeated pro re nata. As-
safoetida, turpentine, camphor, formed a part of the treatment. I
administered to him, at the approach of each and every paroxysm,

732 Casey, on Traumatic Tetanus. [December,

chloroform by inhalation, with no sparing hand. Finding no
great rigidity of the sphincter ani, enemata of oil and turpentine
were administered.

The above means were put in practice, and after three hours
persistence, and rinding no modification of the symptoms, I had
the patient put into a bathing tub partly rilled with a strong infu-
sion of peach leaves, as hot as he could bear it. This seemed to
have some good effect, for while in the bath, the whole body be-
came entirely relaxed: all the muscles, which before were hard
and rigid, now became soft and relaxed. The shades of night were
thickening fast, and engagements requiring my attention in other
localities, I left my patient in the tub, and was soon on my "wind-
ing way."

I had made arrangements for a physician to see the boy, and
remain there for the night, and I had promised (nothing prevent-
ing") to be with him again early on the morrow. At sun-rise the
the next morning I was at the side of my doomed patient.

According to the programme, a physician from your city saw
the boy in two hours alter I left him, and remained with him till
3 o'clock next morning. There was no disagreement between us,
in the diagnosis, save on its etiology. He thought the wound in
the hand too trivial not cause enough there for such a terrible
effect. He was rather disposed to locate the fons et origo of the
malady in the prima? visa. There was nothing abnormal in that
region so far as I could detect, except the constipation, which, so
far as my experience and observation extends, obtains in all cases
of tetanus.

The same treatment was kept up ; but dashed with 20 grs. of
calomel, ol. ricini and croton oil, in accordance with his theory.

As I anticipated, Mr. L. informed me that so soon as the boy
was taken out of the bath the spasms returned in all their violence.
The patient remained in the bath for a half hour, and during that
interval there was not even the sign of a spasm ; and that such
was the extent of the relaxation that his mouth, which before he
could but imperfectly open, gave forth one of those uride, long,
characteristic gapes or yawns of the negro.

The history of the case through the past night, added to the
former "record^ made, in my mind, "confirmation strong as proof
of holy writ," that the patient was doomed beyond the power of
the " healing art."

1856.] Casey, on Traumatic Tetanus. 733

Having given the case the benefit of trial of all the remedial
means within my reach, I remarked to the owners of the boy, that
if they were so disposed, they could have the offending member "cut
off" that amputation was at one time resorted to in such cases ;
but that I could not promise them even a hope of success from the
knife. I neglected to mention that, acting upon my theory of the
disease, the first thing I did after seeing the case was to cut down
upon the wound, which I did by making two long incisions and
thoroughly cauterizing them.

Mr. L. replied, that the cost must not be taken into the account;
that the boy was a favorite servant had been faithful and honest,
and that he would pay twice the value of the boy to have him
saved

It is recorded in the authorities, that at one time Port wine was
extolled as a remedial agent, in tetanus, of great value. A favor-
ite horse was seized with tetanic spasms : the owner ordered the
wine without stint ; the horse recovered ; and in footing up the bill
the cost of the wine exceeded the intrinsic value of the horse.

Appreciating Mr. L.'s feelings of humanity, I dispatched a mes-
senger with a letter to you, giving you the full particulars of
the case, desiring you to come up with your amputating case, if
you thought there was even the remotest prospect of success from
the operation, but you were not at home.

I remained with this patient until 1 o'clock P. M., when in death
he fouud the only quietus to his sufferings.

From the time of my first seeing the case to its termination,
some twenty -two hours, four ounces of chloroform were used ; and
I cannot say that I ever saw the least benefit from it. I gave it
myself, when with the boy, and watched its effects closely, and if
the boy was at any time under its influence I could not see it.
The same may be said of all the other means, with one exception,
of which mention is made before. He would drop to sleep during
the lull of a paroxysm, but only to be awakened by its recur-
rence. But during sleep, there continued the tonic rigidity : hence
I could not infer that the temporary sleep was a quid pro quo
from the agents employed that the sleep suspended the paroxysm
but rather was the result of their suspension ; which last was from
the prostration from the disease. The least noise was jarring to
his extremely sensitive nerves; the prick of a pin; the act of
swallowing all, but served to bring on the spasms, which were

73-i Casey, on Traumatic Tetanus. [December,

indeed awful to look upon, but to the unfortunate sufferer agon-
izing agony.

Sir Gilbert Blane is said to have mentioned a case of tetanus,
where the patient is reported to have suffered no pain, but rather
described it as an agreeable sensation. If this be true, there must
have been a perversion of the sense of feeling.

This boy gave unmistakable evidence of the most intense suf-
fering. And the cramp colic, for which the boy was first treated,
was but a cramp of the diaphragm, the scrobiculus cordis being
the locality of greatest suffering in tetanus.

I omitted to note the fact, that foul play had been suspected ;
and my opinion had been asked as to the poisons "if there was
any known poison that would produce symptoms at all analogous
to those manifested in the case. I replied that strychnine would :
that it was exceedingly difficult to distinguish between tetanic
spasms and those produced from an over-dose of strychnine. I
remarked, however, that I could very easily, I thought, verify my
diagnosis of the case ; that by dissecting off the skin from the hand
over the wound, I expected to find the wound internally giving
more evidence, or marks, of the splinter than was observable on
the outer skin. I should expect to find some pus probably some
portion of the splinter, and the surrounded tissues softened, lacera-
ted, or otherwise altered from a normal appearance. And that if
I did not find the condition of things there to warrant the charge
of causation, by their permission, a general post-mortem would be
instituted. This was agreed to very readily, as the owners of the
boy were desirous of having their minds satisfied.

I dissected and reflected the skin, and beneath I found a quan-
tity of pus bin-rowing in the tissues; three portions of splinter, in
and immediately beneath the extensor tendon of the ring finger.
The tendon itself was partly disorganized, and throughout its
structure, so far as observable, presenting an abnormal appearance.
I did not push my investigation to examine the condition of the
nerve, but in all probability the corresponding nerve of the dorsal
collateral branch was implicated in the wound.

Here, then, in my judgment, was the focus of the disease, though
the tendinous origin of tetanus is doubted by some of the authori-
ties. The examination being very satisfactory to myself and the
owners of the boy, a further exploration was deemed unnecessary.

Now, what are we to expect from this ? Not that tetanus will

1856.] New Method for Removing Calculi. 735

be the result of all such wounds; for how often is it we see
wounds, even worse than the one described, going through the re-
gular stage of suppuration among tendons and nerves to a healthy
resolution, and no tetanus supervening. And again, we see causes
even more trivial, bring on tetanic spasms and death.

The reasonable deduction is, (based upon past experience,) that
there is a marked predisposition in the African, from some peculi-
arity of constitution, to traumatic tetanus aided by the exciting
causes which are sometimes necessary to its development.

I would also remark : about the time of the boy's attack, the
temperature of the atmosphere was exceedingly high, the thermo-
meter ranging from 98 to 102, for five or six consecutive days.

In taking a retrospect of this case, I would in the first place re-
mark; the great susceptibility of the negro to tetanus the import-
ance of inquiry into each and every case of tetanic spasms, as to
any injury having been received the fact that the injury is
slight, or the wound trivial, is no guarantee that the cause or origin
of the spasms is not located there. I would also call attention to
the very great insusceptibility to the impression of remedies, as
evidenced from the vast amount of chloroform used, and its per-
fect insignificance to combat with the formidable malady. Ho-
moeopathy! where are thy charms in such a conflict? When four
ounces of pure chloroform, potent as it is, is as so much water, to the
enemy, what say you, with your " thousandth part" of nothing?
When fifty drop doses of laudanum fail to lull, can "sleep to the
eyes or slumber to the eye-lids " be expected from Infinitesimal
Homoeopaths?

Remarks on the various operations for removing Calcidi from the
Bladder of the Female,, with a new Method. By &USTAV C. K
Weber, M. D,, of New York.

The methods of removing stone from the bladder of females are
many, there being hardly any point where the bladder has not been
entered in order to achieve this object. But if we consider all the
advantages and disadvantages of the different methods hitherto'
known, we find they are all, without exception, very frequently at-
tended with evil consequences, which are more to be dreaded than
the original complaint itself.

In order to justify this latter assertion, I will recapitulate all the
different operations practised for stone, on females, to the present

736 New Method for Removing Calculi. [December,

time, and compare their indications and contra-indications so as to
show that in reality they ought to be carefully and prudently
weighed before undertaken. If rashly performed, we bring upon
our patients a source of suffering by far greater than the one we
promised to relieve, or even endanger the lives that were given
into our hands for protection.

In connection with the methods which I find recorded in the
newest editions of our standard works, I shall bring before the
surgical public a new plan by which I removed a stone of an inch
and a quarter in length, and three quarters in width, weighing
about three ounces, from a lady of fifty -four years of age, and ef-
fected a radical cure without leaving any troublesome symptom
whatever.

The various operations of lithotomy may be classed under five
heads :

I. The high operation,

II. The gradual or instantaneous dilatation of the urethra.

III. The operation underneath the symphysis pubis entering
the bladder by dividing the urethra and the neck of the bladder.

IV. The operation underneath the symphisis pubis without
dividing the urethra.

V. The operation underneath the symphisis pubis with divi-
sion of the urethra and dilatation of the sphincter.

1. High Operation. The high operation (lithotomia hypogastri-
ca) has been known since Franco, in the year 1561, performed it
on a small child, where he could not extract the stone on account
of its great size. But still, with the exception of a few men who
practised Franco's operation, (Kousset,* Nicholas Pietre,f ) it found
but few advocates until the last century, when Douglas,:}: Middle-
ton, and Cheselden,|| in England, andMorand,T in France, class-
ed it among legitimate operations iu surgery.

The object of the operation is to enter the bladder by cutting
through the abdominal wall in the line of the linca alba, just above
the symphysis pubis, through the space formed by the reflexed
peritoneum, the symphysis, and the bladder.

In order to accomplish the latter many methods have been de-
scribed. Franco performed his operation by introducing into the
anus the index and middle finger of the left hand, and with them

* Rossetus de part. C.-esarea cap. 7. Dionis ehirnrgia. Cap. vom. Steinsehnittft
GTarengeot pag. 358. Tom. I.

f N. Pietre a Mercier Thcs. anat. ad extrahendum calcal. dissecanda ad pubem
vesica.

X John Douglas, Lithotomia Donglassiana, with a eonrse of operations. London,
1714.

Middleton. A short essay on the operation of lithotomy, as is perfonned by
the new method above the pubis; to which is added a letter relating to the same
subject, from Macgill and Dr. Douglass. London: Mil.

|| W. Cheselden. A treatise on the high operation of the stone. London: 1823-8.

if S. Morand. Traite de la faille au haut appareil. Paris : 1141.

1856.] New Method for Removing Calculi. 737

pushing the stone upwards just above the pubis, and then, with a
small scalpel, cutting down through all the intervening tissues un-
til the stone was reached, by continuing the pressure from below
upwards, the stone escaped.

This way of operating resembles the one of Celsus* for the lat-
eral section, and was soon superseded, like the hitter, by the more
prudent and careful method of llousset, in the year of 1580.

This eminent surgeon divided the operation into four different
steps :

First. Dilating the bladder by gradual injections of warm wa-
ter, and compressing the urethra.

Second. Cutting through the abdominal wall, just above the
symphysis, reaching the bladder, where it is uncovered by the pe-
ritoneum, carefully avoiding the same.

Third. Making a small opening in the bladder, just behind the
symphysis pubis, with a pointed bistoury, and therein inserting a
probe-pointed concave bistoury, and enlarging the opening up-
wards to a sufficient size.

Fourth. Extracting the stone by means of the finger or a suit-
able stone forceps.

In nearly the same manner, with but slight modifications of the
instruments hitherto used, Cheselden, Middleton, and Douglas op-
erated and followed, in fact, Eousset, who, undoubtedly, can be
considered the first who undertook the high operation methodically.

Morand, of France, after cutting through the linea alba, inserted
the index finger of the left hand into the upper extremity of the
wound, and by that means pressed the peritoneum upwards, then
split the bladder downwards behind the symphysis pubis. After
this act he introduced his index finger into the bladder, and held
it up until the stone was extracted either by the fingers of the
right hand or by a suitable instrument.

But, so much was the attention of surgeons then directed to the
invention of new instruments, that this, the best modus operandi,
was again modified by Frere Come.f Eousset's method seemed
not to guarantee to him the entire safetjr of the peritoneum, and
he therefore substituted his method, which deviated from the
former operations by introducing into the bladder, through a second
incision made in the perineum, and the membranous portions of
the urethra, his sonde a dard. This sound contained a triangular
stilet, which was grooved on its anterior surface. After the blad-
der had been laid bare by the section above the pubis, this stilet
was pushed through the walls of the bladder, then drawn upwards
and using the grooved surface as a director, the bladder was laid
open by extending the incision downwards. The irrationality of
augmenting the dangers of the operation by a second incision in
the perineum, did not find many advocates.

* Methodns cum parto apparatu. Cel. Libr. VII. Cap. 26.
\ Frere Come. Nouvelle methode extraire la pierre de la vessie pardessus 1 pu-
bis. Paris: 1779.

738 New Method for Removing Calculi. [December.

But his sound was, and is still, used in France, with many slight
modifications, by introducing it through the itrethra.

At the present time, in America, England, and Germany, where
the armamentarium chirurgicum has been reduced to a rational
size, Rousset's operation is generally performed with this modifi-
cation, that, before opening the bladder, tk;s viscus is hooked up
and held by sharp hooks, so that no regurgitation, and consequent-'
ly, infiltration of the urine, can take place. Professor Pitha, of
Prague, in his article, " Diseases of the Genital Organs," in the
Handbuch d'Spez. Path u. Ther., edited by Prof. Virchow, gives
his opinion as to the superiority of the latter method. This con-
curs with the experience of my estimable friend, Prof. Parker, of
this city, which he has presented in his valuable paper on the
high operation for stone in the female.*

I have performed, in the same manner, very recently, the high
operation upon a small boy of four years of age with the best suc-
cess ; the little patient passing his urine through the urethra as
early as the fourth day. On the twelfth day he ran about in the
yard, the wound being nearly closed.

I found it an important point in the operation to separate the
peritoneum with the finger, gently, sufficiently high to expose the
urachus; then pushing the same upwards to make the incision into
the bladder, just underneath the urachus, downwards to a necessa-
ry size. After the stone is extracted, the peritoneum falls forward
over the wound in the bladder, and through a slight adhesive in-
flammation closes it in a few days. If the incision is made lower
down behind the symphysis pubis, down to near the neck of the
bladder, then the peritoneum cannot reach it, and I should judge
that then it would take more time to close the opening of the blad-
der. I also consider the introduction of sponge or lint through the
external wound into the bladder for the absorption of urine or
pus, as injurious, also the leaving of a catheter in the urethra,
which gives rise to pain and uneasiness. The external wound
ought to be kept constantly clean by means of a small piece of
sponge moistened with fresh water. Every other bandage is inju-
rious. Infiltration and consequent formation of pus in the cellu-
lar tissue in the space uncovered by the peritoneum, are not much
to be feared, because if left unobstructed by tents or bandages, the
least quantity formed will readily flow out of the external wound.
To the great variety of methods of treating the wound after this
operation, I believe we may ascribe the bad success attending the
operation in its infancy. f

* New York Journal of Medicine, March, 1855, p. 262.

| If -we run over the statistics of the lateral, as well as the high operation, with-
out the least prejudice against, one or the other, we find the true per centage of
mortality about equal In the lateral section, I think, the good result is always
noted down, but not the bad consequences, which are liable, even with perfect suc-
cess of the operation itself, to follow after, as, for instance, " impoteney." I consider
this an important point, in the discussion as to the superiority of either method.

1856.] New Method for Removing Calculi. 739

I look upon the high operation, when properly performed and
managed, as sine dubio, the best way of removing stone from the
bladder of the male, and, also, under certain circumstances, of the
female, but only such as exclude the possibility of extracting the
stone by the method which is hereafter described.

We cannot, however, deny the danger of the operation, the pos-
sible peritonitis, and the fatal results which have followed, when
it has been performed by the greatest surgeons. When we consi-
der the statistics, which exhibit a mortality of one in six, or one in
seven, I am sure the great mass of surgeons will rather risk an in-
continence of urine in the operation underneath the symphysis
pubis, than risk the life of their patients by the high operation. I
should prefer the high operation only in exceptional cases (as
where the stone is uncommonly large and hard, or the urethra
and vagina so much diseased that a division with the knife would
be fatal) ; and I, therefore, cannot concur in the opinion of Prof.
Parker, who considers the epicystotomy the safest method of re-
moving a stone from the female bladder.

We ought to have an operation which does not endanger the
life of our patient, and still achieve its object. We find that there
are operations practised in a different manner, that can avoid the
former and lead to the latter. We will briefly recapitulate them,
and see in what regard they are preferable to the operation just
described, and what are their disadvantages and contra-indications.
Among the operations that were practised principally for the
removal of stone, was the dilatation of the urethra, by means of
compressed sponge, roots, specula, or dilators expressly invented
for the purpose.* Heister's observation, that pretty large-sized
stones would sometimes pass away with the urine, with pains sim-
ilar to those of labor ; and Middleton's case, in which a woman
forced, during a hard attack of tussis convulsiva, a stone weighing
four ounces, through her urethra, led to the experiments with gra-
dual, as well as instantaneous dilatations of the urethra, and con-
sequent extractions of the stone with a suitable pair of forceps.
Although there are cases on record from Douglas, Broomfield, and
A. Cooper, men who merit our highest esteem, we still must con-
sider this operation as one only practical in very exceptional cases.
I have examined women of young and robust constitutions,
whose urethra I could enter with the greatest ease, with the index
of my right hand, up to the sphincter, but I think that the urethra
of a female suffering a year or more with calculus in the bladder,
is a " noli me tangere" that will not allow even a slight dilatation,
much less a dilatation that will allow a stout pair of forceps to pass
holding in its grip, its prey, in the form of a calculus of an inch or
two in diameter, without laceration of the mucous and muscular
coats, and consequent incontinence of urine. Besides this lacera-

* Heister, Chirurgic, 1728.
N. S. VOL. XII. NO. XII. 47

740 New Method for Removing Calculi. [December,

tion of the parts, there is the extreme pain that ought to be con-
sidered, and which is so excessive, sometimes, that it cannot be
endured without endangering the life of the patient. Fortunately
for the poor, suffering females, this proceeding of dilatation a* a
method, has now been abandoned by the better surgeons of the
day, and the knife takes the place of the compressed sponge to re-
lieve them from this troublesome companion.

The operations with the knife have undergone many changes
since the time when Celsus performed, after his method, by which
he removed stone from both sexes. Lisfranc* imitated Celsus in
the invention of his method, the so-called " Vestibular Section."
He entered the bladder by making a semilunar incision, with its
convexity towards the pubis, commencing to the right of the ure-
thral orifice in the same plane as the urethra lies, about one line
from the pubic arch, and carrying the knife from the right to the
left side, ends the incision in the same plane wherein the section
was commenced. Then the cellular tissue is carefully divided by
the handle of the scalpel or the finger, until the anterior wall of
the bladder is reached, which is subsequently opened by a second
incision to the necessary size for the extraction of the calculus.

Every one conversant with the surgical anatomy of the parts,,
knows that even the most extensive opening here is not sufficiently
large for the removal of a medium-sized stone without laceration,
and that it is very difficult to make a large incision without injur-
ing the internal pubic artery. Prom these two important facts,
the vestibular section is objectionable, and not to be selected for
the purpose of removing calculi from the bladder of females.

There is another method by which, through vertical section, the
spincter, the neck of the bladder, and vaginal wall are divided. It
is the method of Kern,f but Marianus operated by making a late-
ral section between the urethra and the ischium, and entering the
bladder at the sphincter, which he divided with the neck of the
bladder after the method of operation in the lateral section on the
male, but with this operation we risk, just as in the vaginal section,
where the posterior wall of the bladder is incised, the possible con-
sequence of a vesico- vaginal fistula. The history of the operation
shows, that in the plurality of cases, this most dreadful of all com-
plaints followed the undertaking. It is possible, that with the
application of Dr. Sims' clamp suture, which has justly gained so
"much celebrity in America, that thes,e consequences might be ob-
viated, but still we possess no facts to guide us, and till we do,
Kern's operation, as well as the vaginal section, ought not to be
performed under any circumstances whatever. A vesico -vaginal
fistula is more to be dreaded than the suffering with stone.

Me ire sur une nouvelle methode de praticpier ['operation de la taille chez la

ferrmio, Paris, 1828.

\ Kern. Die Sterabeeclrwerden der Hnrnblase, ihro verwandten Uebel nud der
Steinsclmit.t beideu Geschleclitern. Wien, 1828.

185 6i] New Method for Removing Calculi. 741

We come now to the consideration of the methods by which the
whole urethra and the neck of the bladder were divided, and we
find here again a number of modifications which were used. First,
we have the lateral section by which the urethra and neck of the
bladder are divided, on a sound downwards and obliquely in the
space formed by the vagina, the descending ramus of the pubis,
and the ascending ramus of the ischium. In order to make thia
incision either the sound of Pare, of Eudtorfer, and Potts' probe-
pointed bistoury, Langenbeck's lithotome, can be brought into ac-
tion, as also the gorgerets of the English, or Frerecosme's lithotome-
cache, Second, we have the horizontal section, by which the
urethra and neck of the bladder is divided horizontally ; third, the
superior vertical section, and lastly, the inferior vertical section. In
all these operations, the sphincter and neck of the bladder are di-
vided, which leave, as the result of the cases in which they were
used shows, very frequently, an incontinence of urine. We can
easily explain why this system, in most cases, must necessarily
follow : the urine that flows out of the divided neck of the bladder
cannot escape readily ; it has to pass through parts in the lateral,
as well as in the horizontal, superior or inferior vertical section,
that are filled with nothing but cellular tissue, the consequence
often is infiltration of urine, inflammation, formation of pus near
the wounds in the bladder, which destroys the possibility of re-
union by first intention. We all know, then, how difficult it is to
bring about a union of a wound of the bladder, if not by first in-
tention. For these reasons the operation in which the urethra,
sphincter, and the neck are incised, are not safe proceedings for
the benefit of females that seek relief from the suffering with stone.

We have now spoken of all the different operations that were
entitled to be classed among the legitimate methods of proceeding,
for the removal of stone in the bladder. We have still remaining
the few exceptional cases. The study of these led me to resort to
quite a novel method as this review of the various operations will
prove, and which justifies the title of this article, " A new method
of Lithotomy.1''

Pare has left a description of a proceeding, although not very
distinctly expressed, by which he only divided the urethra, dilated
the wound, with his dilators, pressed the stone by means of two
fingers introduced into the vagina, into the neck of the bladder,
and extracted it with hooks or the forceps.

Lecat introduced a Georgeret a sonde cannelee into the urethra,
divided it with a urethrotome, without reaching the sphincter. He
then introduced the gorgeret through the sphincter, and dilated it
with his instrument, and with one of his fingers.

In the like manner LeBlanc, operated with his gorgeret, and di-
lators, dividing the urethra towards the left and the pubic arch.

Rust split the urethra after the manner of the lateral section, and
then dilated the neck of the bladder with his finger.

742 New Method for Removing Calculi. [December,

Dionis, Tolet, Greenfield, Ledran, Sinz, Lorenz Colot, and Fer-
gusson, have operated on the same plan, by partial or total section
of the urethra, and dilatation of the neck of the bladder.

Now, this plan of Pare, Lecat, etc., etc., is indeed the best, and
most simple method that we have met with, and it is surprising
that it is so seldom employed. There is, however, yet a modifica-
tion to be substituted that seems to me most essential for the suc-
cess of the operation. By this plan, through the division of the
urethra, this part of the urinary organs comes out of the care of
the operator, because then he can reach the bladder, without forc-
ing his way through, so that no laceration, and consequent para-
lysis of the muscular fibres can follow. The only error these last
mentioned operators fell into was, that they all divided the urethra
either upwards or horizontally, or laterally, which gave rise to the
inconvenience that we have already mentioned, that is, the urine
could not flow off easily, and would give rise to the infiltration in
the cellular tissue that lay laterally and superiorly around the
urethra. The reason of their proceeding thus was because they
thought in case the divided urethra did not unite, they must pre-
serve some kind of a canal for the urine to flow in. This caution
was, according to my experience, not necessary. In my case,
where I divided the urethra in the median line, downwards, I
found that after the operation, the patient, after the bladder was
well filled by an injection with water, could throw a stream of
water in a semicircle about half a yard. This showed to me, that
the reunion of the urethra is not of so much importance for the eja-
culation of urine as is generally believed.

The only question that merits consideration now is, will the
sphincter and neck of the bladder, after the division of the urethra
bear the instantaneous dilatation, to a sufficient degree for the ex-
traction of a good sized calculus. My opinion is, that they will
not, and that when we undertake to force the sphincter open by
instruments, or by the finger, beyond a certain limited extent, thai
we risk the same possibility of an incontinence of urine, as when
we undertake to operate by dilatation alone. I certainly believe
that the sphincter is dilatable to the size of three-quarters of an
inch in diameter, because I find that this is, with slight variation,
the ordinary size to which the sphincter opens for the evacuation
of a full bladder. To prove this, I have distended, in my case,
the bladder by an injection of warm water, after I had divided the
urethra, as I before mentioned, and then directed my patient to
empty it with as much force as possible. While she was doing
this, I could introduce, with the greatest case the index finger of
my right hand up to the second joint into the bladder.

To dilate the sphincter bej-ond this extent I consider, as I have
said, to be very hazardous indeed, and we, therefore, should select
a modus operandi, by which it will not be necessary for the extrac-
tion of stone to open the sphincter beyond the natural capability
for dilatation.

1856.] New Method for Removing Calculi. 743

We find such, an auxiliary remedy in the great armamentarium
litlwntripticum, if we select from it an instrument that can break
the calculus into three or four pieces. If the calculus be of a brit-
tle composition, as in the generality of cases, a small pair of for-
ceps, whose blades are narrow but stout, will effect this object. If
the stone is hard, which is very seldom the case, the straight drill
of Civiale, or some other instrument will suffice, being guided by
one finger, to take hold of the stone, and break it immediately.
The fragments will be removed through repeated injections of wa-
ter, or with a suitable pair of forceps without stretching the sphinc-
ter to such an extent as to cause laceration, and consecutive
paralysis.

With this proceeding we combine lithotomy and lithotripsy to
a, harmonious union ; we perform lithotomy in order to be able to
exercise lithotripsy, and remove the consequences immediately
after. Without the previous urethrotomy, lithotripsy, would be
tedious, and could not be (as much as Heurteloup says, about the
performance of lithotripsy in one seance, I cannot believe it,) ful-
filled in the space of from ten to fifteen minutes.

These are the considerations which I acted upon in the execu-
tion of my operation with so much success, and which I now
bring before the surgical public, so that imitation might prove what
I believe it to be, that this operation is the solution of the ques-
tion : " Which is the best mode of extracting calculus from the bladder
of Females V

Case.' On Monday, the 6th of March, I was called upon to
visit Mrs. Eehr, a lady of 54 years of age, residing in 46th Street,
between 8th avenue and Broadway, who was suffering, as I was
told, upwards of two years with a disease of the womb and blad-
der. Upon examination, I found no pathological condition what-
ever, except the existence of stone, and consecutive great irritabil-
ity of the bladder, with slight purulent discharges therefrom.
Proposing an operation, my patient was willing to submit to every-
thing in order to get rid of her sufferings. For that purpose I
undertook, March 13th, the operation which was commenced by
emptying the bladder and the rectum. The patient was laid
crossways on the bed in a position so as to elevate the pelvis, and
expose the parts sufficiently for the manipulations. My assistant,
Mr. S. J. Holley, then, with his right hand held the labia majora
and minora well apart, and with the left pressed with a gorgeret
the posterior wall of the vagina downwards. I then introduced a
curved sharp-pointed bistoury (Wutzer's for the operation of fistu-
la ani) protected by a conductor into the urethra, withdrew the
conductor and plunged the point of the knife through its posterior
wall, about one line from the sphincter, and then divided by draw-
ing it downwards and outwards, the urethra in the median line.
After this step having been taken, I introduced into the sphincter
the point of a syringe, and injected the bladder with tepid water.

744 Excessive Smoking of Tobacco. [December,

Then, while the woman evacuated this injection, I introduced my
finger, and on my finger a pair of narrow polypi forceps, grasped
the stone, and with some pressure broke it into five pieces. After
this another injection of water was made, and the woman directed
to empty her bladder forcibly ; on doing this, three pieces came
away. The other two I took away with the forceps, using my
finger as a guide to bring, with care, the fragment between its
branches.

After I ascertained that every particle of stone was extracted, I
directed the woman to lay quietly on her back, and have the parts
frequently well sponged with cold water. Hardly any reaction
took place. The patient could retain her urine always, and has
never had any trouble with her urinary organs ever since ; the
soreness of the parts disappeared in the course of four or five days.

The two anterior thirds of the urethra did not unite, but still
there exists no difficulty in passing the urine with a good stream.

This is in short the history of my operation, the success of which
was exceedingly satisfactory to myself, as well as to my patient.

[_N. Y. Journal of Medicine.

On the III Effects arising from the Excessive Smoking* of Tobacco.
Memoir of Dr. Ginseppe Levi, read before the Society Medico-
Fisica of Florence, 1855. (Translated for Charleston Medical
Journal and Review, by F. Peyre Porcher, M. D.)

It is with great satisfaction, gentlemen, after having many years
reflected upon it, that I can take up, in the bosom of this academy,
this grave and important subject of public and private hygiene.
And surely if the meditating upon these facts which avail to render
less difficult the practice of our art is fruitful in utility if it is in-
teresting to trace the many bonds which from the different sources
from whence our science is constituted, every day go on extending,
I think the gravity and the dignity ot the work to which we are
called does not show itself in any way more strikingly and distinct-
ly than in the conscientious freedom with which we lift up our
voices to invoke laws by which human safety may be better direct-
ed ; or opposing the weight of our authority against certain uses and
habits, the practice of which tends so frequently to impair and
weaken the strength of the body.

I do not think, then, that I can better entertain you to-day, than
by referring to the evils which arise from the excessive smoking of
tobacco, which in our days we see practiced by every age, sex, rank
and order of citizen.

In the civil life of nations every thing changes with the lapse of

If the ill effects resulting from the smoking of tobacco to excess are shown to be so
great, with how much more force' must the observation apply to the American who
uses it in so many ways, and with so little moderation. F, P. V.

1856.] Excessive Smoking of Tobacco. 745

time. New laws succeed to old ; inveterate customs disappear by
degrees, giving place to others which follow ; obsolete ones are re-
stored, and vices and habits which at first seemed the heritage of
but few, acquire dominion over whole communities. The leaf of
the tobacco, introduced in Europe, as it is known, in the second half
of the sixteenth century, was at the beginning received with prodi-
gality of praise by some, and by others was covered with blame.
Amid this approval and condemnation between the pontifical bull
which interdicted, and the princely edicts which sought to limit its
sale to the pharmacien, the use of the weed extended itself beyond
bounds. Many governments appropriating to themselves its exclu-
sive preparation and sale, it became the source of immense wealth.
Now, in France, according to Michel Levy, sixteen thousand mil-
lions of killogrammes are consumed, two-thirds of the best of which
is smoked. Whoever will take pleasure in examining the statistics
of other countries, and of our own, will see that proportionally to
the different populations the example of this is closely imitated.

It could not be otherwise, since from corners the most remote, to
cities the most populous from the cabin of the poor, to the mansion
of the wealthy from the humble workshop of the artizan, to jhe
bureau of the statesman wherever you encounter any one, weak
or strong, during any hour of the day, he almost incessantly emits
smoke from his mouth. And do you not feel yourselves moved
with indignation at seeing in the public streets children, who have
scarcely completed their second lustrum, who seem to take
pleasure in smoking, as if it was something reflecting honor upon
them, or gave cause to hope well for their youth, and for their man-
hood?

How shall we describe the disgust which arises at entering, in
our days, places of meeting, halls for public spectacles, among a
pleasant company, but where you always find yourself in the midst
of a thick cloud of smoke which disturbs, saddens, and annoys you,
without even the liberty of complaining, unless you wish to incur
the blame for superfluous delicacy, or for being too rigid a censor of
the times. What thing more disagreeable than the conduct of cer-
tain persons who nevertheless come to ask your advice respecting
some grave infirmity of the stomach, or that tubercular phthisis
threatens to cut off their life, or, indeed, any as yet slight affection
upon which apoplexy may snpervene, nevertheless they do not for a
moment abstain from the wretched habit of smoking, neither fear-
ing that this conducts them to graver danger, or that reproach for
what is so imminent will fall upon them. That this habit does not
create more either of surprise or disgust, is singular, when we re-
flect upon the physical and chemical qualities of the Nicotiana,
when we call to mind the effects produced by experiments with it
upon the animal economy; when, in fine, in the works of classic
writers we find descriptions of diseases not unfrequently produced
by smoking this plant. This, indeed, for which so many feel so

746 Excessive Smoking of Tobacco. [December,

great, so irresistible a longing, is really one of that family of sola-
nacese at the mere mention of the name of which many are alarm-
ed : it possesses an acrid, pungent, disagreeable taste strong, disa-
greeable odor, produces in him that ingests it, either in one form or
another, first a sense of anguish at the stomach, heart-burn, nausea,
and vomiting, then atrocious intestinal pain, accompanied with
diarrhoea, a coldness of the extremities, viscid, sweaty, a diminution
of the cardiac pulsations, a considerable bluntness of nervous sensa-
tion, and, in fine, according to Orfila, narcotic poisoning. Chemis-
try discovers in it those principles to which, in great measure, its
poisonous action is due. Nicontina and nicotianina are substances
the murderous effects of which are only surpassed by prussic acid.
The empyreumatic oil of this, Albino and Fontana studied among
the first, and of which the experiments of Brody indicate such ac-
tivity, that a few drops are sufficient to destroy an animal. And
these principles, we repeat, actively hurtful, the modern chemist
knows to be unfolded during maceration, and in an equally marked
degree during combustion of the leaves, the physiologist attesting
its injurious influence upon animals and man, not only when it acts
directly upon the nervous system, but also when introduced into the
organism alone, or combined with other principles through the di-
gestive canal or the respiratory organs.* These observations serve
to explain certain facts and furnish analogical arguments sustaining
the opinions expressed by us above : we mean the effects produced
in those who remain entire days occupied in the many operations
necessary to prepare the leaves for the various uses to which it is
destined. Bernardo Ramazzini, with that profound genius and vast
learning with which he was gifted, described in black colors the
affections of the brain, lungs, and stomach, from which the manipu-
lators of the weed suffered, and which the dust of the plant smoked
produced.f The opinions of the Hippocrates of Modena receive
confirmation in the facts since observed by Fourcrois, Percy, Patis-
sier, and Merat J The last mentioned, speaking of the workmen
employed in the manipulations, describes them as thin, anaemic, yel-
low, asthmatic, subject to colic, to narcotism, to diseases more or
less acute of the thorax; and concludes by saying, that a substance
so useless as is tobacco, causes innumerable evils, and even death,
in those employed in preparing it for others, the most insignificant
of pleasures. Parent-Duchatelet, and Darcette, first followed by
Simon, deny what many other physicians asserted from Ramizzini
down to Merat: for this reason so important a controversy of pub-
lic hygiene, at the desire of the Academy of Paris was taken up, in
1843, as a special study by Dr. Melier. These, after a long and
conscientious investigation, came to the persuasion that during
large operations with tobocco, the principal injury befell those who,

* Trousseau et PiJeaux Traite de Therap.

\ De M orbifi Artificrum. Londini, 1718.

\ Michel Levy. Op. Cit. p. 763. Diction, des Sci. Medicales. Art. Tabac.

1856.] Excessive Smoking of Tobacco. 747

in scalding and fermenting the leaves, were exposed to the vapors,
in which.is contained the nicotina and other poisonous substances.

The slow action of the tobacco upon the operatives, according to
Sig. Malier, is not less active because their symptoms are not ap-
parent; it produces a profound change, consisting in a particular
alteration of the color of the skin ; it is not, he continues, a simple
discoloration, or an ordinary paleness, it is a greyish aspect, with
something of a heavy, tarnished look, a mixed gradation of color
between that in chlorosis and in certain cachexies.*

And if we admit that perhaps the ancients sometimes painted in
too black colors the effects of tobacco upon the manipulators of it,
some modern writers err just as far from the truth in undrtaking
absolutely to deny them, without considering that the observed les-
ser injury caused by the leaves of the tobacco is due, not to the
innocuousness of the powder, or of the vapour, but to the material
change in the method of handling it ; in reducing it in a more sim-
ple way, and thus improving the hygienic condition of the opera-
tives.! But tell me, in courtesy, if many of the recorded effects
of injury which occur in the workshops are not due also to the
smoking it so many hours of the day ? Did I not, a little while
since, call your attention to the fact that it is by means of the com-
bustion of tobacco that the acrid and poisonous principles are evolv-
ed, particularly the nicotina, which, according to the calculations
of certain chemists, includes from four to twelve parts in a thousand
by weight. The mouth of the smoker, exposed as it is to the con-
tinued action of that which in itself contains substances eminently
stimulating, must of necessity have its mucous surface which invests
it irritated, which, with all the peculiarities which belongs to it,
extends itself along the schneiderian membrane, even to the con-
junctivae of the eyes ; from thence the easy separation, according
to Laycock, of the epithelium with which the membranes are cloth-
ed, the swelling of the gums, the black coloring of the teeth, the
production of aphthous eruptions, the excoriation of the lips, the
inconvenient i tchinsr of the nose, the abundant secretion of tears,
the over-sensibility to light, especially during the morning, and cer-
tain peculiar spasms of the orbicular muscles of the lids, accompa-
nied by heavy pains in the region of the frontal sinus. J

Besides the necessary effect upon the head, of the marked irri-
tating action, is the superabundant secretion of saliva, and of the
humours salutary in their nature, destined, when in due proportion,
to maintain the first acts in the digestive process. And these abund-
ant secretions not unusually at the cessation of the stimulus becomes
altered, with remarkable dryness of the fauces, of the tongue, and of
the oesophagus, which obliges the smoker to seek new means of
stimulus, in alcoholic drinks, which increases the primitively injuri-

*Annal d'Hyg. torn, xxxiv. p. 241.

f Tardieu Dictionaire d'Hygiene publique. Tomeiii. Art, Tobac. Paris. 1854.

\ Annales d'Hygiene publique xxxviii., 339. Paris. 1847.

748 Excessive Smoking of Tobacco. [December,

ous effects of tobacco. That ptyalism continued for a long time
should be an efficient cause of injury to the animal organism, no
one will deny, when they reflect that by this means are abstracted
from the blood those principles which in normal quantity are neces-
sary to the integrity of organs and functions, and that if the ordina-
ry secretion of any gland is continually increased, the humour
secreted will be altered in its elemental constituents, and conse-
quently become less adapted to those offices naturally reserved to
them. Every time, said Boerhaave, speaking of saliva, any one
makes a useless waste of this secretion, he is deprived of a great
inciter of the appetite and a great aid to digestion. The ehyle, to
the preparation of which this fluid does not concur, is of bad quali-
ty, and the blood remains more or less altered. To this authority
many others can be added, but let that of Cullen, Tissot and Ber-
nard suffice, who, always availing themselves of the advances made
in science in different epochs, confirm the ideas of the illustrious
professor of the University of Leyden. In the stomach, besides, of
smokers, during the deglutition of the alimentary mass, or of the
drinks, as well as at other moments, the saliva descends altered in
quality, or containing those noxious principles so often mentioned
by us: these are those which by their nature better arrests the fer-
mentative process, thus, according to the opinion of^nodern chem-
ists and physiologists, should by analogy remain available to arrest
or weaken the action of the digestive function.

And this weakening of chymification, will it not exercise a mor-
bid influence, even upon that fluid to which in great measure organic
reparation is due ? we mean upon the chyle. In accomplishing
what of necessity the different acts of the digestive process do bad-
ly, the forces of the stomach and of the intestines become slowly
destroyed, the appetite fails, anorexia, nausea, vomiting, heart-burn,
etc., arise, all phenomena, according to the best instructed, easily
observed among those smoking tobacco to excess.

These points being dwelt upon, let us next consider the injurious
effects upon other parts of the economy, and particularly the appa-
ratus of respiration. First among these is the irritating influence
of the smoke upon the entire mucous membrane, which invests the
respiratory surfaces from the larynx to the ultimate ramifications of
the bronchial tubes. But the irritating influence should now show
itself in a more violent and more injurious way, for the reason that
the respiratory function is among the different ones which consti-
tute life ; that which with less impunity submits to variations from
the normal standard ; and consequently slight disturbances give rise
to phenomena of great gravity. From thence the ready manifesta-
tion in this mucous membrane of hyperemia, of inflammation and
its attendant consequences, and finally of ulcerations ; observe the
fetor of the breath, the appearance of cough, accompanied or not,
by different secretions: observe the great tendency to haemoptysis,
to a weakening of the pulmonary circulation ; see, in fine, that

1856.] Excessive Smoking of Tobacco. 749

uniting of various causes to which conspire, according to recent
pathologists, and especially Lebert,* are due the development of
tubercle. And what shall I say to the injury of haematosis, that
inflicted on the blood necessarily perceived, when, instead of the
contact between the long cells and atmospheric air in its primitive
purity, it is in its place impregnated with nicotina, with empyreu-
matic oil, and with other poisonous matters? To the absorption of
this, besides quite an extensive superficies of the mouth and bron-
chia, is offered which two facts alone are in themselves sufficinnt
to account for that species of dyscrasia of the blood which we have
said had been noticed by Melier that slight tolerance of blood-
letting that absence of crasis in the vital fluid which in those
exposed continually to tobacco, according to the observation of
Harleaux,f are found to occur. The nature of the blood being
altered by reason of improper chylification, by an abnormal haema-
tosis, or by the introduction into it of improper substances, the
assimilative acts will be greatly disturbed; the nervous system will
find itself injuriously affected by it ; that natural energy will dimin-
ish which enabled it to resist certain impressions ; vertigo and
mental hallucinations will occur ; the moral character will undergo
considerable variations; tremor of the limbs will manifest itself: in
one word, all of those signs which show a more or less evident nar-
cotism, and which we deem useless to record.

If to these proofs, sustained by our opinion, we add those collect-
ed from the authority of the best writers, we find Etmullero assert-
ing that want of appetite and weakness of the stomach are found
among smokers and drinkers; J we find Richard Morton stating that
the smoking of tobacco tends to render the lungs flaccid, and to
bring on a true marasmus ; Bonnet refers to the many great lesions
found in post-mortem examinations of those who used tobacco to
a very great extent ;|| Tulpio saw in its use frequent cause of apo-
plexy ; read, if you please, among the Letters of Tissoflf addressed
to the celebrated Haller, that in which, among many other argu-
ments, the Physician of Lausanne uses even the words of that which
occupies us now;** you will accept the names of those we have
cited already those of Swieten, and of Verloffio, and conclude
by saying, that the excessive smoking of tobacco injures in every
instance, and each class of persons ; and this truth is not weakened
by the example of him who tolerates it, without finding it immedi-
ately followed by injury, for habit accustoms us to poisons the most
dangerous, which do not destroy the constitution at a blow, but
nevertheless do not fail in the end, to produce that result.

And even to these, if you wish to have other authorities added,
we can easily refer you to the works of Ramazzini, Morgagni, Hal-

* Traite des Maladies scrofuleuses et tuberc. Paris. 1849.

+ Tardieu op. cit. vol. cit. 1 De Togatorum valetudine tuenda, c. 4.

V. Morton, cited by Ramazzini. || Sepulch. t. 2.

*j[ Tulpio. cit. by Ramazzini. ** Tissot. Works of Tausanne, 1784.

7o0 Remote Effects of Anaesthesia. [December,

lev, Borseiri, Frank, and a thousand others, which I omit for brevity,
merely contenting myself to record the opinion of Laycock. By
his own observations, and that of others, he was led to affirm that
inflammation and ulceration of the larynx in men who had made
too great use of tobacco smoked. Leroy d'Etiolles writes, that
owing to the smoking of tobacco, cancer of the lip presents itself in
twenty-seven times out of a hundred cases among men. and one and
a half in a hundred among women. Finally, Becquerel sustains us
in signalizing, without hesitation, the use of tobacco as a custom
useless and bad. and of which Hygeine ought, if possible, to seek
some means to eradicate among those who contract it.

We, then, called to the exercise of an art which begun as a pro-
fession ends often as a virtue,* should do what we can by word and
act to weaken the dominion of this habit; in which, however, it
does not seem to me just to find in it as a certain celebrated mod-
ern writer f wishes, a remedy against ennui, which he calls the
disease of politeness; because if this, according to the great Romag-
nosi, is a cultivated and pleasing intercourse, it should not certainly
give rise to one of the most painful states of the mind. And should
this state unfortunately occur, youth should not seek for compensa-
tion in those habits which weaken the energy of the body, and
renders still less vigorous the spirit ; but they should seek for relief
in the affections which purify the heart, in the hopes which comfort
it, in those grave and severe studies by which the mind is elevated,
and neither becomes intoxicated by prosperity, nor unduly cast
down when fortune does not dispense her smiles. [Charleston Med.
Journal and Review.

The Remote Effects of Anaesthesia on the System. By Frederick D.
Lente, M. D., Surgeon to the West Point Foundry, New York.

In the September number of this journal is an article on the
"Permanent Effects of Anaesthetics," by Clark, of Newark, in
which he mentions three cases occurring in his own practice, where
he considers that the anaesthetic, without producing any untoward
effects at the time of administration, sets up a train of symptoms
subsequently, such as are usually denominated nervous, which were
not controlled, in two instances, under the lapse of a year or more.
Besides these cases, the writer mentions several others, without go-
ing into details, which have occurred in the practice of other phy-
sicians in his vicinity, in which very serious effects followed the use
of anaesthetics, and were thought to have been produced by their
agency, one by the late Dr. Bliss, of New York, of idiotcy and am-
aurosis following the use of anaesthesia during labor. Whether the
unfortunate scquelai of anaesthesia, in all these cases, bear the rela-
tion of post hoc procter hoc must be exceedingly difficult to determine,

* Lamartiue. Raphael. Cap. 89- \ M. Levy.

1856.] Remote Effects of Anccsthesia. 751

even by those who watched the cases ; but that this relation existed
in some of them at least, is very probable by all the rules of medical
evidence.

Although it has been very common, ever since the general intro-
duction of anaesthesia into medical and surgical practice, to meet
with individuals who supposed themselves suffering from the remote
effects of anaesthetics, and who would assert most positively their
determination never again to submit to inhalation for any purpose,
we have had, as far as our information extends, no direct medical
evidence bearing on the subject previous to the publication of Dr.
Clark's article.

The great advantages of anaesthesia in medicine and surgery
have now been established on too firm a basis to be easily shaken.
For a time, like all great discoveries and inventions, it had its op-
ponents to contend against, but they were soon borne down by the
overwhelming evidence of eminent men throughout the world in its
favor. Therefore, we may, at the present time, with less hesitation
inquire, whether there may not be other dangers attending its use
than that of immediate death, and suggest the propriety of watch-
ing patients who have been subjected to its action, for some time
after, and noting any apparent ill effect. It is time that so im-
portant a subject should be investigated, and that the great experi-
ence of the profession should be known. If instances of the remote
ill effects of anaesthetics occur so frequently, as we would infer from
Dr. Clark's experience and that of his friends, their use certainly
ought to be more circumscribed than it is. It is very probable that
those who advocate the almost indiscriminate use of anaesthesia,
and there are not a few in the profession who appear to do so, and
who practically ignore all danger, will sneer at the record of cases
tending to produce any distrust of its safety, and to restrict its ap-
plication. It will be very easy for them to force the conclusion on
their own mind that the alleged bad consequences were due to other
agencies than anaesthesia. On the other hand, there will be some
danger on the part of those who have never been strong advocates
of its use, of ascribing to its influence effects which might be attri-
butable to other causes. Still, we think it important that cases in
which anaesthetics appear to have been productive of serious ill
consequences should be brought to the notice of the profession, that
some idea may be formed of the relative frequency of these acci-
dents. With this view we beg to present, in connection with Dr.
Clark's record, the three following cases which have occurred with-
in the last five years in our own practice :

Case 1. In the summer of 1853, assisted by Dr. Leroy, formerly
resident surgeon of the New York Hospital, I operated on a boy in
apparent good health, eight years old, for contraction of the index
and middle fingers of the right hand, the result of the cicatrization
of a burn some years previously. As the case required a careful
and somewhat protracted dissection of flaps into the palm of the

752 Remote Effects of Anesthesia. [December,

hand, the patient was subjected to the influence of sulphuric ether,
administered by Dr. Leroy, on a sponge in the usual way. Nothing
remarkable occurred either during the administration of the anaes-
thetic or during the operation, and but a moderate quantity of blood
was lost. The patient soon recovered consciousness, but in a short
time he became very feeble, and soon commenced vomiting, al-
though no food bad been allowed for seven hours previous to the
operation. The pulse commenced sinking rapidly, consciousness
being unimpaired. Frictions were at once resortod to, and stimu-
lants attempted, but were immediately rejected by the stomach.
The prostration soon became extreme, and dissolution appeared im-
minent both to Dr. Leroy and myself. Brandy was freely admin-
istered by enema, and retained, and, in the course of an hour or two
reaction slowly commenced, but it was not until several hours had
elapsed that it was considered safe to dress the wounds, so slowly
did the patient recover from ihe prostration.

Case 2. This patient, a young man in ordinary health, not ro-
bust, aet. about 25, of nervous temperament, wished to have a large
number of decayed teeth and fangs of teeth removed. At the request
of the dentist, who was to operate, I administered sulphuric etherr
patient sitting upright in the operating chair, a necessary position
during such an operation. The patient had previously been consi-
derably frightened both at the idea of the operation, and of the
anaesthetic, although unwilling to undergo the suffering without it ;
he had accordingly primed himself pretty thoroughly with brandy,
but was in no wise intoxicated. Nothing unusual occurred during
the administration of the ether, and anaesthesia was induced without
difficulty. Six stumps were rapidly and skillfully extracted, say
within three minutes, perhaps within two. The patient then showed
some signs of returning consciousness, and more ether was adminis-
tered ; anaesthesia was soon re established, and six more teeth were,
with equal rapidity, extracted. The anaesthesia was very complete,
but there was no unusual difficulty in recovering the patient, and he
was soon able to walk home. A week or two after this, he applied
to me complaining of debility, pain about the head, and dizziness, a
disposition to faint and fall down, and various nervous symptoms,
which, he said, had troubled him ever since the operation. He was
very low spirited and fearful of some serious disease. He of course,
attributed all this to the ether. I endeavored to divert his mind
from this idea, and prescribed change of air and tonics. He went
away, but returned within a few weeks not much better. Subse-
quently he improved, and after a couple of months longer was much
better, though still rather nervous and desponding, He afterwards
went to the city to reside, and since that time I have not seen him.

Case 3. W. M., a young gentleman, about 30 years old, in robust
health, of temperate habits, was attacked with ulceraion of the soft
parts of the mouth from pressure of a crowded wisdom tooth, the
pain was very severe, causing loss of rest and food. I advised the

1856.] Poisoning by Stramonium. 753

extraction of the tooth, but the dentist to whom he applied merely
cut away the overhanging edges of the ulcer; the inflammation in-
creased and extended to such a degree as to produce almost complete
closure of the jaws with inability to open them. It was absolutely
necessary now that the tooth should be extracted as the only means
of arresting the inflammation, and it was therefore proposed to ether-
ize the patient in order to allow the jaws to be forced open suffi-
ciently to admit the introduction of a forceps. Sulphuric ether was
accordingly administered: the patient came rapidly under its influ-
ence, scarcely requiring an ounce and a half, though not entirely
unconscious ; the jaw was forced open with but little difficulty, and
the tooth rapidly extracted by the dentist in attendance. The
patient soon recovered, but seemed a little nervous and considerably
excited, but expressed himself as entirelv relieved from the severe
pain he had been suffering. He was advised to go home and lie
down for a few hours. He walked home, about a quarter of a mile or
more, and followed my advice ; but in the afternoon complained that
the ether was still in his lungs, and sought to get rid of it by riding
and walking. In the evening he was at the house of a friend in gay
society, and seemed to enjoy himself, still however, occasionally
complaining of some difficulty about his chest, when, all at once, he
fell from his chair, exhibited great restlessness, tossing about of the
arms and legs, with great difficulty of breathing, but no loss of con-
sciousness, declaring all the time that he could not get his breath
for the ether, and that he should die ; his hands and feet were said
to be cold. Before I reached him, various restoratives had been
applied, and he had been almost drowned by the assiduous applica-
tion of hot water. It was evident at once that it was a case of
violent hysterics, unusually well marked in a male. Patient at times
would laugh and joke, then express fears of impending suffocation,
with jactation, declaring that as vapor of ether was heavier than air,
he ought to be held up and allow it to run out of his lungs. As he
was rather weighty to allow of convenient inversion, his request
was not granted. Large doses of morphine were administered but
had no effect ; it was only after several hours that he could be qui-
eted. The next day he was able to be up, but complained of weak-
ness and a disposition to faint on the slightest attempt to walk, also
of some difficnlty of breathing. This continued for some days, but
finally disappeared, and, within ten days, he was apparently in his
usual condition. Patient has never previously exhibited any tenden-
cy to hysteria. [New York Journal of Medicine.

Case of Poisoning by Stramonium. By Geo. T. Elliott, Jr., M.D.,
Physician to the " Nursery," and to Bellevue Hospital.

At 5 P. M., October 11, I received a note from the matron, re-
questing me to call immediately at the Nursery, as one of the chil-

754 Poisoning by Stramonium. [December,

dren presented alarming symptoms, and had probably eaten some
stramonium seeds.

I found Samuel Richardson, a robust little fellow, aged four years
and five months, in the following condition: Skin very red, very
hot, and moist ; expression of countenance wild and staring ; pupil
nearly fully dilated, and utterly insensible to light a lighted candle
could be so held as almost to singe the eye-lids, without inducing
contraction of the iris, and without attracting the patients notice;
child so wild and restless as to be controlled with difficulty, and in
raging delirium, biting with fury at those who restrained him. Un-
able to stand, and yet plungnig in a restless manner in whatsoever
position he could be placed all the movements being ill-coordinated,
and resembling those of chorea. The pulse more rapid than I could
count. His respiration greatly hurried, and at times gasping and
choky; constantly talking, and yet unable to articulate a syllable,
while from the expression of his face and movements, he seemed at
times to be chasing, or fleeing from, imaginary objects.

On inquiry, I learned that his very flushed face had first attracted
the matron's attention, and on noticing that there was no perspiration,
she watched him; and soon found him staggering and behaving as
though intoxicated, when she learned from his playmates that Sam-
mie had been playing with the stramonium plant about an hour
and a half before.

Just before I arrived he had thrown up some indigested food, and
some thirty seeds, which were found to be those of stramonium.
He passed water, but had had no movement of the bowels.

Ordered a tea-spoonful of mustard dissolved in water, which caused
him to gasp in a somewhat alarming way, but was promptly ejected,
together with more seeds. In a short time a half tea spoonful of
alum dissolvod in warm water was given, and after that had opera-
ted, warm water was administered. He vomited three times a
very few seeds appearing in two, and none in the third.

6 P. M. Called the matron "a nasty thing " distinctly, otherwise
no change. He then slept till eight o'clock, with much jactatation
and restlessness, and had one large movement of the bowels uncon-
sciously, contents not examined ; when he awoke his skin was com-
paratively cool, and the pulse 150 ; pupil the same, no apparent
thirst ; restlessness, intolerance of control, and chorea-like move-
ments continue.

> 9 P. M. Has had two more passages, one quite copious, a few
seeds in the second. Head to be rubbed with iced water every few
minutes.

II P. M. Has improved. Pupil answers slightly to the candle
held as before, and child conscious of its presence, and afraid of its
proximity ; has had two more passages with a few more seeds ; can
articulate pretty distinctly; can stand, and has taken three steps;
chorea-like movements persistent, and patient, when not aroused,
lies in a state of mild delirium; sings, talks, fancies that there are

1856.] Ipecacuanha in Dysentery. 755

dogs in the room, which he describes, and attempts to chase, spring-
ing suddenly to his feet, and as suddenly toppling over ; sometimes
talks of events of the day as though they were now taking place.
Cold to the head to be discontinued.

3 A. M. Has had two passages with more seeds; passed water
twice more, once very freely, thirsty. More conscious, gained in
distinctness of articulation, coherence of speech, and coordination of
movements, though still restless.

Oct. 12, 10 A. M. Has slept until 5 P. M., with about the same
amount of jactitation, and, on awakening, had a passage containing
some twenty seeds ; at 8 A M. another containing some few more,
and then slept peacefully. Is now perfectly conscious ; voice and
articulation natural ; face still markedly red ; pupil somewhat dilated;
pulse 120. Ordered arrow-root, hominy, or rice, with an occasional
tea-spoonful of a mixture made with olive oil and thin mucilage
sweetened. The pupil did not resume its natural state until the
14th, but the child is perfectly well in every respect.

The Nursery has occupied its present position for the last eighteen
months, but the likelihood of such an accident was never contempla-
ted. The writer believes that the poisoning from this source cannot
but be more frequent than is generally appreciated, and for that
reason has presented every symptom and incident in this case as
minutely and as accurately as possible. [Ibid.

Ipecacuanha in Dysentery.

It is well known that ipecacuanha was first brought into use as a
remedy by the remarkable success which attended its administration
in dysentery; and that, for a long while afterward, its principal use
was confined to this disease, and it was considered by many to be by
far the most valuable remedy known. By degrees, however, as
other and important remedies were introduced, this gradually fell
into comparative disuse, and now it is not uncommon to read, in
our works on practice and in our medical journals, long lists ot reme-
dies for dysentery, without even any mention of this once celebrated
article. Our convictions, founded on experience, not unfrequently
lead us to the employment of old remedies in preference to new, and
thus we have been able, in several instances, to cure this formidable
disease by a substitution of the ipecac treatment for other means,
under the use of which life had well-nigh been despaired of. Many
years ago a young man came under our care after a long and ineffec-
tual course of treatment for dysentery, when nearly all hope of
recovery had fled and nearly every other remedy having been used,
under the direction of able physicians, scarcely any resource remain-
ed but an experiment with this ancient remedy, which was made, the
ipecac being given in very large quantities for several successive
days, exclusive of all other medicine, when the disease subsided and
the patient was cured. We have used it frequently since, with

N. S. VOL. XII. NO. XII. 48

756 Treatment of Pneumonia and Pleurisy. [December,

excellent effect, both in substance and decoction ; but very recently
a patient has recovered under this treatment, whose case is worthy
of notice, as showing what large quantities of powdered ipecac the
stomach will bear in a confirmed and obstinate case of this disease.
This was a case of several days' continuance, resisting the reme-
dial power of various appliances in common use in this disease. The
continuance of the same plan of treatment, or any part of it, seemed
to promise little benefit after the experiments already made, and we,
therefore, determined to make a fair trial of the ipecac. We began
by administering one drachm of powdered ipecac, which producing
no nausea, or other perceptible effect, was followed by another
drachm in half an hour. Two other one-drachm doses were given
at intervals of one hour, before vomiting was produced, and then
only to a slight extent. Soon afterward a feculent stool gave the
patient temporary relief from the painful tenesmus with which he
was suffering. The ipecac was continued in doses of one drachm
each, prolonging the intervals as the nausea and vomiting indicated,
until one ounce had been given. Afterward, as the stomach had
become more and more impressionable, the doses were reduced to half
a drachm each, with occasional prolongation of the intervals, until
a full half-ounce more was given. Then, on account of the greater
susceptibility of the stomach to its influence, the doses were further
reduced to fifteen grains, which now caused greater nausea than one
drachm in the beginning. The dysenteric symptoms gradually
subsided under this treatment, and the patient recovered. No other
medicine was used until the day after the dysenteric symptoms were
relieved. [Memphis Med. recorder.

On the Treatment of Pneumonia and Pleurisy. By Dr. Niemeyee,
Professor of Clinical Medicine in Greifswalde.

Professor Niemeyer is much opposed to the employment of ge-
neral venesection in pneumonia and pleurisy, and only uses it
exceptionably with a view to prevent impending suffocation, and
to facilitate the reflux of the blood from the brain, but not for the
purposes of arresting the inflammation, He agrees with the ob-
servation of Dieck, that the convalescence is more rapid in those
cases that have been treated without, than in those which have been
treated with venesection ; and he explains the fact by the increase
of fibrin, and diminution in the amount of red corpuscles, induced
by the venesection.

The treatment adopted by Professor Niemeyer consists in the
application of compresses wrung out in cold water over the affect-
ed part of the thorax, and their renewal as often as they become
warm. The great relief experienced by the patient is a sufficient
guarantee, that the repetition of the application will be carefully
attended to. The only internal remedy employed, was nitre,, in

1856.] Circumcision in Preventing Syphilis. 757

doses of two drachms in the course of twenty-four hours. Al-
though employed at different ages, and in various forms of the
disease, no metastasis or other evil consequences have ever been
noticed by the author. He has seen persons attacked with very
tumultuous symptoms, enabled by this treatment to return to their
occupation on the seventh day after seizure. Professor Niemeyer
recommends an early exhibition of steel in the convalescence from
the diseases under consideration. [Brit, and For. Med. Chir. Rev.
and Prager Vierieljahrsschrift.

On the Influence of Circumcision in Preventing Syphilis.

Mr. Jonathan Hutchinson says : " The Metropolitan Free Hospital
being situated in a locality in which many Jews reside, its out-pa-
tients room furnish a good field for estimating the relative prevalence
of different diseases among them and others. The following state-
ment of my past year's experience as to veneral diseases appear to
have some importance, and I am induced to communicate it at the
present time with especial reference to a paper which appeared in
the ' Medical Times and Gazette ' of November 17, from my friend
Mr. Cooper Forster, recommending the more general practice of
circumcision as a preventive of certain diseases of childhood. My
Jew patients have, I believe, been in proportion of nearly one-third
to the other. The subjoined Table shows the proportion of the two
classes of venereal disease.

Total of Venereal
Cases.

Gonorrhoea.

Syphilis.

Proportion of Gonor-
rhoea to Syphilis.

Not Jews. . . .

272

58

107

47

165
1

0-6 to 1
3-4 to 1

Thus we find that, notwithstanding a gross proportion of nearly
one-third to others, the cases of syphilis presented by Jews are only
as one to fifteen. That this difference is not to be accounted for,
either by their superior chastity, or by their unwillingness to seek
medical aid for such diseases, is conclusively proved by the fact they
furnish very nearly half the cases of gonorrhoea. The circumcised
Jew is, then very much less liable to contract syphilis than an uncir-
cumcised person. This conclusion has, I believe, been long enter-
tained by many surgeons of experience, but I am not aware that it
has ever before been made the subject of demonstration. No one
who is acquainted with the effects of circumcision in rendering the
delicate mucous membrane of the glans hard and skin-like, will be
at a loss for an explanation of the circumstance. Taking, then, this
fact as established, it suggests itself as probable that circumcision
was by Divine command made obligatory upon the Jews, not solely
as a religious ordinance, but also with a view to the protection of
health. Among them promiscuous intercourse was certainly not
regarded in the heinous light which it is under the present dispen-

758 Perchloride of Iron in Panniform Keratitis. [December,

sation while polygamy and concubinage were openly permitted.
One is led to ask, witnessing the frightful ravages of syphilis in the
present day, whether it might not be worth while for Christians also
to adopt the practice. Such a proposition, if intended only to
protect the sensualists from the merited consequence of loathsome
vice, would, as it is to be hoped, be dismissed at once by every
right thinking man. But the matter is much wider. In syphilis
the innocent suffer with the guilty, and the wife and children have
often to bear the penalty of the sin of the husband and father.
During the period from which the statistics just adduced have been
obtained, I have had under my care at the hospital a total of 252
children under the age of five years. Of these, 179 have been of
Christian parentage, and 73 of Jewish. Among the former have
occurred 27 cases of congenital syphilis, while among the latter there
have been but three. Thus it would appear but one twenty-fourth
of the surgicaldiseases of Jewish children acknowledged a syphilitic
cause, while no less than one-sixth of those of Christians are of such
origin. In this calculation I omit altogether the numerous diseases
which are, in all probability, remotely dependent on syphilis, and
comprise those only which present the disease in a well-marked form.
The same inferences are pointed out by counting the proportion of
syphilis cases in women. Of a total of 97 women who have, during
the years come under treatment for one or other form of venereal
disease, 92 have been Christians, and 5 Jews. Of the 91 of the
former, no fewer than 61 have suffered from syphilis, and at least
two-thirds of these have been married women, who, there was evrey
reason to believe, had contracted the disease from their husbands
without any fault of their own. With regard to its being the duty
of the surgeon invariably to remove the prepuce of infants born
with congenial phymosis, which Mr. Forster, in the paper referred
to, so ably points out, I have long held a similar opinion with his
own. That opinion, together with some reason for it, are recorded
at page 415 of the "Medical Times and Gazette" for Oct. 23,1852.

Glasgow Med. Journal.

Perchloride of Iron in Panniform Keratitis. By M. Follix.

M. Follin, after adverting to the obstinacy of chronic keratitis,
and to the frequent inefficacy of the various means proposed for its
relief, states that he has found in the employment of the powerful
astringent, the perchloride of iron, a most useful application, and
that he has had his views of its utility confirmed by MM. Broca
and Gosselin. He does not recommend its employment in a high
degree of causticity, and believes that at 30 Beaume it is best
suited for this purpose. He lets fall a large drop into the eye, by
means of a quill, every second or third day, the great contraction
of the eyelids that ensues rendering it necessary that all should be
introduced at once. It imparts a yellow color to the eye, and

1856.] Gonorrhoea! Epididymitis. 759

gives rise to a sense of painful constriction, which lasts for about
a quarter of an hour, and then gradually diminishes, a burning
sensation still continuing for some hours. A slight phlegmasia is
sometimes induced the next day in the eye ; but however that
may be, the perchloride must be abstained from, and cold and
slightly astringent applications among which, the decoction of
rhatany is a good one must alone be resorted to. The perchlo-
ride is to be used again on the second, third, or fourth day after,
according to the amount of irritation remaining from the former
application ; and generally it is after the second or third applica-
tion that decided amelioration is perceived. The perchloride has
never given rise to any accidents; and when its application could
not be borne, it has not aggravated the condition of the eye.
Several cases are related. [Brit, and For. Med. GMr. Review and
Archives Gcnerales.

On the Employment of Gold in Gonorrhoea! Epididymitis. By
Professor Sigmund.

Whatever may be the success attendant upon the treatment of
gonorrhoea in recent times, the number of cases of epididymitis
does not seem to be diminished. Prof. Sigmund published in 1850
an account of the advantage he had derived from treating it with
cold, and all his subsequent experience has confirmed the statements
he then made. Under the term he includes the inflammatory condi-
tion of the tunica vaginalis, of the epididymis itself, and of the
cord, the affection of one of these parts preponderating in different
cases. The form in which the tunica vaginalis becomes rapidly
distended with exudation is a very painful one ; that in which the
inflammation of the epididymis preponderates is less so, and when
there is considerable effusion into the tunica and around the epi-
didymis, which cases are, however, rare, the suffering is excessive
and is accompanied by general disturbance. In all degrees and
combinations of the affection, cold is found to be a powerful remedy,
assuaging pain, preventing further effusion, and, when continuous-
ly applied, expediting absorption more than any other means.
The patient lying on his back, the scrotum is supported by means
of a light suspensory, or a towel placed between the thighs, and
then covered with compress dipped in water. For the first three or
four hours, the degree of cold should be only moderate, lowering
the temperature then gradually, and in six or eight hours adding ice,
if the application acquires heat rapidly. This degree of cold is con-
tinued as long as it gives the patient relief, but when it ceases to do
so, and still more when it induces an uneasy sensation, the tem-
perature must be raised from cold to merely cool, and the applica-
tion allowed to remain on until it becomes warm. Finally, lukewarm
applications are to be continued until all inflammatory appearances
have subsided. The application must be constant, continuing it

760 Employment of Chlorate of Potass. [December,

uninterruptedly day and night, its occasional use not sufficing.
There are persons who cannot bear the application of even moder-
ate cold, and especially when made to the abdomen, without colic,
diarrhoea, catarrh, rheumatism, &c, being induced ; and this is es-
pecially the case with those disposed to scrofula, tuberculosis,
rheumatism, or gout. It is found, however, by experience, that
even very sensitive persons will bear well-wrung compresses, pro-
vided that the degree of cold be gradually and slowly increased.
Conjointly with this treatment, the patient takes a saline purgative
at intervals, so as to induce from two to four fluid stools, one or two
such being also procured during the diminution of the inflamma-
tion. For diet, the patient is to be limited to thin, easily-digested
fluid substances, tea and coffee being prohibited during the acute
stage. Young plethoric persons, in whom the symptoms run high,
and are attended especially with much exudation around the epi-
didymis, may, exceptionally, first require the application of leeches
to the groin. Very severe, enduring, or increasing pain may be
relieved by anodynes, and when the tunica vaginalis is much dis-
tended, a puncture or subcutaneous incision may be required : but
such cases are quite exceptions, the cold proving, in the great
majority, the best anodyne and antiphlogistic. At most, an ano-
dyne is required at night, in order to secure sleep. When the
inflammatory symptoms have disappeared, and the epididymis will
bear the moderate pressure of the hand, we must seek to obtain
the absorption of the exudation ; and for this purpose, Professor
Sigmund prefers Frickes's treatment to any other mode of making
compression. ,

Numerous comparative trials have convinced him that the treat-
ment of this affection by repeated bloodletting in nowise deserves
prefference, the enjoyment of cold alone proving in its results far
more satisfactory in the great majority of cases. When resorted
to early, also, it exerts a very rapid effect in arresting the further
development of the affection. [Wiener Wochenschrift. British
and For. Med. Chir, Rev,

On iJie Employment of Chlorate of Potass. By M. Isambert.

In this paper, M. Isambert, after giving the history of the em-
ployment of the chlorate since its discovery by Berthollet, its dis-
use, and recent revival by llunt and others, states that he has of
late investigated its therapeutical action in M. Blache's wards, at
the Children's hospital, and its physiological effects by experi-
ments upon himself. Passing over these latter, we briefly present
the conclusions he has arrived at in regard to its medicinal em-
ployment.

1. Gangrene of the mouth. On carefully examining Mr. Hunt's
observations, he considers it very doubtful whether he has always

1856.] Employment of CI dor ale of Potass. 761

bad to do with true gangrene of the mouth, having rather con-
founded this affection with ulcero-membranous stomatitis, in which
the effects of the chlorate are truly remarkable. In two cases of
gangrene he did not find it very serviceable ; and West, who care-
fully distinguishes between the two affections, seems to have come
to the same conclusion.

2. Ulcero-membranous stomatitis. This term, adopted by Eilliet
and Barthez, well explains the nature of the affection, there being
in fact, both ulceration and the formation of false membrane pre-
sent, the one predominating in some cases, and vice versa. It is
a most obstinate affection, having no natural tendency to a cure,
and being very liable to relapse. West first employed the chlo-
rate in this affection, and his success with it has been amply con-
firmed by Blache, Herpin, Bergeron, and others on the continent.
Eight cases which have occurred to the author speak equally
favorably. Belapse may, however, occur, though far seldomer
than under any other remedy ; and it should, therefore, be contin-
ued for some time after the fall of the false membrane. The
chlorate, too, is powerless against the alveolo-dental pyorrhoea, or
ulceration of the borders of the gum, with purulent issue from the
alveoli on pressure being made upon the gum. The mean dura-
tion of treatment of these eight cases was from three to five days
for the production of the fall of the membrane, and five to ten for
a complete pure. When the cure was longer delayed, relapse had
occurred, or the alveolo-dental pyorrhoea was present.

3. Aphtha. The vesiculo-ulcerative state of the buccal cavity,
to which this appellation is now confined, is in general a very
mild affection, and curable by simple means. Sometimes, however,
numerous and confluent ulcers produce much pain, impede feed-
ing, and are very tedious in healing, and induce constitutional
disturbance. In a case of this kind the chlorate effected a rapid
cure.

4. Muguet. M. Legroux has tried it in several cases of epidemic
muguet at the Hotel-Dieu, but without any favorable result. Dur-
ing the trials it was found to pass rapidly into the milk of the
nurses, and in this way it may be administered to infants.

5. Scorbutus. M. Fremy has found the medicine of use in this
disease ; and thus we find the moderns returning by another route
to one of the first affections the chlorate was recommended for, on
the theory of deoxidizing the salt in the economy.

6. Diphtheritis. Observations commenced by M. Blache, and
continued by the author, leave no doubt as to the utility of the
chlorate. In this affection there is, however, every gradation from
the most simple to the most malignant form, a sign of most unfa-
vorable augury being found in the swelling of the parotid and
deep-seated cervical glands enlargement of the submaxillary
glands occurring in even the simplest forms. Of thirteen cases,
the chlorate was exclusively employed in four, and the cure was

762 Sub-Arterial Cysts of the Wrist. [December,

rapid, the cases being mild ones. In two, although cauterization
with nitrate of silver, was employed at the beginning, the suecess
was attributable to the chlorate. In two others, cauterization was
simultaneously employed, but the cure was not more rapid than in
the others, The 9th case was a very severe one following scarla-
tina, and the patient was cured by the- chlorate and quinine, with-
out the aid of cauterization. The four others died, but they were
cases of a very grave description. The chlorate is, therefore, no
heroic remedy, always curing angina maligna, nor is its action im-
mediate ; for, although it appears in the saliva a few minutes after
administration, it requires at least twenty-four hours, and usually
three or four days, before it can effect its purpose. It should,
therefore, be commenced with early.

7. Group.' The success attendant up the chlorate in diphtheritis
naturally led to its employment in croup. The author relates four
cases in which the chlorate seemed to have succeeded, and refers
to eleven others, in which tracheotomy was resorted to also, whe-
ther because tbe medicine did not seem to be taking effect with
sufficient speed, or that tracheotomy having been already employ-
ed, it was given as an adjuvant to prevent the reproduction and
extension of the diphtheritis. Of these eleven cases, some of which
were very severe, there were eight recoveries and three deaths.
Between the 1st of January and end of March, 1856, tracheotomy
was performed in M. Blache's wards fourteen times with nine re-
coveries and five deaths, all the children taking the chlorate either
prior to or subsequent to the operation. If this success be not due
to the occurrence of a run of lucky cases, which occasionally
occurs in practice, the result is remarkable, as the proportion of
recoveries after tracheotomy, at the same hospital, has averaged
during the last six years but one in four to one in five. When
tracheotomy has been performed, the use of the chlorate is espe-
cially indicated, when there is a tendency in the diphtheritis to
extend to the bronchi, pharynx, or nasal passages. It should be
combined with expectorants and considerable doses given.*

[Gaz. Afedicale. Virginia Med. Jour.

On Sub-Arterial Cysts of the Wrist. By M. Chassaignac.

M. Chassaignac calls attention to a form of ganglion which, placed
beneath the radial artery, unless properly understood, may give
rise to very serious errors. From excess of labor, or the exertions
necessary to raise heavy burthens, the small tumor may acquire
considerable development. The fingers of the surgeon, when
applied over the cyst, are raised by the pulsations, which are re-

* Wc publish the observations of M. Isanibert, because we are disposed to think
thai- the salts of chlorine are not regarded with sufficient favor by American phy-
sicians. The usual dose of the chlorate of |>ot:isli is from ten grains to two scruples
in the 24 hours, eithor in tho form of powder or solution. Ed.

1856.] Treatment of Ague hy Iodide of Potassium. 763

markable for their energy and the breadth of space they extend
over. This extent of pulsatile surface immediately suggests the
idea of radial aneurism, and if the examination be continued with
the limb remaining in its ordinary attitude, an error can scarcely
be avoided. The differential diagnosis may be established by
bringing the wrist into a state of forced flexion, when whether it
is that the artery is displaced, or that it ceases to be stretched over
the eminence formed by the cyst the pulsations no longer exist,
and it is evident that no aneurism is present. In treating these
cases, M. Chassaignac employs the iodide of potash ointment, rub-
bing it in every two hours during a week. On the dorsal surface
we may treat ganglia with advantage by crushing them, by subcu-
taneous puncture, seton, or iodide injection ; but in the case of these
sub-arterial cysts of the wrists, which are in communication with
the radio-carpal articulation, these means of treatment are not
applicable. The iodine frictions give rise to no accident, and
seem possessed of all desirable efficacy.

On one occasion, M. Chassaignac had the opportunity of exam-
ining one of these cysts in a subject brought for dissection. The
tumor resembled an almond in form and size, and occupied the
space comprised between the tendons of the supinator longus and
the palmaris longus, lying on the anterior portion of the pronator
quadratus. The radial artery in its downward progress having
reached the upper part of the tumor, was at first so intimately con-
nected with its front part as to seem to form a portion of its walls.
Very soon, however, it deviated obliquely on its external side, and
reached the fossette called the anatomical snuff-box. With the
object of ascertaining the anatomical origin of the tumor, it was
dissected with the greatest care, and separated from all parts with
which it had not contracted fixed adhesions. In this way it was
circumscribed for four- fifths of its extent, but posteriorly and below
it was firmly fixed to the bone by a kind of pedicle proceeding
from the anterior part of the lower radio-cubital articulation. It
was only, in fact, a diverticulum of the synovial membrane of this
joint, and it had raised up the lower fibres of the pronator quadratus,
which, forming a kind of arc, produced a sort of strangulation of
the pedicle, at its upper part. The continuity of the cyst with the
articulation was completely demonstrated, a probe freely passing
from one to the other. [Moniteur des Hopitaux. British and For.
Med. Chir. Rev.

The Treatment of Ague by Iodide of Potassium. By E. F. Sajstkey.

Ever since I have resided in this village, (now five years,) I have
been dissatisfied with the usual treatment of ague by quinine, as
in some cases the disease yielded to that remedy, and in others did
not. But I could think of no other treatment likely to be success-
ful, though I tried many, including arsenic, till, some three years

76-i Lupulin in Spermatorrhoea. [December,

ago, I read in a number of the Medico- Chirurgical Review, (I forget
which,) that the German pathologists considered that the congested
spleen (ague cake) was the cause and not the effect of the disease ;
and I remembered that Dr Williams had written on the efficacy of
bromide of potassium in such a lesion ; but not having that drug
in my surgery, I determined to try the iodide of potassium instead,
in the next case of ague that came before me, intending, if that
failed, to procure the bromide. But I am happy to say that the
object of my writing is to state to my professional brethren that I
have used the iodide of potassium now in considerably more than
a hundred cases, and have never yet failed in curing the disease
very quickly. In some cases, where the disease has been of long,
standing, and the patient very much reduced, I have added a grain
or two of quinine to each dose of the iodide of potassium; but my
general prescription has been for an adult: ft. Potass, iodid.,
3iss.; aquae menth. pip., xj. M. Coch. Mag., ij. 4ta quaque
hora sumend. So that there could be no doubt what was the
remedy that cured the disease. In proof of the value of this drug,
I will only mention one case out of all that I have thus treated.

Mrs. Smith sent for me early last month, having suffered from
tertian ague, off and on, since September. Not being in very good
circumstances, she went to the clergyman's wife of the parish in
which she resided, who very kindly gave her some quinine, telling
her it was no use sending for the medical man, as he must give her
the same remedy. However, not getting well, she sent for me.
After hearing what I have related, and finding she had a tolerable
pulse, her bowels open and motions healthy, with a clean tongue, I
sent her nothing but the above mixture ; and she never had a return
of the ague after the second she took of it.

I shall be glad if, by inserting this letter, other medical men will
try this remedy, and report to you their experience. [Association
Medical Journal.

Lupulin in SpermatorrJia'a. By Dr. Pkescheck.

Dr. Prescheck has employed lupulin for several years in a great
number of cases in which spermatorrhoea seemed to depend upon
no mechanical cause. At first, he used to give two grains night
and morning ; but finding such doses of no avail, he prescribed
from ten to fifteen grains to be taken just before bedtime, prohib-
iting the drinking of water after it. From such doses, even con-
tinued for a long time, he has found no inconvenience to arise,
while they have acted beneficially on the disease. In some cases
he combined with it one or two grains of pulv. digitalis. A valu-
able peculiarity in the operation of lupulin, is the beneficial action
it exerts upon the digestive process, which so often sutlers in these
cases. It is also very useful in mitigating the urethral irritation
and discharges consequent on former excesses, and in many cases

1856.] Mode of Reducing Dislocation of the Thumb. 765

more so than iron or quinine. Its especial utility in the chordee
of gonorrhoea, Dr. Pescheck has had many opportunities of wit-
nessing. It is best administered without any additions that might
diminish its bitterness, as its effects are very proportionate to the
intensity of this property. Old lupulin deprived of its oil and bit-
ter taste is almost always useless. [Bucfaier's Repert. fur Pharm.
Brit, and For. Med. Chir. Rev.

Mode of Reducing Dislocation of the Thumb. By JOHN Doe, M. D.,
of Cabot, Vermont.

Having had occasion to reduce a dislocation of the thumb several
times, when the first phalanx is thrown upon the dorsum of the
metacarpal bone, and having never encountered any particular
difficulty in effecting it, it has been a cause of surprise to me that
the method I am now to describe is not more generally known.
There is not an English writer on surgery, from Sir A. Cooper to
Ferguson, nor an American one, so far as I know, that alludes to
this method ; and if we are to judge from an article by M. Demar-
quay, published in the Medical News, of May, 1852, and accredited
to the Bulletin de Therapeutique, it might well be presumed that
the French are also innocent of practising or teaching it.

The common method of reducing this luxation is, as is well
known, to flex the thumb, fasten upon it a tape with a clove hitch,
and with this make extension. If this, or more violent means do
not succeed, we are directed either to abandon the attempt at re-
duction, or what is still worse, effect it by making incision, or by
amputation of the end of the metacarpal bone. Extension has
sometimes been persevered in to such a degree that the soft parts
have been lacerated, or the thumb actually torn off; and in Braith-
waite's Ketrospect, part xxii., M. Blandin describes a forceps well
calculated to do this.

In this dislocation, the phalangeal end of the metacarpus projects
into the palmar surface of the hand, forcing itself between and
through the flexor muscles of the thumb, which form a loop around
the head of the bone. Extension made upon the thumb makes
this loop more tense ; and as the metacarpal end of the first pha-
lanx is broad and considerably flattened on its palmar aspect, it
must be apparent at once that the difficulty of reduction isdirectly
as the amount of extension. There is good reason to believe that
extension would never succeed in these cases without rotation.
The principal indication in treatment here, is to relax the flexors
forming the loop, so that the end of the phalanx can be pushed
forward into the loop, and by carrying the muscles forward with
it, disengage the head of the metacarpus. This can be done in the
following manner :

Having previously warmed the hand, if cold, in warm water,

776 Editorial and Miscellaneous. [December,

the surgeon should seat himself by the patient, facing in the same
direction, and upon the same side with the injured thumb, and
place the hand upon his knee. Tip back the thumb upon the
dorsum of the metacarpus to more than a right angle, or so as to
form a slightly acute angle with the latter bone ; place both index
fingers against the ball of the thumb, and the ends of both thumbs
against the dorsum of the disarticulated end of the phalanx. Now
by pushing forward forcibly, yet steadily against the phalangeal
bone with both thumbs, reduction will generally be effected on
the first trial, and almost instantly.

The writer claims not the honor of originating this method, but
supposes it to be adopted by many surgeons in this country.

[New Orleans Med. News and Hosjntal Gaz.

EDITORIAL AND MISCELLANEOUS.

Congenital Absence of the Patella.
Dr. Wm. M. Greene, of Lexington, Ga., toiinnunicat.es to us the follow-
ing account of a case in which the Patella was not to be found in either
of the lower extremities.

" The subject is a negro boy, now about nine months of age, and well
developed in every part except the legs, which flex anteriorly instead of
doing so in the natural direction. The hip-joint is in the normal state, the
trochanter standing out as usual. The muscles of the thigh seem to be
natural, but the quadriceps femoiis bifurcates just above the condyles of
the os femoris, and sends the tendon on each side of the knee-joint, to be
inserted upon the sides of the tubercle of the tibia, leaving between them
the space usually occupied by the patella. No patella, nor vestige of it,
can be found in this case in either leg, both of which present the same
anomalous aspect. The tendons forming the ham-strings, the tibia, the
ankles, and the foot, are all in their natural positions. The fibula appears
to be too far back, and its upper end, instead of being attached as usual, is
prolonged behind the joint into an olecranon-likc process which terminates
in the cotyloid cavity of the femur between the posterior surfaces of the
condyles, and works there after the manner of the olecranon at the elbow.
While the legs flex anteriorly, no posterior flexion can be executed. The
child has as yet made no effort to walk, but crawls, and sits alone."

Cases of this kind are comparatively rare. We saw one somewhat simi-
lar a few years ago, the details of which were published in this Journal
by Dr. II. F. Campbell, in the volume for 1851, p. 305.

1856.] Editorial and Miscellaneous. 767

Obstetrics : the Science and Art. By Charles D. Meigs, M. D., &c, &c.
3d edition, revised, with 129 illustrations. Philadelphia : Blanchard &
Lea. 1856. 8vo., pp. 755. (For sale by T. Richards & Son.)

The present edition of the very popular author's treatise has been so re-
vised, as to include such valuable acquisitions to knowledge in this depart-
ment, as may have been made since the publication of the last. The
preface also announces some amendments in the style. We doubt not
that this edition will be extensively patronized by the profession, as all
good books by American authors should be.

Lectures on Materia Medico, and Therapeutics : Delivered in the College
of Physicians and Surgeons of the University of the State of New York.
By John B. Beck, M. D., &c, &c. Prepared for the press by his friend
C. R. Oilman, M. D., &c, &c. New York : Samuel S. k Win. Wood.
1856. 8vo. pp. 560. (For sale by T. Richards & Son.)

This is the second edition of one of the best works on the subject, for
the use of students. It has been carefully " brought up" by the editor.
Prof. Beck was one of our most eminent and judicious teachers, and his
book bears the impress of his physiological mind.

Handbook of Inorganic Chemistry ; for the use of Students. By William
Gregory, M. D., F. R. S. K, &c, &c. 4th Amer. from the 3d Eng. edit.
To which is added, the Physics of Chemistry. By J. M. Sanders, M.D.
LL. D., &c, &c. New York : A. S. Barnes <fe Co. 1857. 8vo. pp. 426.
(For sale by T. Richards & Son.)

This is an exceedingly valuable manual, being full of interesting matter
not easily obtained elsewhere. Its division devoted to Light, contains a
good account of the many and varied processes by which images are trans-
mitted and fixed by the chemical influence of Light, from the first inven-
tion of Daguerre to the present time. It is equally complete on the
subjects of Heat, Electricity, the Metalloids, and the Metals. We cheer-
fully commend it to the student, and others who wish to be posted up ire
Inorganic Chemistry,

An Introduction to Practical Chemistry, including Analysis. By John E,.
Bowman, F. C.S., &c, &c. 2d Amer. from the 2d revised London edit..
Philadelphia: Blanchard & Lea. 1856. 22mo. pp. 300. (For sale
by T. Richards & Son.)

As its title indicates, this is a mere introduction tc chemistry and
although a good one, it is too brief for the use of those who ought to be-
come well acquainted with the subject. It is better adapted to students of
literary institutions, than to those of medical colleges.

The Practical Anatomist ; or Student's Guide in the Dissecting Room. By
J. M. Allen, M. D., &c, &c. With illustrations. Philadelphia : Blan-
chard & Lea. 1856. 12mo. pp. 630. (For sale by T. Richards & Son.):

The author having lately held the Professorship of Anatomy in the

W8 Editorial ami AfSsoeBane [December*,

medical department of Pennsylvania College, has had ample opportunity
to become acquainted with the real wants of students in the dissecting room.

and has famished us with a manual well calculated to moot these wants.
It is gotten up in the best style of the distinguished publishers, and reflects
credit upon them, as well as upon the author.

The Transactions of the American Medical Association. Vol. IX. Phila-
delphia: T. K. A- F. G. Collins. 1896, Bvcpp 907,

We have just received this volume, and not Wing able at present to no-
tice it as \\t would like to :.o. we simply append the list of its contents:

N Annual Mooting of the American Med. Association.

: the Committee of Publication.

Report of the Treasurer.

Address s ' Pros lent oft'. ition.

Report on Deformities after Fractures. By Frank Hastings Hamilton.

Report on Hydroph

Report on the Cau>es which Impede the Progress of American Medical
Literature.

Report of the Committee on Medical Literature.

Report of the Committee on Plans of Organization for State and County
B

Report on th _ sition and Properties of the Milk of

the Human Female, produced by Menstruation and Pregnancy. Bj N.
S. Davis, M. R. A-c. Chicago. Ui'inois.

Report on the Sanitary Pi - By James M. Newman. M. D,

Buffalo, N. V.

Report on Treatment of Cholera Infantum. By A. J. Fuller.

Rejxirt on the Use and Efloet of Applications of Nitrate of Silver to the
Throat either in Local or General Disease. By Horace Green. M. D,

Report on the Best Mode of Rendering the Patronage of the National Gov-
ernment Tributary to the Honor and Improvement of the Prou ss
By Joshua P. Flint. M. P.

Report of the Committee on Education. By Win. Henry Anderson. M. 1>.

Roj>ort on the Medical Topography of the Eastern Shore of Maryland. Bj
P. Wroth. M. D,

History of the Epidemic of Yellow Fever in Charleston. S. C. in 1854.

Report on the Epidemics of Louisiana, Mississippi, Arkansas, and Tea i&
By Erasmus 1>. Fenner. M. !>.. of New Orleans,

rt on the Meteorology. Mortality, and Sanitary Condition of New Or-
leans, for the years 1So4 and 1859. By F. II. Barton, A. M.. M.P.

Report on Strychnia : Its Physiological Properties, and Chemical Detec-
tion. By Lewis II. Sterner, M. P.. of Baltimore, Man-land.

Partial Report upon a Uniform System of Registration of Pirths, Marri
and Deaths, and the <. - sol Death. By G. S. Palmer.

Trize Essay. I hi the Arterial Circulation: Its Physiology, and Chief Ta-
thological Relations. By Henry Hartshorns, M. P ..

rian of Organization of the American Medical Association.

Officers of the Association for 1S56.

List of Permanent Members,

1856.] Miscellaneous. 769

On the Removal of Tattooed Figures from the Skin. The Parisian grf-
settes, anxious to extinguish those tokens of their former love ami troth,
use for this purpose, as a caustic, a solution of indigo, in sulphuric acid,
after the application of which, as both epidermis and chorion peel off, a
very indistinct cicatrix remains. But this process, however innoxious it
mav seem, is according to Parent Duchatclet, not without its dangers, he
having seen it terminate fatallj in the ease of a young girl, where a serious
erysipelatous inflammation of the arm ensued. A more safe and effica-
cious plan has been recommended by Dr. Ambr. Tardieu. He applies for
24 hours to the tattooed surface, a cerate, saturated with concentrated
acetic acid. Then he rubs the reddened part well with strong alkalic liquid
several times, and washes it well afterwards with diluted muriatic acid.
In this manner, a thick scab is formed, which peels off and re-appears
again several times, until after about three weeks, a plain scar is (eft, in
which not the least trace of the former marks can be recognized, especially
if cinnabar, or the vegetable red or blue inks have been used as coloring
matters.

The translator of this tested the above in a case where a young gentle-
man in his boyish days had been guilty of the foolish practice of tattooing
his hands. And this abstract is given for the benefit of those who may be
consulted in similar cases. [Nashville Jour, of Med. and Surgery.

Impacted Rectum from Cherry Stones. Dr. Chapin, of Winchester,
Mass., states the following case in the Charleston Medical Journal.

"In July of last year a case occurred, in my practice, of impacted rectum
from cherry stones. The man had eaten freely of cherries, and had swal-
lowed the stones. The next day he found himself unable to evacuate his
feces, and after repeated unsuccessful trials gave it up and sent for me.
He appreciated correctly his case, and had taken no physic, nor resorted to
any other medicinal means for relief. He reasoned sensibly, that the pas-
sage way being thus obstructed, anything which increased the pressure
downwards would only distress him without removing the cause. I of
course concurred fully in the views and the course taken by the patient,
and without loss of time made use of a scoop, with which a large quantity
of cherry stones and hardened feces were removed, which gave immediate
and entire relief." [Boston Med. and Surg. Jour.

Menstruation in Old Age. J.J. Dixon, M. D., of Ashland, Tennessee;
in a letter to the editors of the Atlanta (Ga.) Medical Journal, gives the
following interesting item :

" In a few lines, I wish to record a brief account of a singular case to
which I was this day called. The patient was an old lady, aged 67, who
is now menstruating ; she is the mother of eight children ; her menses
ceased nineteen years ago, since which time she has enjoyed respectable
health. Menstruation returned eleven months since, and has now occurred,
in all, six times. She has not suffered any serious difficulty until the pre-
sent period, and her symptoms now seem to be only those attendant upon
painful menstruation." [Ibid.

New Use of Gutta Percha. It has been found that by covering a .part
of the conductor of an ordinary electrical machine with a thin sheet of

770 Miscellaneous.

gutta percha, the sparks that may be drawn from the part thus covered
greatly exceed in length those which can be obtained from the part uncov-
ered. It appears that this effect depends upon the obstacle which the
insulating sheet offers to the dispersion of electricity, which dispersion
tends to take place from the asperities of the surface of the conductor, and
which discharge it in part at a distance from this same conductor, when-
ever it is approached with a non-insulated conductor for drawing the sparks.
It is proposed, therefore, to cover the whole conductor of the machine in
this way in order to protect it from the action of moist air. [Memphis
Medical Recorder.

Fatal Error in a Medical Book. We insert the following important
correction, only adding that, in our judgment, either dose named is too
large for safety :

Strychnia. Dr. Fleetwood Churchill calls attention, in the English
journals, to an error in his work on Diseases of Females, which might lead
to serious consequences. He states in the work alluded to, in treating of
amenorrhcea, that strychnia has been given advantageously for its cure, in
the dose of from one-tenth of a grain to a grain, three or four times a day.
The latter dose would be unquestionably a poisonous one. The dose should
be from one-sixteenth to one-twelfth of a grain, and it would not be wise to
give more. [American Medical Gazette, Sept. 1856.

New Method of Making Sulphuric Acid. According to Kuhlmann,
when oil of turpentine is placed in contact with an aqueous solution of
sulphurous acid, and exposed to the air for some days, the mixture becomes
heated, and its temperature rises 90 Fahr., and even higher ; the odor of
sulphurous acid quickly disappears, after which, the ordinary temperature
is restored. By this reaction, for which, as it appears, the influence of the
sun's rays is required, sulphuric acid is formed at the cost of the oxygen of
the azonized oil of turpentine. The azonized oil exhibits the same oxidi-
zing properties towards hyposulphites, arsenious acid, etc. [N. Orleans
Med. News aud Hospital Gaz.

New Method of Forming Ether. When dry oxide of silver is treated
with an equivalent quantity of iodide of ethyl, a reaction at once ensues,
and there results iodide of silver and ether. This reaction is best conduct-
ed in a sealed glass globe which dips in cold water. Without this precau-
tion the globe breaks, from the violent evolution of heat. In the cold, this
double decomposition proceeds so slowly, that from one to two days is re-
quired to convert the whole of the iodide of ethyl into ether. The ether
separated by distillation in a water bath should be again treated with a
small quantity of oxide of silver, to remove the last trace of iodide of ethyl.

The same reaction takes place with iodide of methyl and oxide of sil-
ver. [Ibid.

A New Alloy resembling Gold. For some time a new alloy has been
employed in Paris for various purposes, which resembles gold in the highest
degree. It consists, according to an analysis made at the Royal Industrial
Institution of Berlin, of 90 parts of copper and 10 parts of zinc, [Ibid.

INDEX TO YOLUME XII.

PAGE.

Abscesses healed by first intention . 1 77

Abscess, Pharyngeal 287

Agassiz, Prospectus of new work. . . 65

Albany Medical College 258

Albinos 702

Allen's Practical Anatomist 767

Alexis St. Martin 380

American Med. Association, Trans-
actions of. .127, 190; 376, 437, 704, 768
American Pharmaceutical Associa'n. 18*7

American Physicians in Russia 255

American Contributions to Medical

Knowledge 574, 641

Amputation, its propriety in Spha-
celus 490

Anaesthesia by cold 58

do. local 193

do. by congelation 688

Anaesthetic uses of intense cold 402

Anaesthetics in the Austrian Army. . 192

Anaesthesia, remote effects of. 750

Anaphrodisiac, Brom. Pot 642

Aneurism Subclavian, new treatment 46

do. of sup. pal. artery 64

Angina, Pseudomembranous 244

Anchylosis, new operation for 312

Animal Odor 360

Antimonial Poisoning 634

Aorta, obliteration of 502

Aphtha 761

Apoplexy in relation to renal disease 310
Arnold, on relation of bilious and

yellow fevers 515

Articular bodies, removal of. 177

Arsenic, detection of 195

Arthritis, suppurative 613

Asphyxia, jugular venesection in. . . 481

do. new treatment of 631

Astringent application, new 321

Asylum for inebriates 258

Bandage, gypsum 103, 291

Barlow's Practice of Medicine 187

Bearded woman and child 125

do. do. another 251

Bebeerine, sulphate of 465

Beck's Mat. Med. and Therap 767

Bedford on diseases of women and

children 59, 511, 702

Beef-tea, acid 642

Bennet on Uterine Pathology 702

PAGE.

Billingslea on Quinine in uterine dis-
eases 77

Billingslea's case of bone in rectum. 145
Billingslea's appeal on behalf of So.

Med. Colleges and Literature. . . . 398
Blindness, vaccination in relation to 578

Blood-letting in young subjects 569

Bowman's Medical Chemistry 375

do. Practical do 767

Bones, tumors of the 564

Bougies, easy mode of constructing. 703

Borax and ergot 704

Brain, diseases of the 498

Brain, wound of 503

Bromo, ioduretted preparations. . . . 314

Brom. Pot., an anaphrodisiac 642

Brown on surgical diseases of women 373

Brandon's case of Lithotomy 678

Budd on diseases of the stomach. . . 187

Burney on typhoid fever 643

Burns, nit. silver for 250

Calculi in the female, new operation 735

Callus, promoted by phos. lime 688

Cancer in children 101

Cancerous tumors, etiology, &c, of. 227
Cancer, Llandolfi's treatment of . . . . 626

Caoutchouc, liquid 513

Carpenter on the Microscope 701

Casey on Tetanus 730

Cataract, seat and varieties of 50

Cataleptic Hysteria 284

Cauterization of abnormal divisions, 181

Caesarean operation 234, 386

Chancre, treatment of 102

Chalk, metastasis 175

Chambei's on digestion and its de-
rangements 510

Charcoal, properties of 561

Chlorate of Potass, its uses 760

Chlorate Pot. in mercurial stomatitis 55

Chloroformization in midwifery 104

Chloroform, deaths from 189

do. Formic acid in blood of

persons killed by 250

do. internal use of 322

do. in cynanche trachealis.. 494

do. in chorea 689

Cholera infantum, prize essay 386

Cholera infantum, &c. treatment by
water 677

772

INDEX.

PAGE.

Chorea, chloroform in 689

Children, how to nurse sick 60

Chilblains 642

Churchill on diseases of infants "700

Cincinnati Medical Observer 129

Cinchona, substitutes for 160

Cinchonia in intermittent fever 570

Circumcision to prevent syphilis. . . . 757

Cleft Palate 181

Cleaveland's Med. Lexicon 511

Collodion for entropium 66

Cooper on diet in disease 323

Collyrium of chloride zinc 450

Cornea, opacity of, treated by opera-
tion 99

Cotton Plant, on the root of 18

Cranium and brain, wound of. 503

Croup, treatment of 430, 7bl

Croup, chloroform in 494

Croup, diagnosis of true and false. . 637

Curling on disease of the Testes 610

Cysts of the wrist 762

Deafness, etiology of congenital. . . . 574

do. remote causes of 680

Death of J. McCafferty 437

Diarrhcea, premonitory 307

do. chloric ether in 509

Diabetes, pathology of 251

Diet, its value in disease. . . ., 323

Dilution as a principle in therapeu-
tics 553

Diphtheritis 761

Dislocation of the femur reduced by

manipulation 48, 296

Dislocation of the lower jaw, new

method of reduction 106

Dislocations of the shoulder joint, di-
agnosis of 131

Dislocation of the knee 186

Dislocations of tendons 680

Dislocation of thumb, new treatment 765

Disinfection, <fec, of manure 376

Disarticulation and amputation com-
pared 488, 697

Diuretic, grape-vine root as a 688

Dropsy, diuretics in renal 818

do. new mode of paracentesis. . 689

Draper's Human Physiology 7nn

Dugas on non-congenital Talipes... J7

do. local anaesthesia by cold. . . 58
do. diagnosis of dislocation of

shoulder joint 131

do. lithotrity in the female. .. . 212

do. cases of lithotomy 267

do. American contributions to

lical knowledge 574

do. prevention of yellow fever. 688
Dunglison's Human Physiology.... 7ol

do. new remedies 702

Dysentery, ipecac in 755

PAGE.

Eclampsia, uremic 231

Ecraseur, or crusher of Chassaignac . 61

Eczema 64

Empyema, peculiarities of 91

Eueuresis 568

Entropion treated by collodion 66

Epididymitis, cold in gonorrho3al . . . 759

Epilepsy, etiology of 112

Epithelial villous growths 183

Ergot and Borax 704

Ergot of wheat 322

Errata 514

Erysipelas, treatment of 577

Ether, new mode of forming 770

Eve's address to the class 61

Favus, poke-root in 417

Feeding, on forcible 321

Fever, blending of periodic and con-
tinued 467

Fever, cinchona in intermittent. . . . 570

do. iodide of pjt in 763

do. prevention of yellow 638

do. relation of bilious and yellow 515
do. Stone's treatment of yellow. 51

do. tar water in typhoid 507

do. temperature of body in inter-
mittent 629

do. treatment of tvphus 572

do. typhoid 643

Fistula in ano, treatment of. . . . 56, 302
do. lachrymalis, treatment of. . . 435
Flint on the diseases of the respira-
tory organs 373

Ford on the detection of arsenic. . . . 195

Ford, Dr. W. 1") 703

Fungus (nematodes, chlor. zinc for. . 508

Gallic acid 434

Gangrene from arteritis 695

do. of mouth 760

Gardner on sterility 510

Gold, new alloy resembling 770

Gonorrhoea, injection for 706

Goss on contagiousness of phthisis

pulmonalis 461

Gregory's inorganic chemistry 767

Gun-shot wounds, escape ofvesselsin 576
Gutta-percha, solution of 578

do. new use of 769

Bcemoptysis, treatment of 429

Bsemostal ic agents, value of different 178

1 [eemostal ic, new 514

Headland on the action of medicines 817

Heart, motion of, indicated 513

Hemorrhoids, new remedy 64

Hemorrhage and after pains 513

Hernia, strangulated femoral, 26 ca-
ses .it 563

Hernia, new mode of reducing 673, 686

INDEX.

773

PAGE.

Holt on general pathology 9, 67, 136,

202, 239, 387, 451, 536, 593, 663
Howard on treatment of pneumonia 590
Hubert ife Culver, gun-shot wound of

brain 79

Hydrocele 192

do. diagnosis of 320

do. radical cure of 498

do. of children, treatment. . . . 635
do. danger of iodine injections 573

Hydrophobia 512

Hydro-therapeutics 576, 707

Hydrocephalus, anatomy of chronic 108
Hypopyon, collyrium in 706

Impotence, lecture on 605

Insanity in France 192

Iodine paint for nsevi 107

do. vapor in ophthalmia 184

do. antidote to poison of rabid

animals 416

Iodide of iron, pills of 240

do. of potass in ague 763

Ipecac in dysentery 755

Isaac's anatomical remembrancer. .. 60
Itch, new treatment 322, 372

Joints, excision of 304

Jones on ophthalmic medicine and
surgery 374

Keratitis, prochlor. iron in 758

do. rhatany in 191

Kidney, microscopy of the 418

Kollock on the health of Savannah 332

Labor, presentation of dead chidren 316

Labor, induced by carbonic acid. . . . 488

Labor, new method of inducing. ... 621

LaBorde's Physiology 701

Labels, composition for attaching. . . 614
Laryngotomy <fe Tracheotomy, com-
parative value of 238

Law of patent nostrums 381

Lead, its effects on the heart 255

Lehmann's Chemical Physiology. ... 374

Liniment, St. John Long's 322

Lithotrity in the female 212

Lithotomy 267, 678

Liver, minute anatomy of 290

Liver, minute structure of 110

Liver, fatty Ill)

Lizard in the stomach 63

Louisville Review 375

Lower Jaw, removal of 42S

Lupulin in Spermatorrhoea 764

Manuscript of the Elder Pliny 386

Medical Society of Georgia, 190, 254, 318

do. College, female 192

do. do. of Georgia 252

PAGE.

Medical College of Savannah 253

do. do. Oglethorpe 253

Meigs' Midwifery i 767

Menorrhagia, bebeerine in 57

Menstruation, vicarious 358

Menstruation in old age 769

Mercurial Ointment, by a quick pro-
cess 450

Milk in the breast, removal of 577

Miller's Principles of Surgery 374

Monthly Stethoscope 189

Mortality Statistics of the U. S 127

do. influence of occupation on 384

Muguet of infants 95

Muguet 761

Muriate of Opium 450

Muscles, progressive atrophy of. . . . . 480

Muscular Atrophy and Paralysis. . . 628

Na;vi cured by iodine paint 107

Nrevus treated by vaccination 632

Necrology ' 37 5

Necremia 414

Necrosis from vapor of phosphorus. . 428

Needle removed from thigh 512

Negro race, peculiarities of the 21, 88, 147

Neill's Analytical Compendium 374

Neilson, on Sulph. of Bebeerine. ... 465
Neligan's Atlas of Cutaneous Diseases 375
Nerve and muscle, metamorphosis of 478

Neuralgia, cafein in 698

New York Medical Times (. . . 703

Nose, congenital absence of 413

Ophthalmia, iodine vapor in 184

do. ol. tereb. & cod-liver oil in 690
Ovariotomy, thirty cases of 182

Pajot's obstetric tables 511

Pancreas, pathology of 236

Paraphimosis, operation for 566

Parasite in man, a new 190

Parish's Pharmacy 126

Pathology, Letters on General 9, 67,
136, 202, 259, 387, 451, 536, 593, 663

Patella, absence of. 766

Pectoral Syrup 578

Perineum, laceration of m Prima Para; 409

Pertussis, sweet whey in 193

do. its history, &c 346

Peritonitis terminating in suppura-
tion of testicle 143

Phagedena, new treatment 493

Phosphorus, detection of poisoning by 568
Phosphate of Lime in the production

of callus 688

Phthisis Pulmonalis. Is it conta-
gious ? 461

Phymosis, simple operation for 248

Placenta Prasvia 271, 299, 419, 558

Pneumonia 590

774

INDEX.

page.

Pneumonia, various treatments of. . . 43

do. discussed in 33 aphorisms, 426

do. treated by quinine 691

Pneumonia and Pleurisy, treatment, 766

Poisoning by antimonials 634

do by stramonium 753

Pregnancy, influence of in certain

diseases 122

Pregnancy, fallopian and uterine si-
multaneously 129

Pregnancy, dropsy of 565

Professorial changes 703

Puerperal fever, contagiousness of. . 108
Puerperal convulsions prior to labor, 192
Puerperal fever, protection against . . 254

Quinated cod-liver oil 492

Quinine in uterine diseases 77

Quinine, consumption of. 514

do. in pneumonia 691

Ramsay, Dr. H. A 436

Ranula, treatment of 698

Rectum, cherry stones in 769

do. bone in. 145

Renal disease and apoplexy 310

Renouard's history of medicine 60

Rhatany, decoction of in keratitis. . 191

Rheumatism, alkaline treatment of.. 573

Rhinoplastic operation, new 413

Rivers, peritonitis terminating in

suppuration of testicles 143

Sargent's minor surgery 126

Savannah spring school of medicine . 254

Scarlatina 3

Scarlatina anginosa 366

Scarlatina, relations to rheumatism. 548

Sciatica, treatment of 54

Scorbutus 761

Seton, discussion on the 436

Skin diseases 308

do. iodine in 6-12

Skin, remedy for tatooed 769

Smith on Scarlatina 3

Spermatorrhoea, lupulin in 764

Sphacelus, propriety of amputation

in 490

Spinal marrow, functions of. 173

Spinal cord and nerves, structure of 306

do. lesions of 432

Spontaneous escape of fluid from pe-
ritoneal cavity 185

Statistics applied to medical science 165

Stomatitis, mercurial 55

do. ulcero-membranous 761

PAGE.

Stomach, ulcer of the 5o6

Strychnia, detection of 496

do. antidote for 509

do. error of dose 770

Sugar, rapid detection of 578

Sulphuric acid, new formula 770

Sulph. bebeerine in monorrhagia. . . 57

Sun-stroke, cause of 483

Surgery, sub-cutaneous 119

Sweet gum 491

Syphilis prevented by circumcision. 757

Syphilis, a sign of congenital Ill

Syringes, glass female 191

Talipes, non-congenital 17

Taylor's medical jurisprudence 700

Tephrosia Virg., fluid extract of . . . . 156
Tetanus, seven cases of 97

do. traumatic 730

Thunder storms, safety during 705

Tobacco, experiments on smoke of. . 109

do. excessive smoking 744

Toe-nails, ingrowing 637

Tooth extraction, painless 193, 437

Tracheotomy in Croup 303

Twins, researches on 256

Ulcers of the legs 562

do. do. chalk ointment in. 322

Urinary organs, anatomy of 636

Urethra, diseases of the female 338

Uterine diseases, quinine in 77

Uteri, prolapsus of, treated by tannin 158

Uterine affections 214

Uterus in a man 449

do. action of digital-is on 567

Uterine haemorrhages 271

Vaccine matter 256

Varicocele 371

Varicose veins, origin of 311

Varioloid and varicella. . . .'. 369

Veterinary colleges in the U. S 189

Vidal on venereal diseases 60

Vitis vinifera, as a diuretic 633

Vomiting arrested by sulphur 436

Watson's history of the Med. Prof. . 511

White swelling 36

Wharton's medical jurisprudence. . . 126

Wilson on hydro-therapeutics. .579, 707

do. on cholera infantum, &c. ... 677

Wilson's dissector's manual 702

Women's hospital of New York. . . . 375

Wood's therapeutics 699

Works received 129, 254

Wright on headaches 511

c^^3^

TWENTY-FIFTH

ANNUAL ANNOUNCEIENT

OF THE

tVttnl s\U$t f tst$h.

AUGUSTA.

FACULTY

OF THE

cbttal dtjlltge flf (tap.

G. M. NEWTON, M. D.r

PROFESSOR OF ANATOMY, GENERAL AND DESCRIPTIVE,

L. A. D UGAS, M. D.,

PROFESSOR OF THE PRINCIPLES AND PRACTICE OF SURGERY,

ALEXANDER MEANS, M. D.,

PROFESSOR OF CHEMISTRY AND PHARMACY.

I. P. GARVIN, M. D.,

PROFESSOR OF MATERIA MEDICA, THERAPEUTICS, AND MEDICAL
JURISPRUDENCE,

L. D. FORD, M. D.,

PROFESSOR OF THE INSTITUTES AND PRACTICE OF MEDICINE.

H. V. M. MILLER, M. D.,

PROFESSOR OF PHYSIOLOGY AND PATHOLOGICAL ANATOMY.

J. A. EVE, M. D.,

PROFESSOR OF OBSTETRICS AND DISEASES OF WOMEN AND INFANTS.

H. F. CAMPBELL, M. D.r

PROFESSOR OF SURGICAL, COMPARATIVE & MICROSCOPIC ANATOMY.

ROBERT CAMPBELL, M. D., Demonstrator of Anatomy.

S. B. SIMMONS, M. D., Assistant Demonstrator.

JURIAH HARRISS, M. D., Prosector to the Professor of Surgery.

G. M. NEWTON, M. D., Dean.

Hon. WILLIAM SCHLEY, President of the Board of Trustees
Hon. EBENEZER STARNES, Vice-President,
H. F. CAMPBELL, M. D, Secretary.

Augusta, Ga., July, 1856.

%

mural ^ttttottttmntttt.

The Twenty-fifth Course of Lectures in the Medical College of
Georgia, (at Augusta) will commence on the first Monday in November
next, with a general Introductory by Professor L. D. Ford.

It affords the Trustees great pleasure to announce to the Medical Profes-
sion, and the Public generally, that the Institution is still in a highly pros-
perous condition, as the number in attendance at the last session will fully
testify. A quarter of a century has sufficed, not only for the permanent
establishment of the College, and the collection (at a cost of between fifty
and sixty thousand dollars) of all the appliances for a thorough Medical
Education, but has secured the favor and unwavering confidence of the
Profession. The Trustees appeal without hesitation to the character of
their numerous graduates now numbering about eight hundred for the
the evidence of the thoroughness of the course of instruction.

For the purpose of furnishing an Education to those who expect to prac-
tice in a Southern field, where the diseases are so strikingly modified by
climate and the many other influences of locality, the Trustees feel fully
warranted in saying that public opinion has for years past been decidedly
in favor of Southern Medical Institutions. Not among the least of
these influences are the peculiar phases assumed by many diseases as they
occur in the coloured portion of our population, which must necessarily
constitute an important part of the practice of every Southern Physician,
and in relation to which, he can receive but little available indoctrination
in the Northern Schools. This point the Trustees feel it their duty to insist
upon with great emphasis, as an advantage of which no amount of sophis-
try can deprive their Institution and its graduates, before any thinking and
judicious community ; and they would appeal to the Graduates of Northern
Colleges, now practicing in the South, to vouch for the correctness of the
assertion, that it was only by experience and personal observation that they
were enabled to remedy the deficiencies attaching to a Northern course of
instruction, in relation to this class of their patients.

We are aware that whenever these claims of Southern Medical Institu-
tions have been advanced, they have been met with the warmth of severe
criticism on the part of the Northern press, charging us with mixing up
unworthy sectionalism with scientific enquiry, or, at least, of pandering to
popular prejudices ; but feeling fully persuaded of the justness of these
claims, we still urge and insist upon their recognition as truths, the denial
of which is an insult to common sense, reason and universal observation,
and which the everyday experience of Southern Practitioners will abund-
antly substantiate.

With an able and experienced Faculty, an extensively supplied Museum,

a large and well selected Li braiy, and constantly increasing facilities for the
study of all the various branches of Practical Medicine, the Board of Trus-
tees feel safe in presenting their Institution as in every respect worthy the
continued confidence and support of the Southern Medical Public.
The branches taught in this Institution, are :

ANATOMY.

BY GEORGE ffl. NEWTON, M. D.

The lectures on this branch will describe minutely the various parts of
the human organism their intimate structure, and the relations to each
other and to practical purposes. The entire course will be illustrated by
recent dissections, anatomical preparations, models, plates, and diagrams.

PHYSIOLOGY AND PATHOLOGICAL ANATOMY.

BY H. V. M. MILLER, M. D.

It is generally admitted, that the phenomena of disease cannot be inter-
preted with any probability of correctness, nor remedies applied with any
reasonable expectation of success, without a thorough acquaintance with
the normal action of the system. It will be the object, therefore, of the
Professor of Physiology to bring to the notice of the class a full considera-
tion of the elements entering into the formation of living tissues; the devel-
opment, structure and action of these, in their primary forms, and the
functions of the various organs of the body keeping in view throughout
the course, the practical ends of professional study, and passing lightly by
the numerous speculations which crowd the pages of writers on this de-
partment. Those facts and objects of investigation which will be most
beneficial to the practitioner will receive the fullest and most faithful at-
tention.

As morbid action is most easily comprehended when studied in connex-
ion with the healthy, of which it is but a perversion, the study of Patholo-
gical Anatomy not unnaturally connects itself with the Physiological
course. The changes in the living organism induced by disease, will be
traced to their origin in the original elements, or the primary tissues of the
body; and the mode of formation, the classification, and description of
morbid specimens will be as fully treated as the length of the term will
permit.

Both of these branches will be illustrated by drawings, diagrams, speci-
mens, &c, in such manner as greatly to facilitate the comprehension of
the student.

SURGICAL, COMPARATIVE ANR MICROSCOPIC ANATOMY.

BV HENRY F. CAMPBELL, M. D.

Much of the importance of the study of Anatomy to the Medical Student
consists in its application to Surgery, and Surgical operations. The prac-
titioner who may be located in the country, deprived of the opportunity of
repeating his dissections, and often called upon to operate without even the

5

advantage of a consultation, must deplore the want of such an accurate
knowledge of Anatomy, as will give him confidence for his task, and secure,
through him, safety to his patient. The Trustees, being fully impressed
with its importance, and persuaded that lessons in Anatomy cannot be too
much varied or too often repeated, have instituted Surgical Anatomy an
important branch of this chair. The course will consist of a series of de-
scriptive Lectures and Demonstrations of the Relative Anatomy of the most
important regions of the Human Body, particularizing the arteries, nerves,
veins, <fec, of each region, the injury of which would endanger the life of
the patient or embarrass the surgeon during his operations.

The Lectures on Comparative Anatomy, will give a general, but suffi-
ciently complete, review of the various orders in the zoological scale, to
enable the student to obtain a knowledge of the transcendental or philoso-
phical anatomy of the various organs in the human being. In addition to
the knowledge of comparative anatomy which the student will thus obtain,
this branch will be found to assist him very materially in his study of
human anatomy, by bringing in review before him the various organs as
they occur in their simplest forms in the lower orders, till finally they have
attained their greatest perfection in the more complicated structure of the
human frame.

In this course, the lecturer will endeavor to make his teachings as much
as possible subservient to the simplifying of the study of Human Anatomy,
and thus this last study, instead of being a mere labor to the memory, will
become enlivened by the contemplation of beautiful correspondencies, be-
tween the organs which will universally present themselves for the contem-
plation of the student.

The course of Microscopic Amatomy will be illustrated principally by
large painted diagrams, and also by the blackboard; but when time will
allow, opportunity will be afforded the Class of seeing the objects treated
of through the Microscope. This opportunity will be frequent even to
every member of a large class, as our Institution is well supplied with fine
Instruments there being six in the College, some, the work of the very
best makers in the world.

SURGERY.

BY L. A. DUGAS, M. D.

The Professor of Surgery arranges the studies of his Department under
five distinct heads or classes, of which the following is a very brief epitome :

The 1st class comprehends the Diseases which occur spontaneously, or
such as are induced by causes more or less unknown. This class is sub-
divided into five orders, thus :

Order 1. Inflammatory affections to wit: Inflammation, its phenomena
and terminations in resolution, adhesion, effusion, suppuration, ulceration
and mortification ; furuncles; whitlows; abscesses, both acute and chronic,
of various parts of the body; ulcers of all kinds; gangrene; carbuncle;

erysipelas; scrofula; diseases of the bones and joints, &c, &c. Oorder 2.
Morbid Productions. Tumors of all kinds: ganglions, glandular enlarge-
ments, bronchocele, lipoma, polypi ; fibrous, nervous, encysted, and malig-
nant tumors. Order 3. Lesions of Bloodvessels. Aneurism, Aneurism by
anastomosis, naevus, varicose veins, hemorrhoids. Order 4. Displacements :
prolapsus ani, prolapsus uteri, hernia. Order 5. Congenital Deformities, such
as may require surgical treatment : club-foot, contracted or webbed fingers
and toes, spina bifida, imperforate anus or vagina, hare-lip, cleft palate, &c.

The 2d class includes the Diseases induced bg special irritants, to wit :
1, by Animal Poisons syphilis, gonorrhoea, glanders, malignant pustule,
bite of venomous reptiles and insects, hydrophobia, dissecting wounds. 2,
by Chemical agents. 3, by Caloric. 4, by Cold.

The 3d class contains the Diseases induced bg external violence : as
1. Concussion ; 2. Contusions ; 3. Wounds incised, punctured, lacerated,
gunshot ; 4. Tetanus ; 5. Fractures, in general and in particular ; 6. Sprains ;
7. Dislocations, in general and in particular ; 8. Foreign substances intro-
duced into the eye, ear, nostrils, pharynx, esophagus, larynx, trachea,
urethra, vagina, rectum, &c.

The 4th class comprehends the Diseases of special apparatuses as Dis-
eases of the Eye and its appendages; Diseases of the Ear; Diseases of the
Genito-urinary apparatus.

Finally, the 5th class refers to Operative Surgery in the study of which
no pains are spared to demonstrate and make familiar to the student all the
details of minor surgery as well as all the operations that may be perform-
ed upon the dead subject. The Professor will here avail himself freely of
the valuable aid of Dr. J. Harriss, Prosector.

During the session, the Class will have the opportunity of witnessing as
many operations as the combined efforts of the Faculty may be able to
bring before them,

CHEMISTRY AND PHARMACY.

BY ALEXANDER MEANS, M. D.

To facilitate the acquisition of knowledge in this interesting department
of a medical education, an extensive Philosophical and Chemical Apparatus
is at the disposition of the Professor. Many of the most important instru-
ments have been selected under his own eye, or prepared to order some
of them, never before constructed; and the entire collection, embracing
articles of the latest patterns and finest model, manufactured by the most
approved makers in Paris, Boston, New York and Philadelphia.

The laws of Pneumatics are illustrated extensively both in their relation
to Philosophy and Chemistry, by one of Chamberlain and Ritchie's magni-
ficent Lever Air-pumps, accompanied by an imposing series of appendages,
all made available in simplifying the principles involved, and bringing them
clearly to the apprehension of even novitiates in the science.

A beautifully finished Electrical Machine, mounted upon a cruciform,

rose-wood frame, 8 feet long and 4 feet high, with a French Glass plate,
32 inches in diameter, supplies an abundant current for the boldest and
most brilliant experiments in the Science of Electricity.

The phenomena of Electro-Magnetism, and Magneto-Electricity, now
so intimately connected with the most recent researches of Matteucci,
Zantedeschi, and Favio in Electro-physiology, are exhibited by many pieces
of new, delicate and striking Apparatus, and the principle taught, made
applicable, as far as the present advancement of science authorizes, to the
laws and phenomena of organic matter.

A large Grove's Battery, consisting of from 24 to 48 pairs of zinc and
platinum, furnishes to the Professor, the best arrangement for a vigorous
and constant Galvanic current yet known to Chemistry.

The Course will consecutively embrace :

1st. The Imponderable substances, i.e., Light, Heat, Electricity, Galvan-
ism, Magnetism, with their various combinations.

2d. Inorganic Chemistry, preceded by experimental illustrations of the
laws of Chemical Affinity and Specific Gravity, together with an explana-
tion of the Chemical Nomenclature, Chemical Symbols, &c. Its natural
division being:

(1.) The non-metallic elements gaseous, fluid, and solid.

(2.) The metallic elements.

The simple substances being known, next follow their combinations, em-
bracing the whole range of Salts used in Medicine, the Arts, &c.

3d. Organic Chemistry, mainly with reference to the constituents of
the various solids and fluids of the human body, and to the chemical
changes going on under the laws of life. Under this head may be classed
the Chemistry of Animal Heat, Vital Force, Respiration, and the sanguif-
erous circulation, all of which will command the special attention of the
Lecturer. Chemistry with its application to the Medical Profession,
will receive more than the usual share of attention by the Professor of this
Department.

According to the order most approved, the Pharmacy of the course is
blended with the disposition of the simple and compound bodies exhibited :
the mode of preparation, coming in most appropriately, with these details.

INSTITUTES AND PRACTICE OF MEDICINE.

BY L. D. FORD, M. D.

The Professor of the Institutes and Practice of Medicine, commences his
course with a general survey of the human body, leading to the view of its
composition of a collection of organs. These organs examined in the
physical, chemical and vital habitudes of their elementary tissues, under
the guidance of Analytical Anatomy, leads to a high and due estimate of
this science in the study of critical pathology. The functions of life re-
sulting only from the action of these organs, the mechanism of these normal
vital actions is examined and analysed, so far as can be done, by physical

8

science this knowledge indispensable to the understanding of the abnor-
mal actions.

Some of the more prominent subjects of General Pathology examined

Disease Its nature, deduced by consideration of its characters, its
physical and functional symptoms the disordered state of the disordered
acts forming two indispensable elements of disease.

Symptomatology and Semeiology. Symptoms What they are how
they come their use physical and functional, their relative value their
observation their interpretation into signs.

Diagnosis. Its value its methods, &c. Prognosis, Nosology, Etiolo-
gy, dc.

The examination of these subjects presenting the opportunity of estab-
lishing the general principles of a sound medical philosophy, according to
the organic school of medicine.

In the study of individual diseases, they are arranged in five general
divisions :

I. Fevers 1. Ephemeral fever. 2. Paroxysmal, Intermittent and Re-
mittent with variations, 3. Yellow fever. 4. Continued fevers a. Simple.
b. Typhus and Typhoid.

II. Diseases of the Brain and Nervous System preceded by physiologi-
cal considerations.

III. Diseases of the Chest of the Heart and Lungs, and of their ap-
pendages preceded by the full development of the method of physical
exploration, by mensuration, auscultation and percussion simple and
stethoscopic.

IV. Diseases of the Abdomen.

V. Diseases of the Skin, &c.

These diseases are studied with the end of obtaining as critical a know-
ledge of their pathology as the present state of the science affords, as the
best basis for their successful treatment : Hence advantage is taken of the
Plates of the best writers on Pathological Anatomy and Special Pathology,
with which the College Library is so amply furnished; as also, of those
valuable, plastic, colored pathological preparations, which grace the Col-
lege Museum.

OBSTETRICS AND DISEASES OF WOMEN AND INFANTS.

BY JOSEPH A. EVE, M. P.

The Professor of Obstetrics and Diseases of Women and Infants divides
his course of lectures into four parts:
, The first consists of the peculiar Anatomy and Physiologv of the female
svstem, except parturition, which constitutes the second part.

After a full description of the bony pelvis and foetal cranium and all the
organs concerned in the process of parturition, menstruation and all its
disorders are considered, in detail. The various stages of development of
the gravid uterus and evolution of the embryo and foetus are illustrated by

9

two series of beautiful models, which are most life-like and true to nature,
one of wax and the other of papier maehe. The symptoms and signs of
Pregnancy are carefully explained, as well as the diseases incident to that
state.

In the second part, after treating of the process of parturition and the
conduct of the accoucher, and the assistance to be rendered during labour,
its mechanism in all the various presentations and positions, and all ob-
stetric manoeuvres and operations are plainly demonstrated on the manakin.
All the impediments and complications that may render labour tedious,
difficult or dangerous, are thoroughly considered ; after which, attention
is directed to the management of the puerperal state and the diseases pe-
culiar to it.

The third division, consists of lectures on the most important affections
peculiar to females such as, the various displacements of the Uterus and
the structural diseases of that organ, malignant and non-malignant, most
of which are illustrated by a very valuable set of models, carefully selected
by Professor Dugas, while on his last visit to Paris, and also by elegant
Plates and morbid specimens from the College museum. All the instru-
ments required in the treatment of these maladies are exhibited to the
Class and their use explained.

The last division comprises lectures on Infantile Diseases, principally
those that are congenital or that occur during the first few months.

MATERIA MEDICA, THERAPEUTICS, AND MEDICAL

JUK1SPBIUENCE.

BY I. P. GARVIN, M. D.

In this Course, the general principles upon -which the action and appli-
cation of the various medicinal agents depend are fully examined. The
botanical relations, chemical constitution, and therapeutic application of
each article of the Materia Medica is fully explained, and specimens of each
exhibited to the Class. The course on Medical Jurisprudence will present
a full notice of the medico-legal questions connected with Legitimacy,
Impotence. Sterility, Rape, Pregnancy, Delivery, Insanity, Wounds, and
other subjects belonging to this department of knowledge.

PRACTICAL ANATOMY.

To render the Instruction in this important department of Anatomy
efficient, has been the constant and combined care of the whole Faculty,
Attaching great importance to 1 >issections, they have made the most reliable
arrangements for an ample supply of material, and the best opportunities
will be afforded each member of the Class, to acquire a thorough acquaint-
ance with the Anatomy of the Human Frame in all its bearings and rela-
tions. This department is still under the care and experienced management
of Dr. Robert Campbell, assisted by Dr. S. B. Simmons.

10

CLINICAL INSTRUCTION.

The Class have free access to the City Hospital, which is under the
charge of the Faculty. Clinical Lectures are delivered in the Hospital
twice a week. In addition to this, all the cases of interest, and Surgical
operations, in the Jackson-street Hospital, under the charge of the Drs.
Campbell, and in the Infirmary of 1'rof. Dug as, will be brought to the
notice of the Class. Students who may desire practical instruction in
Obstetrics, will find ample opportunities among our large colored popula-
tion, and the Professor of Obstetrics, in every such case, will superintend,
and give the pupil practical instruction.

No extra charge is made for Clinical instruction.

COLLEGE LIBRARY.

The Library consists of over four thousand volumes of the most valuable
and latest works on the various departments of medical science, besides
beautiful plates, diagrams, <fec, &c.

MUSEUM.
The College Museum is one of the most extensive, interesting and valua-
ble in the United States; and is continually receiving new contributions.
In order to convey some idea of its value to the student, we will merely
enumerate the following objects it contains :

A number of articulated and disarticulated skeletons; numerous preparations of the
cranial and facial hones connected and disconnected.

Several complete series of disarticulated foetal bones, arranged in frames.

A number of articulated skeletons of deformed individuals.

Complete scries of pelves, normal and deformed, for obstetrical study.

Large collection of diseased bones, illustrating the various affections of the osseous
system.

A collection of 80 specimens, natural and artificial, illustrative of craniology.

Complete series of foetal crania.

A series of foetal skeletons exhibiting the conditions of the osseous system at twelve
different periods.

A series of 12 preparations showing the process of dentition at all ages.

A series of preparations of the distinct vertebrae and of the vertebral column,
showing the human and comparative anatomy, internal conformation and oste-
ology of these bones.

Entire skeletons of the principal divisions of vertebrated animals; for the study of
comparative anatomy.

The skeleton of a foetal acephalous monster.

Auzoux's Adult Clastic Anatomy, being a preparation of full adult size, made of
papier mache, and representing a complete dissection of every portion of the body,
muscles, blood-vessels, nerves, brain, and spinal marrow; thoracic, abdominal
aitd pelvic viscera; organs of the senses, Ac; the whole so constructed that its
minutest subdivisions may be taken asunder and again put together.

Auzoux's Magnified Clastic Anatomy of the Head and Neck this preparation being
made very large for purposes of demonstration.

Models exhibiting the minute distribution of the vascular and nervous fsystems of
the head.

11

Model showing the minute distribution of nerves within the orbit.

Separate models of all the viscera, the eye and the ear.

A series of beautiful Wax preparations by the best French artists, exhibiting the
muscular, vascular, nervous, splanchnic, and sensorial organs. Also, one of the
Foetus, in which the peculiarities of foetal circulation are displayed.

Models of the Brain, large and small and also of the cerebrospinal axis.

Preparations of the lymphatico-chyliferous system.

An extensive series of preparations of the natural subjects, dry and wet, consisting
of complete dissections illustrative of all the ligaments, muscles, heart, arteries
and veins, brain, spinal marrow and nerves, membranes of the cranial and verte-
bral cavities, ifce.

Carteaux splendid series of Models illustrating Surgical Anatomy.

A complete series, preserved in alcohol, shewing the development of the embryo
from the earliest moment to the full period of utero-gestation, embracing at least
twenty distinct periods.

Auzoux's extensive series of Ovologieal preparations, exhibiting the development of
the embryo, its membranes, and the womb at each month of utero-gestation.

Another series, by Guy, shewing also the development as well as the relative posi-
tions of the pelvic organs and the changes of the os tincae at all periods prior to
and during parturition.

Auzoux's Clastic Anatomy of the female pelvis and pelvic organs.

Models of the male and female genito-urinary apparatus.

Obstetrical mannikins.

Specimens illustrating morbid conditions of the foetal life.

Collection of Parasitic worms.

A beautiful series of 42 models in enamel, exhibiting the various diseases of the eye.

Numerous preparations in alcohol, illustrative of Morbid Anatomy.

A dry preparation, in which all the thoracic and abdominal viscera were found to
be transposed.

Numerous specimens of human monstrosity comprehending several acephalous
monsters, two cases of duplex or Siamese monstrosities, one of Hypospadias, and
a fully developed Cyclops, believed to be the most perfect specimen of the kind
in any museum.

An interesting collection of monstrosities of lower animals.

Collection of preparations in Comparative Anatomy, in alcohol.

Thibert's splendid models illustrative of the diseases of the uterus, of the male
genito-urinary organs, and of cutaneous eruptions and ulcerations.

A complete set of Surgical instruments and apparatus.

Acomplete cabinetof Materia Medica, carefully selected and put up in glass-stopped
bottles by one of the best druggists of New York, specially for this College.

This museum contains also a large collection of objects, which, although not
strictly appertaining to the domain of Medicine, may be deemed of general inter-
est. Among these may be mentioned: an extensive Mineralogical and Geological
Cabinet also, of Conchology, and of Ornithology. Numerous antiquities of the
Aborigines ; Egyptian mummies, entire and in fragments, <fec, &c.

12

FEES.

For the whole Course $105 00

Matriculation, (to be taken once,) 5 00

Practical Anatomy, 10 00

Diploma fee, 30 00

REQUISITES FOR GRADUATION.

" No Student shall be an eligible candidate for the Degree of Doctor of Medicine,
until he shall have attended two full Courses of Lectures in this, or one in this, and
one in some other Medical Institution, in addition to the usual private reading
in Medicine, and shall have delivered to the Dean of the Faculty an original Thesis
on some medical subject, one month previous to the annual Commencement. In no
case shall a Student of immoral character be admitted to examination."

The Graduates of the Medical College of Georgia are entitled to practice Medicine
in this State without license from the Medical Board. Upon this question, we ap-
pend the legal opinion of the late Hon. A. J. MrLLER.

(LEGAL OPINION.)

AUGUSTA, February 15th, 1853.

I have been requested to give my opinion upon the qnestion, whether the Gradu-
ates of the Medical College of Georgia are required to undergo an examination
before and to receive license to practice from the Board of Physicians.

This inquiry, I think, is plainly and satisfactorily answered by the ninth section of
the act of 1828 (Dawson's Compilation, 196) incorporating the Medical Academy
(now the Medical College) of Georgia. That section declares that

"The Graduates of the Medical Academy shall be allowed to practise Medicine
and Surgery in this State, in the same manner as they would have been, had they
been examined and licensed by the Board of Physicians of the State of Georgia;
any law, custom or usage to the contrary notwithstanding."

Considering the act of incorporation a contract between the state and Institution,
and the section in question as giving a privilege conducive to the prosperity of the
latter, I do not believe it to be in the power of the Legislature, by any subsequent
act, to impair any part of the franchise conferred. The Legislature has not so in-
tended ; for while, by the arts of 1829 and 1833, the name of the corporation has
been twice changed, and by the last an outfit provided, thepowers and privileges
conferred by the original charter upon the College and its graduates have not been
interfered with.

It is true, that the Act of 1825, (Cobb's New Digest, 886.) prohibiting physicians
fromipractising without a license from the Board of Physicians, has been revived by
the Acts of 1889 and 1817 yet, as the Charter of the College relieved it from the
provisions of that Act, afterwards repealed, the revival of it cannot affect the ex-
emption previously granted.

ANDREW J. MILLER,

Attorney at Law.

&I&&3M&W

OF THE

MEDICAL COLLEGE OF GEORGIA

To tlie Commencement held March* 1856.

Adams, David
Adkins Daniel F.
Adkins, Wm. L.
Agar, Charles
Alexander, J. F.
Alfriend, Wm. L,
Alfriend, E. W.
Allday, A. P.
Allen, James P.
Anderson, A. F.
Anderson, L. G.
Anderson, W. A. J.
Andrews, T. G.
Antony, Edw. LeR.
Antony, Milton
Antony, D'Coucy
Antony, S. W.
Ardis, C. W.
Archer, R. A.
An'ington, W. J,
Attaway, A. F.
Austin, Robert
Avary, J. C.
Bailey, D. F.
Bailey, B. B.
Bailey, W. T.
Baker, J. L.
Baker, P. D'L.
Barber, J. W.
Barton, J. F.
Barton, Willoughby
Barton, R. T.
Bartow, J. T.
Barry, E. J.
Bass, C. H.
Baston,
Bates, James
Banks, A. L.
Beach, Asahel
Beazley, J. S.
Bedel, Joseph
Bedell, C. W.
Bell, E. T.
Bell, F. R.
Bell, John S.
Belt, L. C.
Belt, R. B.

Bentley, B. F.
Berrie, E. J.
Bexley, A. R.
Bignon, II. A.
Bignon, A. F.
Billingslea, J. C,
Bird, R. L.
Black, R. C.
Blair, C. L.
Bod die, T. A.
Bolnn, M. J.
Bolton, G. W.
Bond, W. P.
Bothwell, W.C.
Bothwell, D. J.
Borders, J. M'D.
Bow en, Isaac
Bowers, J. M.
Bowers, B. F.
Bowdoin, J. W.
Bowdre, T. E.
Bowie, W. C.
Boyd, Samuel
Boyd, J. C.
Bozeman, R. L. G.
Brantley, F. M.
Brewster, B. D.
Brewster, S. H.
Brock, Elias
Brooks, T. J.
Browne, Jasper
Brown, Josiah
Brown, E. A. D.
Brown, A. G.
Broadhurst, W. W.
Brunson, S. T.
Brunson, S. C.
Bryans, J. H.
Buchanan, J. C.
Bunch, J. M.
Burdell, Thomas
Burns, J. M,
Burt, W. M.
Burton, G. T.
Burton, G. W.
Bussey, N. J.
Burke, Rodney

Byrd, John G.
Calhoun, J. C.
Campbell, H. F.
Campbell, Robert
Cade, G. M.
Carroll, J. C.
Carswell, E. R.
Carter, J. W.
Carter, J. A.
Carlton, J. B.
Camac, James
Carey, H. H.
Casey, H. R.
Cartledge, J. J.
Cartledge, J. J.
Caver, S. R.
Clarke, S. B.
Clark, J. W.
Clarke, C. E.
Clarke, G. T.
Claybrooks, W. E,
Clardy, William
Clardy, John
Clement, J. S.
Clopton, J. P.
Cochran, W. L.
Cochran, R. J.
Cochran, J. W.
Cody, J. M.
Cobb, J. C.
Colley, F. S.
Collier, H. G.
Collier, W. E.
Collins, Dennis
Cooke, H. R.
Cook, J. E.
Colquitt, J. M.
Cooper, J. D.
Cooper, V. S.
Cooper, John J.
Couch, J. M.
Couch, A. G.
Cousins, W. E. M.
Cox, A. M.
Cox, W. D.
Cox, M. C.
Crawford, W.W.B,

Crawford, J. L.
Creighton, A. J.
Crews, J, E.
Crowder, O. W.
Cullens, A. A.
Culver, E. V.
Cumming, W. H.
Cummins, R. L.
Cunningham, L. S.
Cunningham, G. C.
Dannelly, F. 0.
Dansby," D. MeA.
Darden, G W,
Darling, T. J.
Darnall, J. M.
Davidson, Paul
Davis, W. H.
Davis, T. C.
Davis, L. W.
Davis, J. G.
Davis, C. Z. W.
Davis, Elias
Davenport, I. T.
Day, David
Deane, W. W.
Dearing, W. Edward
Deadwyler, M. P.
Dent, j. M.
Dicken, B. B.
Dickinson, J. F.
Dickinson, R. A.
Dillard, J. H.
Dill, C. B.
Dismukes, J. T.
Dixon, R. K.
Donald, Alexander
Dorsey, T. A.
Douglass, Tilman
Dougherty, W. H.
Doyle, B. R.
Dozier, T. H.
Dozier, L. P.
Dunn, W. G.
Dunn, J. B.
Duncan, T. W.
Dunham, T. K,
Dunham, M. S,

14

Earle, J. W.
Earle, P. H.
Ellington, W.H.
Ellison, J. E.
Elliot, \V. M.
Etheridge, J. A.
Etheridge, R. H.
Eshom, J. L.
Eskew, Isaac R.
Evans, B. C. II.
Eve, E. A.
Evins, J. A-
Fambro, L, C.
Fant, E. M.
Farmer, S. J.
Felton, W. II.
Ferguson, S. G. K
Fitten, F. E.
Flake, B. C.
Fleming, N. K.
Floyd, L.
Foote, R. T.
Ford, T. B.
Ford, H. W. D.
Fort, G, W.
Fokes, J. M.
Forbes, J.
Fowler, A. S.
Fryer, R. II.
Fryer, B. E.
Gaither, Henry
Galphin, J. M.
Gait, II. J.
Gantt, John
Gardner, Jos. M.
Gardner, D. G.
Garrett, T. S.
Garrett, Benjamin
Galluchat, J.
George, Franklin
Gibert, J. T.
Gibbs, Jasper
Gibson, Cicero
Gibson, Sterling
Gilbert, William
Gilbert, J. B.
Gilbert, J. N.
Gilder, G. P.

Gillespie, J.

Gilliland, It. J.
Giltenan, A. A.
Girardev, Edward
Glenn, J. A.
Glenn, J. J. W.
Glover, T. C.
Glover, B. W.
Godkin, J. R.
Goldsmith, W. T.
Gorfion, T. B.
Gordon, J. M.
Gorman, C. H.
Goss, J. J. M.
Goulding, William
Gowin, R. A.
Graham, W. W.

Graves, Thomas
Greene, A. B.
Greene, W. M.
Green, J. M.
Griffin, J. D.
Grimes, T. W.
Gross, B. W.
Groves-, J. F.
Groves, J. T.
Gullett, J. M. T.
Gunn, J. M.
Hagood, M. G.
Halev, J. F.
Hall, B, F.
Hall, Absalom
Hall. Isaac B.
Hamilton, J. L.
Hamilton, S. L.
Hammond, C. C.
Hammond, A. L.
Hammond, D. W
Handley, J. T.
Hanson, A. C.
Harden, W. S.
Hardin, J. J.
Harlow, J. A.
Hartridge, Theodore
llarriss, Juriah Jr.
Harriss, J. R.
jjarris, J. L.
Harris, J. J.
Harris, W. L. M.
Harper, II. Q.
Hart, F. T.
Hart, V. T.
Hart, A. C.
Harvey, Milton
Hatton, Joseph
lleacock, R. P. II.
Heard, W. N.
Heard, T. O.
Berlin, W. L,
Henley, A. W.
Hester, T. J.
Hewell, J. W.
Ilibler, E. S.
Hicks, Henry
Hill, James
Hillhowse, J. P.
Hines, H. C.
Binton, W. G.
1 [itcheock, S. C.
Boekenkull, John
Holland, J. L.
Holland, C. L.
Holland, A. J.
Holeonibe. G. II.
Holliday, J. S.
Hollingsworth.W.T.
1 [olloway, J. O.
Holman, J. A. R.
Holmes, G. W.
Hook, E. B.
Holt, J. W.
Holt, W. J.

Holt, P. R.
Houston, J. L.
Howard, J. G.
Howard, C C.
Howard, N. F.
Howell, J. H.
Hoxev, J. J. B.
Hubbard, G. A.
Hubert, R. W.
Hudson, N. L.
Hughes, J. L.
Hughes, E. C.
Hughes, J. L.
Hulsey, A. G.
Humphries, J, B.
Hunter, G. II.
Hunter. J. W.
Hurst, H, E.
Hurst, W. R.
Irbv, J. J.
Jackson, H. T. M. 8-
Jackson, A. H,
Jamieson, F. Y. T.
Jennings, J. II.
Jennings, T. E.
Jcrnigan, W. T.
Jernigan, A. A.
Johnston, S. B.
Johnston, J. W.
Johnson, N. B.
Johnson, W. J.
Johnson, J. R.
Johnson, W. B.
Johnson, Absalom
Johnson, W. G-
Johnson, W. A.
Johnson, William
Jones, F M,
Jones, II. F. A.
Jones, J. W.
Jones, Taliaferro
Jones, A. W.
Jones, E. C.
Jones, E. 11
Jordan, R. J.
Keish, T. F.
Key, R. S.
Kilpatrick, A. R.
Kinchley, T. J.
King, Joshua
Ki,,-. W. R.
Knight, Lovd

Knight, G."B.
Knox, John
banc, J. S.
Lanier, J. C.
Lafitte, D. M.
Lamar, John T.
Lamar, James I.
Lark, John
Landrum, Z. P.
Latimer, J. H.
Lawrence, G. D. W.
Leak, W. S.
Leak. W. W.

Leak, Robert
Lee, J. C.
Lewis, J. L.
Lewis, J. 0. A,
Liddell, M. F.
Liggin, W. M.
Linen, Ransom
Lindsay, Win.
Lindsay, R. F.
Little, William
Long. II. R. J.
Long, J. D.
Longstreet, A. P.
Lowe, Jesse
Lovett, Robert W,
Lumpkin, George
Mackie, J. D.
Mackie, J. H.
Macon, T. J.
Maddox, Jackson-
Mangnm, 0. F.
Magruder, T. J.
Mann, J. A.
Maharrey, W. F.
Martin, Martin H.
Martin, F. J.
Martin, W. A.
Martin, Alexander
Massey, P. B.
Massey, R. J.
Massingate, T. E.
Mattax, Elijah
Matthews, W. L.
Matthews, G. G.
Matthews, C. C. II.
Matthews, Johnson
Matthews, D. A.
Man hews, A. C.
Matins John G.
Mathis, J. M.
Mayes, W. A.
Mayson, C. N.
McCarty, Sherod
McConn, L. B.
McCoy, A. W.
McCleskev, Green L,
McCrea, G. W. A.
MeCord, J. P.
McCullcrs, J. C.
McFall, W. T.
Mcintosh, M. E.
Mcintosh, Samuel
McKee, A. A.
McKiunon, Daniel
McLestcr, James
McLester, John
McLestw, Leonidas
McMath, J. A.
McMichael. J. M.
McNair, J. D.
McTyre, John
McWhorter, J. P. K.
Meals, H. II.
Means, L. S.
Means, 0. S-

15

Mell, J. P.

Meriwether, N.
Miller, Bright
Milligan, J. A. S.
Milligan, W. L.
Mills, J. L.
Milner, W. A.
Minis, W. W.
Mitchell, G.
Mitchell, W. J.
Mitchell, G. W.
Mitchell, B. J. J.
Mitchell, H. N.
Mobley, L. W.
Moore, 0. 0.
Moore, I. D.
Montague, W. H.
Moody, Waldemar
Montgomery, Rob't
Montgomery, C.
Montgomery, A. B.
Morgan, J. M.
Morrison, Roderick
Mulkey, Enoch
Murph, J. M.
Murph, T. J.
Murphey, W. R.
Murray ,"E. W.
Murray, J. H.
Murray, W. H.
Musgrove, W. C.
Nash, J. M.
Nagel, A. G.
Neal, W. R.
Neal, A. C.
Neal, W. C.
Neely, R. F.
Neeson, Horace
Neilson, Robert
Nesbitt, H. O'K.
Newman, D. A.
Newman, E. M
Newsom, L. L,
Nisbct, R. B.
Noble, J. A.
Oakman, R. II.
O'Farrel, John
O'Keefe, D. C.
Ogilvie, P. S. S.
O'Leary, Pierce
Olive, Y. B.
Olive, Richard
Oliver, J. A.
Oliver, J. H.
Oliver, R. W.
Orr, J. C.
Osline, J. W.
O'Sullivan, D. B.
Palmer, J. T.
Palmer, S. W.
Park, C. M.
Parker, Robert
Parker, E. T.
Parker, W. P.
Parker, A. M.

Parks, R. M.
Parmer, C. D.
Patten, A. L.
Pattison, T. H.
Paull, O. H.
Pearson, B. H.
Pendergrass, S. F.
Pentecost, L. M.
Penn, James
Perkins, D. S.
Perkins, F. W. B.
Perritt, T. A.
Perry, W. II.
Perry, E. W.
Peterson, Barthol'w
Peters, M. W.
Phillips, J. P.
Phinizy, T. B.
Pierce, H. R.
Pinkerton, Ormond
Pitman, E. D.
Pitts, W. M.
Polhill, J. G.
Pope, J. II.
Porter, J. L.
Powell, Green B.
Powell, J. R.
Price, J. R.
Price, J. W.
Prior, \V. H. C.
Proctor, J. W.
Pugesly, S. A.
Quarles, R. W.
Rngan, J. H.
Ragland, Robert
Ragland, W. P.
Rambo, John
Ramey, W. II.
Ramsay, H. A.
Rawls, J. P.
Rawls, E. S.
Reagan, T. J.
Rees, W. L.
Reeves, W. J.
Reeves, J. A. G.
Reid, J. A.
Reid, J. T.
Reynolds, A.
Reynolds, J. F.
Rhodes, William
Rhodes, L. C.
Rice, T. M. C.
Rich, D. A.
Richardson, E. H.
Richardson, S. L.
Riley, Lafayette
Riley, E. G.
Riley, D. F.
Riordon, John
Rives, B. R.
Rivers, W. B.
Roach, M. A.
Robert, W. H.
Robert, L. J.
Robert, S. J.

Roberts, F. A.
Roberts, J. A.
Robertson, J. J.
Rogers, L. D.
Roll, W. A.
Rossignol, Henry
Rufhn, W. R.
Rusk, W. J.
Russell, R. M. D.
Rutherford, H. W.
Ryan, T. D. L.
Sabal, A. M.
Saddler, C. W.
Sanders, S. II.
Sanders, L. L.
Saunders, M. D.
Saunders, J. M.
Schatz, Isaac
Schley, J. M.
Schley, F. W.
Scogin, John
Scott, J. R.
Scott, J. J.
Searls, Thomas
Seay, R. F.
Selman, W. L.
Sessions, A. M. R.
Sessions. Lewie
Settle, 0. J.
Setze, E.J.
Shands, A. C
Shannon, Joseph
Shaw, II. A.
Shaw, J. C. A.
Shaw, W. B.
Shelton, W. F.
Shelton, V. H.
Sheppard, P. M.
Sheppard, A. R.
Sheridan, W. C.
Shewmake, A. D.
Shackelford, J. T.
Shipman, A. J.
Simmons, J. N.
Simmons, J. A.
Simmons, S. B.
Sims, J. T.
Sims, J. C.
Sims, John
Slaughter, J. T.
Slaten, 0. H. P.
Smith, C M.
Smith, C. W.
Smith, J.N.
Smith, Lawrence
Smith, B.l).
Smith, J. T.
Smith, G.F.
Smith, J. W.
Smyth, G.E.
Snellings, G.T,
Spalding, A.M.
Sparks, H. B.
Sparks, B.C.
Spenoer, Alex

Spruill, A.B.
Standifer, W. M.
Starr, E. F.
Stell, R.M.
Stell, R. T.
Stephens, A. G. W.
Stephens, J. W.
Stephens, A. G.
Stewart, Theophilus
Strawn, J . W.
Stribling, E. A.
Strickland, A. G.
Strong, B. R.
Tabb, Thomas
Tabb, T. B.
Tate, H. G.
Tatom, S. Z.
Taylor, Joseph
Taylor, G.F.
Taylor, W. S.
Taylor, J. P.
Tessier, M. M.
Thacker, E.N.
Thigpen, Job
Thomas, C. C.
Thomas, F. A.
Thompson, B.L.
Thompson, E. N.
Thompson, S. E.
Thompson, C. A.
Thompson, R.E.J.
Threadgill, S. J.
Tison, W. M.
Tison, T. W.
Todd, J. W.
Toole, Jonathan
Trammell, P.T.
Trammell, W. M.
Trammell, A. A.
Trent, Peterfield
Trezevant,G.W.C.
Trippe, R. A.
Trippe, J.F.
Trippe, J. H.
Tucker, J. R.
Tucker, F. M.
Tullis, J. M.
Turner, II. F. P.
Tutt, W. H.
Tutt, H.B.
Twiggs, J. D.
Underwood, L. M.
Urquhart, II . A.
Vann, A.J.
Veazy, J. W.
Verdell, D. B.
Verdery, A , F .
Wait, P. C.
Wakefield, T. A.
Wakefield, F. B,
Wall, W. W.
Walker, F.J.
Walker, V. H.
Walker, J. E.
Walker, G. W.

16

Wallace, J . II .
Walthall, J. E.
Walton, Bryan
Walton, Oliver
Walton, J. H.
Walton, Simeon
Walton, 0. R.
Walton, T. M.
Ward, T. A.
Ward, M. A.
Ware, W. C.
Ware, B. A.
Warren, It. L.
Wnsson, G. W.
Watts, Jnbal
Watts, D. S.
Waters, Z. L.

Watkins, J. L.
Weaver, D. A.
West, Charles W.
West, G. W.
West, J. W.
West, F.J.
West, W. T.
Westmoreland, H.
Westmoreland, J. G.
Westmoreland, W.T.
Westmoreland. D. D.
Whale, J. G. W.
White, Boling A.
Whitloek Isaac W.
Wightman, J. S.
Wiggins, N. II .
Wilchar, W. T.

Wilhight, C. F.
Williams, J. A.
Williams, D. M.
Williams, Z. C.
Williams, W. M.
Williams, G. A.
Williams, W. A.
Williams, John G.
Wilkinson, A. M.
Wilkinson, J. W.
Willis, P. A.
Wilson, J. S.
Wilson, A . A .
Wilson, J. S.
Wilson, T. C. H.
Wilson, J. S.
Wilson, W. H.

Winn, P. C.
Wise, Joseph
Witcher, Hezekiah
Wofford, Benjamin
Wofford, J. F.
Wooten, J. II .
Wooten, II. V.
Word, T.J.
Wynn, A. W.
Wynn, J. A. C.
Yarbrough, J . W.
Young, J . M .
Young, W. D.
Young, Andrew
Young, Thomas J.
Young, J. D.
Zachry, W. T.

WILLIAM SCHLEY,

President of the Board of Trustees.

Augusta, Geo., July, 1856.