Southern Medical and Surgical Journal, 1857

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SOUTHERN

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MEDICAL AID SURGICAL JOURNAL,

EDITED BY

HENRY F. CAMPBELL, A. M., M. D.,

PKOFKSijOK OK SPECIAL AND COMPARATIVE ANATOMY IN TUE MEDICAL COLLEGE OF GEORGIA ;

AND

llOBERT Cx\MPBELL, A. M., M. D.,

DliMONhTRATOR OK ANATOMY IN TMK MEDICAL COLLEGE OK GEORGIA.

Medical College of Georgia.

Je prends le bicn oil Je le trouve.'

VOL. XIII. 1857. NEW SERIES.

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AUGUSTA, GA:

McClFFERTY'S OEFICE-J. MORRIS, PRINTER.
1857.

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ENLAROED EDITION

OF THE

SOUTHERN

MEDICAL AID SORGICAL JOURNAL

VOLUME XIA^.XEW SERIES. FOR 1848.

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SOUTHERN

MEDICAL AND SURGICAL JOURML,

(NEW SERIES.)

Vol. XIII.] AUGUSTA, GEORGIA, JANUARY, 1857. [No. 1.

ORIGIML AND ECLECTIC.

ARTICLE I,

Addendum to the " Ussay on the Relation of Bilious and Yelloiv Fe-
ver. By EiCHARD D. Ar]^oli>, M.D.,- Professor of the Theory
and Practice of Medicine in the Savannah Medical College.

Since the reading of my essay, several circumstances have
occurred to me which I consider as bearing directl}^ and practical-
ly on the subject treated therein.

The beginning of each summer, since our epidemic of 1854, has
been a time of anxiety for many citizens, and the physician was
often catechised as to his opinion, whether or not, Yellow fever
was likely to appear- Being no prophet, I could not answer such
queries; but, I always said, that if we had such an awfully hot
summer as that of 1854, I should look out for an epidemic. The
difference of mean temperature does not give any correct idea of
the relative heat of two summers. According to the registry pub-
lished in our newspapers in 1855, the mean temperature of Julyj
1854, was but one degree above that of July, 1855. When I
state that the register was kept by my scientific friend^ Dr. J. F.-
Posey, its correctness will not be doubted. Now, the contrast as
to feeling was immense. July, 1855, was a remarkably pleasant
month : July, 1854, will live in the memories of those who swel-
tered under it in this city, as by far the hottest and most oppres-
sive month ever experienced by the "oldest inhabitant."

N. S. VOL. XIII. NO. I. 1

4 Aejstold. Addendum to the Essay on the [January,

Measles prevailed epidemically, and with nnnsiial severity dur-
ing the latter part of January, and during Februar}^^ March and
April.

In May, there was very little sickness of any kind. It is vei-y
rare ever to see a periodical fever of any type in that month. I
was called on the 21st May to see a boy, a native^ aged about seven
years. I found him with a diarrhoea, and a good deal of general
fever: I treated him accordingly. The fever abated notably to-
wards evening, and the next morning it as notably exacerbated,
again remitting at night to a perfect apyrexia. As there was thus
evident periodicity, I determined to use quinine, which I did.

On the morning of the 23rd, the apyrexia continuing, there being
no pain of any kind, no nausea, a pulse down to 80, the skin of
a temperature to entitle it to be considered normal, quinine was
again given and kept up all day and in the evening, I quitted my
patient for the night without the shghtest anxiety. At sunrise, I
was aroused by a hasty summons, and I found things very much
changed with my little patient. The face was pinched, the nostrils
dilated, the eyes sunk, the complexion pallid, the expression of the
face anxious and haggard, the pulse small, weak and compressible.

A dark stain on the sheet attracted my attention. I was
told that at about two o'clock, he began to be nauseated,, and
shortly after, threw up the black stuff which stained the sheet.
The vomiting had continued until my visit. While examining
him he threw some of it up, with the spasmodic jerk so often no-
ticed, and it w^as literally squirted over my clothes. This contin-
ued all day, until death closed the scene on the same evening.

He was a very delicate child. What was his disease? I an-
swer unhesitatingly, a case of sporadic Yellow fever. The apy-
rexia was the deceitful calm so often met with in that type of fever.
About the black vomit, there could be no doubt. It was at once
recoo-nized by those about the child, for they had seen such too
frequently in 1854.

As. I will not indulge in speculation, but deal only with facts,
let us pass on through the summer. June was remarkably pleas-
ant and remarkably healthy. On the 3d of July, I was called to a
case in consultation with my friend, Dr. Wragg. He informed me
that the patient had thrown up black vomit, in which I agreed
with him after I had examined the ejecta. The skin was discolor-
ed of a universal yellow. Death soon let down the curtain of
existence.

1857.] Relation of Bilous and Yellow Fever. 5

Here, again, was an undoubted case of sporadic Yellow fever.
A singular fact is connected with the last case, a gentleman of
about thirty -five years of age. He had passed untouched, through
the epidemic of 1854, from beginning to end, and was a most ac-
tive and untiring member of the Young Men's Benevolent Associ-
ation ; for often and often had I met him during that fearful season.

In neither case could an autopsy be obtained.

Up to the very end of September, I never experienced a healthier
summer in twenty-six years' practice. After a cold period of wea-
ther at that time, there was a warm period. The cold had not
produced any frost. 1 ascertained from various authentic sources
that the sweet potato vines were not even wilted. During Octo-
ber, there was a good deal of malarial fever, and of a congestive
type.

While attending a case of hydrocephalus, in consultation with
my colleague. Dr. J. B. R^ad, he informed me that he had a case
of fever which looked very suspicious, as his eyes were bloodshot,
his pulse was sixty, and there was glairy vomiting, and he feared
black vomit would follow.

On Thursday, the 23rd, he did throw it up. On Sunday, the
26th, I saw the patient and the black vomit. Every sj^mptom
announced genuine Yellow fever. Here was another sporadic
case of Yellew fever. An important question to determine, in
case of death, was, will it present the same pathological appear-
ances as a case of epidemic Yellow fever?

With but faint hopes of recovery we gave him very large doses
of acetate of lead, and chamj^agne f rappee^ freely.

He died on the night of the 28th. Dr. Eead fortunately suc-
ceeded in obtaining permission for an autopsy, which was made
the next morning by Dr. Read, and by my pupil, Mr. Theodore
McFarland, who was in the Savannah epidemic of 1854, and then
conducted my autopsies, and was one of the Savannah volunteers
who went to Korfolk in 1855, assisted by my other pupils, Messrs.
Joseph M. Turner and Franklin Jones,

The notes were taken by me on the spot, and sanctioned by Dr.
Read, who, in addition to his experience here in 1854, was sent
on by the City of Savannah to Norfolk, in 1855.

Autopsy fourteen hours after death. Body fat, of a bright yel-
low color.

Liver, enlarged, filled with bloody serosity, presenting the pecu-

6 Arnold. Addendum to the Essay on the [January,

liar box-wood color, described before as the characteristic color of
Yellow fever livers as presented in this locality, during a period
of time now covering twenty-nine years.

The acini were not distinct^ the liver when cut, was smooth and
compact. The liver was much enlarged. The pancreas was also
very much enlarged,, and had tubercular deposites in the circum-
jacent glands, and under the peritoneal coat.

Spleen was enlarged^ of a lively purple color.

Stomach was intensely and uniformly injected, of a dark red.

The veins of the stomach were very much congested, showing
themselves by a black streak, as well as by their distension. The
blood in them was black and fluid. The mucous membrane at
the cardiac extremity tore off in flakes a quarter of an inch long;
in the larger curvature the flakes were half an inch long.

The mucous membrane was mammellonated over most of its
surface. Black specks could be seen scattered about all the surface.

Lungs healthy.

Heart softened, the finger passing easily through the walls of
the right auricle.

There was a very large deposit of fat in the omentum. Several
of the glands near the pancreas were enlarged,, and contained a
black fibrinous deposit resembling the softening coagulum of an
aneurism.

The gall-bladder contained a small quantity of thin dark bile,
Not a trace of bile could be found in the intestinal tube, from the
cardiac orifice to the anus.

The kidneys were natural. There had bees the usual suppres-
sion of urinary secretion.

The head was not examined, because it was not affected until
shortly before the termination of the case.

Dr, Bead saw autopsies of Yellow fever in 1852, in 1854,. and
in Norfolk in 1855 \ Mr, Turner, in 1854, here, and in Norfolk in
1855, They all agreed as to perfect similarity of all the Yellow
fever livers they had ever seen.

I consider it useless to spin out; any further proof. The color
compared well and. accurately with the lithograph of the Yellow
fever executed for mc^ by Thomas Sinclair k Co., of Philadelphia,
which with the two others of the bronzed liver, and the varieties
of colors of Bilious fever liver, executed by the same artists, from
drawings from nature in my possession, will be sent to the various

1857.] Relation of Bilious and Yellow Fever. 7

members of the profession to whom these articles will be sent in a
pamphlet form.

Let us hasten on and ascertain if any of the peculiar colors of
I Bilious fever can be found at the present day.

A British seaman, in the Marine Hospital, came under my care
in my clinic at the hospital, on the loth of JSTovember. He had
been aboard of his ship for five weeks, Now frost did not occur
until the first week of November, and consequently he had been
exposed to the exhalations of the concentrated poison of malaria
late in the falL

Without going into detail, suffice it to say, the case was marked
by distinct periodicity, by the pallid ancemic hue so peculiar to
malarial fevers, and many cases of which I have pointed out this
season to my class, in cases of prolonged malarial intermittent.
- There was always a torpor about him, and two days before he
died, he sank into a profound stupor. He died on the 22nd, at ten
o'clock, P. M-, and was examined thirteen hours afterwards.

Body, considerably reduced. Sallow, pallid, anaemic hue.

Head. Yery little blood in sinuses or veins, a good deal of se-
rum escaped while taking out the brain.

The arachnoid was distinctly pearl-colored and opaque where it
passes over the interstices between the convolutions of the brain ;
also, where it passes from the nates and testes to the medulla ob-
longata. I cannot say the eff'usion was as great as I hav often
seen. The substance of the brain was anemic. There was a great
many air-bubbles under the arachnoid.

Spleen, usual color, perhaps a little enlarged.

Kidneys, much larger than natural, nothing peculiar inside.

Liver, externally, of a bluish slate color.

Gall-bladder, distended with bile. Undoubtedly enlarged about
a third above its ordinary size, when cut into, of a uniform bronze
color, easily broken, friable, breaking into small pieces^ a good
ideal of serum in it.

Stomach. Mucous membrane injected, arborescent towards
cardiac extremity. Towards the greater curvature, it was of an
olive color, with, occasionally, spots of a blackish brown.

The mucous membrane was thickened and corrugatod, a piece
of white paper rubbed on its coat, received a yellow tinge of bile.
A piece rubbed on the cut surfaces of the acini of the liver, also
received a decidedly yellow tinge. The lower part of the ileum

8 Campbell. Strangulated Ventral Hernia. [January,

was cut open ; it was perfectly sound and contained yellow bilious
matter.

The foregoing facts prove conclusively, that sporadic cases of
Yellow fever may occur, having all the symptoms of those during
au epidemic, and the same pathognomonic appearances after death.

ARTICLE II.

operation for Strangulated Ventral Hernia during Pregnancy
Recovery. By Hekry F. Campbell, M. D., Professor of Surgi-
cal Anatomy, &c., in the Medical College of Georgia.

Jenny, a negro woman, aged about 80 years, was brought to
the Infirmary on the 7th of July, 1854, at one o'clock at night.
Her master, a physician, had correctly diagnosticated her disease
as Strangulated Ventral Hernia. He said that she had been suf-
fering for nearly forty -eight hours from the constriction. On
account of her condition, four months advanced in pregnancy,
and also from not having at command the proper appliances and
assistants for operating himself, he had concluded to bring her to
this place, a distance of forty miles from his residence.

On examination, we found the patient in a condition of extreme
depression ; her extremities were cold, her pulse very feeble and
rapid and she had vomited excessively. There was a tumor in
the umbilical region of size equal to a large orange, and the skin
covering it, was tumid and somewhat infiltrated from the frequent
attempts made by the Doctor for its reduction.

Of course, under the above circu.mstances, no time was to be
lost. "We attempted taxis, but finding it offer no hope and hav-
ino- much reliance on the skill of her master, Dr. Gr. C. Furse, and
of his brother. Dr. Furse, who had both tried that mode and
failed, we determined, after consultation, to proceed at once to the
operation for strangulated hernia in this region.

Operation. Having given the patient a large potation of bran-
dy, and placed her upon a suitable surface of support in the recum-
bent posture, and administered chloroform to the amount w
considered prudent in her low condition, we made an incision ir

1857.] , Campbell. Strangulated Ventral Hernia. 9

the vertical direction, the whole length of the tumor. The integu-
ment being loose over the tumor and easily sparable from the
hernial sac, this first incision was made by raising a fold in the
transverse direction, passing a long sharp-pointed bistoury through
it, and thus cutting out to the surface. Dissecting carefully through
a quantity of fat at the bottom of this incision, brought the perito-
neum into view, when we again attempted reduction by taxis; this
failing, a small opening was made in the peritoneal sac near the
centre, and a grooved director introduced, and upon this, the sac
was laid open by incision with a probe-pointed bistoury, first in
the upward, and less freely in the downward direction. The intes-
tines being now exposed, and presenting what we considered a
sufficiently sound appearance, though much darkened by conges-
tion, we proceeded to dilate the opening through which they 'had
passed, which now appeared rather to one side the umbilicus than
in the exact situation of the umbilicus itself. In making this dilata-
tion, the fore-finger of the left hand was introduced above the neck
of the sac, an assistant supporting and holding out of the way, the
mass of protruded intestine; a curved probe-pointed narrow bis-
toury was then introduced flatwise upon the palmar surface of the
finger, and the incision made upwards and rather to the left side
to the extent of nearly a quarter of an inch. The ring, (if we may
be allowed to transfer here a word which has become a technicality
in another region,) which before was hard and rigid, soon yielded
to the pressure of the finger after the knife was removed, and the
intestine and also the now empty sac, were readily returned into
the cavity of the abdomen. The lips of the external wound were
approximated and kept together by three sutures, and the part
dressed by the application of a towel wet with cold water, which
was to be renewed as often as it became warm by contact w^th the
surface of the b(jdy.

Either on account of the obtunding influence of her extreme
state of exhaustion or from the anaesthetic effect of the chloroform,
the patient evinced but httle suffering during the whole of the
operation. Her state immediately after the operation cannot be
said to have improved upon that before it, her depression continu-
ing until an advanced hour on the following morning.

We referred above to the unusual amount of caution we felt it
necessary to exercise in the application of the chloroform in this
case: this was suggested to us by the fact that early in the admin-

10 Campbell. Strangulated Ventral Hernia. [January,

istration of it, the patient manifested decided symptoms of syncope,
from which moment, we abandoned its further continuance.

A short time after the operation, an injection of warm water was
administered to provoke the action of oil previously given by Dr.
Furse. This was followed by no immediate effect ; probably the
oil had been vomited previously to her arrival at the Infirmary.

The first indication she evinced of teturning health, was a de-
cided craving for food ; and though her bowels remained long
constipated and uninfluenced by cathartics, she did not appear to
suffer inconvenience from this state, and continued to convalesce
without interruption.

About the tenth day after the operation, at her urgent solicita*
tion, we allowed her to rise from bed. The incision having united
^rmly, the only support we deemed necessary at first was a small
pad and broad bandage, which was afterwards changed for an
umbilical truss. This last, however, had to be abandoned after a
short time, as the patient was refractory and would not attend to
keeping it on in the proper situation, and indeed, from the solid
condition of the part, care upon this point did not appear to us as
very important.

This patient remained under our care until the 2oth of August,
during which time, there was no embarrassment of the favorable
progress of gestation, which, indeed, as we afterwards learned
through Dr. F., continued on to a fortunate parturition, uncompli'
cated by any untoward incident. At last accounts, she was preg'
nant again, with but slight threatenings of a return of her former
hernial difiiculty.

We have the more willingly reported the above case, as we have
been for a long time under the conviction that such herni^e are of
not infrequent occurrence, a number of this kind having come un*
der our observation.

It is the opinion of Dr. Gr. M. Newton, Professor of Anatomy in
our college, expressed in his lectures on this region, that ventral
hernia may be the result of a dilatation of the openings along the
linea alba above the umbilicus intended for the transmission of
vessels ; these openings become enlarged by a deposition of fat
around the vessels they transmit, are left patulous on the absorp-
tion of the adipose tissue, and thus afford a means of exit to omen*
turn or intestine.

1857.] B.EAGAN^S Case of Spasmodic Affection, 11

ARTICLE III.

A Singular Case of Spasmodic Affection. Reported by Thomas J.
Beagan"^ M. D.^ of Alma, Texas,

Messrs. Editors I send jou a report of the following case, on
account of its novelty, to me at least, and for the purpose of ob-
taining information from others who have had such cases to treat :

August 27th. Called to see Mrs. C, pregnant for the first time,
being advanced some three or four months. She was taken the
preceding evening, about midnight, with pain in the left hypo-
chondriac region, which was removed by local applications and
anodynes, administered by Dr. Hensun, who was in attendance.
She was then attacked by a spasmodic jerking of the muscles of
the abdomen, which continued up to the hour of my arrival, 6
o'clock P, M,

I found the muscles of the abdomen only involved, there ap-
pearing no arterial excitement, and no pain ; only much wearied
by the continued spasms, appearing sometimes as if she would be
^^ jerked double,^^ as she expressed it. I examined her minutely,
and could find no tenderness, not even of the spine, as I anticipated.
Thinking perhaps it was only an undue mobility of the nervous
system, I gave her a full dose of sulphate of morphine, and appli-
ed a sinapism to the spine.

There being no relief, but on the contrary spasmodic action
increasing, I bled her, and administered calomel, pulv. Doveri,
and ipecac, in combination, to be followed by castor oil in the
morning, if the calomel did not operate freely. I also directed a
mixture of sweet spts. of nitre, ipecac and paregoric, one teaspoon-
ful to be given every three hours, unless productive of nausea, in
which event, the dose was to be diminished.

28th, 9 o'clock A. M. Better, having been free from spasms
since 10 o'clock on the previous evening. Sulph. quinine with
Dover's powders to be given every morning. Since my arrival
the spasms have recommenced, and seem to be brought on by the
sight of any one to whom she is unaccustomed, or by being touch-
ed. Promised to see her if requested.

I learn that the spasmodic twitchings continued until the night
of the 30th, when she was threatened with abortion, or at least

12 Continued Fevers and their Discrimination. [January,

had uterine pains, since wliich she has had no return of the spasms,
but has regained her accustomed health.

Was this a case of partial chorea, or was it a development of .
one of the many nervous conditions to which pregnant females are
subject?

I neglected to state that about a month prior she was similarly
affected, though in a milder degree.

Lectures on the Varieties of Continued Fevers and their Discrimination.
Delivered at St. Thomas's Hospital, by Thomas B. Peacock,
M.D., Assistant-Physician to St. Thomas's Hospital, etc.

Lecture on the Relations of Typhus and Typhoid Fever. In my
last lecture I described to you the general symptoms and morbid
appearances of Typhoid fever. In the present, I propose to
inquire how far we are justified in adopting the view advanced
at the commencement of the course, that typhus and typhoid are
not mere varieties of the same disease, but distinct specific forms
of fever.

I have already mentioned, that with the advancement of Medi-
cal science, the tendency has been to limit the so-called essential
fevers, and to ascribe the constitutional symptoms to local causes,
and especially to lesions of the gastro -enteric mucous membrane.-
Various writers have at different times described inflammation
and ulceration of the mucous membrane of the bowels as occur-
ring in fever, but such appearances were only regarded as acci-
dental complications, arising from peculiarities of climate or season,
or in particular forms of disease. Thus the characters of the
typhoid fever of Paris were well described by Petit and Serres, in
1813, under the name of "fievre entero-mesenterique." Brous-
sais,^ however, ascribed much greater importance to the inflam-
mation of the gastro-enteric mucous membrane, regarding it as
existing in all cases of fever, and contended that the febrile symp-
toms were the direct effects of such local disease.

In 1826, M. Trousseauf gave an account of M. Bretoneau's ob-
servations on typhoid, as he had observed it at Tours, under the
names of Dothinenterie, or Dothinenterite. In 1827, Dr. Bright^
published several cases, affording examples of the intestinal dis-
ease occurring in the fever of London ; while Dr. Alison showed
its almost constant absence in the epidemic fever of Edinburgh.

* Examen de la Doctrine Medicale, Paris, 1816.

f Archives Generales de Medecine, Tome X, 1826, p. 67.

X Reports of Medical Cases, Vol.1., p. 178.

X Edinburgh Medical and SurgicalJourual, Vol. XXVIIL, p. 223.

1857.] Continued Fevers and Hieir Discrimination. 13

In 1829, the first edition of M. Louisas work appeared, in which he
illustrated most fully and philosophically all the features of the
typhoid fever of Paris, both during life and after death, aod in
particular demonstrated the constancy of the intestinal disease.
Dr. Tweedie and Dr. Southwood Smith, in 1830, reported, howe-
ver, that in London, while the intestinal disease generally occur-
red, it was also very frequently absent ; and in 1836, M. Lombard,*
who was well acquainted with the morbid appearances of typhoid
fever, as he had observed it both in Paris and Geneva, having had
an opportunit}^ of witnessing post-mortem examinations of cases
of fever both in Glasgow and Dublin, was not a little surprised to
find that the intestinal disease, which he had believed to be a con-
stant feature of the disease, did not always exist in the English
fevers. The first impression produced by these observations was
to raise doubts in Dr. Lombard's mind as to the importance of the
intestinal lesion as a constant occurrence in fever, while he still
held to the identity of the two forms of fever. Subsequently, how-
ever, after he had seen more of the English fevers, he adopted the
view that there were here prevalent two distinct forms of disease
typhus, which he regarded as originating in Ireland, and as pro-
pagated by contagion by the Irish laborers; and typhoid, which
was an endemic disease, precisely similar to that with which he
was previously familiar.

In 1836, Dr. Gerhardf published an account of an epidemic of
t3'phus in Philadelphia, in which, while the symptoms and morbid
appearances bore entire resemblance to the tj^phus of this country,
they presented very marked distinctions from the typhoid fever, or
dothinenterite, which he had beforqmet with in the United States,
and which he had found to be in everj^ respect similar to the ty-
phoid fever which he had studied in France; and he hence inferred
the specific difference of the two diseases.

Such was the state of the question when, in 1838, the Academy
of Medicine proposed for the subject of a prize, the investigation of
the analogies and difterences between typhus and typhoid fevers. :j:
This led to the publication of the Essays of Gauthier de Claubry
and Montault, :j: the former of whom contended for the two fevers
being one and the same disease, while the latter inferred their spe-
cific distinctness.

In 1839, M. Valleix entered into an elaborate investigation of
the respective features of the two forms of fever, founded upon the
reports of fourteen cases collected by Dr. Shattuck, of Boston, at
the London Fever Hospital ; and he was led to adopt the conclu-
sion that the fevers of this country embraced two distinct species
one, an essential fever, typhus; the other, typhoid, which is iden-
tical with the typhoid fever of Paris.

* Dublin Journal, Yol. X., pp. 17 and 101.

f American Journal of Medical Science, Yol. XIX., p. 289.

X Mem. de I'Academie Roy. de Med. T. VIL, pp. 157, 185.

1^ Continued Fevers and their Discrimination, [January,

In 1839, Drs. Henderson and Reid published a report* on the
typhus fever of Edinburgh, in which they investigated fully and
carefully the symptoms of that disease during life, and the appear-
ances of the body after death, and established the almost constant
absence of any abdominal symptoms and of the intestinal lesion.
On the other hand, they published a communication from Mr.
Groodsir, showing that a fever, every way similar to the French ty-
phoid, prevailed endemically in some adjacent districts.

In 181:0, Dr. Stewart, who had closely studied both typhus and
typhoid at the Glasgow Infirmary, and the latter disease in Paris,
published an xable memoir,f in which he advocated the non-identi-
ty of the two diseases ; and in the following year, M. Louis, in the
second edition of his work, adopted the same view.

The peculiarities which distinguish the two diseases, and which
have been relied upon as indicating their specific difference, may
be briefly stated as follows :

1. The mode of invasion of the two diseases is generally very
different. Typhus usually attacks suddenly, and rapidly produces
such prostration of strength as to compel the patient to seek medi-
cal relief ^t an early period. Typhoid is usually more gradual in
its mode of invasion, and less rapidly advances; so that the time
at which the cases come under treatment is usually much later.

2. Typhus can generally be traced to contagion ; the origin of
cases of typhoid is often very obscure, and the disease, most pro-
babl}^, generally originates in common causes, or, at least, is very
much less contagious.

3. Typhus affects persons at all ages, both those in early and
in advanced life, though most common during middle age. Ty-
phoid affects chiefly young persons, and very rarely those more
than forty years old.

4. The eruptions which characterize the two diseases are differ-
ent in their form, mode of appearance, and progress ; that of ty-
phus assumes the form of a rash, is not, except at the very com-
mencement, elevated above the surface, and has a livid-rose color,
and subsequently becomes petechial ; that of typhoid consists of
several spots, few in number, always elevated, and of a pale-rose
color. The typhus rash appears at an early period, follows a re-
gular course, and its disappearance is usually succeeded by conva-
lescence at the end of a few days. The typhoid spots come out a
few at a time, and continue to make their appearance in successive
crops, and their final disappearance may precede for many days
the establishment of convalescence.

5. The predominant spmptoms in typhus are ordinarily those of
prostration of strength and of cerebral disturbance; while the
evidences of gastro-intestinal disorder are of minor importance and

* Ed. Med. and Surg. Journal, Vol. LII.

f Ed. Med. and Surg. Journal, Vol LIV., p. 289.

1857.] Continued Fevers and their Discrimination. 15

frequency, and, indeed, are often absent. The symptoms of disor-
der of the gastro-enteric mucous membrane are, throghout the pro-
gress of typhoid, predominant: while the cerebral symptoms are
less constant and usually less severe, and the prostration of strength
is also generally less.

6. The duration of an attack of typhus is comparatively short,
and is limited to a tolerably definite period. Typhoid is usually
of longer duration, and is less regular in its course ; some cases
being short, others yqtj much prolonged.

7/ In typhus, when convalescence is once established, the pro-
gress of the case to recovery is generally satisfactory, and true
relapses seldom, perhaps never occur. In typhoid, relapses are of
by no means infrequent occurrence^ and inflammatory affections
of the viscera and serous membrenes frequently supervene during
convalescence.

8. Typhus usually proves fatal during the second week of ill-
ness, and rarely after the expiration of the third week. Typhoid,
though it may prove fatal at as early a period as typhus, usually
destroys life, in from the third to the fifth week, and occasionally
death takes place at a much later period.

9. After death from typhus, the only constant pathological con-
dition found in the body^ i& the altered state of the blood, and the
follicles of the intestinal mucous membrane never present any ap-
pearances of disease. In fatal cases of typhoid the follicular disease
of the intestines is of constant occurrence.

These circumstances certainly afford broad grounds for distinc-
tion between the two forms of fever: but it has-been contended
that they do not prove their specific distinctness.

1st. It has been argued that the absence of the intestinal lesion
in typhus is owing to the much earlier period at which death oc-
curs in that disease than in typhoid. This objection does not,
however apply ; for, though the period of death in typhus be ear-
lier than in typhoid, it is not too early for the intestinal disease to
have appeared; while occasionally typhus proves fatal at a late
period. Of the cases of typhus to which I have referred in my
first lecture, one proved fatal from pneumonia on the thirt}^ -first
day from admission, the precise duration of illness not having been
ascertained; and I have examined cases which have died on the
nineteenth to the twenty first days of illness, without meeting with
any evidence of intestinal disease; indeed^^ after death at the latest
period, the solitary and aggregate glands are even less distinct than
in cases proving fatal in the earlier stages.. Of the cases of tj^phoid
also one died on the seventh or eighth day of serious illness, and
yet in that instance the plates were not only greatly enlarged and
much inflamed, but in places sloughs had already formed ; and I
exhibited to you a portion of intestine from a patient Avho died on
the fourteenth day, which exhibited the most extensive and ad-
vanced disease. M. Chomel, indeed infers, from the observations

16 Continued Fevers and their Discrimination. [January,

collected by M. Louis and himself, amounting to 92 in number,
that in typhoid, ulceration commences in the plates from the eighth
to the twelfth or fifteenth day at the latest.

2ndly. It has also been contended that the peculiarities of the
eruption on the skin, and the presence or absence of the intestinal
affection in the two forms of fever, may depend on the relative
vigor and age of the subjects attacked; that typhus is a disease of
the young and robust, typhoid of the aged and infirm or debihta-
ted. But this is not the case, typhus appears sufficiently frequent-
ly in young subjects to prove its features to be similar in them
and in th^ aged. The disease also may be conveyed by conta-
gion to persons under the most diverse conditions, and yet in
all, however its malignity may vary, its general features remain the
same.

3rdly. It has been supposed, that the disease of the intestinal
follicles is only an accidental complicatioo, superinduced by pecu-
liarities of local climate or epidemic influence. This argument
would possess much force were the two diseases never found to
prevail coincidentally in the same localities if the fever which
prevails in one locality were always typhus, as is ordinarily the
case in Edinburgh ; or always typhoid, as in Paris. It fails, how-
ever, entirely to explain, how, in other localities, as in London,
for instance, we sometimes meet with one and sometimes with the
other form of fever ; and each of them, instead of being modified
or displaying certain intermediate gradations, is found to present
its clearly defined and characteristic features. For the establish-
ment of the latter point we are indebted to Dr. Jenner,* w^ho for a
period of three years conducted a most elaborate investigation into
the history, symptoms, and morbid appearances in the cases of
fever treated at the Fever Hospital ; and he has conclusively shown
that the typhus of London is as distinctly marked as that of Edin-
burgh, and the typhoid as that of Paris. In this state of the ques-
tion it must, I think, be admitted, that the argument preponderated
in favor of the non-identity of typhus and typhoid ; but Dr. Jen-
ner was able to furnish still more conclusive evidence of their
distinctness. He has shown, that during the years 1847, 1848,
and 1849, in all instances in which two or more cases of fever
were admitted into the Fever Hospital from the same house, with
one solitary exception, whatever was the character of the case first
received, such also was that of the cases subsequently admitted ;
and he has justly concluded, that if the diseases were not propaga-
ted by separate contagions or poisons, there would certainly have ,
been numerous exceptions to this rule, instead of the solitary one
I have referred to. This, too, could hardly be regarded as an
exception. It was the case of a boy received laboring under
typhoid after his father had been previously admitted with typhus ;

* Medico-Chirurgical Transactions, Second Series, Vol. XV. 1850, page 23.

1857.] Continued Fevers and their Discrimination. 17

but the boy was from home till after his father's removal to the
Ilospital.

The constant absence of any evidences of intestinal disease in
typhus was confirmed by a report published by Dr. Eeid* of the
pathology of fever in Edinburgh in 1842, which embraced no less
than 100 examinations; and in 1813 f by one of myself, detailing
the results of examination in 31 other cases. These several reports
give a total of 161 cases of fever examined between the years 1838
I and 1842, in only eleven of which was the follicular disease found,
or in about 1 in 14 cases. Dr. Bennett, however, % in 1846 and
I 1847, found the follicular disease more frequent in Edinburgh ;
1 or, in 19 out of 63 cases examined after death ; but, as this report
is not accompanied by any statement of the features of the cases
during life, so far from invalidating the general conclusion, it only
proves that, at the period in question, typhoid was usually preva-
lent in Edinburgh. Of the cases of fever in which the intestinal
lesion was found, examined by Dr. Keid and myself, all were ad-
mitted into the Infirmary from districts adjacent to Edinburgh, and
not from the town itself; or, if so, had come to Edinburgh labor-
ing under the disease.

After having had my attention for several years specially di-
rected to these points, I have seen no exception to the rule, that
the fever characterized by the general features and eruption of
. typhus is unattended by any lesion of the intestinal mucous mem-
\ brane ; or that the equally marked disease characterized by the
; rose-spots of typhoid is as constantly connected with the follicular
i disease. These facts have also recently been confirmed by Dr.
I Wilks from his experience at Guy's Hospital; and similar evidence
! has been brought forward by other writers both in this country
and in America.

At the time when Dr. Jenner's paper was read at the Medico-

I Chirurgical Society in 1849, I Avas induced to look over the notes

. of the fever cases which I had treated at the Royal Free Hospital,

I to which institution I was then attached; and I found that, though

' these observations had not been collected with any reference to

that investigation, in every instance where two or more members

of the same famity w ere admitted into the Hospital, the character

of the fever corresponded in all the cases. Since this time, while

I have been connected with St. Thomas's Hospital, I have equally

directed my attention to this question. I have seen many instan-

I ces in which several persons of the same family or from the same

I house, have been admitted with fever, or have been laboring un-

j der fever, and have found no exception to the rule, that all the

I cases in such instances corresponded in character. Yery recently

we have had several sets of cases of typhus occurring in members

* Lond. and Ed. Journal, 1842.

f Lond. and Ed. Monthly Journal, 1843.

X Ibid. 1848, N. S. Vol. IL, p. 299.

18 Continued Fevers and their Discrimination. [January,

of the same family or in the same house ; as, two patients under
my care in Jacob's ; threq of a family under Dr. Bennett, Dr.
Bristowe, and Dr. Goolden ^ and two of a family under Dr. Bar-
ker and i)r. Goolden. Yet in all these sets of cases the character
of the fever was identical.

We have also in the General Hospitals, the opportunity of ob-
serving what in the Fever Hospital could not be seen,' patients
laboring under other diseases becoming affected by typhus, from
their vicinity to typhus patients. Of the cases to which I have
referred, in six the disease was thus contracted, and very recently
three or four similar instances have occurred. In these cases the
character of the fever always corresponds with that of the case
from which the others are derived. I have, indeed, seen typhus
affect persons under the most diverse circumstances, old and
young persons, medical students, nurses, persons in depressed state
of health, from unhealthy districts of town, and others in robust
general health, and fresh from the country ; but I never observed
any material modification of the character of the disease, though,
of course, its intensity or malignity will vary. If, however, the
poison of typhus and that of typhoid were the same, it is impossi-
ble to doubt that, instead of all the cases being characteristically
cases of typhoid^ some would be cases of typhus and some of ty-
phoid ; while others would present more or less of the characters
of the two diseases.

I have reccDtly treated a case, regarded as an ordinary instance
of typhoid, and which passed favorably through the disease, and
recovered, so that the patient was able to walk about the ward ;
he then was again taken with fever, having the usual features of
typhus, and characterized by a typhous rash on the skin. In this
instance, the patient lay in a bed near one occupied by a typhus
patient, and appeared, during his convalescence from typhoid, to
nave contracted typhus. Facts of this kind must be regarded as
strongly upholding the doctrine of the specific difference of the
two diseases ) for it is well ascertained, that both affections like
the eruptive fevers confer, to a great degree, immunity from sub-
sequent attacks.

Lastly, Dr. Jenner has shown that typhus and typhoid may be
epidemic, at the same time, or the one disease may decline, while
the other is becoming more prevalent, or vice versa ; and we have
continual opportunities of observing this to be the case. Often
you will find many cases of typhoid in the Hospital, but only one
or two of typhus; at other times, and such is now the case, the
typhus cases will be much the most numerous.

With these various facts before us, there can be no longer much
hesitation in adopting the conclusion, so ably illustrated, and, I
think, fully established by Dr. Jenner, that typhus and typhoid are
specifically distinct diseases. There may, it is true, be sometimes
a difficulty in deciding as to which class a given case should be

1857.] Continued Fevers and their Discrimination, 19

assigned. The typlius eruption may be more discrete tban usual,
the spots* may be more distinctly defined, and when they first ap-
pear may be usually elevated; and thus, at first sight, the eruption
may bear a very close resemblance to that of typhoid. On the
other hand, the eruption of rose-spots in typhoid may be mingled
with a petechial eruption, which may assimilate it to the typhus
rash ; or, from the presence of other eruptions on the skin, the char-
acters of either rash may be disguised. There may thus be diffi-
culty in deciding as to the true nature of the eruption, but this
difficulty will generally vanish on careful inspection, or, at any
rate, on watching the progress of the case. I do not recollect to
have ever failed to make up my mind as to the kind of eruption
at the time I first saw the patient ; or, on further examination a
day or two after, to have found that the opinion first formed was
incorrect. AYere, however, the difficulty of distinguishing the two
diseases much greater than it really is, this w^ould not prove their
identity; it would only show, as contended by M.Louis, that they
formed no exception to the rule, that most diseases, even some of
those which are the best understood, are occasional!}^ difficult to
discriminate.

While, however, typhus and typhoid are distinct diseases, they
are, nevertheless, very closel}^ allied. This^ at first sight, might
scarcely appear to be the case ; for typhus presents the type of an
essential fever, unconnected with local disease; while, tyjDhoid is
always associated with the intestinal affection. This difference is,
however, more apparent than real ; for in typhoid, as I have be-
fore mentioned, there is not any certain or constant relation be-
tween the intensity of the general symptoms and the amount of
local disease. The intestinal affection can, therefore, only be re-
garded as one symptom or result of the essential disease. Both
affections are thus closely allied to the eruptive fevers, while they
are markedly distinct from the intennittent and remittent fevers
dependent on malaria.

But it may be asked, what is the advantage of thus elaborately
drawing the distinction betvv^een these two forms of fever? Much
every way. In the first place, thou.gh the practical application
should not be now apparent, the extension of our knowledge
would yet be desirable; for it cannot be doubted that all advances
in our acquaintance with diseases must ultimately prove useful in
practice.

But the distinction between typhus and tj-phoid is one which is
full of importance. The prognosis in the two diseases is differ-
ent ; and, though the principles which should guide our treatment
may be similar in both, they must be greatly modified in their
application by the peculiar character of each. [iV. Orleans Med.
News and Hasp. Gaz.

N. S. VOL. XIII. NO. I. 2

20 Effects of Dentition on Nursing Children January,

The Effects of Dentition on Nursing Children, By M. Trousseau.
(Clinical Lectures delivered at the Hotel Dieu. Transiated for
the Boston Med. and Surg. Journal, from the Gaz.desHopitaux,
Dec, 1855.

Eemaeks. The subject of the following article^ we consider of
such deep interest to the practitioner, and the views therein ex-
pressed embody, in the main, so mucli of truth in regard to this
important period of infantine existence, that we deem them worthy
of something more than simple republication.

In order to form a proper appreciation of the subject of Denti-
tian,. we mu^t look at this period in a somewhat different relation
frcvm those in which M. Trousseau has viewed it in the present
article,, viz,, in its relation to the Nervous Sysiem>. In a former
number of this Journal (June, 1850, p. 821^) we had occasion to
discuss, at length, the influence of Dentition in producing the
Cholera Infantum of this period,, and the observation of the
six years, elapsed since that time, has only served to confirm
the views we then expressed in reference to the agency of the
nervous system. It is in this relation, we apprehend, that most
of the interest attaching to this period is to be found; and,, in our
opinion, all the evils resulting, as the effects of teething,, are referri-^'
ble to this system, in one or the other of two ways : the irritatio-n
may be transmitted /mTTi thegumSj Istly, through the cerehro-spincsl
system* to the voluntary muscles,, and give rise to the convulsive
affections and paralysis of this period ; and 2ndly, the irritation may
be transmitted from the gums, through the ganglionic system of
nerves,, to the various vascular organs, as the lungs and liver, and
secretory surfaces, as the gastric and intestinal mucous membrane
giving rise to congestions, in the one case, and excessive secretion,
diarrhoea and cholera infantum, in the other. "A few days before
it (meaning diarrhoea) begins," says M. Trousseau, "the in:^nt is
restlesSj wakeful, cries violently, sucks its fingers, bites the nipple,
refuses to feed, if it takes supplementary nourishment,, and some-
times will not nurse. Its gums are red, and there is very evident
prominence at the points which the teeth are about to pierce ;: there
is cough, the voice is changed, the mucous membrane of the mouth
is irritated."'

Here it will be observed that we have unmistakable evidences
of local irritation in the gums, which we know are supplied by

* "An Essay on the Influence of Dentition in Producing Disease."

1857.] Effects of Dentition on Nursing Children. 21

branches of that most exquisitely sensitive of all sensitive nerves,
the fifth pair ; if we admit the principle of reflex action, we must
recognise here a competent cause, considering the impressible char-
acter of the infants nervous system, for convulsive phenomena. On
the other hand, we may trace a connection between this local irri- ^
tation and the diarrhcEa succeeding it, in an analogous manner,
taking into view the intimate connections existing between this fifth
pair, and the nerves of the ganglionic nervous system, from which
the intestinal mucous surfaces receive their secretory endowments.

We have been thus careful in pointing out the manner in which
we think this local irritation may produce the convulsive symp-
toms, and also even the increased secretion from the mucous sur-
face of the bowels and the diarrhoea,, in order to give it what we
consider its proper amount of importance, and to direct attention
to this, as the chief source of those difficulties, calling for early and
continued care.

Throughout the whole of his communication, M. Trousseau
does not refer once, to the measure of incising the gums, as a means
of relief. This, it is needless to say, is ever in this country deem-
ed an important means of relieving the local irritation, but one
we think too often neglected. Opiates also, as a means of quiet-
ing irritation may be mentioned, but we have found great caution
necessary in their administration.

We have little doubt, that the character of the symptoms and
the phases^ assumed b}^ the diseases incident to dentition, are much
modified by climate. In those regions where paroxj^smal diseases
prevail, the symptoms will partake of the general character of
these diseases, and become, in a great degree, amenable to the in-
fluence of quinine. This is more especially true of the convulsive
diseases attending dentition, which manifest a great disposition to
recur^ unless treated Y/ith quinine, after the manner of paroxysmal
fever,

" It has been said,"" again remarks our author, "' that convul-
isions are common with infants whose bowels are constipated, but
do not attack those who have diarrhoea. This is not true. CoH-
vulsions almost always accompany diarrhoea and are prevented by
a good state of the bowels." From this opinion, our own observa-
nt tion, and doubtless that of most Southern practitioners, would in-
II cline us to dissent. We have uniformly found, where there was
much irritation in the gums-, and this unaccompanied by diarrhoea

22 Effects of Dentition on Nursing Children. [January,

or at least a loose state of the bowels, that the cases were more li-
able to suffer from convulsions, than when the opposite state of
the bowels existed.

We have been thus far led into restating gome of our views in
regard to this subject, in connection with this excellent lecture of
M. Trousseau, more because it has met with, from us^ such heartj
approval, than from any disposition to criticise it; and still more^.
from the conviction,. Ihat the general outline which may be given^
almost of any disease, undergoes modification as we change the
climate, and that, as we mention above, this is more especially
true, in regard to the diseases of dentition, which we think, in
our latitude, present many traits which we may look for in vain^.
in the reports given of them in other climates, H. F. c.

" The most elementary questions in medicine are often the least
understood. It would seem, at first sight, that we need not much
concern ourselves about the trifles which daily swarm- beneath the
feet of the practitioner ; but remember that Stoll has written a
chapter entitled De quihusdam magni raoraenti TriinuiiiSj and learn
early to neglect nothing.

" The infant has twenty teeth, the adolescent twenty -eight, the-
adult thirty-two. Tlie evolution of the twenty teeth of the infant
is not completed before the thirtieth to thixty -sixth month ; but
they are only temporary ^ for^ at the age of seven years, he begins-
to lose them, exchanging them for others which are more durable..
This process is normally accomplished at thirteen or fourteen
years. Except the great king, who formed an exception to every
thing, and who w^as born, it is said, with two teeth, the infant
comes into the world with defenceless jaws^ and it is not till to-
wards the eighth month that the first milk teeth appear.

"Bat since the laws of nature are capricious, it often happens
that one infant has teeth at four months, while another has no'ue
at the end of a year ;. henee no limits can be fixed. Generally^
the two middle incisors of the lower jaw first appear, and I anti-
cipate a stormy dentition whenever I see a child begin that pro-
cess by the upper teeth. These two first teeth appear together,
with an interval of twenty-four hours, forty-eight hours, four days,
and sometimes a week between them, but always together^ remem-
ber, and they are the only ones which present themselves in this
manner. Six weeks or two months afterward, the two superioi
middle incisors make their appearance, not together, brat at th
distance of eight,, fifteen, or thirty days from each other. The
process of dentition is- thus very rapid for the first two teeth, anc t*
more slow for the others. ' ^liili

Meanwhile, two other teeth are about to protrude the latera' ^\

1857.] Effects of Dentition on Nursing Children. 23

incisors of the upper jaw very soon, one or two months after the
upper middle incisors. Towards the end of one year the child
has six teeth, and whereas he began with two lower, he has fin-
ished with four upper.

" The teeth of children appear in groups ; denies in infantibus
catervatim erumptmt : Rvst group, two inferior middle incisors, at
about eight months : second group, two superior middle incisors,
towards ten months ; third group, two superior lateral incisors, at
one year, more or less ; fourth group, two inferior lateral incisors,
and the first four molars (six teeth in this group, from fourteen to
eighteen months); fifth group, four canines, from eighteen to
twenty-four months; sixth group, four second and last molars,
from thirty to thirty.six months.

The canine teeth appear after the infant has twelve teeth, and
when he is from eighteen to twenty-four months old ; their evolu-
tion lasts from two to three months, sometimes for ten months;
they then take their places, at the age of three years ; when those
, of the last group have pierced the gums (the four second molars,)
the process of dentition is finished.

It is not without object that I have spoken of groups; you will
see that a knowledge of this arrangement is very important in
respect to weaning. It is a fact worthy of consideration, that im-
mediately after a group of teeth has appeared, there is an interval
of rest for the child. Profit, then, by this interval to wean, for the
moment is propitious. Do you know what is commonly done?
Children are weaned indifferently when they have two, seven, nine,
eleven, fourteen teeth, no attention is paid to the number. Now,
I entreat you to pay close attention to this, otherwise j^ou will lose
your little patients by that terrible affection of the intestines, cho-
lera infantum.

You will often be consulted as to the time for weaning; never
give an opinion, therefore, until after a scrupulous examination of
the state of the dentition, and do not authorize the mother to wean
her infant until it has six, twelve, or sixteen teeth. Good practi-
tioners will never permit a child to be weaned after the evolution
of the first two teeth ; the patient is two young ; he is ordinarily
but eight months old. It is only by careful management that you
will succeed after the eruption of the third group ; still, if you are
l strongly urged by the parents, consent, for you have before you a
j.;m.onth or six weeks of respite before the evolution of the fourth
5 group. Allow it, then, in case of necessity, but never forget that
^j uhe child has only six teeth, that he is only a year old, and that
. irtificial alimenation will not always be successfuL

"The most favorable period for weaning is, beyond all doubt,

lie interval separatiug the fourth from the fifth group. The

iiild, in fact, is armed with twelve teeth, eight incisors and four

^jj^polars, and he has before him a tolerably long time of rest, about

';W0 months, during which there is no reason to dread any intes-

-{

24 Effects of Dentition on Nursing Children. [January,

tiiial trouble ; and when tlie canines begin to appear (wbicli group
causes the greatest danger in its evolution,) he is accustomed to
his new diet, and prepared for the crisis which he is about to un-
dergo.

"Learn, then, to wait until after the fourth group, before wean-
ing. If the health of the mother or nurse, or the circumstances of
the family, oblige you to authorize an early weaning, always see
that there are six teeth ; but if, on the contrary, you are not
obliged to yield to considerations of this nature, do not allow
weaning until you can count twelve.

Do not imagine that things always go on so regularly. You
will see children who have the molars before the incisors, or the
superior incisors before the inferior incisors ; for although denti-
tion ordinarily takes place in the way I have described, it is no
less true that it frequently presents irregularities which greatly
perplex the physician who is earnestly watching for an interval of
repose. In such a case, do the best which the circumstances will
admit of; examine the state of the gnms, and have the child
weaned immediately after the complete evolution of a tooth, which
wall probably be followed by a period of repose, during which
you will have leisure to guard against evil consequences.

"Among the affections which are common to dentition, the most
important, the most grave., and the most obstinate are seated in
the alimentary canal. A few days before it begins, the infant is
restless, wakeful, cries violently, sucks its fingers, bites the nipple,
refuses to feed, if it takes supplementary nourishment, and some-
times will not nurse. Its gums are red, and there is a very evi-
dent prominence at the points which the teeth are about to pierce;
there" is cough, the voice is changed, the mucous membrane of the
mouth is irritated. From the moment the child has two teeth, the
neighboring gums become inflamed, and the protruded teeth will
be surrounded by a ring of red and swollen gum,

" If you give mercury to a person who has no natural teeth, but
who wears an artificial set, you will not see salivation nor mercu-
rial stomatitis follow. But if the patient have a single tooth re-
maining which has escaped destruction, the effects of the mercury
are manifested around it. The gum surrounding the tooth will
inflame, while the rest of the mouth will be free from disease. The
same is true with regard to the first two teeth ; their eruption
causes no affection of the gums, which, however, swell and be-
^ome red with the evolution of the second and succeeding groups.

'' In almost all children the process of dentition is accompanied
with diarrhoea. This is sometimes moderate, consisting of three
or four dejections only, daily, but is frequently excessive, with
green stools, resembling chopped herbs or grains of curdled milk,
with glairy, and sometimes bloody matter. In certain cases mark-
ed tenesmus manifests itself, prolapsus of the rectum. Thesi
jsyjnptoms, which precede, by several days, the eruption of th^

1857.] Effects of Dentition on Nursing Children. 25

tooth, often continue, and even lasts until the entire group pene-
trates the gums. If the diarrhoea does not cease, you are aware
what treatment should be adopted, and what attention should be
paid to the diet You will restrain and mitigate it as much as
possible.

"Would you advise weaning during this diarrhoea? No, un-
less the nurse's milk seems to keep up the intestinal flux.

"During the summer season, the injurious effects of dentition
are chiefly directed towards the intestines, very rarely upon the
air passages. Intestinal derangements, fever, peripneumonic ca-
tarrh, and other morbid pulmonary manifestations, occur in the
, winter.

"I must warn you against a popular prejudice, which I advise
you to oppose on every occasion that ofiers. You will hear it
said again and again, that diarrhoea is beneficial to children; be-
lieve it not, for too often it will cause the death of your little pa-
tient. Diarrhoea prepares the way for chronic enteritis, and chro-
nic enteritis debilitates and destroys its victims. On the contrary,
i restrain the intestinal flux, and you will find that the other symp-
toms are mnch better borne.

" In the same way, it is considered highly advantageous to leave
untouched the filth which covers the head of a new^-born infant.
^This ridiculous prejudice no longer exists in England or America ;
|let us do away with it here.

" When, during dentition, the evacuations are merely more
^loose than common, without amounting to diarrhoea, this slight
^derivative effort requires no interference, but it should not be al-
['lowed to continue too long.

' " It has been said that convulsions are common with infants
whose bowels are constipated, but do not attack those who have
diarrhoea. This is not true. Convulsions almost always accom-
pany diarrhoea, and are prevented by a good state of the bowels.

" I call your attention particularly to the diet, as a point of the
(greatest importance. If j'ou neglect caution in this respect, you
^^'ill have diarrhoea, followed by enteritis, serious indigestion, and
3clampsia. Nothing is more common than severe cases of indi-
^estion, aggravated by enteritis, and leading to convulsions ; and
lothing is more alarming to the parents, who generally lose their
senses, and while the domestics or the neighbors run to bring
'.he doctor, the mother, following the advice of some officious
,2:ossip, pours hot water over the hands and feet of her infant ; he
!s scalded, and dies from the effects of it. This reminds me of
vhat occurred to an eminent brother-physician. Professor Marjo-
in, during the course of a typhoid fever, which threw him into a
tate of profound stupor. They applied to his legs napkins wet
vith Avater at a temperature of 158 Fahr. Large eschars follow-
d, which were not completely healed for several months.

" If convulsions occur, the less you do, the better. The attack

26 Belladonna in Arresting the Secretion of Milk. [January,

indeed, is most frequently over when you arrive, and although
there may be a slight recurrence once or twice during the day,
the remembrance of it is only left, the day after. If there have
been indigestion, administer a laxative, in order to expel any un*
digested food ; allow the child to nurse but little, give it water
with some albuminous substance in solution, and, in an urgent
case, a bath, and you will soon see the alarming train of symp^
toms disappear. Almost any treatment succeeds in the majority
of cases, even the infinitesimal doses of that absurd system--"
homoeopathy."

On the lUffects of Belladonna in Arresting the Secretion of Milk,
By E. H, GooLPEN, M.D.

As nothing is read with greater interest by practical men than
your reports of clinical facts, I hope I may claim a corner in your .
journal, at as early a date as convenient, to relate the following
cases, illustrative of the effect of bellodonna in arresting immedi-
ately the secretion of milk.

E. J- , aged twenty-eight, was admitted into Anne's Ward,

St. Thomas's Hospital, with severe rheumatic fever. She had
been ill four days, with a child at the breast four months old. At
the time of her admission she had swelling and acute pain in both
wrists, right elbow, both knees, and left ankle. The knee-joints
were distended with synovia, and erythematous patches were on
the skin of the knees, ankles and wrists. She was bathed in per^
spiration, and the secretion of milk was abundant. According to
the regulation of the hospital, the child was removed; indeed,
from her helpless condition, it was necessary, considering the dif-
Acuity of attending to an infant in a ward with other patients,
Soon after her admission she took eight grains of calomel and a
grain and a half of opium, followed by a senna draught ; and one
scruple of nitrate of potassa, ten grains of bicarbonate of potassa,
and half a drachm of spirit of nitric ether, in peppermint water,
every four hours. The joints were covered with cotton wool.

On the following day, at two o'clock, I found she had been
freely purged ; the joints were in nearly the same state. She had :
had no sleep. The breasts had become tumid, hard, painful, knot*
ty, and extremely tender. The superficial veins were distended,
Some milk had been drawn, but the process was attended with^
great pain, and we could not listen to the heart's sounds on ac
count of the tenderness.

A milk abscess, in complication with rheumatic fever, was of all
things to be avoided, and unless the secretion could be at once
arrested, it appeared inevitable. In this state I recollected that ]
had somewhere met with an observation (but I cannot remembei
whether it was in an Enghsh or foreign journal) that atropim

1857.] Belladonna in Arresting the Secretion of Milk. 27

applied externally to the breasts would dry up the milk ; and
thinking it reasonable, I caused the areola of the breasts to be
gm^ared with extract of belladonna, in the same way that it is used
to dilate the pupil of the eye. I likewise ordered the addition of
half-drachm doses of colehicum wine, knowing that whenever
milch cows eat the meadow safron in the pasture, they immediate-
ly become dry.; and though I have not much faith in colehicum
as a remedy in rheumatic fever uncomplicated with gout, there
could be no objection to its use, an it has the sanction of much
higher authority than my own.

On my third visit the following day, the first inquiry was about
the breasts. They were all right. But was it the colehicum or
belladonna that had relieved them? The extract was used before
I left the ward; before the mixture was given, the secretion of
milk had been arz-ested and the breasts had become soft. The rest
of the case has no further special interest. I will only state that
there was no heart affection, and that the fever, though very se-
vere while it lasted, was of shoz't duration, and the patient leit the
hospital quite well in fourteen days.

The second case that occurred to me was uncomplicated with
any disease, and such as would usually fall under the care of the
accoucheur rather than the physician :

A lady, the wife of a clergyman, was travelling with her hus-
band, and in order to accompany him, had weaned her baby,
{then seven months old). Happening to be at Oxford at the com-
memoration festival, he came to me in great trouble, telling me
that his wife had done a foolish thing in weaning the child, and
that they were now arrested in their progress in consequence of
the state of her breasts. They were tumid, very tender, painful,
and hard, with large superficial veins, and the milk had been
drawn with difS.culty several times, with temporary relief I re-
commended the application of the extract of belladonna to the
areola, desiring them to send for a medical practitioner if the in-
convenience did not immediately subside, or unless she felt quite
well. A few days brought me a letter, giving a very satisfactory
account, and thanking me for what she was pleased to call my
wonderful prescription. Within two hours she was perfectly re-
lieved, the milk absorbed, and (what is very important) there was
no fever or other inconvenience attending the sudden suppression
of the milk ; and instead of taking the opening medicine I had
prescribed for her, she continued her journey the next morning.

I have not been able to discover that the fact that belladonna
is available for the purpose of arresting the milk secretions is at
all generally known certainly it was not to several accoucheurs
in large practice of whom I have inquired. The fact is important,
if true, for then milk abscesses will become a matter of past history,
and probably many diseases of the breast may be rendered lesa
complicated by its use.

28 Extra- Uterine Pregnancy. [January,

The two cases I have detailed are not sufficient to prove that it

will always be either successful or safe, but they render it highly
probable that it is so. My assertion may have a temporary inter-
est, and soon be forgotten, and the opportunities of observing milk
abscesses, and their early progress, do not occur with such fre-
quency to a hospital phj^sician, even in private practice, as that I
may hope to bring together a sufficient number of facts to lay
them before you. The fact has alread}^ been noticed, and if you
will invite others who have more opportunities of special observa-
tion to try the experiment, and give you short extracts of cases
bearing on the subject, with the names of observers, I am sure you
will confer a favor on the profession. \_LondGn Lancet.

Extra- Uterine Pregnancy of Four Years^ Standing, tJie patient in the
interim being twice delivered of a healthy living child. By A. W.
Heise, M. D., of Addison, Illinois.

In November, 1855, I was called to visit Mrs. Yungels, residing
one mile east of Aurora, and thirty miles west of this place. Upon
my arrival I found the patient, a woman of robust constitution, S6
years of age, to have been ten days since delivered of a healthy
male child. The three or four days following delivery she was
quite well, since which time she has had a chill every day, follow-
ed by fever and profuse perspiration. Has had the usual lochial
discharge, but no secretion of milk ; pulse 100 to 110; tongue red,
-dry and hard ; no appetite. On applying my hand to the abdo-
men, which is painful and irritable, I find an enlargement resem-
bling a hard tumor, which, is moveable, and not connected with
1:he integuments commencing in the umbilical region about three
inches above the umbilicus, extending downwards parallel with
the linea alba to the os pubis, filling three-fourths of the lumbar
-and illiac region of the right side. Left of the linea alba it seems
to be perfectly free from any morbid growth. Examination per
vagina shows the uterus in situ, contracted ; the os uteri somewhat
enlarged, hot, dry and painful; vagina natural. By moving the
uterus and placing the other hand over the tumor, the motion of
uterus afi'ects the tumor, and vice versa.

Upon inquiry, I was informed that, four 3^ears since, the patient
supposed herself pregnant, experiencing the usual symptoms
attendant upon gestation for a period often months, during which
time the abdomen constantly enlarged, particularly the right side,
which was hard and painful, rendering her unable to lie upon it
after the third month. At the end of ten months, labor commen-
ced, and a midwife was summoned, who, after expressing her fears
that the child did not "lay right," declared it was yet out of her
reach, the os uteri not at all dilated, would not be delivered yet, &c.

Bearing-down pains, however, increased, and were finally re-

1857.] Extra- Uterine Pregnancy. 29

lieved by a discharge of a large quantity of watery matter having

the appearance of beef brine, followed by coagulated blood. This
not only very much relieved the patient, but diminished the size
of the abdomen, and the mid-wife assured her she had sufiered
only from obstructed menstruation, and would soon recover. The
abdomen gradually decreased in size, for the space of three weeks,
when the locliial discharge ceased, and with it the diminishing of
the bowels, leaving still an enlargement of the right side, which
she was yet unable to lie upon.

Finding no alteration in the tumor from that time, four months
afterward she consulted a physician, who told her he could not
ascertain the nature of the tumor; could do nothing for her without
an operation, which, so long as she suffered so little pain, and it
did not enlarge, he would not advise.

She soon became enciente^ and in time was delivered of a large,
healthy child. Parturition was easy, and she soon regained her
usual health, having experienced no unusual sjmptonjs, with the
exception of the total absence of any secretion of milk. The tumor
had been painful during confinement, but otherwise retained its
former appearance.

Eighteen months afterward, she again became pregnant, and in
November, 1855, was once more delivered of a healthy male
child both are now living.

Dr. Young, of Aurora, who attended her, says he observed
nothing unusual in her case ; did not notice any enlargement of
the abdomen: called again and discharged her as doing well.

On the tenth day after her confinement, I first saw the patient,
and found her as above stated.

I prescribed those medicines which were indicated, directed
emolient poultices to the abdomen, and left, with directions that if
the patient did not improve, or there was any alteration in the
tumor, to inform me. Thought the tumor might be an enlarge-
ment of the right ovarium, and that when the irritation of the
uterus subsided, and the fever abated, it would cease to be painful,
and she might again enjoy her usual health.

Heard no more from her until May 5, 1856. I was summoned
to see her again. I found her much emaciated, exhibiting a great
degree of nervous excitability; pulse 90, small and irritable- has
sufiered much from pain since 1 saw her, having been constantly
confined to her bed. The tumor at the umbilicus has ulcerated,
and discharges a very offensive fluid. Through the orifice, which
is nearly the size of a half dime, a bone has protruded ; another
now closes the opening.

The case was now plain, and I advised an immediate operation.
Dr. Yonng, of Aurora, was called to assist, and upon his arrival,
requested to have his friend. Dr. Allaire, of Aurora, present.

Adhesion of the peritonium had taken place around the orifice,
to the extent of from three to three and a half inches. I made an

30 Uncontrolahle Vomiting in Pregnancy. [January,

incision of about three inches toward the right lumbar region, and
commenced at once to extract the bones. The flesh was decom-
posed, but the skeleton was perfect, and was of the size of a foetus
at the seventh month, though the bones appeared to have the
firmness of two years' growth. Its extraction through the rather _
small orifice was tedious, in which Dr. Allaire very kindly and
effectually assisted, Dr. Young, meantime, quieting the patient
by administering chloroform. The bones of the head and pelvis
were too large to pass through the incision, until they were sev-
ered by a strong pair of scissors. We succeeded in removing all
the bones, together with a mass of semi-decomposed matter from
the sac. The sac, which was formed of a gristly substance, and so
hard as to almost resist the passing of the bistoury, seemed to have-
contracted close around the foetus, and evidently had performed
the ofiice of placenta and uterus, in being connected with the
latter.

The wound was simply dressed with lint, a bandage applied,
and the patient directed to lie in a position to facilitate the dis-
charges. She was left under the care of Dr. Young, and up to
May the 10th was doing well. \_North Western Med. and jSurg,
Journal,

Uncontrolahle Vomiting in Pregnancy.

Remarks. In connection with the above caption, we will re-
cord a remedy which we have not, elsewhere, seen reported. Our
excellent friend, now Reverend Dr. C. T. Quintard, of Randolph,
Tennessee, formerly Professor of Physiology and Pathology
in Memphis Medical College, having been perplexed for a long
time, with a case of obstinate vomiting during pregnancy, resorted
to the expedient of cauterizing the fauces freely with a solution of
Nitrate of Silver^ about 15 grs. to the oz. of water. The experi-
ment was entirely successful. We can very readily explain this
result: The nerves supplying the fauces are the excitor nerves of
vomition; from the long continued efibrt, they had become per-,
manently irritable; the cautery obtunded their irritability, and
their corresponding motor branches, from the pneumogastric, in the
stomach, were no longer provoked to act. Query. May not the
5,bove, be the pathology of protracted vomiting, under other cir-
cumstances, and might not a similar measure act as efficiently in
relieving it ? h. f. c.

The attention of physicians has of late been directed towards
the subject of excessive vomiting during pregnancy, with a view
to discover some more efficient mode of treatment than that usual-

1857.] Uncontrolable Vomiting in Pregnancy, 81

\j employed for tliis unpleasant and sometimes alarming symptom.
Although the cause of the vomiting has always been recognized
as seated in the uterus, yet the means at our disposal for ascertain-
ing the condition of that organ having until of late been limited,
it has been necessary to treat the disease as one of the stomach,
and to address remedies chiefl}^ to that organ. It is needless to
say that in many cases this mode of treatment is ineffectual. In-
stances^now and then occur in which, in spite of the employment
of prussic acid, creasote, alcalis, acids, narcotics, leeches, blisters,
sinapismy the vomiting still continues unabated, or increases
sometimes to such a degree as to render necessary the artificial in-
duction of abortion as the last resource, and that a doubtful one,
in order to save the life of the woman, if indeed that result does
not follow spontaneously the violent contractions of the stomach.

It is now well known that in these cases there is often some-
thing more than the presence of the ovum in the uterus, and the
, enlargement of this organ ^ to account for the sympathetic irritation
of the stomach. The speculum often reveals various morbid con-
ditions of the cervix^ and since the removal of these conditions, or
their diminution, by appropriate local treatment, is followed by a

cessation or diminution of the vomiting, it is fair to attribute this
( exaggeration of a natural phenomenon to a morbid condition of
! the parts which are concerned in its production. An interesting
\ case confirming this view, which we see reported in a foreign jour-

* nal, suggested to us the above remarks, and believing that it may
' serve to call the attention of others to this interesting subject, we
1 give a brief abstract of the paper, which was read by Dr, Brian;, be-
fore the French Academj' of Medicine,

A woman aged 25, of good constitution, became pregnant for the
third time at the beginning of March, 1856. In the middle of
Aprily vomiting began and continued, gradually increasing in fre-
quenc}' and violence. About the first of Ma*/, the patient was
obliged to keep her bed. The stomach soon became incapable of
retaining or digesting any thing. Severe gastralgia, thirst and'
constipation followed, combined Avith spasmodic movements, pro-
found depression and emaciation. After all remedies which could
be thought of had been tried, a vaginal examination showed that
I the uterus was completely retroverted, and incarcerated in the'
hollow of the sacrum. It was disengaged from this situation, and
placed in its normal position. Immediate relief followed, and the*
vomiting ceased, to return no more.

It does not absolutely follow that because obstinate vomiting is-
sometimes owing to a definite source of irritation seated in the*
uterus, this effect should always follow such local cause. Womer
in whom there is every reason to believe that the so-called ulcera--
tion, or the granular condition of the cervix exists, may go through
pregnancy without unusual vomiting, just as these same conditions-
axe sometimes found after death in persons who never suffered

32 Suhcoracoid Luxation of the Humerxis^ &c. [January,

during life from leucorrhoea, bearing-down pain, or other troubles
usually associated with them ; but the fact that the two sometimes,
perhaps often, stand in the relation of cause and effect, is a suffi-
cient reason why the uterus should always be examined in every
case where the vomiting can not be controlled by general remedies,
that any abnormal condition may be rectified by appropriate treat-
ment. [Boston Journal.

Suhcoracoid Luxation of the Humerus^ with laceration of the Axillary
Artery and Paralysis of the Arm. By T. EouYER. (Rev. Med.
Chirurg., Sept. 1855.) Translated for the Western Lancet, by
Dr. Krause.

In Mny of 1855, the author had the opportunity to observe in
the clinical department of ^N'elaton, a luxation of the humerus with
complications so rare, that he regards the case itself, as well as the
remarks by Nelaton, worthy of publication.

On the 15th of May a man was admitted to the Hospital des
Cliniques^ who had received a severe injury 75 days before. A'
Suhcoracoid luxation of the humeriis could at once be diagnosed
on the left paralyzed arm. The patient, a workman, stated that
his left arm when flexed and elevated, had been caught in the
turning-wheel of a machine. Tlie wheel pressed his body against
the axle-tree and pulled his arm violently. Immediately after the
injury he was brought to the hospital of Marly^ where the surgeon
did, not attempt to replace the dislocated limb until after 22 days..
He did however, not succeed even with the power of 10 assistants.
During the next eight weeks, neither the position of the arm nor its
usefulness had improved. On examination the shoulder was found
remarkably flattened. The head of the dislocated humerus could
distinctly be felt close under the coracoid process. The acromion
appeared very prominent and a depression below it. The anterior
wall of the axilla had a less extent, than on the other healthy side.
Though some writers set down a proloncration of the anterior axil-
lary wall as a symptom of suhcoracoid luxation, the inserting
point of the pectorallis major muscle being lowered with the dislo-
cated head of the humerus, yet this sign holds good only for recent
luxations. For in old cases the muscle becomes atrophied, the
anterior wall of the axilla proportionally shortened. The head of
the humerus felt uneven so much so as to render stalactiform de-
posits of bone on it ver}^ probable. In front of the head of the
humerus the brachial plexus of nerves was situated, a pressure on
which caused stinging pains extending along the arm. In follow-
ing the course of the arteries down the injured arm the axillary
artery was distinctly perceptible from the clavicle to the head of
the humerus below which pulsation ceased. It was wanting also in
the brachial, radical and ulnar arteries. About the acromion be-

1857.] Subcoracoid Luxation of the Humet-us^ d-c. 33

Death the skin a hirgc pulsating artery was felt, wliieh was tracea-
ble to the middle of the humerus. '^Jlre whole up|)er extremity
was highly oedematous, the oedema in the axillary region hard and
resistant. The arm hung down near the chesty the muscles of the
humerus and forearm were paralyzed, only the extensor muscles
of the fingens, especially of the thumb, had retained some mobility.
This case, therefore, was an instance of a very rare injury. The
axillary- artery was torn, (?) though no aneurism tumor was present.
Instances of laceration of arteries by the luxating power are not
common. It takes place much more frequently in consequence of
the force applied by the surgeon^ particularly in cases of long
standing. The artery is either torn completelj^ or, it happens, that
only the two internal membranes are divided, while the external
sheath of the artery remains intact in the form of a distended C3'l-
inder. The related case seems to range among the latter class.
The absence of an aneurismal tumor is very remarkable, Malgaigne
has collected 12 cases of the laceration of arteries by powerful at-
tempts at reduction. Among these is a case of Xelaton, occurring
to an aged ladj^ with subglenoid luxation of the humerus. The
reduction of the recently luxated arm had been easily effected.
Soon after, however, a tumor formed in the axillary cavity, gradu-
ally increasing in size so as to present the appearance of an aneu-
rism. The ligation of the subclavian artery did not arrest the
growth of the tumor j a few days after the operation it burst and
proved fiital. The post mortem showed, that the aneurism commu-
nicated with the dorsalis scapulae, rendering thereby the ligation
of the subclavian artery of no avail.

, Another very uncommon complication in the case related, is the
paralysis of the upper extremity. The parah'sis, following luxa-
tion did not attract the attention of the profession till after the
beginning of this century, Boyer first noticed the paralysis of the
ieltoid muscle. Paralysis of the whole extremity, however, has
3een accurately observed but recently. The paratysis as well as
;he les-ion of the arteries^ are either brought about bj the luxating
f )r reducing power, causing laceration, compression,, contusion or
I excessive stretching of the nerve. Laceration of the nerve is of
' jxtremly rare occurrence. It has been observed only a few times
ii n conseqiience of two powerful attempts at reduction in old cases.
?i Compression of nerves, though mentioned by Van Sweiten and
ii )esault, seems- to- have been presunied only on theoretical grounds.
There is at least not a single instance on record, where it was pro-
? ^en beyond doubt. Contusion and stretching of the nerves is most
frequently observed, immediately after the luxating power has
-: eased to act. The plexus of the nerves or a single branch- is
1 tretched beyond measure and contused by the dislocated head of

he humerus, and the paralysis is proportionate in degree- to the
-ion of the nerve. Sometimes the paralysis may have been caused

y a power, acting but momentarily upon the nerves ia a siniilar

8-i Vesico- Vaginal Fistula. [January,

manner, as paralysis of the arm without luxation falls under obser-
vation, subsequent to a fall on or blow at the shoulder.

The question, whether in a case like that reported, anything is
to be done, in order to improve the Usefulness of the limb, is, indeed,
difficult to answer. In regard to the reduction, it is not to be tried
for several reasons. The hard oedema of the upper arm indicates
that the exudation at this place has organized to such an extent
that the reposition of the head of the humerus would be possible
onl}' at the expense of an extensive tearing of the soft parts. The
other complications present, moreover, the rupture of the artery
and the lesion of the nerve, might give rise to more serious acci-
dents, if a very powerful force, as required in all probability, should
be brought into action; gangrene of the extremity might even be
a consequence. It is likely, that also in this case a spurious artic-
ulation will graduall}' be formed, which will allow a freer use of
the limb. The muscles of the arm are completely paralyzed with
our patient. Some favorable effect might therefore be expected
from the use of Electro-magnetism, if it should become evident,
that the paralyzed muscles contract under this stimulus. Without
the use of this agent the muscles will probably undergo fatty degen-
eration. The patient, we are sorry to say, left the hospital after 2
davs.

A case of fesico- Vaginal Fistula^ treated with the Button Suture of
Dr. Bozeraan, By T, Wood, M. D.

Mrs. C. B, -, et. 26, was brought to bed with her fourth child

on the 27th of June last. She was attended by a woman who can-
not give any definite account of the labor further than that "it
was slow, and that the child's head was in the bones about twelve
hours before it was born.^' The child was still-born. One week
after her confinement I was called to see her and found her with a
dry parched tongue, full quick pulse, hot dry skin, and bowels
constipated, with a constant dribbling of urine from the vulva, and
extensive excoriation of the pudendum and nates from the irrita-
ting discharge.

On examination per vaginam the uterus was found intact, with:
the OS tolerably well closed, but the lips were swollen and of a duU ;
florid hue. The entire mucous membrane lining the vagina ap-
peared inflamed, and was very sensitive to the touch of the spec-
ulum or finger. A small spot about the size of a dime, at the lefi
side of the median line and about mid- way between the caruncuk^
myrtiformis and the os tincse, was white and ragged, and at thi;
point the urine could be seen issuing from the bladder into tht
vagina. Through this point the forefinger passed readily into tht
bladder, and the white appearance proved to be cellular tissue tha
had lost its vitality, but was still attached to the living parts.

On inquiry, I learned that the patient had been unable to pa-

1857.] Vesico- Vaginal Fistula. 85

any urine for about five days after her confinement, and had suf-
fered much from that cause, but it had suddenly burst away, giving
immediate relief from the pain of retention, but ever after she was
unable to restrain the flow.

The history and examination clearly revealed the nature of the
difficulty, and she was at once advised that the only hope of relief
was in an operation.

A cathartic was ordered, and a dilute solution of the acetate of
lead directed to be thrown into the vagina several times a day. In
a few davs the sloughing process was completed, and the inflamma-
tion of tlie vagina had disappeared, except around the margins of
the fistulous orifice.

From this time her genefal health improved and she suffered no
inconvenience, except the painful scalding from the urine on the
skin.,

! Forthepurposeof securing efficient attendance I had her admit-
I ted into the Commercial Hospital to Undergo an operation, and

just six weeks from her confinement,, the button suture of Dr.
, Bozeman was applied to the fistula.

i For a description of the button suture the readers of the Lancet
i are referred to the May number ofthe Louisville Ee view (page 76),
f where a valuable article appears, from the pen of Dr. Bozeman, of
:' Montgomery, Alabama.
; The various stages of my operation did not vary in any essential

particular from the method of Dr. Sims, except in the application
of the button suture. After the operation, absolute rest and a low

; diet were strictly enjoined, and the bowels,- which had been freely
opened by oil the day before the operation,, were quieted by occa-
sional doses of opium. The operation gave rise to no constitutional
disturbance,- and at each daily visit, until the seventh day, she
uniformly replied to inquiries,- that she felt perfectly well. On the
seventh day^ I found her with cold feet and hands, her countenance
somewhat flushed, and some pain in the head.

Her bowels had not moved since the operation, and supposing
the constipation to be the cause of the headache^ I ordered her a
dose of oiL

: The next day the disturbance in the circulation had disappeared
^ith the operation of the medicine. As no urine had passed
through the fistula, after the operation, I felt pretty well assurec^
that the union was complete, and, therefore,- removed the stitures,-
when I found my hopes fully realized^ Union throughout the
seam, about three-fourths of an inch in length, was perfect and firm.
My main motive in giving this hasty report, is to offer my hum--
ble testimon}^ in favor of the ingenious and simple contrivance of
Dr. Bozeman. I believe that it possesses many advantages over
all other methods that have been recommended, and, in mv hands
it has full}' justifi-ed all that ha-s been said of its talented in ventor.-

[Western Lancet.

N. S. VOL. XIII. >'0. I. 3

36 Nitrate of Silver in Small-Fox. [January,

On the Prevention of Pitting in Small Pox, by a Strong Solution of
Nitrate of Silver. By Alexander Kowand^ M, P., Physician
to the Marine and Emigrant Ho&pital, Quebec,

John Henry Smith,, lumberman,, aged 20 ; well proportioned
and athletic^, was admitted under my care, at the Marine and Emi-
grant Hospital, Quebec, on the 23d April, 185G. Three day&
after admission, an ejuptio;Q of small pox made its appearance,,
which soon became confluent. Three days after the eruption pre-
sented itself, I applied a solution of nitrate of silver all over the
face, of the strength of one drachm of the salt to an ounce of wa-
ter, which was much stronger than I had heard of having ever
been employed before. This was done with the view of prevent-
ing pitting, which appeared inevitable^ from the severity of the .
disease and its tendency to confluence. For, in addition to higb
fever and constitustional excitement, the cutaneous infl'ammatk)n ran
a severe course, in some parts assuming an erysipektous cliaracter^
terminating in subcutaneous abscesses. The patient experienced
a grateful sense of cooling from the application^ which also reliev-
ed the distressing itching, and tension from which he sufiered,. and
he begged earnestly to have the wash again applied. The prac-
tice was pursued daily till the 13th May, Avhen it was discoatin-
ued. The blackened cuticle now began to peel off, leaving the .
face perfectly free from pitting,, while the hands, in which the dis-
ease had been purposely allowed to follow its course,, were deeply
and numerously scarred. i

Other striking and beneficial effects were observed to follow
the use of this strong solution, besides the prevention of pitting -
the inflammation about the face and head became diminished, and
the itching and heat were lessened, whilst the application caused
no- pain, gave rise to no disagreeable odor, and was not followed
by any secondary fever. The patient recovered completely fron^ .
the disease, and is now a servant in the hospital.

In addition to the above advantages, I believe an important
step is- attained towards the patient's safety by so materially dim.-
inishing the intense inflammatory action about the head,, and in.
such close proximity to the brain ; and I am- so strongly impress-
ed with its utility in this respect, that I shall apply it not only tO'
the face,, but all over the scalp, in all future cases.

Having every reason to be gratified with the result of treatment
iu the foregoing case,. I nw3ntioned the circumstance to my friend
Capt. Reeve, the commandan^ at Grosse Isle quarantine station,,
and strongly urged him to recommend a trial of the same plan in
the quarantine hospital,, when an opportunity should occur.. He
did so, and it wa& a<)Cordingly tested in four cases^ during the fol-
lowing months of Jmi-e and July^ with the most satis&tory
results.

These cases have been reported in the October number of the

1857.] Nitrate of Silver in Small- Pox. 87

Montreal Medical Chronicle, by Dr. Yon Iffland, assistant phy-
sician at Grosse Isle, and I have received letters from that gentle-
man, and from Capt. Kceve, and Dr. George Douglas, the medical
superintendant of the station, acknowleding that it was from me
they obtained the first idea, as to the utility of a strong solution
of nitrate of silver in the ectrotic treatment of small pox. I am
well aware that weak solutions of the same salt have been recom-
mended, but from their weakness, they proved irritating and inef-
ficient, and have consequently been abandoned. The solid stick
of caustic has been a|)plied to each punctured vesicle, hut this
process was found to be painful and tedious, and in confluent
cases almost impracticable.

None of these objections apply to the strong solution of one
drachm to the ounce of water. Its application is free from pain, it
has been proved to be highly ef&cacious, and its employment can
be entrusted to a common nurse, or attendant on the patient.
Moreover. I would recommend its application to the mouth and
fauces. I do not, however, recommend its application to the cor-
nea, when attacked with the small pox pustule^ as that organ de-
mands special and separate treatment from the surgeon.

I have ventured to publish the above case from a firm belief in
the superior advantages of the remedy in preventing pitting, and
likewise as an antiphlogistic agent of great potency, tor I am fully
convinced that its more general UvSe wall not only prevent much
disfigurement, but tend materially to lessen the danger to the life
of the patient, and I trust I shall also be pardoned for claiming to
'be considered the originator of the plan, a step which has, how-
ever, been rendered unnecessary by the frank admission of my
|,rriendy Dr. Yon Mand.

! Of course, my readers are not to suppose that in the foregoing
rase, or in those reported by Dr. Yon Iffland, that constitutional
I'.reatment was neglected. [ITon^reaZ Med, Chronicle.

Vitraie of Silver in Small Pox. By A. YoN Iffland, M.D., Yice-
President College of Physicians and Surgeons, C. E.

It In my article published in the October issue of the Medical
^Jhronicle, on the ectrotic or abortive treatment of small pox, with
tj, solution of the nitrate of silver ^ 3^ou cannot but have perceived,.
1 ihat I assumed no other merit, than that of successfully testing
, jhe application as suggested to me by Dr. George Douglas, (and
i|o whom, as I therein observed, it had also been suggested). In-
n'eed, I did not in the least, attempt to discover any new fact, but
^berely verified one, already expressed, and noiv, I am happy to
J nnonnce, even tried by a distinguished member of the profes-
,ion Dr. Alexander Rowand -and, I have therefore only to
li ! ope, that I have been chiefly instrumental in awakening general

88 Case of Spina Bifida. [January,

atteiitian to it,, and thereby, extending tlie benefits of so import-
ant an ectrotic in tliat loathsome and disfiguring disease, the
small pox.

The importance of obtaining a modifying power over the vari-
olous pustule, had engrossed my attention for a number of years.
I have brought to the test, independent of what may have origin-
ated from my own mind^ almost qyqvj means-, which had been
considered by several gentlemen prominent in the profession, as-
efficacious in preventing th-e nrnturation of the pustule,, and the
subsequent pitting. The sulphur ointment, tincture of iodine^
mercurial ointment, thickened with starch,, and even the pure ni-
trate of silver, have all,, from time to time, been employed by me,,
but with no very satisfactory result, at least^ they more or less
possessed such properties as to render them, if not dangerous^
highly objectionable, and sometimes impracticable in confluent
small pox.

It now remains with me to observe,, that nothing but a sense of
moral obligation to the human family,, as well as the interests of
science,, has induced me to recommend most earnestly to the mem-
bers of the profession,, a solution of the nitrate of silver, in the
form prescribed in my article as the safest,, and most efficacious-
application, which in the present state of our knowledge,, can be
employed as an abortive^ in the incipient, or m.ore advanced stage
of the eruption in small pox.

For this important and valuable application,, second only i.
consideration, to that of vaccine inoculation, the claim of priority
(in Quebec^') appertains alone to Doctor Alexander Rowand^ and 1
am happy, in common with his numerous professional friends, to
reQognise it. Bis zeal and activity in the cause of practical sci-
ence is well known, and his labors in the field,, cannot fail to
bring forth useful fruits. [Tbid.

Case of Spina Bifida^ with Post-natal Hydrocephalus y in ivhich the
operaiion of Paracentesis Capitis was performed seventeen times,
By J.. B. Gibson, M.D., of Clarenceville, C. E.

On the 17th December, 1855^ attended Mrs. IST in her con-
finement. She was delivered of a male child,, which, upon exam
ination^ was found to have a tumour that was situated low dowr
in the lumbar region,, of the size of a couple of goose eggs.. I
was soft, impressible, and fluctuating, presenting all the ordinary
character of the swelling, familiarly known as hydro-rachitis,, o
spina-bifida;, a third of its surface, however, was peculiar, froB
presenting a raw appearance, and discharging a thin,, water;
fluid. Co-existent with this local condition, the lower limbs wer
partially paralyzed. These circumstances caused me to give

The parenthesis is eurs. Ed. Med. Chkon.

very unfavorable opiuion as to the probability of the child's sur-
viving for any groat length of time. The tumour was dressed
with ung, simplex, and I left it, expecting that li^hould soon hear
of the death of the infant.

On the 28th December, I was sent for to see the child, as the
parents were anxious to have something done for the tumour;
and hoping that it might in some way or other be made to heal,
I -prescribed a mild astringeiit lotion, without, however, any fur-
ther expectation than that it would lessen the secretion constant-
y pouring out from the exterior. The result supported this view,
for under the use of the application the abraded surface cicatrized.
Almost simultaneously with the stoppage of the discharge, the
head began to enlarge, although I was unaware of such being the
case until re-sent for on the 25th January, 1856, I then discover-
^ that the infant was laboring under well marked symptoms of
hydrocephalus. The medical treatment (mercurials, diuretics,
Jte.,) usually adopted in such cases was trie-d, but without deriv-
ing any benefit from it, as the head kept on enlarging until the
24th April, when it had attained the size of twenty-six and a half
inches in circumference, and seventeen inches from ear to ear
over the vertex ; it was furthermore remarkably tense, so much so
' at, to the anxious eyes of the parents, it seemed on the point of
rsting. 'No amelioration occurring after a continued perse ver-
ce of the above remedial measures, but the case becoming rather
orse, at the earnest solicitation of the parents that something
ore might be done for the relief of the child from its evident dis-
ss, I advised puncturing the brain; another phj^sician was
nt for in consultation, and on the Mth April, I performed the
peration in the usual manner. Haifa pint of a transparent co-
orless fluid was drawn off, and the head was then carefullj- band-
d, the child apparently experienced much relief from the oper-
ation, and none of the evil results occasional^ witnessed were
mtailed The paracentesis was repeated on April 19th, 26th;
lilftfay 5th, 19th, 23d, 29th; June 9th, 16th, 22d; July 8th, loth,
; August 1st, 11th, 18th, 25th, making in all seventeen times;
e amount of fluid drawn off at each operation gradually increas-
until it measured a pint. But besides these copious evacua-
ons a yet larger quantity of serous liquid absolutely escaped,
ce, after each operation an unknown leakage drained away for
e or two days until the puncture healed, and it probably ex-
ded the amount measured at the time of the operation. After
e tapping of the 26th August, symptoms of encephalitis mani-
d themselves, and the child died on September 1st. No post
rtem examination was performed, as I did not think it neces-
to urge the propriety of it, in opposition to the feelings of the
rents. Nor was there any reason to expect the presence of any
iation from the pathological peculiarities of similar cases. The
ial bones were distinctly disarticulated from each other, and

40 Ckse of Spina Bifda. [January,

floating, as it were, on the fluid beneath. I was inclined to be-
lieve that the encephalitic symptoms were rather of the cerebral
than the meningeal type, and arguing from this, it is to be assum-
ed that the hydrocephalus was of the ventricular type, or that
species in which the brain is distended into a bag of thin nervous
pulp in contradistinction to the second variety, in which from the
fluid being extra-peripheric in location, the brain is flattened
down towards the basis cranii in a laminated like manner. If
this opinion be correct^, the case is further interesting by shewing
how much injury the brain can sustain without a serious result,
for from the effect of the sixteen operations, antecedent to the last,
the recovery was perfect. The fluid was secreted with amazing
rapidity after its abstraction^ so that the original volume of the
head was but very temporarily reduced; that withdrawn on the
11th, 18th and 26th August, was of a dark reddish color, at all
other times it possessed the properties and appearance answering
to the description of it above given. The preceding case is en-
couraging to future operators, by assuring them with what extra-
ordinary frequency and comparative impunity paracentesis capitis
may be undertaken. As a surgical procedure, simply, the punc-
ture is neither destructive nor untoward, and under this consider-
ation the case adds another link to the chain of evidence that has
already been collected by inquirers in substantiation of the little
apprehension that is to be entertained of the consequences of en-
cephalic wounds when pkieed under favorable circumstances. So
long as the system possesses strong recuperative powers, it is capa-
ble of effectually defending itself from the covert invasions of the
inflammatory conditions, we are taught, must nescessarily co-exist
during the progress of reparation from such injuries. And how
forcibly is this truth impressed upon the mind of the observer in
witnessing recoveries without the entailment of a single bad
symptom, after the losses of brain-substance from violence, such
as in the catastrophe described by Dr. Harlow, (Banking's Ab:
stract, 1849,) of an iron bar passing harmlessl}^ through the skull;
or again, as is perhaps less often noticed in the perfect exemption
from ulterior consequences of a dangerous kind, that patients en-
joy who died afflicted with a hernia cerebri, since in them it is
quite common to see portions of the protruding brain actually cut
away by the surgeon, or the same parts slough from their outward
exposure, and yet in neither case is positive harm incurred. Ex?'
amples like these seem confirmatory of the proposition advanced,
by shewing not so much depends on the condition of the parts, oi
its importance to life, as rather on the anterior or concomitani
states of the vital powers. For if now the opposite states be cou
tracted, states of life in which these energies are depressed or worr
out by previous disease, as in fever, or oppressed by an accumulat
ing train of sickly events, as in scrofula, we find that their inhe
reftt recuperation i^ incapable of exertion, or else in the struggl

1857.] Carbonic Acid an AncBsthetic. 41

to assert its dominancy, it is led by the inclinations of disease into
a perverted action. It is under uupropitious circumstances like
these that the slighte-st injury or wound turns out bad and ends
; wrong. Of this abundant proof could be adduced. Applying
I then these reflections to the case above reported, we would seem
I to have an explanation of the final establishment of encephalitis,
for as long as the recuperative powers were sufiiciently competent,
the danger of the operation was averted, but as they grew ener-
vated by the protraction of the original disease, then reparation
was supplanted by a fatality the simple restricted inflammation
of the former passed uncontrolled into an action of a higher grade-
Extending now these observations to the general question of the
propriety of paracentesis capitis in cases of hydrocephalus, it
would seem we had an easy guide offered us for our determination
of the uncertainty in any individual case, by giving a due estima-
tion to the condition of the constitution of the patient. This cer-
tainly appears to be a trustworthy indication, and I think the
facts now advanced demonstrate that the operation in itself is
not dangerous, and is not precluded from employment as some
surgeons once supposed by any such fear. Kor would it seem
that one form of hydrocephalus more than another, is preferable
in an operative point of view, in opposition to the opinion that
has been elsewhere expressed, which contends that in the external
variety there is less risk of subsequent evil than in the internal
form, because the preceding serves to shew that in the latter the
supposed source of danger has in reality no existence. And in
conclusion, I would remark it is well for practitioners such an
equal immunity should prevail, for, I believe, it will be generally
granted, it is impossible during life either to diagnose the one
kind of intra-cranial dropsy from the other, or to fix correctly
upon the precise seat of encephalic inflammation, whether it be
meningeal, cerebral, or both. [Ibid.

Carbonic Acid an Anoesthetic,

At a regular meeting of the Academy of Medicine of ISTew York,
ifaiH^h oth, 1856, Dr. William Parker, President, a communication
xras read from Prof Simpson, of Edinburgh, addressed to the
icademy, "On Carbonic Acid Gas as a Local Anaesthetic in
Jterine Diseases," etc.

It appears that Prof Simpson was led to the use of carbonic
icid gas as a local anoesthetic in painful conditions of the vagina,
iterus, and neighboring parts, from reading the case of a lady,
reated by Dr. Rossi, of Italy, and reported in the second edition
i Pereira^s Materia Medica., vol. 1, p. 155. In this case there was
Q organic disease and merely an increased irritability, which was
(papletely relieved by the injection of carbonic acid gas.

42 Carbonic Acid an Ancesthetic. [January,

Prof. Simpson has frequently resorted to this treatment within
the last two or three years ; and, though not always with success,
yet frequently with great relief, and occasionally with immense
benefit. Several cases were given in illustration. One lady who
had been bed-ridden for years from pain, and bearing down when
standing erect, was almost entirely cured by injections of this gas.
His method of applying it is, to use a bottle having a flexible,
tube attached to the cork. The materials used for generating the
gas are tartaric acid, six drachms ; bicarbonate of soda in solution,
eight drachms; and water, six ounces. The injection may be used
several times a day. Other materials may be used.

Prof Simpson ' adds, that the employment of carbonic acid gas
a^ a local anaesthetic to the uterine mucous surface and other parts
of the body, is not a recent discovery. Dr. Dewees, of Philadeb
phia, speaks favorably of it in his w^ork {Dis. of Fern., p. 269),
Prof Morjon, of Geneva, has used it frequently, and with decided
advantage,

Keferring to ancient writers, the author is disposed to consider
the practice of burning certain aromatic and medicinal herbs, and
applying the fumes to the interior of the vagina by means of prop-
er tubes^ to be but another phase of this practice, as carbonic acid
is the result of such combustion.

He also ascribes the beneficial effects of mineral waters, in many
cases at least, to the topical application by means of baths and
injections of these waters, which generally hold in solution large
quantities of carbonic acid. Female patientB have assured him of
the relief they experience from uterine pains^ while using injections
of the waters of springs, as practised at different German baths.
The same is true in certain cutaneous diseases. ^ The common
effervescing draught, in gastric irritability and nausea, acts on the
sarne principle. The injection of carbonic acid gas in dysentery,
^s practiced with success, by Hey, of Leeds, in 1772, Perkins, etc.,
is directly in point, The benefit of the common yeast poultice,
which gives rise to carbonic acid gas, may be similarly explained,
Many other examples were alluded to in the paper, showing how
frequently this agent is used in practice without recognition of its
anodyne properties.

Dr. Detmold remarked, that members would recollect that, about
the year 184:7, he called the attention of the Academy to certain
propositions, which he then made, proving quite conclusively that
carbonic acid gas is the efficient agent in causing anaesthesia. The
carbonic acid may be given as such, or one of its chemical ingre-
dients may be so administered, that, finding in the blood the other
constituents of this compound, carbonic acid gas i^ generated, and
anaesthesia, to a certain extent, is the result. Thus we may admin-
ister oxygen in large quantities, in the form of nitrous oxyde
(protoxide of nitrogen, or laughing gas,) which has all the chemi^
^.^1 redactions of Ds:jgen, but is much more soluble in water and

1857J ' Carbonic Acid an Anoesthetic. 48

the serum of the blood than pure oxygen, and, therefore, is much
more readily taken up. This conipoutid meeting with the carbon of
the blood, carbonic acid gas is formed in large quantities, with the
production of ana3sthesia to a certain extent. Or we ma}^, on the
contrary, administer the carbon, as the oxyde of carbon or any of
the hydro-carbons, alcohol, the ethers, etc. ; in this case the blood
again furnishes the other constituent of carbonic acid, oxygen, and
anaesthesia is again the result.

The stage of excitement corresponds to the period of combination
of .these elements and the formation of carbonic acid gas. If the gas
is administered as such, there will be no stage of excitement ; but
if the constituents combine slow^ly, and the gas is generated in lim-
ited quantities, there will be a corresponding stage of excitement.
Thus, in the stupor of drunkenness, carbonic acid is exhaled in
normal quantities ; but as the stupor passes oif, large quantities of
that gas are exhaled. The yenous state of the arterial blood, during
anaesthesia, is another proof that carbonic acid is being generated
in large quantities. If it is true that in post mortem examinations
of those dying while under the influence of chloroform, bubbles of
air are found in the heart and blood vessels, it is highly probable
that this air is carbonic acid gas, unless, perchance, it has entered
the circulation by some mechanical lesion.

The only means, in his opinion, of any avail in restoring a pa-
tient from profound or fatal anaesthesia, is artificial respiration, or
.such other means as., by exciting reflex action, will restore respira-
tion, and thus hasten the elimination of the^ carbonic acid gas. It
has been recommended in threatened and apparent death from
anaesthesia, to resort to the.inhalation of oxygen or nitrous oxyde.
Eeasoning from the premises which he had given, such remedies
would be in the highest degree dangerous. To satisfy himself in
regard to this fact, he had made numerous experiments upon ani-
mals, and invariably found a fatal issue hastened by administering
oxygen. [N. Y, Journal of Medicine.

At a subsequent meeting, Dr. Detmold favored the Academy
with a written exposition of his views of the rationale of the action
of chloroform, gulph. ether, and nitrous oxyde, the three agents
employed for the purpose of producing anaesthesia. He attributes
the action of all of them to the production of carbonic acid gas in
file system. The first two supply the carbon, wdiich absorbing
oxygen from the blood, and the last supplying oxygen, which
labsorbing carbon, in either case carbonic acid is the result, w^hich
by its action" on the living organism produces anaesthesia. This
theory, though not absolutely susceptible of demonstration, is yet
apparently based on a logical foundation, and finds a seeming con-
firmation in a number of well-known facts: indeed it was elicited
hj the allusion made to the anaesthetic properties of carbonic acid,
^y Prof Simpson in his recent paper, of which I gave an account
in mj previous letter. [^Charleston Journal,

44 A New Iodide in Secondary Syphilis. [January,

On Secondary Syphilis Treated hg a New Preparation of Iodine^ &c.
By J. C. Christopheks, Esq , F.R.C.S. York-place, Aug. 1856.

The good results ordinarily obtained from treating cases of se-
condary syphilis by the various officinal preparations of iodine are
universally known, yet there are cases which resist their influence,
and there are constitutions which rebel under their administration.
The object of this paper is to introduce to your notice a new pre-
preparation, perhaps a new compound, which, combining the good
effects to be derived from iodine, is devoid of its disadvantages
a preparation which, in my hands, has proved valuable in curing
cases of secondarj^ syphilis which liad previously resisted the bene-
ficial actions of iodine in all its usual combinations and forms a
preparation, moreover, which does not produce the evil eflPects of
iodine in those constitutions Avith which that substance is known
to disas^ree.

My experience of the action of this remedy is limited to cases of
secondary syphilis; but in the hands of some other surgeons, I am
told, it has been found efficacious in cases of scrofula, anaemia, and
in the furunculoid plague which has infested this city during the
last three or four years.

To Mr, Hockin, the chemist, in Duke-street, (w^ho manufactures
it under a patent granted to M. Dupont,) I am indebted for my
knowledge of this preparation, and for its formula. There are,
indeed, two preparations: the one (that which I have found so
useful in treating cases of secondary syphilis) the names " liquor
cinchonce hj^driodatis ;" the other, (that which has been found use-
ful in treating boils, anasmia, and scrofula,) "liquor cinchonas hy-
driodatus cum ferro." The former contains in one fluid drachm
of liquor, twelve grains of cinchouc^ flav., and one grain and a
half of iodine, in the form of hydriodic acid. The latter contains
in addition to the former ingredients, one grain of protoxide of
iron in each fluid drachm of the liquor. These preparations are
produced by exhausting the powdered bark wdth an aqueous solu-
tion of hydriodic acid ; then with water, and the liquor is subse-
quently evaporated to the above bulk.

The circumstance that the iron compound ever remains in a
state of proto-salt, and that the liquor never, either by time or by-
exposure, becomes inky, through the action of the tannic princi-
ples in the bark, goes to show that there is here something more
than a mere mixing of ingredients, and that some new combina-
tion of iodine, the cinchona alkaloids, and the peculiar tannic
principle, exists in it, which the fact corroborates, the same mate-
rials act differently when used singlj', together, or when otherwise
combined.

The dose in which I have prescribed these preparations varies
from one drachm to three drachms of " the liquor cinchonae hy-
driodatus," and from fifteen minims to two drachms of "the liquor

1857.] Treatment of Inverted Toe Kail. 46

cinchonae hydriodatus cum ferro ; aud in these doses I have not
found any of the evil effects arise which smaller doses of the other
preparations of iodine have l>e.cn known to produce.

I must not omit to say, (inasmuch as I attach much importance
to its use,) that in some of the successful cases treated by means
G)f the preparation described, I have also employed the hot-air
apparatus, in order to produce profuse sweating, and always with
marked good effect. Indeed, I do not know a more potent reme-
dy for in tj:",ac table and inveterate cases of secondary sj^philis than
this is.

The anciejits recognised the great .advantages of sweating their
patieiits when treating them for this disease and most of the au-
thocs of an early period, prescribe it as a remedy, and some of
them give elaborate directioas for producing and for prolonging
its ejOfeete. They describe the sweating hy medicines, sweating in
bed, sweating in a hot- hoiose (whenever it can be procured), and
sweating by la]x>ur, and either of tho^e processes they designated
the '^ sweating course."

It has occurred to me to find that it i;^ far more difficult to cure
secondary syphilis in the higher than in the labouring clases, and
I have thought that the daiij- occupation of the latter, whereby the
skin is forced into constant action, maj^ in some measure account
for it.

Opium was at one time considered to be a specific for syphilis.
I have found it useful, and most so in those cases in which it pro-
duced free perspiration its very usual effect.

The use of the hot-air bath is impeded by the thought that it
entails a difficult and complicated apparatus, and that it cannot be
used by the patient when at home. It is not so. Few things are
more simple, easier of access, or less costty than it, and the patient
can be submitted to its action in his own bed. There are many
forms : one of the most simple was employed by Dr. Wilson, in
the Middlesex Hospital, with good effect; another by Mr, Kurtz,
a chemist at Liverpool. The former was employed for sweating
only ; the latter for sweating, and for the administration of iodine
and sulphur. \_London Lancet.

Treatment of Inverted Toe Nait. By J. Broke Gallway, Surgeon
Royal Artillery. (Communicated by Dr. Andrew Smith.)
Corfu, July, 1856.

A good deal has been enunciated from time to time of late
years upon the most legitimate line of practice necessitated
by the frequency of an affection of no very dignified pretension
in the catalogue of chirurgical woes, but for all that possessing
strong claims to our notice from the suffering occasioned by its
presence, and still more from that attendant upon the means ia
common use for its relief ingrowing of the nail of the great toe.

46 Treatment of Neuralgia. [January,

In systematic works on Surgery, the acknowledged line of prac-
tice for thiri condition is the barbarous rule of forcing a sharp
instrument from the free edge up to the root of the nail, and tear-
ing the latter away by a process of evulsion an operation which
is certainly deprived of much of its suffering by chloroform,
though still the opprobrium of surgery to the eye and the imagina-
tion. The periodical press has teemed with modihcatious of and
improvements upon this practice.

I have found the following litile expedient attended with but
trifling pain, while it offers a most efiicient remedy for the evil:
With a line and well-tempered file, let a vertical incision be car-
ried down to the matrix, from the root to the free margin of the
nail, a few lines from the lateral border, according to the degree
and extent of the inversion. This part of the step can be per-
formed by the patient himself, and at his own leisure, which in
private life has the advantage of robbing the operation of much
of its terrors. It is easily etfected, and, I need not say, painless.
When thus prepared the surgeon should gently seize the divided
edge of the smaller section with a pair of broad-bladed dissecting
forceps, and with an intinitesimal amount of tractile and of slight-
ly jerking force tear the offending portion of the nail from its bed
and lateral connexions. It is really a very neat operation, and
most satisfactory in its results. It should be repeated at the op-
posite border of the nail, supposing both lateral margins to be
inverted.

By this little expedient I have lately resuscitated a poor fellow
who had become quite lame in both feet from this condition. [Ih.

Treatment of Neuralgia^ hy the Valerianate of Ammonia. By Dr.
Declat.

We have prepared an abstract of an interesting translation from
the Kevue Med. and Etrangue, which may be found in a late
number of the Medical Examiner, as it brings to our notice a new
remedy, which may be of value in the treatment of a class of dis-
eases increasing in frequency and often-times obstinate in their
persistency. According to Dr. Declat, such cases will yield to the
influence of the valerianate of ammonia; and as proof of his state-
ment, he gives the two following cases :

Case I. The Marchioness of Fontanelle suffered with facial
neuralgia for six years, first appearing as she was cutting a wis-
dom tooth. Legrand and Jobert (de Lamballe) ordered its extrac-
tion, which was done, causing agonizing pain. The neuralgia
still continued in spite of every effort of such advisers as Sedillot,
Velpeau and Jobert. Quinine, opium, belladonna, strychnia, iron,
gold and quinquina were employed, and external applications, as
blisters, opium plasters, dulcamara, chloroform, collodion, aconite,

i

1857.] Phenomena in the Life of Pigment Cells. 47

&c. Every thing failed. Jobcrt applied the actual cautery along
the course of the inferior niaxilhiry nerve, and after trying the
waters of Flombiere with partial though temporary relief, the Mar-
chioncjs applies to Dr. Dcclat,

The first remedy used was Fowler's solution, which was pushed
until it produced constitutional symptoms^ without success. The
patient had become almost insane from the agony^ when an ex-
periment was made with valerianate of ammonia on the 3rd of
January. A teaspoonful that night relieved partially, and two
teaspoonsful the next day entirely banished pain: The medicine
was discontinued May 6th. Occasionally^ however. Mad. Ferrand
has '^slight twinges,'' but resorts to the specific, and always suc-
cessfully^ This lady seems to have hereditary right to neuralgia,
her mother having been a great victim to the disease, whilst her
brother^ the Earl of Essex, has had tic dolonreux from his youth.

Case II. M. Letellier, who had suffered horribly with pain in
the head, extending to the neck, and losing itself on the branches
of the facial nerve, was at Plombiere^s when taken, and returned
to Paris in great agony. Dr. Louis tried blisters, sage, quinine
and morphia, without any offect. He used morphia to such ex-
cess as to remain in stupor almost constantly. Dr. Declat admin-
tered the valerianate of ammonia in drachm doses twice a day.
in five days he was np. and in nine days all pain had passed away.
He has since stated that his cure was complete. [ilontreal Med,
Chronicle.

Phenomena in the Life of Pigment Cells.

Busch (Miiller's Archiv.) has made a series of highly interesting
observations upon the various changes which take place in the
pigment-cells of the skin. His attention seems to have been first
drawn to this subject by portions of coloured skin separated from
the larva of the frog and the triton, and by the web of the frogs
foot. He found that often the cells put out projections from their
walls, which went to form pigment globules or balls,, and as these
projections lengthened, these globules became, as it were, pedun-
culated. The stalk then gradually thinned, and finally altogether
retracted, leaving the pigment-globules isolated. The process
was repeated in the same cell, and was a second time watched.
Sometimes a species of sac was pushed out, which became divided
into two, and after in creaseing greatly, became disjoined from the
main pigment-cell,, and another one was then pushed out in its
I, place. Changes of form in the pigment-cell and in the peduncles
. were also observed, and are figured by the author.. Busch also
^ found the pigment-cells to be very contractile, and responsive to
J J the stimulus of eleetrici-ty. [Brit, omd For. Med. Chir. liev.-

48 Physiology and Pathology of the Heart. January,

Contributions to the Physiology and Pathology of the Heart. By
H. Bambergek, Prof, of Med. CliDic in Wiirzburg, (Transla-
ted for the Medical Examiner.)

On the Motion of the Heart. During the past aummer^ the rare
opportunity was afforded me of closely observing through a wound
in the parietes of the chest, the conditions of the hearths pulsation ;
a phenomenon frequently discussed, but as yet very obscure. The
case occurred in a healthy man, 30 years of age, who attempted
to take his life by stabbing himself in the breast with a sharp
knife. The deed took place in a public garden, and I saw the
patient about half an hour afterwards, when he was brought into
the hospital. According to the testimony of those who brought
him there, the bleeding had been profuse, and must at first have
spirted in streams from the wound. He was pale aod exhausted,
but conscious. It was a smooth-edged, gaping wound, about an
inch broad, inclining downwards, somewhat in front of the nip-
ple, and at the lower side of the fifth left rib \ upon each contrac-
tion of the heart, a considerable quantity of dark blood was
discharged. It was evident that the patient, who belonged to the
higher class, had intentionally selected that spot where the pulsa-
tions of the heart were best perceived. I pressed my index finger
into the wound, and was greatly surprised to meet the flat, slip-
pery point of the heart, which had, however, received no percepti-
ble injury. There was scarcely a doubt that the pericardium was
opened, as it would have been scarcely possible otherwise to have
felt the point of the heart with the accuracy above described. Of
course, I availed myself of this favorable opportunity to study, as
far as was possible, the motion of the apex of the heart. When
my finger was introduced from the point towards the back, I
could convince myself with the greatest certainty that at every
systole the hardened and pointed apex of the heart slipped down
along the front wall of the breast downwards, somewhat to the
left, and a little below the lower margin of the wound ^ a copious
discharge of blood taking place at the same time near my finger,
whilst in the diastolic moment, the apex retreated upwards and
could not be felt. The duration of the 1st period, when the point
of the heart moved along my finger, appeared to be somewhat
shorter than the 2nd period, yet I could make no positive asser-
tion regarding this, as the contractions of the heart were so fre-
quent, about 100 in a minute. Notwithstanding the strictest at-
tention, I could not perceive the lever-like motion of the point of
the heart, nor the rotation of the same about its longer axis. As
regards the patient, it is merely necessary to state, that the suture
was immediately applied. After a few days, pericarditis develop-
ed itself, with a loud, grating, friction sound, that lasted about ten
days, accompanieci by a moderate effusion into the left pleural sac.
In spite of this condition, and of a slight hsemoptysis that occur-

1857.] Physiology and PaOtohgy of Uie lltart. 49

red, the general symptoms \vere light ; the patient rapidly recov-
ered; the wound" healed by the first intention, and after a few
weeks he was discharged. jSTeither in the pericardium nor in the
pleural sac, as daily investigations showed, did any admission of
air take place.

It may be permitted me to offer a few remarks upon these ob-
servations. The most important object gained by it is, I consider
the establishment of the fact that during the systole of the heart, a
true movement of its apex takes place in the direction from above
downwards and towards the left. The question might arise as to
whether this movement may not be considered only as an appa-
rent one, induced by a systolic elongation of the heart; but since
Harvey has shown more clearly the relations of the heart to the
circulation, the previously accepted view of the heart's lengthen-
ing by the systole is entirely exploded, and at present the results
of numerous vivisections and observations of Ectopia of the heart
places beyond doubt the fact that the heart during the systole is
lessened in its long diameter. The fact, therefore, that the apex
of the heart can be felt considerably lower during its systole than
during its disastole only by an actual depression of the whole
heart can only be explained in the manner as described long since
by Skoda. Skoda has published similar observations on a new
born child, with deficiency of the stern timy where the fissure was
only covered by skin. I had been a loiig time convinced of the
correctness of Skoda's view, that in decided hypertrophy of the
heart, the deeper position of the apex of the heart during the sys-
tole might be proved by percussion,, and those observations fur-
ther made it highly probable to me that similar rekti-ons existed
for the normal condition ; this probability has since become posi-
tive certainty. This circumstance explains also the fortunate
results of the above mentioned case. If the communicated facts
are considered, we are necessarily led to the view that the stab
must have been made at the time of the diastole, for only on such
a supposition is it conceivable that the apex of the heart, which
was felt beating so distinctly in the wound, could remain nn injur-
ed. Besides it is not inconceivable that the violent physical con-
cussion at the moment of stabbing may have prevented the occur-
rence of the systole.

How is it now with reference to the oft-menticm-ed lever -like
notion of the heart, in consequence of which the heart beats
, against the parietes of the chest? Harvey, Cruveilhier, and Fol-
I in have observed this in Ectopia of the heart, and the numerous
, nvestigations of Yolkmann seem further to place this fact bej'ond
, loubt. It may be imagin-ed,. that I am not inclined to oppose-
, uch authority,, oi to place too mnch value upon one negative ob-
, ervation, whilst at the same time I do not wish to undervalue its-
. mportance, as it appears to me to be the only one whose outward
J elations differ as slightly as possible from its normal condition.

60 Physiology and Pathology of the Heart. [January,

For it appears to inc,, that it can be readily conceded that the pos-
sibility of a lever motion of the heart may take place where the
wall of the chest is absent or broken through, without its being
necessary to maintasin its actual occurrence in an uninjured tho-
rax } it may be exactly as it is in the motions of the exposed brain,
the possibility of which we can with justice deny in an uninjured
skull } in one case as in the other a normal obstacle is absent, and
forces are put in action which could not be so at an earlier period,
although in each ease they must have been presents So long as
we are ignorant of the quantum and quale of the determining
forces of the heart's motions, it will reinain a useless task to deter-
mine a po'iori the direction of these motions; if we concede, how-
ever, the motion of the heart to be downwards, and consequently
the existence of a force that drives it there, as is proved by the
foregoing^ then may we also grant the existence of another forcei
which has the tendency to move the heart lever-like forward.
This, however, is so restricted by the chest-parietes, that the re-
sulting motion is in the direction downwards,, the heart moving
downwards is pressed more strongly against the breast wall^ which
condition possibly assists the object of the hearths contraction.
The lever motion can never of itself be the measure and the true
reason of the heart's pulsation. For the greatness of these pulsa-.
tions does not depend upon the material of the lever, upon its
thickness, &c., but upon the length of its arm and the moving
force. The heart's pulsation ought therefore,, all other things be-
ing equal, be stronger in a giant than in a dwarf; in an adult than
in a child; which all experience contradicts^ On the contrary, it
cannot be denied that the thickness of the heart's walls has a po-
sitive influence upon the force of the hearths pulsations, as daily
experience in hypertrophy of the heart proves.

The complete parallelism that exists between the anterior sur- !
face of the heart and the interior wall of the chest,, the perfectly
flat surfaces of both, and the intimate contiguity of the same in
the closed thorax, do not accord as Kiwisch has already shown,
with the idea that the apex of the heart beats against the breast
wall, and is forced into the intercostal spaces. In narrating later
experiments upon animals which I have had the opportunity oJ
making, I shall return again to the question of the lever motion
Though I cannot entirely agree with Kiwisch's view, and nni
hold to the motion of the heart in every case being downward
and toward the left, yet I fully coincide with him when he make;
the perceptible impulse of t"he heart depend not upon a peculia
beat of its apex against the breast, but merel}^ upon the eviden
systolic hardening of the muscles of the heart pressed into the in
tercostal space. But it may be asked if this is the case, why i
the pulsation of the heart felt only at a small spot correspondin
to its apex, and not over the Avhole surface where the heart lie
upon the breast- wall ? Several things appear to me to contribul

1857.] Physiology and Pathology of the Heart, 51

to this. First, that part of the heart, that is directly upon the
breast- wall, belongs entirely to the right ventricle, which on ac-
count of its comparative thinness, is far less fitted to make its sys-
tolic hardening outwardly apparent, whilst that point of the left
ventricle that lies close upon the breast wall, from its greater mus-
cular character is consequentl37- better fitted to make its action
apparent. Besides, we must not forget that the juxta-position of
the upper ribs which are closer even than the sternnm, and more
particularl}' the thick muscles of the breast, render it almost im-
possible to perceive the heart's contractions under ordinary cir-
cumstances. I have myself often observed, in children and in
emaciated persons, that the heart's impulses frequently occupy
much greater space, and indeed can often be clearly felt wherev-
er the heart touches. In hypertrophy of the heart, that is, as is
well knoAvn, a daily phenomenon. I have seen very frequently
the right ventricle of the heart giving as decided an impulse as the
apex, and jQt there exists no reason for supposing that the motions
of hypertrophical hearts, leaving the strength out of the question,
differ in any way from those of the normal ones. If the breast
muscles of a rabbit be removed, and the intercostal space exposed,
the pulsation will be distinctly felt on every part that the heart
touches, though this could not have been previously perceived.
There is, therefore, no necessity to postulate any other than the
usual motions of the heart's pulsations.

Skoda (5te. Aufl. p. 162,) opposes his view of the action of the
contracting power of the lungs upon the chest parietes, to the
views of Kiwisch. The conclusion of his argument purports as
follows : " Since the heart is held in contact with the chest-pari-
,3tes, and the diaphragm by the expanded lungs, and the contract-
ing power of the lungs causes a continual contraction of the soft
smarts of the chest-wall, then the heart, whatever form it may take,
,3an never by a change of form cause an arching of the intercostal
^!pace or diaphragm from above or below ; it must rather,, if there
{)e no other influence upon its condition, produce a slio-ht drawiug
[nward of the intercostal space and of its diaphragm.'

In spite of my great reverence for Skoda, I must here be per-
aitted to differ from him. If we were treating merely of the
Hminished space of the heart during the systole^ a contraction of
he intercostal space rather than arching of the same would occur;
J>ut when on that account the heart passes into a more ball-like
:3rm, its muscular fibres hardening, and consequently producing
' pressure against the chest-wall, which does not take place during
le systole, then the question is, whether this pressure from with-
ut is sufficiently great, not only to prevent the contraction of the
|ings, which acting through the heart produces a contraction of
|.fie intercostal space, but actually produces a positive rest. Al-
' mdy a priori this possibility must be admitted, since no other

N. S. VOL, Xni. KO. I. 4

52 Various Forms of Obstruction of the Bowels. [January,

sufficient reason exists^ and a posteriori shows even that the exist-
ence of a systolic arching is in fact the case.

On the rotary motion of the heart, mentioned by many experi-
menters, the consideration of this case offers no conclusions.
"Whilst it is at first sight probable that such a one can only be suf-
ficiently clear on the bases of the heart, and not merely at its apex,
and it were unjustifiable to deny the motion solely on the ground
of one negative observation; on the other hand, the peculiar un-
dulating arrangement of solid exudations in pericarditis confirms-
the same to a very great degree..

I have intentionally mentioned the results of my observations,,
and such as immediately grow out of them, without bringing into-
the question any experiments on animals,, because I am of the
opinion that any deduction from the phenomena of the heart's
motions in animals can only be applied with great care to man. .
But I believe not the less,, that they must jield exceedingly im-
portant data, if they are brought into harmony with the observa-
tions on healthy and diseased men. I have the liveliest desire to-
observe the phenomena of the heart's motion in animals, in a.
much more extensive manner than has yet been offered to me in
man ; but I also believe that an actual advantage can only be-
drawn from such observations, by preserving intact the relative-
position of the heart and lungs, because,, from the beginning, I
was convinced that any important disturbances in the normal re-
lations must produce such considerable changes in the heart's-
motion that any application of the same could not be thought of,.
Further observations have in the highest degree confirmed this
view, and convinced me that in the open pleura, or in the removal
or tearing out of the heart, its motions suffer the most important -
changes, and indeed not rarely are completely opposed to its nor-
mal condition. Too true it is, that the various investigations of
extracted hearts have rather hiadered than assisted the student on
the motions of the same. [Archiv. far Pat^wlogische, and Medical
Examiner^

On tUe Various Forms of Obstruction of the Bowels. By W. Si
Ranking, M. D. s

The various forms of intestinal obstruction may be convement}^,
arranged under the following heads :

I. Simple enteritis. ,

II. Impaction by faeces, or other solid formations. i

III. "Narrowing of the canal from disease within the bowel

IV. Pressure of tumors external to the bowel.
Y. Displacement of a. portion of the bowel, causing it to twK|

itself upon another portion. W^

Is:

1857.] Vanotcs Forms of Ohstruction ofie Bowels, 68

YI. Incarceration of a portion of the bowel in a loop, formed by
false membrane, or adhesions, or in some abnormal opening.
VII. Invagination or intussusceptio.

1. Simple enteritis, or inflammation of the bowels, is usually,
but not always, attended by constipation, which purgatives, if
given in ignorance of the true nature of the case, fail to overcome.
In this case the obstruction is due to the inability of the inflamed
bowel to propel its contents ; it allows itself to become distended.
The transition from inflamed to healthy bowel is in some of these
instances very marked, the upper portion being distended, con-
gested and even gangrenous, while the lower portion is abrupted-
ly pale, empty and contracted.

2. The usual cause of obstruction from impaction is by the pre-
sence of hardened fcT-ces,- but in some instances concretions of
other kinds take place, and complete obstruction has been known
to be caused by a large gall-stone. Dr. Watson relates such a
case in his lectures,

3. Narrowing of the bowel from internal disease is the result
either of chronic infiammatiou, with ulceration and interstitial de-
posit, or of cancerous degeneration of the coats of the bowel. Giles'
is an instance of the former disease. The stricture thus induced,
may occur in any part of the intestinal traet^ but is most common-

> ly found in the rectum, and within reach. This is specially the
t case with reference to cancer^ for of 378 fatal cases from this cause,
i in 221 the disease was located in the lower bowel.'
'1 4. Obstruction from tumors pressing on the bowel from with-
out is comparatively rare, but cases are recorded in which such a
result has been induced by large malignant tumors, and by a re-
troverted uterus.

5. Strangulation from simple twisting of the bowel upon itself
is also rare,, but several cases are on record. I have myself met
with two marked instances^ one of which I related some years ago
to the Pathological Society ; the other has recently occurred. In
both the descending colon had turned over upon itself, producing
fetal obstruction. Two cases are also related by Mr. Mackenzie
in the Medical Gazette^ in which the colon was similarly dislocated.
Now and then, also^ an analogous displacement takes place in the
i small intestine,, in consequence of a preternaturally deep mfesen-

t; 6. The sixth variety of internal strangulation of the bowel is

.'Ikiore common. It has occurred to me to see several cases, and an

fi:nstance you lately witnessed in this hospital was one. The more

;5ommon appearances found are a band of false membrane, the re-

'mlt of some former attack of partial peritonitis^ an adhesion of

:he free extremity of the appendix vermiformis^ giving rise to a

looze through which the bowel slips < or a rent or congenital fis-

ure in the mesentery or diaphragm.

7. The last form to be mentioned is intussuceptio. In this case

54 Various Forms of Obstruction of the Bowels, [January,

one portion of the bowel slips into the portion below it, as may be
imitated in the linger of a glove. The portion thus inverted is
sometimes of considerable length, and when it gives rise to a tu-
mor perceptible through the abdominal parietes, it is called a
volvulus.

There is a great difference in the relative frequency of these se-
veral causes of intestinal obstruction, as may be seen in an analy-
sis made by Mr. Philips in an admirable paper published in the
81st volume of the Medico-Chirurgical Transactions. He has here
collected 169 cases, and of these 69 were instances of invagination
r intussusceptio ; 60 of strangulation by the constriction of bands,
adhesions and abnormal openings ; w^hile 19 only were caused by
disease of the coats of the bowel, 11 by impaction of hardened
fces or concretions, and 16 from the pressure of tumors external
to the bowel-
Whatever be the cause which offers impediment to defecation, a
certain train of symptoms sooner or later ensues, though it must
be added they do not follow any regular gradation or combination,
peculiar to individual lesions ; hence the difficulty I have spoken
of in deciding upon the exact seat and nature of intestinal ob-
struction. The first thing that usually attracts attention, is pain ;
this is or is not accompanied by vomiting, and it is found on in-
quiry that from a certain date there has been no action of the bow-
els. Day after day passes without relief being obtained, and the
symptoms become more severe, the pain more constant, the vom-
iting more urgent and eventually stercoraceous :. the abdomen also
becomes more and more distended^ the pulse quickens, the coun-
tenance becomes haggard, and in fatal cases sooner or later symp-
toms of collapse ensue, and the patient sinks retaining his mental
faculties to the last. This is a description of an average case of
ileus ; but great variation is manifested in particular cases in thdi
relative urgency of the several sj'mptoms and in their grouping. J
will briefl.y consider these symptoms seriatim^ and first, of the pain;
This symptom is usually present in greater or less intensity, but
in some few it is very unimportant, and cases may prove fatal in ,
which there is neither spontaneous pain, nor great tenderness on
pressure of the abdomen. In other cases it is the first symptom
which excites alarm, and occurs often during some exertion or
after an indigestible meal. In such instances it is not uncommon-
ly found that a portion of bowel has become strangulated, and
tne sudden pain would seem to indicate the precise moment in
which the bowel has become imprisoned. In other cases there is
little or no pain for some days, but it soon declares itself in con-
nection with distension of the abdomen, and marks the occur-
rence and progress of the enteritis, which seldom fails to add to i
the fatal tendency of the mechanical obstruction. Towards the j
close of life, when gangrene ensues, the pain, as in idiopathic peri
toneal inflammation, often quickly aaid entirely subsides.

1857.] Various Forvis of Obstruction of the Bowels. 55

The constipation is, in all cases of genuine obstruction of tlie
bowels, complete ; or, if any faical matter passes, it is merely that
contained in the bowel below the constricted point. In some ca-
ses of intussusceptio, blood}^ mucus passes, which, in children
especially, will materially assist in forming a differential diagnosis.

The vomiting is a symptom, subject to much variety. I have
recently had a case under my care in which the obstruction was
of fourteen days' duration, with immense distensioiL, but vomiting
did not once occur. This case proved fatal without the patient
once vomiting. The obstruction w^as in the sigmoid flexure.
For the most part, however, vomiting is a very distressing symp-
tom and adds materially to the difficulties of medicinal treatment.
At first it is simply the ejection of the ordinary contents of the
stomach, but at some variable intervals it becomes fsecal.

The abdominal distension likewise varies both in degree and pe-
riod of occurrence. In some cases, where the obstruction is high
up, as in the duodenum, there is little or no distension ; on the
contrary, the abdomen becomes flat or even retracted. Generally
a tympanitic condition soon declares itself, and may proceed to an
enormous extent, so that distended coils of intestine become per-
ceptible to the naked eye.

The condition of the urine is thought by many, and especially
by Dr. Barlow, to give important evidence as to the site of the
impediment. Where it is copious, it is supposed to indicate ob-
struction of the lower end of the tube, and the reverse when it is
scanty in quantity. Further inquiries are, however, requisite to
.establish this as a trustworthy symptom. The state of the circu-
lation in intestinal obstruction fluctuates. The pulse may be un-
affected at first, but rarely fails to sj^mpathize with the gravity of
the disease, in a rise of frequency and subsequent loss of power.

\_Medical Times and Gazette.

' Glycerine and Tannin in Vaginitis. By M. Demarquay. Ie the treat-
ment of this affection, M. Demarquay has found a composition, consisting
of eighty parts of glycerine and twenty of tannin, of great service. When
the vaginitis first appears, the intlammatory symptoms should be calmed
by appropriae regimen, baths, and frequent emollient injections. When
the first stage of the inflammation has passed away, and the careful intro-
duction of the speculum has become possible, abundant injections of water
I are to be thrown in, so as to remove all the muco-pus which lines the walls
|0f the ragina, and these are then dried by a plug of charpie placed at the
end of a long forceps. Then, three plugs of wadding, well soaked in gly-
cerine and tannin, are to be introduced. Next day, after a bath, the plugs
are removed, new^ injections made, and the dressing repeated. M. Demar-
<[uay has never had to have recourse to more than four or five such dress-
ings. After discontinuing them, astringent injections, consisting of infusion
jof walnut leaves, in which one drachm of alum to the quart has been dis-
solved, are employed two or three times a day for a week or ten days. [Bid-
letlii de Therapeutique, and N. 0. Med. News and Hasp. Gaz,

56 Editorial. [January,

EDITORIAL AND MISCELLANEOUS.

We beg leave respectfully to announce that in consequence of other
engagements, our Editorial supervision of the Southern Medical and Surgi-
cal Journal terminated with the volume just completed. It is a source of
much gratification to us that the publication of the work will be continued
by gentlemen eminently qualified to sustain its literar}^ and scientific repu-
tation, and to add to its extensive patronage. In retiring from the Editorial
Chair, we cannot refrain from the expression of our grateful acknowledge-
ments for the indulgent liberality of our patrons and the courtesy extended
to us by the conductors of other periodical^.

L. A. Dug AS,

Augusta, 10th Dec, 1856. H. Eossignol.

Introductory. We feel that "the lines have truly fallen io us in
pleasant places." We enter upon our Editorial duties in charge of a jour-
nal in the full tide of prosperity, and in the vigor of an unbroken and
healthful prime. The present number initiates the Thirteenth Volume of
the New Series of the Southern Medical and Surgical Journal, and while
we are disposed to congratulate ourselves on the well-established and pros-
perous condition in which we find it, we can but feel, that the amount of
responsibility imposed upon us is thereby greatly enhanced.

Feeling the incompleteness of Southern Medicine without some accessi"
ble and convenient medium for the interchange of thought among South-
ern Physicians, the late Professor Miltox Antony having associated with
hjm Dr. Joseph A. Eve, the present able Professor of Obstetrics, began this
publication, under its present title, in the year 1836. Notwithstanding the
difficulties attending such an enterprise at that early period, it was issued
regularly until it had nearly completed its Third Volume, when it was
suspended by his lamented death in the year 1839.

In 1845, its publication was resumed under the Editorial conduct of
Professors Paul F. Eve and I. P. Garvin ; and with but few changes since
that time, it has continued to greet its readers with a regularity unsurpass-
ed by any Journal in the country.

Its late Editors, Professor L. A. Dugas and Henry Rossignol, M. D.,
now retiring, it will be acknowledged have not only well sustained the
early character of the Journal, but have kept it well up to the require-
ments and style of progressive Science, during the six years of their able
paanagement.

The plan of the work and the arrangement of the various heads of read-
f pg matter will not be changed from that adopted by its recent Editors, aj

1857.] Editonal 57

they appear to us the most convenient, both for ourselves and the reader,
that could possibly be chosen. In its publication, w ar happy to inform
our readers, that the well trained efforts of Mr. J. Morris (the half-brother
of the late Publisher, Mr. James McCafferty) have been secured. Mr. M.
has been for many years the foreman of tlie office, and a principal con-
ductor of the pnnting dejrartment, and we can therefore promise satisfac-
tion in the style and execution of the work.

Fully aware of our inexperience in the field of labor we have entered,
we can but acknowledge tlmt we are not without misgivings; but an
earnest desire to contribute our quota to the promulgation of sound medi-
cal doctrine strongly impels us to the obligation, however scant may be
our resources for its accomplishment. From our Brethren we invoke that
indulgence, which the known hberality of our Profession entitles us to
expect.

With this valuable work, so long established, so fostered and so well sus-
tained, we now present ourselves before the Profession, and claim for it in
the future, that support which they have so freely given in the past. We
earaestly solicit contributions for our pages, and promise to use every effort
on our own part to sustain the present character of the Journal, and to emu-
late our predecessors, at least in their energy and devotion,

Henry F. Campbell.

Augusta, Ga., Jan. 1st, 1857. Rorert Campbell.

Professor L. D. Ford's Lecture. Accompanying our present issue,
our readers Avill find this highly polished and philosophical production pub-
lished by the Class. Any enconium of ours, would be inappropriate as
well as superfluous ; for in it we behold the author himself too nearly
allied to us by position, and the yet closer ties of personal friendship, to
allow us the gratification of praising him. "Self-praise is no praise at all,"
says the old proverb ; " Let another man praise thee and not thine own
mouth, a stranger and not thine own lips," says the hook of Proverbs, and
the Book of books.

The Southern Journal of the Medical and Physical Sciences. This
excellent Journal has for a short time disappeared from our list of ex-
changes from causes not affecting its soundness financially or other\^^se.
We are glad to welcome it again, and wish it uninterrupted success. In
the present number (for June) the Editors say : " Our next issue, to con-
sist of some 200 pages, will be issued forthwith, and will embrace the
months of July, August and September. We will give in a third number
the months of October, November and December, so that by the close of
the year, our subscribers will have received their full complement of 768

58 Editorial and Miscellaneous. [January,

Works Received. We are indebted to tlie authors for a large number 'of

works, some of which are highly interesting, and deserve special notice.

We regret that we are not able at present to do any more than merely to

direct attention to them.

The History and Statistics of Ovai-iotomy, and the circumstances under
which the operation may be regarded as safe and expedient ; being a
Dissertation to which the Prize of the Massachusetts Medical Society was
awarded, May, 1856. By George H. Lyman, M. D.

Transactions of the Illinois State Medical Society, for the year 1856.

Transactions of the South Carolina Medical Association, at the extra meet-
ing in Greenwood, July 18, 1855, and at the annual meeting in Charles*
ton, Feb. 6, 1856.

The Transactions of the New York Academy of Medicine, instituted 1847.
Vol. L Part V.

Report of the Eastera Lunatic Asylum, in the City of Williamsburg, Va.
1853-4 and 1854-5.

Thirteenth Annual Report of the Managers of the State Lunatic Asylum,
at LHica. Transmitted to the Legislature, Feb. 9, 1856.

Annual Report, with the Medical Report, of the Commissioners of Emigra-
tion of the State of New York, for the year ending Dec. 31, 1855.

Proceedings of the American Pharmaceutical Association, at the fifth annual
meeting, held in-Baltimore, Sept. 1856. With a list of the members.

First Report of the Woman's Hospital Association, presented to the Execu-
tive Committee, at the Anniversary meeting, Feb. 9th, 1856.

Jlssays on the Physiology of the Nervous System, with an Appendix on
Hydrophobia. By Benjamin Haskell, M. D., of Rockport, Mass.

Encysted Osseous Tumors ; or a thin secreting membranous cyst, developed
in cancellous structure of bone, and surrounded by a thin bony wall. By
Alden March, M. D., of Albany.

History of the Ligature applied to the Brachio-Cephalic Artery with statis-
tics of the operation. (Pai^er read before the Tennessee State Medicab
Society, May, 1856.) By Paul F. Eve, M. D.

Bronchial Injections : a Report, with a statistical table, of one hundred and
six cases of Pulmonary Diseases treated by bronchial Injections. By
Horace Green, M. D., LL. D., President of the Faculty, and Professor
Emeritus of the Theory and Practice of Medicine, of the New York Medi-
cal College, (fee.

Jlemarks on Vesico- Vaginal Fistule, with an account of a new mode of.
Suture, and seven successful operations. By N. Bozeman, M. D., of
Montgomery, Ala.

The Mutual Responsibilities of Physicians and the Community ; being an
Address to the Graduating Class of the Medical College of the L^niversity
of Michigan. Delivered March 2 7th, 1 856. By Henry P. Tappan, D. D.,
LL. D., Chancellor of the University of Michigan. r

Dr. Graily Hewitt exhibited at a meeting of the Pathological Society of
London, Mr. Arnott, President, in the Chair, the Lungs on four children who
died of Hooping-cough,

"The specimens now presented consist of the lungs of four children, who
Jjftye recently died in the St. Marylebone Infirmary and Workhouse, from

1857.] Miscellaneous. 59

hoopino'-couo-h^ under the c^re of Mr. Filliter. They are ilhistrative of the
lesioJivS whii'li will in ahnost all cases be found to be associated with the
disease, and all exhibit one peculiar lesion in a greater or less deg-ree. In

these cases certain jiortions of the lungs will be found, on examination, to

, present that condition formerly known as lobular pneujuonia, but which
now is ascertained to be in reality collapse of the lung substance, without
necessarily, intiammation of the parenchyma of the lung itself. Particulars
of tour fatal cases of hooping-cough Avere then read, together with an ac-
count of the post-mortem appearances in each case, of which the following
is an abstract :

In case 1, that of a child aged sixteen months, there was collapse of por-
tions of both lungs, with emphysema and subi)leural ecchyraosis, some of
the collapsed portions presenting minute bronchial abscesses.

In case 2, a child aged twelve months, there was collapse of the lungs,
the right middle lobe being qinte collapsed, together with the catarrhal or
vesicular pneumonia of Legendre and Bailly, and slight depositions of tu-
bercle in one lobe. '

In case 3, a child aged eleven months, there was partial collapse of the
lungs, together with double pleurisy and catarrhal pneumonia. Maceration
and intiammation of the Peyerian and solitary glands of the ileum were also
noticed.

In case 4, a child aged fourteen months, collapse of the lungs w^as also
present, with a few bronchial abscesses. This case presented a pathological
condition in other respects interesting. The gastric fluid had, after death,

\ 'perforated the oesdphagus one inch above the cardiac orifice of the stomach,
and escaping into the left pleura, had eroded the posterior and upper part
of the left lung.

In all the cases, slight enlai'gement of the bronchial glands was observ-

; ed. The bronchial tubes, especially the smaller divisions, were always filled
with a thickish muco-purulent fluid. Emphysema of the lungs always co-
existed Avith collapse of the lung tissue.

i Remarks. The points of interests in these cases may be now^ briefly
recapitulat-ed. The subjects were all infants of tender age from ten to
'sixteen months old. The collapse of the lungs was found. It presented
for the most part the usual characters, and with it was associated emphy-
sema of the neighboring lobes or lobules. This is an important fact, as

I related to the physical examination of the chest during life. Small bron-

II chial abscesses were also present in most of the cases. The history of these
i, cases during life illustrates one or tw^o points important to bear in mind

I with reference to hooping-cough in very young children. Only one of
I' tfiera was observed to hoop. So far as I have observed, the intensity and
j I frequency of the hoop is a circumstance of good augury, rather than the
i I reverse. The treatment adopted in these cases was of a stimulating char-
il.acter, mild expectorants, and ammonia, together with a little wine, and
I counter-irritation by means of blisters. The unfavorable hygienic condi-
itions in which the children were placed, however, coupled with their ten-
' der age, precluded a favorable result. Death took place, on an average,
) about three weeks after the commencement of the disease." [London
Lancet.

Phosphate of Iron in Human Bones. IS ikies has described two strongly
coloured blue-gi-een bones (the cubitus and the radius of a female skeleton),

60 Miscellaneous. [January,

Mliicli he found in the burial-ground at Eurnont. The bones were coloured
through their entire mass. Nikles found that this colour was due to the
presence of phosphate of iron which existed in a crystalline form in the
bones, and considers that the existence of this salt was due to the circum-
stance of the bones lying in ground impregnated with ferruginous water,
which had decomposed their phosphate of lime. [^Ihid.

External Application of Ergotin. (Translated by Ch. F. J. Lehlbach,
M. D., Newark, X. J.) Dr. Hoppe, Professor of Basle, recommends in his
medical letters the external use of ergotin. This induced Dr. V. Brenner,
at Ischl, to make trials with this remedy, and he obtained satisfactory re-
sults. According to Dr. V. Brenner, the character of disease prevailing in
that region at present, is the typhoid, tending to decomposition of the
blood. Acute intiammations are seen very rarely, and those that occur,
have a tendency to assume the typhoid form, so that the abstraction of
blood is not only of no avail, but sets injuriously, by diminishing the forces
of life very rapidly. This typhoid character, which is prevailing, exercises
its influence upon wounds and ulcers. It is very difficult in cases of wounds
and ulcers to induce a sufficient amount of reaction, necessary to establish
the process of healing. Left to themselves, a long time passes, until suppu-
ration and granulation take place. The same thing is observed after opera-
tions. Wounds can almost never be brought to heal by first intention. K,
on the fourth day, the dressings are removed, the wound gapes as before,
without a trace of inflammation and suppuration. Under these circum-
stances, a dressing as that of ergot is exceedingly valuable. Under its ap-
plication the wound or the ulcer soon becomes more lively and clean ; it
begins to suppurate and granulate ; there arise no exuberant granulations,
and cicatrization takes a very rapid course. Brenner's usual formula is
a. Axung. porec. j ;

Ergotini 3ss. to 3ij. M.

With this salve the wound or ulcer is dressed twice a day.

[As a similar typhoid character is prevalent among us at present, and a
.similar difficulty of inducing healthy infiammation in wounds and ulcers,
.the remedy recommended thus by good authority might be worth a trial.]

N. 0. Med. iHJ'ews and Hospital Gaz,

Effects of Digitalis on Generative Organs. ^L Brughmaons says, that
if from 35 to 40 centigrammes of pulv. digitalis be given for five or six days,
the most complete hyposthenizing eiiect is produced on the generative or-
gans. He has thus given it with very great advantage to combat erotic
excitement, whether due to excitable temperament, sedentary hfe, stimulant
regimen, or the privation or excess of venereal pleasures, etc. He also finds
it very useful in subduing the inflammatory accidents that so often accom-
pany syphilitic diseases, and which may be prevented by its early adminis-
tration. It is pre-eminently useful when phymosis or paraphymosis, chor-
dee, epididymitis, or adenitis are either present or feared. [Review Med.
Chirurg., and Ibid.

Preparation of Caustic with Gutta Percha. M. Richard has recently
brought this before the Paris Society of Surgery. Gutta percha in powdei
is intimately mixed with pulverized caustic in proportions according to th(

1857.] Miscellaneous. 61

strength required, as, e. g., two parts of chloride of zinc to one of gutta per-
cha. The mixture is to be gently heated in a tube or porcelain capsule,
over a spirit lamp. The guUa percha softens, and becx^mes thoroughly
impregnated with the causae, so that on cooling a gutta percha port-caus-
tic is formed. By its properties the gutta percha possesses the advantages
of not altering the tissues, of presen-ing its consistence and flexibility, of
in^iHuUiug itself by its suppleness into'either natural or abnormal canals,
however tortuous, of assuming any desired form under the fingers of the
Surgeon, and of allowing, by reason of the porosity of its molecules, the
exudation and unimjK'ded action of the caustic it contains. [Journal de
Chimle Med.^ 1856, and Ibid.

Air Poison. People have often said that no difterence can be detected
in the analy/.ation of pure and impure air. This is one of the vulgar errors
difficult to dislodge from the public brain. The fact is, that the condensed
air of a crowded room gives a deposit which, if allowed to remain for a
few days, forms a solid, thick, glutinous mass, having a strong odour of
animal matter. If examined by the microscope, it is seen to undergo a
remarkable change. First of all, it is converted into a vegetable growth,
and this is followed by the production of multitudes of animalcules ; a de-
cisive proof that it must contain organic matter, otherwise it could not
nourish organic beings. This was the result arrived at by Dr. Angus Smith,
in his beautiful experiments on the Air and Water of Towns ; wherein he
showed how the lungs and skin gave out organic matter, which is in itself
.a deadly poison, producing headache, sickness, disease, or epidemic, ac-
cording to its strength. Why, if " a few drops of the liquid matter, ob-
tained by the condensation of the air of a foul locality, introduced into the
vein of a dog, can produce death with the usual phenomena of typhus
fever," what incalculable evil must not it produce on those human beings
who breathe it again and again, rendered fouler and less capable of sus-
taining lite with each breath drawn ? Such contamination of the air, and
consequent hot-bed of fever and epidemic, it is easily within the power of
man to remove. Ventilation and cleanliness will do all, so far as the abo-
lition of this evil goes, and ventilation and cleanliness are not miracles to
be prayed for, but certain results of common obedience to the laws of
God. [Dickens' Household Words, from din. Med. Jour.

Poisoning by Chloroform. Ricord extirpated the testicle of a strong
man, 38 years of age, and with all caution let him inhale a very good chlo-
Toform. After half a minute narcosis had completely set in without con-
' vulsions, the operation was performed. After the chloroform had been
\ taken away for some time, all at once the pulse ceased to beat, respiration
stopped, death-like paleness overcame the patient, who turned the eyes
j upwards and seemed to be dead. Instantly Ricord threw himself over him,
and putting his mouth to that of the patient, blew air in it, wdiich he ex-
ij pelled again by compression of the thorax. After this had been done
twice, pulse and respiration returned ; the color improved, and after half a
minute the patient commenced to speak. Ricord makes the following re-
flections :

1. In consequence of hemorrhages or violent emotions, syncope not sel-
y dom occurs after these causes cease. Just the same with chloroform. 2,

62 " Miscellaneous. Jamiarj,

The difference of the action of chloroform depends less on the purity of the
article, as Dedillot asserts, but, like with other medicines, from idio.syncra-
sis. The above treatment of poisoning by chloroform is, according to
Ricord, who often had resort to it, safer and quicker to ap})ly than any
other counter poison. \Jahrh. d. ges. Med. Journal of Pharmacy.

Small-Pox Contagion Prolonged. An instance is reported in the Medi-
cal Examiner of the prolongation of.small-pox cantagion five years. The
disease prevailed in Oglethorpe county, Georgia, pretty extensively, in
1851. xi second wife having been introduced during the present year, into
a family which had suffered with the disease in 1851, and a general up-
turning of the domicil having taken place in consequence, during which all
the old clothing, bedding, carpets, &c., were handled and exposed, the
small-pox attacked the wife and a servant, neither of whom had been from
home, nor had any suspicious person been to see them. They had not
been to or passed through any town. They lived five miles from the near-
est town, and had no intercourse whatever with any person from whom
they could have contracted the disease. [Mem'jjhis Med. Recorder.

Ice vs. Yelloio Fever. IsIy. Meiiam, the meteorologist, has suggested
that a recently invented ice-making machine may be used to prevent and
to check the progress of yellow fever, by the mere power of refrigeration.
The air in both ships and dwellings may by this means be kept at the
freezing temperature at will, and thus free them from the epidemic influ-
ence. Mr. M. thinks that infected vessels can be cleansed in forty-eight
hours, snd then released from quarantine, and that fomites can be purified
in the same way. He even proposes the construction of ice-docks, in which
the outer as well as the inner part of the vessels can be refrigerated.
Without expressing any opinion upon the necessity, or eflicacy, of such j
disinfecting agency for ships and goods, we should hail as a great boon, i
any conti'ivance which will have the eftect to release commerce from the
onerous burden, and murderous influence of quarantines. According to all
experience it is of little avail to prove a thousand times over, the entire
uselessness of such quarantines as are commonly instituted, but it might
be less diflicult to impress upon human credulity the conviction that refri-
geration with artificial ice is an inftillible disinfecting agency. \Ihid.

New Operation for Phymosis.. ^The cavity of the prepuce is filled with
cotton or lint, so that the mucous membrane will be put as much on the \
stretch as the skin. A circular incision then makes a complete division of j
both, while the glans is protected from injury by the cotton or lint. This ji
obviates the necessity of cutting the skin and mucous membrane separate- 1

ly, rendering the operation more simple and less painful. \Ihid. \

I i

A New Method for the Speedy ApjjUcation of Leeches. Dr. Avenier de
Lagree, in the Gazette des Hopitaux, gives the following notice of his me-
thod of applying leeches :

" It is well known how tedious and difficult, not to say impossible, it is,
especially in winter, to cause a number of leeches to adhere to the integu-
ments to which we wish to apply them. I have lately discovered the fol-
lowing method, which I doubt not will be welcomed, since it accelerates in

1857.] Miscellaneous. 63

a remai'kable degree the functions of these valuable annelides. Having
selected the spot to which they are to be applied, cover it with a sinapism,
which is to be allowed to remain some time, in order to etVe(;t conirestion of
the capilhiry vessels. Tlien wash the place carefully, and ])lace the jjlass
containing the leeches upon it. In 2ifew minutes they will all take hold
and draw with an energy and rapidity quite remarkable. After the leeches
fall oti', tl]e flow of blood from their bite is more abundant, and continues
for a longer time, than under ordinary circumstances." [Nashville Jour,
of Med. and Surg.

Abscess of Tihia Amputation. Dr. AVillard Parker showed a log which
he had that day removed from a man aged 35 years. lie was of good
constitution, and fifteen years ago had si)rained his left ankle. Five years,
after the accident, he consulted Dr. P., Avho directed the usual remedies for
intlammation, and enjoined repose. In January last, he had inllaramation
in the joint, and three months ago the doctor was called in to amputate.
He advised delay, and found no ulcer, but some pus over the internal mal-
leolus, which he discharged. Within ten days past he has had a return of
the violent symptoms, since wdiich time his suftering has been intense, near-
ly equalling that of tetanus. On examination of the limb after amputation,
the tibia w^as found to contain an abscess, such as are particularly described
by Brodie. No pain had been produced by pressure of the foot against
the leg. Dr. Parker had seen a similar abscess in the femur of a woman,
some years ago. [Med. cmd Surg. Eej).

Extensive Injuries during Pregnancgr In this city, last winter, a robust
German female, about 26 years of age, and five months pregnant, fell into a
well, and descended 51 feet ! She suffered an oblique fracture of the thigh,
complete dislocation of the knee-joint, and a fracture of the tibia and fibula
jnst above the ankle ! At no time after the accident did she manifest any
signs of abortion, but went her full time, and was delivered, some time in
June last, of a well-formed, healthy child. It may not prove uninteresting^
to mention that, during the pregnancy, the fracture in the vicinity of the-
ankle-joint failed to unite. After delivery, the process of reparation com-
menced, although slowly, and she is now regaining the use of her limb. -
Dr. H. Tyler SmitJi's Obstetric Lectures in London Lancet,

Considerable Hypospadia, ; Fecundation. Dr. Taxel, of Krerasier,
{(Weiner Med. Wochensckrift, 1856,) was lately called upon to decide upon
the sex of a child, which presented exactly the same genital malformation a&'
its father. The latter had hitherto been taken for a woman, and sleepiitg'
habitually in the same bed with a fellow farm-servant, really of the female-
sex ; the child had been the consequence of that circumstance. The fol-
lowing is the condition of the father : The penis is shorter than usual, but
thicker and imperforate ; the scrotum is divided into two sacs, each of
which contains a testicle. At the root of the penis, in the anterior com-
missure of the sacs, there is a foramen, which would admit a small pea,
and from that foramen springs a groove running along the under part of"
the penis. There is no prepuce. In the groove, and about a line behind?
the corona, are two eUiptical openings, large enough to admit a bristle,
and another small hole is observed further back, two lines from the urethral

64 Miscellaneous. [January,

orifice. The author of the paper is inclined to beheve that the anterior
foramina are the orifices of the ejaciilatory ducts, and that by their means
fecundation had taken place Perhaps it would be simpler to look upon
them as the openings of the mucous ducts usually foimd in this region, and
to conclude that fecundation had taken place at the foramen allowing of
the passage of the urine. [London Lancet.

Diminished Frequency of Croup. Dr. Kuttner, Physician to the Chil-
dren's Hospital at Dresden, observes, that while GoUis, at the commence-
ment of the century, met with 1,663 cases within five years, and other
practitioners reg-arded it as the most frequent of children's diseases, the
number of cases seems, during the last thirty years, to have undergone
great diminution. In the Dresden hospital, among 13,120 patients during
twenty years, only 33? cases (21 boys and 12 girls) have occurred, i. e. 1 in
400, although inflammatory diseases of the respiratory organs are of com-
mon occuri-ence among tlie Dresden population. [Journal fur Kinderk.
Virginia Med. and Surg. Jour.

Case of Aneurism with Contraction of the Pupil. By Dr. W. T. Gaird-
NER. The patient, a middle aged man, bad come under Dr. Gairdner's
notice at the Royal Public Dispensary, ai>d, from one of the eyes present-
ing a well marked dimiuution in the size of the pupil, Dr. G. was at once
led to examine the chest, when evidence of the existence of an aneurism
(probably of the arteria innominata) was obtained. The case was of inter-
est, as it added another to the rapidly increasing number of cases in which
this remarkable sign had been noticed. [Edinburgh Med. Jour,

Statistics of Chemists and Druggists. In 1831, the number of chemists
and druggists in England was 5835 ; while in 1851, there were 3632 men
and 12 Avomen carrying on the business under the age of twenty years,
and 11,701 men and 298 w^omen of twetity years of age and upwards (ex-
clusive of 15,163 surgeons and apothecaries); making a total of 15,643
persons, unrestricted, uncontrolled, and irresponsible, wnth a stock-in-trade
sufficient to depopulate the whole continent of Europe. [Letter to ' The
Times,'''' condemnatory of the Sale of Poisons.

Method for the Detection and Quantitative Estimation of Quinine an(i'
other Alkaloids when combined with Fatty Oils. If, for example, the pre-
sence of quinine, as well as its quantity, in cod-liver oil have to be deter-
mined, agitate strongly a measured quantity of the oil with a sfolution c4
sulphate of so<.la in w^ater slightly acidulated with sulphuric acid. After
the aqueous liquor has separated, by rest, from the oil, separate by meanal
of a pipette rather more than half the aqueous solution employed. Filter
this solution to remove a few adhering globules of oil, and then measure
off" exactly one half of the quantity of the aqueous solution originally added
to the oil. Precipitate the quinine, if pi-esent, from this filtered solution:
by means of caustic soda ; slightly wash the precipitate with water and
redissolve it in alcohol ; filter, and evaporate the filtrate to dryness on a
water-bath ; the residue will represent one-half of the quantity of quinine
present in the quantity of cod-liver oil measured oif.

Theprecipitate obtained from the solution by the caustic soda should

1857.] Miscellaneous. 65

be examined by the methods described in the ordinary maniuils of chemical
analysis, to learn whether it be quinine or not.

The method described for se}>arating quinine from cod-liver oil is ap))li-
cable for the sejxaration o-f other alkaloids when conjbined with fatty
oils. (Bastick.) YLondon Lancet,

The Late Case of Poisoning hij Croton Oil. Gallagher, the soldier of
the 89th Regiment, who was condemned to death for " administering Cro-
ton Oil with intent to murder," and in whose defence we wrote an editorial
in our last number, which was approved of and commented on by our
caw/rer^5 of the daily Press, has since had his sentence commuted to five
years in the Provincial Penitentiary. ^Montreal Med. Chron.

Death from Chloroform. A patient recently died at St. Thomas's llos-
pital, London, from the effects of this anaesthetic administered prior to an
amputation of a finger. The house-surgeon, assisted by another gentleman,
had the sole management of the case, the Surgeons of the Hospital having
been absent. [ Western Lancet.

The Use of Glycerine for the Preservation af Organic Bodies. Luton
states that animal and vegetable substances may be kept for a long period
perfectly free from decomposition when immersed in glycerine. He also
finds that it is a good anticeptic agent for injecting dead bodies. [N. 0.
Med. News and Hasp. Oaz.

Rem.arkahle Case. Mrs. Julia Syles, wife of John Syles, of Blackstone,
died on the 14th ult., of dropsy, from which she had suftered for five years.
During that time she had been tapped upwards of one hundred and forty
times, and more thari three thousand poimds of water were extracted. [/&.

Secretion of Butyric Acid hy Beetles. Pelouze states, that many kinds
of the species Carabus^ when they run about, leave behind a foetid liquid,
secreted from a gland near the anus, which, as he has proved,- contains
Imtyric acid. [London Lancet.

Honors to Dr. Von Ifflaiul. It affords us much pleasure to a?mounce
to our readers the election of Dr. Von IfBand, of Quebec, to the distinguish-
ed position of a Corresponding Member of the Epidemiological Society of
London. The report was mooted last month in the letter of our London
Correspondent, and we now are enabled to substantiate it by a more per-
sonal confirmation. We are also informed that Dr. Von Iffland is about
being created a Fellow of the Royal College of Surgeons, of which corpora-
tion he has been for very many years a member. The latter appointment
is pre-eminently distingue, and places our talented collaborateur and es-
teemed friend upon an eminence of celebrity, enjoyed, we believe, by only
one other gentleman in the Province. We are sure these just honors will-
be as gratifying to the numerous friends of the worthy Doctor upon whom
they have been " so thickly showered," as to ourselves. [Montreal Medi-
' cal Chronicle.

Miscellaneoics.

A FEW UINTS RELATIVE TO THE COLLECTION OF SOME INDIGENOUS DRUGS.

It is a matter of some importance to the tliorougla pharmaceutist to keep
in mind the proper time of gatlierino- plants and barks, roots, leaves and other
parts of plants, in reference to laying up a store for future use, and for the ma-
nufacture of quantities of preparations requiring them to be used at the
period of their greatest medicinal power.

Wild Cherry Bark. According to the results of Mr. Perot, the proper
period of collecting wild cherry bark is in the fall, September or October,
as then it contains a larger proportion of amygdalin, and consequently
yields more hydrocyanic acid and volatile oil than in the spring or summer.

American Serma. According to the late Dr. R. E. Gi'iffith, (Medical
Botany, p. 261,) American senna leaves should be collected when the fruit
is ripe or neai'ly ripe, which is in September.

Dandelion Moot. Roots generally, as is w^ell known to many, should be
collected in the fall months, and before frost sets in. This is especially
true of taraxacum, which in October has its juices well stored with the
bitter principle, the presence of which is usually considered an index of
medicinal power, althougli we believe physicians have yet to prove on what
constituent of the plant that power depends.

Pith of Sassaf7-as. An experienced collector of medicinal plants in-
forms us, that pith of sassafras should not be collected until after the iStli
of October, as when removed before that time it frequently assumes a
brown hue, probably from the presence of juices subsequently remwed by
absorption, as the period of suspended vegetation approaches.

Diospijros Unripe Persimmons. Former!}^ the bark of the persimmon
tree was the part made officinal, but in the Pharmacopoeia of 1850, the
unripe fruit was substituted, which is now the proper officinal substance to
be dispensed under the name "Diospyros." llie fruit should be collected
when it has attained its full size, and on the point of changing color, but
before the conversion of tannin into sugar has commenced, a change ra-
pidly promoted hj frost. In September is the time for the collection of
this fruit. When not used fresh, it should be sliced and dried, in a w^arra
situation with free circulation of air.

Dulcamara. The terminal twigs of hitter siveet sliould be collected iij
October, or after the fall of the leaves, and, for convenience of division by
the mill or pestle, should be cut in short transverse slices, not over half an-
incli in length ; a treatment which also favors their dessication.

Ulmits. Slippery elm bark, as found in the market, varies much in ap-
pearance and quality ; sometimes its color is uniform throughout, fibrous
and full of mucilage, ^ntli but little astringence. At other times its fibrous
character is wanting, and the bark breaks transversely without difficulty^
is much less mucilaginous, and consists chiefly of cellular structure.
Again, it is met with much discolored and with portions of the outer bark*
adhering. Now it is highly probable that the season of collection has a-
marked influence on the structure and medicinal value of the bark ; yet we
know so little, positively, of the times and circumstances of collecting the
varieties of commerce, that it would be, perhaps, presumption to hazard aiir
opinion, and therefore sugo^est that some pharmaceutist, who has the op-
portunity by location, will investigate the influence of season on the charac-
ter of the inner bark of Ulmus Fulva. \^Am. Jour, of Pharmacy.

SOUTHERN

MEDICAL AND SURGICAL JOURIAL.

(NEW SERIES.)

Vol. XIII.] AUGUSTA,. GEORGIA, FEBRUARY, 1857. [No. I.

ORIGIML AND ECLECTIC,

ARTICLE IV.

Ancient Medicine. By W. T. Grant, M. D., of Wrightsboro',
Columbia county, Ga.

In the preparation of an article published during the past sum-
mer in the Atlanta Medical and SurgicaUouryial, captioned Diseases
of the Bible, &c.^ I had frequent occasion to refer to the ancient
historians, Tacitus, Herodotus, Thucydides and Josephus, for the
[purpose of substantiating certain conclusions at which I arrived in
' jthe course of my investigations upon that subject. In examining
'^ ffhose works, I found a great deal of very interesting medical mat-
jter, and I have since concluded to give a condensed account of it
jto the Profession. I conceive that it presents many points of very
^ i^reat interest, and also demonstrates most incontestibly the anti-
\ baity of a number of our remedial appliances. I am not ignorant
;e.l>f the fact that works have been published upon this subject
;:MiNCiENT Medicixe ; but as such works possess but little interest
^'ibr the generality of medical men, they have but a limited circula-
;^j|ion, and a monograph upon the subject would therefore, from its
liifeiy brevity, be far noore interesting.

' The earlier lights of the Profession were few in number, and
7ith. some of them we arB sufiiciently well acquainted to need no
otice in this place. The practitioners of Medicine in early times

N. B. vol.. XIII. NO. II. 5

68 Grant, on Ancient Medicine. [February,

were undoubtedly as numerous, in proportion to the population,
as they are now, *^ Every great family, as well as every city, must
needs (as Herodotus expresses it) swarm with the faculty." The
medical men of Egypt were renowned in those early times ; Cyrus
had a physician sent him from Egypt, and Darius always had
Egyptian physicians with him. But of all, I propose to give a
sketch of one only Damocedes. " He was a physician of Crotona,
and the most skillful practitioner of his time." Damocedes, it is
presumable, lived in Crotona during the earlier portion of his life,
but was induced to remove thence by " the austere manner of his
father, which becoming insupportable, he left him and went to
^gina. In the first year of his residence at this place, he excelled
the most skillful of the medical profession, without having had
any regular education, and indeed without the common instru-
ments of the art. His reputation, however, was so great, that in"
the second year, the inhabitants of .^Egina, by general consents-
engaged his services at the price of one talent (nearly one thousand
dollars of our currency). In the third year, the Athenians retain-
ed him at a salary of one hundred minae (about sixteen hundred
dollars) : and in the fourth year, Poly crates' engaged to employ him
at two talents. His residence was then fixed at Samos ; and to
this man the physicians of Crotona are considerably indebted for
the reputation which they enjoy ; for at this period, in point of
medical celebrity, the physicians of Crotona held the first, and
those of Cyrene the next place." (Herodotus 3. 131.)

We have made the above quotation from Herodotus, not on^v
far the purpose of sketching the character of Damocedes, but al
to add more evidence in demonstration of the fact that physicians
were quite abundant in former times.

Herodotus mentions two cases in which Damocedes was engag .
with success, and which are of much interest. The first was ic j
the person of Darius, who, in leaping firom his horse on one occr.
sion, "twisted his foot with so much violence that the ankle boL
was quite dislocated." This was a dislocation of the ankle-joint, |
or, to be more surgical, it was a luxation of this joint. Darius hc^
some Egyptian physicians with him at the time, who, howeve
increased the evil by twisting and otherwise violently handlinj
the affected part. He was in very great pain, which indeed wa
so extreme that he ^ passed seven days and as many nights witb
out sleep." And on the eighth day Damocedes was mentioned t

1857.] Gkant, on Ancient Medicine. 69

him as being a skillful physician, for whom he sent immediately ;
"who applied such medicines and strong fomentations as were
customary in Greece, by which means Darius, who began to des-
pair of ever recovering the entire use of his foot, was not only
enabled to sleep, but in a short time perfectly restored to health."

The second case occurred in Atossa, the daughter of Cyrus, and
wife of Darius, who "had an ulcer on her breast, which finally
breaking, spread itself considerably." Damocedes succeded in
curing it, but by what means we are not informed.

While upon this subject, we may introduce also the following
two cases : Miltiades, the Athenian general, in getting over a
fence, in some way dislocated his femur^ and never recovered from
it It mortified, and growing worse, finally killed him, (Hero-
dotus 6. 134-136.)

The following case may be believed or notj as the reader likes;
I give it as I find it : Hegeiestratus was in prison, in Sparta, and
bound in irons. He Avas threatened with death, and preferred any
means of escape to such an event. Therefore, procuring a knife,
he cut off as much (one-half) of his foot, as would enable him to
extricate himself from his irons ; after which, he dug out of prison,
and made his escape to Tegea. "When his. wound was healed
he jjvocured himself a vsooden foot^ and become an avowed enemy
of Sparta.

Of the Practice of Medicine, Herodotus gives us a very complete
although concise account. He says, that among the Babylonians
'they had no distinct profession of medicine, but in cases of sick-
tiess, pursued the following course. Such as were diseased among
ithem they carried into some public square^ and every one who
oassed by, had to interrogate the sick as to the nature of their
'iisease, and if he had either been afflicted with a similar disease
aimself, or seen its operation upon another^ he may communicate
he process by which his own recovery was effected, or by which,
Q any other instance, he knew the disease to be removed. And

o one was allowed to pass by an afflicted person in silence^ or
.'ithout inq^uiry into the nature of his complaint.

Among the Egyptians, medicine was practised as follows r --

One physician is confined to the study and management of one
isease; there are of course a gi-eat num.ber who practice this art;

)me attend to disorders of the eyes, others to those of the head ;

)me take care of the teeth^ others are conversant with all diseases

70 Grant, 07i Ancient Medicine. [February,

of the bowels ; whilst many attend to the cure of maladies which
are "less conspicuous." Our author says that the Egyptians used
"purges, vomits, and clysters, for three days successively every
month," as a matter of health, under the impression that the dis-
eases of the body are occasioned by the different elements received
as food. He offers himself the opinion that, "changes of all kinds
and those in particular of the seasons, promote and occasion the
maladies of the body."

Herodotus mentions but two cases in which the special senses
were affected one the son of Croesus, affected with dumbness ;
the other, a soldier named Epizilus, who was suddenly and inex-
plicably struck blind in the midst of a battle.

Josephus makes frequent mention of dumb and blind persons,
but does not give any particulars. He says that when David
besieged Jerusalem, the citizens of the place, in contempt, placed
upon the walls of the city, in full view of David's army, all theii
lame and dumb and blind, from which we may justly infer thai
their numbers were considerable.

Tacitus introduces a very interesting case of blindness, whichl
am inclined, from the description, to think was Pterygium. It alsc
falsifies the assertion of Pettigrew, that the royal gift of healing
originated in England with Edward the Confessor. I will quot-
the case in Tacitus' own language. Vespasian, the Roman en^
peror, was spending some months at Alexandria, when "a ma:
of mean condition, born in that city, had lost his sight by a de
fluxion on his eyes. He presented himself before Yespasian, an
falling prostrate on the ground^ implored the Emperor to admix
ister a cure for his blindness. The request was, that the Empero:
with his spittle, w^ould condescend to moisten the poor man's fac
and the balls of his eyes. Another man, who had a paralyti-
hand, begged that the Emperor would tread on the part affecte(
Yespasian smiled at a request so absurd and wild. The wretche
objects persisted to implore his aid. He dreaded the ridicule of
vain attempt ; but the importunity of the men, and the crowd
flatterers,, prevailed upon the Prince not entirely to disregard tl.
petition. He ordered the physicians to consider among tin :
selves, wkether the blindness of the one, and the paralytic affe
tion of the other, were within the reach of human assistance. Tl
result of the consultation was, that the organs of sight were not ;
injured, but that, by removing the film,, or cataract, the patie:

1857.] . , . Grant, on Ancient Medicine, 71

might recover. As to the disabled hmb, by proper applications
and invigorating medicines, it \yas not impossible to restore it to
its former tone. Accordingly, in the presence of a prodigious
CQultitude, all erect with expectation, the Emperor, advanc^ with
m air of serenity, and hazarded the experiment. The paralytic
band recovered its functions, and the blind man saw the light of
the sun."

In regard to Obstetrics, Herodotus is not so full as upon other
subjects. He merely mentions three cases one a case of still-born
:hild ; another, a case of twins ; and the third, a case of abortion
from violence. It occurred in the person of the sister and wife of
Cambyces, and was produced by violence he used towards her.

Tacitus mentions a similar case to the last, and which was like-
wise fatal. It was Popp^a, the wife of Nero. When she was ad-
vanced in pregnancy, for some trivial cause he gave her a kick on
tier womb, from which she died. We presume that abortion was
the result in this case, and was the cause of her death, although we
ire not informed that it was so.

We may gather from a remark of Tacitus, that abortive reme-
dies were quite common in ancient times. It appears that Octavia,
:he wife of Nero, was much addicted to adulterous commerce.
f'Nero issued a proclamation, declaring the guilt of Octavia, and
[idded, that by the use of medicines to procure abortion, she had
thrown a veil over her adulterous connections, and the facts were
?aid to be clearly proved."

t Josephus mentions only that abortion could be produced, and
f,dds, the punishments that were inflicted by law upon any one
|*^ho procured the abortion.

'\\ We may, while upon this part of our subject, introduce the fol-

bwing from Herodotus, in proof of the existence of hysterical

rlffections. I believe that obstetricians consider that these affec-

bns are the result of our modern refinements ; but this opinion

! refuted by Herodotus. The Budini were a rude and barbarous

eople. In their country there was a ''large lake, with a ma,rsh

irrounded with reeds. In this lake are found otters, beavers,

id other wild animals, who have square snouts : of these the

dns are used to border the garment ; and their testicles are esteem-

i useful in hysterical diseases.'^

72 Campbell, on Inverted Toe Nail [February,

ARTICLE V.

Inverted Toe Nail ^Treated without Operation. By Egbert Camp-
bell" M. D., Demonstrator of Ai^atomy in the Medical College
of Georgia,

On page 45, of our last number, we have inserted an article
under the above heading, from the London Lancet. The sugges-
tions of Dr. J. Broke Gallway, therein conveyed, have, it is true,
the merit of novelty, and moreover of affording some slight ameli- '
oration of the barbarous practices so long in vogue, for the relief
of this painful affliction.

Dr. G.'s recommendations and the ordinary mode of procedure,
are alike subject to several considerable disadvantages ; of which,
the most prominent are, the extreme severity of such an operation,
and the inadequacy of the same, to the securement of permanent
relief^as after repeated divisions and disruptions of a portion of ,
the nail from its exquisitely sensitive matrix, it may repeatedly be
reproduced, the part generally remaining exceedingly tender on
pressure.

Always dissatisfied with the various modifications of the opera-
tion that contemplates evulsion of the nail, which we have long,'
deemed an unwarrantable measure of torture, in the treatment of
this most excruciating trifle^ in the year 1851, having an oppor-
tunity of experimenting, in a severe case of this affection, we
endeavored to devise some expedient, which might answer the
indication, (of keeping the nail apart fi'om the irritated flesh,) byj
affecting the position and condition of the Jiesh itself, by pressure^.
as a substitute for the only plan we had ever seen proposed in 1^"
journals, or in systematic works on Surgery, whereby an opera
tion was involved.

From the entire success- of this experiment, we have treated al
the cases which have fallen in our wa}^ since, in the same manner-
some of which were very unpromising in appearance and hav<
never had occasion to abandon it in any one case, or seek it
modification. The condition of the part results, most probably
from the use of too narrow a shoe, which contracts the toes int<
so small a compass, as necessarily to force the flesh at the margin
of the great toe above the nail, from the lateral pressure of th
Iftfter si(Je of the shoe, from within, and the other toes from witl:

1857.] Campbell, on Inverted Toe Nail 73

out. The difficulty occurs most frequently, we believe, on the
outer side of the great toe nail, from the fact, that the second toe
becomes depressed habitually, from this cause, and is impacted
against the lower portion of that side of the great toe, and being
pushed upward by the pressure of the ground from below, in
walking, together with the lateral pressure, forces the flesh ^gainst
the nail, (which has not, necessarily, more than its normal breadth,)
until it becomes irritated, sore and swollen, the inflammation often
resulting in a fungous growth, (see cut, p. 74,) which is sometimes
so sensitive as to disable the limb entirely..

The indication is to adapt* an apparatus of counter-pressure, at
the same time training the second toe to such a position, that it
will be available afterwards, as a natural, permanent compress, for
the prevention of a repetition of such an obtrusion. '

This apparatus is formed of a bandage somewhat broader ihan
the length of the nail say Jth of an inch and'li yards long,
having a roll at one end about ith of an inch thick, to be used as
a compress, to which the last turn of the bandage is tacked, to
prevent the disposition, otherwise, to unroll on traction. This
compress is applied in the groove, between the flesh (which is
generally much enlarged) and the naiL The margin of the com-
press, at which the last turn of the bandage is sewed, must present
always upward and opposite to the direction in which the pres-
sure is to be exerted i. e., if the outer border of the great toe on
the right side is affected, the seam should be directed upwards and

\ towards the left side of the patient. Thus applied, the bandage
will become somewhat wound around the outer side of the com-
press, which is to be pressed, at first, very gradually and tenderly,

5 but somewhat forcibly, downwards and outwards, until secured in
that position by several turns of the bandage around the great toe,
carrying it first down, between that member and the second toe,

\ and around several times. The great toe is then to be depressed
and forced outwardly, under the second, which is placed upon the
compress, and lightly bound in that position by a few turns of the

- bandage. (The following wood-cut will exemplify its mode of
application.) The projection beyond the compress, in front of the
toe, is intended to represent a fungous growth or enlargement of
.the lateral ridge.

I The advantages of this treatment over the operation, will, no
(doubt, be apparent to every one as substituting a practice as

74

Campbell, on Inverted Toe Nail.

[February,

shocking to the operator as agonizing to the subject ; which con-
siderations, in many instances, rendered the art a perfect nonentity
in reference to these cases deterring the Surgeon, as well as the
patient, from all attempts at relief, and entailing upon the latter
months, perhaps years, of comparative indolence or of unmitigated
sufferijig, and upon the former, the opprobrium of incompetency
on account of the frightful nature of the only alternative.

This bandage should be re-applied, at least, as often as once
a week. If the prominence of flesh, against which the com-
press is to rest, is very irritable, a layer of lint, anointed with
simple cerate, should intervene. At the first impression of the
compress to the sore flesh, the patient experiences some degree of
pain or soreness ; but the very prompt abatement of suffering fol-
lowing the relief of the inflamed tissues from the irritation of the
sharp nail, and also the diminished turgescence of the part, induced
by the uniform pressure of the compress and bandage, will prove
an ample recompense. The comfort of the patient and celerity
of recovery are much enhanced by keeping the limb in an eleva-
ted position. It is a matter of surprise, bordering upon astonish-
ment, to see the great diminution of sensitiveness in the part, at
each succeeding application of the apparatus. Six or eight weeks

1857.] Campbell's Lecture on Traumatic Tetanus. 75

is time sufficient for relief, generally, or for such an improvement
as to render it safe to entrust the case to tlie care of the patient.

We have been thus minute and comprehensive in the above de-
tail, in order hat we might be comprehensible hoping that the
suggestions which, confiding in our experience, we have ventured
to advance though contrary to "written law," may not fall into
disrepute through inefficiency of application.

ARTICLE VI.

A Lecture on Traumatic Tetanus^ with Notes of Cases Delivered to
the Class, at Jackson-street Hospital, by Henry F. Campbell,
M.D., Professor of Surgical Anatomy, etc., in the Medical Col-
lege of Georgia.

Gentlemen, There are some diseases, fortunately but few,
about the pathology of which, there exists so much uncertainty
and whose manifestations are wrapped in so much mj'stery, that
we are left for the present, but to observe and to record what we
see, without daring to attempt the perilous task of interpretation.
Hydrophobia is one of these diseases, and Tetanus is another.
Both evidently diseases, when considered according to all rational
symptomatology, of the nervous system, closely analogous to each
other in their general bearing, but differing most widely in many
of their most prominent manifestations. It is not my intention,
to-day, to discuss before you the differential relations of these two
terrific maladies, or to present a full account of even one of them
in all its bearings, but to present to you the historj" of the case of
the boy Cornelius, with that of another recently treated by us,
and to make such comments upon them as I may deem useful to
you hereafter in the management of such cases.

The term Tetanus from the Greek verb Ts/vw, to stretch, or
! Tsravog-, stretched, refers to a most prominent, and what is consid-
ered by some, the pathognomonic symptom of the disease, viz :
the permanent and unbending rigidity of the muscular system, or
I at least the voluntary muscular system. Trismus, another term of
Greek origin, signifying to gnash, relates to another symptom not
. quite so constant as the rigidity, but which has for a long time
supplied the popular name for the disease, viz ; lock-jaw^ though
; properly, this is but a partial tetanus, confined principally to the

76 Campbell's Lecture on Traumatic Tetanus. [February,

elevator muscles of the lower jaw, causing inability to open the
mouth.

Tetanus has been distinguished, 1st, relatively to the causes
which have produced it, into traumatic anji idiopathic or sponta-
neous; 2ndly, relatively to its locality, into general and partial;
Srdly, relatively to the character of the contractions into straight
and curved, perfect and imperfect tetanus.

Traumatic tetanus is that which succeeds an injury of any kind,
the introduction of a foreign body into sensitive parts, such as the
foot or head, a lacerated wound, the bite of a dog, or other ani-
mal, a bruise or a surgical operation. That tetanus termed idio-
pathic or spontaneous is that which manifests itself, not indeed with-
out cause, but under the obscure influence of predisposing or occa-
sional causes, such as great and sudden elevations of temperature,
excessive cold, the suppression of habitual evacuations from the
system, or strong emotions these last two, however, I will remark
in passing, occur almost invariable in the case of females, and are
doubtless spurious cases of tetanus, but genuine cases of Hysteria,
that notorious " mimic of all diseases."

The various preparations of nux vomica also produce symptoms
strongly simulating tetanic spasms, the first approach of which
are always anticipated and regarded as an indication to abandon
or modify their exhibition.

Some authors lay much stress on the temperature of the atmos-
phere, and especially in relation to cold as a cause of tetanus ; to
this I cannot give an assent, but it is certain that particular localities
and also certain unexplainable conditions of the atmosphere, do
seem more favorable to its occurrence than others. If I mistake
not, it is the opinion of the Profession in Savannah, that the dis-
ease is of more frequent occurrence in that city and vicinity, than
in most other parts of the State. In the summer and autumn of
1855, Dr. J. J. Kobertson, of Washington, related to me the sketch
of an epidemic in the neighborhood of that place which he and I
both thought presented many of the prominent characteristics of
tetanus. It was confined to the negroes of a few plantations in
Wilkes county, of this State, and was marked by great fatality.
It was shortly after the disappearance of the affection in that re-
gion, that there appeared in this place an unusual number of cases,
and among them, three or four of the luhite population, which is
almost unheard of ordinarily in this region.

1857.] Campbell's Lecture on D-aumatic Tetanus. 77

It is the opinion of Professor L. A. Dugas, that it is much more
fatal among negroes in this chmate, and if I state him correctly,
he has never seen a white patient die here of it. According to
M. Chomel, the form of tetanus termed trismus nascentium is very-
common amonor the nei^ro infants in the Antilles, and he attri-
butes it to the fact that but little care is taken there to guard
against the vicissitudes of climate, and the little attention paid
to the umbilicus during the first few days aller the birth of the
child. This form is YQvy fatal on the rice plantations below Sa-
vannah among negroes, and has been variously accounted for :
Dr. J. M. Sims' theory in regard to it is, that the position of the
infant, viz : on the back, with the occiput impinging up a resist-
ing surface favors the occurrence of the disease. I forbear from
making any suggestions for the treatment of this form of the dis-
ease, it is sufficient to say, that it is generally fatal in a few days,
and treatment, generally, but hastens the denoument and adds to
distress of the patient.

As a case well calculated to illustrate the course of traumatic
tetanus, I will read to you the following, which I have just trans-
lated from the Revue de Therctpeutique Medico- Chirurgicale Paris,
December 1st for the Southern Medical and Surgical Journal ; it
is entitled " Traumatic Tetanus cured by Chloroform," and de-
monstrates the efficiency of a remedy which I think is rapidly
gaining favor with the profession, in all parts of the world, in the
treatment of this truly fearful disease : it is reported from the notes
of M. Busquet, of Bordeaux.

" Case I. A little girl, aged nine years, fell and received a lacera-
ted wound of considerable extent on the lower and external part
of the left thigh. This wound was almost healed on the thirteenth
day, when there occurred a stiffness of the jaws with opisthotonos,
pain in the back of the neck, in the region of the trapezias and
splenius muscles. Of the following mixture, prescribed one tea-
spoonful every two hours :

V^. Chloroform, .... 3ss.

Mix.

Extr. opii. gum. . .

. gr. i.

Aqua laur. ceras. .

. 3 iii.

Aqua flor. tihae, . .

3xiv.

Syr. Acacias, . , ,

, ! iss.

78 Campbell's Lecture on Traumatic Tetanus. [February,

Towards evening, her condition being unchanged, M. Busquet
added to the mixture one drachm of Chloroform.

On the second day, the tetanic stiffness of the posterior muscles
of the neck and of the jaws was increased ; the head bent back-
wards; pain in the region of the upper dorsal vertebra? ; inability
to separate the teeth more than the 8th of an inch ; deglutition
easy ; jerking in every part of the body on the least irritation.
Prescribed the same 'dose as the day before.

Third day. At four o'clock in the morning, at the time of the
spasm, the elevator muscles of the jaws contracted, the tongue was
held between the dental arches and it was impossible to return it.
Prescribed inhalation of chloroform for half an hour ; about one
drachm of it was used. To his great satisfaction, M. Busquet saw
then that the inferior maxilla was depressed: the tongue with-
drawn, the patient smiled; speech returned; the head, which had
been fixed for two days, moved indeed the patient complained
of no pain, the left leg only continued a little stiff.

During the three following days she continued better ; but the
left leg remained in the extended position by the contraction of the
triceps femoris. Prescribed continuance of the inhalations and
doses of chloroform; also a bath during the course of the fourth
day.

Sixth day. Pleurosthotonos on the left side ; pain towards the
base of the thorax, with difficult respiration. Prescription : Tepid
baths each day until the tenth, whenever the patient was calm
enough.

Tenth day. The whole left side more and more bent upon itself
it and the left leg forming together, a curved line, with a very
decided arch. The child can stir the great toe a little, and very
shghtly, the flexors of the foot; the left leg in forced abduction,
the right rigid ; the feet in forced extension. In the evening :
The teeth are more closed, deglutition of liquids less easy, abdomen
more tender, abdominal parietes harder. At this time there
appeared on the left lower extremity an eruption of Herpes cir-
cinatus.

From the tenth to the twentieth day, the incidents of the case
presented many variations; in short, the rigidity diminished.
Prescribed tepid baths, and then vapor-baths. Gradually she got
to moving both the diseased limbs.

Thirty-sixth day. She can be raised, but complains of cramps.

1857.] Campbell's Lecture on Traumatic Tetanus. 79

Thirty-eighth day. She walks with a crutch ou the left side,
and a cane on the right.

Forty-sixth day. She walks without either crutch or cane, but
the left heel is constantly raised, as in club-foot {lalipes equinus).
The limping lasted three months more. Even three years after,
this young patient presented a slight deviation of the vertebral
column towards the left side."

I will now give the notes on the case of the boy Cornelius,
transcribed from our book, and you will perceive how purely
empirical the treatment of this disease is; for it is not without
authority in the records of Medicine, and may be considered fairly
illustrative of the management of such cases by most of the Pro-
fession at the present day, though I must confess I would not
repeat it, in every particular, did the opportunity offer. I have
some doubt as to the utility of the large quantities of quinine given
in this case, although he lived too long after it was abandoned, to
admit of an 3^ suspicion that it had any influence in the unfortunate
result. His intemperate habits, worn-out constitution and uncared
for course of life generally, I think had more to do in bringing
about the fatal result^ after he had passed through the acute and
most dangerous stage of the disease, than any incident either in
the disease or the treatment.

Case II, Cornelius, a negro man aged 40 years, of very intem-
perate habits, was employed as a fireman, by the Georgia Rail Road
Company. On the 6th of January, 1855, while engaged in coup-
ling two cars, received injuries of the right hand, which made it
necessary that the amputation of portions of two of the fingers be
performed; the other fingers of that hand were also in a lacerated
condition. We performed the operations immediately after the
receipt of the injuries, and the wounds on the other fingers were
carefully dressed at the same time. The case progressed regularly,
without any remarkable incident, the wounds suppurated abund-
antly, more particularly the fingers which were injured and not
amputated, while in th'C usual tim.e th stumps healed firmly,
leaving us the task of dressing only the others. On the 12th Feb-
ruary, only twenty-four days after the injury, these wounds had
been replaced by the peculiar white cicatrices of the tissues of the-
negro, and the healing was complete.

80 Campbell's Lecture on Traumatic Tetanus. [February,

During the whole time of treatment, this patient, without doubt,
continued to pursue his irregular and intemperate mode of living,
for he was subjected, during this time, to less control by his own-
ers than at ordinary times.

On the 13th February, he complained of pain and a sense of
constriction about the fauces, and also in the pit of the stomach,
which circumstance induced us to examine his cicatrices; and
while thus engaged, he was attacked with opisthotonos so decided-
ly and so violently that he fell from the chair upon the floor. He,
however, quickly recovered sufficiently to walk the distance of
nearly two hundred yards, to his place of abode. The convulsions
soon returned violently, and the jerking was incessant. Prescribed
quinine 10 grains, every two hours till 60 grains were given ; in
the intervening hours, portions of an emulsion containing in each
dose

^. Chloroform . . gttse. 20
Tr. Camphor . . "15
Sulphate of Morphia, gr. \
A large blister was applied over cervical and dorsal regions, and
hot poultices kept constantly to the injured hand. At night, the
convulsive- movements had been somewhat controuled, and under
the influence of the morphine he slept at short intervals,

15th. Convulsions less frequent. Bowels constipated; suffering
from retention of urine. Prescription : Emulsion to be continued,
the morphine being omitted, and only given on the approach of
spasms. Catheterism was applied, and a large quantity of urine .
evacuated. In this operation, a firm spasmodic stricture at the
neck of the bladder was found. Calomel 20 grains, to be followed ,
by oil and turpentine, in the evening. Quinine to be continued
as on previous day.

16th. Convulsive movements less violent and less frequent;
great rigidity of the muscles about the neck, and also in those of
the inferior extremities and back ^patient somewhat cheerful not-
withstanding. Calomel and oil had produced no evacuation.
Prescription : Injections of warm water and salt. We were present
during their administration. After the second injection, the rectum
and abdominal muscles contracted with ^uch violence as to pro-
ject the fluid from the bowels to the distance of six feet. This was
followed by an ample faecal evacuation, affording much relief to
the patient

1867.] Campbell's Lecture <m Traumatic Tetanus. 81

From the 16th to the 20th. Convulsions less frequent than at
first. Prescription : Emulsion to be continued.
^. Quinine, .... grs. v.
Carb. Ferri. Precip. " x.
Every three hours during the day. Catheterism twice daily.

From 20th to 25th. Condition of patient much improved
convulsions appearing only at night. Prescription : Omit emul-
sion, except on approach of convulsion ; omit quinine and pre-
cipitated carbonate of iron. Prescription : Laudanum, 40 drops,
each night at bed-time ; oil and turpentine, pro re nata, to evacu-
ate the bowels ; Brandy, in liberal quantities, frequently during
the day. Daily catheterism still necessary.

2oth to 27th. Patient able to go to the fire but the pulse very
feeble ; he appeared cheerful ; convulsions disappeared ; he com-
plained of bed-sores. Prescription : Brandy during the day, with
laudanum at bed-time. Nourishing diet.

28th. Did not rise from bed extremely feeble. Prescription :
Brandy and nourishment.

29th. On our visit this morning, we are told that Cornelius
*'died in the night suddenly with a fit." No autopsy.

It is not at all unusual, in our Profession, for reputation to be
made and much credit claimed for the management of unsuccessful
cases ; this, in a certain degree, Grentlemen,. we feel inclined to
do, in default of better grounds, in the case of the boy Cornelius.
I must at least call your attention to the fact, that by the treat-
ment, or haply in spite of the treatment, he had been conducted
through the most dangerous, viz. the acute stage of his disease,
and had ceased to have any convulsions whatever : but starting
with a constitution worn out with drunkenness, this shattered
wreck had to sustain the storm of a fearful and most exhausting
disease, and what with bed-sores (you will remember, that the
Tetanus came on after he left this institution) and the many evils
which, under the most careful management, a protracted case of
Tetanus must suffer, it is not surprising that he should have in the
end, "died cured,"

Among the remedies which appeared to us, to have most power
in arresting his disease, we consider that in the early stage, the
chloroform was invaluable^ while later in the disease, brandy did
much to sustain him and keep off the paroxysms.

82 Campbell's Lecture on Traumatic Ihtantis. [February,

In the case next presented, you will find that anaesthetic inhala-
tion constitutes a more prominent part of the treatment, perhaps,
than in either of the others just read in your hearing. I would
call your attention to the mixture used in this case viz : Chloro-
form and Sulphuric ^ther; and also to the immense quantity of
it consumed during the progress of the case, without permanent
injury to the patient, although a part of the time a fact which I
perceive has been omitted in the notes he was often for hours in
a profound stupor from its effects.

Case III. June l7th, 1855. E. C, a young man, a native of
Ireland, aged about 22 years, of sanguine temperament, regular
habits, applied at our office for advice. He complained of pain in
the region of the fauces, and experienced much difficulty in deglu-
tition on account, as he affirmed, of a stiffness in the muscles con-
cerned in that act. The neck was stiff, and an habitual slight
strabismus was much increased, giving him a strange and unusual
expression of countenance. Our city, at that period, had been the
region of Epidemic southward, marked by exacerbations of a
paroxysmal nature, and as, about three weeks previously, this
young man had been under our care as a case of the above kind,
we naturally concluded he was laboring under the hebdomadal
return of his former attack. On examination of the fauces, there
was found decided redness, and during the examination he com-
plained of inability to open the mouth freely. Prescription :
^Application of sinapism to the back of the neck ; a gargle of
pepper-tea and alum and 15 grs, of quinine, divided into three
doses, to be taken on the following morning, at intervals of two
hours.

18th. He came again to the office in the afternoon of this day:
said that he had been much relieved of his symptoms duriDg the
morning, but was now suffering from a return of all of them in a
much enhanced degree. On attempting to examine the throat,
we find that the difficulty of opening the mouth is increased, more
on account of the pain in throat, than from the rigidity in the
muscles of the jaw. There was considerable increase in the pulse
both as to volume and number, with other evidences of fever.
The bowels were constipated. Prescription : Blue mass, 20 grs.
at bed-time; castor oil, 1|- oz. next morning, and quinine and
gargle as on the day previous.

1857.] Campbell's Lecture on Traumatic Tetanus. 83

19tli and 20tb. Symptoms neither increased nor diminished in
severity cathartics had acted slightly.

21st. The patient is still able to apply at the office for advice.
He presents great rigidity of the muscles, especially of those about
the neck and throat, the strabismus increased to a most remarka-
ble degree and the face presents a truly sardonic expression he
walks with extreme difficulty. After being seated upon a chair,
favorable to the light, we attempt to explore the condition of
the fauces, but find it impossible for him to open the mouth.
Upon placing the hand upon the face with the view of steadying
the head during the examination, and turning his face towards
the light, we find he is seized with a spasmodic twitching in
the muscles of the face, accompanied with a slight jerking of
the head backward, upon which, our suspicions, before aroused,
that his affection, (notwithstanding its slow progress and the
absence of any wound, partook of the nature of tetanus,) be-
came confirmed, and we now insisted upon treatment being
pursued under more favorable circumstances, viz : with the pa-
tient in bed. Up to this time, he had been able to remain in
his store, and in some manner to attend to his sales. Visiting him
in the afternoon, we apply cups freely to the nape of the neck and
afterwards a blister to the same region. We now subject the
patient to a most rigid examination in order to detect any wound
to which we may refer the origin of his disease. About the mid-
dle of the right leg in front, near the spine of the tibia, we find a
narrow scab covering a cicatrix nearly an inch long, the result
apparently of a scratch which had entirely healed. Upon inquiry
we are informed by the patient that this was caused by a very
superficial cut with his razor, which, while upon the dressing-
table, had been dislodged, and in falling, the edge had touched
this part of the leg. The condition of this very slight wound was
such as to give the certain conviction, that it had healed by the
first intention, and had certainly never suppurated. It could not
be re-opened without actual violence, or the use of an instrument;
to this we did not deem it advisable to resort. The opisthotonos now
very constant, almost without remission, and attended with great
pain along the spinal column and at the pit of the stomach. The
rigidity much greater on the right, than on the left side. Lauda-
num in large doses failing to arrest the convulsive movement, we
prescribe the following :

N. S. VOL. XIII. NO. II. 6

84 Campbell's Lecture on Traumatic TetanVrS. [February,

^ Of Chloroform, , . , ! ss.

Syrup Gum. Arabic^ I viiss.
Mix welL Dose, one teaspoonful every two hours.

After repeated doses, this was found to afford but little relief,
and in the interval of doses, we administered by inhalation, the,
following mixture which, with us, has superseded in a great de-
gree, the use of pure chloroform as an anaesthetic during surgical
operations, the author of the formula we cannot at this moment
recall..^

^ Of Chloroform, .... I].
Sulphuric ^ther, . . !iij.

Quantity applied^ two drachms, to be increased or diminished
according to the effect produced. During the inhalation, and for
80 or 40 minutes after, the convulsive action was much diminish-
edy and by this means the patient obtained a certain amount of
sleep.

22nd. Morning visit. We find the symptoms but little amend-
ed. Opisthotonos almost incessant. After consultation with Dr.
H. H. Steiner, of this city,, the inhalations were continued and a
cathartic of castor oil and turpentine administered. From a gen-
eral tepid bath at this time, the patient experienced very decided,.
but temporary relief. The following was also administered
^ Of Extract Belladonnce, grs. iv.
Syrup Grum Acacige, I iv.

Dose, one tablespoon ful every two hours ^to each dose, ten drop-
of laudanum were added, when the convulsions were not other-
wise controlled.

23rd and 24th. Condition unimproved treatment continued
repeated enemata followed by free evacuation of the bowels, and
the discharge of scybalous matter. Great flatulence and forcible
expulsion of wind per anum.

25th. Prof L. A. Dugas^ Dr. H. H.. Steiner, and my brother,

* In the American edition of Erichsen's Surgery \re find the following note :
"See Banking's Abstract, Nos. 17 and 18, and also the Medical Examiner for Nov.,
1853, in which Dr. Betton, of Gennantawn, Pa., reports a case of Tetanus resulting
from a woxmd of the foot by a nail. A mixture of chloric jEther and Chloroform
was freely administered, and the patient recovered. Dr. Betton says, ' to the Ances-
thetic alone, I attribute liis recovery, and its influence appeared almost miraculous
Maj^ it not be equallj' valuable in Hydrophobia?'" [Here the mixture was made
with chloric ^ther, while we used sulphuric. This is the nearest we can at present
lay our hands upon a misture like the one used in our case.]

1857.] Campbell's Lecture on Traumatic Tetanus, 85

Dr. Robert Campbell, in consultation. On examination there is
"discoyered great tenderness in the right iliac and lumbar regions
of abdomen, and on pressure here, the spasmodic action in the
muscles is much increased. Prescription : blister over this region,
and to continue the tr'^atment otherwise, lessening the amount of
ana3sthetic mixture which the patient now calls for incessantly.
The tepid baths were also less freely applied for fear of weakening
the patient.

From 25th to July 1st. No improvement: during this time, the
patient appeared, once or twice, to be on the point of dissolution
from exhaustion, after the more violent attacks of convulsions,
which now were invariably generaL If any improvement was ob-
served it was in the longer interval between the spasms. The treat-
ment consisted now, mainly, in the inhalation on the approach of
the attack with Brandy and Laudanum, at intervals of three or
four hours. Nourishment : beef- tea, soups, &c.

July 4th. Convulsions less frequent. The patient, on the ap-
proach of the paroxysm, calls for the anaesthetic mixture, and
frequently by this means the attack is rendered much less violent
or altogether aborted.

I continued to visit m}^ patient, in company with Dr. Steiner
and Dr. Robert Campbell, till about the 20th of July ; during this
long interval, the improvement was very gradual, and towards
the latter part of the time, the convulsive movements were confined
to the muscles about the neck. The inhalations were resorted to,
pro re nata. Brandy regularly taken, and laudanum in sedative
doses at bed-time of each night. The most nourishing diet w^as
also now recommended. The muscular rigidity continued long
after the subsidence of the convulsions, and for months after he
was able to go into the street. During the convulsive stage of his '
disease there was used in the inhalations over two quarts of the
anaesthetic mixture above referred to, and of brandy and lauda-
num, an untold and untellable amount.

A few words now in relation to the nature of the disease, and
I will close these rather desultory remarks about Tetanus.

Since the valuable discoveries of Dr. Marshall Rail, Mr. Grainger,
and Mr. Newport, in relation to the reflex function of the nervous
system, it has been a matter of possibility to reason about the
character of the phenomena presented by a ease of Tetanic

86 Campbell's Lecture on Traumatic Tetanus. [February,

Spasms, and the result has been, that in the extreme impressibility
of the sentient surface on the one hand, and the extreme motility
of the muscular system on the other, we see nothing more than
two of the normal endowments of the cerebi'O-spinal nervous sys-
tem, in a state of exaggeration or permanent exaltation.

The excito-motory function is, so to speak, a privilege granted
to the true spinal system which it ever exercises in a subordinate
and subsidiary manner, and momentarily subject to the mandates of
the Will, which can at any time call the nerves out of the exercise of
this function, and make them act directly under the influence of vo-
lition, and then they no longer respond to those external influences
and excitants with which they were so lately entirely engaged ;
but there are conditions of the nervous centres^ constituting a part
of this excito-motory apparatus, in which they no longer attend
to the indications of the will, but act independently of it. Tetanus
is just one of these conditions, and Tetanic Spasms are but the
automatic movements of this true spinal system, submitted to the ,
sport of mere external influences, and deprived of that safety
which is naturally conveyed to it, and to the muscles it governs,
by the influence of the will, which Will, may in this relation, be
looked upon as the protector and guardian of the whole frame ;
which, when once its dominion is upset, leaves the muscular
system to be racked to pieces, by the uncontrolled excitation of
the true spinal system, goaded on by every impression, whether
from without or from within.

I hope you will excuse me, gentlemen, if in my ardent desire to
impress a doctrine indelibly upon your minds, and in my earnest
endeavor to simplify that which is of acknowledged intricacy, I
bring into relation things never meant to have relation, and per-
petrate in parting with you this evening, what might at first sight,
appear, truly " a far-fetched" analogy.

The Persian Empire is indeed remote from us, both in time and
in space, but with your permission I will place it in juxtaposition
with some of the different bearings of the subject under consider-
ation, and perhaps as a mnemonic exercise, if in no other way, it
may serve you as a reminder in this rather obscure pathway 0i
your studies.

This vast region, now of so little importance in the world's af-
fairs, was once, as you remember, under the dominion of a singit
king. Stretching away in every direction from the capital, Susa

1857.] Campbell's Lecture on Traumatic Tetanus. 8T-

it became in time, too unwieldy and too cumbrous for tlie efficient
personal administration of a single monarcli ; the detail, in parti-
cular, had of necessity to be entrusted to provincial governors,
called Satraps. These Satraps were allowed ordinarily to rule in-
dependently in their subsidiary capacity, and to perform certain.
acts according to their own will, or as dictated by circumstancas ;
but even in these acts, they were amenable to their sovereign, and
when his attention was called to them particularly, they were per-
formed in accordance with his supreme will. Now these Satraps
would occasionally, in times of excitement from accidental causes,
get up rebellions, become independent, and even dethrone the
monarch, and it was by a process somewhat similar to this, that
this splendid empire fell into anarchy and was finally destroyed.

From what I have heretofore said in relation to the brain, the ex-
citomotory system, and the tetanic phenomena, you are already
well prepared to make the application. The human organism is a
realm then, over which presides the brain, endowed with volition,
judgment, reason and caution ; for convenience, certain portions
of the nervous system are invested with the excitomotery endow-
ment, by means of which they govern particular regions of this
dominion by a kind of vicarious authority, but which is at all times
liable to be supplanted, in the normal state, by the more authori-
tative determinations of the will. An " accidental cause," that is,
a wound, in some manner which we cannot explain, destroys this
wholesome equilibrium in the nervous powers; a "time of excite-
ment," that is tetanus occurs in which the true spinal nervous
centres, the Satraps, obtaining the advantage, rebel, and no long-
er obey the prudent and conservative behests of the will, but urge
the muscular system into action independently of it, and under
the stimulus of every external impression, however trivial ; a mo-
tion of the bed, the slightest noise, a sudden gleam of light, a
touch upon any part of the sentient surface, or the mere attempt
of the will to re-assert its sway, as in the contraction of a muscle,
will initiate a convulsion of the most exhausting character ; until
volition becomes finally null throughout every part of the mus-
'3ular system. And thus from day to day, do these alienated ner-
vous centres, now literally brainless functionaries, rack to pieces
iihe distracted human organism a domain richer than Persia at
':he acme of her gTandeur and once more exquisitely governed
;han Persia, even in the palmiest days of the mighty Cyrus.

88 Campbell's Lecture on Traumatic Tetanus. [February,

Let us review our cases and see how much of all this, they will
be found to illustrate :

You will observe that in all three of our cases, the tetanic state
was preceded by a w'ound; that in Case 3rd, the ordinary stimu-
lus of light produced a fixed contraction in the motor muscles of
the 3-6, causing strabismus, afterwards on turning the face to the
light, twitching of the facial muscles occurred, and on touching
lightly the cheek, violent jactatations in the muscles of the neck
Uvshered in the characteristic opisthotonos ; while in Case 2nd, on
earefiilly raising the affected hand to examine the cicatrix, the pa^
tient was so violently convulsed that he fell from the chair upon
the ground. The presence of the urine causes spasmodic stricture
at the neck of the bladder, while in all these instances the authori-
ty of this will is ignored, and a universal automatism holds empire
over the muscular system. How is this brought about? you ask.
The wound prohaUy excites, and in some manner, permanently
exalts this excitomotory function of the nerves, but in what way,
we cannot at present safely answer. \

As to treatment, I think we may safely say that oar cases seeift"
to favor tlie opinion, that in the early stages of Tetanus, sedatives
and revulsives are beneficial, while in the latter stages, stimulants
should claim the first place. Chloroform, in heavy doses, will
produce, in our opinion, all the sedation we could devise from any
one remedy, while in the latter stages, we can still recommend i%
but in smaller doses, or in the manner in which it was applied ill
Case 3rd, viz., in combination with another anaesthetic of a moi^iii
stimulating character. We have great reliance in this combin*-:
tion, *|!f

In regard to revulsives, the idea just now occurs to me, m
from a consideration of the nature of the disease, than legitimatelj'
from a review of the above cases, that I would not recoromend yo
to apply them as a prominent part of the treatment, for I thin
they are more calculated to enhance and exalt peripheral excit:
bility without materially improving the condition of the disordc
ed nervous centres. Although we have generally applied thei
freely, I must confess that I cannot recollect at present, any instanc
wherein marked benefit has accrued from their use, and sometime
I have seen decided injury follow their application.

There are many other ways of viewing the pathology of tli
disease, scattered every where throughout the books and througl

ii

1857.] Means. New Parisian Instrumeut, &c. S9

out the journals, and also many other modes of treatment. Ampu-
tation of the entire part, or a section of the nerve, are both rational,
the last especially, and should be considered^ in every case of the
disease ; Indian hemp (canahis itidica) has, it is said, done much
in many cases; and Dr. E. B. Todd recommends a long bag of ice
to the spine. I would probably use one or all of these remedies
in certain cases, but at present, and from the few cases I have had
the opportunity of comparing, I would never allow Chloroform or
Brandy to be excluded, except under very peculiar circumstances,
from the medication.

ARTICLE VII.

New Parisian Instrument for AmputatioUj dtc. By Professor
A. Means, M. D.

The progress in almost every department of human knowledge,

which has characterized the last half century, has been signally

manifested in the numerous and invaluable contributions made to

: the Healing Art. Even within the range of one of its branches,

' the civilized world has been laid under a debt of lasting gratitude

; to the scientific intelligence of the age, for those wonderful Anaes-

I thetic agents, which so promptly and efficiently obtund the nervous

sensibilities of suffering humanity, and prepare it to submit, in

(Utter unconsciousness of pain, to the successful application of the

, knife, the saw, the ligature, or the forceps.

, Chemistry stands pioneer in the progressive movements of the
present century. She has already discovered many new elements,
produced many new compounds, revealed the existence, and
traced the action of mysterious laws, and evolved a host of inter-
esting and astounding facts from the hitherto unexplored treasures
of the natural world. Nor can it be that our time-honored and
scientific profession, should not share in the wealth of her gener-
ous disclosures. Nay, no other profession is likely to reap such
large harvests from her toils. Her resources are exhaustless, and
(Will still submit to be largely taxed, in time to come, to carry
out the benevolent purposes of the enlightened physician. And
iven while this article is under the pen, French mind, ever pruri-
^nt, penetrating, and active, has, in the ardor of its experimental
esearch, levied upon one of her most common gases, for the per-

90 Means. New Parisian Instrument, &c. [February,

formance of a new function, and carbonic acid is now employed in
the hospitals of Paris, to produce local anaesthesia, in some of the
most painful maladies, and with the most gratifying results.

Heretofore, this Binary compound was mainly characterized by
its capability to form salts by combination with bases to extin-
guish combustion and when inhaled, to produce spasm of the
glottis, asphyxia, and ultimately death. Now, in the Hopital Cli-
nique, and the Hopital la Charite, under the direction of such
minds as Velpeau, and Nelaton, the most excruciating neuralgia,
and spasmodic affections of the bladder, uterus, and other accessi-
ble organs, and even the pain of abraided and inflamed surfaces,
yield to the soothing effect of a topical bath, supplied by this in-
visible anaesthetic the atmospheric air (in the mean time) being
wholly excluded, whose oxygen, when present, and allowed to
combine with the elements of the tissues, must ever evolve heat
and augment the nervous excitability of exposed surfaces.

But chemical discoveries, aided by the power of genius, are
rapidly advancing the Arts, and appropriating the richest results
to meet the utilitarian demands of our enterprising, galloping age;
The French surgeons unless, indeed, they are to find their rivals
in the cis-atlantic branch of the confraternity are scarcely equals
ed by those of any other nation, in the construction of instruments;
and the adaptation of scientific and mechanical appliances, for
securing, greater ease and safety in the performance of important
operations. The most recent projection which has yet met ou!*
eye, in surgical dynamics, I beg leave to extract from a letter ju^
received from my son. Dr. T. A. Means, now in Paris, and the
practical application of which he witnessed while "attending thfei
service" of Maisonneuve and Chaissagnac. The apparatus and"
mode of operation seem to find great favor with the leading sur
geons of the French school, and whether likely to be generalh
adopted by English and American surgeons, or not, challenge, a
least, their impartial consideration, and a fair trial in suitabL
cases.

The objects proposed to be accomplished by these new mechani
cal appliances may be thus enunciated, viz :

1st. To complete amputations without the use of the saw.

2nd. To substitute adhesion by first intention, for the ordinar
and more tedious suppurative process.

3d. To prevent haemorrhage.

ii

1857.] Means. New Parisian Instrument^ dec. 91

4th. To preclude entirely the use of ligatures.
5th. To avoid the occurrence of phlebitis, and
6th. To effect a rapid adhesion, and a perfect cure of the trun-
cated extremity, in about one week's time.

A transverse fracture of the bone or bones of the arm, forearm,
thigh or leg, is preferred to a separation by the saw, and obviates
the necessity of its use. The limb to be amputated is, therefore,
surrounded above and below the point at which the force of lever-
age is to be felt, by two broad, strong, semi-cylindrical clamps,
each divided lengthwise into halves, and moveable upon a hinge-
like arrangement, so as to allow of an easy accommodation to the
circumference of the limb. These are gradually and closely
screwed on to tightness. From the opposite sides of each clamp,
and at an angle of 90, there protrude two short, strong axes, per-
haps one inch in length, and some two or three inches, longitudi-
nally apart, to allow the attachment of a strong bifurcated lever,
with its forked extremities curved upwards, to fasten the more se-
curely upon the axes referred to. An assistant slips the open
lever over one of the clamps, so that the upper part of the fork,
when the lever is pressed toward the limb, rests upon two of the
above named projections, and the lower, curved ends pass under
the other two, thus allowing the action of strong lever power,
the axes nearest the hand of the operator constituting the fulcrum.
When both levers are adjusted, above and below, and pressure
uniformly made upon the handles by the surgeon and his assist-
ant, the intermediate portion of bone is readily snapped asunder,
and a Iteration of the surrounding soft parts entirely prevented.
An incision, some four inches below the point of fracture, is now
made to the bone, the entire integumentous and muscular tissues
separated, and the included four inches of bone drawn out, with
the exsected extremity. The Ecraseur of Chassaignac, a new in-
strument invented by that distinguished surgeon, is now brought
into requisition. Derived from the French verb, "ecraser" "to
crush or bruise," it is intended as its name imports, by compressive
force, to bring into juxta-position, the interior surfaces of the mus-
cles of the stump, to supply the place of the removed bone, pre-
vent hemorrhage, effect early adhesion, &c. The chain-loop of
the Ecraseur, to be described hereafter, is made to include the
soft extremity, and is then gradually tightened by drawing the
chain back, along the grooves in the canula, through which it

92 Means. New Parisian Instrument^ &c. [February,

passes; so as to strangulate the vessels; entirely arresting hae-
morrhage, preventing suppuration, and allowing, in due time,
ae Chassaignac asserts, the degeneration of the rugged end of the
bone, followed by a rounded, smooth surface and a rapid cure.

The latter instrument is already used extensively, among the
Parisian surgeons, and, in accordance with the recognised claims
of its inventor, found to effect admirable results, not only in am-
putations, but in the removal of tumors, whether vascular, steato-
matous, or cancerous, uterine polypi, hasmorrhoids, &c. Indeed,
Chassaignac himself, but a few weeks since, fearlessly advocated
its use, in ligating the largest arteries, as the femoral, and the ca-
rotid, and without the apprehension of after haemorrhage ; and in
the presence of his class, tested the practicability of his views, with
entire success, by ligating the aorta of an ox.

An article in the December number of the London Lancet, an-
nounces the use of this latter instrument, and its adoption in the .
English hospitals, for the removal of tumors, etc., by strangulation,
without predicting, however, what may be its future success.
-Chloroformation generally precedes the extirpation of tumors,
piles, etc., by the Ecraseur. Its first application in the London
hospitals, says the Lancet, was '' by Mr. Stanley, at St. Bartholo-
mew's, in July last, who removed a singular looking, horny
growth, a warty exudation from an epithelial, chimney-sweeper's
-cancer of the scrotum." " Mr. Lawrence, some days after, remov-
ed a very large cellular tumor, weighing nearly a pound and a
half, and in size, equal to a small child's head, from one side of the
generative organs of a young woman, aged thirty. Seven minutes
served completely to detach it ; it was followed by no bleeding
no ligatures, and the parts were brought together by sutures,"
In the University College Hospital, Mr. Erichsen is reported, by
the Lancet, to have operated on the 22nd of October, in the remo-
val of "some piles from a man, under chloroform, which were
partly internal, by means of the Ecraseur of Chassaignac. The
piles were elevated with a pair of hooked forceps, and the chain
applied around the tumor, and in the course of five minutes and a
quarter, the mass was completely cut off, without being followed by
the slightest bleeding whatever." -

The description of this novel compressor and extirpator may be
given in the language of the article referred to in the Lancet.
*^ The Ecraseur consists of a handle, and steel canula within which

1857.] New Yorh Pathological Society Reports. 93

are grooves for the passage of a jointed chain, like a chain -saw, but
without any teeth, or perhaps more like the chain used in watches,
the edge being blunted, but not serrated. From the extremity of
the canula, projects a loop, as long as may be required, which is
passed around the tumor, and gradually tightened, the handle be-
ing moved, once in fifteen seconds, when a little click is heard,
and the chain tightened by the drawing into the groove of one of
the links. This process continues till all the linlvs are drawn into
the canula, and the tumor is cut off."

This slow method of producing strangulation and division of the
growth, entirely prevents any haemorrhage. A contused wound
is produced, and the orifices of the vessels are thus closed.

Kew York Pathological Society. Reported by E. Lee Jones, M.D.
Secretary.

From other interesting matter, we select the following cases, il-
lustrating the liabilities of this portion of the alimentary canal, and
the serious nature of accidents occurring here.

Ulceration of Ajoj^endix Vermiformis. Dr. McCready presented
a specimen of ulceration and perforation of the appendix vermifor-
mis, from hardened feces.

* On Wednesday, June 4th, he was called to visit a slight, some-
what delicate boy in appearance, though habitually enjoying good
health. Two days previous, immediately after dinner, he had eaten
a large piece of cocoanut. From that time he had suffered colicky
pains in the bowels. He had vomited slightly, and a dose of castor
oil had been administered, which had acted freely. He was found
with a cool skin, and a tranquil expression of countenance ; the
tongue clean, the pulse about 100, and without tension. The pain
complained of was aggravated at intervals, and was located in the
epigastric and right hypochondriac regions. He complained of
tenderness on pressure ; but when it was made grEidually, he bore it
well. A dose of calomel and Dover's powder was ordered, to be
followed in the morning by a mixture of rhubarb and soda. The
medicine operated freely, but without affording relief Morphine
in full doses was now prescribed, and the pain was for a time alle-
viated, and the pulse reduced in frequency. The pain, however,
returned, and the pulse rose to 116. The abdomen was slightly
swollen, and the tenderness referred to, in the same region as before,
was somewhat increased. He complained that it hurt him to rise,
or to turn in bed. This, however, was not constant, since he, on

94 New York Pathological Society Reports. [February,

different occasions, turned and raised himself to a sitting posture,
at my request, without complaint. The decubitus was natural,
generally on the side ; legs were not drawn up ; the countenance
was natural and the skin soft. He was put on the use of calomel
and opium : two grains of the former, with a half grain of the latter,
being ordered every three hours. The opium, as is frequently the
case, diminished the secretion of urine, and also produced slight re-
tention; the patient passing it but once in twenty-four hours.

On the morning of Sunday, June 8th, Dr. Gurdon Buck saw the
child, in consultation. The symptoms had not materially altered ;
the pulse ranged from 116 to 120, and was soft, and of moderate
fulness; the tongue clean ; the skin, countenance, and decubitus na-
tural. As the bowels had not been moved for nearly three days, a
large enema, with a spoonful of castor oil was ordered, and w^arm
fomentations to the abdomen, which had previously been applied,
were continued. On visiting the patient at 1 P. M., his counte-
nance was sunken, and pulse very frequent and scarcely percepti-
ble. The skin was bathed in perspiration, and there was some
coldness of the extremities. The pain was gone, and the little pa-
tient moved freely in all directions. Soon after the administration
of the enema, he had a large watery evacuation, and had passed
urine freely. This was followed by vomiting of a quantity of dark,
green-looking fluid.

During the afternoon and evening, the vomiting recurred several
times ; and acute pain in the abdomen was complained of. The
child became exceedingly restless, tossing about in bed; the extre-
mities colder ; the countenance more livid and sunken, and finally
expired at about 3 o'clock on the morning of the 10th.

Post-mortem examination, 14 hours after death. Abdomen. On
opening the abdomen, it was found filled with a considerable quan-
tity of sero-purulent fluid. The intestines were universally glued
together by soft adhesions, which were readily broken up. In sev-
eral places where two folds would be adherent, there would be at
the place of adhesion a dark brown, circumscribed patch, with a
well-defined margin, resembling so closely the appearance of gan-'
grene after strangulated hernia, as to be at first taken for gangrene
by Dr. Buck.

The intensity of the inflammation was evidently greatest about
the hypogastric region, and raising the intestines from the pelvis,
the effused fluid was found there of a darker color, having a brown-
ish tinge. There was, however, no feculent odor.

Amid the mass of large intestine which dipped down into the
pelvis, the appendix vermiformis was found intensely inflamed,
much enlarged, and having a flattened appearance. It contained a
concretion about the size of a swollen white bean. No perforation
was noticeable. On being laid open, the mucous membrane of the
appendix was intensely inflamed ; the inflammation extending to
the neighboring large intestine, the follicles of which were enlarged

1857.] Neio York Pathological ^Society Reports. %

and prominent. The concretion consisted apparently of a small
feculent mass which had formed itself around two or three minute
whitish bodies about the size of strawberry seeds. The appendix,
with the caput coli, was removed, and after maceration one hour in
water, several minute ulcerations were evident ; one of which,
about the size of a pin's head, had perforated into the abdominal
cavity. The other organs were not examined.

Perforation of the Appendix Vermiformis. Dr. Gobrecht gave the
particulars of a case of perforation of the appendix vermiformis.
, " The patient aged 21, a carpenter engaged in making and set-
ting heavy joist, was muscular, of average height, and had been
apparently in good health. He was not originally under my own
care, but according to the statement made when he took charge of
the case, at 11 o'clock on the night of Sunday, Feb. 10th, the first
symptoms occurred at about 5 A. M., on the previous Thursday,
consisting of abdominal pain, but no purgation, for which some
' cholera medicine' was taken, but without relief, vomiting super-
vening at about 11 o'clock. During the day, and on Friday, the
symptoms increased in severity, and oil Saturday and on Sunday,
cups and poultices were applied to the abdomen, and internal rem-
edies were employed, which, however, failed of their purpose ; the
pain continuing until Sunday noon, when it ceased suddenly and
entirely, but the vomiting was unabated. For the first time since
.the attack the bowels were moved that evening by a clyster, but
the passage, which was copious, had no fetid odor.

" At this time, when Dr. G. first saw^ him, there was no abdomi-
nal tenderness, the belly being soft without tympanites, and the pa-
tient lying at length in the bed. Voice was good, respiration
natural, pulse frequent, cool skin, moist clean tongue ; but there was
great general exhaustion and constant rejection from the stomach,
of a dark liquid like black vomit. He supposed, from the detailed
symptoms: 1. That he might have had enteritis resulting in gan-
grene. 2. Or internal strangulated hernia terminating in gangrene.
3. Or that he might have had peritonitis."

Lime-water and ice internally, and counter-irritants externally,
were used to combat the obstinate vomiting, while a stimulating
and nutritious diet and stimulating applications to the body and ex-
tremities, were prescribed to combat the symptoms of exhaustion.
Under this treatment the patient rallied somewhat until the after
part of Monday, when the vomiting increased again, and the mind
wandered a little.

" On Tuesday morning I found that his physical powers had been
slowly failing since the previous evening, and when left perfectly
quiet there was some disturbance of intellection, but he returned
intelligible answers when addressed. It was evident that death
would occur before many hours had elapsed, thougli not immediate-
ly, and being of perfectly clear mind, it was thought best to apprise
him of his actual condition, which was done in the gentlest manner

96 New York Pathological Society Reports, [February,

possible. It was found that he had no apprehension of his extreme
danger, and his life seemed to have been prolonged by the hope of
recovery, for when informed of his real situation he asked anxious-
ly, * Can you not try to do more ?' then turned on his side, became
restless, and had himself propped up in the bed; his mind wander-
ed, breathing was labored, vision became indistinct; he was insen-
sible to those around, and died at half-past ten o'clock, within a half
hour after being informed of his hopeless condition.

''Autopsy. On examination twenty-four hours after death, cada-
veric rigidity being complete, extensive peritonitis was discovered.
The great omentum was thickened, vascular, and bound firmly to
the right iliac region. All the coils of the small intestines adhered.
The cul-de-sac between the bladder and rectum, by the agglutina-
tion of the sigmoid flexure, small intestine and upper fundus of the
bladder, was completely shut off from the general peritoneal cavity,
thus forming an abscess lined by very thick false membrane, con-
taining more than a teacupful of purulent fluid. Several small cir-
cumscribed collections of purulent fluid formed in a similar manner
were found in the vicinity of the ascending colon, which was drawn
down and attached to the caecum and appendix vermiformis so
firmly that some force was required to separate them.

" The removal of the colon revealed the appendix, which was
quite capacious, perforated at the bottom of a large ulcer, situated
at about one-third of its length from its extremity, the portions sur-
rounding the ulcer being gangrenous. Just below the orifice of
communication between the appendix and the caecum, was found
impacted, a seed or stone with its exterior much softened, which
appeared to be that of a large cherry or small plum.

"At the time of death there seemed to have been no communi-
cation between the intestinal and peritoneal cavities ; the adhesions
of the perforated part to the colon preventing it.

" The stomach contained a fluid similar to that vomited ; there
was no noticeable lesion of its parietes.

" The mucous coat of the intestines was not involved in the in-
flammation, and contained, nearly throughout, only mucus colored I
by bile. The lower portion of the ileum and colon contained fecj
matter.

" The bladder was empty.

" The specimen presenting the lesion described, was exhibited by
Dr. Gobrecht."

" Several of tbe Fellows referred to similar cases that bad fallen
under their observation. Dr. Griscom mentioned one in which the
foreign body was a watermelon seed ; and Dr. Keating referred to
one reported by Dr. Meigs, where a collection of fig seeds in the
appendix had occasioned the attack. A case was also reported by
Dr. H. Hartshorne, in March, 1851, and another in April, 1845, by
Dr. Pepper. In the former, a mass of hardened feces, and in the
latter, a grape seed, was the oflending body." Med. & Surg. Bep.

1857.] Supra-renal Capsules and Bronze Disease. 97

'Physiology and Pathology of the Supra-renal Capsules and Bronze
Disease of Addison. By Professor Trousseau. (Translated from
the Archives Gencrales.)

In an important communication, made to the Academy of Medi-
cine at its session on the 2Gth August, 1856, M. Trousseau adduced
some new facts and added some reflections which form a valuable
complement to the work already published in the Archives, upon
the diseases of the supra-renal capsules. A literal copy of the note
is here subjoined.

The supra-renal capsules have been nearly forgotten by anato-
*nii3ts, physiologists and pathologists. The researches of Addison
and of Brown- Sequard prove that they merit consideration in
respect both of their physiology and pathology. We subjoin the
principal facts discovered by M. Brovvn-Sequard, relative to the
physiology of these organs, which were submitted to another learn-
ed society :

1st. These capsules are endowed with great sensibility.
2nd. They increase in weight and in volume from birth until
adult years ; hence they can no longer be regarded as special organs
of embryonic life.

3rd. The extirpation of the two organs as rapidly and as certain-
ly destroys life, as the ablation of the kidneys. M. Brown-Sequard
operated on sixty animals of different species and found death super-
vene after an average interval of eleven and a half hours.

4th. The auration of life, when but one of the organs was extir-
pated, did not exceed seventeen hours.

5th. In not a single instance could the death be attributed to either
hemorrhage or peritonitis, nor to lesion of the kidneys,, the liver or
other important organ in the vicinity of the capsules.

5th. When the semi-lunar ganglions were accidentally injured in
these experiments, the heart's action was accelerated ; but this could
, Qot be assumed as the cause of the rapid death of the animals.
: 7th. After the extirpation of these capsules, there follow with al-
most perfect constancy an excessive weakness, at first an accelerated
'espiration, then becoming slow, jerking and irregular; anaccelera-
lon of the heart's action, a depression of the temperature and various
. .lervous phenomena, such as vertigo, convulsions and coma, super-
^ened on the near approach of death.

: .8th. When but one of these organs was removed, the same

>: 'ymptoms were exhibited, but less rapidly and after an interval of

pparent restoration ; when convulsions occurred, they were mani-

3sted only on the side of the extirpation, snd the animal performed

,^ piral rotations, much as when the middle cerebellar peduncles have

een divided, rotating from the injured toward the sound side.

9th. There occurred among the hares of Paris an entozooty or an

^izooty, characterized by an infl.amn>ation of the supra-renal eap-

98 Supra-renal Capsules and Bronze Disease. [February,

sules, which give rise to the same symptoms as the extirpation of
these organs.

10th. The blood of the diseased animal, when injected into other
hares, produced similar morbid phenomena to those resulting from
the ablation or inflammation of these capsules.

1 Ith. Wounds of the spinal cord determine an active hyperaemia
of these organs, resulting in an hypertrophy or an acute inflamma-
tion, and speedily proving fatal. A fact established by Brown-
Sequard in 1851,

The preceding facts, says Brown-Sequard, lead to the following
conclusions, viz : 1st. That the supra-renal capsules are absolutely
essential to life. 2nd. That their ablation or morbid change dis-
turbs the economy, either by interrupting the functions of the organs
as blood-vascular glands, or by irritating ihe nervous system and
giving rise to convulsions limited to one side of the body.

If these experiments were exact, (of which there can be but little'
doubt,) or perhaps we should say, if the conclusions deduced by M,
Brown-Sequard are legitimate, then the functions of these organs iu
the animal economy is infinitely more important, than we have pre-
viously been led to believe.

Let us now consider their pathology. Some months since, mf
excellent friend Dr. Lasegue published in the Arch. Gen. de Med. a
very good abstract of the labors of Addison and other British physi-
cians upon the diseases of the supra-renal capsules. They have
established that certain individuals are affected with a peculiar
cachexia, with an anaemia analogous in many respects, among other
anaemias, to that resulting from haemorrhage, and very unlike that, i^
special anaemia known as leucocythemia, (this name is not mine, I'
and God forbid that I should forge a similar one.) a disease in which! j
the blood contains globules analogous to the globules of pus. , , ;

In the cachexia described by Addison, the debility experienced j ;
was out of all proportion to the lesions that could be discovered^ | '
for those lesions, at least those known before the labors of Addison
were insignificant, and simultaneously with the debility a deep
bronze-like coloration of the skin was remarked, particularly on th(
face, the internal surface of the lip?:, in the axillae, on the penicej
and many other points ; pigmentary matter was deposited under tRBr^;
epidermis and under the epithelium, giving the patient the appe^BJ"^
ance of a mulatto ; the hands and the penice sometimes presenrtBjJ^
a hue as deep even as that of the negro. Addison moreover protrWr'
that the disease is always fatal, and the autopsies performed kW^
himself, as well as several other physicians, furnished invariatHFJ
evidence of the presence of grave lesions of the supra-renal cijBW
sules, viz., cancer, tubercles, fatty degenerations, purulent collectiafcH^
hypertrophy, &c. Jll

Since these labors have become known in France, two cases jB-**
the bronze disease have been observed in the hospitals of Paris, oJJfH
at St. Louis, by M. Second-Ferreol, the other in my ward at t'(Bj

1857.] Supra-renal Capsules and l3ronze Disease, 99

Hotel Dieu. The patient that fell under my observation, was a
coachman of the Minister of the Interior, aged thirty-seven }^ears,
apparently in good condition and well nourished. During the past
five or six months his skin has acquired a peculiar and persistent
sallow hue. At the same time he grew weaker progressively ; he
ate little, and had an especial aversion for animal food. He stated
that he had lost three-fourths of his weight, which, exaggeration
apart, was equivalent to stating that he had been fat and had be-
come lean. The symptoms presented by this man were very striking,
and the more so as we recollected the details furnished by the ab-
stract of Laseorue, and I dias^nosticated a disease of Addison. The
patient was soon attacked with a profuse diarrhoea, to the extent
of eight or ten dejections in twenty-four hours, yet without the spe-
cial character of cholera; the body became cold, and he speedily
'Succumbed to the disease. The autopsy revealed no lesion of either
the brain, lungs, heart or intestines, that could explain the S3'mp-
toms or cause of death ; the kidneys presented but a slight hyper-
trophy, and, according to Brown-Sequard, who examined the case,
a few tubercular granulations and fibrous filaments, but the supra-
renal capsules contained numerous tubercular masses. The apex
of one of the lungs contained a very small tubercle, but none in
either the bronchial or mesenteric glands. The blood, examined by
\ 'M. Robin, presented no other alteration, but such as exists in hem^
\ orrhagic anaemia.

I We here see a man, yet comparatively young, suddenly attacked
j with a cachectic and cachochymic disease, of which the data fur-
I nished by the previous condition of pathology yielded no expla,na-
tion. * We recognized in it the disease of Addison. He died, and
the autopsy revealed abundant lesions of the supra-renal capsules,
land no other.

! The other case of the bronze disease was more carefully observed
and reported by M. Second-Ferreol, interne of the hospital. The
patient was a waiter and thirty-five years of age. He was addicted
to all kinds of excesses, and had contracted a gonorrhoea a year be-
fore admission into the hospital. He had previously been admitted
into the hospital Necker, and treated for some serious difficulty of
the digestive organs ; he then presented a deep coloration of the
'face, which varied in intensity with the condition of the digestive
'apparatus. He took at that period I'Eau d'Enghien, probably for
an incipient pulmonary lesion. Towards the close of the year 1855
he presented himself at the hospital St, Louis with evident signs of
tubercle in the apex of the lungs, yet the debility was greater than
occurs in phthisis. He left the hospital and returned, and at last
jdied there.

I The autopsy, carefully observed by M. Second-Ferreol, rex^ealed
very important lesions of the supra-renal capsules ; neither cortical
Tior central substance could be recognized ; a fatty mass of an intense
'rellow color, as if from bile, was alone visible; filamentous tracts

N. s. VOL. Yirr. >o. IT. 7

lOQ Continued Fevers and their Discrmdnation. [FebrnatT';

resembling fibro-cartilage traversed the bodies of the capsules. M,

Robin found pus globules, but no tubercles in the midst of the fatty
mass. M. Ferreol adds that the hands presented the characters of
that from the hands of the negro, and that pigment granules were
abundant in it.

Let us remark that in the negro race the capsulee supra-renales
are of large size ; on the other hand, the accidental development in
excess of the pigmentary matter is connected with an augmented
size or morbid change of structure of these organs. We might
hence infer their connection with the production of pigment in the"
system. \PeninsulaT Journal of Medicine.

Lectures on the Varieties of Continued Fevers and their Discriminations
Delivered at St. Thomas's Hospital, by THo:\rAS B. Peacock,
M. D., Assistant Physician to St. Thomas's Hospital, etc.

Lectuke, General Principles of Treatment. It was not my
intention in these lectures to have spoken of the treatment of the-
disease, but as the subject would be incomplete without some allu*
sion to this point, I shall very briefly refer to the general principles
which should guide us in our practice.

The first question which arises is, can v:e arrest or cut short a
attach of fever f This question must be regarded as a purely prac-
tical one, to be decided by experimental investigation. We have
sufficient proof that those forms of febrile affection which follow
the most definite course the eruptive fever may be cut short
as variola; by vaccination, and, in some cases, by vaccination
practiced after the receipt of the variolous contagion ; and, though
the cases are not precisely analogous, there seems no reason why
similar results should not ensue from the employment of remedial
agents ; and in typhus and typhoid, as well as in other forms of
fever.

I. The means by which tlie arrest of fever has been attemptedi
have been, 1st, Cold afiusion ; 2ndly, Remedies acting upon the
secretions ; and, 3rdly, Specific remedies.

1. At the time when Dr. Currie's work had attracted much at-
tention, the plan of employing cold affusion was very much had
recourse to in the treatment of all forms of fever more especially
in the early stage in the hope of arresting the progress of the
disease, and there is reason to believe that the remedy was occa-
sionally, at least, successful. The prostration of strength which it
occasioned, was, how^ever, sometimes so serious, that the risk more
than counterbalanced the advantage, and the practice Avas aban-
doned. Cold bathing is still, I believe, used by the hydropathic
practitioners as a means of checking the course of fever, but '.
know not with wliat result.

1857.] Continued Fevers and their Discrimination* 101

2. Keniedies wliicli act upon the secretions have been employed
for the arrest of fever, under the idea that as the subsidence of some
forms of the disease is attended by so-called critical evacuations,
such remedies may be the means of eliminating the poison from
the system. Thus, as one of the most common symptoms which
attends resolution in some forms of fever is profuse sweating, dia-
-phoretics have been exhibited to promote perspiration, and so to
bring about resolution. This is, however, an entirely erroneous
view. In many cases the occurrence of sweats during fever, espe-
cially when only partial, so far from causing the subsidence of the
disease, is followed by serious or even fatal prostration of strength.
On the other hand, in cases in which the perspirations are most
profuse, as in relapsing fever and sometimes in typhoid, the occur-
rence of the perspiration, so far from eliminating the poison, does
not prevent the occurrence of the future paroxysms in the one
case, or cut short the progress of the disease in the other. We can,
therefore, only regard the occurrence of perspirations in these
cases as indications of the resolution of the fever and not as its
cause. Again, we sometimes see febrile attacks subside on the
occurrence of spontaneous vomiting or purging ; but it by no
means follows, that the occurrence of these symptoms is the cause
of the subsequent resolution ; and even were sweating, vomiting
or purging proved to be the means by which nature endeavors to
eliminate the poison from the system, it would still not follow that
it is sound practice for us to imitate.

Of the remedies of this description upon which the most reliance
has been placeda s useful in arresting fever, emetics occupy the first
place. It is quite possible, that, exhibited quite at the commence- .
ment of an attack of fever, before the chain of diseased action has
been fully established, they may, by exciting powerful reaction,
arrest the further progress of the disease. In the emplo3^ment,
however, of these remedies, great caution should be exercised ; the
more depressing emetics, such as the tartarized antimony and
James' Powder, are of very doubtful usefulness, at least in the
low forms of fever which we are called upon to treat in this me-
tropolis. They may excite irritability of stomach, which is often
a troublesome symptom, as in relapsing fever, and which it may '

be difiicult afterwards to check ; or they may cause great depres-
sion, if given in cases which are attended with much prostration,

as in typhus ; or they may excite diarrhoea, if given in typhoid.
The objections do not, however, apply to the milder emetics, as

1 ipecacuanha, or, at least, not to the same extent.

* In the exhibition of purgatives yet greater caution is needed.

In typhoid, diarrhoea is often present from the commencement of
' the disease, and at all times it is very prone to occur and active

purgatives may excite very undue action; indeed, I have seen

them give rise to uncontrolable diarrhoea and so occasion death.

During the progress of typhoid it is always necessary to exercise

102 (Jontinued Fevers and their Discrimination. [Febrtfary,.

the greatest caution in the exhibition of aperients'; and in cases
where the bowels have been confined for several days, and where
some interference becomes unavoidable, the action of mild aperi-
ents will sometimes prove injurious. In taking into consideration
the propriety of having recourse to any of these remedies, with the
view of cutting short an attack of fever, it must be borne in mind^.
that^ at the commencement of an attack of fever, when only they
could be exhibited with the probability of accomplishing that re-
sult, it is impossible to know what will be the character of the^
disease, and, consequently, to decide as to the special applicability
of the remedy to be used.

8. Mercurials were much employed in the treatment of fever a
few years ago, under the idea that they might destroy the poison
existing in the system or assist its elimination; and also with the
view of preventing what was regarded as a complication of the dis-
ease, the inflammation and ulceration of the mucous glands of
the intestines. It was even contended, that if the system could bo
brought under the influence of mercur}', the patient always recov;
ered. While, however, there is little doubt that in fever the in->.
fluence of the mercurial remacdies is resisted, there is no proof that,
where the system is brought under their influence, they produce
any beneficial effect ; and practically, their use has been almost
abandoned, except for the relief of accidental complications of an
inflammatory character.

4. The only remedy which has recently been regarded as pos-
sessing any specific power in arresting fever is bark, and especially
its alkaloid, quinine. This power has been supposed to be exerted^
when quinine is exhibited in large and frequently repeated doses,
so as to produce a sedative operation on the nervous system, indi*
cated by well-marked symptoms, vertigo, headache, tinnitus
aurium, and depression of the force and frequency of the hear!}
and arteries. To this condition the term cinchonism hasbeeiii
applied. During the last autumn, I entered into an investigatioH
of the claims of quinine thus exhibited to its asserted power of ar-l
resting fever. I found that the reports of the different practition-
ers, who had made trial of the remedy were so varied that they
could not be referred to as aifording any satisfactory rule for prac-
tice. In our own Hospital, I ascertained that of 35 cases of fever
of all kinds treated during two years with quinine, in doses of 8
to 10 and 15 grains, repeated three, four, six, eight, and twelve
times daily, the mortality was somewhat greater^ and the duration
of residence in Hospital of the cases which recovered was very
nearly the same, as in the other cases of fever treated by the ordi-
nary means. I further found that, in trying the remedy in large
and frequently repeated doses, in particular cases of fever of as-
certained character typhus and typhoid in some, while th
physiological effects were fully manifested, no remedial influence
"was exerted;, in others, the use of the remedy added greatly to tb^

1857.] (Omitinued Fevers and their Discrimination. lOS

prestation of ^strength, and was obvioiislj injurious; and in one
only, out of iiFe cases, did it exert any bcnelicial influence; and
in that it operated only in ai^sisting tlie favorable progress, not,
vcertainly, in arresting the disease. From these facts, I inferred
that quinine, thus exhibited, did not possess the asserted power of
iirresting the progress of fever. An investigation of this kind is
one of much difficulty; for it is evident that, if the remedy to be
tested be not applied at the commencement of the disease, it is not
likely to check the progress ^of the attack ; and, if so applied, as
we cannot a priori with certainty ascertain the form of disease
which is commencing so we cannot decide, if the attack subsides
rapidly, whether it has done so in obedience to the natural law of
the disease, or as the eftect of the remedy employed. We, conse-
quently, are in .many instances left in doubt as to whether the
remedy has, or has not proved beneficial. It is only by repeated
;trial and careful ^observation that we can arrive at a satisfactory
conclusion.

Practically, in 'the treatment of fever, we may dismiss from our
minds the endeavor to arrest the .progress of the disease, and must
-be contented to avni at conducting the cases to a successful issue.

II. In this endeavor we should be guided by the principles so
philosophically laid down by Dr. Alhson.. We must remember
that the different forms of fever are dependent on poisons, which
vcan operate on the system for a certain length <of time only, and
consequently, that they wiM terminate favorabty, provided the
strength of the patient can be upheld for a sufficient length of
time, and the occurrence of local applications be averted.

The modes in which death may occuj: during fever .are by coma,
ji^pnoea, and asthenia.

j 1. The most common mode of death m all forms of fever is
^icoma. It is that which wc have especially to guard against in
typhus, where it is caused partly by the presence of the morbid
poison in the blood, and partly by the impure condition of the
bloody from the imperfect mode in which all the secretions and ex-
cretions are performed. It is also a frequent cause of death in
typhoid, and in relapsing fever, from the presence of the elements
of the bile, or of urea in the blood; and, in all the forms, it may
supervene from congestion or inflammation of the brain and its
membranes.

2. Death from apnoea is of common occurrence in the acute sta-
ges of all the forms -of fever, depending either npon " diphtheritic
inflammation of the fauces, extending into the larynx and trachea-;
on bronchitis, and especially on capillary bronchitis, or on pneu-
monia ; or lastly, .on collapse of the lung, from want of power
during the latter stages of the disease. It may also occur from
jany of these causes, or from pleurisy or pericarditis, during con-
; jvalescence, and especially is apt to do so in tj^phoid.
i ! 3. Death from asthenia is seen to occur in the simplest form

104 Continued Feverrs and their Discrimination, [Febman'

when it results from inanition, in consequence of the inabihty to
get the patient to swallow the full amount of food required, as in
typhus, and especially in prolonged cases of typhoid. The food
which is taken may also be rejected by vomiting, as in some cases
of typhoid, and especially in relapsing fever; or the patient may
be exhausted by profuse diarrhoea, during the course of typhoid
esjDCcially, but occasionally in typhus ; or he may be worn out by
long continued diarrhoea, when the discharge is never very pro-
fuse, as in the atonic stage of typhoid. Profuse sweating in re-
lapsing fever, or copious dischai'ges of blood from the nose, much
more frequently from the bowels, in typhoid or relapsing fever,
may occasion the same result. Death from asthenia may also oc^
cur from the supervention of acute peritonitis, dependent on per-
foration of the bowel, in the active stage, or during convalescence
from tj^phoid ; or when extensive sloughing occurs on the back,
or, as occasionally happens, when the extremities become gangre-
nous in typhns or typhoid. And lastly, the fatal termination may
be caused by sudden syncope, from allowing the patient to sit up
in bed or leave the bed, during the active stages of any form of
fever, or even at too early a period during convalescence.

Our practice, then, in the treatment of all the various forms of
fever, must consist in guarding against their various tendencies to
terminate, in death ; and we must bear in mind, that it is not against
one only of these sources of danger that we must be on our guard,
but that we consequently have to contend with the several thread
ening symptoms at the same time, or find them occurring at differ-
ent periods of the attack.

1. It is essential that stimulus and support be exhibited in doses
apportioned to the prostration of health, and in the mode best cal-
culated to assure their ready assimilation.

In the early stages of the disease, the patient should only taktj
light and easily digestible food milk, arrow-root, sago, panada,
broth, and soups, or light puddings ; with the advancing weak
ness, the food must be given in a more concentrated form ^beel-
tea, jelly, chicken-broth, etc. ; and at a still later period, or when
there is greater prostration of strength, stimulus must be had yc
course to ; at first, of a milder character, as wine, nnd subsequentl}
or when the depression of power is greater, brandy, ammonia, etc
must be given.

It is impossible to lay down any rules as to the quantity of sti
mulus that may be required. In some cases a few ounces of ^vin<
may be sufficient, in others it is impossible to give the supper
too freely, or in too concentrated a form. I have seen a youiT
lady take, during twenty -four hours, a full bottle of brandy, tc
gether with compound tincture of bark and ammonia, etc. An<
again, I have known a child take a full bottle of wine, with brar
dv, and other stimulus and support during the same period, an
this, too, without producing any symptoms of intoxication, or a<

1857.] Continued Fevers and tJieir Discrimination. 105

oomplishing more than the mere maintenance of life. Indeed, in.
nmny cases, the hope of recovery rests entirely upon the contin-
ued exhibition of stimulus and support, and these must sometimes
be constantly given, at intervals of a very few minutes. It is
often, in the low stages of typhus or typhoid, and especially in
children, very difficult to get the amount of nourishment which is
required to be taken.

The stimulus should be exhibited in conjunction with food, and
this should be prepared in the most concentrated form, and be ex-
hibited in the liquid form so as to be readily swallowed and equal-
ly readily assimilated. It should be given every hour or half hour,
or even every few minutes, and often it can only be exhibited in
teaspoonfals at a time ; indeed, I have seen life sustained by the
more constant wetting of the lips with wine. The diffusible sti-
mulus should, in cases of this kind, be frequently varied, so as not
to satiate the patient; sometimes wine, then brandy, or tincture of
bark, or the sesquicarbonate of aromatic spirit of ammonia, in de-
coction of bark, or with some stimulating infusion, as the serpent-
aria or senega. Generally, stimulus is required at the earliest pe-
riod, and in the largest quantity, in the treatment of cases of ty-
phus; but it is often necessary to exhibit it most freely in the
other forms of fever , and especially in children ; and while the
prostration of strength is of comparatively short duration in ty-
phus, it is in typhoid often very prolonged, and requires the per-
sistent use of stimulants for many days. It is also very necessary
after the exacerbation in relapsing fever. In the employment of
alcoholic remedies in fever, we must, however, bear in mind that
they may occasion the comatose tendency, which it is one of our
most important objects to prevent, and we should, therefore, be on
our guard against their too liberal exhibition.

2. Bark and Quinine. I have before alluded to the employ-
ment of quinine in large doses, with the hope of arresting an attack
of fever. When so exhibited, the remedy operates as a sedative ;
but, in smaller doses, it acts as a tonic, and is often a valuable ad-
junct to other treatment; but, even when exhibited only in doses
of two to four grains, three or four times daily, it is apt to excite
headache, restlessness, vertigo, excessive dryness of tongue, and
other unpleasant symptoms. Its use therefore requires great cau-
tion.

It is often very beneficial in accelerating convalescence when
exhibited towards the end of an attack of fever, especially of Ij-
. phus. It is very useful in cases of typhoid, which, in some local-
ities and in some seasons, have a great tendency to assume a remit-
tent character, having a marked exacerbation each evening, or to
' relapse. I have also been in the habit of employing it more freely
in relapsing fever ; but on the usefulness of quinine in this form
of fever practical writers are not agreed. Quinine, exhibited in
moderate doses, is also very beneficial in a form of typhoid which

106 Continued Fevers and their Discrimination. [Eebruary,

is not of uncommon occurrence, where the fever, without being
very intense, is very prolonged, and day after day elapses without
any material progress towards convalescence. In these cases the
use of the remedy is often productive of very striking effects, and
greatly accelerates recovery. I am generally in the habit of em-
ploying, during the active stages of fever, the infusion, decoction,
or tincture of bark, in preference to quinine, believing these rem-
edies to possess, in a greater degree, the tonic properties of the
drug while the quinine seems rather of use as an antiperiodic,
and in strengthening the appetite at the end of an attack of fever.

3. Remedies which have been swpj^osed to exert a specific influence
in checking decomposition have also been employed in the treatment
of fever. Of these, 'that most frequently used has been the chlo-
rate of potash ; and it has been much had recourse to since Chomel
advocated its use in the typhoid fever of Paris. I have been con-
stantly in the habit of employing the chlorate in all forms of fever
in doses of about ten grains dissolved in water, or in decoction of
bark, slightly acidulated with hydrochloric acid, in all forms of
fever, and with good results ; but using it in combination with
other active remedies, it is difi&cult to say what amount of credit
is to be assigned to its asserted powers.

4. Anodynes are most useful in the treatment of all the various
forms of fever. They may be exhibited to calm agitation and
procure rest during various stages. Thus it is not very uncom-
mon, in cases otherwise of mild fever, to find the patient wholly
incapable of sleep, and thus the disease is kept up ; in other cases
there is active delirium, the patient being constantly talking, and
endeavoring to get out of bed ; and, in yet others, there is much
tremor, agitation, and nervous excitement. In these cases an
anodyne may at once break the chain of diseased action, and dis-
pose the case to advance satisfactorily to convalescence. The ex-
hibition of anodynes in fever requires, however, the greatest care ; '
they may occasion the coma which should most cautiously be
avoided, and in some cases, when they do not produce their ano-
dyne effects, they give rise to distressing restlessness, and increa.-
the delirium and excitement which may be present. General] \
speaking, they may be exhibited more freely in the early stages ot
fever than at later periods; and, in typhoid and relapsing fiever,
more largely than in typhus. In some cases, where there is reason
to suspect inflammation or congestion of the brain or its mem-
branes, their use must be preceded by, or combined with, anti-
phlogistic treatment, cupping, leeches, ice, or blisters. In others
when there is great prostration of strength, they operate mo.-
beneficially when combined with diffusible stimulus, as wini
brandy, ether, or ammonia, or can only be safely employed whei
so combined.

Opiates are also very useful in checking diarrhoea, and they ma;
be more freely applied under such circumstances ; they are espe

1857.] Continued Fevers and ilieir Discrimination. 107

cially useful in this way, and also in relieving the abdominal pain,
in cases of typhoid; and, when therein any suspicion of a tenden-
cy to perforation, they should be freely exhibited; when perfora-
tion has already occurred, their use in large doses, offers the only
possible nieaus of relief. In the eaily stages of typhoid, and also
during convalescence from that disease, it is a good plan, when
there is pain in the abdomen and the bowels are confined, not to
exhibit an ordinary aperient ; but rather to give a small dose of
calomel with a full proportion of opium, and to repeat this in two
or three hours, if the pain be not relieved. A small quantity of
castor oil may afterwards be given, and the bowels are then gen-
erally soon relieved without further inconvenience. I have thus
seen attacks threatening perforation of the bowels, readily re-
lieved.

5. Astringents. In cases where there is diarrhoea, or discharge of
blood from the bowels, astringents must be employed. For the
relief of slight diarrhoea, the milder vegetable astringents, as kino
catechu, may be used in conjunction with the compound chalk
mixture. In more severe cases, the gallic, and especially the tanic,
acid, or the acetate of lead with opium, may be used; and these
remedies must also be had recourse to in cases of hemorrhage from
the alimentary canal, or other mucous membrane.

When the discharge, whether simple diarrhoea or hemorrhagic,
takes place from the stomach or bowels, the tannic acid, having
stronger local action, is probably the preferable remedy; but in
discharges of blood from other organs, the gallic acid, being more
readily absorbed, is probably more to be depended upon. I be-
lieve, however, in all such cases, that the acetate of lead exercises
a much more powerful astringent action than any other remedy.

6. I have already alluded to the emploj^ment oi mercurials^ as a

means of arresting the progress of fever. These reniedies are also

exhibited for the relief of the hepatic complications of different

forms of fever, more particularly of typhoid and relapsing fevers.

-When, during the course, or at the commencement, of those dis-

il eases, there is more or less jaundice with pain or tenderness in the

[ region of the liver, I have usually had recourse to the employ-

(-ment of the milder mercurials, as the hydrarg. c. creta; and as, in

' such cases, there is also generally diarrhoea, it should usually be

B combined with astringents and anodynes, as Dover's powder, or

1.. the compound chalk powder with opium. This plan I believe to

j be preferable to the attempt at once to check the diarrhoea by the

[ji use of the more powerful astringents.

jji 7. Remedies employed to check vomiting^ etc, Ice, hydrocyanic
^e^acid, effervescents, soda-water, with brandy, etc., must be had rC'
,ji i course to as circumstances require ; and they are especially needed
in cases of typhoid, more particularly when assuming the remit-
tent form, and in the various stages of relapsing fever.

8. Counter-irritants ma}^ be employed for the relief of local com-

i

108 Gontinvd Fevers and their Discrimination. [February,

plications in all forms of fever, but they are especially useful in
the comatose affections of typhus or typhoid, and especially in the
latter disease, in children. In such cases the free application of
blisters to the neck or to the scalp is of the greatest use. . It is not
by the discharge that tliey excite that their application seems to
be beneficial, but from their powerfully arousing the patient. I
therefore prefer the application of a succession of blisters, to the
continuance of the discharge from the same surface. Asa general
remark, the liq. vesicatorius produces this etiect much more de-
cidedly than an ordinary blister, and I have certainly seen the
lives of children saved, under the most unfavorable circumstances,
by the free application of the blistering liquid to the scalp ; nor
did I ever know any unpleasant effects result from the practice.
Sinapisms applied to the calves of the legs or feet, or hot mustard
and salt batlis may also be used in cases of cerebral complication,
or as the means of arousing the patient when greatly prostrated.
The continued use of warm poultices, or turpentine and other
fomentations, is of the greatest use in cases of severe abdominal
disturbance.

9. AniijMogistics ma}' be employed for the relief of the inflam-
matory complication of the different forms of fever ; but, in mod-
ern practice, blood-letting is only practised locally by cupping or
leeching. Either of these means may be employed for the relief
of S}' mptoms dependent on inflammation of the brain or its mem-
branes ; or the patient may be cupped on the chest or between
the shoulder-blades in cases of pneumonia or bronchitis ; or leeches
may be applied on the abdomen, and especially in the right illiac
region, in cases of typhoid, where there is pain, and other symp-
toms of unusually active abdominal inflammation : or on the right
hypochondrium in cases of inflammation or active engorgement
of the liver, especially in relapsing fever; but in all forms deple-
tion is onl}'- applicable in the early stage, and requires the greatest
caution. Antimony judiciously exhibited, and in combination
with other means, is occasionally useful in the bronchitic or pneu-
monic complications of the different forms of fever.

10. Lastly, the greatest attention should be paid to the hygieiiir
management of the patient. His hair should be cut short or shave-
at the commencement of the treatment, according to the urgenc;
of the cerebral symptoms. He should be kept clean ; and fn-.
ablution of the hands and foce, and of the body generally should
be frequently practised. Though, indeed, cold affusion has been
abandoned in the treatment of fever, ablution is stil Imost usefully
emplo3^ed. Sometimes the patients prefer to be sponged with cold
water, at other times with tepid or warm water ; and in the lattei
stages the emploj^ment of warm vinegar and water is often verj
beneficial. Ablution of the whole surface can rarely be borne a1
the later periods: but the head, face, hands, and feet may usuallj
be sponged, several times in the day, with the greatest advantage

1857.] Treatment of Chronic Dysentery. 109

and often patients obtain great relief in the early stages from
keeping their hands in cold or tepid water. The bed and body
linen should be frequently changed ; and the room should have a
free pertiation of air through it, care being taken not to allow the
air entering to be too cool or damp, or the patient to be exposed
to a direct draught. In making the requisite changes the patient
shauld be disturbed as little as possible; and he should, on no ac-
count, be allow^ed to rise from the bed during the active period of
the disease, to make use of the close stool, or for other purpose, or
leave his bed at too early a period during convalescence. I have
known neglect of these precautions attended with fatal effects, in
cases otherwise progressing favorably.

During convalescence also the regulation of the diet is of the
greatest importance and especially in typhoid, in which a long
period may elapse before the mucous membrane of the bowels
recovers its healthy condition. The food should be light, simple,
and eas}' of digestion ; and should be taken in small quantities at
a time and at frequent intervals. As the appetite returns, the
stimulus should be diminished, and replaced by more nutritious
food, the liquid should be gradually changed for the solid form,
and the intervals allowed to elapse between the meals should be
longer. The friends of the patient are apt to transgress in these
respects, giving food in too large quantities, too frequenth', and of
too stimulating a character. This should be carefully avoided. So
far from convalescence being accelerated by such a course, it is
apt to be protracted ; and in typhoid, especially, serious or per-
manent evil may result. When during convalescence, the exhi-
bition of stimulus materiall}' quickens the pulse or gives rise to
flushing, heat, or dryness of the skin, it cannot be beneficial, and
"should only be given in smaller quantities, or be entirely abstain-
ed from. [yew Orleans Med. Xeivs and Hasp. Gaz.

On the Treatment of Chronic Dysentery. By R. W. Ellis, Esq.,
M.R.C.S.E., Bristol.

' In consequence of the prevalence of dysentery among our brave
troops during the late war, and the generally intractable and often
fatal character of the complaint, any new sugo;estion wdth reference
to the treatment, however insignificant in itself, assumes a degree of
interest and importance which otherwise could not be claimed for
it. It is under these circumstances that I wdsh to call attention to
a remedy in the chronic form of dysentery which has proved very
useful in my hands, but which requires more extended observation
lo establish its utility than I can expect to have the opportunity of
giving to it.

In dysentery, the large intestines are very often the principal
parts affected, and in all cases they are very much involved in the

110 Treatment of Chronic Dysentery. [February,

disease. The discharge in the early^stage consists of a slimy mu-
cus and of a more serous portion mixed or streaked with blood ;
subsequently pus is discharged, still streaked with florid blood, epi-
thelial debris^ &c.; and now and then small portions ot imperfectly-
formed faeces will be observed with the stool. The calls to stool
are frequent and distressing, on account of the tenesmus that ac-
companies the least evacuation; there is also uneasiness or tender-
ness in one or both flanks.

Now, when the functions of the colon are performed in a healthy
manner, the faeces are figured, of a firm consistence, and of the well
known color. In dysentery, or, as it is sometimes called, colitis,
this function is completely in abeyance ; but whether this is pro-
duced by the relaxed state of, and consequent want of tone in, the
muscular coat, or (coin the extreme irritability of the mucous mem-
brane of the intestines, or of the character of its contents, or all
combined, I cannot determine. The compound tincture of benzoin
I have found, when administered in this disease, particularly useful
in restoring, and that in a very short time, this function of the colon.
Whether it also acts beneficially by protecting and sheathing the
ulcerated portions of the gut, or by its stimulating qualities induces
just as it does in chronic ulcers of the surface, the reparative pro-
cesses to go on more rapidly, I am unable to determine. The tinc-
ture of benzoin, I need scarcely say, consists of benzoin, styrax, to-
iu, a small quantity of aloes, and spirit. The dose generally given
is from fifteen to twenty minims. The following cases I have ex-
tracted from mv note- book, as beinsr the most striking instances
that I have met with of its beneficial effects :

Case 1. C. S , aged fifty, female, married, the mother of sev-
eral children, has suflfered for years from diarrhoea, with tenesmus
and discharge ol' blood per anum ; no piles. Has been in the habit
of taking drops of the tincture of sesquichloride of iron, as prescrib-
ed for her by a physician, and with benefit. Hassutfered from her
complaint in an aggravated form since last Christmas, and has lately
taken a great deal of medicine for it without relief. At present
(May 29th, 1855,) she passes a great deal of blood by stool ; pain
great; bowels loose; blood mixed with the stool ; breath short; lips
very pale ; countenance exsanguine. Ordered twenty drops of
compound tincture of benzoin, to be taken on sugar three times a
day.

June 1st. Has not passed any blood since the third dose ; feels
better ; is stronger, and has more appetite ; lips rosy ; more color in
cheeks, and expresses herself as "wonderfully better."

Srd.^Ordered twenty drops of the tincture of sesquichloride of
iron, one ounce of the infusion of columba, to be taken twice a day;
one grain of compound calomel pill, every night.

July 24th. Still continues much better ; the pills act gently on
the bowels.

Case. 2. M. E , aged thirty, female; ill ever since March

1857.] Cause of Congenital Deafness, 111

8th, with looseness of the bowels, pain in the left flank, and a dis-
charge of purulent, fcrtid n:>atter streaked with blood, per anuni }
emaciated, and has a hectic blush on cheek ; skin muddy, and of a
dirty yellow tinge ; cries, and feels thoroughly miser;djle with her
condition, and disgusts others by the smell which the discharge.;
which passes involuntarily, gives her ; has piles ; has taken nearly
all the medicines enumerated by Dr. Copland as useful in such ca-
ses, with but little benefit.

May 14th. Ordered, compound tincture of benzoin, twenty min-
ims, three times a day.

June 8th. Nearly well ; motions natural. To take, tincture of
sesquichloride of iron, ten minims; infusion of columba, one ounce,
three times a day.

Case 3. S. M , age not ascertained ; aborted ffyiir weeks-

previously ; after which she suffered very much from hemorrhage.
Having attended her for this, and finding her again weak, faintish,
complaining of pain and loss of blood, she was treated at first for
loss of blood per vaginam, and took some pills of acetate of lead and
opium. Two days after, finding her no better, I made a more mi-
nute inquiry into her case, and found that the loss took place by the-
rectum. She was now ordered the tincture of benzoio, and, three
days after, I found that the discharge had. ceased, and the motion
had become quite natural.

Case 4. July 28th, 1854. John W , aged two years ; bow-
els loose ; discharge of blood and matter ; pain. Ordered, a mustard
poultice. Mercury-with-chalk, two grains ; compound ipecacuanha
powder, one grain, every four hours.

July 30th. State of bowels not relieved ; drowsy ; pain severe.
Ordered, a warm bath. Mercury vvith-chalk, two grains; ipecacu-
anha powder, half a grain, everv three hours.

August 1st. Much better ; no blood by stool; no pain.

7th. Relapse; considerable pain; powder as last prescribed
again tried ; also a chalk inixture, with ipecacuanha, etc., but with-
out benefit. Ordered, compound tincture of benzoin, one drachm ;;
tincture of opium, ten drops; peppermint w^ater, three ounces; twc
small spoonfuls, three times a day.

10th. Nearly well ; felt relief shortly after taking the medicine,-

15th. Cured. [Lomdon Lancet.

Marriage between Relatives considered as a Cause of Co'agenitaX
Deafness. Read before the Academy of Medicine, 29th of April,
1856, by M. Meniere, Fellow of the Faculty, Physician of the
Imperial Institute for the Deaf and Dumb. (Translated from;
Gaz. Med. de Paris.)

' ' A person is deaf and dumb, is it possible to determine the causes'
which have produced this fearful calamity ? Such is the problem
which we would endeavor to solve ; but thus stated, and in its vast

112 ^ Cause of Congenital Deafness. [Fcbrtiary^

extent, it admits of expansion tar out of all proportion which the
Acadeniy accords to })hysicians desirous of niakinfj known the result
of their researches. 1 shall, then, confine the subject within bounds,
by elimination, in order to arrive at the principal causes at those
which have, so to speak, a specific character, and which may be*
come the source of efficacious preventive measures.

Let us take, at hazard, a number of one hundred deaf mutes, from
the ages often to fifteen ; let us select the intelligent, those instruct-
ed, and furnished with papers containing positive information on all
points of their history ; we shall find that two-thirds of these child-
ren heard up to a more or less advanced age, and that they belong
to the great class of deaf-mutes arising from accidental causes. We
tieed not occupy ourselves with them here, as the reasons which
have destroyed their hearing belong to the department of ordinary
pathology.

The remaining third that is to say, deaf-mutes, having never
heard, those who mav be regarded as atiected with congenital deaf-
ness, and, as a consequence, with dumbness are not deaf to the
same degree; there are those among them who are accessible to cer-
tain sonorous concussions who i^erceive some noises, and even
sounds. These slight differences do not affect their general condi-
tion : they are the deaf and dumb, whom no medical art can cure ;
at least hitherto, it has not beneficially modified this state of being*
But if therapeutics are insufficient, it is not, therefore, necessary to
abandon these unfortunate persons ; art may intervene efficaciously
in seeking to prevent the evil, and it is the attainment of this desir*
able end that gives such deep- interest in the study of the causes of
this malady. There, where therapeutics are at fault, hygiene offers
remarkable resources ; let us, therefore, endeavor to show that con-
genital absence of hearing belongs more especially to this great
division of the art of curing.

When the parents of a child deaf and dumb from birth are care-
fully interrogated, so as to ascertain the probable causes of this in-
firmity, we find the same accidents almost always indicated. The
vivid impressions felt by the mother during gestation play the pro-
minent part; but if the knowledge of these facts is insisted upon, in
order to appreciate their value, their unimportance is soon compre-
hended, arranged as they are, for the most part afterwards. The
human mind easily creates circumstances capable of explaininQ
phenomena ; it accepts more readily those which are of a mysteri-
ous nature, and it clings to them the more closely the less they are
to be explained.

We have no reason to deny, absolutely, that the very vivid im-
pressions experienced during pregnancy may exert an unfavorable
influence upon the foetus ; but as nothing in science has demonstra-
ted to us that causes of this kind have a specific action upon the
sense of hearing, we shall not allow ourselves to dwell longeron
this point of the controversy.

1857.] Cause of Congenital Deafness. 113

After the moral impressions come the physical accidents, and mo-
thers often invoke them as the cause of the infirmity of the child.
Falls, blows acting directly upon the distended uterus, producing the
cessation, during a longer or shorter time, of the movements of the
infant, may have a direct influence upon it ; but in what way can
this action be injurious to the ears? Why should deafness be the
result ? Hitherto, nothing has led to the appreciation of such a fact,
therefore we are not authorized to take it into account. Heredita-
ry transmission remains ; for we are naturally led to believe that the
loss, or rather the absence, of an organ like the ear, is the conse-
quence of a primary congenital state, and it is asked if the parents
have not themselves a sunilar infirmity. During a long time, re-
searches, made with a view of throwing light upon this point of the
history of deaf-mutes, have furnished a negative result that is to
say, it has been found that children deaf and dumb from birth were
born of parents who had the faculty of hearing. But statistical
truths are rarely absolute, figures have ceased to favor this opin-
ion; new facts, closely observed, demonstrate that deaf-mutes have
given birth to children deaf and dumb ; but I hasten to add that
these few facts only constitute an exception to the rule previously
indicated.

Observations, instituted with the greatest care, show that the in-
fant during the intra-uterine life, may be affected with cerebral
lesion ; those who survive these serious maladies, hydroccphales^ mi^
crocephales, are ordinarily idiots, or paralytics; in some of them
there is a want of hearing, but it is less the ear than the brain which
is injured, intelligence is wanting rather than the sense of hearing,
in such a wa}^ that it is difficult to establish the diagnosis of deaf-
ness. However, facts of this kind, although small in number, have
a real importance; they show that, in certain cases, the absence of
hearing may be the consequence of an organic disease developed
before birth. We may even admit that infants totally deaf upon?
coming into the world, owe this infirmity to cerebral accidents su-
pervening during the intra-uterine existence, and analogy suffices"
for this ; but in many cases no trace of such lesion exists, conse-
quently there is no sufficient reason for recurring to this supposition.

When a pregnancy has, however, been disturbed by serious acci-
dents, when the movements of the foetus, before regular, have sud-
denly made considerable and unusual variations, or have ceased for
a long time, we should be authorized to think that the child had
been attacked with some serious evil ; and if, after birth, the want
of hearing should be promptly proved, if the head should present
some anomalous malformation, or if nothingr analogous should be
lound, w^e might regard deafness as a direct consequence of these
accidents ; and I know not that the most severe judgment could
make any serious objection to this manner of viewing the subject.

In the greater number of cases, those born deaf and dumb cai?
not come under any of the preceding categories. The most carefu-]

1 14 Cause of Congenital Deafness, [FebniaT}^

and perse verinijj researches tail to find, in any of these causes, ma-
terials adequate to legitimize the results. It is necessary, then, to
go still farther, to mount yet higher, to the human organism, and
see if there do not exist circumstances calculated to modify it in
such a way that certain morbid conditions should manifest the pow"
er of these primary causes.

Invincible arguments exist to support the following proposition :
Maii^ or rather the human species, deteriorates under certain appreci-
ahle conditions. All the world feels that this is true; the history of
all ages and all countries is full of facts, v.hich are of public noto-
riety ; all have seen and known of races of men degenerated, de-
based, of families becoming extinct ; and science cannot answer,
at the present time, the question, to what causes these pubHc and
private calamities are to be attributed.

The influence of climate has been more generally cited than any
other, because it involves not only the physical, but the moral nature,
the diet, and the education, the form of government, and all that
constitutes the organization of society.

Let us, however, abandon these speculations, in order to cooie
simply to the statement of certain facts, adequate to furnish legiti-
mate argument; let us examine the statistics of authenticated docu-
ments, and find, for, example, what countries in Europe contain
the largest number of deaf and dumb. Since the comn}encement
of this century, the greater part of the governments, stimulated by
the zeal of some generous souls, and at last by public opinion, have i
sought out calamities in order to afford relief; they have made an
inventory, as it were, in this particular ; and, by successive exam-
inations, the number of deaf and dumb in each of the central states
of the Old World has been ascertained. Official statements have
been published in various works. I have indicated some of the
principal results in a book printed more than fifteen years ago, and
I may add, that since that period they have not sensibly altered.

One general fact is apparent from those documents. the number
of deaf and dumb vary much in each country ; sometimes there ar'
one in every three thousand inhabitants, sometimes one in tW'
thousand, and in certain localities one in two hundred, and evei
more. These great differences can not be attributed to the inac-
curacy of official statements ; only want of precision in determining
the infirmity can be taken into account. Very often idiots are
confounded with the deaf and dumb, but this cause of error is not
sufficiently great to vitiate the results of approximate statistics.

If there are countries w here there are ten times more deaf and
dumb than others, it is impossible not to believe that there exists
some local causes capable of producing such a result. Kow, these
regions so sadly circumstanced are those also which contain the
greater number of cretins those in which the human race mani-
fests the characteristics of the most profound deterioration. Let u^
endeavor, then, to reach the true source of this public calami tv

1857.] Caiisc of Congenital Deafness. 115

The average duration of life is not the same in all the countries of
Europe. If it attains thirty-eight and forty years among the most
hardy nations, and the best provided with all the necessaries of ex-
istence, it falls to thirty and to twenty-eight in countries less favor-
ed in this respect. There, also, the greater number of children die
in infancy ; there, also, youth is less rich in healthy subjects ; and
among the adults the number of individuals fit for military service
diminish in a considerable proportion. Wherever there are many
cretins, wherever the children commonly die before the fourth year,
wherever the cases of exemption among the conscripts are numer-
ous in consequence of infirmities, it is there also that we can count
the largest number of deaf and dumb. It is impossible to avoid
establishing a connection between these facts : they are harmoni-
ous ; they are all the expressions of a like condition namely, the
deterioration of the species, the diminution of the vitality of indi-
viduals.

We thus reach the culminating point of this important question :
the determination of the general causes which exercise an unfavor-
able influence upon the human organism. Among these causes is
one which plays a prominent part ; it is in some measure recognized
by all the world ; it forms one of those traditional ideas which time
consecrates, which certain laws confirm, which everybody accepts,
and which, nevertheless, are not clearly enough defined to give rise
to official prescription. I speak of marriage between relatives
consanguinity between husband and wife.

It would not be difficult to discover, in the most ancient, literary,
or religious records of nations, traces of this idea. Former legisla-
tors have given rules for the civil constitution of families, and these
ordinances are founded upon the consideration of the evils which
result from the union of individuals springing from the same origin.
The crossing of races is the natural consequence of these practical
views ; and it must have entered, gradually, into the intelligence of
nations, that to intermarry with strangers was a guaranty of the
preservation of the human species. But between these vague be-
liefs and a law there is a wide difference ; and it became necessary
to place this rule under the protection of Christianity, in order to
insure for it all the development of which it was susceptible.
! During a long succession of centuries, marriage was absolutely
interdicted between all persons related in any degree whatever ; the
' church alone reserving the right to infringe the rule she herself im-
:)osed, in rare instances, the value of which she could appreciate.
But these rigorous measures were subject, like many other things,
t' 0 deplorable relaxations, and at this time all trace of these interdic-
s ions has disappeared. If ecclesiastical dispensations are still soli-
i ;ited, it is very well understood that there no longer exist any in-
} 'alidating circumstances, that civil marriage out of respect for in-
J 'lividual liberty is authorized to all degrees of consanguinity, and
1 'hat, with the single exception of his mother or sister, a man may

N. S. VOL. XIII. NO. II. 8

116 Cause of Congenital Deafness. [February,

marry whom he will. Religious law must follow the civil law it
bestows the consecration necessary to an act already accomplished ;
and whatever difficulties it opposes to this union, it must ratify
what the civil state has permitted. The consequences of this liber-
ty are deplorable more deplorable than would be believed, for it is
easily demonstrated that here is to be found the principal cause for
the deterioration of races. Experience has abundantly proved, that
in the work of the reproduction of living beings, whatever place in
the scale of nature they may occupy, there are useful conditions
which favor the result, insure the vitality of the productions, not
only for the present^ but the future ; for the duration of the species
is guaranteed in proportion to the perfection of the individual. Do
we not know that in agriculture all the vegetables we plant and
cultivate are subject to laws based upon centuries of experience?
Is it not the same in domestic economy for the reproduction of all
animals useful to man, and do we not obey, in these cases, habits
which establish the absolute value of the crossing of the races ?

We cannot deny the analogy of functions between all living be-
ings. It is not necessary to be a great physiologist in order to-
comprehend that wheat, hemp, maize, all alimentary and textile
plants, etc., deteriorate when their seeds are not renewed, and their
distribution varied. The most common experience demonstrates
that in the animal races the productions, to be healthy, should be
the result of the introduction among the herd of foreign bloods
Now, why should it not be the same in the human family ? If our
pride shrinks from such comparisons, we must, nevertheless, submit
to them, for they are necessary, and the title of nobility inscribed
upon our foreheads does not destroy the tie of parentage which .
connects us with the rest of creation. Thus man is subject to the I
same fatal law which imposes upon all living beings ; he can con-
tinue in time and space only by the aid of usages which he has in
common with all who breathe ; and the law of general preservation
is for him as for others the crossing of races, the renewal of the
vital agencies.

Those who live in flagrant contradiction to these universal rule.^
will, sooner or later, feel the punishment of their faults, and suffer
the disastrous consequences of a practice in opposition to the precept^
of experience. Marriage between blood-relations is nowhere
such frequent occurrence as in the localities where are born the
greatest number of deaf and dumb. I have before described certair
valleys of the canton of Berne, the inhabitants of w^hich, collected ir
masses, and living almost without any means of communicatior
with neighboring countries, offer all the conditions favorable to thest
unions between relatives. There, the men marry very young, ii
order to avoid the troubles and cares of a celibacy without compen
sation. They marry their cousins, and all the families have beei
allied for a long time, The children of two brothers, of a brothe
and of a sister, marry as a matter of expediency, and thus preserv

1857.] Cause of Congenital Deafness. 117

the inheritance intact ; consequently, the new family is founded in
physical conditions than which nothing could be more injurious. It
is in the midst of these isolated populations that we find, in all its
hideousness, the degradations of the species, the corruption of the
race. There reign cretinism, idiocy, and congenital deafness, to
such a degree that the demonstration of the fact I have advanced
blazes forth with all its brilliancy. The experiment has been made
along time; it is practiced among the masses; the consequences
which flow from it are as clear as they are afflicting; and, finally, it
would be to reject all evidence not to recognize in these results the
condemnation of such abominable customs.

That marriage between relatives is one cause of the deterioration
of the species is certain ; but it may be asked, how can congenital deaf-
ness be considered as a proof of the degeneration of the offspring of
these unions ? I do not pretend to clear up all these mysteries, only
it may be said, as a general rule, that the nervous system, which
holds the first rank in the human organization, is also that which
suffers the most serious injuries : shortness of stature, slowness and
imperfection of development, infancy prolonged far beyond its ordi-
nary limits, as M. le docteur Baillarge has so fully proved, and,
finally, obtuseness of the senses, and more particularly feebleness,
or even want, of hearing, are the disasters which are to be observed
in the brain and its dependencies. It is man reduced to a merely
negative condition, manifesting only rudimentary traces of intelli-
gence, a sorrowful object of disgust to all except to the unextinguish-
able tenderness of maternal instinct.

If we are reproached with coloring too highly the features of this
picture, of attributing to a single cause this degraded organism,
while it may be the result of a rare combination of exceptional
circumstances, it would be easy to prove that it is in nothing ex-
aggerated, and that the practice of marriage between blood-relations
is the most important of those which can be invoked in such a case.
There exists, in truth, families who, living in the midst of luxury
and abundance, watched over with the most enlightened care, offer,
nevertheless, the sad spectacle of these infirmities of body and mind.
These families, instead of seeking a new element adequate to reviv-
'ily their exhausted organism by making foreign alliances, obstinately
'persist in contracting marriages with branches issuing from the
same trunk, perpetually contract the circle instead of enlarging it,
iconcentratitig in these intimate unions the double influence of an
origin already debilitated, and suffer the laws of degeneration im-
aosed upon all those who walk in this path of perdition. If, in the
confined and isolated localities I have mentioned, a man marries his
nvn cousin, if the uncle marries his niece, because the scarcity of
matrimonial elements renders the thing necessary, other considera-
;ions dictate the same practice among those especially who occupy
ihe most elevated stations in the social scale, l^oyal families, envi-
oned by motives of policy, subjected to the exigencies of govern-

118 Cases of Tetanus, [Februarj,

ment, or restrained by incentives of a different order, as the
dominant religion of the people over whom they hold sway, can
only select their alliances within a very narrow circle ; and thus, in
spite of the best-directed care, the royal races become enfeebled
under the fatal influence of these intermarriages among themselves.
Some of these unions remain absolutely sterile ; others produce
miserable offspring, destined to premature death ; the intellect is
weakened, or imbecility reveals itself, and even idiocy pierces
through all the privacy of a respected seclusion ; and the people, who
willingly believe that all the miseries of life are reserved for them,
see with secret contentment that the throne is not exempt from the
most cruel sorrows, and that all the happy privileges are not the
portion of those who are the sovereigns of the world.

The history of all ages contains terrible lessons of this kind ; it is
not necessary to recall them ; whoever will reflect upon this subject
will find in his memory many celebrated examples to the support of
this argument, and will rest convinced that in marriage there exist
natural incompatibilities : and that in transgressing the law of dis-
persion of races, the lessening and even the destruction of the spe-
cies is involved.

In stating thus distinctly this precept of public hygiene^ we have
for an end the prevention of the development of one of the most
deplorable infirmities ; we would wish to exhaust at its source the
cause of these organic deteriorations, whose secret reveals itself ta
the attentive observ^er. Pathological anatomy of the nervous system,
with whatever care it may be exercised, does not always show the
lesion which determines congenital deafness ; but, in taking counsel
from experience, we may destroy one of the most prolific causes of
this organic imperfection, and we may diminish the number of those
unfortunates to whom the most enlightened and conscientious med-
ical science has not hitherto been able to afford the slightest relief. ^
We prevent formidable evils, which would be better still than to
cure them ; and, finally, families would have no longer to deplore
the existence of these imperfect creatures who will rise up in judg^
ment against the improvidence of their authors. [American Jou
nal of Insanity.

Cases of Tetamis. Reported by J. G. Sewall, M.D., Physician'
the Northwestern Dispensary.

Case 1. Tetanus {idiopathic). Thomas Mc Andrew; a native
New York ; of Irish parents; aged 10 years. When taken ill,
sided at 122 Perry street, in the basement. Owing to the unkii
treatment of his step-mother, he was removed to the shanty n(
9th avenue. He was often forced to sleep in wet clothes, and tui
ed into the streets at night to find shelter where he could. Ab(

1857,] Ckses of Tetanus, 119

Sunday, September 7th, was seized wilh what seemed a bad cold ;
had sore tongue and throat.

September 9. Tetanic symptoms set in, the muscles of the head
and neck first becoming rigid ; afterwards those of the shoulders,
trunk, and lower extremities. Through the whole course of the dis-
ease, the upper extremities were but slightly affected.

Sunday evening, September 14. First tetanic spasm. Tuesday,
16th, had two. 18th, one ; and so on every day one or more.

September 16. Was first seen by physician. Up to this time
had received no treatment save a blister applied to throat within
two or three days of the attack. At first it was difficult to decide
whether the blistered surface or the disease occasioned the most
suflering. General condition was good; pulse 80 to 90, strong;
skin natural; is devoid of pain; articulation intelligible though im-
perfect ; muscles of head, neck, and trunk, rigid ; head thrown back ;
bowels constipated ; swallows with difficulty ; throat slightly inflam-
ed, filled with mucus, giving a rattling sound to respiration.

An ounce and a half of castor oil was ordered, with dressing for
blister, and mild liquid diet.

September 15. Condition the same ; bowels freely opened. Or-
dered tr. assfoet. 3i. every three hours, with liniment containing
chloroform to spine.

September 20. The same. Takes beef-tea and broths. Con-
tinue same medical treatment.

September 21. Consultation was held. General condition the
same ; pulse 88 ; skin cool ; has had several severe paroxysms, with
marked opisthotonos ; continue assafoet. and apply ice to whole
course of spine. This was tried for one day without marked
effect.

September 22. An enema of oil of turpentine and castor oil, to
relieve constipation. Continue other treatment.

September 23. Arms somewhat rigid ; jaws less movable ; sur-
face cool; pulse 90 ; strength slightly diminished. At this time the
violence of the paroxysms were much abated, being limited subse-
quently to sudden twitchings of the body, brought on by movements
or attempts at swallowing, or even unexpected changes in position,
or remarks of attendants ; occasionally marked by considerable en-
ergy, yet always without pain.

September 27. Pulse 96, intermittent; bowels freely opened.
Omit assafoet. to take chloroform, fifteen drops every four hours.
Considerable mucus rattles through lungs.

September 28. Slept well ; has had no spasms ; did not get his
nedicine ; appears and reports better.

September 29. Pulse 99 ; three spasms reported since yesterday,
fP.M.; little sleep; no pain, although constant expression of anguish;
ongue coated with thick yellowish fur, cannot be protruded ; moves
-imbs freely; muscles of neck and abdomen rigid; swallows freely.
3eef-tea and punch.

120 Cases of Tetanus. [February,*

September 30. Pulse 84 ' slept well ; did not get chloroform till
to day ; takes two quarts milk per diem by report.

October 4. Chloroform discontinued, and tr. cannabis indica, 20
drops three times a day, ordered. Pulse 96 ; has had three or four
dejections after oil; spasms reported occasionally in night; appetite
good; improves rapidly.

October 6. Pulse 84 ; sleeps well after medicine, which he now
takes but twice a day. Yesterday, at one o'clock, had a slight
spasm with protrusion of tongue ; perspires freely ; gets out of bed
now and then.

October 13. Pulse 92 ; has improved in all points. All medi-
cine has been discontinued for a few days past, and may now be
altogether laid aside. Appetite is strong ; muscles much less rigid ;
sleeps well and reports very favorably generally.

October 22. Has been up and dressed for a few days past ; walks
about the yard barefoot, and wi-thout coat or hat, by holding on to
the fences; muscles of neck and abdomen very much relaxed ; bow-
els regular; appetite strong; sleeps well.

November 1. Cannot be kept in the house; moves about rather,
stiffly, walking on his toes in part; says he cannot run, yet can
climb about with ease. Discharged well.

Case 2. Tetanus {traumatic). Felix McGill ; aet. 35; Ireland.*
First seen, Saturday, October 4. Eighteen days previously, fell
with a scaffold s:ix or eight feet high upon a pile of stones, sustain-
ing an incised wound of the chin and of forehead, the edges of both
of which were united by sutures. Both now appear to have kindly
healed. Was well and about till yesterday, when he experienced a
sense of constriction about fauces, with a stiffness of the lower jaw,
and inability to protrude tongue, with a fear that if he did so he
might bite it off. Accompanying these symptoms w^as a severe
pain between shoulders. Has had several paroxysms, when mouth
was drawn to one side and neck very stiff. These attacks resem-
ble, in part, epilepsy, the patient lying on the floor ; foaming at the
mouth ; great rigidity of muscles of neck and face, with strong fa-
cial contortions and a drawing of the facial muscles to the left side,
the right appearing palsied. One of these lasted ten minutes with-
out loss of consciousness. Tongue partially protruded affected the
left side, the right commissure of mouth being shut while the left
was raised and in motion. This condition was permanent ; no pair
in spine ; sight and hearing both equally good on either side ; moutt
cannot be opened above one quarter of an inch ; pulse 60, soft anc
natural ; face flushed with an anxious expression. Can sit up oi
walk, though with difficulty.

Blister between shoulders. Cathartic of oil, also tr. cannabis in
dica, gtt. XX. every fourth hour.

October 5. Much the same ; sleeps after tr.; has had no parox
ysms ; oil operated.

1857.] Cases of Tetanus. 121

October 6. Was seen by two or three doctors, who used opiate
enemata. While one was being administered in evening he sud-
denly died.

Case 3. Tetanus {traumatic). John McG., set. 9|-.

July 16. Sustained aslight wound of left foot, between second and
third toes, from a rusty nail. Went to school in two or three days
after, having suffered no inconvenience beyond a trifling lameness.

Tuesday, August 1. Complained of soreness of throat, which
attracted no attention till Thursday the 3rd, when his mother walk-
ed with him to the dispensary, to be treated for it. The physician
in attendance noticed, on inspection, an inflammatory blush about
the fauces, with some tumefaction, and ordered a stimulating poul-
tice, giving internally spirits mindererus. The boy walked home,
and was about the house the rest of the day. Next day, by report,
had a high fever, with increase of stiffness and soreness of throat.

August 5. Found him in bed, tongue hot and dry, countenance
anxious, pulse about 90. Complains only of throat, on seeking to
examine the tongue, found patient unable to open mouth more than
one-fourth inch, through which space its tip was protruded. Think-
ing the stiffness of the jaw arose from the supposed quinsy, I gently
endeavored to depress it, preparatory to the introduction of an in-
strument, for the inspection of the fauces, when the boy, for the
first time, was seized with tetanic convulsions. In lifting him from
the bed, the anterior and posterior muscles of the trunk and lower
extremities, so counter-balanced each other, that he preserved the
stiffness and straightness of a board. Great dyspnoea ensued for a
few moments, and the countenance assumed a livid hue, probably
from spasm of the glottis. Consciousness was preserved during the
convulsions, the boy asking in their midst, that his tongue, caught
between his teeth, might be liberated, he being unable to do so tor
himself. In a few minutes he was returned to bed, the tetanic rigid-
ity continuing, being aggravated, at intervals at from ten to thirty
minutes, by strong convulsive movements of various degrees of se-
verity, lasting from one to five minutes, accompanied with severe
dyspnoea. Thus he remained during twenty-four hours, without
sleep, consciousness, with the power of deglutition and articulation,
remaining intact. The only voluntary muscles that appeared to be
unaffected were those of the arms, and partially so of the face; no
medicine was ordered save a calomel purgative.

August 6. Continues much the same ; no effect from medicine.
Compound powder of jalap was ordered. Pulse 92 ; cannot now
protrude tongue at all. While the convulsions seize him, he requires
to be raised entirely from the bed. In this act, the body moves
upon the feet as a fulcrum being, together with the lower extremi-
ties, extremely rigid. Four, P.M. Free operation from medicine,
with relief. Ordered Hoffman's anodyne and tincture hyosciamus
in drachm doses, every two to three hours.

122 Nitric Acid in Pertussis. [February^

August 7. Much as before ; no sleep as yet, much thirst, and
drinks freely, holding the cup himself; urinates also very freely.
Has no pain in wound, which is barely perceptible, nor has had at
any time, save when exercised by the convulsive movements.
Omitted anodyne of yesterday, ordered tincture cannabis indica,
fifteen drops every two hours, terebinthinate liniment to spine, and
poultices to abdomen. Four, P.M., slept one and a half hours, the
first for more than two days ; rigidity less, can sit propped up at an
obtuse angle, lower extremities bend upon knees by his own effort,
can open mouth one-fourth inch, paroxysms fewer. Continue can-
nabis indica every hour, if paroxysms are more often; beef tea.

August 8. Has had two or three severe convulsions, rigidity
now very marked ; pulse 120 ; mind clear ; no more sleep ; did not
get medicine, but three times in night; continue it, twenty drops
every hour ; takes beef-tea freely ; tobacco poultice to abdomen.

August 9. Has slept perhaps one hour, all told ; paroxysms con-
tinue at the intervals, before alluded to ; some last longer, and are
more severe ; complains of no pain, save during convulsions, and
now and then in right thigh and foot. For two days has had a
cramp-like pain, confined to right foot, occurring frequently, and
relieved by slight flexion of foot upon the leg ; muscles of face quiet,
save in the paroxysms, when they are strongly contorted ; mind
clear, talks and swallows freely ; left arm paralyzed, moves right
readily, still holding his cup ; is not apt to have a paroxysm directly
after swallowing ; which has been noted from the first. Medicine
has been very irregularly given ; continue it. Two, P. M., gave
chloroform by inhalation, was kept under its influence for five or
six hours, during which time he slept; during sleep relaxation of all
the muscles ensued.

Thursday, 10. Pulse 130, very small; countenance has expres-
sion of great exhaustion ; rigidity as great as before ; body more
strongly inclined to left side. Chloroform was omitted after nine
last evening, as child refused it ; commenced giving it this morning.
When patient was partially narcotrized, a frightful convulsion en-
sued, lasting from five to ten minutes, giving a strong feeling, as if
dissolution were impending ; chloroform was discontinued. Father
reports that since midnight, he had two or three paroxysms, more
severe than the one just alluded to. At two, P.M., patient died, no
more paroxysms having ensued. Two minutes before death, he
was conversing with his parents. \_N. Y. Jour. Medicine,

Nitric Acid as a Remedy iii Pertussis icitli Remarks on its Modus
Operandi. By Charles Witsell, M.D., of Cbeeba, S. C.

Pertussis made its appearance upon Mr. S. C 's plantation

about the first of June. June 17th, I was requested to visit the
place : I found six children quite sick with complicated hooping-
cough ; and I learnt that a negTess, about a year old, had died in

i

1857.] Nitric Acid in Pertussis. 123

convulsions the night before I was called. The disease was very
violent in its form ; the paroxysms of cough were frequent, long,
and painful ; and of those I had under treatment, one had inflam-
mation of the brain, a second a discharge of i)us from the right ear,
(which I think was caused by the disease,) and a third, a girl
about eight years of age, had a discharge of blood from the nose
during each paroxysm of the cough, and was much debilitated.
The remaining three were affected with infantile remittent fever.

The children upon the plantation sick with Pertussis, at that
time numbered about twenty ; and each stage of the disease was
present. Alarmed at its violence, I was induced to give Nitric
Acid a trial ; and I used it as recommended by Dr. McNelly, of
Tennessee, sweetened and diluted so as to resemble lemonade ;
and I directed the nurse to give the patients as much as they
would drink.

The disease has passed through the plantation ; and of twenty-
seven patients onlj^ three died : two before I commenced with the
Acid, and one after. (An infant was found dead in its bed ; and
died, I presume, of suffocation.) The patients used Koche's Em-
brocation from the commencement of the disease ; but it continued
severe until the Acid was used, when a marked abatement took
place in its violence. The patients were also properly nourished.
Great attention should be paid to this point in treatment. The
diet of the sick should be simple and nutritious: but it is highly
important that they should receive nourishment frequently, and
in small quantity ; for where they are fed but seldom in twenty-
four hours, they eat voraciously. A full meal always excites a
paroxysm of cough ; vomiting follows ; they are thus deprived of
nourishment ; their systems sink for want of nutrition ; and they
die of inanition. The negro constitution is naturally weak, and
if not carefully husbanded, it readily succumbs under disease.
Hence the awe with which the approach of Pertussis is viewed by
the Southern planter. If the disease visits his plantation in sum-
mer, one in four cases usually fall victims to it. It is more fatal
in summer, because at that season of the year children, residing in
a malarious district, are extremely liable to infantile remittent fe-
ver ; and when sick with the one disorder, and attacked by the
other, they readily sink under the combination.

The next point that I will allude to, is the modus operandi of
Nitric Acid in Pertussis. It is not without some embarrassment,
that I attempt to show the manner in which Nitric Acid is benefi-
cial in hooping-cough, as the pathology of the disease is stiU.
debatable, for it is only by ascribing to the disorder an inflamma-
tory disposition, that I can account for the efi&cacy of the Acid. I
I have, however, good authority for so doing. Dr. Watt describes
the appearances, on examination of several bodies, dead of Pertus-
sis, as distinctly showing an inflammatory affeetion of the pulmo-
, nary mucous membrane ; and he goes on to conjecture that

124 Uditorial [February,

*' hooping-cough consists in some eruptive disease of the air cells
and bronchi, so minute as 1x) escape ordinary observation, yet so
considerable as to excite inflammation." Professor Dickson, in
writing of the disease, says : " It is, I conceive, in the first instance,
a specific irritation of the bronchi, nervous and spasmodic, but
readily becoming phlegmasial. " I therefore believe that Kitric
Acid owes its efficacy in hooping-cough to an alterative power ;
for daily observation teaches us that Eutrophics place the system
in a condition inimical to inflammation. So well is the fact known,
that M M. Trosseau and Pidoux, in giving the definition of an al-
terative, says : " they are agents that change the character of the
blood, render it less adapted for interstitial nutrition, and for
furnishing elements for acute or chronic phlegmasia ; these take
the name of alteratives." The " specific irritation " of Pertussis,
caused by the contagion, being prevented by the alterative, Xitric
Acid, (by its producing certain changes in the blood,) from passing
into inflammation, it soon ceases, and the disease ends. Nitric
Acid seems to be peculiarly applicable to Petrussis, in-as-much as,
in this disease, we frequently require a tonic influence upon the
system ; and Nitric Acid is both tonic and alterative. [Charleston
Medical Journal and Review.

EDITORIAL AND MISCELLANEOUS.

Medical Society of the State of Georgia. We do not deem it at
all too early, to call the attention of the Profession to the meeting of this
Society next April. We most earnestly hope that the Profession will give
this cause that consideration which, as Southern men and laborers in the
field of a progressive Science, it deserves at their hands. To become a mem-
ber of the Society, it is only necessary to attend, and apply for membership
through some member of the body. Our last meeting at Macon, althou^rh
rather thinly attended, was a most interesting and improving one to the
members of the Society, and there is not one who attended at that time,
hut will join us in saying, that the enjoyment he derived from his visit to
Macon, more than amply repaid the trouble of the journey.

Committees have been appointed to prepare essays upon many import-
ant subjects relating to the Science and Practice of Medicine, but voluntarv
contributions are ever looked for with great eagerness, and receive much
attention from the Society. The next meeting will be held in April, at this
place (Augusta), and the Profession here extend to their brethren at a dis-
tance, a most cordial welcome.

i '

1857.] Editorial. 125

The North American Medico-Chirurgical Review. The first number
of this able periodical is before us, and it aftbrds us much pleasure to call
the attention of our readers to its valuable pages. In its present garb, the
Review may be called a new comer to our sanctum ; but in it, we recognize
the spirits of two of our valued friends: the Philadelphia Medical Exam-
iner and the Louisville Review recently departed, but now merged into one
and embodied in this enlarged form, they come to greet us, and to claim from
the Profession, the respect and patronage they so well merited and so long
enjoyed in their former individual existence.

The present work is edited by Prof. S. D. Gross, of the Jefferson Medical
College, and Prof. T. G. Richardson, of the Medical Department of Penn-
sylvania College, both gentlemen, too well known to need any endorsement
from us. It is published in Philadelphia, by the long established house of
J. B. Lippencott & Co. The style and execution of it, well sustain their
reputation in their particular department.

We have none other than the most cordial greeting to give this new
Bi-monthly Journal, for while as a Review, we think that it will do good
sei-vice to the Profession ; we do not feel that as a competitor, its success
can diminish that of works like our own, devoted as we are more particu-
larly to another branch of journaHzing, viz., the early promulgation of
Medical news for the daily supply of the Profession.

A Review, in our opinion, stands in a somewhat different relation to its
readers, than do the other scientific Journals. It is the selector of their
reading, and the ordeal in which each new production .is tried and each
new opinion submitted to critical examination, before it is commended to
their adoption. At the present day, when books are so multiplied and
many of them so voluminous and on the other hand, when time is so
important to the active practitioner, these mentors and condensers are of
great value to the Profession, and are becoming daily, more and more use-
ful. The work now under consideration, however, contains several original
communications, and will be found interesting in this phase as well as in
that of a Review.

The monthlg Journals we regard as a necessity to their readers. They
supply the practitioner with new principles, new precepts and suggestions,
as well as new experiences, at the earliest moment of their bringing-forth,
and these serve to guide him and to sustain him in the every-day perplexi-
ties of his career, affording to the isolated, nearly all the advantag;es which
would accrue from the frequent intercourse of minds and a diversity of ideas.
In order to carry out this important object efficiently, the entire space
must be occupied with practical matter, devoted to the end in view, leaving
the fuller criticisms and more extended renews to works issued at lono-er

o

intervals and which make this important branch, a principal object of their
lal^ors.

126 Editorial [February;

Our sixty-four pages, we find barely sufficient to elaborate the month-
ly accumulation of valuable matter Avhich the daily progress of the
science is crowding upon us, and which duty impels us to lay before our
readers. We have held it an object very near to our hearts, to keep the
Southern Medical and Surgical Journal, as it has ever been, the conserva-
tive exponent of sound Medical Doctrine, steering clear, if possible, of any
involvement in the many vexatious jarrings which too often destroy the
symmetry and dim the glory of periodical literature, both Scientific and
Polite ; rendering the life of the Editor truly, but a " vanity and vexation
of spirit;" a vanity, because it fritters away, in small things and personali-
ties, time and labor which should be earnestly devoted to the high and
important objects of his calling ; and a vexation, because "grievous words
ever stir up anger," and " an angry man stirreth up strife."

A Pocket Formulary and Phf/sictans Manual Embracing the Art of
Combining and Prescribing Medicines to the best advantage ; with many
valuable Recipes, Tables, etc., adapted to the Profession throughout the
United States. By Thomas S. Powell, M. D., of Sparta, Ga. Savan-
nah : W. Thorne Williams. 1855. pp.181.

This truly excellent little work comes to us from a source in which w^
have great confidence. Dr. T. S. Powell having been long engaged in the
Practice of Medicine in the Southern country, knows well how to appreci-
ate the wants and also how to smooth down the rough places for the young
practitioner in the same field. The title of his work should have been
" The Young Physician's Friend and Pocket Counsellor," for it indeed con-
tains much friendly advice and many suggestions, where impromptu action
is necessary, which can \vitli difficulty, be found any where else. The
author has labored to make the work efficient and comprehensive, while at.
the same time, it is not encumbered with a bulk which would render it
inconvenient.

The detail of daily intercourse between Physician and patient is well por-
trayed, and suggestions are made for his guidance undefr all circumstances ;
to the old and experienced Practitioner, we know, that these are not neces-
sary, but to the novice, in his first entrance on his debut in the battle-field
of life these very details, and the manner in which they are performed by
him, make up the sum total of his success, and stamp him in the begin-
ning, either as the promising aspirant or the awkward blunderer. There
are marf^ things connected with the Practice of Medicine, which require
experience in the daily matters of ordinary life; persons out of the Pro-
fession are more or less familiar with them, and capable of passing judg-
ment upon them ; but the recent graduate devoted, up to his entrance
into the Profession, either to study or to some solitary occupation, is unfa-
miliar with these very things, makes a faux pas, and his fate is settled in that

1857.] Editorial and Miscellaneous. 127

circle. On these points we tliink Dr. P.'s suggestions arc very happ>%
The work contains also many useful torniulai and prescriptions which will
enhance its value to the junior members of the Profession.

Dr. Powell, we think, deserves the thanks of the Profession, and espe-
cially in his own State, and we take great pleasure in giving our recom-
mendation to a work which possesses so entirely our approval.

Medical Department of the University of Louisville, Ky. We
regret to have to chronicle the burning of this line edifice. It appears that
little has been saved College building, Library and Museum, all consum-
ed in the devouring element. Loss estimated at over one hundred thousand
dollars. The Trustees and Faculty have our sincere sympathy in their
severe calamity.

Barning of the Medical Department of the University/ of Louisville.
The Medical Department of the University of Louisville, including the li-
brary, laboratory and museum, was destroyed by fire on the 31st ultimo.
The loss is estimated at $100,000, with insurance for $50,000. The build-
ing in which the " Old Medical School" was held, was donated by the city
for this purpose in 1839, and since that time the Trustees and Professors
of the Institution have been constantly adding to its usefulness andinteresty
by appropriations from their personal profits, for books, apparatus and me-
dical curiosities ; Professors Silliman, Gross and, Flint having each, at dif-
ferent times, visited Euroj^e for the purpose of procuring for the Institution
instruments and books. Its library of French works, relating to the vari-
ous branches of the profession, was, probably, the most complete in the
Union. Some books, a few retorts, and jugs of acid, and a desk or twOy
was all that was saved of the contents of this interesting and useful Insti-
tution. In one hour all was destroyed. There were between two and
three hundred students attending the lectures. [Boston Med. < Surg. JL

We, not without some hesitation, introduce the following from a daily
secular journal ; but the statements so well corroborate what would be a
rational j;heory in such cases, and at the same time are so suggestive in the
treatment of Tetanus from this, and even from other causes, that we lay it
before our readers to let them give it what importance they think it de-
serves. The chloroform, of course, did not act as an antidote, in the proper
sense of the temi, but only served to control tetanic action till the noxious
substance was eliminated from the system.

*' Chemical Poisons and their Antidotes. The employment of subtler
poisons in many remarkable cases of poisoning by intelligent criminals'
cognizant of their eflScacy, has fjw-akened a spirit of dread among the re-
flective portion of the community as it is generally believed that science-
has discovered but few, if any, a"ntidotes to the working of these destructive
agents. This is particularly the popular prejudice with respect to strych-
nine ; but we glean from the Rochester Democrat a case of a remarkable
character, in which a complete recoveiy from the effects of this deadly poi-

128 Miscellaneous. [February,

son has been wrought by the ap])lication of most simple antidotes. The
narration of this case we deem of such general interest as to authorize epito-
mizing its features.

A policeman having accidentally swallowed a large quantity of strych-
nine, which he used for dog-killing, at once struck upon the idea of at-
tempting to neutralize its effect, by swallowing an emetic. This operation
he twice repeated, before the services of a practising physician were called
upon.

When the son of Galen ari-ived, he found the policeman laboring under
severe spasms ; his body was bent in the form of an arch, and his teeth
were convulsively closed. The physician immediately placed the subject
under the influence of chloroform, which appears to have entirely negatived
the power of the spasmodic action, and continued the administration of
powerful emetics ; and thus, at the end of some twenty-four hours, the
sufferer was found not only to be relieved of every particle of the poison,
but entirely free from the spasms and convulsions which had seized upon
him. At the last accounts the man appears to be rapidly recovering, he
having retained consciousness during his period of treatment. We have
now indisputuble authority that chloroform, when correctly administered,
acts as an antidote to poison ; and the very simplicity of the remedy should
place it within the reach, as well as remembrance of every indi\T.dual."

Substitute for Cod-Liver Oil.

New York, Nov. 26, 1856.
To the Editors of the New York Journal of Medicine :

Gentlemen : I wish to direct attention to the oily substance taken from
the cavities in the head of the spermaceti whale, known in commerce as
the head-matter. In summer, it presents the appearance of oil with a co-
pious white fleecy sediment ; but in winter, when chilled, resembles imper-
fectly frozen ice-cream or beef-drippings. It may be obtained from the
manufiicturers of bperm candles, and should be used while fresh (in its crude
state as landed from ship-board), becoming rancid by long keeping. 01.
ethal would be an appropriate name for this substance as being composed'
mostly of oils and ethal, the peculiar base of spermaceti. " The spermaceti
itself consists of two atoms of margaric acid, one atom of oleic acid, and three
atoms of ethal. The ethal is remarkable for its analogy, in composition and
properties, to the bodies of the alcohol group." Kane's Chemistry.

It is preferable to the cod-liver oil, on account of being more agreeable
to the taste, leaving a pleasant flavor in the mouth, and also being mora J
nutritive and soothing. It is also less apt to disagree' with the stomach,
and does not cause offensive eructations. The patient may take it eith(
pure, in coffee, or with bread, boiled rice, potatoes, etc. When require
tr. opii. camph. and syr. ferri iod. may be added.

Yours respectfully, G. P. Cammann.

Messrs Editors, Will you publish the accompatiying card in the ATe?^
York Journal of Medicine, and oblige,

Yours respectfully, G. P. Cammann.

A Card. The Double Self-adjusting Stethoscope. Being informed that
Dr. Marsh, of Cincinnati, complains of my hanng infringed the patent of
his double stethoscope, I would sta^e that,

1857.] Miscellaneous. 129

1. Dr. Marsh's instrument and mine ditier essentially one from tlie otlier
both in principle and construction.

2. I Avliolly disclaim any intention of interfering with tlie rights and in-
terests of Dr. Marsh. I have never received any advantage from tlie sale
of my stethoscope, but presented it free to the profession. Dr. Marsh has
remained perfectly (piiet for rwo years from the first appearance of tlie
double self-adjusting stethoscope, and now, when the period has elapsed
within wdiich I might have secured myself by patent, if so inclined, his aim
and endeavor seem to be not to dispose of his original 'potented inatnnnevt^
but to avail himself of mine with all its improvements and adaptation to
practical 2^ur poses. Is the Profession, then, prepared, on the ipse dixit oi
Dr. Marsh, to sustain him in the sale of my stethoscope under restrictions,
when he has not taken the usual course to establish his legal i-ight so to
do. lie certainly cannot acquire the moral right to receive the benefit of
other men's labors.

3. Dr. Marsh's stethoscope appears to be but a modification of other in-
struments long known in Europe and now in my possession.

The above statement, including the opinion that my stethoscope is not
an infringement of Dr. Marsh's patent, is made under advice of eminent
counsel. G. P. Cammann.

Xew York, Dec. 2, 1856. [N.Y. Jour. Med.

Nutriment in Sugar. The nutrttive properties of sugar are much un-
deiTated in this country. As an aliment, Dr. Rush, of Philadelphia, main-
tains that sugar affords the greatest quantity of nourishment, in a given
quantity of matter, of any subject in nature. Horses and cattle were fed
wholly on it at St. Domingo for some months, when the exportation of
sugar and importation of grain were prevented from want of ships. Dur-
ing the crop time in the West Indies, all appear fat and flourishing. The
cattle fed on the cane tops become sleek and in fine condition. The ne-
groes drink freely of the juice, and become fat and healthy. Sir George
Staunton observes, that many of the slaves and idle persons in China hide
themselves among the canes, and live entirely on them for a time. In
that kingdom the emperor compels his body guard to eat a certain quan-
tity of sugar every day, that they may become fat and look portly. Sugar
and rice constitute the common food of the people, and every kind of do-
mestic animal is fed on sugar. Plagues, malignant fevers, and disorders of
the breast, are unknown in the countries where sugar is abundantly eaten
as food. The celebrated Dr. Franklin used to drink syrup every night be-
fore he went to bed, to alleviate the agonies of the stone. Vir. Med. Jour,

Phosphate of Lime in the Treatment of Fractures. We notice in a late
nimiber of the Gazette de Hopitaux some cases of fracture, in which the
union of the bones appeared to be promoted by the administration of the
phosphate of lime. In one of these cases, of fracture of the humerus, there
was union in forty-five days loithout the phosphate. The patient, a fort-
night afterwards, fractured the arm in the same place, by a fall from a
horse. The phosphate of lime was then prescribed, and the arm was
placed in splints as before ; the bones united in thirty-jive days. The man
had the ill-luck to break the callus a third time, and, under the use of the
lime, the fracture was consolidated in twenty-five days. The remedy in

130 MiscellaneoiLS.

question lias \o\\<f been employed by M. Piorry in the treatment of rickets,
inollities ossium and Pott's disease, but it appears to have been only recent-
ly suo-gested by M. A. Milue Edwards as a useful remedy in cases of frac-
ture." We are surprised that no allusion is made to its employment in
ununited fracture; whether it has been tried in these cases which are often
so difficult to cure, we do not know ; it would seem that it could hardly
fail to be of service. [^Boston Med. Jour.

Iodoform. A new preparation of iodine, discovered by Sevillas, and
more especially bi'ouo-ht to notice by M. M. Dumas and Bouchardat, pos-
sesses properties wdiich promise to make it a valuable addition to our means
of employing, with benefit, this important therapeutic agent. It presents
itself in a solid state, in the form of small pearly particles, of a sulphur-
yellow color, friable, soft to the touch, and with a very enduring aromatie
odor. It contains more than nine-tenths of its weight of iodine. It ifi
sweet to the taste, and is not corrosive.

It destroys animals in a smaller dose than iodine, after having produced
more or less depression, and rai-ely produces vomiting. This depression is
followed by a stage of excitement, convulsions, contractions, etc. Iodo-
form does not produce the least local irritation, not producing the slight-*
est increase of vascularity of the mucous membrane of the stomach and
bowels. ,

Its therapeutic properties are thus arranged : 1. In consequence of the
large quantity of iodine which it contains, it can replace iodine and the
iodides in all the cases in which these are indicated. 2. It is absorbed
with the greatest facility. 3. It has the advantage over all other prepara-
tions of iodine of never causing any local irritation, or any of those acci-
dents which render the suspension of iodine necessary in certain cases.'
4. In addition to the properties it enjoys in common with iodine, it has*
advantages peculiar to itself: it allays pain in certain neuralgic affections,
and produces a sort of local and partial anaesthesia of the rectum, when
introduced into that organ. 5. It may be given in doses of from five to#
fifty centigranmies a day. 6. The principal diseases in which it has been
employed with advantage are endemic goitre, scrofula, rachitis, syphilis,
certain affections of the neck of the bladder, or of the prostate, and certain
neuralgic affections. 7. It forms, with the greatest facility, most import-^
ant pharmaceutic preparations. \_Arch. Gen. de Med. New York Jour.
of Medicine.

Lobelia in Erysipelas. Dr. Livezey recommends the saturated tincture
of lobelia as a local application in erysipelas. He applies it by means of
fine linen or muslin cloths, saturated and frequently renewed, and believes
it will prove more satisfactory than other applications, acting on this
inflammation especially, as it does upon the inflammation induced by
the rhus toxicodendron, which he considers a similar disease to the other,
each alike being capable of being arrested by this local application ; the
gastro-enteric affection being always attended to, not only in these, but in
all aflections. [Memjihis Med. Recorder.

SOUTHERN
MEDICAL AND SURGICAL JOURNAL.

(NEW SERIES.)

Vol. XIIL] AUGUSTA, GEORGIA, MARCH, 1857. [No. t

ORIGIML AND ECLECTIC.

AETICLE Vlli.

A Case of Strangulated Ventral Hernia Recovery after Operation,
B J Henry F. Campbell, M. D., Professor of Surgical Anatomy-j
&;c., in the Medical College of Georgia*

In tlie January number of the present volume of the Southern
Medical and Surgical Journal, page 8, will be found the report
of a case almost exactly similar to the following, except that in
the present, the patient was not in the pregnant condition. This
last has come under our observation since, and even before the
other was issued from the press.

December 80th, 1856. Called to visit Mrs. J. F. J., of Columbia
county, twenty miles distant from this city. Mrs. J. is aged about
86 years, the mother of five or six children, the last of them about
four years old. Of rather lymphatic temperament, and much
inclined to obesity, but of sprightly mind, and most active habits
of life. She had ever enjoyed uninterrupted health, requiring the
Services of the Profession only during her confinements, the last
two of which had been natural, but protracted and very laborious.
Her appearance indicated even now, a fine constitution and con-
siderable power of endurance.

Her attendants report that she has been distressed by uncontrol-
lable nausea and vomiting for over two days. We find her in a

N. S. VOL. Xm. NO. III. 9

I

132 Campbell. Strangulated Ventral Hernia^ [Marcfiy

state of extreme prostration ; countenance pale and dejected ; skiD
eool and somewhat clammy; pulse feeMe, and about 120 beats
per minute. Doctor J. Maddox, tlie attending physician, reports
that on his visit two days previously, he found her vcnniting and
complaining of pain in the epigastric and umbilical regions ; there
was also, at that time,, as now, obstinate constipation of the bow-
els. The colic pains were of the most agonizing character, re-
turning at intervals of ten or fifteen minuftes, and each time, witb
an aggravation of the vomiting.

On approaching the patient more closely, to examine the tongue^
we perceive the foecal odour very decidedly manifested in the-
breath and the ejecta, on inspection confirm our opinion in
regard to the character of the odour. We now examine the
abdom^en, which we find very much enlarged, tumid and tym-^
panitic, and in the umbilical region, we find a large tumor,.
nearly the size of an orange, and somewhat flattened. Thi^-
tumor, though flattened upon the top, was very tense, and ex-
tremely tender to the touch, though the patient, a highly intel-
ligent lady, insisted that none- of her present symptoms were to-
be referred to the condition of the tumor, as she had frequently
observed it in this state without experiencing inconvenience of any
kind. The history she gave of the tumor was, that it originated
during the parturition before her last, about eight years ago, and
had remained pretty constantly there, except on lying down, when
it invariably subsided, so as almost to disappear. Now, it did not.
Our examination being ended, we find during the consultation
with Dr. Maddox, that the statements of the lady and her attend-
ants in relation to the case are fully corroborated by him. In his
early attendance upon the case, not having been made sxiquainted
with the existence of the tumor, he had administered at first mild
laxatives, and directed enemata all the while endeavoring to
overcome the distressing nausea and vomiting. Finding these
means fail, and suspecting mechanical obstruction of some kind,
his inquiries led to the discovery of the tumor, and the probable
explanation of the more prominent features of the case. Diligent
taxis having failed, and apprehending the necessity of more seri-
ous surgical interference, he suggests further counsel in a manner
not to alarm the family.

In the mean time, the patient had been subjected to a general
warm bath, without relaxing the constriction ; and among the

1857.] Campbell. Strangulated Ventral Hernia. 133

the laxatives given, were frequent moderate doses of castor oil,
most of wliich was probably rejected by the mouth ; the enemata
had been repeated very frequently, but, like the other means,
without any good result. One or two of the last evacuations were
shown us; they consisted of a considerable quantity of glairy
mucus tinged with blood, but did not present either the appear-
ance or odour of fcecal matter. Finding that every thing which
could offer any hope of relief to the patient had been done, with-
out any abatement of the distress, we determined upon the opera-
tion, as a probable necessity, but again try the faithful application
of taxis during at least one hour longer. Upon first grasping the
tumor, the patient complains of severe pain and gTcat tenderness;
but the manipulations, although they did not lessen the tumor,
seemed to be attended with an abatement of the soreness. The
colic pains continued unabated during the whole time. Now,
fully persuaded of our inability to save the patient without it, we,
assisted by Doctor Maddox, performed the operation in the follow-

Opeeation. The patient is placed upon a couch, convenient
to an open windoAV, in order to obtain light. The shoulders and
hips are somewhat elevated, so as to relax the integuments cover-
ing the tumor these being loose now, are easily separable from
the tumor. Pinching up a small quantity of the skin over nearly
the centre of the elevation, we pass through it a sharp-pointed
bistoury, with the edge turned towards the surface, and thus cut
outwards, making an incision in the skin, not more than an inch
and a half in length. The upper end of it came within a very short
distance of the umbilicus. The superficial fascia, very much load-
ed with fat and thickened by the long existence of pressure from
the tumor, was then divided, laj^er by layer, upon a grooved
director, until the opalescent peritoneal sac was brought into view.
This was rubbed between the fingers, to free it from the intestinal
contents, and a small opening, not an inch in length, made into
the sac to admit the index finger of the right hand. A large
tnass of lobulated fat and intestine were now distinctly felt, and
It the bottom of this mass, by insinuating the finger between cer-
:ain loops of intestine, a small ring, tightly occluded, could be
;iistinguished, through which the en trail protruded, and to which
nuch of the fatty matter appeared to be attached. Not wishincr

134 Campbell. Strangulated Ventral Hernia. pMarcli;.

to enlarge the openings in skin and peritoneum if we could feel
safe in returning the intestine without looking at it, we explored
it carefully with the finger, and from its firmness and smoothness,
and also from an imperfect view obtained of it through the small
opening, we, after consultation, concluded to attempt its reduction
this we found no very difficult matter, even without further use
of the knife ,- for although the constriction was very great and the
parts rigid, after once getting the index finger in actual contact
with its border, we continued to press gently, but firmly, against
it, after the manner recently recommended by Baron Seutin^
in reducing hernise without operation, and it was felt gradually to
yield; we then changed the direction of the palmar surface of
the finger a little, so as to make it bear upon the constricted
neck of the tumor, and by little and little, it began to go back^
when, at a certain stage, it suddenly sank away from the finger,
affording instantaneous and almost inexpressible relief to the
patient.

We then endeavored to explore the condition of the other con-
tents of the sac, we found them composed of the masses of nodu-
lated fat before described; no longer jammed together by the
impacted intestine, they moved freely about in the now ample
chamber, and could be brought to the edge of the ring, and some
of them, pushed into the abdominal cavity, but they immediatel}
returned, and by other actions, showed plainly that their principa
attachments were outside. We examined carefully for any othe;
loop of intestine which might be in the sac, but finding none, pro
ceeded to close up the small incision by one stitch,- several strips o
plaster and a firm wet compress and a bandage. The patient wa
directed to keep a towel wet in cold water over the whole, in orde
to subdue inflammatory action. This was faithfully done; 4>
faithfully, for ice was kept on, a part of the time, which may har;
something to do with certain sequelne to be described in the latte
part of this report.

Immediately on the return of the intestine, the patient exper
enced an urgent desire to evacuate the bowels, but this was nc
effected for more than an hour after the dressings were complete!
There was no anresthetic used during the operation, as we had n
chlorofonn. The operation, however, was entirely painless, tl
patient anxiously begging us, "to let her know when she w
going to suffer," from the beginning to the very end of the oper

L857.] CAiffPBELL. Strangulated Ventral Hernia. 135

iiou. Prescription : 15 grs. quinine, in 5 gr. powders, for the
lext day, and the day after.

January 1st, 1857. The second day after operation, Doctor
Maddux writes:

Columbia County, G-a., Jan. 1st, 1857,
Bear Doctor Mrs. J. appears to be doing very well to-day.
Wound looks healthy, and adhesion taking place; not much ten-
derness of abdomen ^some flatulence of bowels ; tongue a little
3oated ; pulse ninety-one^ and a little fall. A free evacuation of
bowels soon after we left on Tuesday evening two small ones
since a little nausea, but no vomiting.

Yours, &G. J. Maddox,

To Dr. H. F. Campbell, )
Augusta, Ga. 4

-o"

January 7th. Eequested to visit Mrs. J. Find her in a state
of great uneasiness mostly, however, mental anxiety. We are
informed that on the fourth day after the operation a restricted
tenderness was observed somewhat to the left side of the incision,
and shortly after, the integuments began to be elevated over that
locality. Dr. Maddox was sent for, and we are informed by the
attendants, (for we have not had the pleasure of meeting Dr. M.
since the operation,) that the patient was found suffering the most
intense pain, and that after examination, the Doctor lanced the
itumor, from w^hich was evacuated a large quantity of pus, afford-
ing the patient great relief. At the time of our visit, another of
fohese abscesses had formed, and before we arrived it had become
>7ery tense, and then burst, again relieving the patient. The two
')riiices were now discharging freely, and. the eva<iuated matter con-
[iisted of pus in w^hich could be seen a great number of oil globules.
We were much concerned, to find that the odour of this discharge
)resented, most decidedly, the/cecZ taint, and also gave the im-
)ression to the senses of decaying intestines. There is no mistake
-s to this latter odour. What added much to our uneasiness was,
=he report from the attendants, that air was observed to bubble
ut with the matter as it came from the orifices. The bowels con-
tinued regular.

I On a closer examination, we find that the tumor had flattened
' jonsiderably, and that on pressure upon the abdomen any where
i l^ithin three or four inches of any of the orifices, there issued from

136 Campbell. Strangulated Ventral Hernia. [March,

them a large quantity of the oily pus above described, with an
occasional shred of cellular tissue. There was no tenderness, ex-
cept immediately in the neighborhood of the orifices.

The patient had no fever, and her appetite was remarkably
good apart from mental anxiety, she was cheerful. Prescription ;
Absolute rest in horizontal position, free potations of Port- wine, a
nourishing diet, and the continuance of poultices of ground flax-
seed over the tumor to facilitate the discharge of matter, as direct-
ed the day before by Dr. Maddox.

January 13th fifteen days after the operation. Notwithstand-
ing the assurances of Dr. M., the friends of our patient became
again alarmed ; for now the idea of intestinal perforation has oc-
curred to them, and, on failing to obtain Dr. M., we are again
called to the case.

We find the patient suffering much from navisea ; the bowels
are resolutely constipated ; but she has not suffered much from
colic pain since the day indeed, since the moment, of the opera-
tion. She is free from fever. Pulse somewhat feeble, probably
depressed from protracted nausea. The tumor and the orifices
looking very well, the latter granulating, but still discharging ;
the matter is thinner, nearly milky in appearance, presenting
many striae of blood. In the fluid, we observe many white grains^
and the matter presents, though to a somewhat less degree than
before, the foecal ordour above described. The patient is more
emaciated than heretofore, and less cheerful, as she now believes
that perforation of the intestine has taken place, and the idea if ,
confirmed by the odour of the discharge, its color, and also by th(
fact, that in moving the body about, and also on removing th(
poultices, bubbles of air or gas are seen to issue from the orifices./
We must confess, that we were not without certain apprehensions ol^ili
a similar nature. On our near approach to the patient, to examiMinf,]
the odour of the breath, instead of the foecal odour which we dreadec *
and which before existed, we found a very strong odour oi chlor,
form. On inquiry, we were informed that, during the lancing of th
second abscess, two days previously^ Dr. M. had allowed the patier
to inhale chloroform, and that she was then affected with a nause
which had continued ever since. She had taken none of the chlo;
form since. We cannot explain this long persistence of the odoT
in the breath ; but we are able to say, that the same feature atterii
ed a protracted nausea which followed the inhalation of chlofi

1*857.] Campbell. Strangulated Ventral Hernia. 137

form, in a case of abscess of the breast, whicli occurred in our
practice a few days after our visit to Mrs. J,

Being satisfied upon what theory, we will hereafter ex-
plain that no perforation existed, we advise to continue treat-
ment as on previous visit, supplying the place of the poultices by
lint and simple cerate, and washes of sol. chloride of soda. On
the administration of an enema, a free evacuation is produced, and
the patient experiences much relief. The Port-wine is now more
freely allowed, and a generous diet, otherwise, recommended. The
patient is also now advised to sit up in a chair during a considera-
ble portion of the day.

January 81st We hear from our patient to-day, and are much
gratified to learn that she is so far improved as to go about the
house, and attend to some of her domestic duties without in-
-convenience.

February 9th. To-day we are informed by Mr. J. L. Coleman,
through whose kind perseverance, we were induced to visit the
the above case, under very forbidding circumstances, that Mrs. J,
has taken a pleasure- walk of over two miles, without experiencing
any unpleasant symptom.

Eemarks. A few points in tTie above case, we deem worthy of
brief reference: Firstly, notwithstanding the extreme and pro-
tracted distress of the patient, she did not once suspect that the
tumor had any causal relation to her suffering, and without care-
ful inquiry, its existence would not have been developed. 2ndly.
The contents of the tumor were also somewhat unusual viz :
Entero-epiplocele ; the intestine being reducible, while the omen-
tum was partly adherent to the edges of the ring, and floating about
in the interior of the sac, after the reduction of the intestine, but still
irreducible. Srdly . In the operation, the only unusual point was the
small size of the incision necessary to effect the reduction. 4thly,
tin the after progress of the case, we are inclined to attribute the
abundant suppuration, to the destruction or disintegration of the
large quantity of fat on the interior of the sac. This loss of adipose
[matter was probably due, in the first place, to the low vitality of
fthis tissue, causing it to be more readily affected by the pressure
phan was the intestine, while the ice used, probably added considera-
j'jly to this result. The foecal odour of the discharge, which at one
dme produced the suspicion that perforation had taken place, we

138 Campbell. Strangulated Ventral Hernia. [March,

can only account for on the theorj, that the long residence, (eight
years,) of the intestine in the sac had communicated to the tissues of
the part its characteristic odour, and when suppuration took place,
the taint continued until it was obliterated by a destruction of these
tainted parts. The oil globules, which might have been mistaken
for ingested castor oil, and also the granular particles, resembling
half digested food, were doubtless only the cells of the adipose
tissue and their contents, resulting from the breaking up of the
fatty portion of the tumor. The bubbles of air^ issuing from
the sac, were, doubtless, drawn into it during the movements
of the body, and did not certainly issue from the interior of the
intestinal canal of course there was no perforation. A feature
that proves, beyond doubt, that no perforation existed, is the
repeated filling up and distention of the sac; for by this, we have
evidence that the ring had become impervious, and firmly so, or
the pus must inevitably have passed into the abdominal cavity :
whereas there was not even the least inflammation of the perito-
neum or tenderness.

The fortunate result of this case, and also of the case recently
published by us, inclines us strongly to the opinion, that the
operation in such cases has been too much a matter of dread, and
that inasmuch as delay in hernia is ever attended with dangen^^ the
operation should be more promptly performed than it general'
ly is.

In reference to the universal dread of peritonitis by the Profesi
sion, we would humbly suggest, that it has probably originated!
from the fearful nature of that form of it termed. Puerperal Perito^j
nitis, a disease beginning in a restricted locality, generally aboutj
the hypogastric region, and rapidly extending to every portion
the abdomen, and terminating fatally in a few days and sometimes
in a few hours. This rapid extension and this fearful mortality,
think, has become associated in the mind of the Profession, wit
all kinds of peritonitis and all injuries of the peritoneum, to
extent which, more dispassionate observation and an unbiassoc]
investigation of the records of Surgery, will prove to be unfoi
ed, or at least very much exaggerated.

1857.] Grant, on Cutaneous Diseases. 139

ARTICLE IX.

Cutaneous Diseases their Principles of Treatment. By W. T,
Grant, M. D, of Wrightsboro', Columbia county, Ga.

It may be laid down as an axiom in Medicine, that every mor-
bid condition of the system goes, pari passu, through certain phases
or conditions, and each disease, according to its cause. We may
illustrate this remark by the disease. Variola, in which we have a
gradual change of conditions, from a mere erythematous blush,
through papilla3 and vesiculte to the umbilicated pustule. And it
is extremely doubtful whether genuine small-pox ever fails to go
through these different changes, or ever skips over any of these
forms. It is the same with every other disease each one pursu-
ing a definite course, which is in accordance ^with the cause that
originated it.

If this be true, then must the cause, whatever it may be, exer-
cise a controlling influence throughout the disease beginning with
its beginning, and following it through its whole course, guiding
and directing. The more proper mode, perhaps, of considering
this state of things, Avould be to look upon the cause as a morbific
agent, entering the system, and attacking first one part and then
another, and continuing thus until the whole body is sick as W6
have it in pneumonia, where the cause indicates its presence first
by exciting an irritation in the lungs, next by producing a con*
gestion, next a condition denominated spleenificatipn, and finally
hepatization. So, then, we may consider that in every disease,
the specific cause or morbific agent exists in the system just as
long as the disease continues to increase, and acts as an excitor of
the changes that are taking place. And just as soon as that cause
ceases to exist in the system, these morbid changes will likewise
cease, and the morbid conditions left, called pathology, will then be
subjected to the recuperative energies of the system, and be heal-
ed, if the vitality is not too far exhausted. Here, then, we must
make a distinction between the cause and effect, and we must di-
vide the treatment accordingly. Therefore the treatment must be
of a two-fold nature, which is as follows : first, against the morbific
agent, and second, against the morbid condition of parts left af-
ter the agent has ceased to operate. And it should be applied in
the order in which these are laid down, we must first assail the

140 Grant, on Cutaneous Diseases. [Marcli,

cause or agent, and then heal the pathological lesions ; for it would
be folly to attempt to heal a wounded finger, without first extract-
ing the nail or splinter which produced the wound. And I may.
here remark^ parenthetically, that herein seems to me to be the
difference between physicians some attempt to cure the lesions
while the cause is still in operation, and consequently fail ; while
others pursue the more rational course of assailing the cause first,
and then the lesions.

The above remarks are prefatory to what follows, and serve to
introduce the practice which I shall recommend, while at the same
time they give the rationale of the treatment.

In the most of the cutaneous diseases, upon the subsidence of
the eruption, or during the desquamation, some one of the excre-
tory glands, either begins to act with more energy than during the
course of the disease, or has an increase in some one of the consti-
tuents of its secretion. I may mention, as instances, the occur-
rence of diarrhoea during the subsidence of Rubeola, which, if
moderate, is generally considered favorable, and if immoderate,
should be checked, but not stopped. Also, during the subsidence
of Scarlatina, there is an increase of the urea excreted through the
kidnej's. 1 will take this last example to illustrate the subject.
The urea is here increased : then there must have been more of it
in the system during the course of the disease than natural ; or to
tell the whole truth, there must have been more of its elements in
the blood while the disease increased, than there is wont to be
naturally. These elements may have been combined one or more
of them into some new compound, which was the niateries morbi .'
that acted to keep up the disease ; but as soon as the compound
was destroyed, and its elements united into urea, they were excre-
ted by the kidneys, and were thus prevented from keeping up any
further irritation, in consequence of which, the disease abated. Or
another view is, that some one of them may have been induced to V
assume some allotropic form, by the entrance into the system of
the Scarlet-fever poison, and may thus have been the means of ^
keeping up the irritation. Just as it is with the diarrhoea of Mea-
sles, and in this way is it beneficial. And just so is it with every
other cutaneous disease, as well also as a great many other diseases,
not included in that category.

Thus much in regard to the disease and its cause; and now for -
the treatment. What is the indication ? It is evidently to find-%

1857.] Grant, on Cutaneous Diseases. 141

some remedy which, when introduced into the system, will com-
bine with, or in some other way neutralize the offending element or
elements. Such a remedy will be foun d amon g the organic medicines^
such as camphor, turpentine, opiates, &;c. These remedies the
organic medicines when introduced into the system, are the most
of them decomposed into their ultimate elements, which, obedient
to their affinities, combine with whatever other element may at the
time exist in a free state in the blood. In this connection I may
note an item, which is exciting considerable interest in England
and France, among the medical world and that is, that Carbonic
Acid is a most excellent local anaesthetic. And I see that they are
reasoning about it in this way. If carbonic acid is an anaesthetic,
may not the element carbon be the element which produces anaes-
thesia, when chloroform, ether, and the narcotics are administer-
ed? And it is concluded that it is, and that these remedies are
therefore decomposed in the system. Three years ago, I arrived
at the same conclusion, and I have now an article which I pre-
pared just three years ago to-day, (30th January,) for publication,
but without publishing it, upon the " History, Effects, &c., of
Chloroform," in which I took the position that the element car-
bon was the anaesthetic element, not only in chloroform, but also
in ether and the narcotics. Another position I assumed, and
which I think now was correct, was, that one invariable effect of
the existence of free carbon in the blood, was local congestions in
vital parts. I cannot stop now to rehearse the various steps by
which I arrived at these conclusions. I only note the above to
show that the organic medicines are decomposed in the system
into their ultimate elements. If further proof is required, I may
cite the reader to the fact, that whenever chloroform or ether, or
indeed any anaesthetic or narcotic, is administered to any one,
there is always an increased secretion of sugar by the liver, and,
in consequence, a good deal is excreted through the kidneys, and
may be detected in the urine. Whence comes this sugar? It
arises from the decomposition of the anaesthetics used, and a
recomposition of its elements into sugar.
^ I have said enough to convince the sceptical reader that at least
'"ipome of the organic medicines are decomposed in the system, and,
as I believe, all of them.

Now, to return to our subject: If in the cutaneous and some
other diseases, there is an offending element or agent in the sys-

142 Geant, on Cutaneous Diseases. [March,

tern, and if, as soon as it is gotten rid of, the disease abates ; and
if, also, there is an organic compound which can be decomposed
into its ultimate elements in the system, is it not reasonable and
proper, in view of all the chemical affinities concerned, to expect
that the elements of the medicine will combine with, or in some
way neutralize the offending agent? I hold that they must
and will ; and I cannot conceive how it can be otherwise. It may
be objected, that the vital force would interfere. I don't believe
in' the vital force not a Avord of it. All the actions of the sys-
tem are carried on by elements of matter moved and moulded by
chemical laws. Life itself is but a perfect aggregation of chemical
effects. The operation of the mind is nothing more nor less than
the effects of an oxidation of the constituent elements of the brain,
and I have frequently thought that, from its origin, it might with
propriety be denominated oxide of phosphorus.

The great test for such opinions as the above is experience :
try them at the bed-side, and their success is another evidence of
their truth. I do not recollect to have seen much among the
journals that bear upon this question, but I have noticed some,
and it all corresponds well with our conclusions. Several years
ago, some Bussian physician I do not recollect the name, as I*
write from memory published the result of his experience in the
use of Camphor in Erysipelas, and according to the report, he had
extraordinary success. A year or two ago, I noticed in some two
or three American Journals the successful use of Camphor in cases
of Scarlatina. There was published in the " Georgia Blister and
Critic," a case of Erysipelas, which was very quickly and entirely
relieved by camphor. The case was reported by Dr. W. T. Gold-
smith, of Cartersville, Ga.

My own experience is hmited, and I cannot.therefore draw upon-
it. One case I may introduce, which, although not cutaneous, will
yet serve to illustrate the treatment. It was a case of aphthous
sore mouth, in a child seven months old. I find the following ac-
count of it in my note-book :

Dec. 23. Mouth sore, no white curdy matter ; lips swollen, keeps
them parted. Ordered a wash peach-tree root, alum and oak
bark, boiled.

Dec. 24. Same in other respects as yesterday ; sucked a little this
morning; quiet. Continue decoction, and quarter grain of calo-
mel three times a day.

1857.] GraM', on Cutaneous Diseases. 143?

Dec. 25. To-daj still the same, only that the cheeks are greatly
swollen feel like an incipient or forming abscess could feel in
each a well-defined tumor, extending from the lower edge of each
jaw to the lower edge of orbit result of the aphthas in the mouth.-
Continue decoction ; discontinue calomel, which had operated, and
substitute the following: 1 dr. tinct. camph., 2 oz. aqua. Mix,
Ten drops, three times a day.

Dec. 26. Child doing well-to-day, according to overseer's report:
improving; swelling of cheeks considerably diminished.

Jan. 1. The above child is well and hearty.

The benefit derived from the camphor in this case was, as is at
once perceived, prompt and unequivocal, I will state here, that
in the majority of those diseases^ in which, according to the fore-
going principles, the organic medicines may be expected to be of
much avail, camphor is the most eligible one of the whole group,
from the fact that it does not possess, like all the others, such
other strong effects as narcotism, &c. It is simple in its effects,,
and unobtrusive in its operation. It is therefore preferable to any
other. I may now ask, if there is not a mine of wealth to the
practitioner, among this class of remedies, whose value was never
suspected ? I think there is, and that we may find among their
number, remedies which will far exceed our utmost expectations,
even in some of those diseases which are considered as opprobria
to the Profession. I would like to discuss this subject more at
large, but the circumstances under which I write preclude the pos-
sibility of treating it as I would like. I could add demonstrative
facts, which would carry conviction with them, but I cannot do
more just now.

I cannot forbear adding the following condensed synopsis of
the admirable explanation, offered by the great German chemist,
Justus Liebig, of the modus operandi of miasms and contagions.
It is, in my opinion, a master-piece, and looks so natural, and
bears so much truth upon its face, that we are almost obliged per
force to subscribe to its truth. It has likewise a very important
bearing upon the remarks above.

There is a principle known to chemistry called catalysis, and
means an action set up in one body by another, without the last
one participating itself in the action which it thus excites simply
by the majesty of its presence. Only by being present with ano-
ther body it stimulates it to enter into some chemical change.

144 Grants, on Cutaneous Diseases. [Marct,

Now, this power, possessed by some bodies, is catalysis. Some
compounds which possess this power exert it upon other com-
pounds, in such a way that within certain limits, almost any com-
pound may be thus generated whilst others exert their catalytic
force in such a way as to generate themselves. The former class
may be denominated indifferent catalytic bodies, and the latter
self -generating. Of the former class the indifferent catalytic bo-
dies the following may be taken as an example: Mix a quantity
of muriatic acid with a mixture of hydrocyanic acid and water:
The result is, that the muriatic acid, simply by its presence, sets
up an action among the elements of the hydrocyanic acid and wa-
ter, by which they are decomposed, and their elements recombined
into two new compounds -formic acid and ammonia. And this
is accomplished without the muriatic acid itself undergoing any
change.

An example of the second of the above bodies the self-gener^
ating catalytic bodies is found in the following example : If to a '
solution of oxalic acid, a quantity of oxamide be added, the oxalic -
acid, by its presence, sets up an action among the elements of the
oxamide and the water, by which they are decomposed, and their*
elements recombined into oxalic acid and ammonia, the first ox-
alic acid itself undergoing no change. Here we see it has repro-
duced itself, and in this way, says Liebig, by adding more oxamide,
it may be made to decompose several hundred pounds of oxam-
ide, and one grain of oxalic acid may be made to reproduce itself
in unlimited quantity.

Another example is seen in the action of the vegetable ferment*
yeast. If yeast be added to a solution of sugar, it sets up an action
among the elements of the sugar and if at the same time a quan
tity of gluten be added, the action going on in the sugar commil
nicates itself to the elements of the gluten, and the gluten isf
changed into yeast ; and thus the yeast reproduces itself. These*
examples prove the existence of catalysis. ^

The application of this principle of catalysis to the understand*
ing of the operation of miasms and contagions is now evident,
contagion that of small-pox, for example-centers the system
a healthy individual, and by its presence alone, causes some ele-
ment in the blood to undergo a change, which change consists in
a conversion of this element into the offending contagious princi-
ple or agent. This change continues as long as there is any of the

i

1857.] Walton. Case of Puerperal Convulsions. 145

element in the system which is susceptible of this change. That
such a change does take place no one can deny^ and I am inclined
to think that the element which, in the system^ is thus made to
alter its nature from an inert compound to a most virulent mass,
will be found to belong to that class of compounds which are
known to exist in the blood, and which are produced by the de-
composition of -the tissues, and are endeavoring to make their way
out of the body through some of the excretory organs. Professor
Draper would call them downward progressing bodies. And
herein lies the explanation of the observed fact, that some persons
are partially exempt from the ravages of some of these contagious
diseases, and others are wholly insusceptible to their influence. It
is because they have little or none of this convertible element in
their system. Each of the contagious diseases have a contagious
element peculiar to itself^ the action of which ^^ upon a healthy sys-^
tem, finds its explanation in the above principles. I need say no*
more, than merely to point to the connection between the exist-
ence of such unhealthy elements in the blood, and what has been
already said in regard to the treatment of such diseases. The-
principles I have laid down, let those who are interested,, observe.-

ARTICLE X.

Case of Puerperal Convulsions, Reported by C". H. Walton, M.D.;

of Augusta, Georgia.

Saturday, Feb. 2nd, 1856. Called in haste tosee Miss S-

aged about twenty : taken suddenly ill, with a supposed fainting
fit. She was lying prostrate head thrown back, perfectly -un-
conscious, muscular' system relaxed ; pulse very slow, and full ;
respiration much less frequent than normal ; bloated ; skin livid
and cold ; eyes half open and staring, with tremulous lids. Sinap^
isms were at once applied to the spine and calves of the legs,
ammonia held to the nostrils, and spts. camphor rubbed over the
face and forehead. Reaction, to some extent, ensued a quantity
Df bile and mucus was ejected from the stomach, but the patient
continued insensible and motionless ; there was no decided stupor,
;bsut the inspirations were deep and sighing. Further inquiry into
;;"he history of the case revealed the fact, that she had not menstru-

146 Walton". Case of Puerperal Convulsions. [Marchj

ated fer six or seven months : had had morning sickness and fre^
quent headaches, and had complained, just before the present
attack, of intense headache, accompanied with dizziness and bhnd^
hess. Upon examination, her abdomen ^yas found to be consider-
ably enlarged ; feet and legs cedematous. Suspecting pregnancy,
but unwilling to make an exploration per vaginam, until the
Urgent symptoms were relieved, a continuance of the remedies
was enjoined, while a messenger was sent for Dr. Joseph A. Eve,
who had previously been called to this same patient. Previous to
the arrival of the Doctor, Miss S - had had two convulsions,
and was just recovering from the second. Chloroform was sent i
for, and advantage taken of the interval to make a vaginal exam-
ination. The condition of the os uteri, and the results of ballotte-
ment convinced us that pregnancy existed, and was advanced to
nearly the seventh month ; the condition of the mammae verified
the diagnosis \ they were turgid, the areolae very dark, and milk
was easily pressed from the nipple. The sonorous breathing of
the patient, and some mucous rale, obscured the sounds of the
foetal heart.

Miss S. had several convulsions, attended with violent jac*

titation, before the chloroform Was obtained ; there seemed to be
no lucid intervah The coma was not profound, yet the convul-
sions were recurring with increased frequency, and their duration
was greater, The pulse had now become very frequent and smajMij
varying from 120 to 140 pulsations per minute, and it became ^Sj
nice point to determine whether bloodletting ought to be pr;
tised or not ^the convulsions evidently partaking more of l^'Mi
epileptic than of the apoplectic form, although the persistent '^^oM^
consciousness of the patient indicated some degree of cereb
engorgement.

Several ineffectual attempts at venesection were made, in con
sequence of the violent jerking of the patient whenever the poin
of the lancet was applied ; these muscular contractions being alto
gether the result of reflex action and unattended with any sensa

tion, as Miss S subsequently declared. It was about half-pa.^

11 A. M., when the chloroform was procured, the convulsions sue
ceeding each other with fearful rapidity and violence, increasin,
in duration and the intervals becoming shorter. The effect of thi
powerful anaesthetic was at once evident, in diminishing the inter
sity and duration of the fit. While the patient was under th

i

1857.] Sill. Treatment of Neuralgia. 147

influence of the chloroform, venesection was easily accomplished,
but very little blood flowed from the orifice, and that was thick
and dark ; this condition of the blood being induced by interrupt'
ed respiration, and further, by the substitution of the chloroform
vapor, for atmospheric air. About 1 o'clock, we ordered an in-
jection per anum consisting of about a pint of tepid isalt water,
from which the patient experienced great benefit, the Uterus and
pelvic viscera being relieved from the pressure of an accumu^
lated mass of foeces, and the congestion of the brain removed by
revulsion. She had one or two slight convulsions afterwards,
which were easily subdued by the chloroform. The vein was now
re-opened, about a pint of blood taken, and the following mixture
ordered every hour, in tea^spoonful doses, as an arterial and nei-
Vous sedative :

Sulph. Morphine, ) i ^^

Tartar Emetic, aa. ] ^ ^'

^Yater, . ^ - 4 ounces^

We now left our patient for a time, and about 11 o'clock at

night visited her again. Her condition was much improved:

pulse regular, about 80 pulsations per minute skin moist and

soft; breathing nearly natural. After 2 o^clock there were no

more symptoms of convulsions, and consciousness gradually re-*

turned ; but it was not until Monday morning that her senses Were

, completely restored. Labor pains came on regularly, and she Wag

easily and naturally delivered of a living child on "Wednesday

evening no ill consequences resulting from the act of parturition,-
: either to mother or offspring, although the latter was evidently

premature, and died within a fortnight after its birth,

ARTICLE Xl.-

Treatment of Neuralgia. By L. A HiLL, of Antioch, York Dis-
trict, South Carolina,

Messrs. Editors : An article appeared in the January numbef
for 1846, (page 54,) of your excellent Journal, in which Dt. Blakis^
ton's method of treatment for Uncomplicated Sciatica is given,
and which has been attended with considerable benefit; and the
writer also mentions that some other forms of Neuralgia had been
treated with some success in the same manner.-
N. s. vol. xm, Ko. 111. 10

1148' HiLIi. Treaiment of J^euratgia. fSfarcfiv

I>r. Blakiston first saw it adopted in Paris, in 1883-. It consistar-
m removing the cuticle, by placing *' a blister, about the size of 2t
crown-piece, over the chief seat of pain, which is usually the fiat"
tened part of the buttock. After it has drawn,, and the cuticle has-
been thorcHighly removed, the raw surface is sprinkled with a
powder, consisting of, generally,, about one grain of acetate of
morphia, 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 required, by cantharides, or savine cerate, or else by Al-
buspeyeres' plaster. This suffices for a very mild case ;- but in
severe cases, of long standing, the pain will now be found to have
left its original seat,, and to have seized on the kn^e of the affected
side. The same treatment is then applied to the ham; and after
six- dressings,, the pain will have generally disappearedy and the
patient will rapidly recover."

Not long after the article of which the above is an extract
appeared, I had an opportunity of witnessing the g-ood effects of
morphia, applied endermically, in Neuralgia of the Scalp.

Mrs. M. W., set. 57, was attacked, on two successive days, with
a sudden sharp- pain,, near the mastoid portion of the temporal-
bone, extending chiefly in the direction of the occipital protu-
berance, but it could be distinctly felt down the sid'e of the neck-
also. The pain, however, did not continue long, and did not ex-
cite much uneasiness, until on the third da^v when she was attacked-
violently the pain continuing for several hours. Upon examina
tion, I soon came to the conclusion that the pain complained of"
OTviginated in the nerves, and entertaining some daubts in regard'
to its cause, I determined to try the effects of mor^Ata, as abov*
directed for Sciatica. I accordingly placed a small blister below,,
and a little posterior to, the mastoid process, and directed it to be'Jl
dressed for six successive days, with near a grain of the sulphate of
morphia, and a' little refined sugar, well pulverized,- At the time,
I did not have the acetate, and substituted for it, the sulphate.
After the fourth dressing, the surface of the blister became dry,
and the patient refused having it kept raw, saying, that the pain
was entirely removed. There was no other remedy usedy and- there
has been no recurrence of the disease since.

The next case of Neuralgia that I met with, was in July, 1856.
Mrs. J. H., set., near one hundred>je2iYa much emaciated, and en-
feebled, by age and' suffering had been laboring under the fearful

1857.] HiLti. Treatment of Neuralgia, 149

malady termed Tic-douhureux, Several physicians, of acknow*
ledged skill, had failed in effecting more than giving the patient
mere temporary relief The sufferings (giving the patient's own
expression) were indescribable ; she could not take any nourish-
ment, not even a sup of water, without suffering the most acute
pain.

I placed a small blister immediately below the zygomatic region
of the cheek, and directed it to be dressed after the cuticle had
been thoroughly removed with the acetate of morphia, as direct-
ed by Dr. B. for Sciatica. After the fifth dressing the surface
became rather dry, and it was allowed to heal np. The five dress-
ings, however, were altogether satisfactory, although some remains
of the disease could still be felt occasionally.

The patient could now eat and drink) with impunity, and said
(using her own expression again) she could "only feel a slight ting-
ling sensation, occasionally," and expressed her gratitude, for being
enabled to entertain the hope, that she would not suffer any more
from that disease. Unfortunately, however, about this time she
deceived a slight scratch on the back of the hand, which began to
inflame, and was soon developed into a phagadenic ulcer, and be-
fore it was arrested, the sloughing was so extensive as to produce
a severe sho(|)i to the system, which it Was never able to overcome.
The process of healing Was extremely slow, and before the wound,
caused by the sloughing, was finally healed, the powers of life
gave way. The patient died near five months after the applica-
tion of the morphia ; but without a recurrence of the neuralgic
pain, except in a very slight degree.

The above cases, of themselves, are by no means sufficient to
establish the practice therein recommended, but it is hoped that
they, in addition to those already on record, may induce others
to try the same method, and give to the Profession their results.
We would recommend the practice, particularly, in cases which
had undergone the ordinary plans of treatment, without being
cured.

Now, it may so happen, that the cause of the disease is obvious,
and the treatment plain ; as was in a case that came under my
aotice a short time ago, in which the extraction of a carious tooth,
completed a cure but sometimes the cause is very obscure ; it
cnay depend upon some source of irritation in the spinal chord, or
n the brain itself; or it may depend upon some irritation along

150 Treatment of Stndures of {fie UretJira^ &c. [Marclr^ i

the trunk of the nerve^ that is distributed to the parts where the ^
pain is felt. If, then^the preparations of morphia are sufficient ta
benumb the sensibility of the nerves so completely^ it will surely
prore a blessing to those who have fallen victims to the cru^l
malady,

I have observed no bad effects attending the administration of
morphia^ as above directed ; it is but right,, however,- to mention,
that an extraordinary thrilling is sometimes feit over the whole
body, particularly at the extremities, with great Bausea^ and a ten-
dency to faint in particular idiosyncracies^

On the Tubular Tveafment of Strictures of the Urethra and other Mu
cous Canals. By Thomas Wakley^ Esq.^ F.E.C.S., Surgeon to
the Eoyal Free Hospital. (Read before the Medical Society ol
London, Nov. 22, 1856,)

Five years hare now elapsed since I had the honorofintroduc
ing to the notice of this Society a set of newly designed instru
ments for the Treatment of Strictures of the Urethra, The justl}^
acquired celebrity of this Association for the encouragement giver
by it to the authors and promoters of all improvements in the sci-
ence of medicine, emboldened me to take that stip. The ne^
instruments, therefore, and the novel system of treatment whicl:
they were intended to establish,- were brought under the consider
ation of the profes-sion through the influential medium of the Med
ical Society of London.. To that circumstancre I attribute, in great,
measure, the attention that the subject at once received from prao
titioners of distinction and acknowledged standing and ability
The modes of treatment practised at that time were all more o:
less unsatisfactory f much diversity of opinion prevailed respectuJ|
them,, and frecjuently all were tried without any permanent bene
fidal results- being obtained. The forcible and frequent introduc
tion of bougies and caustics into a delicate and sensitive canal, ant
the division of the implicated structures by cutting instruments
whether nsed internally or externally, appeared to me to be vie
lent modes of proceeding, which might be entirely supplanted b;*
an operation of a mild description, that approximated more closel;
tO' a scientific application of the mechanical means placed at ou
disposal. All surgeons of any experience had witnessed the fail
sre of the systems of treatm^ent ordinarily pursued. Besides, i
mnst be confessed that it was not failure alone that was to be K
gretted; but tedious, protracted confinement, and sometimes evei
Sital catastrophes had to be deplored. The dif&culties, annoyac

1857.] Trmtmtnt of Strkiuves of the Ur-etlwa, ttc. 151

ces, and disappointments, which seemed to be frequently the most
inevitable attendants of the measures adopted in tlie treatment of
stricture, pointed sigxiificantlj to the establishment of another
system to one that should place the obstructed canal more com-
pletely under the control of the surgeon to one that would aJBfbrd
prompt and at the same time permanent relief^ and without des-
troying in the slightest degree any of the natural tissues at or near
to the parts implicated.

It was under the influence of these views and impressions that
a plan of treatment was devised, which, after the first introduction
of the smallest possible instrument into the bladder, secured to the
operator the perfect command of the disordered canal, and thence-
forth enabled the surgeon to introduce dilating tubes at pleasure,
without the risk or the possibility of makmg or even entering a
false passage in the urinary canal. Such were the hopes and an-
ticipations entertained, when Mr. Williams, of the firm of Weiss
and Co,, kindly undertook to construct forme a set of instruments
on the principle of those now placed before you, and he is but too
well acquainted with the trouble and anxiety which the new un-
dertaking occasioned; but^ happily, success the most agreeable
of all rewards ha^ crowned our efforts.

At first, the expectations tliat were entertained were only sup-
ported by theory. The utility of these instruments now rests on
that rock whereon is sustained all tkat is valuable in our profes-
sion namely, experience. Since the instruments were first intro-
duced to the notice of this Society, hundreds of sets of them have
found their way into public institutions and private practice, and
I have the best authority for stating that they have been distribut-
led throughout numerous parts of the globe.

L Objections to their employment were necessarily anticipated,

but certainly not the extraordinary one tliat they w^ould give the

surgeon too much power over the disease which his skill is called

upon to remove. A similar objection, v/ithout doubt, might be

urged against almost every useful instrument employed in surge-

ty. The possession of power is undoubtedly requisite in order to

accomplish the object contemplated, but a proper exercise of the

udgment of the surgeon is necessary for the due performance of

'ill operations that he may undertake. These instruments have

3een used by surgeons of great eminence and abilit}'-, who have

spoken of them in terms of high commendation, I niay mention

n this place the names of Guthrie, Keate, Fergusson, Crampton,

'.-jiddell, Solly, Coulson, and Lizars. Since the tubular treatment

:,)f stricture was first introduced to the notice of the profession, it

;ias been adopted in hundreds of cases under my own observation,

J^ith almost invariable benefit, even where difficult complications

ixisted, such as lesion of the urethra, from whatever causes pro-

luced, urinary fistula, false passages, and vesical calculi, and with-

ut, I believe, a single fatal event The results of the tubular

152 Treatment of Strictures of the Urethra^ <i:c. [March,

treatment of stricture have been so satisfactory that it would be a
dereliction of duty not to endeavor to draw attention to what
these instruments have already accomplished, with a view to their
more extended operation and general adoption.

The instruments are composed of three guides of different sizes,
eleven dilating silver tubes, and the same number of flexible tubes.
The guides are numbered 1, 3, and 5.

A guide consists of a hollow silver director, thirteen inches in
length, straight, excepting near the end, which is slightly curved,
the extremity being closed and rounded, and having an aperture
at one side. A moveable handle is fitted to it, for assisting its in-
troduction into the bladder ; when this has been effected the han-
dle is removed, and a steel rod of the same size, five inches in
length, is fixed into the external extremity of the director by one
turn of a screw. This now forms the urethral director, over which
the tubes are made to pass.

The silver tubes are nine inches in length, and straight ; the
opening at the vesical extremity being bevelled off and exactly
adjusted to the surface of the guides. The upper end terminates
in two flanges, for being worked with the fingers and thumb.

The flexible tubes are manufactured of gum-elastic, lined Tvith
flexible metal, and are ten and a half inches long, conical towards
their points. Like the silver tubes, they glide over the guide with
the greatest precision. Their upper end is furnished with a silver
collar and rings, to enable their being secured in the urethra.
Both the flexible and the silver tubes are numbered, and work
upon their corresponding guides.

It is my object, however, on this occasion, to refer not only td
what has already been accomplished in treating strictures of the
urethra on the tubular plan, but also to urge that the same prin-
ciples of mechanism ma}^ be beneficially applied to the treatment
of strictures of other mucous canals, as the rectum and oesophagug,
for the dilatation of the neck of the uterus, and also for the intro-
duction of a largC'sized O'Beirne's tube. The various mucouA-
canals of the body are very similar in their structure, and are lia^
ble to similar diseases, especially contractions, resulting, in manj^
instances, from like causes. Indeed, the term '^ Diseases of tire
Mucous Canals of the Body" appears very naturally to include a
set of maladies analogous in kind. The instruments usually em-
ployed in the treatment of stricture of the urethra resemble ir
principle and form the bougies used for stricture of the rectum,
and also those for stricture of the oesophagus. The object to b(
attained in all cases is the same viz., the dilatation of the canal tc
its normal calibre. In addition to the new instruments for dilat
ing the urethra, others formed on the same principle for dilation o
the rectum, the oesophagus, and the uterine neck are now upon th(
table, and their mode of action will be shown to you by thei
manufacturer, who is present.

IS^.j Treatmenl of Strictures of the Urethra, cCt. 15S

It forms no part of my intention at this time to eiiter into any
discussion on the relative merits of difiercnt and rival plans of
treatment, and I disavow any desire of detracting from the scien-
tific eiforts of other surgeons Avho employ other sj' stems, and who
^dopt other methods advocated by once eminent surgical practi-
tioner, who have passed from the scene of our labors.

Probably it ma}^ be stated with confidence, that in forty-nine
cases of stricture of the urethra out of fifty, in which any instru-
ment can be passed into the urethra, the application of cutting in-
struments, or of caustics, or any other means interfering with the
normal structures of the urinary canal, might be entirely avoided
hj the tubular system of treatment.

That the mode now recommended is consistent with the anato-
my and pathology of the structures involved cannot be questioned;
and the advantage of effecting a cure without causing any breach-
es of healthy textures is equally free from dispute. The infliction
of wounds even trivial in extent, in persons having depraved or
debilitated constitutions, is often attended with great danger, and
is not unfrequently followed by the worst results.

The mechanical power which the guide and tubes place at the
disposal of the surgeon is unquestionable. It is absurd, however,
to pretend that any resemblance exists between that power and
the forcible catheterism of M. Boyer, as has been stated. The dif-
ference of action in the two cases being taken into account, a stri-
king contrast, instead of the smallest resemblance, will be rendered
obvious. In the French system, the catheter is forcibly directed
towards the bladder, without any guiding implement whatever,
the surgeon relying simply on his knowledge of anatomy. The
tubular dilators, on the contrary, are passed over a guide, and can
i, not by any possible means diverge from the natural course of the
canal, an advantage peculiar to this system of treatment ; and it
would be difficult to overrate its importance as a source of safety
to the patient. TTith the guide and tubes, it has been found that
the rapid and permanent dilatation of a stricture can be accom-
plished in the most prompt and effectual manner, and, at the same
. time, the proceeding may be so cautiously regulated as to afford
J the patient the utmost possible protection against the application
j of all unnecessar}^ force.

\ ' After the last silver tube has been passed at any sitting, an elas-
;tic one may be introduced, and left in the canal, the guide being
i withdrawn through it The utility of leaving a flexible instru-
ment in the canal has been described by Sir Benjamin Brodie, in
his Lecture on Surgery, in the following terms:

' This method is particularly applicable

"^ 1st, Where time is of much value, and it is of great conse-
(quence to the patient to obtain a cure as soon as possible.
i "2nd, Where a stricture is oiistly and cartilaginous, and there-
ifore not readily dilated by ordinary means.

154 Treatment of Strictures of the Urethra^ (kc. [March,

"3d, Where, from the long contmuance of the disease, the ure-
thra has become irregular in shape, or where a false passage has
been made by previous mismanagement.

" Now if, instead of a bougie, you use a gum-catheter, and allow
it to remain, the urine flowing through the catheter, the contact
of it with the urethra is prevented, and the rigor is prevented
also."^

The flexible tube, therefore, will not only furnish the ready
means for re-introducing the guide without the danger, or even
the possibility, of making or entering a false passage, but it ap'
pears by its action to maintain the dilatation which the tubes pro*
duce, and to promote the rapid absorption of the submucous depo'
sits, which, in many cases, caused the obstruction of the canal.
In a word, the permanent cure of strictures of the urethra .by the
plan of the tubular treatment depends mainly on the thorough
absorption of the extraneous substance usually interfering with
the normal condition of the urinary canal.

When once a guide has been introduced into the bladder, the
power of the operator over the stricture is all but unlimited. The
fate Mr. Guthrie, to whom this Society is indebted for many highly
valuable communications, has stated, in his work on "Diseases of
the Urinary Organs," that it is impossible to speak too highly of
the invention of treating diseases of the urethra by means of the
urethral guide and tubes. The same distinguished surgeon also
remarked that " it is capable of rendering great service when the
withdrawal of a sound or catheter cannot always be certainly fol-
lowed by the re-introduction of another, and which ^^ithdrawal it :
renders unnecessarj^ until a larger one is introduced over it a
very great improvement, which no surgeon should neglect; for
when this can be done, no other operation is immediately neces-

Bary."t

Mr. Solly, surgeon to St. Thomases Hospital, at a meeting of
the Boyal Medical and Chirurgical Society in April, 1853, whilst
objecting to the use of the knife in the treatment of stricture, said
that " he had found the plan of the urethral guide and tubes very
useful in expediting the cure,"

Mr, Coulson, in a lecture on the treatment of stricture of the
urethra, delivered at St. Mary's Hospital in December, 1853, spoke
of the instruments before you in strong terms of approval.^

* Brodie, Sir B. C, Lectures on Diseases of the Urinary Organs, Third edition,
pp. 48-9.

f Guthrie, G. J.. On the Successful Treatment of Stricture of the Urethra, d;c.,
pp. 40-1,

i In this lecture, published in The Lancpt, Mr, Coulson said: "Mr, Thomas
Wftklev has invented several ingenious instruments, the utility of -u-hieh has been
demonstratfd by very extensive practical application. They are intended to en-
eure entire commnnd over the pervious xirethra ; and they present this additional
novelty, that in their effects thej- combine two methods of treatment commonly em-
ployedviz,, rapid and permdnent dilatation of the stiicture," After describing the

1857.] Treatment of Strictures of the Uretltra, (Jcc. 155

Mr. Lizai-s, iu the preface to the third edition of his work oii
^'Stricture of the Urethra," states of the tubuhir instruments that
" those who have witnessed their operation speak favorably of their
beneficial effects. They appear to me," he says, "to be formed
upon a very ingenious principle, and I have no doubt, if cautiouS'
ly inserted, that they may prove a useful curative auxiliary."
(p. xxiv.)

Quotations of a similar character might be multiplied, but pro-
bably, enough have been cited to prove to this Society that the
method of treating the strictured urethra, by means of the instru-
ments now recommended, is worthy of their earnest consideration,
I may also observe that the late Mr. Guthrie, who several times
witnessed their action at the hospital with which I am connected,
frequently remarked to me, that the objection to their use arose
from the great power which thej^ placed at the disposal of the sur-
geon, and' that "a surgeon could really do too much w^th them at
one operation." When, however, it is considered to whose hands
the employment of these instruments is to be confided, it cannot
be believed that patients w^ill suffer from an undue exercise of
power, or that a want of caution w^ill be shown by the operator.

The removal of the stricture may be effected, either rapidly or
elowly, according to the intention of the operator. Sir Benjamin
Brodie has most truthfully observed that "the temper of the m^e-
thra varies as much as the temper of the mind.""^ The surgeon
must therefore exercise his discretion as to the rapidity with wdiich
the strictured part should be dilated. If the intention be to pro-
ceed slowly, the treatment may be conducted, after the first two or
three operations, by means of a silver tube, which may be allowed
to remain in for an hour or so. Flexible tubes, except at two or
three of the earliest sittings, need not be employed in such cases
as these. But if a rapid cure be decided upon, all the means at
the disposal of the operator must be employed with promptitude,
caution, and watchfulness, in order to effect a safe and speedy ter-
mination of the treatment. It may be observed that strictures of
many years' standing have been removed with remarkable prompts
tude by the tubular system of treatment.

Before using the instruments, two or three days should be occu-
pied in preparing the patient for operation. Opportunity should
be also taken of examining the urine, and obtaining a clear history
of the malady. By examining the urine, of course an elaborate

jji&tniments, Mr. Coulson adds : " Those who are acquainted witli the difficulties
which often beset the surgeon during the treatment of stricture, must confess that
the principle on which Mr. Waklej's instruments act is one of deep importance,
and that great credit is due to him for the ingenious and perfect manner in which

i he has attained the desired object To dilatation it is objected, that the surgeon

' can never be sure of being able to re-introduce any instrument after it has been
I once withdrawn ; but the disadvantage has been i-emedied by the excellent instrU'
j ments of Mr. Thomas Weakley,"
I * Brodie, op. cit, p. 54,

156 Treatment of Strictures of the Urethra^ &c. [March,

quantitative or qualitative analysis is not meant ; but the specific
gravity of the urine should be ascertained, its reaction determined,
and it should be examined for vesical mucus or pus, and the pro-
ducts of calculi. It is necessary to be the more particular with
respect to these preliminary measures in proportion to the severity
or complications of the case. Cushions, made of Hooper's prepared
India-rubber, containing hot water, should be apphed to the re-
gion of the bladder above the pubes, and also against the perinae"-
um. The urethra should be carefully examined with a guide
suited to its calibre ; and the necessity cannot be too strongly urged
of carrying the point of the instrument along its anterior surface.
With patience and perseverance, aided by the usual dexterity
which a surgeon should possess, the instrument will be passed
through the stricture. This step having been accomplished, the
movable handle of the guide is to be withdrawn, the index- rod
screwed on, and a corresponding silver tube passed upon the guide
through the stricture. It will be observed that the guides are
straighter than the catheters used by the late Mr. Liston, and they
are made so as to allow the urethra to be straightened as much as
possible, which is effected by making a fulcrum of the triangular
ligament, the penis being brought rather lower than at a right an-
gle to the body. By this mode of proceeding, the tubes are easily
passed to the neck of the bladder. Having sufficiently expanded
the stricture, the last used silver tube is wdthdrawai, and a flexible
one is then passed over the guide, which should be mimediately
withdrawn through it.

This is commonly a very easy proceeding, and requires no
further manipulation than a rotatory motion of the instrument,
given to it by means of its flanges. The tubes, which are lined
with flexible metal covered with elastic fabric, glide easily. The
urine is then discharged, and the tube, at the discretion of the
operator, is gently withdrawn to such an extent as to allow only
a small portion of the point to project beyond the neck into the
bladder. By retaining it in that position its point is prevented
from irritating the mucous membrane of the bladder, and thus
those rigors are prevented which are so distressing to the patient
and alarming to the operator.

Many cases are on record where the point of the instrument,
tied down against the walls of the bladder, has caused their ulcer-
ation and perforation. I remember being present at the post-mor-
tem examination of a gentleman who was said to have died of
stricture, but the inspection disclosed an ulcerated perforation of
the bladder, just at the place wdiere the point of a small silver ca-
theter had rested. In that case the catheter had been tied in for
three days. The gentleman was reported to have a stricture for
thirty years, and a hard, gristly tumour was found, nearly en-
circling the urethra, w^hich could be easily felt externally. Upon
slitting open the urethra, the stricture was discovered to occupy its

1857.] Treatment of Strictures of the Urethra^ drc. 157

membranous and bulbous portions, where the instrument had been
grasped by the contracted part. The mucous membrane there was
more congested than elsewhere, and covered over by a thick muco-
purulent matter. (The instrument that had been used was quite
blackened from this part to its point.) The contracted portion had
evidently been greatly widened by the long pressure of the cathe-
ter. Upon cutting out a portion of this gristly part of the urethra,
the mucous lining was found to be thin, and strongly adherent to
the subjacent structure, from which it could not be torn without
bringing away some of the indurated tissue. When scraping it,
a very minute quantity of the same kind of viscid matter came
away upon the knife. Upon dissecting back the indurated part,
it was found to merge into the structure around which it had form-
ed; no defined border to it could be ascertained. The hardened
Btructure was of a reddish-white colour and fibrous, and was de-
posited by the inflammation which had at some time or other been
set up. A false passage existed, which left the urethra half an
inch in front of the thickening, and passed between the urethra
and the subjacent structures, entering the surrounding callosity.

This case appears to assist greatly in the solution of that most
difiicult problem, How is it that the pressure of an instrument
on the urethra relieves or opens a stricture? The rationale
in the case of this man seems to be, that upon the introduction of
the catheter the mucous lining of the urethra became inflamed,
and secreted a muco-purulent matter; and that the pressure pro-
duced softening and absorption of the hard callus external to the
mucous membrane. Although the pressure was exerted upon the
hardening through the elastic mucous lining, the lattter was nei-
ther absorbed nor ulcerated by this pressure, but only irritated and
excited to the extent of secreting and discharging the muco-puru-
lent matter. A similar action is manifested in the absorption of
, tumour from pressure made upon it over and through the skin.
My belief is, that in rapid dilatation the constant or frequent pre-
sence of an instrument induces absorption of the adventitious sub-
mucous formation producing the stricture, but that in slow dilata-
tion the action is only a mechanical distension of the contracted
canal, the interstitial structures losing in length what thay gain in
circumference, and soon again relapsing into their previous form.
Opportunities such as were afforded by this case the man dying
whilst actually under treatment are very rare. A catheter had
been kept in the bladder until a very short time before the death,
for no symptoms were noticed by his surgeon, a very able practi'
tioner, indicating the accident that had taken place. The patient
evinced merely excessive prostration ; he did not complain of pain
until a few hours previous to his decease.

In resuming the subject of the treatment^ I may state that the

urine having been discharged, the external surface of the tube

' should be plugged, and the instrument secured with its point still

158 Treatmsnt of Strktures of Oie TJreilira^ &c. [March,

only just projecting within the bladder, by means of tapes passed
through its flanges and tied around a broad piece of India-rubber,
which should encircle the peni>s. The knees of the patient should
be raised and supported by pillows placed underneath them, and
the India-rubber bags containing hot water used as before stated.

If the flexible tube be retained without exciting disturbance it
may be removed at the expiration of twelve hours after the guide
has been reintroduced through it; and then, the appropriate me-
tallic tubes having been fl.rst passed over the guide, a larger flexi-
ble tube maj^be introduced and retained, as in the prior instance.
By this mode of proceeding, in seven diiys a hard!^ cartilaginous
stricture has been so far dilated that a common N'o. 12 sound or
catheter could be easily passed ; but as a rule the safety of the pa-
tient would be best consulted by not endeavoring to obtain such
a result in less than a fortnight or from the commencement of the
treatment, the more extended term allowing to the urethra a more
protracted repose between ihe different operations. The strictly
medical treatment accompanying these proceedings is too plainly
indicated to require description.

In illustration of the action and utility of the tubular treatment
of strictures of the urethra, I could furnish the Society with the
details of numerous cases, including almost everj- variety and com-,
plication, but the time already occupied precludes me from doing
more than reading abstracts from some interesting cases which
have lately been under this system of treatment.

Case 1, A gentleman from the country, aged about forty-five
years, married, but without children, was sent to me by his medi-
cal attendant. For many years past he had suffered from a most
distressing stricture of the urethra, A small-sized instrument could'
occasionally be introduced into the bladder, but severe rigors, last-
ing for hours, generally supervened upon the manipulation. Lat-
terly attacks of complete retention of urine had become frequent.
Instrumental relief was impossible; and the general local and
medical treatment on each occasion became less efficacious. The-,
urine only dribbled away, accompanied by a constant desire to.
micturate, the discharge of it never satisfying the desire of the pa-
tient, or giving him a sense of relief, so large a quantity continu-
ally remaining in the bladder, after all the efforts made for its
expulsion. Indeed the capacity of the bladder, from its incessant
distension, had become enormous.

When first seen by me, this patient presented the appearance
usually indicated after the long continuance of a wearing and fa-
tiguing disease. On examination, I found the perineum swollen
and indurated, and the prostate painful to the touch. Upon the
introduction of a small common catheter, I could do little more
than discover a hard stricture, existing in all probability through-
out the length of the indurated tumour. Believing, from the con-
tents of the note which this oeutleman brouo-ht to me from his

Q^^V^V. .^- Q-

I

1857.] Treatment of Strictures of the Urefhra^ ic: 169

surgeon, that I had to contend with aWery severe &x\A intractable
case. I advised that he should take up his abode at the Sanatorium.
The progress of hi? case was carefully and minutely narrated by
Mr. 1\ Gill, the resident medical officer.

After the preliminary treatment, the patient was placed in bed,
and the small-sized guide was, after very considerable trouble and
difficulty,- passed into the bladder. The handle of the guide w;is
screwed in, and a No.- 4 silver tube was carefully passed over it,
through the stricturcd portion of the urethra, into the bladder,- and
then an elastic tube No. 4. The guide was then withdfal^'n. Tbef
tube was drawn out to the prostatic portion of the ureth?a^ During.-
the examination,- I had discovered the urethra, anterior to the
stricture, to be somewhat more contracted than natural;' and there
was a false passage to the right side, into which the point of the
instrument alw^ays slipped, unless held well toward^s the other side.
The contraction extended along at least two inches of the urethra.-
The patient was greath' fatigued ; but was ccmfor^ed by hot cush-
ions placed over the bladder and the penton^eum. The tube was
kept in for several hours.

On the following day the small guide was passed. The point
again hitched at the commencement of the false passage,- but it was
-' safely introduced into the bladder,- The Urethra was,- however,,
tender throughout. The handle of the guide was screwed on, and
a No. 6 silver tube was glided on the guide throttgh the stricture
by a rotatary motion, conducted by means of the flanges of the tube.-
A No.- 6 elastic tube Avas then passed into the bladder, and the
guide was withdrawn through it. The bladder was washed out
tvith a very weak solution of dilute nitric acid. The peg was in--
serted and the tube withdrawn just to the opening of the bkdder,.
and fixed there. To remaifi in for twelve hours.

In short, in fourteen days,- this distressing case proved perfectly
amenable to treatment with the urethral guide and- tubes, the in-
struments being em.ployed, as already detailed, upon alternate
days, and the flexible tubes being retained in the stricture so long
as was consisteut with the condition of the patient.

Case 2. In proof of what may be effected, even when a strict-
tire of the urethra is accompanied by the most serious complica-
tions, I will cite an instance in which I was consulted b}^ a London'
practitioner, where a stricture of very long standing was success-
fully treated, although complicated with a false passage, urinary
fistul^e, extensive disease of the bladder, and a vesical calculus.
The gentleman was well known to many surgeons, under whose
care, at different times, he had placed himself, but never, by the
adoption of any plan of treatment had so large an instrument been
passed, followed by an ability to expel so copious a stream of
. urine, as when the urethral guide and tubes were employed. The
, iirine, when voided, smelt strongly ammoniacal, and after stand-
' ing a short time deposited an immense sediment, consisting of

160 Treatment of Strictures of the XJreiKr a iScc, [Match ^

mucus and pus. The patient was reported to suffer from long'
continued rigors after any attempt to pass an instrument, and he
told me that a difficuliy^ experienced even in the hands of eminent
surgeons, had been tbe impossibility of introducing a larger in-
strument into the bladder, even when a small-sized bougie had
been passed into it with comparative ease. Under the use of the
tubes, in less than three weeks, a complete command of the urethra
was obtained, without the occurrence of rigors^ or any other symp-
tom arising to delay the proceedings. At the expiration of that
period, a common iS'o, 12 sound could be introduced. The pe-
rineal fistula had quite healed. I lay claim to no manual dexteri^
ty as contributing to this fortunate result : the guide and tubes, in
other hands, would doubtless have proved equally efficacious.

Case 3. ^^A gentleman, forty-one years of age, first complained
of stricture eighteen years since, but it was not then so severe as
to induce him to procure surgical aid. Twelve years agOj the late ji
Dr. Ljmch, of Farringdon-street^ first introduced instruments into 'i
this patient's urethra* Two years afterwards he suffered greatly \\
from stricture ; and afterwards he Avent to Australia, where, he
said, a false passage was made. He returned to England, and
consulted a medical practitioner ; but his condition progressively
became worse, and at length a No. 1 catheter could not be passed. ,j
By the advice of his medical attendant, he now placed himself ,
under my care, and he was recommended to take up his tempora-- [
ry residence at the Sanatorium. On examination, the seat of the i
stricture proved to be about the membranous portion of the nre- \
thra. A No. 1 guide was, after considerable manipulation^ intro- i
duced. The subsequent treatment was pursued rather more slow- <
ly in this case in consequence of the extreme emaciation and t
debility of the patient. He left the Sanatorium, not only relieved }'
as regards the stricture, but much improved in general health, in
three weeks from the day of his arrival.

Finally, the advantages which experience justifies me in stating
are obtainable from the employment of the new instrument may
be thus enumerated \

The rapidity,

The safety, and

The certainty of the removal of strictures of the Urethra^

The permanency of the relief arises from the absorption of the
submucous deposit.

The certainty of the tubes not making or extending any false
passage.

The complete control over the tirinary canal after the first intro-
drtction of the guide.

The relief afforded, often almost without pain.

The obliteration of false passages and fistulge.

The freedom of the urinal flow after the first introduction of the
guide.

'1

I

1857.] Treatment of Strictures of the Urethra^ &c. l&l

The facility afforded for wasliing out or clearing the bladder at
any period of the treatment.

The accomplishment of immediate and lasting relief without
producing any breach of substance by means of caustics, or the
employment of any cutting instruments

Non-malignant strictures of the rectum and the oesophagus may
be treated effectually with instruments constructed mpon the same
principles with those employed for the dilatation of contractions-
of the urethra. This assertion could be illustrated by the histories-
of several very interesting cases^ fully justif3dng its truth,- I must,,
however, defer the details of these cases^ and content myself, for"
the present, with merely describing and exhibiting the instruments'
in question, and leaving the subject for the consideration of tne-"
Society.

The rectum instruments consist of a flexible guide of soft metal
t)r elastic gum-fabric, and four di latin g-tubes, composed of the'
same materials, ten inches in length, shaped at the discretion of the
surgeon, and of different sizes,- numbered 2, 4, 6 and 8, corres--
ponding to those sizes on the guage of common :?ectum bougies.-
One end of the tube is made upon the same principles as those
employed in the construction of those for the urethra, whilst the
other end terminates in a broad, everted, cup--shaped rim.

By the means of a long flexible guide, an O'Beirne's tube of a'
much larger size can be also used. The one on' the table is a full
quarter of an inch in diameter internally. It is believed that this-
will prove of great service when the treatment by means of
O'Beirne's tube is indicated.

The oesophageal instruments consists of a long flexible guide,-
and dilating-tubes of elastic guru, twenty inches in length, of dif-
ferent sizes, and manufactured so as to glide over the guide with
the same ease as the urethral instrilments. I may here advert to
the fact of Mr. Erichsen, in his Work entitled '^Sufgery,'^ having
mentian^ed a case of oesophageal siricture,- in which he used, with
considerable advantage, instruments of a similar construction to-
the urethral tubes.

The instruments for the dilation of the cervix nteri consist of a
guide, eleven inches in length, with a movable handle, to facilitate
its introduction, and of silver and flexible dilating-tubes which'
I glide over the guide in the same manner as those for the urethra,-
aijd are made of various sizes, corresponding, in some respects,
. with those of Professor Simpson, but very considerably lighter.-
These tubes, at their internal extremity, have the same formation
, as those for the urethra. The other end is furnished with an in-
verted, cup-shaped rim, intended to fit the os uteri. [Lon. Lancet.

162 Early Performance of Tracheoiomy in Croup, [Mai'cri;

On the Early Perforraance of Tracheotomy in Croup, B j G. M/
JoNESj Esq,. Surgeon to the Jersey Hospital.

The suc^iessfiil result of an operation leads us tvaturally to re'
commend its adoption in other cases in which identity of charactei'
exists. To propose an operation is one thing, biit to induce
others to follow in our footsteps requires something more; we must j
Idc able to show its utility, probably its absolute necessity^ and
that the well-being, oftentimes the very existence, of our patient
depends on its performance. To hear some speak of tracheotomy
in croup would almost lead us to imagine that the operation is a new
one, a mere experiment and the offspring of some enthusiastic inno--
vator;* It would be foreign to my purpose to prove the contrary^
my present object being to endeavor to persuade its contemners-
that they may be in error, and to show that if resorted to in time,-
it may be the means, the only means left us to preserve the life !
of a fellow-'creature, the greatest and the most heartfelt wish a:
medical man can eJ^perience. '.

It is not the favorable result just given the history of, f which;
leads me to speak highly of the operation.- I have long been im-J
jpressed with its propriety^ and only waited an opportunity lo\
judge for myself ^but even had my views at anytime been differ^ j
ent, or had my case terminated fatally, the success which has!
attended M. Trossearl's endeavors, and which deservedly entitle;
him to be looked upon as the first French authority on this subject^;
and the unwearied exertions of my friend Mr, Henry Smith, of;
London, w'hich place him on the same level as his Parisian com^t
petitor,- would certainly have shaken, or altered altogether my(
Views^ even had they before been opposed to operative interference.!,

It may reasonably be asked Why is tracheotomy in croup so,
little resorted to in England? Why, to make tise of a homely'
phrase, is it at such a discount ? The reason is easily explained ,
We have the prejudices of parents to overcome---the opinion oj

* Altltough croup, rt5 ft distinct disease, ttnd tracheotomy, fts otie of the meanf)
employed for its cure, hrive only been broug^lit conspicuolisly into' notice within tlw
last yeai-s, both are uncioubtedly of ancient date. The quinsy described by Hyppo
erates as existing " without any evident tiimor iu the neck or fauces, but attendee
with viclent strangulation or difficult respiration, and which proves fatal either oi
the first or third day," and thecynanche of the Greeks, stated to be " a contractioi
of the oi'ifice of the aspe'ria arteria, by which not only the voice is suppressed, bu
respiration is performed with difficulty, rind sometimes wholly stopped, often in S(
short rt time as to kill th6 patient in twetity-four hours, or the third day, " is th'
same aflfection which we now designate as " croup j" and the following passage, al
so to ire' met with in one' of the earlier writers, unqiicstionably proves that trache
otomy \*^as the"n one of the established methods of cure in cases of "eynftnch
trachettlis." But if, in & quinsy, after the' use of proper medicines and repeate*
evacuations of blocfd ivom. diffel-ent veins, there is still a necessity for making an in
cision in the trachea, in Oi-der to prevent suffocation, the opei-ation may be perforiii
ed in three different mannei-s," etc.

f Vide Medical Times and Gazette, Oct. 4.

1857.] Early Performance of Tracheotomy in Croup. 16S

Bome of the highest authorities to oppose and the ill success which
has almost invariably attended its performance to account for in
such a manner, as to show that death has possibly arisen, more
from neglect or inattention to other unportant points, than to the
operation itself, or to any efiect it may have produced on the
human economy.

It is by no means surprising, that parents, particularly in the
low grades of life, object to submit their child to an operation,
the nature of which they will naturally make inquiries about, and
which when explained, conveys a degree of horror to their mindSj
only surpassed by the reply given to their second question- its
probable result in the present instance, and the amount of success
which has attended it in others. The conscientious Surgeon can-
not promise a certain cure, a circumstance not to be overcome by
the ignorant precious time is lost, till at last a tardy acquiescence,
at times an earnest entreaty to do any thing which may offer a
chance of saving the sufferer is given ; but then the last stage of
the disease has already set in, the operation is performed, and is
almost immediately, or in a few hours, followed by death. As a
natural consequence the operator has all the odium, and the dis-
ease for which it was performed, and which Dr. West very justly
Bays, "is -unquestionably one of the most dangerous to which
childhood is liable," is forgotten. But if we have this to contend
with among the lower orders, the surgeon has equal difficulties,
equally unfavorable chances of success among the superior classes
of society ; he has " the opinion of some of the highest authorities
to oppose;" and if called in by them, or by those who adhere to
their views, he comes as the "forlorn hope,'^ oftentimes as the
" last witness to expiring life;" this brings me to the most import*
ant point of my subject, "the endeavor to persuade its contemners
that they may be in error."

Many authors of indisputably high reputation, v/hose works are
constantly consulted, and whose views and treatment respecting
the nature and cure of disease are the beacons by which thousands
are guided in their line of practice, speak of tracheotomy in croup
in a manner which, to say the least, offers but little encourage-
ment to its performance. I shall quote the words of a few of the
most eminent on the subject : " When signs of approaching death
fcave come on, lividity of the lips, coldness of the skin, and a ten-
dency to stupor, the question will obtrude itself, whether there
tnay not still be a chance of saving the patient by tracheotomy.
In the first place, the operation is much more difficult to execute
ipon children, than upon adults, and is attended with more per--
^lexing hemorrhage ; but a greater objection is the existence of
he preternatural membrane, which precludes air being admitted
nto the lungs. Tracheotomy has again and again been practised
n this complaint to no purpose, and I should be inclined to look
ipon it as absolutely hopeless, but for two instances recorded in

N. S. VOL. XIII. NO. III. 11

164: Early Performance of Tracheotomy in Croup, [March,

the Medico-Chirurgical Transactions."* " Whenever tracheotomy
is performed, it should be after every other remedy has failed, and
not before any other has been attempted, as the exudation extends-
through the ramifications of the trachea, and probably through the
lungs, there is but little hope^ after all, of any benefit from such^
an operation. "f " There does not appear to be a chance of suc-
cess from this operation in any case wherein the treatment devel-
oped above has failed. * - ^ I perfectly agree with Goelis,-
Cheyne and many others, in concluding that it should seldom or
never be attempted in this disease.":}: " In England the result of
almost every instance of the performance of tracheotomy in croup
has been so imfavorable that the operation is scarcely looked upon
as a justifiable proceeding."! Such, then,, are the opinions pro-
pounded by some of the most weighty of English authorities.

Under such circumstances, can it be a matter of astonishment
that few general practitioners are willing to attempt an operation,
the result of which is likely to bring discredit on themselves ?
Now let me ask, from what cause or causes combined is this oper-
ation so generally followed by fatal consequences ? I have no'
hesitation in stating that a contrary result might, in all probabili-
ty, ensue, if the trachea were opened,, not '* when signs of ap-
proaching death have come on," nor ^* when every other remedy
had failed,." but at a- much earlier stage of the disease -ia a word,
before all hope of the efficacy of medicine had ceased, altogether.
Better to expunge the operation of tracheotomy in cynanche
trachealis from all works on practical surgery^ than perform it
under circumstances which, frora the weakened and exhausted
state of the patient, must render an operation much less formida-
ble than this one an accelerator of death,, and not the means bj
which death may be averted. Why are the statistical returns in case?
of strangiilated hernia more favorable now than formerly ? is i
not from operative measures being resorted to before symptoms o
approaching dissolution manifest themselves? and in what ligh
would the advice of a surgeon be looked on now, were he to re
eommend us to wait till repeated vomiting of fseeal matter tool
place before subjecting his patient to herniotomy? Whateve
theories may have been broached whatever views medical mei.
may have taken of the causes and other circumstances connecte*.
with croup,, there exists, I believe,, among the most experiencec
almost,, if not altogether, unanimity of opinion that blood-letting
antimony, calomel and warm baths, are the means we are calle
upon, first of all, to employ in this dangerous disease. I have to
ef ten had recourse to them, and others as their adjuncts, not t
add my humble testimony to their efficacy ; and, happily, man

* Dr. Watson's Lectures on the Practice of Physic.

\ Dr. Mason Good's Study of Medicine.

\ Dr. Copland's Dictionary of Practical Medicine.

Dr. West on the Diseases of Infancy and Childhood.

I

'

1857.] I^arly Performance of tracheotomy in Croup. 165

cases will yield to their judicious employ mentj but that all the
remedies recommended are to be carried out seriatim^ and some
tried a second and even a third timcj as a matter of course,* before
resorting to tracheotomy, appears to me the point which high au-
thorities ought to employ their pen in condemning, rather than
dwell on the fatality of an operation, possibly occasioned, in very
many instances, from too systematically following out the plan
recommended by writers.

Are there not diseases in which we can safely pronounce our
patients better, although the symptoms continue stationary for a
time ? This is exemplified in several forms of fever ; and, on the
other hand, we meet with complaints in which a stationary state
must be regarded as most unfavorable, and croup can be brought
forward as an illustration. For instance, we are called on at an
early hour to attend a child laboring under a severe form of this
disease ; in the evening we find our patient possibly not worse,
but in no respect better. Are we, then, to rest satisfied in ima-
gining that, although we have not gained, still we have not lost
ground ? K we think so, we deceive ourselves ; for a whole day
we have been unwearied in our exertions, we have exhausted all
the means medical science has placed at our disposal, and with no
better result than having been able to keep symptoms stationaryj
' and that in an aflPection which not unfrequently runs its fatal course
' , in eighteen, twenty-four, or thirty-six hours. Can a repetition of
^ already tried remedies bring on an improved condition ? I do not
\ mean to state this can never happen, but I feel confident practical
^ men will bear me out when I say that, in a vast majority of caseSj
^ the absence of any improvement after steadily pursuing for twelve
\ ^ or sixteen hours the medical course most approved of, leaves but
*' Very slender hopes that a continuation in a similar line of practice
J I "will be crowned with success.

:| I have already spoken of the improved statistical returns in

3; cases of strangulated hernia, and the probable reason why they

* are so satisfactory. Those who have attentively watched the pro-

"^ ; gress of surgery, must admit that it yearly makes rapid strides

'^'^ towards perfection ; and it appears to me that there is, in many

-^^.^ respects, a striking resemblance between hernia and croup, not

^^'jOnly as far as regards symptoms, but also with respect to the in-

^ ' dications of cure. In hernia, we have strangulation of the bowels

to overcome ; in croup, obstruction to the passage of air to re-

' ' move ; both diseases may come on suddenlj^, and without pre-

^^'^M monitory symptoms; in each the most prompt and energetic

treatment is required ; both are fraught with the greatest danger

'^^ to life ; each runs its course rapidly ; the same delay which may

'^ (prove fatal in one case becomes equally so in the other, and the

discriminating judgment which tells the surgeon when it might

be hazardous to delay operative interference, guides, or ought to

guide, the physician in recommending surgical means to super-

106 Early Performance of TracTieotomy in Croiip. plarch,

gede, for a time, those he has zealously, though unsuceessfully,
employed.

Is the operation a dangerous one ? This is a question not easi-
ly solved : some authorities say that it is^ others are of a contrary
opinion,* and when this is the case, I know of no better rale X<i>
follow than this : not allow ourselves to operate solely under the
latter impression, or be intimidated by the former* to hope the
one, and be at the same time fully prepared for any casualty whick
may supervene. But that which must ever make tracheotomy in
Group dangerous, is^ the performing it when s}'mptoms of dissolu-
tion are at hand. Blood lost then is assuredly ^4ife's blood," and
if this operation is at any time attended with "perplexing hemor-
rhage,^ what effect must even the loss of the mos4 trifling quantity
produce on the dying ; almost as well may we operate on the dea^
subject in the hope of seeing returning life, as on the expiring,
with the expectation of witnessing recovery.

In recommending an earlier performance of tracheotomy ia
eroup than is practised in England or advocated by British wri-
ters, I am far from advisiug it to supersede other measures (eoBa<'
patible with existing symptoms). It is said that in France there
are many instances in which this operation has been performed on
patients "^ whose disease would probably have been ameuable \&
ther treatment,- and cases are mentioned in which none of any
description had been tried befare. This practice is not advisable,
for there is no operation, however trivial it may appear^ which
can be positively pronounced as free of ulterior danger, and con-
sequently none ought ever to be performed unless really necessary ;
thus it appears that in France, surgeons often operate earHer than
is required^ while in England they almost invariably do so toe
late. The observations I have made are intended to induce prac-
titioners to adopt a middle course, chat is to be neither too has:
nor tardy, but to be guided in a case of croup as they would iu .
ease of strangulated hernia.

The success this operation h^s been attended" with,, in France, i
most encouraging; but there is another reason, besides operating
eairlier than we do, which undoubtedly gives our continental bretL
jen an immense vantage ground over us. There eroup presents
different character to that which it exhibits in England ; with u
it is certainly a much more dangerous complaint. This differenc
arises, in a great measure, if not altogether, from the parts moi
materially implicated. "In France, croupal symptoms are induce
in the majority of cases, by the extension to the larynx of fal-
mem^brane, originally deposited on the fauces and left palate, whi
the wind-pipe itself is comparatively seldom in a state of active i

* Casserius pronounces, " those men tinskilful, eoTrardly, and even cruel, w
Sbolishly neglect this operation, which is often safe in itself, and attended with t
most speedy and salutary effects, and who suffer their patients to die for want of tl
Dtoper and seasonable assistance."

1857.] Cathartics in Dysentery. 167

flammation, often altogether unaffected ; and the bronchitis and
pneumonia, which in this country so often, and so seriously com-
plicate the disease, are of less common occurrence."* But it ap-
pears to me, that it is this very difference in type which ought to
I lead us to effect an exchange of treatment. In England, the
symptoms brought on by croup are not unfrequently more dan-
gerous than the original disease, to wit, bronchitis and lung affec-
tions will follow, but not often precede cynanche trachealis. Both
these formidable affections are in a greater measure, if not altoge-
|ther dependent on an obstruction to the passage of air ; so that, in
i overcoming this as quickly as possible, we prevent congestion,
'^ and thus have to grapple with one, instead of three separate dis-
eases.

My views are so much in harmony with those expressed by Mr.
Smith, in his valuable paper in the Medical Times and Gazette^ of
the 26th January, 1856,t that I feel more confidence in stating
my conviction that not-\vithstanding the difference both in the
nature and the type of croup in this country, and the more formi-
dable character it puts on than is generally met with in France
3ur earlier introduction of air would not only give us a larger per-
centage of recoveries, but would place this operation in the same
favorable light in which it is now regarded in Paris and other
.parts of France.^ Success would enable us to speak with more
confidence as to a favorable result in those cases to which we are
called early, so that the prejudices of the ignorant would be more
?asily overcome, and the surgeon be found at the bedside of the
opulent, not as at present, when all other remedies have failed,
. \nd when death is at hand, but at a time when there is still strength
mough and hope enough left, to lead to as reasonable prospect of
"ecovery from tracheotomy, as was before held out by each of the
. -emedies which had already preceded its performance. [iY Orleans
^fed. Nevjs and Hosp. Gaz.

\tliartics in Dysentery. By 0. C. GriBBs, M. D-, Frewsbury, IST. Y.

At the meeting of the Buffalo Medical Association, Sept. 2d,
856, as per report of proceedings in the October number of the
>uffalo Medical Journal, a discussion took place in regard to the
ropriety of using cathartics in dysentery; also the /^m<? of cathar-

cs best calculated to fulfill the indications in that disease. As

* Dr. West on the Diseases of Infancy and Childhood.

X I cannot too strongly recommend the perusal of this valuable paper to those
bo are interested in the ti-eatment of this dangerous disease. Mr. Smith, with that
laracteristic candor which speaks volumes iu his favor, is not backward in ac-

'wledging his own failures, while he points out the uoeess of another in proof

I he desirableness of his operation.

X " In certain European countries, and in England particuiarly, tracheotomy in
i-^es of croup is still so isolated an operation, that iu all Great i3ritain it is not so
uch practised as in Paris alone." Lectures on Tracheotomxj in Croup, by Professor

168 * Cathartics in Dysentery. [March,

this question is fairly before the readers of the Journal above
mentioned, we suppose it is open for the expression of opinion or
experience, by any of its raany readers. Hence, we give expreS'
sion to a few thoughts, based partially upon our individual expe-
rience, and partially upon the generally received opinions in regard
to the nature of the affection under consideration. A knowledge
of the nature or pathology of any disease, is, perhaps, the surest
guide to the appropriate indications of treatment. The public
generally, are apt to look upon all diseases accompanied with fre-
quent evacuations from the bowels, as similar at least, if not identi-
cal in character. Physicians themselves are not always free from
this vagueness of nomenclature. In muco enteritis, as well as
milder forms of mucous irritation, each case is accompanied with
a diarrhoea or frequent alvine evacuations, and the public gener-
ally do not discriminate between such cases and dysentery, and we
have seen physicians not unfrequently, if not guilty of the same
error in diagnosis, at least of the same vagueness of nomenclature.
Dysentery consists in an inflammation of the mucous mambrane of
the colon and rectum, and, though the evacuations may be over in
ten minutes, yet, except it may be in the incipiency ofthe disease,
they are not foecal, but consist almost wholly of mucus and blood.
Hence, though the griping pains in the abdomen and the tenesmus
may be never so great, though the characteristic muco-sanguineous
evacuations may be never so frequent, or the straining at stool
never so persistent, the case may be accompanied with obstinate
constipation. The public generally look upon the frequent bloodj
evacuations as constituting the whole of the disease, and, conse-
quently, urge the importance of powerful astringents, which, i
unadvised by the attending physician, they sometimes clandes-
tinely and injuriously bring to bear upon the disease. But th(
physician who resorts to them, to the exclusion of evacuants, wil
certainly have no reason to boast of success.

Permit us to say, that we do not propose to discuss the nature
cause, or symptorns of dysentery, nor to enter into full details o
treatment. We propose only to make a brief expression of on
opinion, upon the question under discussion, viz. , the propriety c
cathartics in dysentery.

Some authorities have condemned the use of evacuants in dj
entery, on the ground of their supposed irritating influence upo
the inflamed mucous membrane. But we feel confident that, whe
the evacuant is judiciously selected, and repeated with due di
crimination, and with proper adjuncts, its irritating influence
more fancied than real. The object of the cathartic seems, at firs
to be to free the bowels from irritating secretions, and the. obje
of their repetition is, conjoined with the above, to prevent consl
pation, which is the inevitable sequence of the inflammation ar
consequent fever. A second, and not less important object to 1
secured by the evacuant, is to unload the portal veins, thus dimi

1857.] Cathartics in Dysentery. 169

iehing congestion in tliat important circulatory system, and to
stimulate the capillary circulation in the liver, which is often
filuggisli, resulting in a deficient biliarj^ secretion.

In regard to the choice of a cathartic there has been and is a
great discrepancy of opinion. Some have ad\ased calomel at first,
to be succeeded by castor oil ; others have advised castor oil from
the first. Rhubarb, compound powder of jalap, cream tartar^
(epsom salts, rochelle salts, &c., have all had their advocates.

We were formerly in the habit of giving, at first, calomel inti-
mately commingled with rhubarb and a little pulverized opium,
and afterwards, whenever an evacuant seemed demanded, gave
c^tor oil with a few drops of laudanum. But recently we have
made choice of a different evacuant, o.nd, so &.r, have been much
pleased with the change. In the June number of the Western
Lancet^ for 1855, Dr. D. B. Dorsey communicated the result of
twenty years"' experience with a cathartic mixture, first proposed
t him by Dr. Lemoyne, of Washington, Pa. Summing up his re-
sults he said " in a practice, not very limited, in the cities of Wheel-
ing, Va., and Steubenville, 0., in the latter of which dysentery
prevailed as an epidemic twice or thrice during my residence there,
I had the high gratification of seeing all recover who were treated
with this remedy from the commencement of the attack."" With
i this high encomium before us, we made trial of the combination in
! the next case that came under our observation, and with such
happy results that, except in young children, we have used it in
all dysenteric cases since, with success in all cases.

We quote Dr. Dorsey^s formula and directions from the paper
above referred to- ^'Take of saturated solution sulph. magnesia,
seven fluid ounces ; aromatic sulphuric ^c\d, one fljiid ounce mix,

'' The saturated solution is prepared by dissolving epsom salts in
an equal quantity of water, by lueight, at 60 deg. Fahrenheit It
will be ready for use in eight or ten hours. During that time it
-hould be shaken occasionatly.

" The medium dose of this medicine for an adult, is one table-
spoonful, delivered with two or three ounces of water, every four
to six hours, until it gently moves the bowels. It should be given
regularly, and perseveringly, until the bowels are manifestly under
its influence, which will be evinced byfeculant discharges, abate-
ment of tenesmus, and general feeling of relief. The size of the
dose and times of repeating it, must be varied by the practitioner's
judgment, according to many circumstances of age, violence and
stage of disease, &c. Sometimes it will require two tablespoonfuls
tof the medicine, every three or four hours ; at others a teaspoonful
every six or eight hours will be sufiicient.

" Accompanying each dose, when the pain and tenesmus are
jgreat, one-sixth of a grain of sulph. morph. may be given. But
'this remedy, also, must be varied, both in quantity and frequency
of repetition, according to circumstances.

170 Ice in Uterine He^niorrliage. [March,

"We have seldom or never exceeded tablespoonfol doses, and of-
tener fallen below that. But instead of giving once in four or six
hours throughout the twentj-four, we have usually commenced
with it in the morning, to be repeated every three hours until it
operates, always combined with a small quantity of morphine.
This course we repeat every day so long as the indications demand,
During the remainder of the twenty-four hours, we give ipecacu-
anha with morphine, or such other remedies as the circumstances
of the case seem to require. It may not be amiss to say here that
mercurials are incompatible with the mixture.

The acid doubtless stimulates the capillary circulation in the
liver, promoting bilious secretion, while the sulphate of magnesia
relieves the portal congestion and frees the bowels from irritating
secretions. From the relief which speedily follows its action, to
the tormina and tenesmus, greater than that following any other
evacuant, we cannot help thinking the acid has a direct sanitary
influence upon the inflamed mucous membrane.

With young children, where smallness of dose and pleasantness
of taste are always considerations of much importance, the above
mixture is decidedly objectionable. The taste is rather disagreea'
ble, and the necessity for diluting the mixture, renders the bulk
such as no child will readily take. In such cases we have been in
the habit of scorching rhubarb, adding boiling water and extract
of hyosciamus, the dose of such proportioned to the age and con-
dition of the patient, sweetening the mixture and flavoring with
nitre.

This is to be given in repeated doses in the morning, sufficient
to produce a laxative effect, and during the balance of the day we
give hydrargyrum cum creta, in small doses, with Dover's powders
or such orher medicines as the circunistances of the case may
indicate, [Buffalo Medical Journal,

On the Use of Ice in Uterine Hemorrhage. By E. A, Hildreth,
M, D,, Wheeling, Ya.

Every physician has experienced the uncertainty, or to say the
least, the want of promptness in the effect of the "usual" rem-
edies for this difficulty. The remedy we propose is the introduc-
tion of ice into the uterus. It is not proposed as an " experiment, "
for it is now about ten years since we first used it, and have a
sufficient number of recorded cases to prove its utility.

The safety of passing a quantity of ice into the cavity of the
uterus after the expulsion of the child or placenta, has been ques-
tioned by some, as we believe, on purely theoretical grounds. The
effect in every case we have used it, has been to contract the uterus
quickly, energetically and permanently ; and as a matter of course
stop the uterine flow. We have yet to see any unpleasant result.

1657.] Ice in Uterine Hemorrhage. 171

directly or indirectly arising therefrom, on the contrary, the relief
[|j afforded is prompt and permanent.

We do not wish to theorize on the subject at this time; allow me
jx) subjoin a few facts as observed and noticed when they occurred.
Case I. June 16th, 1846, Mrs. McC, a3t. 40, in labor with her
fourth child. Describes her previous labors as "lingering." On
examination "per toucher" found theos uteri thick, firm, opened
as large as a half dollar membranes entire breech presenting,
pains slight. Prescribed Pulv. Ipp. Comp. grs. xii, and left
i:equesting them to call on me when the pains became more active,
/Dalled back in 6 hours, found her pains strong and expulsive, and
half an hour after, the child was expelled. Upon introducing my
hand along the umbilical cord, it was ascertained that hour-glass
contraction was present; the placenta remaining at the fundus of
the uterus. An attempt was made slowly to pass the hand through
the contracted portion, but failed. Gave her Morphia Sulph. grs.
e^. and permitted her to rest. Says she has felt no pain since the
^irth of her child. In about half an hour she had some pain with
profuse hemorrhage. Used effusion of cold water over abdomen
with pressure and gave her ^^, Morphia Acet. grs. J. Acet,
Xead, grs. iii. Flooding is checked. Endeavored to extract pla-
centa but failed. In about fifteen minutes flooding returned to
an alarming degree placed pounded ice over hypogastrium, and
introduced several pieces of ice into the vagina as high as os uteri'
flooding restrained and hour-glass contraction relaxed so that the
hand could be introduced and placenta extracted. Five minutes
after the flooding returned. Passed my hand into the uterus in
hope of provoking contractions, but without effect it feels like a
leiH *^6^ leather bag. Pulse very small and frequent, face and lips pallid,
uM complains of faintness and dizziness. Fearing now her rapid dis-
P solution unless a. more seccessful treatment was pursued, I seized
a lump of ice as large as a lemon, and carrying it through the os
uteri slipped it from my hand. The effect was immediate and
powerful, expelling a quantity of coagula, and contracting the
uterus to its usual size and firmness ; a graduated compress and
bandage were then applied pulse 120, small, weak, complains of
^ i giddiness M, M, perfect rest in horizontal posture pulverized opii.
. - grs. iii immediately after rest> Panada with Brandy. Saw her
four hours after has slept some no return of " wasting " feels
comfortable pulse 100, soft, full womb well contracted no pain
on pressure.

17th. Feels well -slept well last night pulse 90, weak- likes
her Panada no pain or tenderness over abdomen lochia not more
free than usual M. M. let her rest.

18th. doing well -22d thinks she can sit up forbid it and dis-
charged her, well.

Case II. Nov. 7th, 1847. Called in haste to see Mrs. B.; found
a German woman attending her as midwife the child has beeu

172 Ice in Uterine Hemorrhage. [Marcli,]

"born about an hour placenta not delivered, but she is floodin
profusely, which alarmed the midwife removed the placenta an^
gave Morphia grs. ss. friction with pressure over uterus sent for
ice hemorrhage somewhat less her face is blanched and anx-
ious pulse very frequent passed a lump of ice as large as a wal-
nut into the uterus which was followed by expulsion of coagula and
firm contraction repeated Morphia gr. i and left her in care of j
midwife. She had no return of hemorrhage and subsequently i
did well.

Case IIL Called in consultation with Dr. W. of M., to see Mrs.
M., a large, fleshy woman, who has had miscarriages at the third
month of utero-gestation. The foetus has been thrown off for sev-
eral hours, but placenta retained frightful hemorrhage superven-
ed, during which she has twice fainted while in the horizontal
posture the placenta can be felt through the os uteri with the
point of the fore-finger sent for ice, and during the absence of the
messenger, endeavored to extract the placenta with Dewees' Pla-
cental Hook, but failed. Dr. W. had previously used Morphia,
Acetate Lead, cold applications, etc., but the flooding continued,
though in a more moderate degree. From her general appearance,
coldness of surface, feeble pulse, etc., she must soon sink, if not :'
quickly relieved. At this juncture the ice came, and we prepared
a crystal about the size of the index finger, and passed it through
the OS into the cavity of the uterus, as far as possible, and allowed
it to melt; the flooding ceased and did not return again, although
the placenta was not thrown off for 30 hours afterward. She
recovered.

Case. IV. April 22d, 1849. Mrs. 0., after a natural and easv
labor was delivered of a second child placenta followed in 15
minutes, bandaged her and left her doing well.

May 30th, called to her in haste says she was taken "unwell"
yesterday, the discharge growing more profuse ever since (there
is a case of cholera in the next room and she is badly frightened)
her bed is now saturated with blood, and she is flooding rapidly
OS uteri easily admits the fore-finger, and is soft and dilatable.
Gave her Acet. and Opium, applied douche of cold water, ordered
ice and used the plug hemorrhage still profuse complains of
giddiness and singing in the ear, pulse very frequent and feeble
face blanched re-applied cold douche but without effect her
husband, after considerable delay brought the ice removed the
plug which was followed by a considerable gush of blood intro-
duced into the uterus several pieces of ice the size of a chestnut
the effect of stopping the flooding was instantaneous. May 31st.
Has had no occurrence of hemorrhage since the use of the ice. June
1st. The discharge from the uterus scarcely stains her cloth. She
recovered.

We hope the above detail is sufficient to give an idea of its appli-
cation ; we have never tried it in a case of Placenta Praevia. As

) ^57.] Convulsions in Children. 178

to being " something new" we do not know nor care : if by making
tiie practice more generally known through the pages of your val-
uable journal, we are instrumental in saving one poor woman from
diath by Uterine Hemorrhage, we are fully compensated. [Cin-
cinnati Medical Observer.

1. Convidsions in Children considered in an Etiological Point of
View. 2. Whooping- Cough. Translated from the French, by
M. MoRTOX DowLEB, M. D., New Orleans. (Z' Unioyi Medicale,
July 22, 1856. Journal fur Kinderkranhheiten^ 1856, etAnnales
Medicates de Flandre occid.^ Juillet^ 1856.

I. Convulsions, it is known, are amongst the most frequent
symptoms of the morbid affections of infancy. M. Tilner, of St,
Petersburg, has made the different conditions by which convul-
sions are produced, a subject of special study, the chief of which
Le has found to be the following:

1. Convulsions proceeding from a morbid condition of the ner-
vous system. In this categorj^ must be included all of the organic
modifications of the brain as congestion, inflammation and its
consequences, softening, foreign bodies, exostoses, etc. These are
the most frequent causes of the convulsive affections of infancy,
and have little that is favorable in the prognosis. Most of these
affections, it is true, can only be considered as secondary, and as
proceeding from a dyscrasia originating in derangements of the
digestive organs, or from functional anomalies presenting them-
selves under the form hyperaemia, and serous effusions. The con-
vulsive phenomena which these causes provoke, carry with them
*the character of legitimate cerebral convulsions, are either tonic or
clonic in their character ; but always accompanied with a loss of
consciousness more or less marked, and in these diseases present
themselves as a precursor of death and they come on quickly,
lind sometimes periodically. The cerebral affection may extend
itself to the spinal marrow, and then tetanic convulsions show
liiemselves.
. \2. Convulsions which proceed from a pathological condition of

I the blood. The causes are : a, by toxicosis, from medicines and
poisons, such as narcotics, directly producing cerebral convulsions,
hux vomica, and strychnia, giving rise to tetanic symptoms, which
J tave their starting point in the spinal marrow ; Z), by toxicosis,
from the maternal milk, vitiated by the use of spirituous liquors,
or by violent mental emotions ; c, by modification of the blood in
acute exanthemata. This cause often produces convulsions before
the eruption of the exanthem, and convulsions may also occur be^
fore the accession of fever in interraittents ; c?, by sanguineous
modification in phlebitis, and especially in suppurative inflamma'

174 Convulsions in Children. [March,

tion of the umbilical vessels, which, as is well known, may cause
tetanic convulsive symptoms.

8. Convulsions take their origin in a morbid condition of the
digestive organs. These are the most common kind of convul-
sions and this we might readily anticipate, from the improper
alimentation which we witness amongst both the rich and the poor.
This cause becomes especially powerful at certain periods of infan-
cy, such as those of dentition and weaning, and in the presence of
worms in the intestinal canal.

4. Convulsions arise from certain conditions of the organs of
respiration ; such as those which supervene in the latter stage of
bronchitis and pneumonia, and they are, as is well known, often
the result of whooping-cough and laryngismus stridulus.

5. Convulsions accompany diseases of the urinary organs, and
we may here specially note the eclamptic symptoms which mani-
fest themselves in children attacked with albuminuria.

6. Convulsions proceed from a morbid condition of the genital
organs. The writer recalls to mind a case of convulsions, in a
boy four years old, in consequence of the retention of a testicle in
the inguinal canal.

7. Convulsions arise from diseases of the osseous system.
Amongst these may be named rachitic malformation of the cra-
nium.

In view of this aetiological tableau of the convulsions of infancy,
we may offer the following reflections : The convulsions called
cerebral, are amongst the most frequent of the affections of infan-
cy. Nevertheless, the primitive cerebral affections are very rare
in children. The convulsive manifestations are more often the
consequence of the extension of other acute and chronic diseases
which manifest themselves symptomatically, producing ultimately
convulsions at the precise period when the brain begins to parti-
cipate in the morbid condition.

Next in the order of frequency, come convulsions from reflex
action, which have their starting point in the intestinal canal, ma-
nifesting themselves ordinarily after the prolonged existence of in-
tractable abdominal disease. Notwithstanding, the diseases of the
digestive apparatus may also accompany secondary cerebral affec-
tions, which are in a condition to produce cerebral convulsions.
The convulsions arising from a morbid condition of the spinal
marrow, are rare, especially in the pure form ; for they appear
more often as subsequent phenomena to cerebral spasms, than as
an affection of the brain, propagated to the spinal marrow. It is
to a morbid alteration of the blood that we are to look for the
most frequent cause of tetanic spasms, though the latter may have
their orimn under certain climatic circumstances.

I

1S57.] On the Seat and Nature of WJioopwg- Cough. 176

II. On the Seat and Nature of Whooping -Cough. {Gazette ffehdom,'
adaire de Medecine et de Chirurgie^ of August 22, 1856. Acade-
my of Sciences.)

M. Beau has satisfied himself^ bj numerous anatomical investi-
gations, that whooping-cough is an inflammation of the mucous
membrane which covers the supra-glottidian region of the larynx ;
that is to sa}", the narrow zone which is situated between the su-
perior orifice of the organ, and the superior vocal chord. "When
the muco-purulent product, secreted by the inflamed membrane,
eomes in contact with the glottis^ it determines the production of
suffocative symptoms, similar to those which are experienced
when any one has, as is said in popular language, swallowed the
uTong way. All at once the glottis is closed, and there results^
from this, an acute crowing inspiration, which is followed by the
violent paroxysmal and jerking cough, which constitutes expira-
tion ; and this cough causes the expulsion of a considerable quau"
tity of pituitous liquid to be cotemporaneously secreted. The
muco-puralent matter which has come in contact with the glottis
is the cause of these symptoms, and it& tenacity and adhesiveness-
causes it to be with difpiculty expelled.-

The phlegmasial nature of the disease is perfectly evinced to M.-
Beau, from the following considerations : 1, the march of the dis-
ease, which exhibits a catarrhal period, or a state of acute supra-
glottidian laryngitis, and a nervous period or chronic state, in
which the suffocative symptoms are at once more intense and more
frequent, from the fact that the secretion of muco-pus is also more'
free and abundant; 2, from the infiuence of moral causes on the
paroxysms of cough provoked by the inflammatory secretion,,
which emotion has rendered more active ; 8, from the special sen^
sation of constriction about the throat ; 4, from its contagion for
the contained, and in some sort volatile, corpuscles of the inflam-
matory matter, may very readily, after having been expelled in
expiratian,. be inspired by other individuals, and deposit itself in
the healthy larynx, which thus becomes inflamed by the contagi-
eus influence. New Orleans Med. & Surg. Journal.

On Nux Vomica in Constipation. By J. H. HoUGHTON, Esq., Dudley.

[We are constantly consulted by patients who tell us that they
hardly ever have their bowels moved without taking medicine.
They have generally tried every kind which we can recommend,
and the only consolation we can give them is, that they must ring
the changes and increase the doses. The effect of this is often
only to aggravate the mischief and hasten on some of the thousand
and one ill consequences which we may expect from such a state
of affairs. As the result of much experience, Mr. Houghton says

176 Nux Vomica in Constipation* [Marcli^

that in nux vomica we have a remedy capable of relieving many
cases of this nature, of which he gives the following: ']

Case 1. December 4th. Emma Gibbs, aged 29, came under
my care at the Dispensary on October ord, suffering from an at-'
tack of congestion of the uterus and vagina, which yielded to local
depletion, rest, baths, &c. She is naturally of a delicate frame
and constitution, and was left very much debilitated by the attack.
She got relief to her debility by taking quinine and iron; but
during the whole of the time her bowels were unmanageable and
obstinatel}^ costive. To relieve this, she has taken, and had given
to her, castor oil, senna mixture, pills, and, last of all, pills contain--
ing two parts of colocynth and one of henbane. Of these, at first,
she took two with relief; then three became necessary, and then
four ; she then took four at night, and followed it by castor oil in
the morning, and thus obtained a motion once in two or three
days, with much pain and trouble. On the 13th of November I
I gave her twelve pills, consisting of 3 ss of henbane, Bj of com-
pound extract of colocynth, and gr. iij of extract of nux vomica^
and desired her to take one every night, and to continue her ton-
ics as usual. From that time to the present (three weeks) she has
taken one pill every night, and had one comfortable motion every
morning, without the aid of any other aperient, and her health
has much improved.

Case. 2. Sarah Silvester, aged 85, applied to the Dispensary
on December IGth, suffering from a severe attack of gastrodynia/
attended by some derangement of the uterus. I extract the follow-
ing from my notes: ^Tongue furred, yellow, indented by the
teeth, moist. Appetite bad ; violent pain after eating, worse at
times; frequent regurgitation of food, sometimes vomiting; some-
times she is compelled to produce vomiting before she can get re--
lief after eating. Bowels habitually costive, and very unmanage-
able. Her habit is to take medicine twice a week, after which she
has two or three stools, and then the bowels do not act again till
she again takes medicine. She says she has taken *' all sorts of
medicine," including many quack pills, for the relief of her bowels,-
but only with temporary benefit, the bowels returning to their
inactive state. She had bismuth three times a day, and the pill
before named every night.

December 19 til. One motion daily, with perfect comfort; she
lias not been so comfortable in her bowels for years. Gastrodynia
and vomiting much relieved.

January 16th (thirty-two days). She has taken one pill every
night, and had one motion eVery day with comfort. The pills have
never missed. Her stomach symptoms are relieved.

Februar}^ 13th. She was at the Dispensary to-day. She has ta-
ken one pill every night, now two months, audit has never failed.

Authorities are very silent on the peculiar property of the nux
vomica which I am now discussing. The last edition of " The

1857.] Nux Vomica in Consiipation. Ill

Pharmacopoeia Londinertsis^' dismisses the whole matter in these
laconic words: " Use in some cases of paralysis."

Pereira does not allude to it, though he speaks of the efficacy of
the drug in " dyspepsia, pyrosis, and some forms of dysentery."

Dr. Copland, whose mind seems to have embraced almost every
thing in medical science, says, "In cases apparently depending on
deficient tone of the muscular coat of tlie large bowels, and imper-
fect propelling power of the upper part of the rectum, I have seen
benefit from combiniug the extract of nux vomica with the pilula
aloes c. myrrha or compound extract of colocynth."

Dr. Neligan, in his excellent treatise ' On the Uses and Modes
'of Administration of Medicines,' observes: '*I have used the ex-
tract of nux vomica with much advantage, as an addition to pur-
gatives in constipation depending on want of tone in the muscular
coat of the large intestines, one of the most frequent causes of this
state in females, and one which is distinctly characterised by great
secretion of flatus, and colicky pains which accompany it.

So far as I have been able to learn, we are indebted to Magen-
die for the first suggestions on the powers of nux vomica,- In
1845, Dr. Tessier, of Lyons, published a paper which was quoted
in ' The Lancet,' and in which he says that " he considers it par-
ticularly indicated in cases where there is reason to suspect general
want of tone in the bowels, as in paralytic and old persons, or
where we suspect want of tone of the muscular coat, in conse--
quence of great and long-continued distension ; or^ in short, where
the constipation can be referred to an undue secretion of gas,
which in itself, by causing distension of the bowels, diminishes
their contractile power."

In the Journal of this association for May, 1848, is an article by
Mr. Boult, of Bath^ on the employment of nux vomica in habitual
constipation, in Avhich he observes : I first tried the extract alone,
.in half grain doses, two or three times a day, and was disappoint-
ed with the result. I was then lead to use the extract in combin-
ation with aloes, rhubarb and scammony, and was surprised at
fehe result." Mr. Boult seems to think that it has the power of in-
treasing the action of other purgatives ; and he says : " Generally
speaking,, a pill containing three quarters of a grain of Barbadoes
aloes, three-quarters of a grain of extract of rhubarb, and half a
grain of extract of nux vomica, taken at bed time, will produce
one or two evacuations the next morning." And he continues :
i"I have prescribed the pill already mentioned for months togeth-
er, and at the end of that time the effect has been produced as cer-
tainly as at first, and no bad consequence has arisen : on the con-
bary, I think it will be found that, when the medicine is discon-
tinued, the tendency to costiveness will be found to be diminished."
' The correspondent of ' The Medical Gazette,' November 10th,
1855, in his Notes on Hospital Therapeutics, has the following ad-
oiirable remarks on the subject: "Among the conditions over

178 On Hepatic Dropsy 4 ' [March,

which mix vomica, and its active principle, strychnia, possess most
useful powers, is that of habitual constipation from muscular atony
of the intestinal tube. At the City Hospital for Diseases of the
Chest, we observe that Dr. Peacock and Dr. Andrew Clark ar^
both in the habit of frequently resorting to it for this purpose. It*
is generally given in combination with the compound rhubarb pill^
and in doses of the extract of from one-sixth to one-half a grain.
Of itself it can scarcely he deemed an aperient ; that is, it does not sa
nmch excite peristaltic action as supply tone to the weakened
muscular coat, by which it is enabled to reply ef&ciently to other
irritants. Hence the need of combination with aloes, rhubarb, of
some similar dnig.'^

Dr. Peacock has mentioned to us a case in which a man of fee-
ble intellect and torpid nervous system generally, had derived
great benefit from its employment. At first, the bowels were oV
stinately costive, and lavements produced no action ; but since the 1
use of nux vomica they have so far increased in power and stis*
ceptibility that simple injections are quite sufficient to procure all
the action that is necessary.

With the observations quoted I generally concur, but specially
with those of Mr. Boult and of the correspondent of the ** Medical
G-azette.".

From the facts and opinions adduced I think we may safely
infer

1. That in the nux vomica we have a new agent in the treat--
ment of constipation : not a purgative or aperient, but a substance
which, added to very minute doses of various purgatives and ape-
rients, forms a kind of tertium quid^ which combines the advanta-
ges of purgatives without the disadvantages, which does not leave
the bowels debilitated and indisposed to act after its operation, but
which, on the contrary, imparts tone, rendering their action more
certain.

2. That the agent does not lose its power by continued use,

8. That it is a perfectly safe remedy when used in the mode
suggested.

4. That it is not an accumulative medicine. [Assoc. Med. Jon

On Hepatic Dropsy. By Dr. G. BuEEOWS, F.E.S., Physician t{
St. Bartholomew's Hospital.

pn a clinical lecture on this subject. Dr. Burrows first noticec
the symptoms which most commonly attend these cases. The;)
may be briefly mentioned,, as, a swollen prominent abdomen, dis
tinct fluctuation, sallow complexion, slightly jaundiced conjuncti
va, pain and tenderness in the right hypochondrium, hard mas
projecting below the ribs towards the umbilicus, high-coloure<
scanty urine, slight fever. Most frequently these symptoms wil

1857.] On Hepatic Dropsy. 179

have been produced by intemperate habits, which generally bring
on cirrhosis of the liver.]

The treatment of dropsy is, at all timeSj confessedly difficult ; but
according to my experience, these cases of hepatic dropsy are not
BO intractable as the}^ are represented to be, in some modern trea^
tises on diseases of the liver.

The first measure to be adopted will depend greatly upon the
duration of the complaint. If the patient complain of pain in the
right hvpochondrium, or if there be tenderness there on pressure,
together with febrile excitement, and the strength of the pulse will
permit, I recommend you to resort to local depletion, A few
ounces of blood may be taken by the cupping glasses or by leeches,
from the region of "the liver, and this depletion should soon be
followed by the application of one or more blisters in the same
region. In many cases the symptoms hardly call for vascular de-^
pletion, and we commence the local treatment by the application
of a blister.

2ndly. Evacuate the intestines by a freely acting purgative, and
repeat this once or twice in the week ; this evacuation affords
relief, and, I think, is less distressing to the patient, and less irri'
tating to the alimentary canal, than the daily use of less active
aperients.

' 3rdly. Having premised these measures, I advise you to lose no
further time in resorting to the internal and external use of mer-
cury, not in such doses as to affect the system rapidly, and as would
be proper in cases of acute hepatitis, but very gradually.

I usually prescribe the pil. hydrarg. gr. iv., cum pulv. scillae
gr. j., nocte maneque, and find this quite sufficient for the purpose^
But then, as soon as the blistered surfaces will permit, I order
mercurial friction over the abdomen twice in twenty-four hours,
and here I prefer the stimulating effects of the lin. hydrarg. to the
simple inunction with the ung. h3^drarg. According to my expe^
rience, there is no remedy so powerful in exciting the absorption
of the products of inflammation within the abdomen or of fluid
from the peritoneum, or of stimulating the liver to increased secre-
tion, or the intestines to more energetic peristaltic action, as mer^
curial frictions over the abdomen* This remedy is not only, in
my hands, most efficacious in the treatment of ascites arising'^from
chronic hepatitis, but also of inflammatory effusions within the
abdomen ; and likewise in obstinate constipation, sometimes erro-
neously supposed to depend upon mechanical obstruction of the
bowels. I advise you to place confidence in these means in the
treatment of ascites depending on cirrhosis ; but remember it will
be necessary to sustain the mercurial action for several weeks. It
may be necessary to suspend the mercurial friction occasionally,
- and then, if any tenderness be detected in the epigastrium or hypo*
chondrium, a blister may be applied there.

4thly. Simultaneously with this use of mercurials, you may

K. S. VOL. XIII. KO. III. 12

180 Displacements of the Womh. [March,

employ diuretics freely, if careful analysis assures you the urin^ is
free from albumen. Some writers of high repute upon diseases of
the liver speak disparagingly or doubtingly of the efficacy of diu-
retics in this form of dropsy, or of the ability to reduce ascites by
the use of diuretics. This latter class of remedies are notoriously
uncertain in their operation, but nevertheless, I have found them
far from useless in the treatment of ascites,, especially where they
have been combined with the remedies already enumerated. The
diuretics I prefer are the salts of potash combined with sp. aeth. nit
and sp. juniperi comp. I generally combine two or more of th
following salts of potash in varj-ing proportions ^the potash bi-
carb., potassiB acetas, potassge tartras, potassse nitras, and potassse
iodid. When this plan of treatment has not a sensible effect in
diminishing the ascites in the couree of three weeks or a month, I
should recommend you to resort to paracentesis abdominis at once,
and not wait until abdominal distension has become enormous and
the different internal organs almost paralysed in their functions by
the long-continued pressure of the effused fluid.

Many advantages may be derived from one operation of tapping,
which wdll not follow: upon its repetition; indeed, the frequent
withdrawal of the fluid by tapping causes much exhaustion, and
may be followed by fatal peritonitis. The first removal of the fluid
generally affords great temporary relief to the patient,, but other
advantages may be expected from the operation. If the operator's
hand be carefully passed over the right side of the abdomen, when
it is emptied of the fluid, he may ascertain with more exactness
the real condition of the liver, w^hether it be enlarged or small, or
retracted ; w^hether its upper surface be smooth or nodulated hy
deposits in its substance. Such information may encourage a per-
sistence in former treatment,, or may dissuade from- the use of all
further exhausting remedies. Moreover^ it not uncommonly hap-
pens that, while the abdomen is enormously distended, diuretici
and purgatives have little or no effect ; but that, when the interna
pressure is removed, the kidneys and bowels begin to- evince thei:
susceptibility to the influence of remedies previously administered
with no success.

Lastly, I may warn you,, that patients laboring under this fore
of dropsy have generally been accustomed to intemperate habits
and Avill not bear a very low diet.. A moderate quantity of dr
nutritious food is better digested than slops, and 3-ou will find th
nervous system and the flatulent stomach require a small amour
of some stimulant daily. [Med. Times and Gazette..

Displacements of ike Womb.

It is our impression that there is not a sufficient recognizance (
the uterus as a "floating" body, or rather as a body whose m-
chanical conditions of equilibrium make its support more near]

1857 J Ligation of Arteries. 181

analogous to that than to any other mode of support. The most
considerable solid support of the uterus is the vagina. These two
conditions lead to an easy understanding of many phenomena of
the minor motions of the uterus, called mis* or displacement. The
destruction of the vaginal support by relaxation (sometimes a sort
of paralysis) of the tube, often accompanied by a similar condition
of the rectum, leads to the most complete displacements of the
Womb itself healthy, leads also to all the ordinary symptoms of
uterine ailment in the most aggravated form, and curable only on.
condition of curing the vagina. Again, enlargement, and conse-
quently increased weight, of any part of the uterus, leads to sink-
ing of it. Enlargement of the cervix leads to depression of the
organ. Enlargement of the bodyj causing top^heaviness, leads to
retro- or ante-version, or flexion. It is almost certain, that the
ligaments of the uterus have almost no function as ligaments, but
quite the reverse, and that in those cases of displacement, where
symptoms are ascribed to dragging on them, there is no such drag-
ging at all, the uterus having free motions afforded to it by these
ligaments, which are not to be put on the stretch by any ordinary
misplacement. It must also be remembered, in regard to uterine
flexions, that the organ is sometimes so softened, as not to be ca-
pable of bearing its own weight a circumstance sometimes con-
nected with leucorrhoea and painful symptoms. These considera*
tions we could with pleasure follow out to much greater length,
We shall only say, that their comprehension is a great object to
all obstetricians, for as surely as the}^ attain to a correct apprecia-
tion of them, so will they acquire confidence and skill in prescribing
for or advising the sufferers from them.- [Edinburgh Med, Jour.

On the Ligation of Arteries. By T. P. GiBBOXS, M. D.

The danger of secondary hemorrhage is well known to be one
)f the great drawbacks to the ligation of the large and deep-seated
\rteries. This is particularly true with regard to the femoral ar-
ery, owing to the number of its collateral branches. Indeed, so
nany unfortunate results, from this cause, have occurred in the
'igation of this vessel, that some surgeons prefer, rather than resort
0 it, in certain cases, to amputate the limb.

The method usually recommended for the performance of liga*
ion, is to cut down upon the vessel and open the sheath, without
isturbing the tissues more than just sufficient to carry the aneuris*
lal needle, armed with the ligature, around it. By this plan of
rocedure, it is contended, that the danger of extensive sloughing
* avoided. This is unquestionably true. But how is the dano-er
bnsequent upon the application of the ligature immediately below
'large collateral branch, to be obviated by such a process?

Of aU the animal tissues, that of arteries is least liable to slough ;

182 Ligation of Arteries.. [March,

therefore^ taking this fact in consideration, it appears a fair infer-
ence that by exposing the artery as- much as may be necessary in
the method for applying the iigaturCy presently to be described,
the danger of secondary hemorrhage is,- to a considerable extent^
lessened.

Some tAvo years ago, I witnessed the operation, of the ligature of
the femoral artery^ for an extensive osseous aneurism in the head
of the libula. The case progressed favorably, the ligature came
away at the end of six weeks, and the wound closed. The opera-
tion, so far as the cure of the aneurism is concerned, was success-
ful. The man subsequently died from an attack of delirium
tremens, and an opportunity was afforded of ex>amining the parts.
The ligature had been applied midwa}'- between two collateral
branches, about an inch and a quarter apart. An organized plug,
upon each side of the liguture, had produced complete obliteration
f the calibre of the vessel.

The peculiar plan of the operation was as follows : The artery .
was exposed in its sheath,, to the extent of half an inch ;- a grooved
director was carried obliquely under it, and raised so as to allow
the ends of the instrument to rest upon the edges of the wound;
the director was then brought round at right angles to- the course
>f the vessels, and an eyed probe, armed with a ligafare, carried.
along the groove. The artery was tied at this point

The mechanism of the process is yqtj simple. "Whea the direo-
^r is carried obliquely under the vessel, as the primary step, and
subsequently moved round at right angles with it, it will be ob-
served that the position which the instrument holds beneath the
artery, is such as to insure the application of the ligature midway
between the two nearest points of resistance ;- which points usual'
ly to the connection of the collateral branches.. The reason foF'
its occupying this particular position is sufficiently evident: m
moving it from a branch the resistance becomes less, while ift
moving towards one, the resistance is of course increased; the
consequence is, that the director,, when placed at right angles witfej
and under the vessel, naturally assumes a position where the tw^l
forces act equally, that is, equidistant from the two points of r|
sistance.

That the danger of destroying the vitality of an arter}^ is m^
so great as is usually supposed, may be inferred from the foUol
ing case. Some time ago, I had occasion to cut down upon, anecj
tie the radial artery for secondary hemorrhage, which occu:
from a wound at the wrist.. The artery was exposed and sep;
ted from its sheath for the distance of an inch, and the ligati
applied at the distal extremity of the wound. Everything pnoj
gressed favorabl}^, the ligature came away about the usual timfl
tiie wound healed kindly, and there was no cause to regret haviaj
isolated the vessel from its cellular attachments. We see the sai
indisposition to slough on the part of the arteries frequently mai^|

1857.] Irregular Contraction of the Uterus. 18S

fested when they are exposed in deep ulcerating wounds, where
the process of destruction has involved almost every structure in
the neighborhood, including the cellular tissue immediately around
them ; and yet, under such adverse circumstances, their integrity
is perfectly preserved. If then, nature has endowed these vessels
w^ith such remarkable powers of resistance, why should surgeons
hesitate to act on the suggestion so plainly thrown out, and reap
the obvious advantage which isolation of the artery, and separa-
tion from its vascular conduits, will afford them in the operation
of ligation for aneurism? [N. A. Medlco-Cldrurg. Rev.

On Irregulur CorUraction of the Uterus. By Dr. Chaxniistg,

Dr. Channing observes, that he never now meets with the hour-
glass contractions he supposed to occur in his earlier practice. The
following is his account of the nature and cause of these irregular
COD tractions- " In these cases referred to, the followiug facts have
been observed : They have most generally occurred in first labors.
Everything has proceeded naturally, it may be, through all its
' stages. The after-birth has been expelled, and the patient may
> have been arranged in her bed. Sometimes, however, before this,
( pain may have been complained o This increases until it amounts
I to agon)'-, with expulsive efforts- The abdomen is examined ex-
', ternally. In about its middle, or higher, a hard ball-like tumor is
: felt, very sensitive, and easily distinguished from everything about
it. Below this the abdomen feels soft, and bears pressure without
any complaint. Ifot a sign of hemorrhage is present- We think
of after-pains and of their accidental exaggerations. But it is a
first labor a perfectly natural one and after-pains are rare under
such circumstances. We examine per vaginam. Severe suffer-
ing is complained o We have scarcely entered it when a firm
obstruction is encountered. We proceed along one of its sides,
and discover a verj^ large coagulum. We go on, and at length
feel the firm, contracted portion of the womb above. The open
hand is now passed above the coagululum, and slowly presses it
downwards and out. Belief is instantaneous. Slowly the hard
tumor descends, under regular but insensible contraction, and gets
its natural place above the symphysis. Barely is relief expressed
so completely as after this operation ; not even when the head is
: passing the external organs- These cases strikingly resemble each
; other, and when once seen, they will always afterwards be easily
..Lfecognized."

M- This condition may be confounded with retained placenta, in-

'" verted uterus, severe after-pains, and internal hemorrhage- Of

:he first of these the author gives instances, and the characters of

aversion of the uterus are sufiiciently obvious to prevent error.

iifter-pains do not usually follow first labors, and when present

k

184 Singular Species of Neuropathy^ d;c. [March,

in severity, they probably depend on irregular contraction, with
retention of coagula in the uncontracted portion ; while, in other
cases, when retention of urine has been present, the uterus takes
on pseudo-expulsive action. The internal hemorrhage met with
in this case differs from that usually so designated. Thus there is
sudden and severe pain, and faintness is very rare, and rather due
to prior exhaustion than to the loss of blood, which is much less
than in ordinary hemorrhage. There is not the enlargement of
the abdomen, and it has not the same firmness, except at the spots,
where the contraction exists, where, indeed, it is much firmer.
Elsewhere it is soft and is not tumid. The flow is slight at first,
and the blood coagulates as it takes place. It is forced down into
a solid mass through the dilated os into the vagina, becoming
firmer and firmer, until at last it gives rise to strong painful con-
tractions, for the purpose of obtaining its expulsion. The diagno-
sis is still further aided by the perfect relief that follows the removal
of the coagulum. In none of the cases has secondary hemorrhage,
so common in ordinary hemorrhage, been met with ; and there is
here a feeling of safety which does not attach to ordinary cases.
[Boston Journal^ and Med. Times and Gaz.

On a Singular Species of Neuropathy, the Barking Mania. By M,.-

BOSREDON.

This singular affection, the history of which is lost in the dark- .
ness of the middle ages, appears to have originated in Brittany.-
Dax, a town of Landes, also furnishes some examples. The phe-i.
nomenon, which is tolerably rare, and the nature of which is little^
known to* the medical world, reappears at more or less distant iny
tervals : it is characterized by a piercing, convulsive cry, occasion-
ally musical, imitating at one time the crowing of a cock or the-
ory of a peafowl, at another the bleating of sheep, the mewing of
a cat, or the yelping of dogs. It is this character which has caused*
the name of barkers to be given to women labouring under this I
affection. As medicine has always been unable to combat thidf I
extraordinary ailment, the church has had recourse to exorcisnui 1
and pilgrimages, but these various expedients have rarely t>eeal ^
crowned with success. Chance has just brought under my notidflfl^
a case of this kind, which, under medical treatment, has resulted ^^
in recovery. :* %

Jean Koux, aged 11 years, of a nervous and sanguine tempera*Bift|Q
ment, youngest son of a vine- dresser, who died of phthisis thredjliSiJij
years before his son's illness, living with his mother at Sainte^Bsltliei
Oroix-du-Mont, (Gironde) was attacked, without any known cause,ij!igg^
on the 1st Februar}^, 1846, with an apyrexial cough, tolerably lijje^
severe during the day, accompanied with a slight mucous expeOMjig
toration and headache: he was undisturbed during the night. "^i^

These symptoms had yielded to suitable treatment, when, or

ii^

1857.] Death after Operation with the Ecraseur. 185

the 15th of the same month, he began to give utterance to a cry
like that of a fowl whose oesophagus was obstructed, and which
lasted for seven or eight seconds. These attacks, which were ac-
orQpanied with a painful and jerking respiration, were repeated
eight or ten times during the day. On the approach of night they
ceased until seven o'clock in the morning, v/hen they were renew-
ed. Sulphate of quina, chloroform internally and externally,
various purgatives, cold baths, and. cold immersions, were tried
in vain.

These attacks always following the same course, intermitting at
night, became more intense during the day, and fatigued the pa-
tient more, without, however, proving very injurious to his health.
Despairing of success by the means above enumerated, I em-
ployed a mixture of lime-water, four ounces; acid valeriante of
atropine, half a milligramme [.007716 of a grain ! 1] ; simple syrup
one ounce. To be taken in spoonfuls during the twenty-four
hours.

This mixture produced strong dilatation of the pupils, hallucin-
ation, incoherence of ideas; in a word, a decided effect on the
whole nervous system, especially its cerebral portion.

^ In the course of the following twenty-four hours, the system

> had returned to its normal condition -, the disease had completely
yielded.

Eight days later, under the influence of a slight impression, this
young boy uttered two cries tolerably like the above ; to prevent
their return I advised, on the 21st of August, the use of the same
mixture ; but the patient took only a few spoonfuls, on account of

i the supervention of nervous symptoms.

, He has since had no return of the affection, and his health has

i continued good.

i What are the nature and seat of this disease ? This I shall not

I undertake to decide. However, it is to the acid valeriante of atro-
pine that this young patient owes his recovery. It was as a pow-

' erful modifier of the nervous system, that I determined to employ
it. [^Gazette Medicale de Paris Dublin Med. Press.

, Death after Operation wiili the Ecraseur. By L. E. Desmond, Hon-
orary Surgeon to the Liverpool Dispensar}^

The ecraseur having first been introduced into Liverpool by the
.medical staff of this dispensary, it was my lot to assist at almost
all the operations hitherto performed with it; and having witness-
ed their successful issue, I had no hesitation in employing it in
this case. Five other surgeons, who were with me at the time,
were satisfied as to its fitness, and its apparent safety from hem-
;Orrhage.

Cath. Egan, aged 41, presented herself at the ]S"orthern Dispen-
isary, having suffered great pain, for a length of time, from two

186 Cause of Vomiting in Pregnancy. [March,

hsemorrhoids just witHii tlie anus, one at each side, and a large
prolapsed portion of villous raucous membrane anteriorly, from
an open vessel in the centre of which she had on each occasion of
her going to stool lost considerable quantities of blood ; indeed, it
sometimes flowed from her as she stood upright, the bleeding point
often being outside the anus. She was weak, anaemic, sallow, and
altogether cachectic, and was about three and a half months preg-
nant. I removed first the two hsemorrhoids, occupying three and
a quarter and four and a half minutes respectively in their stran-
gulation, and then the prolapsed mucous membrane, of about the
size of a Spanish nut ; including, of course, the bleeding point, an
assistant's finger in the vagina making this part protrude. As
this was the largest portion, and looked red and vascular, I spent
six and a half minutes in its strangulation. ISTo haemorrhage fol-
lowed their removal, and the wounds remained closed, with their
edges pinched together, as is usual after using this instrument.
She was visited in one hour and a half after the operation, when
it was found that having a desire to go to stool, she had sat up and
passed a clot of about four ounces. There appeared no bleeding
now. A grain and a half of opium was given, the parts kept cool
and strict quiet enjoined. 8, P.M. No return of the haemor-
rhage, nor any further desire to empty the rectum. Another
grain and a half of opium was given, and she was left for the
night, which she passed without sleep, being very restless, and
getting out of bed two or three times for a drink. She parted
with no more blood till nine the next morning, when she passed
about twenty ounces of dark clot. She was visited soon after-
wards, and twenty drops of Battley's solution, with half a drachm
of chloric ether, were given, and brandy and nourishment ordered
at intervals. At 2, P.M., she had had no further heemorrhage;
and on examining the state of the rectum, with a finger in the
vagina, it was found to be quite empty. She had had some vom^
iting, was restless, and the pulse 110. Stimulants and nourish-
ment to be continued, with ten-drop doses of Battley's solution
and ether, and to be watched. At 9, P.M., her condition was
that of great exhaustion, with some stupor ; pulse 130. She was
evidently sinking, and she died without any further bleeding on
the 7th, thirty-seven hours after the operation. No post-mortem
was allowed, [Association Journal,

On a Cause of Vomiting in Pregnancy. By M. Briau.

The conclusions arising from the following case are First, that unman-
Rgeable vomitings may be caused by the confinement of the gravid uterus
in the hollow of the sacrum ; and secondly, that these vomitings may im
mediately cease upon the correction of this irregular condition. M. Briau
mentions that several cases of the kind have occurred in the practice ol
M. Moreau.

Case. Madame X., set. 25, of lymphatic temperament, well formed, and

1857.] Editorial 187

healthy. Six years ago she was confined of her first child, and everything
went on perfectly well. Three years afterwards she was confined again,
and on this occasion also, she went on well, with the exception of some
feelings of malaise and vomiting during the first months. A few weeks
afterwards, however, she was gently startled by an accident, and from this
time she sutfered more or less from leucorrhoeal symptoms. Madame X.
again became pregnant in March, 1856. About the middle of the month
following, she began to vomit, and these vomitings progressively became
more and more unmanageable until nothing would remain on the stomach.
Throughout the whole month of May she was affected with severe gastral-
gia, with constipation and continual thirst. Then she began to sufter from
frequent cramps and convulsive movements, with sleej^lessness and great
depression of spirits.

M. Briau was called to the case on the 2d of May, and all the usual
means were tried without success. Then an exepriment in homoeopathy
was tried, and with the same result. M. Briau was recalled on the 2d of
June, and on this occasion he suspected that the vomiting might depend
upon some uterine displacement. He did this partly on account of the
continuance of the leucorrhoeal symptoms, and partly from the fact that
the uterus could not be felt in the proper position. Two days later, M.
Moreau was called in consultation, and an examination made, when it was
found that the uterus was in a state of incomplete retroversion, as well as
in a state of incarceration in the hollow of the sacrum. This malposition
was corrected without causing any pain to the patient, and immediately
her former sufferings began to subside. On the same day the vomitings
ceased, and some food remained on the stomach. . On the night following
she slept comfortably. In less than forty-eight hours the belly acquired
the usual development belonging to the third month of preg-nancy ; and, in
ft word, the patient recovered rapidly, without another bad symptom.

\^Gaz. de Hehdom. et Med. et Chir. Banking'' s Abstract,

EDITORIAL AND MISCELLANEOUS.

Medical Society of the State of Georgia. " At a late hour, on mo-
tion, the Society adjourned to meet again at 11 o'clock, A.M., on the second
Wednesday in April, 185 V, in the City of Augusta ^

" F. C. Ellisox, Recording Secretary pro tern,

"Macon, April 12th, 1856."

We again call the attention of our readers to the approaching meeting
of this Society. Every physician in the State should consider himself a
member of this body, and we hope, for the interests of the Profession, that
all will make an effort to attend. The Society, wishing to remove all ob'
stacle, however trivial, to full attendance, have judiciously arranged to
have its aff'airs managed without the expenditure of money, [their transac-
tions are published in this journal] and, therefore, even the initiation fee

188 Editorial. [March,

has been abolished, leaving no let or hindrance (except such as pertain to
<:;haracter,) to the co-operation of all, in the advancement of medical science
in our State.

The approaching meeting is one which should be fully attended, from
the fact, that the American Medical Association the j^ational Medical
Congress of our Country will, at its next meeting, in May, convene at a
point (Nashville, Tenn.,) accessible to all who desire to attend- It may be
many years before the same opportunity will again offer. We hope, there-
fore, to see a large attendance at the next meeting of our State Society,
that this body may be entitled to a large delegation to the National
meeting.

This august assemblage, made up of elements from every portion of our
vast country, even now, exercises an influence in the medical world at large,
compared with which, none other, in the same time, has, elsewhere, acr
quired. We, of the Profession in Georgia, are expected by our Northern
brethren, to be well represented in our own South : they will have come
far to meet us, crossing many States^ let us not fail to cross the line between
two States to meet them.

" Calescimcs." The following lines, evidently from the pen of one, who
has burned with " Promethean fire," as well as with the calor mordax of fe-
ver, are hardly out of place, anywhere ; certainly not, in a Southern Medical
Journal. They strongly remind us of a production, of that most genial,
and yet most touching and melancholy, of all modern poets, Thomas Hood,
viz., "The Song of the Shirt;" the rythm suits the description of the
heart's fevered action, even better than the wearied movements of the shirt-
maker's fingers. We consider the words, the measure, the intentionally
monotonous repetitions, and the sentiment, most singularly expressive and
appropriate. They come to us anonymously, but we more than half sus-
pect the gifted source from which they emanate. If our suspicions are
correct, we will here fondly express the wish, that this heart may hence-
forth, only " throb" in that gentleness and benevolence which have ever
guided that same pen, and moved to deeds of christian love and charity,
that same kind hand.

NERVOUS FEVER PULSE 135.

Burn, burn, burn ;

Fever all the day.
Chasing my sleep at the midnight hour,

Burning my life away.

Beat, beat, boat;

My pulse -will beat away.
Forcing the work of a season's length

In its flying path to-day.

Sand Hills, Nov. 1856.

Drink, drink, drink;

Dream of a mountain rill.
Starting to grasp at the cooling draught;

Ah! I am parching still.

Throb, throb, throb ;

Bind ye my temples fast,
And press the weary eye-lids down

'Till the storm of fire has past

1857.] Editorial 189

An Address on the Life and Character of Robert M. Porter^ M.D., late
Professor of Anatomg in the University of Xashville. By John Beu-
RiEN LixDSLEY, Chaiicellor of the University.

" I think," says a livinof Christian writor,* " that Mr. Carlyle has demon-
Btrated, that a biography can be given in the compass of a review-article ;"
we can, with equal truth respond, that the writer of the above address
has fully demonstrated the same possibility, in the smaller compass of a
single lecture.

This excellent address, breathing the incense of an affectionate and be-
reaved heart, over the departure of a beloved and honored colleague, has
been kindly forwarded to us by our friend, the author, and though our
space will not allow us to give it that extended notice, which its merits
richly deserve, and which our pleasure in reading it, would incline us, we
can, at least, recommend it to our readers as the portrayal of the highest
style of professional character, manifested in the life of the lamented subject
of the address.

In the early period of youth, in riper manhood, as the devoted and un-
tiring student, the enthusiastic laborer in the noble cause of science, at last
sacrificing, even his valuable life, upon her too cherished altar ;f in eveiy
relation of life in which he is here described, we can but be warmed with
admiration in contemplating a character so approximating the ideal of the
true Man, the true Christian, and the true Physician.

" As a physician, the character of Dr. Porter will furnish a subject for

profitable and instructive study. He combined in a high degree, those

qualities and attainments which give dignity and grace to the profession,

' which from the remotest periods of history have procured it great honor

I among men, and which, so long as humanity continues subject to physical

' ailments, will continue to secure it a first place in the esteem and respect of

societv.

" He had exalted views of his profession, as to its dignity, responsibility
and utility. He did not undertake either the study or the practice of me-
dicine merely because it furnished the means of gaining a comfortable or
easy livelihood, but because it gave opportunities for making extensive pro-
gress in knowledge, and doing good continually and disinterestedly to his
fellow-raen. It was with him as it is with all men who truly succeed in
the professions called liberal. He loved his profession for its own sake, he
studied it for its own sake, and practised from the same motive."

* Rev. Peter Ba3me The Christian, Life, Social and Individual Preface.

f ' On July 1st, 1856, he ceased to live, after an illness of six weeks, and with a

perplexing complication of symptoms. The case was doubtless rendered fatal by

, the imbibition of a blood-poison taken into the system. May 27th, from dissecting

an offensive subject, while lecturing to the summer class then assembled." Address,

page 13.

190 Ediiorial [March,

The Physician^ s Preservption Book : Containing a list of terms, phrases, con-
tractions and abbreviations used in Prescriptions, with explanatoiy notes,
also, the grammatical construction of Prescriptions, etc.; to which is
added a Key, containing the Prescriptions in an unabbreviated form,
with a literal translation, intended for the use of Medical and Pharma-
ceutical Students. By Jonathan Pereira, M.D., F.R.S. 2d American,
from the 12th London edition. Pp. 282. 18mo. Philadelphia: Lindsay
ifeBlakiston. 1857.

This useful little work has been before the Profession for over thirty
years, and has reached its twelfth edition. That it should have continued
its existence, "nans in gurgite vasto," and not been overw^helmed in
the ocean of medical literature, during all that time, is enough to sub-
stantiate its merit, and render it unnecessaiy, for us, to do more than
simply express our acquiescence in the general commendation accorded to
this second American edition, of Messrs. Lindsay & Blakiston. Every body
knows what the w^ork is, and every body will find in it something useful in
his emergencies.

Medical Notes and Reflections. By Sir Henry Holland, Bart., M.D., F.R.S.,-
etc., etc., Fellow of the Royal College of Physicians, Physician in ordinary
to the Queen, and Physician in ordinary to his Royal Highness Prince
Albert. From the 3d London edit. Philadelphia, Blanchard & Lea.
1857. pp. 493, 8vo.

The above work, embodying the experience and thought of one, well
entitled to be styled, " a master in our Profession," consists of a number of
Philosophic and Practical Essays, published at various periods of the dis-
tinguished author's career; now collected and revised, they are submitted
to the profession in a permanent form. It is not a systematic work on the
practice of medicine ; and when we say this, we think, w^e add to it, a great
recommendation ; it is a series of monographs, so arranged, as that the dis-
cussion of one subject will, as far as is practicable, be made to illustrate the
others. Tlie plan of collecting published treatises, from the journals, into
ft volume, and giving them careful revision, after they have been subjected
to the test of several years' experience, meets with our full approbation,
find we would respectfully recommend it to our cis- Atlantic friends.

Most of the American scientific Hterature is scattered, disjecta membra,
throughout journals. Published in a fugitive and desultory manner, they,
for a time, and only for a time, retain a hold upon the medical mind, but
are soon appropriated, and to use a quaint expression of the Rev. Sydney
Smith,* the illustrious father-in-lawf of our author, " these few strong ideas
are diluted through an octavo volume," by some book-maker across the
water, and we, the very originators of these ideas, with mouths, eyes and

* Elementary Sketches of Moral Philosophy.

\ Vide " Memoirs of Rev. Sydney Smith, by his daughter, Lady Holland."

1857.] Editorial 191

ears open, wonder at the cleverness of our European brethren, and deplore
tlie drony inefficiency of American physicians " It is not in stars, but in
curselves, that we are underlings." If we are too proud to dilute^ let us
at least make a combinatiaTi, however heterogeneous it may be, of strong
ideas, and collect together our scattered thoughts, before time and the
superior energy of others, cause them to pass out of our possession.

Sir Henry Holland's work is no dilution, but a compound of strong
ideas, and his determination to brave, and not yield to, thegenei'al tenden-
cy of the day, to write a sj/stem of practice, speaks well foi* his judgment,
and this, added to other acknowledged merits in his excellent work, must
sceure it a prominent place in the consideration of every thoughtful reader,
in or out of the profession.

TTic History^ Diagnosis^ and Treatment of the Fevers of the Xfnitcd States.
By Elisha Bartlett, M,D., late Professor of Materia Medica and Medical
Jurisprudence in the College of Physicians and Surgeons^ of the Univer-
sity of the State of New York, etc., etc. -Ith edit., revised. By A,
Clark, M.D., Professoi* of Pathology and Practical Medicine in the Col-
lege of Physicians and Surgeons of the University of the State of Xew
York. Pp. 610, 8vo., muslin. Philadelphia: BianchaTd & Lea. 1856.

This excellent monograph, on febrile diseases, has stood desei'yedly high
since its first publication. It will be seen that it has no'w reached its
fourth edition, tmder the supervision of Professor A. Clark, a gentleman,-
who, from the nature of his studies and pursuits, is welT calculated to ap-
preciate and discuss the many intricate and difficult questions in pathology.-
His annotations add much to the interest of the work, and have brought it
well up to the condition of the science, as it exists, at the present day, in^
regard to this class of diseases. It is unnecessury to make an extended
review of this work, it has already been accepted by the profession, and
placed among the standard volumes of every complete medical library.

Our List of Payments. We feel disposed to congi'atulate ourselves,
n the exhibit made by our receipt-list for the two past months. It will
compare favorably with that of any similar work in the countiy, and af-
fords us much encouragement in our labors. We are not pecuniarily
interested, it is true, in this list, but it is indeed pleasing to see, that such
an evidence is given, that our labors are appreciated. We have been char-
acterized " the oldest Medical Journal in the South," by one of our valued
exchanges (The Nashville Journal) ; in the spirit of laudable emulation,
our ambition is to be at least one of the best and most useful in the South.
Our Subscription list is large, our Contributors are many, and able too,
and our Publishers are liberal, and we assure our Readers, that we will
not be backward in drawing upon this liberality, whenever opportunity
offers, to add to the interest and value of the work. A long list of this

192 Miscellaneous. [March,

Ivind looks respectable ; we only ask our subscribers to keep up our re*
spectability in this way, throughout the year, and we promise our most
earnest endeavors to do our part in sustaining it.

Death from Dissections. The statement made, in regard to the cause
and nature of Dr. Porter's last illness, is based on an opinion expressed by
the undersigned, who was Dr. P/s attending jihysician. Its correctness is
proved by the history and the symptoms of the disorder. Dr. P., on the
'27th of May last, Avhen the heat of the weather was and had been for some
days extreme for the season, opened, in presence of his class of pupils, a
body far advanced in putrefaction, and made it the subject of anatomical
demonstration during a period of two hours. The odor emitted was so
offensive that some of his audience were driven to the windows, and others
without the room. On the succeeding day he was seized with a chill, fol-
lowed by a fever, the malignant character of which clearly attested its ex-
traordinary origin. One of the most remarkable of his symptoms, as most
indicative of the source of his disease, was the presence, -y^dthout intermis-
sion, as he himself desci'ibed it, of the odor of his nostrils, and the taste m
his mouth, of tlie effluvia of the dissecting-room, in their most offensive
forms. Tkos. R. Jennings.

[Prof. Lindsley's Address cm the Life^ <fc., of Dr. Porter ^

On the differences in the composition of Milk at different times of the day 4
By Professor Bodeker. The very careful analyses of Dr. Bodeker lead ta
the following results :

1. The quantity of fatty matteT increases continually from morning until
evening, and in the evening it is nearly doubled. In sixteen ounces of milk
drawn in the morning the infant received three-eighths of an ounce of but-'
ter, while in the same quantity of milk drawn in the evening it received
from five-eighths to three-fourths of an ounce of the same substance.

2. This augmentation in the quantity of fatty matter is accompanied by
a trifling augmentation in the quantity of caseitie. In sixteen ounces of
milk drawn in the morning, there were three-eighths of ati ounce of dry
caseine ; and in the same quantity drawn in the evening, abcait nine-twen
tieths of an ounce.

3. As the caseine increases in quantity the albumen diminishe&j and al
most in the same pi'oportion.

4. The sugar of milk undergoes little variation. It is, however, somey
what more abundant ift the morning than in the aftenioon.

6. The quantity of the saline constituents of the milk remains constant*
[Zeitsch. far rat. Med Banking's Abstract

JElectricity in Amenorvhosa. Dr. Sanders says, in his article on Physio^
logical Electricity, that in those cases of amenorrhoea, where no congenital
malformation exists, the application of the electric current will always bd
attended with success, even after the usual remedies have been tried itt
vain ; but that it is important to combine with the electrical treatment, OT
to precede it by certain tonic medicines and invigorating diet and regimen.
He quotes Dr. Bird as observing that, in electricity we possess the only
real direct emmenagogue with which the experience of our Profession has
furnished us. He has never known it fail to excite menstruation, when tli%

k',

1857.] Miscellaneous, * ^^^ 193

uterus was capable of performing this function. But this capability is al-
ways an important consideration. Nothing can be more absurd than to
undertake the excitation of this, or any other secretion, while the state of
the general health, or of the particular organ to be excited, is such as to
forbid secretory action. The electric current may be sent through the
uterus either from side to side through the hips, or from the sacrum to the
pubes. Perhaps it would be still more ettectual in cases of extreme torpor,
to bring one of the wires into direct contact with the os uteri. [Memphis
Med, Recordar.

Tincture of Iodine in the Vomiting of Pregnancy. By I)'r. Eulenberg',
of Koblenz. Dr. Eulenberg, of Koblenz, says that this remetly, even in
veiy small doses, is a most eflicacious agent in arresting the troublesome
vomiting which so often occurs in pregnant women. He orders the tinc-
ture in a very dilute form, (Tinct. lodin., :^j ; Spir. Yini. Rect., 3iij ; M.) and
in small doses, three drops several times a day in wirter. The cardialgia
which accompanies this morbid condition is also relieved by it. Dr. Eu-
lenberg alleges that other sympathetic irritations, and neuroses of the
nerves of the stomach, are alleviated by similar treatment. The author
I has not found io<iide of potassium equally serviceable in the affections al-
hided to. \Preus8.Ver. Zeitung \ Edinhurgh Med. Jonr.; Ranhing^s Ab.

On the Treatment of Cracked Nipple. By M. Legroux, Physician to-
the Hotel Dieu, Paris. M. Legroux proposes to cover the aflected nipple
\vith an artificial epidermis, and he thinKs that the "baudruche" will an-
swer this purpose very conveniently. This " baudruche," first pricked with
a few pin-holes to allow the milk to pass through, is drawn over the nip-
ple, and then fixed to the skin of the breast by a varnish consisting of col-
lodian, 30 gTammes ; castor oil, 50 centigrammes; and turpentine, 1 gram-
me 50 centigi-ammes. In applying this varnish, it is necessary to avoid
the nipple itself, or much inconvenience and pain may be caused by the
subsequent contraction of the drying film. When the infant is applied to'
the breast the "baudruche" is first made soft and supple by the application
of a little sugar and water. With care one of these sacs may last for sev-
eral days until, in fact, the cracks may have healed. [Gaz. de Hehdom,
de Med. et Chirurg. Ranking'' s Abstract.

Solution of Phosphoric Acid in Typhus. By Professor Magnus Huss,
cf Stockholm. Solution of phosphoric acid, two and a quarter ounces ;
jdecoction of marsh mallow*, five ounces ; syrup of marsh mallow, four ounc-

fes ; mix dose, from ten to fifteen drops every two hours. M. Huss recom-
jmends this solution in the first stage of typhus, whether it appear under the
abdominal or petechial form, or under any form intermediate between these.
The state of the tongue by no means contraindicates the use of this reraed)'-,
rthich always renders the course of the disease more favorable. The solu-
ion contains 25 per cent, of phosphoric acid. [Presse Medicate Belge^ and
Dublin Med. Press.

Remarkable Fecundity. In a commune near Lille, a young woman, who
lad on each previous occasion had twins, gave birth in her third confine-
nent to five children, three boys and two girls. Her labor lasted forty

194 MiscelianeouSi

hours. All the children were perfectly formed but small, and two da}^
after the birth of the last, were likely to live. Towards the end of heft'
pregnancy the mother was aftected with double vision, but since her ao*
couchement her sight has returned to its normal state. [Ibid.

A Child Crying iv the Uterus. Dr. Hter of Morbtirg, has published a
case of twin births, where the first ovum was expelled intact with the pla-
centa. The child was tioticed to breathe distinctly within the sac, and it
soon cried when the membranes was a little pinched. The latter swelled *
up, aiid Dr. Soter, after hearing five or six sobs, tore the membranes. The
second child presented with the vertex and the right hand ; it looked dead
when born, but finally breathed and cried. They were both of the male
sex, and ver}- "small. In spite of the warm bath, the first child died four'
hours, and the second five hours, after birth. [Dublin Med. Press.

N'eiv Ecraseurs. Two new forms of ecrasenr are now usiiig in London J
one of a curved form, so as to reach cavities ; the second, in place of the
intermittent motion and unpleasant "clu^k," is furnished with a continuous
action of a very slow kind, like the spring of a common watch. [Ibid.

Vaccination. J. F. Marstoti, Esqr., Surgeon to the Lofidon Smallpol.
Hospital, says that he has never seen any evil results tractable to vaccina'
tion, with the exception of a single instance, in which measles occurred at
the same time, and four or five examples of rather severe sore arms, aiising
from lym23h recently taken from the cow. [Boston Med. d; Surg. Jour.

Dr. Carpenter, of London. ^This distinguished author has resigned
the Chair of Physiology, which he has so long adorned. Physiological
science has sustained a severe loss in his retirement. [^S'^. Loruis Med. and
Surg. Jour.

Eationale of Muscular Eigidity and Contraction it Paralysed
Limbs. As the process of contraction shews itself, in general, most in thcf
npper extremity, so also it generally commences there ; bift now and thed
it will begin in the lower extremity: not unfrequently it will be met with
in the upper extremity only.

The view which I have always taken (and which many of you have heard
me express in passing through the wards), of the manner in which this
contraction is produced, is this ; at the seat of the original lesion, whether
it be simply a white softening, or an apoplectic clot, or a red softening, with
more or less destruction of the brain-substance, there takes place an attempt
at cieatrizaticm, more or less perfect. ^Vttendant on this, there is a gradual
shrinking or contraction of the cerebral matter, ivhich acting on the neighbcfr'
ing healthy tissue, keeps up a sloio and lingering irritation, which is propagik
ted to the muscles, and excites in them a corresp)Onding gradual contraction*.
while at the same time their nutrition becomes sei'iously impaired bj
the want of proper exercise and the general depressing influence of the le
sion [Todd^s Clijiical Lectures on JVervous System, Y>. IVL

* The ItaUcs are all ours. ^Edts. S. M. <fe S. Jour.

SOUTHERN

MEDICAL AND SURGICAL JOURNAL.

(NEW SERIES.)

Vol. XIIL] AUGUSTA, GEORGIA, APRIL, 18,57. [No. 4.

ORIGIML AND ECLECTIC.

ARTICLE XII.

LETTERS FROM SAiTL. D. HOLT, M. D., UPON SOM POINTS OP GENERAL PATHOLOGY.

LETTER KO. 17.

MoKTGOMERY, Ala., February 16tli, 1857.
Messrs. Editors My last letter having been devoted chiefly to
the consideration of the subject of Yellow fever in its essential
character, and an endeavour to show that in that character, and in
its first or early stage, it is often, if not generally, a curable or
ahortable disease, it is my desire in this, to show the contingen-
cies upon which such an issue depends, and that when, in this or
other kindred affections, the typhoid, or necrasmic, condition be-
comes fully formed and established, it is not curable by any known
or certain process, except the gradual elimination of the specific
poison, and others which may have been generated in the system,
and a restoration of the blood to its normal and healthy condition.
And as this process necessarily depends upon the sanative efforts
of nature, and the recuperative powers and energies of the system,
for its accomplishment, requiring a longer or a shorter period, ac-
cording to the essential type and character of the disease, the most
consummate skill and judgment of the physician is generally re-
quired to determine, how much it is his duty to perform how

N. S. VOL. XIII. NO. IV. 13

196 HoLT^S Letters upon General Pathology. [April,

much he should leave to the efforts of nature, and what aids h '
may be able to lend^ to hasten it.

With respect to Yellow fever, ample experience has shown thai"
when it has passed unchecked into its second stage, it is no longer
controllable by potent or heroic remedies ; that great caution is
necessary in the use of all remedies of an active or perturbating
character ; that nature requires an absolute state of quietness and
repose for her successful operation, and that slight distnibance
from officious interference is often sufficient to interrupt and sus-
pend those operations upon which alone the safety, and often the
life, of the patient depends. It is not, however, to the second
stage of Yellow fever, or to other confirmed typhoid conditions
or forms of disease, that these measures of caution, with respect to
the use of active remedies, are confined, but they will apply as
well to all those zymotic fevers which have their origin in a hlood
poison, (not necraemic or typhoid,) and which have a definite course
to run such as small-pox, measles, scarlet fever, &c. So far as
my experience has gone, in the management of all these diseases^
and conditions, the safest and most proper course to pursue, is to
observe a '* masterly inactivity," and an "armed neutrality;" by
which, I do not mean that we should stand idly and indifferently
by, and leave everything to the operation of nature, allowing her
to struggle through difficulties which art could easily overcome }
but I mean, that having placed the patient in the most favorable
condition for sustaining the struggle, which we are satisfied, from
a knowledge of the disease, its peculiar and characteristic symp-
toms, and the course which it has to run, according to its essential
type and character, that we have not the power to prevent or ar-
rest. Our duty must be confined to the task of endeavoring to
conduct it to a favorable termination, (which by judicious means
we may sometimes hasten) by carefully watching its progress, and
combating such symptoms, and warding off such extrinsic influ-
ences as do not belong, to the disease in its essential character , and such
as threaten to interfere with or interrupt its regular and natural
progress. It often happens in these diseases, that no interference
on the part of the physician is required by the exigencies of theit
case, beyond the task of watching their progress especially havej
I found it so with respect to typhoid and scarlet fever. Yet, ho"vrf
few of the profession have the moral courage, in the treatment of
these or other dangerous diseases, to adopt such a course, and to

1867.] Holt's Letters upon General Pathology. 197

withhold medicine when urged to its administration, and to prompt
and vigorous action, by the fear and anxiety, and even the en-
treaty and remonstrance of the patient or friends, whose ignorance
of professional duty and responsibility and, no less, of the nature
of disease, will make no proper allowance for such a course. They
expect, and require that something should be done, and the physi-
cian generally finds it an easier and more agreeable task to gratify
their desires, in this respect, by seeming to do something^ even when
he knows^ or helieves^ it to be useless, so far as the arrest and cure
of the disease is concerned, (unless he deceives himself,) than it is
to endeavor to convince them, that the patient would do better
without his interference and his physic. I would not charge upon
the profession a want of honesty of purpose in this, for it is right
and proper that all reasonable desires of the patient should be
gratified, even to the taking of physic, provided it will be attend-
ed with no danger or inconvenience ; but I do say, that the ad-
ministration of medicine, or other interference, merely as a profes-
sional requirement, when uncalled for by the exigencies of the case,
though sanctioned by therapeutic authority, argues a weakness,
and a want of independence and moral courage, to stem the tide of
popular ignorance and prejudice, which comparatively few of the
profession are willing, single handed^ to encounter, not less with
respect to the administration or the use of certain remedies, than to
"withholding all remedies, when such a course would seem to be
most proper.

The truth is, that the Medical Profession has assumed too much
and promised too much, and the world has thus been led to expect
'and require from the profession, more than it is able to perform,
hence confidence has been shaken, and even destroyed, and thus
the doors have been thrown open, and every species of Charlatan-
ry has been invited to enter. To close the doors against quackery,
to restore lost confidence, and to elevate the character of the pro-
fession, it becomes the duty of every honest member of the profes-
sion, to keep in mind himself, and to let the world know, that he
possesses no power of himself to heal that he is but the "hand-
maid " (as it were) of nature, to whose voice he is bound to listen,
and whose mandates he is bound to obey, and that every act per-
formed, or measure adopted, which is not in conformity to her
suggestions, in compliance with her wants, or in obedience to her
demands, is an unauthorized and unwarrantable act of assumption

f

19S Holt's Letters upon General Pathology. [April,

and Tisurpation. When the world has been taught, and comes to
understand this, more coniSdence and a better understanding will
be established than now exists between the world and the pro-
fession; less action, and less meddlesome interference, will be ex-
pected, and less required, and the physician will have less to dread
from the interference and the intrigues of quackery.

These remarks are not intended as 2^ fling at the moral honesty
of the profession, generally, nor are they dictated in a malevolent
or a Pharisaical spirit, but from an experimental knowledge of the
difficulties to be encountered in adopting the course which I have
indicated in the treatment of a certain class of diseases difficulties
which grow out of^ and are inseparable from, the general popular
ignorance, as I have said before, with regard to professional duty,
and professional responsibility, and of medical matters in general
an ignorance, whose baneful influence the united efforts of the pro-
fession only can counteract ; but an ignorance, alas I which opens
too wide and fruitful a field, and offers too rich a harvest, to justi-
fy the hope^ even, that such an effort will ever be made. But I
will forbear, as such reflections must be painftd and humiliating to
every one who has cultivated an attachment to, and entertains a
proper regard for the honor, the dignity and the independence of
iiis profession.

Although some of the most gratifying reflections arising from 3
retrospect of my professional course are derived from the favorable
termination of cases of great apparent danger, which I had refused
to interfere with, or to take out of the hands of nature when I
believed her to be the better physician in the case^. and for which
I claim the greater credit yet, I must confess, that I never felt
my responsibility diminished on that account, but sometimes pain*
fully increased. Nor have I always found this the most easy mode
f procedure^ or free (for a time at least) from a sacrifice of indi-
vidual interest, to which, and the allurement of popular applause,
I have never willingly forfeited my independence, or compromised
the honor and dignity of the profession, by a resort to any spe-
cies of dissimulation or intrigue, believing that it is always more
honest and creditable to endeavor to enlighten mankind, than it
is to play upon and take the advantage of their ignorance and
credulity. Hence I have never allowed myself to tamper wit&i
Thompsonianism, Homoeopathy, and other such abominations, f(Mr
the purpose of catching the popular breeze, but my constant pray-
er has always been /rom all such sins good Lord deliver us.

1857.] Holt's Letters upon General Pathology, 199

As, however, I am not delivering a homily on professional hon-
I esty, or the duty and obligation of physicians generally, or desire
j to write my own panegyric, I will bring this digression to a close,
! with a few remarks, by way of caution to my junior readers, of
I which the senior are at liberty to avail themselves of any advan-
i tages which the suggestions may offer, which is, to guard against
the fallacious, though popular dogma, that ''^desperate diseases re-
quire desperate remedies^'''' which, in consequence of its general
reception, and indiscriminate application, has done, and will con-
tinue to do, an immense amount of mischiei^ as long as it retains
a hold upon the mind of the medical profession. Whatever truth
there may be in the adage in certain diseases, or a certain class of
cases, in which force is required to repel force, every day's experi-
ence exposes its falsehood, when applied to those malignant and
dangerous diseases which, according to their essential character,
have a definite course to run, and which we have no power or
means to arrest^ and can only conduct to their termination, such as
typhus, typhoid and scarlet fever, small-pox, measles, &c. ; and
' more especially is it so, when these diseases assume an epidemic
form. It is true, that all these diseases, when they require active
treatment, and all others having a dangerous and malignant ten-
dency, which require energetic treatment, require it promptly, at
their commencement, while the vital powers are in their fullest
and most perfect exercise, as it is the rapid failure, or giving way
of those powers which constitutes their chief malignancy and dan-
ger, and which it is the main object and design of treatment to
prevent. But it is a great mistake^ in my opinion, to suppose that,
because these diseases assume, at times, the character of greater
malignancy, that they become altered in tJieir essential character^ or,
in consequence, require a resort to extraordinary means, or extra-
ordinary measures, for their proper management. For if the or-
dinary and appropriate means and measures fail in the early
stages of these diseases, in consequence of their extraordinary ma-
lignancy, a resort to more active and powerful ones (when, from
'4feeir progress, and the further loss of vital power, they become
still more malignant) will generally prove a profitless, if not a
hazardous experiment, not always justified or sanctioned by a
sound discretion. K the question should arise, as to what consti-
tutes a desperate disease^ and what a desperate remedy^ about which
there inight he a difference of opinion^ I would say that all diseases

200 Holt's Letters upon General Pathology. [April,

whicli tend rapidly to tlie destruction of human life, and over
which ordinary remedies have little or no control, might be con-
sidered as desperate. And all remedies may be considered as des-
perate^ when used on the score of their extraordinary power and
activity, and in improper or immoderate quantities, and when
there is a probability of their doing more harm, than there is a
reasonable expectation of their doing good, or when used as a
reckless experiment, or without regard to the consequences which
may follow their use. Eemedies are valuable and proper in pro-
portion to the aid which they are able to give to the strugghng
efforts of nature, without reference to the degrees of their power
and activity ; and remedies which would be perfectly safe and
proper, under one set of circumstances, would, under others, be
properly considered as dangerous and desperate. The question,
then, resolves itself into the mode or manner, and the time and
circumstances of their administration, whether remedies are to be
considered desperate or not.

There are some other lights in which this subject miglU be view-
ed, going to show, how mild, and even impotent or inert remedies
may become desperate ones, by their indirect or negative operation ;
as, for instance, the substitution of a few homoeopathic drops of the
tinct. of phosphorus, aconite, and bryonia, in the treatment of
pneumonia, for such effective remedies as calomel^ tartar-emetic^ and
the lancet] or, in the carrying a hucheye in the pocket, for the cure
of the piles; or, a ''brick in the hat," to cure the tooth-ache, or
a fit of the blues, and many other such acts of desperation. But
it is not to such cases as these that my remarks of caution are
intended to apply ; they require no buoy or beacon^ but show for
themselves. But it is to those dangerous and often malignant
forms of disease, which show, sometimes from their commence-
ment, and throughout their progress, a low and feeble state of the
vital forces, and all those diseases which tend rapidly to such a
condition, that I would caution against the use of active and pei>
turbating remedies, especially when the diseases in question have
assumed an epidemic and malignant form, or the remedies, howe^
ver proper under other circumstances, have failed of their proper Js!
effects, in the first or early stage of those diseases. /!

Yellow fever, which presents the most striking example, andlji
furnishes the best illustration of my views, is usually characterized*^
by a full display and exercise of the vital powers of the system mU^

-S57.] Holt's Letters upon General Pathology. 201

its first or febrile stage, requiring, as I liave urged, the necessity of
prompt and energetic treatment, (even to the point of desperation^
as some might say.) Yet, having passed uncontrolled into its
5eco?zc? stage, which is equally characterized by a prostration of the
vital powers, active or energetic treatment becomes as useless, and
even injurious, as it was necessary and beneficial in the first stage.
In such an emergency, which may very safely be pronounced as
desperate^ what course does it become the duty of the physician to
pursue? He cannot, with propriety, or a reasonable hope of suc-
cess, renew, or continue, a course of active treatment which has
already failed to arrest the progress of the disease. He should not
jeopard the hfeof his patient by tampering with physic, especially
as a matter of desperate experiment. He cannot, or should not,
abandon his patient in his fearful extremity. But, without suffer-
ing himself to he, forced to action, or into the adoption of measures,
which his judgment does not fully approve, he should stand firmly
at his post, patiently and carefully watching the operations of na-
ture, upon which the issue of the case mainly depends, and which
it is often in his power materially to aid ; and though he may not,
by the use of any known antidotes^ be able to neutralize the action
of noxious and poisonous matters received into or generated in
the system, he may, to a considerable extent, counieract their influ-
ence, by a judicious use of such remedies as are calculated to raise
and sustain the prostrate energies and vital powers of the system,
thus affording aid to the depurating and excreting organs in elimin-
ating the poisonous matters from the blood, and restoring it to its
normal and healthy condition. It will be perceived that the the-
rapeutic principles which should govern the treatment of Yellow
fever, according to my views, are about the same, both in its first
and second stadii with this material difference, however, that in
iihefirst^ the object is to preserve the vital powers, and prevent the
breaking down of the healthy constitution of the blood, which is to
be accomplished by prompt and energetic measures ; and that, in
the second^ the object is to reinvigorate the vital powers, and restore
to the blood its normal condition, which is a slow and uncertain
process, and only to be accomplished by mild and gentle meas-
ures. Such, indeed, are the principles which should govern the
treatment of all those diseases which cannot be subdued or con-
trolled by active or heroic remedies, especially those which I have
before named, as well as others belonging to the zymotic class.

202 Holt's Letters upon General Pathology. [April,

Having given my general views with regard to the treatment of
Yellow fever, particularly in its first stage for the subsequent
treatment, and the best and most appropriate means for effecting
the objects and the purposes indicated, I must refer the reader for
more accurate and reliable information to the systematic writers,
and the many valuable monographs upon the subject, my own
experience having been too limited to allow me to speak with con- ,
fidence, upon such matters; besides, it is out of the line of my
general intentions to enter into the details of practice in this, or
any other diseases, of which I may have occasion to speak.

I shall now proceed to an examination of some other typhoid
diseases, and endeavor to show, that though they may all be class-
ed under one general head, they are, nevertheless, separate and
distinct in their essential, suigeneric character, and however close-
ly they may simulate each other, in their general character, and
the nature of the causes which produce them, yet the causes are
essential and specific to each, and each is distinguished by its own
peculiar and characteristic phenomena and symptoms. In a pre-
vious letter, I had occasion to speak of the typhoid condition, as a
condition merely, being the result or product of previously existing
morbid actions, in diseases, not typhoid in their origin, and conse-
quently not entitled to hold rank with those diseases which are so ;
yet the near relationship which exists between them, pathological-
ly, and the importance which attaches to it as a condition, renders
it proper that it should be included in the general family, and
particularly as its further examination will probably enable us to
understand better the nature of typhoid diseases generally. In
order to prevent any misunderstanding, or ambiguity, with re-
spect to the terms which I have, and may hereafter use, to convey
my meaning, it would perhaps be better that I should make a few
remarks, explanatory of the precise sense in which those terms
are to be understood.

The word typhus, signifying stupor, is a time-honored term, ap-
plied to a particular form of fever, which is supposed to have that,
condition {stupor) hq ii'^ principal characteristic feature. So far, T
would not object to a use of the term; nor do I object to a con-^
tinuance of its use, or of its correlatives typhous and typhoid, for
the purpose of distinction, betweeen one form or variety of fever
and another; but I think it rather unfortunate that, in this,
as well as many other diseases, terms more expressive of their

1S57.] Holt's Letters upon General Pathology. 203

ossential and spccLol pathology have not been employed; and it
is upon this ground, that I would base any objections to the use
of the term typhus, and its correlatives. For though stupor may
bo a prominent and uniform trait in their character, yet it cannot
be regarded as an essential or prima^^y element in their pathology ;
and if it was, it could hardly be pronounced characteristic, in as
much, as stupor is often observed in diseases having no other
tj'phus or typhoid traits of character. The correlative terms, ty-
phous and typhoid, are understood to represent or specify.those
particular diseases, and conditions of diseases, which, though not
identical^ yet in their general character, bear a striking resemblance
to typhus, not so much, however, with respect to stupor (which is
but consequential to, and indicative of, deranged innervation, or
impaired function of the animal or senso-motory nervous system),
as in other pathological phenomena, not always so apparent, but
more uniformly present, if not more characteristic and essential to
what is considered and understood to be the typhoid condition
namely : a depraved and vitiated condition of the hlood. Now, this
condition of the blood, to which the term necrsemic has been ap-
plied by a distinguished pathologist, (Doct. Williams,) signifying,
according to the etymology of the word, decith of the hlood ; or, ac-
cording to Dr. W., " death beginning with the blood," which is,
perhaps, more expressive, and the correlative term necroemic^
which I have repeatedly used as synonymous with typhoid, to ex-
press that condition, or a tendency to it, fully expresses, according
to my understanding, the primary essential element in the pathology
of all typhoid affections^ and which brings into one general family
every disease, and condition or modification of disease, which has
this element in its pathology.

This necraemic condition, as I understand it, consists in such
molecular changes in the blood, as to destroy the relative propor-
tion which, in a normal state, exists between the several constitu-
ent principles of the t)lood, and which are essential to its vitality.
Or, it may be, that the loss of vitality results from the direct action
of a poison, destroying the plasticity of the blood, whereby it is
rendered unfit and incapable of undergoing those molecular
changes which are necessary and essential to the vital processes,
without affecting materially the relative proportions of its constitu-
ent principles. However that may be, it cannot be doubted, that
in all malignant typhoid affections, such as, typhus and typhoid

204 Holt's Lettet-s upon General Pathology. [April,

fevers, yellow fever, plague, &c., the blood manifests evidences of
a change, in its vital and chemical properties, at some time during
their progress except in aborted cases often at their commence-
ment, and (during the prevalence of epidemics) even antecedently
to the invasion of the disease, <as shown in its want of plasticity
and coagulability, and a rapid tendency to putrescency. These
facts alone, without reference to the pathognomonic signs of the
condition, or of those diseases, are sufficient, in my estimation, to
justify the assumption that necrcemia is an essential and primary
element in the pathology of all typhoid diseases. It would be
folly to assert, that the circulation of the blood, and its vitality
and integrity, could be long preserved without a healthy nervous
influence ; and I think it wonld be equally so, to assert that the
nervous system is not equally dependent upon an equal distribu-
tion, and healthy constitution of the blood, for the performance of
its functions. ISTo violence, therefore, can be done to reason or to
common sense, in supposing that certain morbific agents may ef-
fect primary changes in the condition or constitution of the blood,
and through and by the blood, upon portions, or all, of the nerv-
ous system., according to the nature of their respective elective
affinities^ as well as to suppose the primary action of those agents
to be seated in the nervous system, or some portions thereof.
That diseases may have their oi-igin^ or first link of their morbid
concatenation sometimes in the nervous, and sometimes in the
circulatory systems, does not, I think, admit of a doubt ; and I
have endeavored to show, on a former occasion, that those diseases,
which had their origin in the nervous system, and are regarded
as dynamic, did not require, as an element in their pathology, any
notable or appreciable change in the character or constitution of
the blood, and that disturbance in the circulatory system in those
diseases, had reference to the distribution, and not the constitution
of the blood. It is true, that the blood often becomes changed,
vitiated, and depraved in its character, during ihe progress of these
diseases; but when it does so, a corresponding change occurs in-
the nervous system, and in the character of the disease, which, from
a dynamic, becomes an adynamic disease, with such a train of
symptoms as is generally characteristic of the necrsemic or typhoid-
condition.

In connection with this subject some very important questions ^
axise, both as to the nature of this condition, and the causes which

1S57.] Holt's Letters upon General Pathology. 205

l)roduce it. Is the condition wliich we recognize as typhoid in
certain protracted or advanced stages of disease, such as bilious
fever, pneumonia, dysentery, etc., really typhoid f It is so, as far
as a2')pearances go; and if it is so in fact, it will furnish us with
some little insight into the nature of the causes of tj^-phus and ty-
})hoid diseases. This condition we know, or have every reason to
believe, is the result of the action of septic and poisonous matters
generated and retained in the system, consequent upon the sus-
] tended secretory and excretory functions of certain organs, as the
kin, the kidneys, the liver and the intestines; and we know that
m consequence of the action of those poisons, certain changes af-
fecting the vitality and chemical properties of the blood take
place, as manifested by a change of color and consistence, becom-
ing darker and more liquid and rapidly putrescent, and giving
rise to a general hemorrhagic tendency from internal mucous sur-
faces, and to eruptions, ulcerations, sudamina, petechias, etc. And
we know that this changed condition of the blood \^ followed by,
or accorapanied with, a corresponding change in the nervous sys-
tem, or parts thereof, and particularly the animal or senso-motory
nerves, as manifested by a dullness of the perceptive and intellec-
tual faculties ; by drowsiness and stupor, by a loss of muscular
power, and often by other signs which show a general adynamic
condition extending to, and including the organic nervous system.
On a previous occasion, speaking of the functions of the brain and
nervous system, and the causes which influenced them, I adverted
to the fact, that in many of those diseases of depression and congestion
which have been miscalled " adynamic," and which owe their ori-
" gin chiefly to miasmatic, meteorologic, and atmospheric influences,
the intellectual and animal powers were often preserved, com-
paratively unimpaired amidst the almost total prostration of the
(organic nervous system. And it is no less remarkable, that in
those diseases, which are more properly "adynamic," oi conditions
of disease, having their origin in animal poisons and animal ef&u-
via as in the condition and diseases under consideration it is
often the case that while the animal powers are almost completely
stricken down, the organic powers continue to act with apparently
little interruption. Many cases I could adduce in proof of this
fact, but one must suffice : I attended a young man in an attack
of typhoid fever, and for fifteen days he laid in a drowsy, semi-
-. comatose state, from which he could be aroused with some little

206 Holt's Letters upon General Pathology. [April,

difficulty, to take food, (for which he had a rehsh most of the time,)
to have his bed and clothing changed, etc., during which time, his
pulse, which varied little from natural in volume and strength, did
not vary three beats from ninety. On the sixteenth day it came
down five beats ; on the seventeenth, five more ; and his stupor
and fever left him ; and on the twenty -second, he left his bed and
room only seven pounds lighter than when he took them. This
case I may have occasion to refer to again, as it furnishes other
points, besides the one attempted to be shown, in the character of
typhoid diseases, and the nature of their causes : but, to resume
my argument.

We know, also, that this condition^ which may originate in any
disease, as the consequence of the defective^ interrupted or suspended
secretory and excretory functions, and varies in degree accordingly,
is the same^ or apparently the same, in its general pathological signs,
with respect to the nervous and circulatory systems, as is observed
in those diseases essentially typhoid in their character^ which are the
product or result of specific animal poisons or effluvia, not gen-
erated in the system but operating from without^ and when taken
into the system, sooner or later, commence the work of regeneration
by their diffusion through, and contamination of the blood, consti-
tuting what is recognized as the zymotic process^ or action of those
poisons which is of longer or shorter duration, according to their
essential and specific nature. This condition differs from the ty-
phoid diseases in its pathognomonic signs, (such as it has,) as those
diseases differ in those signs from each other ; and they differ ma-
terially, also, in their mode of production, one requiring the zymo-
tic process as essential in its production the other, not, unless
the production or generation of poisons in the system from sus-
pended fanctions, where they did not before exist, or their action
upon the nervous system, when produced, be considered as zymo-
tic ; in which light, I hardly think it ought to be considered for
if it should be, certain of those diseases would be liable to a double
zymotic action, in as much, as the condition in question is often .
superadded to typhoid and other zymotic affections, to all of
which it imparts increased malignancy and danger, sometimes
bringing them to a very sudden and fatal termination.

As time and space will not allow me to conclude my remarks,
upon these subjects, I will close them for the present, to be resumed
in my next letter.

1857.] Doughty, on Hydroplidbia with Remarhs. 207

I feel as though an apology was due the reader, for my ramhlings
in the first part of this letter ; but really there are so many side-
issues so many stations^ switches and turn-outs^ that I find it diffi-
cult to avoid running out of the right track, every now and then ;
and as I do not profess to belong to the regular train^ I hope I
may be excused for running off occasionally.

Yours, very respectfully, Saml. D. Holt.

ARTICLE XIII.

A Ccise^ resembling Hydrophobia^ produced by the Bite of a Dog^ sup-
posed not to be Mad ; loith Remarhs on the Pathology of Hydrophobia,
By W. H. Doughty, M. D., of Augusta, Ga.

June 8th, 1856, 7 o'clock, A.M., was called to visit Mary, the
property of W. L. of this city, said to have been bitten by a dog.
She is about 65 years of age, infirm and weak. She states that
upon entering a yard, about two weeks previously, she was bitten
by a dog (very much enraged seemed always to have a special
enmity to her,) on the calf of the right leg. The wound was dressed
ghortly afterwards with adhesive plaster. She suffered but little
pain or inconvenience from it, until the 6th, when she experienced
slight difficulty in swallowing, accompanied with rigors and chilly
sensations ; this, however, attracted no attention until the after-
noon of the 7th, at which time she was seized with great difficulty
of breathing, and a choking sensation upon attempting to swallow.
These distressing symptoms continued to recur up to the present
time, which reveals her situation, as follows :

Great disquietude and anxiety of mind; her hands continually
"brought up to her throat, as if to remove something; occasional
rigidity of the muscles of the neck ; intermitting spasms of the
muscles of respiration, including those of the pharynx and larynx^
recurring every five or ten minutes ; great disfiguration of the
face during the spasm ; dysphagia induced by attempting to swal-
low water, tea, or other fluid the patient seemed to dread even
their approach ; during the spasms (some of which I witnessed,) the
patient was purple and livid in the face, almost asphyxiated ; ex-
treme irritability of the body ; currents of air, motion of the limbs^
or even the access of light, readily exciting the frightful spasms ;

208 Doughty, on Hydrophobia with Remarhs. [April,

anticipating the spasm, she would plead most piteously for pres-
sure (firm) to be made upon the sternum. The wound was situ-
ated upon the inner side of the right leg of a lacerated character
two inches in length by one in breadth ; ragged at the edges,
foul looking and painful ; pulse frequent and small, 130 ; tongue
loaded; bowels obstinate^ constipated.

Treatment. -Sulph. morphine, quarter grain every half hour.

Yisit at 10 o'clock, A.M. Patient seemingly better ; spasms re-
cur at longer intervals; situation otherwise the same.

Treatment. Colomel, grs. xx.; camphor, grs. viij. into two
powders one every two hours. Injections of castor oil, to be re-
peated every hour, until bowels are moved ; blister 6 -{- 2 to the back
of the neck ; dilatation of the upper part of the wound (dark, gru-
mous blood issuing) ; application of lunar caustic to same ; ley poul-
tices; beef-tea and chicken soup, as much as possible.

Yisit at 5, P.M. Patient the same ; has slept some since last
visit.

Treatment. Croton oil, gtts. ij., every two hours, until bowels
are moved ; nourishment, &c.

June 9th, 9 o'clock, A.M. Patient dead. Spasms recurred at
midnight with increased severity, but ceased about daylight;
shortly afterwards, she died from exhaustion.

Eemakks. The pathology of the nervous system, has ever
been, and must necessarily remain, enveloped in much obscurity,
until the science of physiology, aided by all the appliances
of art, has developed much more satisfactorily than it has hitherto
done, that branch of it which refers to the function of the nerves
in health. It affords, however, a pleasing gratification to those
who have devoted themselves to this scientific study, that their
labor has not been entirely unrewarded ; for, if they have not suc-
ceeded in demonstrating to the letter, the absolute function of this
part of our mysterious organism, yet the present state of efficiency
of the practice of medicine, is due to them a proper understand-
ing of its function in health being necessary, before we can ap-
preciate its morbid states. It is not our purpose to go into
a lengthened disquisition on the diseases of the nervous system,
but simply to examine some of the views entertained in regard to
the pathology of that subtle disease, Hydrophobia. It is but sel-
dom that a physician has the opportunity of studying this disease

1857.] Doughty, 07i IlydroplioUa wiili Bemarhs. 209

in the human subject, many men of large professional experience^
never having seen or met with a case. It is to the veterinary
surgeon that cases of hydrophobia most frequently present them-
selves, being a disease which has its origin amongst the lower ani-
mals. It is ascertained, in the study of this disease, moreover, where
the practitioner of medicine is brought in consultation with the
veterinary surgeon, that a knowledge of it, as it exists in animals,
is necessary to a proper appreciation of it in man. Two differ-
ent opinions are held in regard to its pathology, and whilst the
advocates of each agree, that the perverted action of the nervous
system is the principal agent in determining the fatal issue, (near-
ly every case terminating so,) yet they differ in regard to the seat
of the primary constitutional irritation. Upon an examination of
the bodies of those (men and animals), who have died of hydro-
phobia, the lesions most generally found, are an inflammatory
appearance of the mucous membrane of the pharynx, larynx, and
oesophagus, sometimes extending as far down as the stomach
and intestines ; also, congestion and irritation of the brain and
its membranes, the medulla oblongata, cervical spinal marrow
and their membranes, together with, congestion and dark disco-
loration of the lungs.
. No change in the substance or structure of the nerves seemingly
affected, can be demonstrated,, either by the eye, the microscope,
or any other means. It is necessary to state, however, that these
marks of inflammation, more particularly those of the throat, are
frequently wanting no trace of them being discoverable. The
principal nervous phenomenon and most characteristic symptom
,of this disease is dysphagia. Now, the point as to which the dif-
ference exists, is, whether the indications of inflammation found
in the throat are primary or secondary to the irritation of the ner-
.vous system which accompanies it. Some pathologists conceive,
that the inflammation of the throat demonstrated in most cases
after death, is the primary manifestation of the disease in the sys-
tem, and that the nervous state which gives rise to the spasmodic
stricture is due to. irritation of the sentient extremities of the pha-
ryngeal nerves, claiming in its support, in those cases where no
;, signs of inflammation are found, its latent form. They also assert
that this inflanunation is of a specific character, not from any de-
monstrable differences from ordinary inflammation, but to accom-
modate their ideas to the precedence of the inoculation. That

210 Doughty, on IlydrophoUa with Remarks. [April,

hydrophobia is a specijB.c disease produced from inoculation with
a specific poison, is also held by those who locate it in the nervous
system primarily. The following quotation from an author* who
is an advocate of the inflammation being specific, will serve as an
exponent of the class :

" To my mind, (says he,) the evidence that there is specific in-
flammatory irritation in the mucous membrane of the mouth and
pharynx in this disease, stops little short of certainty. The poi-
son, in the first place, comes from the mouth of the dog, and fol-
lowing the general law of morbid poisons, especially of those that
have a period of incubation, it is most likely to locate itself in a
similar part in man, as well as in other animals. Secondly, ap-
pearances of inflammation after death, though not constant, are
much oftener found here than any where else. Thirdly, the spas-
modic symptoms commence in those muscles, whose nerves are in
immediate connection with the surface in question ; and are such as
w^ould naturally arise from reflex action of these nerves. Fourthly,
if the disease is communicable by the saliva of man, as there is
reason to believe, then there must be a perverted action of the sa-
livary glands themselves, or of the surfaces on which these secre-
tions are poured out; and this action must be a specific one, inas-
much as the secreted product when inoculated anew, uniformly
gives rise to the same set of symptoms."

We shall notice these, in the order in which they are laid down ;
and in the first place, we remark, that no significance can be at-
tached to the derivation of the poison from the mouth of the dog,
when we remember that the mouth is the only aggressive, and at
the same time, defensive weapon with which he may operate, and
this explains why this secretion ("poison from the mouth") is thus
deposited in the system of the person or animal bitten. I know
of no general law, whereby any animal poison introduced into the
system, has the tendency to manifest itself in a part similar to that
introducing it : to suppose, that because a poison is communicated
to one animal from the mouth of another, that, therefore, it must
manifest itself first in the mouth of the one bitten, is simply ridi-
culous. The poison communicated by the bite of the rattlesnake
ought, according to this, manifest itself first in the mouth of the
animal bitten, because the mouth was the agency employed in

* Essays on the Physiology of the Nervous System, with an Appendix on Hydro-
phobia, by Benjamin Haskell.

i

1857.] Doughty, on Hydi-ophoUa with Bemarhs, 2H

the inoculation. Following the law which regulates the action of
animal poisons, its influence would be exerted as soon as its entire
absorption takes place, and the manifestations of that influence
would be general and not local, inasmuch, as we know of no spe-
cial affinities of those poisons for particular parts of the system.
The syphilitic virus certainly has no general law of " similarity
of parts communicating it ;'' for, wherever deposited, and by what-
ever means introduced, it is certain of the reproduction of its own
kind. The same is true of gonorrhoeal matter, whether deposited
in tha^eye or the vagina of the female. Smallpox also, whether
induced by contagion or inoculation.

In the investigation of the nature of this disease, no experiments,
I believe, have ever been instituted to ascertain whether or not, it
might be communicated by some other secretion of the rabid ani-
mal, than the salivary, exclusively; but it is presumable that it
might, from the following circumstance, futnished me by a medical
friend, which occurred under his own observation: " A bitch of
his, having seven pups, was poisoned, together with two other
dogs ; one of the pups immediately before the act of poisoning,
was removed by a friend to whom it was given. Shortly after
receiving the poison, she nursed her pups. In the course of two
hours, one of the dogs and the bitch were dead, and by dark all the
pups died, manifesting the same symptoms as did the mother and
dog. The pup that was removed did well and grew to full devel-
opment." Now, the effect of an animal poison introduced, would,
we suppose have the same influence, as did the mineral (arsenic
as was supposed) in this instance : every secretion would become
impregnated with it sooner or later. "We find in Druitt's Surge-
ry,^ the following language in reference to this point: "It is un-
certain, whether the whole solids or fluids of the animal are not
poisonous also. In fact, there is some reason for believing that
^e disease may be communicated by the mother's milk." He
.icites the following instance " Two ewes were bitten by a mad
dog and died hydrophobic. One had two lambs, the other, one ;
all three of which were seized with the disease a week afterwards,
although they had not been bitten by the dog, nor, as was sup-
posed, by the mother." This case certainly throws its testimony
in favor of the general impregnation of the secretions ; for, in the
absence of all proof to the contrary, we are bound to believe that

* Druitt's Surgery by Sargent, p. 167.
-VOL. XIII. NO. IV. 14

212 Doughty, on Hydrophohia with Bemarhs. [April,

the disease was communicated to the young by the milk of the
mothers. The following quotation from Youatt^ is directly op-
posed to the inferences which we would be justified in drawing
from the above cases : "A portion of it (virus) is taken up and
carried into the circulation and acquires the property of assimilat-
ing the secretions to its own nature, or it is determined to one of
the secretions only." Further on, he says : " So it is with the sa- ,
livary glands; in them it is formed, and to them it is determined,
and from them and them alone, it is communicated to other ani-
mals." This expression seems to be unsubstantiated by any ex-
periments or arguments, as given by him, for in all the cases
which that author gives in his treatise upon this disease, not a
case is reported which would warrant such an exclusive infer-
ence, whilst the case of the bitch, and that of the ewes before spo-
ken of, go to prove, the first by analogy and the second positively^
that it may be communicated by at least one secretion of the ani-
mal other than the salivary.

Passing from this point to the consideration of the second, we
remark, that were the disease attributable to a local ioflammation
of the throat, following the order of all the phlegmasise, symptoms of
a local nature should be the first to manifest themselves, but instead
of finding sore-throat in the commencement, we have the follow-
ing constitutional symptoms, viz., "a rapid and irregular pulse
not inflammatory ;" a peculiar disorder of the mind ; chilly sensa- ;
tions running down the back and spine ; pain in the bitten part
(even after it is cicatrized) often following the course of the nerves.

After these have continued some time, " perhaps a couple of
days," the difficulty of swallowing comes on. It is said that "in .
the horse, the disease commences with great distress and terror
and profuse sweating; he soon becomes frantic and outrageous
stamping, snorting and kicking." It is recorded of " eight sheep i
which were bitten and became rabid, they were exceedingly furi-
ous, running and butting at every person and thing, but did not-%;
bite. They drank freely." There is no case recorded, within my : :
knowledge, wherein inflammation of the throat was evident, prior\- ;
to the long-continued spasmodic action of the muscles of the part^ r
In the case, accompanying this article, the gums and mucous
membrane of the mouth were of a pale and whitened aspect, yet,
possibly injection of the capillaries of the throat might have beeri

* Youatt OH tke Dog, p. 221.

1857.] Doughty, on Hydrophobia mth HemarJcs. 213

discovered after death. We conclude our remarks to this, by
giving the following quotation from Dr. James Johnson: "We
must conclude (says he,) that it cannot be denied but that the
most evident indications of inflammatory action attend and distin-
,i:uish the symptoms of hydrophobia ; that we have often inflam--
mation of the oesophagus, pharynx, larynx, and occasionally of
the brain and spinal cord ; yet, it is generally admitted, that these
appearances are more the consequence, than the cause of the dis-
order, and that although frequently present with, they are by no
means essential to the existence of hydrophobic action."

In the third proposition of the author, (Dr. Haskell,) he seems to
regard the spasmodic symptoms as the exaggerated reflex action
of the nerves distributed to the mucous surface of the throat,
caused by the inflammation, but disregards the idea that these are
the result of irritation of the nervous centres. All physicians are
perfectly familiar with the fact, that excitation of the peripheral
extremities of the nerves distributed on the membranous surfaces
of the body, will often prove the exciting cause of a convulsion in
the epileptic ; yet, it cannot be said, that those surfaces whereon
the nervous extremities are distributed, are the seat of the disease
the excitation simply developing the evidences of the already
diseased nervous centres (cerebro-spinal axis). As pertinent to the
issue, we give the following extract from Todd k Bowman's Phy-
[|jology : "Nothing (say they) is more certain than that an affec-
tion of the central extremities (nervous centres) of the nerve fibres,
is sufficient to excite sensations precisely similar to those which
the excitation of the peripheral portion of the same fibres would
produce. Hence it is that a morbid irritation at the centre is fre-
quently referred to the periphery."* It is the direct application
of this certain principle of nervous action which fully explains the
production of these spasmodic symptoms of the throat, and all the
respiratory muscles, so distressingly manifested in this disease.
All the nerves distributed to the respiratory apparatus take on
this extreme excitability, and manifest reflex nervous action under
the slightest stimulus. It is not necessary that the first impression
should be made upon the pharyngeal nerves, to excite spasm, for a
draft of air, a motion of the limb, or the access of light, may give rise
to the dysphagia, as well as the other convulsive movements of res-
piration. That the pharyngeal nerves may and do perform reflex

* Todd <t Bowman's Physiological Anatom. and Physiology of Man, p. 214.

214 Doughty, on IlydrophoUa with Remarhs. [April)

actions in this disease, admits of no question, but their extreme
susceptibility to impressions is the result of primary irritation al -
their nervous centres.

The consideration of the fourth proposition involres the ques-
tion of the communicability of the disease by other secretions of
the body^ besides the salivary. Having expressed our view upon .
this point at some length, in the discussion of the first proposition, '
we dismiss this, with the statement, that the case of the bitch re-
cited, and that of the ewes, prove almost conclusively the first by '
analogy, and the second positively, that the communication of the
disease is not confined to inoculation with the salivary secretion
alone.

Having thus endeavored to give a general exposition of this ",
distinctive pathology of hydrophobia, we dismiss the farther con-
sideration of it with the remark, that those changes found after
death, are rather the consequence than the cause of the disease,
and that they are emphatically secondary to the constitutional irri-
tation, and that this latter exists primarily in the nervous cen-
tres. There may seem to be a discrepancy existing between the ,
character of the arguments adduced and the caption of the case re-
ported, but I have not hesitated to argue the pathology of the true
hydrophobic disease, inasmuch as, this case resembles it in every
outward manifestation. The difficulty of swallowing, the inter-
mitting spasms of respiration, the peculiar disorder of mind, and
the extreme irritability of the bodj^, taken in connection with the
bite, serve unequivocally to confirm it a case of hydrophobia. But
it may be objected, that this disease has its exclusive origin from
inoculation with the poison by an animal actually laboring under
rabies at the time of communication. It is proper to state, how.-
ever, that there are those who believe, that under a predisposition
to the disease in the individual, that the bite of a dog simply eib;
raged may have the effect occasionally of producing hydrophobia*,
Without adopting the latter view, I think that it derives plausibil*
ity from some general facts ascertained, in regard to the influen
of the nervous system upon the secretions of the animal body, and"?
it likewise, receives support from the case reported. That influ-
ence may be exerted to the effect of producing changes, either in
the quantity or quality of the secretions. The first is exemplified,
when under the influence of fear or fright ; an increase in the se-
cretion of urine takes place ^it being sometimes discharged invo-

1857.] Cases of Spina Bifida. 215

luntarilj- The second, in the change produced in the milk of the
nurse, whilst laboring under violent passion, producing in the in-
fant irritation of the alimentary canal, convulsions and even death.
Will it be denied bj those who require the dog communicating it
to be laboring under rabies^ that the nervous system of the dog or
other animal, is capable of exerting the same changes, and produc-
ing similar modifications in their secretions? Eeasoning from
analogy, why may not modifications of the saliva of the dog, for
instance, under the influence of rage or anger, be possessed of
equally deleterious and poisonous properties, as those of the mill^
in the case of the mother and child ? The mode of its absorption
cannot possibly be an argument against it. That it receives sup-
port from the case reported will not be denied, when it is recol-
lected that there were no circumstances in the history of the dog
to warrant suspicion of rabies. The dog had observed his usual
habits, but seemed to have always entertained a hatred for this
person. I saw the dog shortly after the occurrence, there was no-
thing strange or rabid, either in his looks or behavior, but on the
contrary, he seemed to be good-natured and friendly-disposed to-
wards myself Eight months have now elapsed since the accident,
and no symptom of rabies has yet manifested itself in the dog. If
it were not a case of hydrophobia, what was it ?

Hoping that the report of the above case may call attention to
pertain points of interest therein discussed, I here close these re-
marks, already extended beyond mj original design.

\

ARTICLE XIV.

Spina Bifida three Cases frora one Mother, By E. M. Pendleton,
M. D., of Sparta, Georgia.

In a practice of twenty years, I have seen but four cases of that
terrible congenital disease, or malformation, termed Spina Bifida.
The first, was in consultation with Dr. Lynah, of Warren county,
^\'hich terminated fatally, at several years of age. The sac con-
taining water and connecting with the brain through the spinal
column, was at the end of the os coccygis. The other three cases
have occurred within the last five years, and singularly enough,
were all the offspring of the same mother, a lady of this county, of

216 '?'E,'^J)i:e,toi^^b> Cases of Sjpina Bifida. [April,

the first respectability. Her first child, a son, had a very small
sac on the left side of the spinal column, in the lumbar region,
which did not seem to connect specially with the spine, and but
for the further developments of the case, would not have produced
much apprehension. Hydrocephalic symptoms, however, super-
vened in a few months, the head became enlarged and the child
had occasional spasms ; it died in a short time.

The second child was apparently healthy ; but as the parents
had removed from their former residence, I lost sight of the case,
until summoned to attend it, in consultation with another physi-
cian. It labored under the effects of catarrh and dentition, the
brain suffering greatly. It died in a few days after I saw it.

In the third case, I attended the accouchement, and found as i
soon as the child was born, that it presented symptoms of paraly- I
sis. Upon examination, the same fearful sac, at about the same
point of the lumbar vertebrae presented itself, only it was much
larger than the other ; the legs crossed and were perfectly paralyzed.
The head was larger than natural, and soon exhibited hydrocepha-
lic symptoms. It lived several months, and cried nearly aU the
time of its waking existence. ,

Several months since, I was summoned to the same lady in her j
fourth confinement. I went with fear and trembling, feehng
a strange premonition that I would have the same difficulty to
contend with as formerly. Anxiety and apprehension were depict-
ed on the countenances of both parents, and I could but offer a I
silent prayer that this one might be well formed. But, alas ! as
the child presented itself to our vision the first time, we detected
the same inability to move its lower extremities, the same malpo-
sition of the legs, and the same fearful fissure in the back, only
larger, apparently, than either of the others. We turned away
sickened at the sight. In other respects, the child seemed to be
healthy and sprightly. It too, soon followed its predecessors to
the grave.

What can be the cause of this singular concatenation of unfor-
tunate births, from parents who are both well formed, vigorous
and healthy, in every possible respect? The father is of a bilious,
lymphatic temperament ; the mother, sanguino-nervous the pa-
rents of both, still alive and healthy. This would seem to be one
of the best crosses imaginable. The maternal grandmother, how-
ever, springs from a family of over sanguineous temperaments and

1857.] A few Thoughts on Epilepsy, 217

scrofulous diatheses. They are very prone also to intermarriages.
Her immediate offspring, however, are all healthy, and we do not
conceive that there exists any just cause of suspicion on this
ground.

The case is one of great interest to those wlio love to investi-
gate the profound intricacies of the physiological and pathological
relations of parents and offspring. We feel an especial interest in
presenting these cases, hoping that suTch untoward effects may be
traced to their legitimate causes, and some prophylaxis be institu-
ted, that may arrest the calamity in future. If not in the case
under consideration, at least in some which lie in the lap of the
futura

A Few Thoughts on Epilepsy. By L. M. Lawson, M.D., Professor
of the Theory and Practice of Medicine, in the Medical Colleo'e
of Ohio.

This disease, (which has well nigh been ranked among the op-
prohria medicinca^) has of late years received a large share of atten-
tion from practitioners and pathologists. But notwithstanding
these laborious and extensive investigations, it still remains, (so to
speak,) a terra incognita. It is to us, as it was to our predecessors,
a morbus hercvleus or a morbus sacer too often defying our most
"cherished remedies, mocking alike the skill of the physician and
the miseries of the patient

But in the midst of this darkness and confusion a few glimmer-
ing rays of light now and then steal in upon us ; and while, in
some respects, they serve only to heighten the horrors of the scene,
they do reveal a few tangible points, which may assist us in reach-
ing more rational conclusions.

We cannot say that epilepsy has, in fact, any pathological ana-
tomy-^ indeed, the morbid changes which have been observed after
ideath, exhibit but little uniformity, and therefore cannot be re-
garded as essential to the disease. Probably the only condition
which throws much light on the malady, is the state of atrophy
observed in the cortical portion of the brain in old epileptics.
'"This condition indicates a derangement of the nutrition of the part,
I the result of diminished action.

The low state of therapeutics in relation to epilepsy may be
traced to two causes : 1, The absence of any recognizable patho-
logical anatomy ; and, 2, An effort to supply this great hiatus by
the use o^ specifics. Hence, even our French confreres, who usu-
ally exhibit so much philosophy and careful discrimination, do

218 A few Thoughts on Epilepsy. [April,

little more than employ, in the niost routine manner, some faricied
specific. Trousseau, for example, finally fixes on the belladonna
treatment, which he thinks must be continued from two to four
years.

Dr. Todd, of London, has recently attempted to bridge over this
great chasm, b}^ suggesting that a polarized state of the brain, (or
certain parts of it,) occur, and that it is the " disruptive discharge,"'
(chemically speaking,) which induces the paroxysm. He recog-
nizes two degrees : one involving the cerebral hemispheres, leadin _
to loss of consciousness and impaired intellect ; the other, moic
profound, extending to the tubercula quadrigemina and mesoce-
phale, causing the convulsions. All this he ascribes to a change
of nutrition of the part, which induces a highly charged or polar-
ized state, and the tension which ensues leads ultimately to the
disruptive discharge^ and all the phenomena of the paroxysm. He
does not admit that inflammation, congestion, or anemia produce
the disease ; but that it often arises from the specific influence of
some poison circulating in the blood, among which may be men-
tioned the influence of retarded urea.

These expressions, however, are only feeble approaches toward
an explanation ; foi^, although they convey some faint idea of what
may possibly be occurring, they are so dim and shadow-like as to
leave the inquirer still faltering and undecided. The only sugges-
tion of practical value, embraces the idea that the foundation of
the disease is essentially deranged nutrition.

Dr. Radclifie has otfered an explanation of the principal pheno-
mena which occur in epilepsy and analogous diseases, which
embraces as a fundamental idea diminished nervous action. Ac- '
cording to this view, the spasmodic action is due to diminished'
circulation and innervation, in consequence of which molecular
contraction of the muscles ensues. Spasmodic action, therefore, is
due to the withdrawal of stimulants, instead, (as was before be-
lieved,) an increase of excitement.

The novelty of this doctrine will secure for it a hearty rejectioa^
by those who are accustomed to think only in a single channel ;
nevertheless, there are various facts and analogies, (which cannot
be now enumerated,) which strongly favor such a conclusion, if
they do not positively establish it. Let me name but one by no
means the most conclusive : AVe can bleed a patient into, first,
syncope ; second, convulsions. Here is diminished excitement fol-
lowed by violent muscular contraction. Is that contraction due
to an increase or diminution of excitement? But one answer can
be returned.

Independent of either of these theories, I am led to believe that
the essential pathology of epilepsy is diminished action, probably
connected (at least ultimately) with impaired nutrition. It may,
however, arise from the action of poisons, from sympathetic influ-
ence, or direct derangement. It is, in fact, connected with impair-

1857.] A few Thoughts on Epilepsy. 219

cd vitality, generally, such as sluggish innervation, circulation,
secretions, mental manifestations, and so on. All this may result
iVoni onanism, i-etained urea, the elements of bile or other poisons,
sympathetic derangement of the alimentary canal and uterus, and
excessive and exhausting mental efforts or emotions. In each in-
stance, however, the uUimate effect, (and that which leads to regu-
larly developed epilepsy,) is exhausting in its character, and
finally impairs nutrition.

It is a peculiar tact, and one which is very significant in this
eonnection, that an intercurrent excitement such as fever or in-
flammation temporarily suspends epilepsy, which could hardly
happen if the disease was not one of diminished vitality. An in-
stance has come to my knowledge in which a severe fall, from
some considerable height, had the same effect.

The conclusion which appears to me most in accordance with
the phenomena of epileps}' is, that the essential pathological state
is one of depressed vitality, including impaired nutrition. But
while this is admitted, we must often look beyond the nervous
system for some exciting or predisposing cause ; and hence there
is some justness in the following varieties of epilepsy, as enume-
rated by Dr. Cheyne: epilepsia cerehralis^ sympathetica^ stomachica^
liepatica^ nervosa, uierina, a dolore. It must be rememlDered, how-
ever, that these functional derangements may be a consequence
and not the cause of an attack.

In regard to the urinary secretion, it has been shown by Dr.
Hunt and Dr. Todd, that certain derangements of this function
may lead to epilepsy, and that its cure consists in correcting that
condition ; and the same remarks apply with equal force to the
hepatic function. Thus, Dr. Todd found the urine albuminous,
with deficient urea; Dr. Hunt observed the secretion to manifest
a feeble acid reaction, with low specific gravity, increase of mine-
ral ingredients with diminution of urea and other organic matter.
These facts, coupled with the observations of Dr. Prout, that when
soda and ammonia are in excess, nrea becomes diminished, and
that soda and potash seriously injure the nervous system ; and we
have a key to at least some of the morbid changes which occur in
such cases.

But, after all, the great object is to find a successful mode of
treatment Unfortunately, most of the specifics have failed, or if
occasionally successful, they are not so with sufficient uniformity
to establish for either one a particular pre-eminence. Thus, nitrate
of silver, oxide of zinc, sulphate of copper, iron, arsenic, digitahs,
valerianate of zinc, belladonna, the recently vaunted cotyledon
umbilicus and an innumerable host of similar agents have each
in their turn signally failed. It is true, each may at times succeed,
but their application is altogether empirical, and therefore neces-
sarily unsuccessful.

In view of the depressed state of vitality, the leading indication

220 A few Thoughts on Epilepsy. [April,

with me is to improve the tone of the system by the administration
of stimulants, tonics, and suitable nourishment. For this purpose
I employ brandy, iron and animal food. These agents improve the
tone of the system, and I have witnessed the suspension (and
probable cure) of the disease while under this course of treatment.
In one case of six years' duration, violent paroxysms occurring at
least weekly, with the "petit mal" almost daily, the paroxysms
were subdued, and the patient apparently restored, under the use
of ounce doses of brandy three times a day, together with purga-
tives, and small doses of hyoscyamus and strychnine.

But I would by no means neglect the kidneys and liver. If
there is diminished urea, employ diuretics; if the alkalies have in-
creased in the urine, give acids, especially the nitro-muriatic. If
the liver is torpid, (which is almost invariably the case,) give ca-
thartics, containing more or less mercury. I place great reliance
on the judicious (but decided) employment of cathartics ; but none
of these agents should interfere with the tonic and stimulating
treatment. Kestore the general health by means of alteratives and
tonics, and by keeping the renal and hepatic emunctories acting
freely, and then overcome the nervous disease by cardiac and ner-
vous stimulants.

Among the class of remedies known as sjjecifics^ (so called be-
cause their mode of action is unknown,) none has gained more
reputation than the oxide of zinc. M. Herpin (who received a
prize from the Institute of France, in 1850, for his treatise on this
subject,) eulogises the virtues of zinc, and indeed placed his chief
reliance on that agent. The success of M. Herpin was very re-
markable. He gave the zinc in doses of six to eight grains daily,
in divided portions, augmented every week by two grains daily,
until the dose reached forty-five grains! This was continued for
months in succession. The nausea, which appeared at first, soon
passed off, and no further inconvenience from the large doses was
experienced. He mentions one remarkable case in which 1200
fits had occurred, cured by a combination of zinc and belladonna.
Of 40 cases treated with the oxide of zinc alone, 28 were cured
a far greater success than has fallen to the lot of most practitioners.

It does not appear, however, that others have been equally suc-
cessful with this agent. Thus, M. Trousseau, in the very face of
Herpin's experiments, abandons the zinc, and now relies, mainly
on belladonna. He employs a pill composed of the powder and
extract of the roots of belladonna da one-seventh grain. One pill
is given every night for the first month, which should be increas-
ed one for each month up to the fourth month. He has cured 20
out of 150 cases; and M. Blache has had about similar success.

In regard to prognosis, it may be remarked that the principal
elements are age, duration of the disease, frequency of paroxysm,
etc. The periods most susceptible of cure, are, first, between 10
and 20 years, and, second, above fifty ; from 20 to 30 being the

1857.] Stimulant and Tonic Treatment of Epile2->sy. 221

most unfavorable. It is an important fact mentioned by Herpin,
that when the paroxsms have not exceeded 100, he cured 74 per
cent.; but when they exceeded 500 he did not succeed in curing a
case.

One of the most important elements of success in treatment, is
perseverance. Trousseau remarks that if, at the end of one year, a
little mitigation can be perceived, there is ground for encourage-
ment ; but that the medicine must usually be continued from two
to four years. I am fully persuaded that our want of success often
depends on the frequent change of remedies, and the too early
abandonment of even a correct course. We should study well
our case, become perfectly sure of its essential points, and then
adopt such course as promises most success, and 'persevere to the end.
iNo doubt it was in this way that M. Herpin secured a higher per
centage of cures than his cotemporaries, and it is by the same un-
faultering course that others can obtain a like success.

Finally, I would enumerate the following points in the treat-
ment :

1. Cathartics, more or less mercurial.

2. Tonics, especially iron.

8. Acids or diuretics, in deranged urinary secretion.

4. Stimulants, brandy, whisky, gin.

5. The special agents, oxide of zinc being preferable.

6. Belladonna, combined with the oxide or valerianate of zinc,
in special cases.

7. Above all, persevere to the end. [Western Lancet.

Stimulant and Tonic Treatment of Epilepsy.

At one of the late meetings of the Medical Societ}^ of London,
Dr. Eadclifife read a paper "On the Necessity of a Stimulant and
Tonic plan of treatment in Epilepsy." His experience corroborates
the views expressed by Professor L. M. Lawson, in our last No.
We copy the following notice of Dr. Kadcliffe's paper, and the re-
port of one of the cases treated, from the London Lancet for Janu-
ary. \Western Lancet.

" In this paper, the author related several cases in which a sti-
mulant and tonic plan of treatment had been emploj^ed with appa-
rent benefit. Before doing this, however, he directed attention to
a point of some significance, both theoretically and practically, and
this was, the maiied improvement in the feelings of the patient,
which was noticed as having taken place in more than oiie in-
stance after dinner. More than once the patient had made this
remark spontaneously, and he always made it when questioned
upon the subject. This point is not always noted in the cases,
but the author did not remember a single exception to the state-
ment. Now, this point, it is argued, would seem to be a point of

222 Stimulant and Tonic Treatment of Epilepsy. [April,

some significance, both theoretically and practically, for (if the
feelings of the patient can be taken as any guide) this improve-
ment after dinner must show that abstinence is not the rule of the
treatment in epilepsy. Certainlj-, prudence is required in arrang-
ing the meals of an epileptic, and especial care must be taken to
prevent any over-loading of the stomach, but not less certainly is
an empty stomach to be dreaded. Cceteris pjarihus^ there is no
sound practical reason for supposing that an epileptic ought to eat
and drink less than another man, and there is some reason to the
contrary. At any rate, there is no reason for supposing that he
ought to drink less. The author was very incredulous as to any
ease of epilepsy to which these remarks did not apply. These re-
marks did not apply to all cases of an epileptoid character, but
they applied, he believed, to all cases of real idiopathic epilepsy.
Indeed, he found that the supposed exceptions to this rule would
never bear examination. Dr. Eadcliffe also referred to the manner
an which improvement is generally manifested in epilej^sy. It
did not seem to be the rule, he said, for improvement to be mani-
fested in the gradual mitigation of the convulsion. On the con-
1;rary, the rule would rather seem to be for the general health to
improve gradually, and for the sopor following the fit to become
less and less profound, and less and less prolonged, until the pa-
tient wake up immediately after the fit, or even retain his con-
sciousness throughout the fit, the fit in this way becoming more
and more transformed into the milder type of hysteria. Un-
questionably, the convulsion may cease gi^adually, but the ordin-
ary rule is rather that it ceases more or less suddenly at some
point in the process of recovery ; and this ought to be borne in
mind, or much disappointment may ensue to both patient and
practitioner.

Case 1. Mr. C , aged forty. During the last fifteen or

sixteen years, this patient has been engaged as clerk and collector,
and for a considerable portion of this time he has walked, upon an
average, about twenty miles a day. This was the case until with-
in a few months ago, when, his strength having failed, he became
continuously engaged in in-door work. The first epileptic seizure
was five years ago, the immediate occasion being the fright and
grief consequent upon seeing one of his children killed under the
wheel of a carriage ; and since this time the seizures have recurred
at continually shortening intervals, until these intervals are rarely
shorter than a week. The fits are generally violent. They occur
generally in the night, and the exhaustion following them is often
sufficient to prevent him from going to his work on the follow-
ing day. Mr. C is very abstemious in his habits, and for

some time has been a rigid teetotaller. He is always better after
dinner.

Dec. 9th, 1852. His whole appearance is that of a man greatly-
exhausted, and much older than he really is. The countenance is

1857.] On Valerianate of Ammonia. 22S

pale, and the expression inanimate; the pupil somewhat large and
sluggish; the pulse slow (65), and very weak. For some time af-
ter the attack, he passes a quantity of pale urine, and he is very
excitable. He was recommended to live more generously, taking
malt liquor to his dinner and supper, and to have a draught con-
taining half a drachm of naphtha three times a day. He was alsa
recommended to walk no more than he could possibly help.

January 27th, 1858. Much better. There have been two fit^
during the last month, No alteration in the treatment.

March 8rd. Much better. He says that he occasionally walks
over in an evening to a brother who lives in the neighborhood,
and has a glass of whisky-and- water with him, and that he has a
much better night, and is none the worse the next day, when he
does this. He has had two fits since the 27th of January. No
alteration in the treatment.

July 12th, 1855. Mr. C looks many years younger than

he did when he called two years ago, and has altogether lost the
pale and exhausted expression of his countenance. It appears-
that he has been carrying out the prescribed treatment, more or
less assiduously, ever since he saw me last, and that the interval
separating the fits became longer, until the last interval was full
seven months. At present, however, he is not so well, and this
alteration he ascribes to his having been obliged to resiime his old
walking habits. He had walked not less than twenty miles the
day preceding his last attack. He was recommended to live more
generously while the necessity for walking continued, and to re-
turn to the naphtha."

On Valerianate of Ammonnia. By WiLLIAM Peocter, Jr,

Within two months past a demand has arisen for the valerian-
ate of ammonia, owing to the publication in the Medical Examiner
of a notice of its successful employment in severe facial neuralgia
by certain French physicians. Having been applied to for this
substance, and having studied the subject to some extent, the fol-
lowing remarks bearing on the preparation and properties of the
salt are offered to those desiring the information.

When valerianic acid, as it occurs in commerce, is neutralized
with strong solution of ammonia, and the liquid is carefully evap-
orated at 150 F., a syrupy liquid results, which is a dense solution
of the valerianate of ammonia. If left to stand for sometime it
shows little, if any, disposition to crystallize, especially if the at-
mosphere is moist ; but under favorable circumstances crystalliza-
tion occurs, and the solution becomes a mass of crystals.

After several trials, the following method was adopted, which
proved successful. After concentrating the aqueous solution, it

224 On Valerianate of Ammonia, [April,

was mixed with twice its bulk of alcohol of 95 per cent., and suf-
fered to evaporate spontaneously. In a few hours, as the alcohol
disappeared, crystallization took place without difficulty. As va-
lerianic acid is expensive, and the use of this salt will depend
much on its being obtained at a reasonable price, it will be pre-
ferable to make the acid and salt in one operation, which can be
economicall}^ done by the following process, which I have found
to yield a nearly pure product.

Take of Bichromate of Potassa, eighteen drachms,
Sulphuric acid, thirteen fluid drachms.
Fusel oil (Alcohol Amylicum), a fluid ounce,
Water, a pint,
Solution of ammonia, a sufficient quantity.

Eeduce the bichromate to powder in a mortar, add the acid
mixed with an equal bulk of water and triturate, and then the re-
mainder of the water, so as to get a clear solution. Pour this into
a quart flask, add the fusel oil and shake them together at short
intervals, until the reaction has abated and the temperature de-
creased. Then attach the flask to a Liebig's condenser, (or use a
retort and receiver,) apply heat, and distil a pint of liquid from the
mixture. The distillate (which consist of a watery solution of va-
lerianic acid, with an oily mixture of valerianic acid and valerian-
ate of oxide of amyl, or apple oil, floating on its surface) should
then be put in a flask, and solution of ammonia added with agita-
tion, until in slight excess, and the liquid ceases to redden litmus
paper. The apple oil floating on the surface should then be re-
moved, and the solution evaporated on a water bath till syrupy,
mixed with alcohol, as before noticed, and set aside to crystallize.

A very neat process is to pass gaseous ammonia through syrupy
valerianic acid till super-saturated, and then, after slightly heating
the dense solution, to remove the excess of ammonia, cry stall izating
by aid of alcohol, as above.

Valerianate of ammonia is a colorless salt, crystallizing in very
thin micaceous quadrangular plates, soluble in water and alcohol
in all proportions. When added to washed ether, a part of the
salt seizes on the water and attaches itself to the sides of the vessel,
whilst another is retained by the ether. Its taste is at first sharp,
and then sweetish, its odor slightly valerianic, like valerianate of
soda. When its aqueous solution is boiled, ammonia is perceptible
in the vapor. According to Lowig it volatilizes without decom-
position, and Gregory gives it the formula NH*, O-j-C' H^ O^.
Although very soluble, this salt effloresces when exposed to the
air. I have not determined its amount of water of crystallization,
nor have I been able to find any statement of the dose of the salt,
as the paper in the Examiner speaks of a "solution" without no-
ting its strength. [American Jour, of Pharmacy.

1857.] Liquid Perchloride of Iron as a Ilcemostatic Agent 225

On the Preparation of Liquid Perchloride of Iron as a IMmostatic
Agent. By M. Burin Du Buisson, of Lyons.

It is known that a great many substances have the praperty of
precipitating albumen from its solutions.

Almost all the acids precipitate it white ; acetic acid converts
concentrated solutions of albumen into jellies.

Strontia, baryta and lime, form, with albumen, precipitates which
are insoluble in water.

Almost all the metallic salts are precipitated by albumen, and
the white precipitate insoluble in water, which this substance forms
with bicliloride of mercury, is well known. To the other metallic
salts which possess this property, sulphate of copper, but more
especiall}^ perchloride of iron, must be added.

Perchloride of iron possesses, indeed, in the highest degree, the
property of combining instantaneously with albumen, and of form-
ing with it a precipitate under the form of a consistent and insolu-
ble magma, as Dr. Pravaz has just proved, and every one now
knows the importance of the application which this skillful practi-
tioner has recently made of the aqueous solution of this salt for
instantaneously coagulating the blood in the arteries, as regards its
special employment for the cure of aneurisms in man.

Perchloride of iron unites, indeed, all the qualities desirable (and
even exclusive) for fulfilling the object to which Dr. Pravaz has so
happily applied it great haemostatic power, perfect harmlessness,
and solubility in water: it remained, therefore, only to find a mode
of preparation which would enable us to obtain this salt always
very pure, and its aqueous solution at a maximum density^ which
might be always and everj^where identical, indispensable condi-
tions for attaining the object proposed by Dr. Pravaz, who has
been kind enough to entrust this task to us. The following are
the results we have arrived at :

LIQUID PERCHLORIDE OF IRON, OF DR. PRAVAZ.

Grammes,

Take, Commercial sulphate of iron, 1,000

Water, 8,000

Pure iron filings, 100

! Sulphuric acid, 15

The whole is introduced into a matrass, or better still, into an
enamelled cast iron vessel, and allowed to digest on a sand bath
,. until the disengagement of gas entirely ceases ,' it is filtered, and
3 five hundred grammes of liquid hydrosulphuric acid are added to-
,j die liquor, and the whole is left to repose for tv/ el ve hours; at
jj tiie end of this time, the solution is boiled for half an hour and
ij| Altered.

'^ Two hundred grammes of pure concentrated sulphuric acid are
wided to the filtrated liquor ; the mixture is placed in a porcelain
3^sule, or an enamelled cast iron vessel, which must not be moie

226 Liquid PercJiloride of Iron as a Hczmostatic Agent [April,

than half filled, and boiled, and pure nitric acid is added in small
portions until the last addition causes no disengagement of red va-
pors; it is then removed from the fire, the liquor is diluted with
from twenty -five to thirty times its weight of cold water, and all
the iron is precipitated in the state of peroxide with a slight excess
of liquid ammonia: the precipitate is washed by decantation with
pure water a great number of times, and it is dried in the air by
spreading it in thin layers on a cloth.

The dry and pulverized oxide is afterwards calcined at a red
heat in a shallow wrought iron vessel, so as not to raise the tem-
perature too high ; the astringent saffron of Mars, of the shops, is
thus obtaided, which is no other than pure peroxide of iron, when .
it is tbus prepared.

The perchloride of iron is afterwards obtained in the following
manner .

Grammes.

Peroxide of iron as above prepared, . . . 200
White and pure hydrochloric acid, . . . . 1,000

It is allowed to act without heat for five or six hours, and then
the vessel is placed in a boiling water bath and heated until the
oxide is almost entirely dissolved ; this operation must be perform-
ed in a porcelain capsule of known weight; the liquid is decanted
in order to separate the undissolved oxide, and it is carefully evap-
orated on the sand bath, stirring continually to the consistence of
a thick syrup, the weight of which is then determined: a quantity
of distilled water equal to half this weight is then added ; the heat-
is then continued for a short time, and the whole is poured into a
filter; the capsule and filter are washed with a fresh quantity of
water, equal to the first, and sufficient of this liquid is then added
to the first liquid to obtain a homogeneous mixture having the
constant densitj^ of 43.5 to 44

By operating thus, we obtain a very limpid liquid, having only
a slight acid reaction, but perfectly pure, at the maximum of satu-
ration, and always identical, which may be preserved without any
deposition of salt, j)rovided that it be kept in a well corked bottle
it is of a deep brown color by reflected, and of a greenish goldtu
yellow by transmitted ligbt, or in a thin layer.

Five or six drops of this liquid, mixed with the white of an egg, '
suspended in twenty grammes of water, are sufficient for causing
the whole to assume, in less than a quarter of a minute, the form
of a mass which, on reversing the vessel which contains it, remains
adhering to the bottom of the vessel, and it detaches itself only
after a very long time, when the water begins to separate partially,
in the same manner as the serum of coagulated blood.

This preparation, therefore, combines all the conditions required
for realizing all the anticipations to which the observation of Dr.
Pravaz have justly given rise. \Jour. de Chimie Med. Western
Lancet.

1857.] Beady Method of Asphyxia^ 227

Successful Employment of the ^^ Ready Method in Asphyxia'''' of Dr.
Marshall Hall^ in a Case of Poisoning by Laudanum. Eeported
by E. H. Janes, M. D., Secretary of the Society of Statistical
Medicine.

Dr. Lewis read the following history of a case of poisoning by
laudanum, in which he successfully resorted to Marshall Hall's new
method of recovering persons drowned, or otherwise asphyxiated:

On the loth day of August, 1856, Mr. J., a young man, agt. about
28 years; sound constitution and temperate habits; dined and
passed the evening with a friend, in the course of which he was
heard to complain of pain in his left side, about the region of the
heart, for which mustard was applied.

At ten o'clock he left his friend's residence, and made his ap-
pearance at his hotel about midnight, and shortly after retired to
nis room.

In the morning, the door of his room was forcibly opened, and
he was found lying upon his back ; his respiration stertorous, and
not exceeding five or six to the minute ; his pulse slow and full ;
pupils contracted ; countenance livid ; exhibiting no sign of con-
sciousness. An attempt was made to arouse the patient by dash-
ing cold water upon the face and chest, shaking, applying the salts
of ammonia to the nose; but so profound was the coma, that no
indication of consciousness could be elicited. Weak brandy and
water was next introduced into the mouth, and an attempt made
to produce deglutition by exciting the muscles about the pharynx,
when, much to the surprise of the bystanders, his countenance be-
came darker, and all respiration ceased.

The patient was immediately turned upon his face, in order that
the fluid might escape ; sinapisms wxre applied over the entire
length of the spinal column, also over the extremities and chest,
and artificial respiration commenced without delay.
; For a period of five hours and a half, artificial respiration was
constantly continued, with an occasional brief interval to enable
us to determine whether all normal respiration had ceased. Dry
friction was made simultaneously "upward along the course of the
veins, the beneficial effects of which were apparent.

During the time when artificial respiration was performed, the
aspect of the case was very variable. At times the pulse was irre-
gular and thready ; at others, it was less frequent, more regular
and firm. Equally great were the variations noticed in the respi-
ration. When artificial respiration was for a time discontinued,
respiration would continue with some degree of regularity at long-
er than natural intervals, and then become less frequent, and more
regular until artificial respiration was resumed. Once during the
' time that artificial respiration was continued, a pint of warm coffee
i was, by means of the stomach pump, introduced into the stomach
with evident good efi'ect, as indicated by improvement in the pulse

N. S. VOL. XIII. NO. IV. 15

228 Beady Method of Asphyxia. [April,

and respiration, which, however, was not permanent. A stimu-
lating enema of brandy and water was also administered.

After a lapse of four hours and a half, Dr. Cox saw the patient
in consultation with me. At this time, the case was very unprom-
ising.. There had been no manifestation of consciousness; the
pulse was irregular, frequent and feeble ; the pupils still contract-
ed ; the extremities cold and covered with clammy perspiration;
and dissolution was apparently so near, that further efforts with
hope of success seemed useless.

A flannel cloth saturated with aqua ammonite was now applied
to the spine, and artificial respiration continued one hour longer,
when normal respiration was resumed, and with it was noticed a
gradual return of consciousness. The following morning his con-
sciousness was perfect, although there was extreme nervous ex-
haustion, great mental depression, vomiting, loathing of food, etc.,
from which the patient gradually, but slowly, recovered. In the
course of the day, an ounce bottle labelled laudanum, a few drops
of which it still contained, was found concealed in the chimney
flue, behind the damper. It was also ascertained that the patient
had recently met reverses in business, and was laboring under pe-
cuniary embarrassments, which doubtless induced that species of
"moral insanity" that led him to contemplate suicide.

The points of interest in this case are, first, the manner of per-
forming artificial respiration, which was in accordance with the
directions of Dr. Marshall Hall, contained in the London Lancet,
for recovering persons asphyxiated by drowning, viz: by placing
one hand upon the inferior and lateral portion of the chest, and
the other upon the superior portion or shoulder, and rolling the
patient upon the face, at the same time making moderate pressure,
to force the air from the lung ; the body was then rolled back,
completing about one third of a circle. This was repeated slowl}^
sixteen times to the minute.

DR. 3L1RSHALL HALL'S RLXES.

1. Treat the patient instantly, on the spot, in the open air, freely exposing the face,"
neck and chest to the breeze, except in severe weather.

% Send with all speed for medical aid, and for articles of clothing, blankets, etc

I To CUar the Throat.

3. Place the patient gently on the face, with one wrist under the forehead;

[all fluids and the tongue itself then fall forward, and leave the entxaace into the windpipe^rtfe.J
11. To Excite Respiration. ,

4. Turn the patient slightly o-n his side, and

(i.) Apply snuff or other imtant to the nostrils;

(ii.) Dash cold water on the face previously rubbed briskly un^il it is warm.
If there be no success, lose no time, but

III. To Imitate Respiration.

5. Replace the patient on Ms face, supporting the chest on a folded coat or other
article of dress.

6. Turn the body very gently, but completely, on the side and a little beyond,, ana

1857.] Beady Method of Asphyxia, 229

then briskly on the face, alternately ; repeating these measures deliberately, efl&-
ciently, and pei-severingly, fifteen times in the minute only.

[when the patient reposes on the thorax, this cavity is compressed by the weight of the body, aud
expiration takes place; when he is turned on the side, this pressure is removed, and inspiration oc-
curs.]

7. T\rhen the ro;i^ position is resumed, make equable but efficient prewj^re, with
friction, along the back ; removing it immediately before rotation on the side ;

[the first measure augments the expiration, the second commences inspiration.]
All these movement's are performed systematically by the same individual
IV. To Induce Circulatio7i and Warmth
continuing these measures :

8. Rub the limbs upwards, with Jirm pressure and with energy, using handker-
chiefs, etc. ;

[by this measure the blood is propelled along the veins toward the heart.]

9. Replace the patient's wet clothing by such other covering as can be instantly
procured, each bystander supplying a coat or a waistcoat.

Meantime and from time to time

F. Again, To Excite Inspirations-
Id. Let the surface of the body be slapped briskly with the hand;
11. Or, let cold water be dashed briskly on the surface previously rubbed imtil it
is dry and warm.

The measures formerly recommended and now rejected by me are, the removal
of the patient, as involving dangerous loss of time ; the bellows or &uy forcing instru-
ment, and especially the warm bath, as positively injurious; and the inhalation of
oxygen, as useless.

The inhalation of dilute pure ammonia has in it more of promise.
The value of galvanism remains to be tested : can it excite the action of the heart,
or stimulate the muscles of inspiration ; or, by inducing contraction of the muscles
of the limbs, propel the blood along the veins? London Lancet, Dec. 13.

The greater success which attends this mode of performing arti-
ficial respiration, Dr. Hall attributes to the fact, that when the body
is placed in the prone position, the tongue falls forward, while in
the old method, with the patient in the supine position, it falls
back into the throat, closing the glottis, and entirely preventing
the ingress of air to the lungs.

The second point of interest is the manner of making dry fric-
tion of the extremities upwards along the course of the veins,
forcing the blood towards the heart, as directed by Dr. Hall, the
beneficial effects of which were too apparent to pass unnoticed.

The third point of interest is the length of time during which it
was found necessary to keep up artificial respiration, it being full
five hours and a half From the partial examination which I have
been able to make, I think it unusual for persons to rally who
have been so thoroughly overcharged with narcotic poison, as to
create the necessity for the continuance of artificial respiration so
long a time. The details of but few cases are recorded, and I have
noticed no instance in which artificial respiration was successfully
performed for a longer period than four hours.

Dr. Peaslee remarked that this case of Dr. Lewis' was an ex-
tremely interesting one, as it is the first instance among us in which
a practical application of Dr. Hall's method had been made. He
considers this an improvement possessing advantages over all other

'280 Raw Pork as an Aliment [A pri,

methods of treatment, as we can by it introduce a greater quantity
of pure atmospheric air into the lungs than by any other means, it
being three-fonrths as much as in normal respiration. Another
advantage is that we have the means of operating always at hand,
and the treatment may be pursued as well in one place as in ano-
ther, while other methods are subject to more or less delay in pro-
viding the necessary means. Each moment of delay is fraught
with imminent peril to the patient. In restoring persons from
drowning there is no time to be lost, for as long as the asphyxia
continues the patient is in nearly as much danger as if he were
still in the water; hence the necessity of prompt and energetic ac-
tion. He is inclined to think favorably of the application of cold
to the head, and heat to the extremities. If the pathology is con-
gestion of the medulla oblongata, preventing impressions being
conveyed through the pneumogastric nerve, our course should b
to remove this congestion. He has made use of this treatment in
cases of children poisoned with meadow parsley, and always with
prompt effect. The medulla oblongata being the centre of the
respiratory movements when it is disabled by congestion we
should, in addition to removing the congestion, continue our ef-
forts at artificial respiration until the cord resumes its function.
Acting upon this principle, it would seem in theory, that if artifi-
cial respiration was continued long enough, these patients would
all recover. [N. Y, Journal of Medicine,

Raw Pork as an Aliment

"I>r. Henry J. Bowditch gives, in a late number of the Boston
Medical and Surgical Journal, a short account of a trip on the
Penobscot, and tells us that the party were, for a time, forced tc^
live on pork. From the guides he learned that the raw pork was
considered much more nutritious, that it was much the moi
economical way of using it, and that those who ate it thus woulc
resist the fatigue of the journey for a greater length of time. The
custom is to cut the pork in very thin slices, and one or twc
drachms ot a meal was suf&cient."

We would be glad, did time and space permit, to make th(
above, from the New Orleans Medical News and Hospital Gazette
the occasion of extended remark ; but as a substitute for these, w(
here collect a few of the opinions in relation to the subject, whicl:
come under our observation daily while engaged in collecting
matter for our Lectures on Comparative Anatomy in the Medica
College of Georgia. In doing so, we leave the reader to draw th(
plain inferences in regard to the Hygienic influence of the cours(
hinted at, though not recommended, by the Boston Medical anc

1857.] Raw Pork as an Aliment. 231

Surgical Journal, on whose article the short comment is made.
We refer, of course, to the pernicious practice of feeding upon raw
meat, especially in a Southern climate.

' When we read the following, from which we learn not only the
immense fecundity, but also the great tenacity in the lives of these
parasites, we cannot but be thoroughly penetrated with the con-
viction that it is of the first importance that our animal food, or at
least some kinds of it, should be thoroughly cooked before entering
our alimentary organs.

We copy first from Prof. Owen^s Lectures on ComparaMve Anato-
my of InvertebrcUe Animals:

" The ancient philosophers styled man the microcosm, fancifiilly
conceiving him to resemble in miniature the macrocosm or great
world.

'' Man's body is unquestionably a little world to many animals
of much smaller size and lower grade of organization, which are
developed upon and within it, and exist altogether at the expense
of its fluids and solids.

" Not fewer than eighteen kinds of parasitic animals have been
found to infest the internal cavities and tissues of the human body ;
and of these, at least fourteen are good and well established spe-
cies of Entozoa." (Lect, lY., p. 57.)

. , *' The evidence of the fertility of the compound cestoid Entozoa
was sufficiently marvellous. That which I have now to adduce,
feom a calculation made by Dr. Eschricht in reference to the Asca-
fis lumhricoides^ the commonest intestinal parasite of the human
species, is scarcely less surprising. The ova are arranged in the
ovarian tubes like the flowers of the plantago, around a central
'stem or rachis. There are fifty in each circle ; that is to say, you
might count fifty ova in every transverse section of the tube. Now
the thickness of each ovum is 1*500 of aline, so that in the length
of one line there are 500 wreaths of fifty eggs each, or 25,000 eggs!
The length of each ovarian tube is sixteen feet, or 2,804 lines,
which, for the two tubes, gives a length of 4,608 lines. The eggs,
'however, gradually increase in size, so as to attain the thickness
' of jV of a line ; we therefore have, at the lower end of the tube,
sixty wreaths of ova, or 3,000 ova in the extent of one line. The
average number, through the whole of the extraordinary extent of
the tube, may be given at 14,000 ova in each line, which gives
sixty-four miilions of ova in the mature female Ascaris lumbricoides !
"The embryo is not developed within the body in this species:
the ova may be discharged by millions ; and most of them must,
in large cities, be carried into streams of water. An extremely
sraall proportion is ever likely to be again introduced into the

232 Baw Pork as an Aliment. [April,

alimentary canal of that species of animal which can afford it an

appropriate habitat. The remainder of the germs doubtless serve
as food to numerous minute inhabitants of the water; and the pro-
lific Entozoa may thus serve these little creatures in the same rela-
tion as the fruitful Cerealia in the vegetable kingdom stand to
higher animals, ministering less to the perpetuation of their own
species than to the sustenance of man." (Lect. VI., p. 110.)

And in another place he remarks :

!' Both, however, (the Bothrioce'plialus and Toenia,) agree in pre-
senting the most extensive development and preponderance of the
generative system that is known in the Animal Kingdom. In fact
there is scarcely space left in the hinder joints of the tape-worms
for the organs of any of the other systems."

"It has been proved that the mature Entozoa will resist the ef-
fects of destructive agents, as extremes of heat and cold, to a degree
beyond the known powers of endurance of the Rotifera, and which
would be truly surprising were not the simplicity of the organiza-
tion of the Entozoa taken into account. A nematoid worm has
been seen to exhibit strong contortions evident vital motions
after having been subjected above an hour to the temperature of
boiling water, with a codfish which it infested ; and, on the other
hand, Rudolphi relates that the Entozoa of the genus CapsulariSy
which infest the herrings that are annually sent to Berlin, hard
frozen and packed in ice, do, when thawed, manifest unequivocal
signs of restored vitality. If, then, the fully developed and mature
Ent6zoa can resist such powerful extraneous causes of destruction^
how much more must the ova possess the power of enduring such
without losing their latent life.

We find in the Eclectic Magazine, March, 1857, p. 293", thefol*'
lowing, from the London Review. It is given in a review of Dr.:
Carpenter's recent work " The Microscope and its Bevelations."
As it contains much of both interest and instruction, we copy it
in accordance with the principles of our motto ^^Je prends le h'Uvi\
ouje letrouve^

'' Some extraordinary facts connected with the life of intestinal
worms (Entozoa) have until recently perplexed orthodox philoso-
phers : one especially anomalous example being more puzzling
than the rest. A few examples of a curious worm, the Cysticercui
oculi humani, have at long intervals been found in the anterioi
chamber of the human eye. From the size of the animal it is al-
most impossible that it should exist in any man's eye withoul
attracting his attention ; and, from the inconvenience such a guesl
would occasion, it is equally improbable that the case would fai

1857.] jRaw Pork as an Aliment. 233

to reach some medical man who, from its extreme rarity, would
place it upon record in the medical journals. But, as just observ-
ed, the creature only appears on rare occasious. Dr. Mackenzie,
of Glasgow, removed one from the eye of a patient some twenty-
five years ago; and we believe that a second, which came under
our notice a few years since, ultimately reached the same experi-
enced oculist. The question for solution is an obvious one. How
could such creatures be transmitted by the ordinary methods of
multiplication ? Even had the successive instances occurred in
members of one family, (which they did not,) it would be difficult
to explain the preservation and transmission of the ova from one
individual to another, at the same time leaping over a quarter of a
century, "Lineal succession," say the advocates of spontaneous
generation, ^' is here out of the question;" and it was not very
easy for their opponents to explain the anomaly.

'*But not content with asserting the anomalous origin of this
Entozoon, and its independence of the ordinary laws of reproduc-
tion, the attempts was made to invest the heresy with an atmos-
phere of philosophy, by advancing an hypothesis accounting, for
the origin of such objects. Recognizing the vitality of each part
of man's animal organism, they contended that some portions of
his frame could become detached from the rest without losing their
inherent life; and that, after their separation, they became devel-
oped into independent creatures, endowed with all essentials of
individual animals. The supposition was not wholl}^ devoid of
support from anomalous things occurring elsewhere; but the true
history of the entire race of Entozoa has recently been studied by
several continental naturalists, especially M. Seebold ; and by his
masterly investigations the fallacy has been thoroughly exploded

" It appears, from these researches, that the Entozoa, or intestinal
worms, pass the early part of their life in the body of one animal,
hui complete their existence in that of some wholly different spe-
cies. Thus, the tapeworm found in the alimentary canal of the
human subject, spends its early, larval life in the liver, brain, or
other organs of some of the lower animals on which he subsists,
especially the sheep and the pig. A similar worm, found in the
^at, commences its existence in the body of the rat and the mouse;
while the parasite of the dog spends its youth in the interior of the
rabbit and hare. The larval forms occurring in these animals
have long been known and described as so many distinct species,
their very close relation to the tapeworm being wholly unsuspect-
ed ; but now their history is clear enough. The perfect worm can
^alone produce eggs, which it does in vast numbers, but which un-
dergo no further development in the intestine of the animal in
,which the worm resides. They are convej^ed along with the ma-
nure to pastures ; their marvellous vitality enabling them to sur-
vive the accidents of flood and field. Sooner or later thev are
taken up by some of the grazing quadrupeds along with '^their

234 Raw Pork as an Aliment. [-A^pril,

vegetable food, and are thus transferred to the animals stomachs,
where warmth and moisture quicken them into active life. The
germs now escape from the eggs, and become small worm-like
larvae, each with a bladder at its tail, and a circlet of cutting-hooks
at its head. By means of the latter they penetrate the various
tissues of the animal's body ; some reaching the brain, some the
liver ; whilst there is nothing to prevent an odd wanderer from
reaching any part of the body which is their temporary home. In
this stage, as well as in the earlier one of ova, these objects mar-
vellously resist destructive agencies. They accompany the sheep's
head into the pot, and lurk in the mutton frizzling in the pan ;
but, phoenix-like, they often survive the ordeal. The digestive
powers of living stomachs fail to digest them. The cat eats rats
and mice ; the dog consumes the wild animals of the field and the
offal of the shambles; man enjoys his mutton and his pork, and
the tapeworm larvae find their way to a resting-place. Their fur-
ther development is now completed ; they produce eggs by untold
myriads; the cycle of worm- life has been run, and with the ova
commences a new generation.

" How much is to be learned from this history ! In the first
place it gives spontaneous generation its death-blow. Cysticercus
oculi humani is no larger a marvel. The two men referred to had
eaten the larvae along with their pork or mutton, as myriads have
done, are doing, and will do, to the end ; but the larvae they con-
sumed, instead of remaining in the bowel, had, by a rare accident,
found their way to the interior of the eye, where they were seen
as well as felt, and consequently attracted notice. Had they re-
mained in the alimentary canal, they would merely have grown
unobserved into tapeworms. What they would have become,
had they not been removed by operation from the visual organ, it
is impossible to say. Their limited accommodation might have
arrested their development, and compelled them to remain larvae,
as tadpoles are said to continue tadpoles when excluded from the
light.

" A practical idea is also suggested by these discoveries. It is
known that the rot in sheep, and similar diseases in cattle, arise
from the presence of these cysticerci and their allies, these worm
larvae, in the bodies of the afiected animals. The dog is, in all
probability, the active agent in diffusing the multitudinous germs
of these pests of the agriculturist. It has been observed that cat-
tle fed in stalls and pens, dispensing with the aid of dogs, are less
liable to such affections than those reared in the open plain ; and
as the dog appears to play his part in diffusing the noxious germs,
the propriety of dispensing with his services at once suggests it-
self By so doing the grazier will materially improve his chance
of escaping the rot and similar evils. As for us poor bipeds, we
cannot subject all the contents of our larder to microscopic inspec
tion in chase of Cysticerci and Echinororhynchi nuisances witt

1857.] Galactirrhcea its Treatment, etc. 235

armed heads and ugly names. Our only resource is to avoid half-
cooked meats. We must see that the cook sufficiently roasts the
mutton, or risk being plagued by the doctor with his armoury of
turpentine, kousso, and oil of male fern."

H. F. C.

Galactirrhcea its Treatment, etc. By J. W. Beech, M. D., of Cold-
water, Mich.

Writers upon the peculiarities of the human female and her spe-
cific diseases, seem to have paid but little attention to the causes,
effect and treatment of redundant lactiferous secretion. Although
by no means a common deviation from health, its occasional oc-
currence, the grave results which accompany its march, or follow
in its wake, and sparcity of authority in the current medical litera-
ture, afford sufficient excuse for our penning a few remarks upon
the subject. Eegretting that we have not at hand a more exten-
sive collection of works, in which we should expect to find the dis-
order fully treated, we are aware that we hazzard much among the
more favored, who may have elaborate and practical treatises at
command. Professional duty has frequently required us to inves-
tigate its practical bearings, and, oral inquiries from some psofes-
sional friend, encourage me in this communication. Excessive
lactation may make its appearance in the latter months of preg-
nancy. If profuse it seriously impairs the euergy of the "e?icze?ite,"
increasing itself from the want of exercise, and seclusion, to which
young and sensitive females are apt to resort, in fear of the caustic
tongue of gossip. Impassioned connubial fondling may be the
exciting cause ; and abstinence a sufficient remedy. Even in this
case, if the secretion has been copious for some weeks, it may re-
quire medication, very similar to that apphcable post partum.
Venesection is frequently important, which we have not deemed
requisite after delivery. Neither do we advise stimulating topical
applications, as we shall propose in passive galactirrhcea, post par-
tum, lest the uterus be sympathetically aroused to contraction.
We have ventured to paint the upper half of each mamma with
tr. Iodine, once in 24 or 48 hours, with none but good effects.
Antiphlogistic dietetic regimen, abundance of exercise in open air,
mild hydragogue cathartics; "e^ id omne genus,^^ are generally in-
dicated at first, and in full habits. Later, tonics and astrino-ents
may be prescribed, some of which will be hereafter named.

After delivery, this difficulty seldom presents itself in a notice-
able degree, until after the first week, or upon the cessation of the
lochia. The grand panacea mammarum, of Prof. Dewees vine-
gar and water, at low temperature is our first, and often only
remedy. If the lochia have suddenly ceased, and there is inordin-
ate arterial action, venesection would be safer than to run the risk

236 Galactirrhcea its Treatment^ etc. [Aiprilj

of another metastasis of excitement. Brisk cathartics, tepid coxoe-
luvia, stimulating pediluvia, fomentations to the abdomen, sinap-
isms to the lumbar and sacral regions, or to the inner sides of the
thighs, naturally come to the mind as important adjuvants. Sinap-
isms should not remain on one place more than 20 or 30 minutes,
but may be repeated three or four times a day. Eestricted diet,
and cold water or ice, to quench thirst, are eqally important.
When the patient "has gained the feet," the phj'sical annoyance
of wet and souring clothes, etc., may be sufficient to induce a call
for the attention and advice of a physician, while all other func-
tions are normal. The clothing over the breast should be arranged
in the coolest and lightest possible manner, as much exercise by
walking as can be endured, and one of the following pills may be
taken before the morning and evening walk :
^. Scilla3 Mar. Pulv., grs. vj.
Antimoni Tartarizati, ij.
Syrup, qs. Fiant pil. No. xxiv.

By these means, other organs maybe excited to the relief of the
mammse, and when the necessity for their extra secretion has ceased,
they will more readily correct themselves than those newly called
into functional life. It is remarkable what an amount of rich,
nutricious material will flow from the breasts of some wasted wo-
men, whose emaciated and wasted limbs can scarcely sustain their
own weight, or hold the infaniissimus, who preys upon their vi-
tality. The actual demands of the offspring by no means limit the
supply. Cloths, glasses, sponges, and manipulations ("trayant")
must be resorted to, for purposes of cleanliness and partial com-
fort ; while constipation, aneuresis, excessive thirst and epithelial
lesions with their attendant evils, render life miserable and doubt-
ful.

This cause of debilit}^ is often entirely overlooked, or the chan-
ges in the secretion mistaken for the effect, and much time and
strength wasted in futile attempts to restore other functional de-
rangements without restraining this, until, in despair, the infant
is weaned ; when, if cachexia is not too far established, gradual
reparation occurs.

We have mentioned changes in the lactiferous secretion, and it
is not often that it continues of perfect quality, in galactirrhcea.
The attenuated limbs, and venter tumescens of the recipiant prove
it deficient in alimentary compounds. Casein, butter, and sugar,
are not in proper proportion to each other, or to the serum. In
the absence of positive analyses, we can only presume (and we
think safely) that the lacteal fluid resembles that of pregnancy and
menstruation ; and which have been described with so much care
and skill, by Dr. N. S. Davis, in his report to the " American
Medical Association," upon changes in the composition of the
milk of the human female, produced by menstruation and preg-
nancy, &;c. Well directed efforts to guide fluid excrements to

1857.] Oalactorrhcea its TVeatmenty etc. 237

their proper outlets, at the same time restraining lactation, as sug-
gested before, early in the attack, will often succeed to entire
satisfaction.

In the treatment of a more obstinate case, according to the va-
rious derangements which may have resulted, nearly the ordinary
"therapeia" are required; the varieties of which, it would be
supererrogation to suggest. Care must be taken lest the mammae
convert all to the use of the child. Cool applications, used steadi-
ly, so as not to produce shock, or encourage reaction ; systematic
counter-irritation, adroitly managed for revulsive effect; and diet
apportioned in quantity and quality, to the existing physical, or
pathological condition of the patient, and her lacteal secretion, are
^^ sine qua nony Exercise and mental diversion are not less im-
portant than for other valetudenarians. Coitus inter dicer etur. The
family physician should not see a mother losing too much of her
usual rotundity, without giving warning of the danger, investiga-
ting the cause, and advising proper hygienic regulations. The
people seldom suspect the amount of mischief which may result
from hyper-secretion, and are not aware of itt5 amenability to con-
trol.

Gallic acid and decoction of Statice, have given us much satis-
faction as internal remedies for specific action, before debility has
become marked. The latter is also one of the most valuable wash-
es in stomaiatis nutrici^ which, as we have hinted, often results
from galactirrhcea. In the passive forms of this affection, astrin-
gent, tonic, and gentle stimulants must be used with care to pre-
vent constipation. Acid Sulph. Aromaticum^ or the acid saline
solution cum quinia, are most valuable remedies. Ferruginous
preparations are frequently, but we think not always, indicated.
We were formerly partial to Tinct. Ferri. Muriatis, but it is more
apt to meddle Avith other functions than Ferri. Sulphas. "Liquor

' Potass. Arsenitis," largely diluted with syrup or aqua destillata,

. has given us much satisfaction as an alterative tonic in inveterate
cases.
. When the stomach has become extremely irritable, cold infusion

of gentian will generally be borne and produce tolerance of more
active tonics, stimulants and food. Argent. Kitras, with Ext.
Conii, in pills, and where acidity prevails, Heberden's prescription
in Commentary on "Linguas et Oris Dolor," are well adapted.
(" ]^. Testae Ostr. 3.ss., Rad. gentianae gr. iv., Hiera. pier. gr. ss.,

, morning and evening.")

The food must be varied according to circumstances, but should
not consist of many kinds compounded. Animal jelly, albumen
and fibrine in the most available forms for feeble assimilative or-
gans, with but little drink, and that cold. But few condiments
will be borne. If the stomach will bear it, a small quantity of
cream cheese will be better than butter. Topical applications, in
the form under present consideration, may be of more stimulating

238 Case of Gastrotomy. [April,

kinds. Tr. Iodine, applied with C. hair pencil twice a day. So-
lution of Ammonia Murias, in diluted vinegar, or bay rum, with
lint or cloths; Camphor plaster, {^. Mel. Kosie 5.j.; Camph.
Pulv. B.ij. Misce.) to be spread on leather to fit one- half of each
breast. Hot pediluvia, sinapisms to the sacrum and feet, or resin-
ous plaster worn in the hollows of the feet are good derivatives.

Bathing, frictions to the general surface, and all other measures
to encourage capillary circulation, have no less influence than in
other abnormal conditions. We cannot think that the use of nar-
cotic extracts or lead lotions is safe for either mother or child,
unless watched more closely by competent medical attendants than
is usually convenient.

Belladonna has been recommended b}^ high authority, but in
hyperaemia it is far inferior to many safer remedies, and in anaemia
or passive galactirrhoea, its usual specific action would be contra-
indicated.

When the infant has been removed from the patient entirely,
there is less objection to the use of Belladonna, or leaves of Stra-
monium, from which we have seen great relief. [Peninsular Jour.
of Medicine.

Case of Gastrotomy.

Dr. John H. Bayne of Prince George county, Maryland, reports
a successful case of Gastrotomy in a robust servant woman, 25
years of age, in labor with her fourth child. Her pelvis was evi-
dently contracted, and her labors had been lingering from this
c^use. She had now been in labor for two days, and Dr. B. was
sent for, and told that the patient had experienced some hours
before an excruciating pain in the epigastrium, accompanied with
a peculiar tearing sensation; followed by entire cessation of pain, '
and expulsive uterine efforts; pulse 130, dyspnoea and prostra-
tion; OS uteri fully dilated, vertex presenting, and high up. She
soon became comatose, with great tendency to collapse. Head of
foetus seemed to be rapidly receding, and in a very short time the
entire contents of the uterus escaped into the peritoneal cavity ;
child then felt distinctly through abdominal parietes, so high up
as to interfere with the action of the diaphragm ; vaginal examina-
tions now recognized laceration through the fundus. The Doctor
selected the operation of gastrotomj^, and performed it promptly,
without an anaesthetic. He divided the parietes from the umbili-
cus to near the pubes through the linea alba down to the peritone-
um. This was cautiously opened, when a quart of sero-sanguino-
lent fluid gushed out. No haemorrhage, but a large foetus which
was removed with great despatch. No particular allusion to the
placenta made. Wound united with interrupted sutures, and
complete cicatrization took place in twelve days, notwithstanding

1867.] Editorial and Miscellaneous. 239

symptoms of sharp peritonitis. For several weeks, a dark, gru-
mous, purulent, oftensive discharge flowed from the vagina,
unaccompanied by constitutional disturbance.

In two months time she resumed her duties as cook. \^America7i
Jour, of Med. Sciences.

Sciatica. The severe pains of this and other forms of neuralgia are re-
lieved by the enderniic use of morphia. The plan of use advised is, to apply
a small blister the size of a quarter to a half dollar. Vesication being
produced, the skin is removed, and the surface sprinkled over with a half
grain to a grain of morphine mixed with powdered white sugar. The ap-
plication may be repeated two or three times a day for six or seven succes-
sive days, the blister being kept open by irritating dressings. The proper
constitutional treatment being used, this remedy is said to have relieved a
large majority of the cases of sciatica in which it has been tried. The
blister is drawn as near to the seat of pain as possible. [Memphis Med.
Recoi'der.

EDITORIAL km MISCELLANEOUS.

Medical College of Georgta. The Dean's Report, given below, de-
velopes a most encouraging condition in the affairs of the Medical College

. of Georgia. We have still continued to hold well our own even in the
multiplication of medical schools throughout the country. In a review
of our whole history there is little presented to give rise to discontent or
regret, and much to incite gratitude and heartfelt gratulation. Our Alum-
ni every year increasing, both in number and influence, are among our

best reliances for the continuation of that gratifying success which we have
enjoyed for more than a quarter of a century.

While we look with serene satisfaction upon our own happy condition,
we here sincerely protest that we are free from any feeling of jealous regret
at the success of other Institutions. There is, we confess, a proper feeling
of competition among us, but none of rivalry or detraction : we wish all
success, and will ourselves endeavor to command our portion of it,

The Faculty report to the Trustees of the Medical College of Georgia
'that there were in attendance on the Course of Lectures which has just
terminated. One Hundred and Sixty Students of whom one hundred and
five were from Georgia, twenty from South Carolina, twenty-seven from
Alabama, three from Mississippi, three from Texas, one from Tennessee,
and one from Florida. The Faculty are pleased to state that the general
deportment of the Class was unexceptionable, and that the examinations
gave satisfactory evidence of their strict attention to their duties. The

240

Editorial and Miscellaneous.

[April,

Paculty take great pleasure in asking the Trustees to confer the Degree of
Doctor of Medicine upon the following named gentlemen viz :

"W. L. Coleman, of

Mississippi.

1 L. B. Hatcher, of

Georgia.

W. K Bu8li,

Georgia.

M. J. Jones, "

R M. Divine,

Mississippi.

F. Z. Hill,

C. A. Deuson, "

Alabama.

T. K. Mitchell,

G. M. Etheridge, "

S. Carolina.

Thomas De Witt, "

"

David Hudson, "

Georgia.

J. A. S. Todd,

S. CaroUna.

J. W. Brown,

Mississippi.

H. T. Heard,

Georgia.

W. D. Chenev,

Georgia.

Thomas E. Wood, "

S. Carolina.

W. W. Lowman, "

S. Carolina.

J. M. Burns, "

Alabama.

A. J. Sanders, "

Georgia.

Wm. A. O'Hara, "

"

W. M. Standley, "

"

Henry J. Long, "

Georgia.

W. W. Pitts,

"

J. M. Boring,

'

James "Wilson, '

S. Carolina.

B. P. White,

Alabama.

J. A. Thomas, "

Georgia.

S. H. Lamar,

Georgia.

J. K. Price,

S. Carolina.

J. C. Reese,

"

J. A. Stewart, "

Georgia.

D. F. Dickinson,

"

r. W. Cullens,

"

J. T. De Jarnette, "

"

W. H. Henry,

S. Carolina.

D. W. Marks,

<(

M. J. Dudley,

Georgia.

J. E. Meadors, "

Alabama.

A. E. Hunter, "

"

B. C. Cook,

Georgia.

C. J. Saundera, "

"

L. J. Lewis, "

Alabama.

L. B. Bouchelle, "

S. Carolina.

Reuben De Jernett, "

Texas.

J. N. Cheney,

Georgia.

C. C. Schley,
A. M. Bovd,

Georgia.

. E. U. Tison,

"

<(

J. N. Lawrence, '

S. Carolina.

J. W. Walker,

"

J. W. Gairdner, "

Georgia.

M. R. Ballenger, "

W. A. Merriwether, "

<<

R. H. Eaton,

"

G. G. Coker,

S. Carolina.

John Venable, M.D.,

of Jackson Cc

)., Georgia, was admitted adeundem

gradum.

All of which

is respectfully

submitted.

I.]

P. GARVIK, M. D., Dean pro. tern.

Medical College of Georgia, March

3rd, 1857.

Meeting of the Medical Society of the State of Georgia. We.
introduce the following, in order to remind the several Committees and
appointees of the various duties assigned each, and which are to constitute
the work of, and to give interest to, the approaching meeting on the second
"Wednesday of this month (April) in this place Augusta. We cannot add
anything more to what we have already said ; but we repeat, that we would
urge, most earnestly, our friends at a distance to come, and their brethren
here will give them a hearty w^elcome :

" The Committee on Business, consisting of Drs. Dugas, Green, Kollock,

Flewellen and Way, reported the following subjects and essayists, for the

next annual meeting :

1st. Dr. P. M. Kollock On the Treatment of Vesico-vaginal Fistula.

2nd. Dr. J. G. Westmoreland What is the ditference between the " Coun-
try fever " of the sea-board, and the Remittent fevers of the middle
counties of Georgia?

3rd. Dr. H. F. Campbell Are there any means by which the extension of
Yellow fever in the interior may be prevented ?

1857.] Editorial and Miscellaneous. 241

4th. Dr. Joseph A. Eve On the Diseases of the Cervix Uteri.

6tli. Dr. L. D. Ford On tlie Connexion of Pneumonia witli Remittent fever.

6th. Dr. C. B. Xot^ngham On the Diseases of the Spinal Marrow.

Tth. Dr. F. C. ElHson On the Relation of Epidemic Dysentery to Malarial

fevers.
8th. Dr. AY. M. Chartres On the Relation of Acute Meningitis to Malarial

fevers.
9th. Dr. E. F. Way On the Pathological difference between Acute, Arti-
cular and Chronic Rheumatism.
10th. Dr. Ira E. Dupree On the Treatment of Prolapsus Uteri.
11th. Dr. Ebon Hillver Under wliat circumstances is Trepanning justi-
fiable ?
12th. Dr. J. M. Green On the Value of Escliarotics in the Treatment of
. Cancer.
13th. Dr. R. D. Arnold The Pathology and Treatment of Erysipelas.

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 nextplace of meeting. The
Committee of Arrangements are Drs. Campbell, Harris, Doughty, Walton,
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, Rec. Sec'ry, pro. tern."

The American Medical Association. We find in the Nashville Jour-
nal of Medicine and Surgery the following which we present to our readers,
and hope they will embrace the opportunity now offered them of attending
this Medical Congress of their nation, at the time when the place of meet-
is so accessible.

"The tenth meeting of the Association will be held at Nashville, on
Tuesday, May the 5th,"l857.

" All bodies entitled to representation in the Association, would very
much further and facilitate its affairs by sending lists of their representatives
at an early period to the undersigued."

article second of the constitution.

" The members of this Institution shall collectively represent and have
cognizance of the medical profession in every part of the United States, and
shall hold their appointment to membership either as delegates from local
institutions, as members by invitation, or as permanent members.

" The Delegates shall receive the appointment from permanently organ-
ized medical societies, medical colleges, hospitals, lunatic asylums, and other
permanently organized medical institutions in good standing in the United
States. Each delegate shall hold his appointment for one year, and until
another is appointed to succeed him, and shall participate in all the busi-
ness and affairs of the Association.

" Each local society shall have the privilege of sending to the Association

242 Ediijorial and Miscellaneous. [April,

one delegate for every ten regular resident members, and one for every
additional fraction of more than half this number.

'' The faculty of every regularly constituted inedical^ollege, or charter-
ed school of medicine, shall have the privilege of sending two delegates. The
professional staff of every chartered or municipal hospital containing a
hundred inmates 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.

" The Memhers hy Invitation shall consist of practitioners of reputable
standing, from sections of the United States not otherwise represented at
the meeting. They shall receive their appointment by invitation of the
meeting, after an introduction from any of the members present, or from
any of the absent permanent members. They shall hold their connection
with the Association until the close of the annual session at which they
are received, and shall be entitled to participate in all its afiairs as in the
ase of delegates.

" The Permanent Memhers shall consist of all those who have served in
the capacity of delegates, and of such other members as may receive the
appointment by unanimous votes.

" Permanent members shall at all times be entitled to attend the meet-
ings, and participate in the affairs of the Association, but without the right
of voting ; and when not in attendance, they shall be authorized to grant,
letters of introduction to reputable practitioners of medicine residing in*
their vicinity, who may wish to participate in the business of the meetings,
as provided for members by invitation.

" Every member elect prior to the permanent organization of the annual
meeting, or before voting on any question after the meeting has been or-
ganized, must sign these regulations, inscribing his name and address in
full, specifying in w^hat capacity he attends, and if a delegate, the title of
the institution from which he has received his appointment."

Resolutions passed at the eighth meeting of the Association, held at
Philadelphia :

^^ Resolved^ That no State or local society shall hereafter be entitled to
representation in this Association that has not adopted its code of Ethics.

" Resolved^ That no State or local society that has intentionally violated
or disregarded any article or clause in the code of Ethics shall any longer
be entitled to representation in this body.

" Resolved^ That no organization or institution entitled to representation
in this Association, shall be considered in cfood standinor which has not
adopted its code of Ethics."

Resolutiotn passed at the ninth meeting, held at Detroit :

" Resolved^ That any new medical institution not heretofore represented
in this body, be required to transmit to the Secretar}^, with the credentials
of its delegates, evidence of its existence, capacity and good standing."

Medical presses throughout the Union are respectfully requested to copy
the above resolutions at their earliest convenience.

ROBT. C. FOSTER,
Secretary Amer. Med. Ass., Nashville, Tenn.

1857.] Letter to Dr. Marshall Hall^ of London, 243

The following Letter, which we here present to our own readers,
was prepared for, and has been communicated to The London
Lancet :

A Claim of Priority in the Discovery of, and also the naming of the
Excito-Secretory System of Nerves. By Henry Eraser Campbell,
M. D., of Augusta, Georgia, U. S. A., Member of the American Medical
Association, Professor of Comparative Anatomy, &c., in the Medical Col-
lege of Georgia, and Senior Editor of the Southern Medical and Surgical
Journal.

EXCITO-SECRETORY SYSTEiT OE NERYES. LETTER TO DR. MARSHALL HALL, of London.

Augusta, Georgia, U.S.A., March 2nd, 1857.
To Marshall Hall, M. D., of London, F. R. S., &c.

My Dear Sir In the number of the London Lancet republished in this
country, for March, 1857, (present month,) I have just read a paper from
your distinguished pen ; and in this paper you announce a system of Excito-
Secretory nerves^ in the following connection and in the following terms :

" In a memoir read at the Royal Society in February 1837, 1 announced
the existence of an Excito-motory system of nerves.

" I believe I may now announce a system or sub-system of Excito-
6ECRET0RY NcTvcs, uot Icss extensivc."

As the above announcement is here made in close relation with a dis-
covery long admitted to be your own viz., that of the Excito-motory
system of nerves, and inasmuch as in your subsequent remarks, you attri-
bute the proposition to no one else, I am left to infer that it is deemed
by you an original deduction from the admitted facts of Anatomical and
Physiological Science, as developed by observations and experiments du-
ring the last and the present century. Some of these last viz., the Experi-
ments of Mons. Claude Bernard, of Paris you adduce with the apparent
intention of fortifying the views you here express.

Finding in none of your communications upon this interesting topic, any
mention made of my name or of my records, I am, with regret, impelled,
from considerations of courtesy to you and of justice to myself, to call your
attention to the registration of my own labors in the same important field.
I will, however, first direct you particularly, though briefly, to several
portions of your own communication, in order that they may be placed in
convenient juxtaposition with my own records, without giving the trouble
of each time referring to the pages of the Lancet :

" But the most remarkable proof of the doctrine which I am endeavoring
to unfold is furnished bv the brilliant discovery and skillful experiments of
M. CI. Bernard"

N. S. VOL. XIII. NO. IV. 16

244 Excito- Secretory System of Nerves. [April,

And you here refer to his \yell known experiments on the Pneumogastric
nerve in its relation to the secretions of the Liver, pubHshed in his Lec-
tures on Experimental Physiolog}', during the winter session of 1854 and
1855*

In the earlier part of your comraum'cation (March, 1857) you thus an-.
nounce the addition of this, as you suppose, neif> sub-system, to what you
ierm the "Diastaltic Nervous System,'' the term "henceforth" apparently
being used to date the initial moment of an era :

" Henceforth the Diastaltic Xervous System, must be divided into two
Rub-systems ;

L The Excito-motory.
n. The Excito-secretory.
** The former is extended to the entire muscular system ; the latter is dif^
fused over the general system as- the blood is diffused over the system."

Again, in reference to the Pathological Relations of the Excito-secretory
system, you remark :

" The Pathology of the Excito-secretory sub-systera remains to be inves-
tigated and traced. A partial keen current of air falling on any portion of
the skin may induce inflammation in any susceptible internal organ. Ad
extensive burn or scald is apt to produce pneumonia "

Arid as my last quotation for the present :

" But here I close this brief corrmiunicatioTi. My present object is only
to draw the r/ierest sketch of this vast subject which demands a most exten-
sive and cautious series of experiments and observations. The efforts of
many laborers, through many years, will be required fully to develop the
tzco sub-systems of the Diastaltic nervous system.

" I propose shortly to treat this important subject at greater length and
with more details."

JSTow, my dear sir, by a reference to the following series ot* records, run-
ning through a period of nearly seven years, you will at once perceive
that the Excito-secretory function of the nervous system has been the
subject of earnest and diligent inquiry, and also of plain record, with me^
for a length of time far anterior to that, at which either yourself or Mons,
Bernard had published anything on the subject.

You will herein also perceive,, that this system of nerves has been plainly
recognized and set forth as considered in its relations to Pathology, through
whichy indeed, its Physiology has been mainly deduced by me. And, last-
ly, that this system of nerves, befoi'e plainly stated and amply discussed,
was, as early as May 5th, 1853, in the presence of the American Medicsd
Association, the highest tribunal in the Medical Sciences within my reach,

* Le^oa's de Physiologie, p. 325. Paris, 1855.

1857.] Letter to Dr. Marshall Hall, of London. 245

publicly NAMED by me the Excito-secretory : and that too in juxta position
with and contradistinction to, your own discovery, viz., the Excito-motory
function.

This name or verbal combination, then for the very first time printed in
the Enghsh language, or, indeed, in any other language, had not, so far as
I can learn, after continued and interested inquiry on my part, been print-
ed a second time, until taken from your own recent manuscript, it appears
at the heading of your paper in the March number of the London Lancet,
(American edition,) and thus becomes the occasion of the present commu-
nication.

Below, I now present you with certain passages from an article on " The
Influence of Dentition in producing Disease," read before the Medical So-
ciety of Augusta, Georgia, in May, 1850, and afterwards published in
this city, in the Southern Medical and Surgical Journal, a periodical circu-
lating extensively and exchanging -with all the medical journals in this
country and with many of those of Europe. Here you will now find these
several records presented to you seriatim and in that order, together with
the dates and accompanying circumstances, in which they were long ago
successively presented to the Profession.

May 2nd, 1850. "Dr. Henry F. Campbell read an Essay on the Influ-
ence of Dentition in producing Disease."" [From Minutes of a ineeting of
the Medical Society of Augusta^ Georgia.^''

I will not quote from or remark upon the Essay now, but fully hereafter
as published below.

June, 1850. Permit me now, respected sir, to refer you to the pages of
the Southern Medical and Surgical Journal, (new series,) volume 6th, num-
ber 6, June, 1850. Part L Original Communications. Article XV., page
321. You will in this place find the paper just cited, published viz : " An
Essay on the Influence of Dentition in producing Disease. By Henry F.
Campbell, M. D., Demonstrator ofxVnatomy in the Medical Colleo-e of Geor-
gia."

Here you will find that I have in the beginning, sketched prominently
the two orders of phenomena which occur during the period of Dentition,
viz., the convulsive and the secretory, explaining the first easily enough, by
a reference to the principles of ^\QAio-motory action laid down by yourself;
while the other set of phenomena I presented in such a manner as that
from them, the Excito-secretory function of the nervous system became an
obvious and an unavoidable deduction Ayy this means mutually establish-
ing a physiological principle before scarcely ever broached or hinted at
and in the second place, leaving no chance to escape the necessary admis-
sion that this set of phenomena, before perfectly inexplicable to the Profess-
ion, could only be rationally interpreted by the admission of that very

246 Excito- Secretory System of Nerves. [April,

Physiological principle. In doing this, " the two sub-systems," as yon now
term them, were, throughout, kept in close relation^ but in decided contrast,
the one being used, occasionally it is true, to illustrate the other, but never
for a moment becoming confounded with the other thus : " Now let us
inquire how far these phenomena are dependent upon Dentition; and analo-
gy with the ExciTO-MOTORY system will much assist us in our argument,.
We have seen that local irritation can through this system, produce con-
vulsions by the reflex function of the nerves, the sensitive branches of the
fifth pair becoming excitor to the motory spinal nerves ; and so, may we
justly infer, do these same branches, under certain circumstances, become
excitor io the secretory filaments of the sympathetic^ distributed so abund-
antly to the intestinal canal by a transmission of this irritation through the
various ganglia with which it is connected."

You will also here see that the discussion is carried still farther into the
pathological relations of the, then, new function, and that I have instanced
nearly all those localities which you have recently adduced, and that I
have considered those changes in the Blood while eliminating the secre-
tions under nervous influence, which you, in your paper, designate by the
word ^^ methcematous ;^'' as in the following: "Thus the irritation at first
produces simply an exaltation of the innervation of the secretory surfaces, and
secretion is more active than normal, producing simple diarrhoea. A con
tinuance of the irritation, alters the character of the secretion and we have
the various morbid discharges observable during this period. This increa^i
and change in the secretion are effected by the agency of the altered func-
tion of the nerve upon the arteries from which these secretions are elimina-J
ted." (See Southern Medical and SurgicalJournal, p. 331.)

Without further remark at present, I will lay before you that portion 6<
this Essay which embodies my first record upon the Kxcito-secretory funo
tion of the nervous system.

**The period of Dentition has ever been regarded one of peculiar interest
as well to the pathologist as to the practitioner. That certain diseases ajT"
more apt to occur during this season, few pretend to deny; buttheamoujl
of the symptoms, due to the irritation of teething, has been variously
mated, some attributing to this cause nearly all the ills to which infancy jf
liable, while others ridicule the idea, that a process in itself so purely phyi "
logical and natural should be regarded ever a cause of disease.

" The object of our essay is to investigate impartially this important sul'
ject with the view of determining, as nearly as possible, to what extent th
organism is aftected by the evolution of the teeth. In doing so, it appeal
to us niost rational, as a primary step in the investigation, to review briefl
the phenomena of bath normal and anormal dentition, with the view (
finding the foundation of the pathogenic theory, if such exists, in the joAys
ology of this process.

"The phenomena observed during easy or normal dentition may be briefl
summed up as follows : The salivary secretion is increased, the gums ai

1857.] Letter to Dr. Marshall Hall, of London. 247

swollen, the mouth hot, and the child evinces a disposition to press every
Hibstance within its reach upon the gums, in order to relieve the irritation
it here suffers. Later, the gums become more swollen and softer, the irri-
gation more distressing, and, under certain circumstances, the mouth dry
and slightly intlamed. The child becomes fretful; its sleep is disturbed
:md feverisli, its bowels become loose, which latter symptom we frequently
observe accompanied by nausea and vomiting. There is also described by
iOme authors an irritation of the schneiderian membrane, with increased
iecretion, marked by the child's rubbing its nose.

" Cases of anormal dentition are brought more frequently under the cog-
lizance of physicians, and their phenomena arehencefamiliar to every one,
rhe above symptoms become exaggerated some, which in normal denti-
:ion were of trivial importance, becoming so severe as to threaten the life
)f the patient. Thus the gently relaxed condition of the bowels, which in
3asy dentition was even beneficial, is now changed to diarrhoea with dis-
:ressing tormina and alarming emaciation. The salivary glands, which in
3asy dentition manifested their implication only by increased secretion, now
become inflamed and swollen till finally their secretion is altogether arrested,
.eaving the mouth and tongue dry, parched and painful ; and the nervous
retfulness of the normal process is often replaced by actual fever, sometimes
ittended by the most terrific convulsions.

" We have here sketched hastily some of the more prominent phenomena
3f both easy and severe dentition, as we each daily observe in practice, and
ind reported by authors, and we do not adduce them at present as the direct
cesults or consequences of the process, but only as its pretty constant con-
comitants. In referring to those symptoms hereafter in the course of our
?ssay, we will necessarily enlarge upon and develop more fully some of
:heir characteristics. Let us now, wath a little attention, enter into an
malysis of these concomitants of dentition, and endeavor to ascertain whe-
:her or not their origin may be found in the process itself. To this end, we
^ill consider briefly the anatomy and 'physiology of the parts concerned in
,:his important and often perilous process of evolution."
*********

" From the above considerations we are induced to conclude that the con-
mlsions are often produced by the irritation of dentition, and can be directly
eferred to this as the sole cause.

" We arrive now at a point in this somewhat obscure and much disputed
question which perhaps affords more ground for doubt than any of the
oregoing, viz., a consideration of the pathogenic influence of dentition in
'he cholera infantum or diarrhoea so uniformly co-existent with this pro-
cess. Unlike the convulsions, the analogy between which and certain
<nown and established phenomena of the excito-motory system, which it
s only necessary to refer to, and their operation is plain and intelligible,
:his new set of symptoms, if we refer them to the process of dentition, re-
quires us to look yet deeper into the mysteries of our nervous organization,
and to venture still one step further on the terra incerta of sympathetic
:nterpretation.

. " In order to apply our arguments, let us hastily review the foregoing in-
%estigation, that they may bear more fiilly upon this part of our question ;
and, firstly, we have seen that inflammation, pain, and irritation are pro-
duced locally by the process of dentition, evinced by restlessness, biting, <tc.
Secondly, we have seen that this local irritation can be transmitted by

248 ExcitO' Secretory System of Nerves. [April,

excito-motory influence to other and distant parts of the body, manifested
by convulsions. We have also endeavored to corroborate this latter opin-
ion by a reference to the order of succession in the nerves in which this
irritation occurs, and also by a comparison of these phenomena with other
well understood and established analogous phenomena. Heretofore we
have had to deal entirely with functions of the cerebro-spinal system of
nerves ; but to account for this second and more obscure pait of our pro-
blem, we must look in vain to any direct anatomical connection between
the fifth pair and the rest of this system of nerves. We are forced to seek
out other connections, indeed somewhat more intricate and indirect, hut
fortunately no less legitimate and definable. We have now to consider a
set of organs which, unlike the voluntary muscles, have no connection, or
rather, w^e would say, emphatically, they have a connection, though indi-
rectly, with the cerebro-spinal system. We mean the abdominal viscera,
wdiich we know are almost altogether supplied from the great sympathetic
system of nerves. Now, in the prosecution of our inquiry it becomes ne-
cessary, to the elucidation of the question to trace out the same connection
between the fifth pair and the sympathetic or secretory, as we did between
the fifth pair and the cerebro-spinal or motwy nerves, and then, should we
succeed, we will briefly inquire into the bearing which this connection and
its possible results may have upon our question.

" The connections between the fifth pair, the rest of the cerebro-spinal
system of nerves and the great sympathetic, are so abundant and universal
that it is only necessary to enumerate a few of them to illustrate the fact.
Firstly, we have a connection in the ophthalmic or first division, by its na-
sal branch communicating with the ciliaiy ganglion ; then in the superior
maxillary, or second division, are branches of communication with Meckel's
ganglion ; again, in the sub-maxillary ganglion, with the inferior maxillary
or third division. So much for the fifth itself. Then we know that every
one of the spinal nerves throughout the entire chord are connected to each
sympathetic ganglion of the system, thus establishing communications the
most abundant and intimate between these two systems of nerves. We
know also that these ganglia distribute numerous branches to all the
splanchnic vnscera by plexuses which accompany the arterial trunks into
the minute structure of these organs.

"Thus connected and distributed, this nerve presides over the important
functions of nutrition and secretion, which oflBce so characterizes it as to
give it the name of the secretory system. In the physiology of the nervous
system, there is no fact better established by anatomy and pathology, as
well as by experiments on the lower animals, than this, that the sympa-
thetic nerve, whatever else may be its functions, always forms a necessary
element in the nutrient and secretoiy apparatus of all the splanchnic visce-
ra ; and further, that upon its sanity depends the due administration of
these two great functions. It is the nerve for the bloodvessels ; " and,"
remark Todd and Bowman, " as secretion is mainly dependent on the nor-
mal nutrition of glands, it is reasonable to suppose that that function would
be to a certain extent controlled by these nerves." And as early as th(
year 1732, Pourfour du Petit found that the division of the trunk of th(
sympathetic, op])osite the fourth or fifth cervical vertebra in dogs, was fol-
lowed very rapidly by great disturbance of the circulation of the eye-ball
producing inflammation, flattening of the cornea, and finally destruction o
this organ.

1857.] Letter to Dr. Marshall Hall, of London. 249

" The experiments of Dupiiy u^wn the horse, wherein he severed this
nerve at the superior cervical ganglion, alvso corroborate this statement;
general emaciation here ensued, with an anasarcoiis condition of the limbs
and an eruption over the whole cutaneous suiface.

" In some experiments made by Dr. J. Reid, and i-eported by Todd and
Bowman, in reference to tlie sympathetic branches supplying the eye, it was
found that the effect of a section of this nerve was to produce an immediate
injection of the conjunctiva. In one case, he observes, the redness of the con-
junctiva took place in a few minutes after the section. It has been already
stated, continue these great authors, that a section of the branches of the
fifth nerve which supply the eye, is followed by ulceration and other signs
of impaired nutrition in the eye-ball. But these changes do not take place
for some time after the section of the nerve generally many days elapse
and they are attributable to the presence of irritating particles which,
owing to the insensible state of the conjunctiva, are suffered to remain in
contact with the suiface of the eye, giving rise to inflammation and ulcera-
tion of its textures. The effects of section of the sympathetic are imme-
diate^ and are probably due to a change produced in the blood-vessels, in
consequence of the withdrawal of the accustomed nervous influence.

" We have now glanced sufficiently, we think, at the anatomy and physi-
ology of the sympathetic system of nerves, to make the application of such
points as are pertinent in the solution of our pathological problem. In its
anatomy, we have seen its connections with all three of the divisions of the
fifth nerve by ganglia, the connexion of these various ganglia with each
otlier, as well as with the cerebro-spinal axis ; and lastly, the distribution
of branches fi-om these ganglia, which ai-e conducted by the arteries into
every part of every one of the splanchnic viscera. In its physiology, we
find it in entire charge of the imj>ortant functions of nutrition and secretion,
and that wherever these processes are eftected, it is by the agency of this
nerve alone upon the blood-vessels. And further, w^e have seen that pa-
thologv and experiments on lower animals establish its indispensableness
to the due performance of these functions, and that whenever the supply of
its innervation has been cut off from a particular part of the organism, that
part immediately manifests symptoms of impaired nutrition and altered
secretion.

" Now we are all aware that nearly the whole of the intestinal canal, or
rather that portion between the stomach and lower part of the colon, re-
ceives no direct innervation from the cerebro-spinal axis, but is entirely
dependent upon the sympathetic nerve for its supply of nervous influence
of whatever kind it may enjoy, whether motory, sensory, or secretory, and
consequently an impairment of the function of this nerve must necessarily
correspondently alter its condition so far as regards all those functions with
which this nerve endows it. Tlie alteration in these functions would, of
course, depend, in a great degree, upon the amount of impairaient in the
source of irritation ; thus, as we have seen, ?f the supply is entirely cut off,
the functions of tlie arteries seem in a great measure to cease, passive con-
gestions occur, and the parts inflame and ulcerate. Now we can also very
naturally conceive of a condition of these nerves somewhat analogous to
the above, yet intermediate between the entire interruption caused bv sec-
tion, and perfect health a condition of embarrassed or of exalted innerva-
tion. Now this intermediate condition is exactly the state which, from the
developments of the foregoing investigation, we feel that we are authorized

250 Excito- Secretory System of Nerves, [April,

to affirm, is that which occurs in severe dentition, and that upon it is de-
pendent the whole train of intestinal morbid phenomena observable during
this process.

"That this, so far, is legitimately inferable, we do not think any one will
deny. Now let us enquire how far these phenomena are dependent upon
dentition ; and analogy with the excito-motory system will much assist us
in our argument. We have seen that local irritations can, through this
system, produce convulsions by the rellex function of the nerves, the sensi-
tive branches of the fifth pair becoming excitor to the motory spinal nerves;
and so, may we justly infer, do these same branches^ under certain circum-
stances, become excitor to the secretory filaments of the sympathetic^ distri-
buted so abundantly to the intestinal canal, by transmission of this irritation
through the various ganglia with which it is connected. Thus the irrita-
tion at first produces simply an exaltation of the innervation of these
secretory surfaces, and consequently secretion is more active than normal,
producing simple diarrhoea. A continuance of the irritation, alters the
character of the secretion, and we have the various morbid discharges ob-
servable during this period. This increase and change in the secretion are
effected by the agency of the altered function of the nerve upon the arte-
ries from ivhich these secretions are eliminated. Now, when the innerva-
tion of these arteries is still further embarrassed by the long continuance
of the reflected irritation, the state of things nearly approaches that ob-
served in Dupuy's, Reids's and Pourfour du Petit's experiments of actual
destruction of the nerve, and we have ulceration of the intestinal mucous
membrane ; all these phenomena being the result of various degrees of in-
jury sustained by the sympathetic nerve.

" It may here be asked, why should the branches supplying the intestinal
mucous membrane become more implicated than any other portion of the
sympathetic system ] and why do not similar irritations of the fifth nerve
produce like results in the adult ? To the first of these questions we answer,
that most probably the other portions are implicated, but the manifesta-
tions of such implication are greater and graver here than elsewhere, be-
cause these are the sole sources of innervation to the viscus. The other
organs are in all probability implicated, but receiving a certain amount of
innervation from other sources, most of their functions not being entirely
secretory, are still, though imperfectly, carried on. But in the intestinal
canal the case is far difterent ; the requisitions made upon it are of a nature
that it has need for no other innervation than that of the sympathetic sys-
tem. Its functions are secretion and nutrition for the whole animal organ-
ism, and when these are impaired, its primary, indeed its only intents are
altered or completely nullified. The second question is answered by the
greater development of this system in the growing than in the adult indivi-
dual, for the purpose of supplying the more active nutrition and secretion
at that time necessary. We know that disease is more apt to occur in
many parts of the body during this period ; this is the general admission.
Thus, according to many authors, among whom are West, Churchill, &c.,
pneumonia and bronchitis are more apt to attack children during dentition,
than at any previous or subsequent period. Cutaneous eruptions, and
many other aberrations of secretion occurring during this period, but serve
to corroborate our theory of the origin of the morbid intestinal secretion.
The increased vermicular action and tormina attending this aft"ection, find
a ready explanation in the fact, now well established, that the sympathetic

i 1857.] Letter to Dr. Marshall Hall, of London. 251

I

I receives both motor and sensitive filaments from the anterior and posterior
1 roots of the spinal nerves, endowing the organs of their distribution, to a
certain degree, with corresponding susceptibilities.

, " In conclusion, let us define the position which, at the end of our investi-
gation, we feel warranted in assuming. They are the following : that in
the anatomy and physiology, as well as in the dependent analogies of the
process of dentition, we find ample ground for the opinion that the diseases
pertaining to this period, may be dependent^ and in many cases are
entirely so, upon the local irritation attending the process being transmit-
ted throuyh either the cerebrospinal system of nerves, ^jjroc/wcm^ con-
vulsive diseases in the motory aj^paratus, or throuyh the sympathetic,
causing derangements in the secretory organs, particularly the alimentary
canal, by the sway which it exercises over the arterial system, from which
these secretions are eliminated. And the practical deductions to be drawn
from these conckisions are, that we should not be remiss in taking every
measure to arrest or lessen this local irritation, either by free and repeated
incisions of the gums, or by tlie judicious administration of appropriate re-
medies, among which we have found opiates to prove most safe and effi-
cient.

" It would indeed be an improving, and not an unpleasing exercise, to
trace out more fully the connexions between the local irritation and the
various diseases occurring during the period of dentition, to take more ex-
tended views of the abundant analogies and comparisons afforded by this
truly prolific subject ; but time and the special object of our essay, do not
warrant the indulgence in speculations so general and discursive.

" Our object has been to trace the connexion between this process and
diseases in general, only in so tar as it has a bearing upon the establish-
ment of one principal question in reference to the diarrhoea of this period.
The subject has been only glanced at, and deserves a fuller and more ex-
tended treatise; wherein all the concomitant diseases of dentition, as drop-
sy, eruptions, and the many infantile neuroses, should be fully and carefully
discussed. Such views, we would earnestly invite from some abler and
more philosophic member of the profession."

The circumstances of my second published record are the following :
At the fifth annual meeting of the American Medical Association, (1852)
held in Richmond, Viiginia, not being present myself, I was appointed a
special committee, to prepare an essay on the subject of Typhoid Fever,
which essay was read before that body in New York, in May, 1853. In
this paper, I took occasion to consider carefully, the ganglionic system, in
the support of the position therein assumed, that all Typhoidal Fevers
were manifestations of disease through the secretory system of nerves.
While thus engaged, my attention was called to certain experiments per-
formed by Mons. Claude Bernard, of Paris, and made public through the
Gazette Medicale, and translated in the New Orleans Medical Register, to-
gether with his deductions therefrom.

On examination, finding that they contained, what at that time, appear-
ed to me, the germ of a theory similar to mine, recorded in June, 1850,
though he refers to them as " a set of phenomena identical with those

252 Excito- Secretory System of Nerves. [April,

occurring in the cerebro-spinal system of nerves, denominated Excito-
motory by Dr. Marshall Hall," while I had deduced this Excito-secretory
system (in 1850,) saying ^^ analogy with, the Excito-motory system will
much assist us in our argument ;" and further, inasmuch as this distinguish-
ed gentleman's report presented itself to my mind at that time, somewhat
in the form of an announcement, I deemed it advisable to appeal to our
National Medical Congress, in the following brief memoir, lyraying permis-
sion to record before them, my claim to priority, and also my protest against
the palm of originality attaching to Mons. Claude Bernard.

[Abstract from the Transactions of the American Medical Association : Meetixq

HELD IN THE CiTY OF NeW YoRK, MaY 3RD, 1853.]

Dr. Campbell, of Georgia, submitted a paper, on a question of priority
in reference to the discovery of the reflex relation subsisting between the
cerebro-spinal and sympathetic system of nerves. See Minutes of Sixth
Annual Meeting, \o\. vi., page 49.

" On the Sympathetic Nerve in Reflex Phenomena. By Henry F. Camp-
bell, of Georgia.

" In a recent number of the Gazette Medicate appear some remarks,* by
M. Cle. Bernard, on the Reflex Actions of the Nervous System. In these,
he refers one order of such reflex phenomena to the sympathetic system of
nerves, and illustrates, by experiments upon the frog, as well as by refer-
ence to many of the acts of nutrition and secretion, that such a relation
exists between the cerebro-spinal and ganglionic system of nerves, as well
as between the excitor and motory portions of the cerebro-spinal system.
Or, in his own words, '" two kinds of nerves are requisite for the production
of these reflex phenomena of organic life : the first, transmits the impression
to the nervous centres ; the second, to the viscera. With one order of
these nervous filaments is always connected a ganglion of the great sym-
pathetic. Example : the lingual nerve transmits the impression of the taste
to the nervous centres ; a special nerve then conveys a corresponding ex-
citation to the submaxillary gland ; on one of these nerves is situated a
ganglion of the sympathetic, the submaxillary ganglion," &c. He gives
several illustrations of this fact, and farther, appears to be of the opinion
that this set of phenomena are identical with those occurring in the cere-
bro-spinal system of nerves denominated excito-motory, by Dr. Marshall
Hall ; but with this latter part of his paper we have nothing to do. It is
only with that portion in which he appears to claim as his own, the sug-
gestion of the theory that there does exist such a reflex relation between
the sympathetic and the cerebro-spinal systems, and his presentation of it
as an observation entirely new.

" Now, we are not aware of the exact length of time that these views
have been held by physiologists ; they may be old, or, on the other hand,
they may be of recent suggestion ; but certainly, we cannot award to M.
Bernard the merit of being the first to express such views in relation to the
function of the sympathetic system of nerves ; and while we are exceeding-

* Translated by the New Orleans Medical Register.

1857.] Letter to Dr. Marshall Hall^ of London. 253

ly reluctant to refer to our own humble labors in connection with the bril-
liant discoveries of this most philosophic and able observer, a sense of duty
to ourself, as a member of this National Association, prompts us not to al-
low this assertion to pass unchallenged.

"A reference to a paper presented by us to the Medical Society of Au-
gusta, Geoi-gia, and published in the Southern Medical mid Surgical
Journal, on the Intiuence of Dentition in producing Disease, will show
that this subject was fully discussed by us as early as June, 1850, and that
the whole argument upon which our theory of the mode in which denti-
tion does produce certain morbid results (diarrhoea, for instance) is based
upon the supposed existence of such a retiex relation between the cerebro-
spinal and ganglionic systems of nerves, as will be seen by the following :
After referring the occurrence of convulsions, during dentition, to the
reflex relations existing between certain nerves of the cerebro-spinal sys-
tem, viz., the fifth pair as excitor, and the muscular branches of the spinal
system as motory, w'e then endeavor to account for the occurrence of
diarrhoea by establishing the existence of a similar relation between the
cerebro-spinal and branches of the ganglionic system supplying the intes-
tinal canal ; which suggestions will be found embodied in the following
extract from our essay in the June number of the Southern Medical and
Surgical Journal, volume for 1850, p. 329 : 'We have now glanced suffi-
ciently, we think, at the anatomy and physiology of the sympathetic system
of nerves, to make the application of such points as are pertinent, in the
solution of our pathological problem. In its anatomy, we have seen its
connections with all three of the divisions of the fifth nerve by ganglia, the
connection of these various ganglia with each other, as well as with the
cerebro-spinal axis, and lastly, the distribution of branches from these gan-
glia, which are conducted by the arteries into every part of every one of
the splanchnic viscera. In its physiolog}", we find it in entire charge of
the important functions of nutrition and secretion, and that wherever these
processes are eftected, it is by the agency of this nerve alone upon the
bloodvessels. And farther, we have seen that pathology, and experiments
upon the lower animals, establish its indispensableness to the due perform-
ance of these functions, and that whenever the supply of its innervation has
been cut ofi' from any particular part of the organism, that part immedi-
ately manifests symptoms of impaired nutrition and altered secretion.

" ' Xow, we are all aware that nearly the whole of the intestinal canal,
or rather that portion between the stomach and lower part of the colon,
receives no direct innervation from the cerebro-spinal axis, but is entirely
dependent upon the sympathetic nerve for its supply of nervous influence,
of whatever kind it may enjoy, whether motory, sensory, or secretory, and
consequently an impairment in the function of this nerve must, necessarily,
correspondently, alter its condition, so far as regards all those functions with
which this nerve endows it. The alteration in these functions would, of
course, depend in a great degree upon the amount of impairment in the
source of irritation ; thus, as we have seen, if the supply be entirely cut off,
the functions of the arteries seem in a great measure to cease, passive con-
gestions occur, and the parts inflame and ulcerate. Now, we can also very
naturally conceive of a condition of these nerves somewhat analogous to
the above, yet intermediate between the entire interruption caused by sec-
tion and perfect health ; a condition of embarrassed, or perhaps of exalted
innervation. Now, this intermediate condition is exactly the state which,

2o4: Excitory- Secretory System of Nerves. [^pril,

from tlie developments of the foregoing investigation, we feel that we are
authorized to attirm is that which occurs as the result of severe dentition,
and that upon it is dependent the whole train of intestinal morbid pheno-
mena observable during this process.

" ' That this so far is legitimately inferable, we do not think any one will
deny. Now let us inquire how far these phenomena are dependent upon
dentition ; and analogy with the exci to-motor y system will much assist us in
our argument. We have seen that local irritations can, through this sys-
tem, produce convulsions by the reflex function of the nerves, the sensitive
branches of the hftli pair becoming excitor to the motory spinal nerves ;
aifid so, we may justly infer, do these same branches [of the fifth 'pair),
under certain circumstances, become excitor to the secretory filaments of the
sympathetic, distributed so abundantly to the intestinal canal, by a trans-
mission of this irritation through the various ganglia with which it is con-
nected. Thus, the irritation at first produces simply an exaltation of the
innervation of these secretory surfaces, and consequently secretion is more
active than normal, producing simpjle diarrhoea. A continuance of the ir-
ritation alters the character of the secretion, and we have the various
morbid discharges observable during this period. This increase and change
in the secretion are effected by the agency of the altered function of the
nerve upon the arteries from which these secretions are eliminated. Now,
when the innervation of these arteries is still farther embarrassed by the
long continuance of the reflected irritation, the state of things nearly ap-
proaches what was observed in Dupuy's, Reid's, and Pourfour du Petit's
experiments, of actual destruction of the nerve, and we have ulceration of
the intestinal mucous membrane; all these phenomena being the result of
various degrees of injury sustained by the sympathetic nerve. It may here
be asked. Why should the branches supplying the intestinal mucous mem-
brane become more implicated than any other portion of the sympathetic
system ? And why do not similar irritations of the fifth nerve produce like
results in the adult? To the tirst of these questions we answer, that most
probably the other portions are im})licated ; but the manifestations of such
implication are greater and graver here than elsewhere, because these
sympathetic branches are the sole sources of innervation to the viscus.
Other organs are in all pi-obability affected ; but, receiving a certain amount
of innervation from other sources, most of their functions not being entirely
secretory, ai-e still, though imperfectly, carried on. But in the intestinal
canal the case is far different ; the requisitions made upon it are of such a
nature that it has need for no other innervation than that of the sympathe-
tic system. Its functions are secretion and nutrition for the whole animal
organism ; and when these are impaired, its primary, indeed its only intents
are altered, or completely nullified. The second question is answered by
the greater development of this system in the growing, than in the adult
individual, for the puqDOse of supplying the more active nutrition and secre-
tion, at that time, necessary. We know that disease is more apt to occur
in many parts of the body during this period than at other times ; this is
the general admission, thus, according to many authors, among wdiom
are West, Churchill, <fcc., pneumonia and bronchitis are more apt to attack
children during dentition than at any previous or subsequent period. Cu-
taneous eruptions, and many other aberrations of secretion occurring during
this period, serve to corroborate our theory of the origin of the morbid in-
testinal secretion. The increased vermicular action and tormina attending

1867.] Letter to Dr. Marshall Hall, of London, 255

this affection find a ready explanation in the fact, now well established, that
the sympathetic receives both motor and sensitive tilaments from the ante-
rior and posterior roots of the spinal nerves, endowing the organs of their
distribution, lo a certain degree, with corresponding suscx^ptibilities.

" ' In conclusion^ let tis dejine the position which^ at the end of our inves-
tigation, ice feel warranted in assuming. It is the following: That in the
anatomy and physiology, as ivell as in the dependent analogies of the pro-
cess of dentition, toe Jin d ami^le ground for the opinion that the diseases per-
taining to this period may he dej^endent, and in many instances, are entirely

so, UPON THE LOCAL IKRITATION ATTENDING THE PROCESS, BEING TRANSMITTED

THROLGH the cerebrospinal system of nerves, producing convulsive diseases
iyi the motory apjmratus, or through the sympathetic, causing derange-
ments OF the secretory organs, particularly of the alimentary canal,
by the sway which it exercises over the arterial system from which these secre-
tions are eliminated.^''''

" In the above brief quotation, it will be observed that the doctrine of
the reflex function between the cerebro-spiaal and sympathetic systems is
plainly enunciated, and not only is the physiological i-<\Q.t noted, but we
there also have surmised the transmission oi jyermanent irritation, or of pa-
ralysis from the cerebro-spinal to the sympathetic system, giving rise to
various aberrations in nutrition and secretion. This opinion we have held
for several years^ teaching to our classes that there existed between the
cerebro-spinal a7id the ganglionic system of nerves, a relation similar to
that between the sensitive and motor branches of the cerebro-spinal, and xvhich
Marshall Hall terms excito-motory; while we have termed that be-
tween THE cerebro-spinal AND SYMPATHETIC SystcmS EXCITO-SECRETORY.

" As we have before indicated in this report, we do not feel authorized to
lay full claim to the above theory without farther investigation of the sub-
ject; but with all due courtesy to that highly distinguished gentleman, we
can say that we feel assured that these views are not original with M. Ber-
nard, unless he entertained them previous to June, 1850. There may have
been other similar observations ; but until the publication of M. Bernard's,
we had not noticed them elsewhere than in our paper on Dentition."

You will perceive that in the above memoir, I have introduced enough
from the first record to constitute a pretty complete resume of my original
announcement and process of induction. But being apprehensive that the
doctrine of a new function so clearly and publicly defined, would suggest its
appropriate name to some one, before I was prepared to take up the subject
again, I, on this occasion, condensed into a short paragraph, as you will see,
near the end of the paper, a comprehensive re-statement of my doctrine, and
placing it in juxta-position with your own distinguished name, and also, Id
contra-distinction to your own great, analogous discovery of the Excito-
MoroRY system, afler emphasizing the word " similar," to indicate that I did
Tzo^ consider them '' identical ^ I applied to it, the expressive designation
(now used by yourself,) of Excito-secretort a word, never before that
moment, (as I believe and have above stated,) written by any other person in
any language, except by me, in my private notes.

As an evidence of the importance attached to this brief communication

256 ExcitO'Secretory System of Nerves, [April,

by the publishing committee of tlie association, I call your attention to the
ftict that it is rendered conspicuous by not less than four references in the
short index at the end of this volume of the Transactions. On the appear-
ance of the volume, (vol. vi., 1853) several of the prominent scientific peri-
odicals made special reference to my claim of priority preferred -against
Mons. Cle. Bernard, during their review of the Transactions. I send you
two of these, the most prominent, perhaps, now at hand :

From American Journal of Medical Sciences, January, 1854. N"o. LIII,
new series, p. 135. Edited by Isaac Hays, M.D., Philadelphia, Pa.

"The next article is a short paper by Dr. Henry F. Campbell, of Geor-
gia, in which that gentleman lays claim to pnority in the enunciation of
the doctrine that there exists a reflex relationship between the sympathetic
and the cerebro-spinal systems of nerves, which has been recently claimed
by Dr. Bernard, of Paris, as an observation entirely new and original with
him. Dr. Campbell has shown that, at least, priority of publication is with
hun.'"

The next Is from the New York Journal of Medicine, new series, Vol.
XII., Xo. 2, March, 1854. Edited by S. S. Purple, M.D., and Stephen
Smith, M.D. Page 254.

" On the Sympathetic Nerve in Reflex Phenomena,^ by Henry F. Camp-
bell, M.D., of Ga. The desis^n of this short article is to establish the pre-
cedence of the writer's enunciation of the doctrine of a reflex relation ex-
isting between the cerebro-spinal and ganglionic system of nerves, recently
put forth by M. Bernard. The views of Dr. Campbell are contained in a
paper on the Influence of Dentition in Producing Disease, published in the
Southern Medical and Surgical Journal^ in 1850. The author certainly
establishes his claim to priority of publication, as far as regards Bernard's
article referred to in the Gazette Medicate ; but, if we are not mistaken,
similar >'iews have been advanced at a still earlier date. As he does not,
however, pretend to pnority over all others, but only so far as his informa-
tion extends, we will not be to the trouble ofexarainmg the subject farther.'*

You will here perceive that the above claim of Priority over Mons.
Claude Bernard, in 1854, is distinctly referred to, and recognized, by two of
the leading medical periodicals of this countr}-, both of which have ex- ^
changes in Europe, and th first especially circulating and being read, in
your countiy, more, probably, than any other American medical journal.

On the printing of the sixth volume of the Transactions of the American
Medical Association, for 1853, I engaged with the publishers to strike oflf
extra copies, for distribution, of the ^'Report on Typhoid Fever^'' in which
memoir, the principle of the Reflex Phenomena between the cerebro-spinal
and ganglionic or secretory system of nerves is recognized, though not made
a prominent feature of the essay. The pamphlet made up from these extra
sheets was sent to yourself, as well as to your distinguished cotemporaries,

1857.] Letter to Dr. Marshall Hall, of London. 257

Drs. W. B. Carj^enter, R. B. Todd, Mr. W. l^owinan, and Dr. W. Jenner ;
and more recently, to Dr. T. B. Peacock, of St. Thomas's Hospital.

Near the close of last year, I was solicited to become senior editor of the
Southern Medical and Surgical Journal, and with this subject ever upper-
most in my thoughts you will observe, that my first editorial work consist-
ed in certain strictures upon a lecture on " Tlie Effects of Dentition, in
Nursing Children," delivered at Hotel Dieu, by Mons. Trousseau, of Paris,
wherein I enter into a re-statement of my views published in June, 1850,
again bringing the tioo great facts of the nervous iystem into emphatic
contra-distinction and analogy, the Excito-motory being indicated by the
" convulsive Phenomena^'' while the Excito-secretory is instanced, by the
" diarrhoea" succeeding the local irritation in the sensitive bramches of the
fifth pair. From this I quote the following :

" Here, it will be observed that we have unmistakable evidences of loca!
irritation of the gums, which we know are supplied by branches of that
most exquisitely sensitive of all sensitive nerves, the fifth pair; if we
admit the principle of reflex action, Ave must recognize here a competent
cause, considering the impressible character of the infant's nervous system^
for the convulsive phenomena. On the other hand, we may trace a con-
nection between the local irritation and the diarrhoea succeeding it, in an
analogous manner, taking into view the intimate connections between the
fifth pair and the nerves of the ganglionic nervous system, from, which the
intestinal mucous surfiices receive their secretory endowments.

" We have been thus careful (I here continue.) in pointing out the man-
ner in which we think this local irritation may jyfoduce the convulsive
symptoms and, also, even the increased secretion from the mucous surface of
the bowels and the diarrhoea^ in order to give it what we consider its proper
amount of importance, and to direct attention to this, as the chief source
of those difficulties, calling for early and continued care."*

Tliis is my latest printed record, published in this country, as you will
perceive, three months previously to your first ; but this important and ex-
tensive subject has never ceased to possess and stir my thoughts suggested
to my mind in the first instance, by an accidental and trivial circumstance,
occurring years ago, in the earliest days of my pupilage, it became inwoven
with the tissue of my thoughts, first, as an unpromising and tantalizing
problem, it is true, but soon, as a broken seal a revealed fact ; and finally,
as the familiar, self-evident truth of reflex nervous action.

And now, dear sir, I have completed the chain of evidence which I find
in my published records upon this, to me, momentous subject. While it
has been acknowledged on all hands, that there is an unity in the truths
of nature^ it is a pleasing reflection that there is also an universality in the
principles of science nature's humble interpreter which makes them the
property of no one chme, or particular race of men, but parts of that vast

* Southern Medical and Surgical Journal, VoL XIIL, pp. 20 and 21.

258 Excito- Secretory System of Nerves,

and common treasury, for the benefit of all mankind. To this rapidly ac-
cumulating store, your own genius and unremitting energy have contributed
more, much more, than often falls to the lot of one member, of this great
commonwealth, to gather. Your name must ever be associated with the his-
tory of doctrines in the physiology of the nervous system, acknowledged and
made the basis of induction in every portion of the scientific world. Ob-
serving you, admiring you, and studying you closely, can you censure me,
if I have wished, in some degree, to emulate you, and place my humble
name one day, near your own, on the scroll of science. That day is now, I
hope, about to arrive ; you have intimated that this Excito-secretory function
of the nervous system, which, as I think, I have herein shown has been de-
veloped and named by me in 1850 and 1853, is a principle not less exten- I
sive than the excito-motory function developed and named by you in 1837. 1
You have said, most truly, that it is " a vast subject requiring many labor- 1
ers and many years, fully to develop that and the other sub-system." I
here ask permission to express the wish, that as long and as usefully as you
have already lived, you may still be spared, to add much to the fuller de-
velopment of the Excito-secretory system, much more than I could ever
hope alone to accomplish.

Mingled with other feelings, all of which are at this moment those of
sincere kindness, is the regret, that my repeated publications on this subject
have never reached your eye. I feel that I am not chargeable with having
omitted to give publicity to my record^, as the annals of tlie American
Medical Association will plainly reveal. As you intend publishing shortly
more in detail upon these subjects, I here earnestly and respectfully ask the
honor of having my records meet due acknowledgment at your distin-
guished hands.

And now, respected sir, I will close this already too prolonged commu-
nication : as courtesy to you, and justice to myself, were professedly the
instigating causes of its inditement, I do most sincerely hope, that in the
too earnest establishment of the latter, I have not at any moment even ap-
peared to have forgotten the former.

I am. Sir, with feelings of great respect,
Your obedient servant,

HENRY F. CAMPBELL.

Note. "We have not hesitated to occupy so much of our space with the above
letter, as we feel assured that our readers will take sufficient interest in our Ameri-
can Claim for Priority, to excuse such appropriation. The subject is of too deep an
interest to us, to allow the merit of the discovery to pass from our grasp, and we lay
this claim before our confreres in the confident hope, that it will be generously sus-
tained by them now, as it was in 1853, before the American Medical Association.

i

SOUTHERN

MEDICAL A.m SURGICAL JOURi^AL,

(NEW SERIES.)

?ol. XIII.] AUGUSTA, GEORGIA, MAY, 187. [No. 5.

ORIGIML AND ECLECTIC.

ARTICLE XV.

JRemarJcs on the Nature and Treatment of Pneumonia, By E. B.
Gaedxer, M. D., of Barnesville, Greorgia.

As Pneumonia is an important disease, and seems to occupy but
little space in your valuable Journal, I will, with your indulgence,
offer a few suggestions in regard to its progress and treatment,
more particularly as it occurs in the adult, for the consideration^ if
not the benefit, of your readers. While I feel no disposition what-
ever to arrogate to myself any claim to originality in the opinions
I may advance, yet if, by dissseminating more widely what is al-
ready known to some of our profession, I succeed in strengthening
the hands of a younger brother, or enlightening the mind of some
tyro in medicine, I shall feel that I have accomplished my task,
and will feel some degree of remunerative consolation for the
effort made.

Without reference to the prescribed classification of authors.
Pneumonia, as met with in Georgia, will very generally be found
under one of the following forms viz: Acute, Secondary, or Ty-
phoid. It is not proposed to give any account of the latter form
in the following article, since it occurs usually as an epidemic, and
is liable to be very much modified by the influences operatino- in
its development and affecting, in varying degrees, its subsequent
progress.

N. s. VOL. xin. NO. v. 17

260 Gardner, on Pneumonia, [May,

Acute Pneumonia is commonly so fully formed and clearly
manifest as to render minute description entirely unnecessary.
The medical novice seldom fails to recognize ite presence ; and it-
ordinary symptoms are often so apparent to the eye as to enable
n on -professional persons in charge of families and having occasional
observation of disease, to diagnose its existence with great accura-
cy. The pain in the side; the difficult, hurried, and, sometimes,
laborious breathing; the cough often suppressed or muflBed, and
the high fever, at once direct the attention to the condition of th^
pulmonary organs. If any doubt arises in the mind of the physi-
cian as to the real nature of the disease with which he is called tc
contend, he has but to call into requisition the aid of acoustic-
and explore the entire cavity of the chest. By the assistance o.
physical diagnosis he may ascertain with considerable precision
the healthy or diseased condition of the several organs located
within the cavity of the thorax: and by combining this species of
knowledge with that derived from a study of the general symp-
toms, he may arrive at a conclusion so clear and convincing as to
suffer no fear of mistaken diagnosis to lead his wary mind into
error in regard to the course of therapeutics best suited to the case
under investigation.

Early in the attack, usually within the first day or tvv^o, when
the patient is in, what writers denominate, the first stage, or that of
congestion, auscultation will reveal a slight alteration from health
in the respiratory sounds emanating from the diseased lung. This,,
in the books, is generally termed "rude respiration," in conse-
quence of the imperfection of sounds given off by the distressed
organ, they beings as yet, in an undeveloped and transition state.
The breathing is harsh and varying, and the crepitant rhonchus
may be discerned by a well educated ear applied either mediately
or immediately over that portion of the exterior of the thorax cor-
responding with the inflamed pulmonary parenchyma beneath.
This rhonchus, wherever distinctly ascertained to exist, is justly
regarded as characteristic of the first stage of Pneumonia. But to.
the general practitioner, it does not possess so much importance as
other physical signs with which it is associated in the second
stage, in which the patient is more frequently found when he is
first called upon to visit him.

In the second stage, or that of hepatization, in addition to the.
foregoing rhonchus heard more or less distinctly over different

1857.] Gardner, o?i Pneumonia. 261

portions of the affjcted side, bronchial respiration and broncho-
phony may likewise be easily distinguished. At this period of the
attack, also, which supervenes in the course of the second, third,
'or fourth day, percussion, previously hollow and resonant, now
^becomes dull, and often more or less flat, in consequence of the
Iconsolidation of the vesicular structure and the partial or complete
closure and obliteration of the minute ramifications of the bron-
chial tubes. Most deaths occasioned by Pneumonia occur in this
stage.

The third stage, or that of suppuration, beyond a very limited
extent, is not often encountered in country practice, and for that
reason need not detain us here.

Another stage of acute Pneumonia, the typhoid, might, byway
of supplement, be added to the three foregoing. It is character-
ized, as far as I have seen it, by a general diminution and decay
of the vital powers, while the local phlogosis continues to perpe-
trate its ravages. In the course of an ordinary attack, somewhat
protracted, the patient grows dull and listless, complains but little
of pain in any part of the system, and seems, almost wholly indif-
ferent to his personal safety. The pulse grows feeble and increases
in frequency ; the extremities become more or less cold; the cough
abates much of its severitj-; alarming prostration ensues in the
course of a few days ; arid death speedily closes the scene, unless
by great vigilance, skill and energy, the medical attendant suc-
ceeds in warding off the catastrophe.

Secondary Pneumonia is not materially different from the or-
dinary acute variety, except in the circumstances of its origin and
the extreme uncertainty of its duration and result. All are aware
that the changes of weather, cold, and exposure at certain favora-
ble seasons of the year, are liable to produce a variety of inflam-
matory affections of the pulmonary, more than of other organs.
Secondary Pneumonia is that form produced in the usual way,
but following close upon the heels of some other disease frequent-
ly measles which has already enfeebled the system and engrafted
upon the organism a strong proclivity to pulmonary disorder..
Hence the extreme danger often attending such cases.

The symptoms of this variety differ very immaterially from
those belonging to the acute form, except in being generally more
severe and more frequeutly alarmingly perilous, with,, at the same
time, a greater tendency to assume the typhoid form, and that too
at a somewhat earlier period of its progress.

262 Gardxer, on Pneumonia. [May,

The reader will perceive from the foregoing sketch, that I have
not entered into minute detail, or systematic arrangement, in the
account given of the disease under consideration. Mj object in
this communication is to be brief, and at the same time practical,
as I shall devote more attention to the subject of Treatment.

In regard to the Prognosis, which may be studied with more
benefit in the books, I would only remark, that ordinary uncom-
plicated attacks involve but little danger; while in severer cases,
attended with great difficulty and rapidity of breathing, and a
pulse running much above 120 beats in the minute, the peril is
extreme, and the vigilance and skill of the physician severely
taxed. In secondary attacks also, seizing upon susceptible and
already debilitated frames, the prognosis is generally doubtful JTiid
often gives gloomy premonitions, too plain to be misunderstood,
of the most fearful result.

The treatment of Pneumonia most successful in my hands, and
not stereotyped by authors, is quite simple, but founded, I think,
upon the best established rules of medical philosophy. We have
to deal with a disease which is essentially a phlogosis. The paren-
chyma of the lung is highly inflamed; an organ indispensable to
the proper discharge of the functions of health is involved in
serious disorder ; the constitution sympathizes the heart first
sounding the alarm, which is then echoed along the whole vas-
cular circulatory system. The sound lung, or portions of lung,
have now imposed upon them the performance of a double duty,
in arterial izing the largely increased currents of the circulating
fluid. The velocity with which the oxygenated blood courses
along the various channels of the body to disgorge itself into the
cavity of the heart, again to be hurried on to the pulmonary vesi-
cular structure, stimulates the great central organ to a still higher
pitch of excitement, the life-sustaining fluid in consequence being
driven with still greater impulse into the inflamed lung, increasing
the difficulties under which it already labors, and to the same ex
tent lessening the probabilities of recovery. Under these urgeni
circumstances, what are the indications to be met by the enlight
ened physician in the conscientious discharge of professional duty r
By the operations of the disease, fuel is constantly added to th(
spreading flame. The important and responsible duty devolving
upon him here is too evident to be mistaken. He must invoke t(
Lis aid the resources of a well disciplined mind, and by the hel]

1857.] Gardner, on Pneumonia. 263 ^

of the best system of therapeutics known to the profession, give
bis patient the greatest chances of recovery in his power. lie who
dallies here (I try to speak respectful Ij^), is a professional fooL
The life of a human being, perchance, depends upon decisive and
energetic action. Hie practitioner may, if he chooses, administer
an emetic. This will often be necj^ssarj^, for the purpose of clear-
ing the stomach of any acrid secretions or offensive ingesta, and
will be of service so far as it goes. If, however, the patient has
previously enjoj'cd good health, and his attack be recent, and
marked by symptoms of severity, by all means, bleed him at once.
If his pulse be feeble, and doubt be entertained of the propriety of
venesection, the lancet should be tried experimentally; should it
not only be borne well, but the pulse grow fuller and less frequent
lunder the operation, there is every encouragement to push it well
nigh to the extent of producing sj^ncope, always taking the blood,
[when possible, from the patient in a sitting posture. From 12 to
(20 ounces may be safely abstracted at any time within the fourth
or fifth day. And the operation should be repeated, if found ne-
cessary, during that period, taking reduced quantities, of course,
at each subsequent repetition. This done, a far better course for
'the patient may be adopted than the long since hackneyed custom
of keeping him on the periodical exhibition of some nauseating
drng or compound, until his stomach is driven into rebellious dis-
order, and the attendant compelled to desist, at the peril of super-
adding to the original disease a modified form of gastro-enteritis,
much to the embarrassment of his case and to the detriment of his
professional reputation. All praise to Dr. Norwood, of Cokesbu-
ry, S. C, for the invaluable boon conferred upon Southern Medi-
cine, by the publication of his experiments with, and remedial
applications of, the Veratrum Viride, or American Hellebore. The
tincture, prepared according to his formula, and properly adminis-
tered, is, in some cases, a complete substitute for the lancet, while
in others, it displays the full powers of a most efficient adjuvant.
The stormy excitement of the heart and arteries is speedily calm-
ed, as if under the influence of some magical spell, and all their
1 [former furor seems at once forgotten. The oppressed breathinor
soon becomes gentle, easy and natural ; and the drought hitherto
prevailing throughout the vesicular structure and smaller ramifi-
isations of the bronchial tubes is qtiickly followed by a copious
expectoration, which gradually relieves the lung of the inflamma-

264 Gardner, on Pneumonia. [May,

torj' product, and restores its healthy organization. This remedy,
urged to the proper extent, where the patient is seen in time, and
before the inflammation has advanced too far to terminate in reso-
lution, may be relied upon, when judiciously administered, as a
specific in the treatment of Pneumonia. In many cases, I am in
the habit of trusting to its virtue alone; in others, to a compound
of which it is the leading and by far the more powerful ingredient.
In from six to twelve, and sometimes not earlier tban from eighteen
to twenty-four hours, the action of the heart is almost uniformly
brought fully under its control, the pulse subsiding from 120, 130,
140, 150, and sometimes a 160 beats in the minute in the adult, to .
60, 70. 80, or 90. The breathing, to which I have already refer- '
red, now becomes gentler, easier, and greatly reduced in frequen-"-
cy, and the general symptoms altogether more agreeable and
favorable. If the low standard of the pulse be maintained by
continuing the use of the veratrum, the patient will rapidly im-'
prove, the cough become loose and painless, and free expectoration
set in, quickly followed by all the evidences of commencing con-
valescence.

The dose and manner of giving this remedy, which seems to'
combine such valuable properties in so great perfection, should
vary with the age, condition, and peculiarities of each individual.
From one to two drops may be given to a child from 8 to 10 years
of age, every three hours ; from three to four drops to a youth
from 12 to 16 years old; and from five to eight drops to the adult.
It should be diluted with w^ater, or given combined with some
anodyne diaphoretic mixture, if the amount of pain and degree of
fever render it necessary; and as a general rule, the dose should
be repeated every three hours, unless when contra-indicated by
the supervention of much and distressing nausea, or its specific
effect is produced to a sufficient extent. In the event of nausea,
it may be discontinued, as the remedy is equally potent without
its production, until some aromatic or grateful cordial is adminis'
tered, and a quietus put to the complaints of the stomach, when it
should be resumed and steadily persevered in, if found to agree
better with this important organ. I have generally found a little
strong ginger tea to answer this purpose admirably well, and its
efficiency may sometimes be increased by the addition of a verj
slight portion say from a half to one drachm of brandy ; th(
tea to be repeated if necessary. Should the stomach still prov(

%

1857.] Gardner, on Pneumonia. 5*1^

refractory and continue to reject theveratrum, a sinapism, or even
blister, should be apj^licd to the epigastrium and the unruly organ
coerced into submission. Where the specific effect of the Helle-
bore is produced upon the circulation, its use may be continued at
lengthened intervals, or entirel}^ suspended for a time, to be re-
sumed again when required by the necessities of any individual
case: indeed, it should be given very much according to circum-
stances, and may be repeated much oftener than every three hours
in cases of great urgency. Should too much depression follow
its use, stimulants will promptly restore the circulation and obviate
auj threatened evil from that quarter.

The efiicacy of Cathartics should not be overlooked in the treat-
ment of this disease. Their value depends mainly on the depletion
they effect. They are highly useful adjuvants to the lancet, and
Avhen its employment is of doubtful propriety, they, to some ex-
tent, fill its place by draining off the watery constituents of the
blood, and in this way relieving, in some measure, any existing
plethora, and to the same degree moderating the violence of the
inflammation. As a general rule, the saline are preferable, in
consequence of the aqueous discharges they produce, and likewise
their refrigerating and diaphoretic tendency. They should be
aduiinistered chiefly during the early periods of the disease, and
to the extent of producing one, two, or three free evacuations
every twenty-four hours, as the grade of inflammation and amount
of plethora present may seem to demand.

In some protracted and obstinate attacks of Pneumonia,, it will
often be profitable to try the effect of a cautious mercurial course.
An occasional dose of calomel, or some other preparation of mer-
cury, may be safely and sometimes advantageously administered
in all cases of recent invasion. But when the disease continues
I to advance, having successfully resisted the antidotal powers of
all other well selected remedies, then a slight ptyalism, carefully
I produced, will sometimes penetrate to its utmost ramifications, and
I dislodge it entirely from the system. The antiphlogistic powers
I of this remedy are too well known to require notice here; yet,
\ where it can be dispensed with, its employment in prolonged
courses cannot be regarded as being otherwise than highly injudi-
I cious.

I Expectorants that are direct in their tendency are serviceable
i only in the latter stages of inflammation of the lungs, when all

266 Gardxer, on Pneumonia. [May,

inflammatory excitement has nearly subsided, and the weakened
organ needs a stimulant to enable it to expel the humid secretions
discharged into the air vesicles and bronchial tabes. I have not,
however, had occasion to attach much importance to their use in
the treatment of the disease under consideration. The veratrum,
given for another purpose during the acute stages, when success-
ful in controlling the circulation, I have found likewise highly
effective in promoting the secretion and discharge of the mucus and
phlegm, calling for the exhibition of an expectorant ; so much so,
in fact, as to render any other remedy of this class entirely unne-
cessary.

Blisters are highly important remedies in their influence upon
the course and progress of this disease ; and from my own experi-
ence and observcftion, I think it, to a great extent, an erroneous
notion, entertained by many pathologists, that their application
early in the attack excites the pulmonary inflammation, instead of
deriving therefrom. Under the well established principle of pa-
thology that uM irritatio ihi fluxus^ the external irritant uniform-
ly acts as a powerful revulsive, diverting the circulating currents
from the inflamed organ beneath, to the inflammation artificially
excited on the surface of the thorax. The vascular connection
between the lungs and the exterior of the chest, is by no means
so intimate as to render it an inevitable consequence that the afflux
of blood, invited by the external irritant, will necessarily propa-
gate its exciting and engorging influences to the inflamed struc-
tures within, even at the onset of an attack of pneumonitis. The
opposite of this I believe to be generally true, and have accord-
ingly been so governed in practice, without having any occasion
to regret the course pursued. The truth of experiment is higher
in its nature, and should always be ranked higher, than that of
theory, however beautiful its teachings or logical its deductions.
Blisters, when venesection has not, as well as when it has been
practiced, co-operate harmoniously in their effects with the sovei'
eign remedy, so often a specific, of which I have already spoken
the Veratrum Viride. They possess one advantage also over all
other remedial agents in the disease of which we have been treat-
ing viz: their applicability at all stages and in every condition,
whether during the furor of the onset, the abating severity of the
decline, or the alarming prostration sometimes ensuing when ty
phoid symptoms become fully developed. They are highly useful

I

1857.] Gardner, on Pneumonia. 267

as revellants applied to the surface of the chest in conditions of
aggravated inflammatory excitement; and as excitants, applied to
the extremities and over various portions of the trunk, when the
vital energies are fast failing and death is well-nigh ready to claim
its victim.

When the Typhoid stage arrives, it should be treated upon gen-
eral principles, without much regard to the pulmonary affection.
It is in this stage, when at all obstinate or protracted, that much
benefit may sometimes be derived from mercury. Should its pro-
gress be marked by much prostration, stimulants become indis-
pensable. The sinking energies must be supported by external as
well as internal agents; by the application of artificial heat, and
by rubefacients and blisters over a large amount of surface when
necessary, and repeated in quick succession ; and by the prompt
and bountiful administration of wine, brandy, and even sulphuric
ether, when others fail. This course, energetically pursued and
persevered in as long as the patient continues to breathe, will
often induce his languishing powers to rally, and ultimately re-
store him to his grateful family and delighted friends, when to all
human appearances the last ray of hope was obscured behind the
lengthening shadows of death, and the discomfited physician could
see nothing but winding-sheets and burial cases, the reward of his
toil and skill, as the objects of his professional care are in all pro*
bablity soon to be borne away to the silence of the tomb.

The Treatment of Secondary Pneumonia should be conducted

I upon the same principles as that of the primary or acute variety ;
the attendant always remembering that, in consequence of having
ibeen preceded by other disease, it will not often bear bleeding so
well, and in all probability before its close will require a greater
, amount of stimulation, being more subject to assume the typhoid
i character.

In conclusion, I will add, that my success with the foregoing
practice has been highly flattering, very much surpassing that
derived from the course usually commended by authors. It is for
this reason I submit these views to the consideration of my gen
erous professional brethren.

268 KOLLOCK, on Yesico -Vaginal Fistula. [May,

ARTICLE xyi. -|

Vesica- Vaginal Fistula. A Report read before the Medical Society of
the State of Georgia, at their Annual Meeting, at Augusta, April
Sih, 1857. By P. M. Kollock, M. D., Professor of Obstetrics
and Diseases of Women and Children, in the Savannah Medi-
cal College.

In order to secure completeness and systematic arrangement, in
t]je Report which I now present to the Society, on the subject
which was assigned to me at its last annual meeting in Macon, it
will be necessary for me to sro over cjround which has been before
trodden by other Reporters, and to recapitulate historical facts and
statements, which are familiar to many of my hearers, and which,
to them, may be wanting in that degree of novelty and freedom
from triteness, which are requisite to secure a patient and willing
attention.

The immense importance of the subject, however the difficul-
ties by which it has been hitherto surrounded, and the very meagre
manner in which it has been treated of in text-books, will,. I feel i
assured, be received as a sufficient excuse for this unavoidable
repetition.

Whenever an abnormal communication is established by dis-
ease or accident, between the urinarj'- and genital organs of a
female, so that the renal secretion, after arriving in its vesical re-
ceptacle, instead of being expelled at will through its natural canal,
the urethra, passes directly and involuntarily, into the vagina or
uterus it is called a fistula, the character of which will vary, as
regards its curabihty and the inconvenience and suffering which
it induces, according to the point at which the unnatural route
occurs. And in order to distinguish these several varieties of the
affection, titles have been conferred upon them derived from their
locality: hence we have the urethro-vaginal, Vesica- vaginal, and
Vesica- uterine varieties, according as the communication is between
the urethra and vagina, the bladder and vagina, and the bladder
and uterus. In the first, the perforation occurs in the muco-
fibrous septum, which separates the canal of the urethra from that
of the vagina; in the second, it occurs at the point where the
^^bas fond," or lower fundus of the bladder rests upon the front

1857.] KoLLOCK, o?i Vesico- Vaginal Fistula. 269

wall of the vagina; in the third, the rent occurs at the point of
contact of the vesical fundus, with the anterior part of the cervix
uteri.

The gravity of the affection is increased according to the dis-
tance of the fistulous opening from the external orifice of the
urethra. There is no disease, concerning which we learn less from
the writings of ancient authors than the one which we are now
considering. There is no reason to doubt that it did sometimes
occur, even in the most primitive stages of human existence, for
one of the chief causes of it (difficult parturition) had its origin in
the primaeval cause and even the brute creation are not wholly
exempt from it.

Notwithstanding the sad and disgusting picture which is pre-
sented by the victims of this fearful malady, it attracted little or
no attention from surgeons until the commencement of the present
century, and the most recent surgical works alone contain any
thing like an intelligible account of it.

AYe cannot restrain our astonishment at this circumstance, when
w^e contemplate the misery and ruin which is wrought in the ex-
istence of that portion of the human family, w^iich Shakspeare
styles " the cunningest pattern of excelling nature" which, when
robed in charms dependant upon a healthy performance of all the
animal functions, challenges the admiration of the most iuvsensi-
ble, and warms into adoration and love the icy soul of the Stoic.

The causes which usually operate to the production of a condi- '
tion so deplorable, are such as are connected with the performance
of a function, than w^hich, there is none more important, none
more necessary to the existence and continuance of animal life:
the function of procreation. Kature all powerful as she is
sometimes fails in the performance of this, her grandest work ; and
Art, is either summoned too late to her assistance, or proves itself
utterly incompetent.

Whenever, during a protracted or difficult parturition, the pre-
senting part of the child (generally the cephalic extremit}-) is
forced down into the pelvic excavation, and there becomes arrest-
ed and impacted from any cause, the soft parts of the mother
receive a severe nip between the child's head and the osseous cir-
cle by which they are enclosed, as if they were placed between the
jaws of a vice.

When this severe pressure is allowed to continue for many

270 KoLLOCK, on Yesico -Vaginal Fistula. [^^^Ji

hours, occasioned by strong uterine contraction acting on the
child's pelvic extremity, and a continuance of the obstruction
to the advance of the cephalic extremity, the most prominent
point of the vaginal surface, which is generally in front, behind
the symphisis pubis, and where the urethra passes out under the
pelvic arch, has to bear the brunt of the greatest amount of the
acting force; the circulation is arrested at that point; a slough
ensues and a loss of a portion of the soft maternal tissue; which
results in the production of a fistulous opening, through which
urine flows into the vagina, either directly, or, if the slough occurs
at a sufficient distance from the external orifice, the urine passes
first into the uterine cavity, and then into the vagina.

Although this is the usual manner in which these fistulas are
produced, there are other causes equally competent, and which
play an important part in their creation.

Among these, are clumsj^ manipulations with instruments, in
the hands of unskilful operators, for the purpose of effecting deliv-
ery; the introduction of the blades of the forceps into the maternal
organs with undue force slipping of the same instrument during
traction slipping of the perforating scissors, or unguarded crotch-
et sharp spiculae or fragments of the foetal cranial bones, careless-
ly extracted, may lacerate and tear the soft parts of the mother, so
as to terminate in the formation of urinary fistulas. The long
continuance of a foul pessary in the vagina, has been known
to produce ulceration and perforation of the vesico- vaginal sep-
tum; as well as ulcerations of a specific character, both syphilitic
and cancerous. Colombat states, that an example is cited by
Fabricius Hildanus where the fistula was caused by the long re-
tention of a calculus in the bladder. By whichever of the causes
which have been detailed, the malady under consideration is ori-
ginated, it is soon manifested, by a group of symptoms sufficiently
characteristic to render the diagnosis both easy and certain.

When it has followed a tedious labour, accompanied with long
impaction of the child's head in the pelvic excavation, a reten-
tion of urine is the first link in the chain of morbid phenomena,
necessitating catheterism for the relief of the bladder; and this
circumstance should arouse the suspicions of the attendant ac-
couchcr, and put him on the alert. The retention may con-
tinue for several days from seven to twelve and then be
converted into complete incontinence, the sloughs of greater or

1857.] KoLLOCK, on Yeaico -Vaginal Ftstula. 271

less extent having ftillen, and a continued, involuntary stillicidium
will be established.

Such a train of symptoms might possibly be caused by paraly-
sis of the sphincter vesicae ; but the vaginal examination with the
finger will generally detect the abnormal rent, and a probe or
catheter passed into the urethra will come in contact with the end
of the finger. The introduction of the speculum exhibits most
satisfactorily, in the majority of cases, to the eyesight, the lesion
which the soft tissues have sustained, and confirms the diagnosis.

The poor woman is now reduced to a condition of the most
piteous description, compared with which, most of the other physi-
cal evils of life sink into utter insignificance. The urine passing
into the vagina as soon as it is secreted, inflames and excoriates its
mucous lining, covering it with calcareous depositions, and caus-
ing great suff'ering. It trickles constantly down her thighs, irri-
tates the integument with its acrid qualities, keeps her clothing
constantly soaked, and exhales without cessation its peculiar
odour, insupportable to herself and all around her. In cases
w^here the sloughing has been extensive, and the loss of substance
of the tissues great, and where neither palliative nor curable means
have availed for the relief of the sufferer, she has been compelled
to sit constantly on a chair, or stool, with a hole in the seat, through
which the urine descends in a vessel beneath.

As has been stated, the gravity of the case is increased, in pro-
portion to the distance of the perforation from the external orifice
of the urethra. When it occurs in the urethra rather more power
is retained over the discharge, which may not occur involuntarily ;
but when the bas pond of the bladder is the seat of the fistula, all
command over the discharge is lost, and it flows away constantly;
unless the orifice is small, and capable of being closed by the
gravitation of the uterus upon it, while the patient is in a sitting
or standing position ; even then, the urine is liable to be expelled
by the expiratory efforts of coughing, sneezing, laughing, &c., the
contraction of the diaphragm then forcing down the abdominal
viscera upon the pelvic.

As fistulae vary in position, so do they in shape or figure, size
and number. They may be longitudinal or transverse^ round or
oval, or angular ; there may be one or more. I have never seea
more than one in any one case. Dr, N. Bozeman, of Montgome-
Ty, Ala., records cases where there was a plurality.

272 KoLLOCK, on Yesico -Vaginal Fistula, [May,

According to my experience, the transverse are more connmon
than the longitudinah Where the sloughing has been great, and
extensive losses of substance sustained, the vagina after cicatriza-
tion is contracted, its walls rigid and cartilaginous, and its canal
obstructed by adhesions and bridles. The size of the opening
may vary from that into which the tip of the index finger may be
inserted, to one which is capable of receiving several fingers.

Dr. Bozernan, in a letter to me, in reference to cases of this
description, says: "In some of them nearly the whole of the sep-
tum had sloughed out, thus allowing the whole of the superior
fundus of the bladder to protrude through, and appear at the
vulva, in the form of a large fleshy tumour. In one case, both
ureters were to be seen upon the surface of this tumour, thus al-
lowing the urine to dribble away without even reaching the cavi-
ty of the bladder or vagina. Nor was this all : in two instances
a portion of the beginning of the urethra had also been carried
away in the sloughing process, and the anterior border of the
fistula was found finally adherent to the pubic arch."

The Prognosis^ in cases of this affection, has been hitherto un-
favorable, even in such as might appear most within the reach of
curative means, regarding their position, size, &c., so that in the
majority of instances, little more than palliative measures have
been thought of; and, as was once recommended to me by a dis-
tinguished surgeon, whom I consulted in a case of this kind, "a
masterly inactivity" has been deemed most advisable. The inge-
nuity of surgeons has been taxed to the utmost in devising means
for alleviating the sufi'eriugs of those who laboured under this
dreadful calamity. Various means were resorted to for protecting
the parts which were exposed to the irritating action of the urine,
and for rendering the woman as comfortable as circumstances
would permit. Emollient baths and unguents were prescribed
for the promotion of cleanliness and allaying inflammation; and
urinals of different shapes and materials were contrived for the
purpose of receiving the urine as it was secreted. Tamponnement, '
or plugging the vagina, was resorted to as a palliative and cura-
tive measure combined, the catheter being retained in the bladder
for the purpose of conducting off the urine from the fistulous
opening. Dessault was among the advocates for this treatment;
and some cures are recorded as having been effected after a very
long and tedious perseverance in the course. Such fortunate re-

1857.] KOLLOCK, 071 Vesica -Vaginal Fistula. 273

, suits, however, only occurred in cases where the fistula was situa-
ted at some point in the course of the urethra ; where it was situated
above, tamponnement was of no service.

Whether urinary listuk^ in the female are of more frequent oc-
currence now tlian formerly, or whether they were overlooked,
by reason of the imperfection of the means of investigating female
complaints, it is certain that modern surgeons have not rested
satisfied with merely palliative measures; and those designed for
effecting a radical cure have been essayed with more or less suc-
cess.

The treatment for the radical cure of the disease may be divided
into that by Cauterization^ and that by Suturization. The former
may be sub-divided into cauterization by chemical caustics, and
that by the actual cautery, or heated iron, or the galvanic spark.

The method by suturization, is susceptible of a subdivision into
that which includes autoplasty, or the transplantation of a flap
from a neighboring part, and securing it by sutures in the fistu-
lous opening, (the edges of which have been previously freshened
with the knife,) and into that, where the edges of the fistula, after
Laving been pared with the knife, are drawn together and main-
tained in contact by suture.

Another method of cure is mentioned as having resulted favor-
ably viz: laying open the fistula into the urethra, and healing it
as in cases of rectal fistula.

Cauterization^ as a curative measure, has had its advocates among

modern surg.ocs, the most distinguished of whom are Dupuytren

and Liston. When chemical caustics are employed the Nitrate

of Silver is preferable. This is only adapted to small fistulae; it

'lis used for the purpose of promoting granulations on the edges of

,: the fistulous opening, and graduall}^ closing it. Pancoast states

I that he has, "in this manner, succeeded in occluding a fistula of

the size of a large goose quill." For larger fistulae the actual cau-

itery must be used; its effect is to produce contraction, as is usual

:!with the cicatrices from burns.

l| When the cauterizing iron is used, it is advised that it be appli-
t|edat a white heat, for an instant, around the edge of the opening
for some distance on the vaginal surface ; when the orifice is large,
at long intervals; when small, once in three or four days. A late
wiiter advises that the interval should not be less than two or
.three months, in order to allow time for the contraction of the
cicatrix.

274 KoLLOCK, on Vesico- Vaginal Fistula, [^a,y,

Within a short time Galvanism has been employed for the pur-
pose of cauterization in this, as well as other surgical cases, by
means of an ingenious portable apparatus.

My note-book contains the following account of the first case
of Vesico- vaginal Fistula which it has been my fortune to encoun-
ter:

Case. August 23rd, 1856, I was called upon to examine a
negro girl, the property of Mr. Wm. Gibbons, a large rice planter
on the Savannah river. I received the following account of her
case: That she had been delivered a short time previous, after a
very severe and protracted labour, of a large dead child. A short
time after this, her urine began to flow from her involuntarily ;
there was a constant stillicidium, which caused much troublesome
excoriation of the parts externally.

This history of the case led me to suspect, immediately, urinary
fistula, caused either by rupture of vesico- vaginal septum during
labour, or by a succeeding slough. As the incontinence did not
occur instanter, the latter conjecture seemed more probable. In
confirmation of my suspicions, the finger introduced into the
vagina, detected a rent in the septum, which seemed to extend
through the os tineas and cervix uteri. A probe introduced into
the urethra passed readily into the vagina, and came in contact
with the finger in the vagina. The speculum revealed to the eye-
sight what the touch had foretold.

The treatment of the case was commenced by placing the woman
in bed, and introducing a silver female catheter. The difliculty
of retaining this instrument in situ, and the insufficiency of its
length, allowing the urine to trickle over and bathe the vulva,
induced me to substitute a gum-elastic male catheter of the usual
length, passed through a small cork as a shoulder, to prevent its | :
slipping too far inwards ; a belt, made of saddle-girth webbing,
was buckled round the abdomen ; a piece of sole-leather, of suffi- ;
cient length and breadth, was attached to the belt in front, passing ,
down in front of the vulva, and the end of the catheter external
to the cork, was passed through a small hole in the leather. A
bowl was placed at the end of the catheter, which was allowed to
remain open, to receive the urine as it flowed out from the blad-
der. This rude apparatus was found to answer pretty well the
purpose for which it was designed. As, however, the gum-elastic
catheter was soon rendered unfit for use by the action of the urine,

1857.] KoLLOCK, on Vesico- Vaginal Fistula. 276

and the substitution of a new one every day or two involved a
good deal of expense, I obtained a flexible metallic catheter, which
I cut of the proper length, and substituted it for the gum-elastic.
The patient soon was enabled to wear this instrument, without
much inconvenience, it being removed every other day for the pur-
pose of cleaning it. The flow of urine through the fistula having
been thus very effectually cut off, the orifice began to contract,
and its progress was quite satisfactory until the contraction reduc-
ed it to one or two lines in diameter. It then assumed a most
tedious and provoking indolence. Nitrate of silver was frequent-
ly and repeatedly applied without any visible service. On the
10th of December, (more than three months from the commence-
ment of the treatment,) caustic potosh was applied a part of the
vagina, near the fistula, became accidentally touched a slough
i inch in diameter ensued. This ulcer was healed by the applica-
tion of a solution of sulph. cupri. The effect of the vegetable caus-
tic on the fistulous opening was very slight. After this, the actual
cautery was substituted for the chemical. In the course of some
weeks, the fistula was reduced to a point, and finally closed no
urine appearing to pass through.

The whole treatment of this case occupied the greater portion of
a year, during which time, the woman was kept constantly in
bed, and the catheter retained permanently in the bladder. The
tediousness and uncertaintj^ of the treatment by cauterization, are
insurmountable objections to it, and it will certainly never be
employed by those who are acquainted with the more satisfactory
and reliable processes which will be detailed in this report.
. The merit of having introduced the method of treating this
'I description of case by suturization, has been attributed to Rooer-
huysen. DiefTenbach, Jobert, Velpeau, Leroy d'Etoilles, Lalle-
mand, have figured most extensively in this department, and
have claimed for themselves a great share of success. Their
different methods are very fully detailed in the works on Opera-
tive Surgery. The principle common to each method is to freshen
the edges of the fistula either by the knife, or cautery, before the
sutures are introduced. The idea of applying Plastic Surgery to
the cure of the disease originated with Jobert de Lamballe. Leroy
and Yelpeau have adopted the same plan, with some variations in
the manner of executing it. A Viiriety of suturization has been
invented by Lallemand, of Montpellier, which consists in draw-

N.S. VOL. XIII. NO. v. 18

276 KOLLOCK, on VesicO' Vaginal Fistula, [^^^Jt

ing the edges of the opening together by means of a species of
hooked forceps, and retaining them in contact by means of the
same instrument. Finally, in yerj bad cases, where these differ-
ent plans have failed, or cannot be executed, Yidal has recom-
mended that the mucous membrane of the orifice of the vagina
should be dissected off and the opening be closed by sutures,
making a pouch or cloaca of the vagina, for retaining the urine,
and with a small orifice for its passage outwards.

The several methods which have been alluded to the result of
the ingenuity and perseverance of European surgeons are so dif-
ficult of execution, and so uncertain in their results, even in the
hands of their accomplished autliors, that they hold out small
inducement for their imitation, and we turn with disappointment
and dissatisfaction from their contemplation. Their statistical
records contain so large an amount of incurable subjects, that, if
we embrace the popular creed in the infallibility of European au-"
thority of hopelessness of success elsewhere, when failure attendS'
on the efforts of those eminent surgeons, whose names have been
mentioned, it would seem as if the condition of woman, in a world
where her portion of trial has been dealt out with no niggard
hand, wanted but this last drop to fill to overflowing, the bitter
chalice, which it is her lot frequentlj^ to quaff, and that death is the
only friend, under such circumstances, to whom she can appeal
for relief.

Turning, however, from this gloomy picture, which the records
of European Surgery present, in regard to the treatment of this
class of affections, and casting our eyes Westward, we see, in that
direction, a brighter prospect opening.

America, the land of progress in Science and in Art, has not
been behind-hand in this instance, and the superiority of Ameri-
can ingenuity and originality are, as usual, prominent. As
Americans as citizens of the Southern section of our confedera-
cy, we can assert, with truth, and with an honest pride, that in no
part of the world, has as much been done in the way of really
practical improvement in this branch of Operative Surgery, as by
the American surgeons of the South. The records of American
Surgery of the last thirty years, contain a comparatively small
number of reported cases. As it is probable that cases successful-
ly treated are almost the only ones reported, it cannot be doubted,
that a considerably larger number have occurred, which have been

1857.] KOLLOCK, on Yesico 'Vaginal Fistula. 277

abandoned as incurable, of which the medical public have heard
nothing.

The treatment of the reported cases has varied according to
the genius and surgical skill of those into whose hands they have
fallen. The names which have been most prominently asso-
ciated with operations for the cure of this disease, are those of
Pancoast, of Philadelphia; Hay ward, of Boston; Mettauer, of
Virginia; Sims, of New York, formerly of Alabama, and Boze-
man, of Montgomery, Alabama. All these surgeons have adopted
the treatment by suture the edges of the fistula having been first
freshened with the knife. The method of each varies in some
particulars from that of the others.

The peculiarity of Dr. Pancoast's method consists in shaping the
lips of the fistula in such a manner that one is dovetailed into the
other, and secured by sutures of silk.

Dr. Hayward, after introducing into the urethra a large whale-
bone bougie, in order to bring the fistula more within reach,
removes with a knife the edges of the opening all around to the
distance of one line, then dissects np the mucous membrane of the
vagina to the distance of three lines, in order to present a larger
surface for union, and "to prevent the necessity of carrying the
needles through the bladder." The needles were then introduced
*' about one-third of an inch from the edge of the wound, through
the membrane of the vagina and the cellular membrane beneath,
and brought out at the same distance on the other side." The
threads were then " tightly tied," and left about three inches in
length. The catheter was introduced and the patient placed in
bed on her side, and directed to live on thin arrowroot, milk and
water, and solution of gum arabic.

Dr. Hayward reports, in the Boston Medical and Surgical Jour-
nal, for 1851, that he has "operated twenty-six times on nine
patients on one six times, another five, two twice, and five once."
'In three cases the operation was entirely successful ; in five, great
relief was obtained, so that the urine could be retained for a num-
ber of hours; and in the remaining, no benefit was obtained.
Since the discovery of the anaesthetic powers of Ether, he places
his patient under its influence. The position of the patient is, on
the back, as in the operation of lithotomy.

Dr. John P. Mettauer reported in the number of the Virginia
Medical and Surgical Journal for June, 1855, that twenty-five

278 KoLLOCK, on Vesico- Vaginal Fistula. [^aj,

years previous to that period, lie had first operated for vesico
vaginal fistula, during which period he had met with manj
extremely interesting cases, most of which he had treated succesa
fully; that he had expressed the opinion, in a publication on thii
subject, '^that every example of the disease could be cured;" bu
that since that time, he had met with cases which had defied all hij
attempts, and*induced him to modify his opinion ; but that he stil
believed a large proportion could be cuted. His plan of operating
is as follows: The patient is "placed on her back, as for the^
operation of lithotomy, on a high bed, with folded blankets and
sheets under her to protect the bed, the parts being exposed to
the strong light of a window immediately opposite to, and on
level with the perineum care being taken that the nates re.-:
fairly on the edge of the bedstead, so as to render the parts to be
operated on, easy of access. A two-bladed speculum is employed
for the purpose of dilating the os externum and vagina the han-
dle of the instrument being held by the patient herself. The free
borders of the fistula are next denuded of their mucous membrane,
hy the use of delicate hooks to take hold of it, and scissors curved
on their fiat surfaces, or delicate knives curved in like manner, or
of the ordinary form, to excise it beneath the hook." The muc
membrane is next to be removed to the extent of half an inc
beyond the border, in a continuous strip. For arresting hemor
rhage, cold water is to be injected with a syringe. Metallic threads
of pure lead, five or six inches long, are then introduced by means
of curved needles, held in Physic^s artery forceps, and conveying
silk ligatures, to which the leaden are attached. The needles are
passed from the vesical cavity into the vaginal, one inch from the
denuded margin, so as to transfix both vesical and vaginal wall
After as many sutures are introduced in this manner, as are requi
site, the edges are closely approximated,^ and secured in that posi-
tion, by twisting the wires by means of forceps, adapted to the
purpose. Much care and judgment is required, to graduate the
compressing force which is applied by the twisting, so that while
the edges of the wound are kept in close apposition, the circula-
tion is not arrested, so as to endanger sloughing or ulceration.

The rule by which the surgeon is to be guided in determining

^ the proper amount of force to be applied, is, "the fixed and erectee

state of the twisted extremities of the wires, and their bristle-lik(

spring when touched with the probe." The wires having been

1857,] KOLLOCK, on Vesica -Vaginal Fistula. 279

secured iu this manner, *'tlie twisted extremities are to be cut off
transverse!}^, so as to project a few lines beyond the range of the
vulva." A short silver catheter is now to be introduced, and the
patient to be directed to lie on her left side. The bowels are to be
3onstipated by opium. On the third day the ligatures are to be
oioderately tightened by twisting. The sutures are to be remov-
ed about the eighth or tenth day.

Dr. Mettauer remarks that " it is the depth of this suture that
secures its reparative efficacy that is the point on which success
turns; and if the denudations are effectually executed, a failure
will seldom follow. This suture can be safely passed through the
vesical wall, and I decidedly prefer it, because it secures more
iffectual suturizatiou ; and it is entirely free from all liability to
nduce inflammation of the bladder, as my experience fully tes-
tifies."

" The possibility of small fistulous openings following suturizing
through the walls of the bladder, is the only clanger of importance
to be feared ; and if the threads are not permitted to remain longer
than eight or ten days, this accident can hardly take place. I
have often suffered them to remain ten or twelve days, without
such an occurrence. In a few hours the ligature openings close,
I have rarely known them discharge urine after a day."

The American Journal of the Medical Sciences for January,
1851, contains a communication from Dr. J. Marion Sims, at that
time a resident of Montgomery, Ala., detailing a method of treat-
ment of the cases which we are considering, originated by and
peculiar to himself, exhibiting a degree of persevering industry
pand ingenuity in the invention and perfection of instruments
and curative apparatus, deserving of the highest commendation,
and entitled to the admiration of every surgeon who feels the
amount of interest in this subject which it deserves.

Dr. Sims employs a suture resembling that known to surgeons
tasthe quilled suture using leaden clamps, in place of quills, and
silver wire in place of silk thread. Instead of the dorsal position,
which is preferred by most surgeons, that on the knees, the body
bent forward, head and shoulders depressed, nates elevated, knees
separated six or eight inches, is preferred by this surgeon.
' The table, on which the patient rests, is placed in front of an
}open window the sun's rays are concentrated on the vulva by
Smeans of a mirror. The vagina is dilated by a speculum of peca-

280 KoLLOCK, on Yesico -Vaginal Fistula. [May,

liar form the part which enters the vagina is made of polished '
German silver, and shaped like a duck's beak, and is bent at right
angles with the handle. This speculum is introduced- at the per-
ineal commissure of the vagina, which is above, in this position of
the woman; the perineum is forcibly elevated by an aisistant
holding the speculum by its handle with one hand, and drawing,
with the fingers of his other hand, the labium of the side on which
he stands while the other labium is drawn in a contrary direc-
tion by the fingers of another assistant standing on the other side.
In this manner the whole vagina is perfectly displayed, and a fair
view obtained of the fistulous orifice.

"With a delicate tenaculum fixed in a handle five or six inches
in length, the mucous membrane of the vagina near the edge of
the fistula is'raised, and with a small sharp-pointed scalpel fixed
in a handle of the same length with that of the tenaculum, a strip
of vaginal mucous membrane, from J to ^ of an inch in breadth,
is dissected off all around the opening. The lining membrane of
the bladder is not removed, unless it is very much altered in
character, and projects through the opening so as to interfere with
the operation.

The circumference of the opening having been thus thoroughly
denuded, a spear-pointed needle, fixed on a shaft about six inches
in length, armed with silk thread, is introduced at the distance
of \ inch from the incised edge of the mucous membrane, only
penetrating through the thickness of that membaane, and not en-
tering the cavity of the bladder, and brought out at the same dis-'
tance from the freshened edge of the posterior or upper lip of the
fistulous orifice. The farther end of the silk is withdrawn from
the eye of the needle, and afterwards the needle; the proximal
end of the silk is then attached to the end of the silver wire, bent
into a loop, and by means of the silk, the silver wire is lodged in
the proper place. A sufiScient number of sutures are introduced, f.
according to the extent of the opening, and both ends of the wires E
are brought out at the vulva. The distal ends of the wires are j ,
now passed through the openings in a leaden clamp of sufficient
length, and secured by being wrapped round the clamp; and this;
last is lodged in its place above the upper lip of the fistula, bj
making traction on the proximal ends of the wires.

Another clamp of the same length, as the one which has beer
applied, is now threaded with the ends of the wires, which remaii

1857.] KoLLOCK, on Yesico -Vaginal Fistula. 281

at the vulvar orifice, and pushed up by means of a species of fork
Contrived for this purpose. By making traction on the wires, and
pushing up the lower clamp at the same time, the edges of the
li.->tula are brought into close apposition. Small bird-shot, perfor-
ated with holes, are now run on the wires, and pushed up to the
lower clamp, where they are secured by compression with a pair
cl strong forceps. The wires are then cut off about ^ or i of an
inch below the shot. A catheter is now introduced into the ure-
tlira, and removed once or twice a day for cleansing. The woman
is confined to bed diet, crackers and tea; the bowels are kept
entirely locked up by the free exhibition of opium. The sutures
are examined about the third day, and removed on the tenth or
twelfth.

Several very ingenious instruments have been invented by Dr.
Sims for facilitating the performance of the operation. A blunt
book furnishes a point of support to the movable mucous mem-
l)rane, in thrusting the needle through the upper lip of the fistula.
A small fork can be used as a pullej'- for drawing down the upper
end of the silk thread and preventing its cutting out ; and a wider
fork answers for pushing up the clamps and adjusting them.

The catheter, which is peculiar to Dr. Sims, and which he per-
fected, after many experiments, is shorter than those in general
use merely long enough to measure the length of the female ure-
thra ; curved at each extremity, so as to resemble the Italic letter
aS'; the end which is in the bladder, curves upwards, and rests be-
hind the symphisis pubis; the external end curves downwards,
and rests in front of the meatus urinarius. It acts on the princi-
ple of the syphon, and is self-retaining.

[to be concluded IX THE JUNE NO.]

The Rationale of the Fatal Tendency of the Warm Bath in Asphyxia.
By Marshall Hall, M. D., F. R.S., etc.

To the Editor of The Lancet :

SfR, There is a physiological relation between the circulation
Emd the respiration, any deviation from which, in either direction,
Is of a fatal tendency.

During the systematic (not the pulmonic) circulation, carbonic
acid is formed ; in respiration, the oxygen necessary for the forma-
:ion of this carhonic acid is suppHed, and the carbonic acid so form-
id is evolved from the system.

282 Fatal Tendency of the Warm Bath in Asphyxia. [May,

The immediate baneful effects of the suspension of respiration
arise from the privation of oxygen, and from the retention of the
carbonic acid previously formed, which becomes a blood-poison.

An animal placed in perfectly ^wre miro^en or /^2/<^ro^e?zgasdies
in violent convulsions instantly. And this is doubtless owing to
the privation of oxygen, for carbonic acid might be exhaled into
nitrogen or hydrogen gas.

But an animal dies also in air consisting of such a proportion of
carbonic acid with oxygen, as to prevent the evolution of carbonic
acid from the blood, although the quantity of oxygen might be so
great that a taper blown out, and burning only as a sjoark, would
be instantly kindled mio flame.

If without producing effects so sudden as those described, we
change the relative proportion of the respiration and the circula-
tion, morbid phenomena are produced special to each case. If the
circulation be disproportionately augmented, carbonic acid is form-
ed, and being morbidly retained, slighter convulsion and slower
death ensue. If the respiration is unduly and disproportionately
augmented, the animal is cooled ; for mere j^^^Zmo/zar?/ respiration is
a cooling process, by the difference of temperature of this zwspired
and ex'pired air, and in this case also the animal dies, but now from \
loss of temperature.

This latter is the case in the asphyxiated patient, if the respirato-
ry movements be unduly hastened that is, disproportionately to:
the rapidity of the remaining circulation.

On the other hand, if in the asphyxiated we excite the circula-
tion, without simultaneously and proportionately inducing the res-
piratory movements, we destroy our patient by carbonic acid, formed
in the course of that circulation, and uneliminated by respiration.

This statement leads me to the proper subject of this paper the
Rationale of the Injurious and Fatal Tendency of the Warm Bath
in Asphyxia : for it is injurious, and has, I am profoundly con-
vinced, of itself proved fatal in cases in which the patient, without
it, would have spontaneously recovered.

In such a case, it is surely not less essential to the progres of sci-
ence and our art to remove error than to establish truth.

Warmth is so obviously a stimulus, and a stimulus is so apparent-
ly required for a patient taken out of the cold water in a state of
asphyxia, that in recommending the warm bath we seem to be ad-
dressing ourselves to the common sense of mankind, and it was a
step in advance to entertain a doubt on the subject.

But when we begin to experiment when we learn that an ani-
mal deprived of respiration by being submerged under water, lives
longer in cool water than in xvarm water, we learn to consider whether
in fact, coolness is not more favorable to life in the asphyxiated
from submersion, than warmth. We recall to mind, too, that ani
mals bear the abstraction of respiration in proportion to their cool
ness ; the hybernant animals and the batrachian tribes will scarcely

1857.] Fatal Tendency of the Warm Bath in Asphyxia. 283

drown at all. If a kitten be first cooled, or if it be immersed in
cool water, it will not drown so soon as it would do if submerged
at its ordinary temperature in water of the same temperature lacts
established by Edwards, by M. Brown-Sequard, and myself, and
witnessed by the Secretary of the Royal Humane Society, and by
its Superintendent in Hyde-park.

Thus, experiment is made to correct preconceived ideas, howe-
ver apparently consonant with common sense.

There are other facts which point to modes of treatment of the
drowned, which the administration of the warm bath necessarily
excludes. If a poor creature be perishing for want of food, we cau-
tiously administer food. If a man be, in like manner, perishing for
want of air, should we not administer air? Is this not simple and
reasonable ? And in the case of drowning, is not the want of air
the first condition to which we should bring succour, and the want
of temperature the second or third? And should We not adminis-
ter to the first want? Then, in the case of drowning, we should
administer air first and warmth in the second place. But may not
the warmth administered without air, do great absolute injury ? It
raises the temperature, and in so doing augments the necessity of
respiration to life.

In ^he first place, if any eflfect be produced by the warm bath,
the circulation is accelerated. But to accelerate the circulation
without inducing, at the same time, efficient, respiration, is to aug-
ment the formation of carbonic acid the hlood poison without its
elimination from the system, and it induces, consequently, a fatal
result;

Secondly^ all ea:ciVec? respiration through the medium of the cutane-
ous excitor nerves is excluded, the uniform temperature of the warm-
bath excluding the excitants of those nerves arising from the alter-
nate application of Aea^and cold to the surface;

And, thirdly, imitated respiration is excluded by the very sustain-
ed position of the patient, excluding as it does, alternate pronation
and rotation, and pressure applied and removed, or changes of posi-
tion and compression, which induce respiratory movements.

So that the warm bath is not only positively injurious hj poison-
ing, but negatively, by excluding the de-poisoning process.

Lastly, the warm bath excludes those frictions of the limbs up-
wards, with pressure, which really constitute the most effectual
means of promoting the circulation and warmth.

Nor is it unimportant to save the time expended in preparing the
warm bath, or in carrying the patient to it.

And it is scarcely a minor point to direct all our thoughts and
energies, undiverted, to ^Ae important remedies exclusively.

In conclusion, the warn)-bath is o{ doubly fatal tendency: it is so
in itself positively; and it is so negatively, by excluding every real
remedy.

All have heard of the Grotto del Cane, The poor dog is put into

284 Fatal Tendency of the Warm Bath in Asphyxia. [May,

the carbonic acid, and taken out asphyxiated. It is plunged not
into a warm-hath but into the water of the adjoining layo Aguano,
and taken out restored !

I am, sir, vour obedient servant,
December 15th, 2856. MARSHALL HALL.

The Treatment of Asphyxiated Newly-Born Children.
To the Editor of the Laacet :

Sir, I think it may be well to add the subjoined interesting case
to those you have been recordino^. Already four cases of the resto-
ration of the still-born, and two of drowned persons, in a state of
hopeless asphyxia hopeless under four modes of treatment have
occurred within a few months!

I am, sir, your obedient servant,

December, 1856. j\L\RSHALL HALL.

SouTHPORT, Dec. 15th, 1856.

Dear Sir, Every one having a just appreciation of scientific
research, ought to make known the results of his experience bearing
direct evidence upon the truthfulness of new discoveries.

I feel sure that no one will dispute that Science and Humanity
ow^e much to you for the discovery of the new mode of treating as-
phyxiated persons, whether by drowning or otherwise. With this
idea, I beg to forward the subjoined case to you, not only to bear
testimony to the general truthfulness of the theory, but to give you
well-merited satisfaction.

I was called to see Mrs. H , in labor of her first child, on the

evening of the 12th instant. The pains continued through the
night, and about 8 o'clock the following morning I found it necessa-
ry to administer chloroform, the pains were so agonizing. A large
child was born by natural efforts at halt'-past nine,A. M., in a stale
of complete asphyxia, and the head greatly compressed. After
dividing the cord, 1 proceeded to try your method of establishing
respiratory action. I turned the child gently over on the face,
rolled it over on the side, and a little beyond, using gradual pressure
on the lateral aspect of the chest, back again to a prone position,
and so on, about twenty times in the minute. I did it thus frequent-
ly because infantile respiratory acts are more rapid than those of
the adult. 1 dashed cold water on the face and chest, slapped the
region of the diaphragm with the hand, etc.

After some time the child began to show signs of respiratory
power, feeble enou^rh at first, but gradually becoming strong.

I am persuaded this will soon supersede the other method, which
I have always considered most unscientific and clumsy; but which.
for want of a better one, I have hitherto adopted,

Your method is most easily and readily performed ; no time is
lost in preparing a hot bath, etc., or in poking the stem of a tobacco-

1857.] HydropJiohia^ following the Bite of a Dog. 285

pipe, or the pipe of the bellows, into the child's mouth a most bar-
barous and uncertain way of inflating its lungs, and quite as likely
to inflate its stoniacli instead.

I leave it to your own feeling to publish this or not; you are at
liberty to do so if you think proper.

I am, sir, yours truly,

Marshall Hall, M. D., F. R. S. ' G. B. BARRON.

P. S. I have the satisfaction of adding 2i fifth case of recovery
in the still-born infant, I trust in time to be appended to my com-
munication of yesterday.

December 22d, 1856. M. H.

Carlton street, Nottingham, Dec. 21st, 1856.
My Dear Uncle: * * # * # * Early this morning I attended a
lady in her confinement. The presentation was a breech one, and
there w.is much and unavoidable pressure upon the umbilical cord,
which ceased to pulsate a quarter of an hour before the infant was
born. When born the child was quite livid, without perceptible
movement of the heart; indeed to all appearance it was dead, and
under ordinary circumstances I should not have entertained the
slightest hope of its resuscitation. By adopting your method, I had
'the great satisfaction of seeing it fully restored to life in about twen-
ty minutes, when it cried lustily, the nurse and friends being amazed
at the result. Being the only son in a large family of daughters,
the parents' delight was proportionately great. I explained to the
father that he had to thank you for a living son.
Believe me, my dear uncle,

Your affectionate nephew,

MARSHALL HALL HIGGINBOTTOM.
Dr. Marshall Hall.

Hydrophobia, it is true, is a rare disease, but it is a most fearful
one, and as the following short article contains a few practical sug-
gestions, and also illustrates the course of the malady very well, we
venture to select it for the present number:

A Case of Hydrophobia^ following the hite of a Dog Death Autop-
sy. By James B. Reynolds, M. D., House Physician to Belle-
vue Hospital.

James Hutchinson, aet. 16; admitted into Bellevue Hospital,
December 13, 1856. (Service of Dr. Elliott.) The patient was
a healthy, robust lad, of nervous temperament. During the latter
part of August, 1856, while attempting to catch a dog, he was bitten
in the left hand, between the index finger and thumb. The dog
was not considered rabid, but was immediately killed by the patient

286 Hydrophohia^ following the Bite of a Dog. [May,

and the wounds, in the course of half an hour, was burned out by
nitrate of silver. A man was bitten on the same day, by the same
dog, but up to the present time is healthy. The cicatrix has since
been the seat of an uneasy sensation; but, with this exception, all
went on well until Wednesday, December 10, when his parents
noticed that he was dull, and had an undefined fear, not being wil-
ling to go out at night, or to be left alone in a room by himself.
The morning of Friday, the 12th, he did not eat his breakfast with
his accustomed relish, complaining of a general feeling of malaise;
he partook of but little dinner. Up to this time, he had complained
of no difficulty about the throat; but during the afternoon he began
to have some pain over epigastric or lower sternal region, w^hich
gradually rose up to the throat, assuming there a choking character.
A dose of senna and salts was, during the evening, given to him,
which he, by several attempts, managed to swallow ; it operated
freely ; he did no sleep at all during the night, for fear of suffocating.
Saturday morning the l3th, a doctor was called in, and pronounced
it a case of hydrophobia, and advised removal to Bellevue Hospital.
When brought in at a quarter after three P. M., he was very much
excited, having considerable difficulty in breathing, the spasms of
choking being very frequent and severe ; at first, he assumed an up-
right position upon his knees, with his head thrown back, face and
lips, during a paroxysm, becoming of a dusky hue, hardly livid, eyes
projecting with a wild-frightened stare and slight external strabis-
mus ; considerable jactitation or restlessness ; extremities cool and
moist, with feeble circulation; respiration was very irregular a
long deep sigh, followed by a succession of short, catchy inspira-
tions nearly sobbing, together averaging thirty-six per minute;
pulse 96, of natural fullness, but very irregular, varying sometimes
filteen beats in a quarter of a minute ; he soon became comparative-
ly quiet, when he was able to lie down, with head and shoulders
raised. Pulse fell to 86, and paroxysm much less frequent. When
first admitted, water was given him to drink, when he became con-
vulsed, but by clutching it with both hands, and making several
trials, he at last got it to his mouth, but not more than a tea-spoonful
could have been swallowed; the remainder was forcibly ejected.
Another attempt was again made after a few minutes, but he was
unable to get it to his mouth ; his eyes being most of the time turned
from it. Upon the entrance of a number of students, he became
very much excited, which excitement was much increased, or rather
aggravated into a paroxysm, by a draught of air from a window
suddenly raised. The convulsion w^as again brought on by using
a fan near him ; water was handed to him, and after some persua-
sion, he forcibly grasped the glass, and gradually bringing it to his
mouth, gulped down an ounce or two. A small and imperfect look-
ing glass was then brought near and opposite to him, but with little
effect at first, though at last it excited a convulsion. After the
withdrawal of the class of students, he became comparatively quiet,

1857.] Hydrophobia^ following the Bite of a Dog. 287

but the spasms were gradually, but perceptibly, increasing in fre-
quency and force.

At five P. M., he was seen by Dr. Elliot, the attendini^ physician.
Twenty-four dry cups had just been applied to spine, laudanum 3ij,
but with the addition (through a mistake of the nuise,) of gr. vj of
the aqueous extract of opium, and powder of assafcetida 3ss, was
given per rectum ; he drank some water and also some wine.

Seven P. M., Another enema of extract of opium and assafceti-
da, but with only 3 i oflaudanum, was again given ; he now became
drowsy, sleeping at intervals, but waking with a convulsion, and
much frightened.

Eight P. M. Becoming slightly delirious, wishing to rise and
dress, as he thought it time to go to school ; but upon all other sub-
jects, as far as could be ascertained, he was perfectly rational ; his
mind was morbidly acute ; when asked to do anything, he would
immediately control his restlessness or jactitation, and instantly
obey, appearing to be verv anxious to comprehend and to do what
was bidden, About this time he began to have slight spasmodic
actions of diaphragm, accompanying or causing the rejection of
whatever the stomach contained; the vomiting or rather difficult
retching gradually grew worse, until at last, it became one of the
most marked and distressing symptoms.

Nine P. M. The patient was now seen by Drs, Metcalfe, Wood,
Stephen-Smith, and other medical gentlemen. He became much
excited by the presence of so many strangers. After becoming
calm, Dr. Metcalfe asked him whether he suffered from pain any
where ; he answered that there was pain in his breast, placing his
hand over the sternal region. Water was then poured into a bowl
upon the floor, without his knowledge ; but the sound caused a con-
vulsion. A speck was then pretended to be seen upon his forehead
which was gently blown upon, producing much excitement, and
the continuing it brought on spasms ; even the breath o^ the atten-
dant would excite him. Warm milk-punch was then handed to
him ; as he would allow no one to hold the cup, he clutched it with
both hands, and gi'adually, but spasmodically nearing his month, he
gulped down the whole (about four ounces). Chloroform was then
cautiously administered to him ; even the vapor excited convulsions;
it acted badly, causing lividity of the face, and close contraction of
the pupils, which before were dilated ; and nearly suspending respi-
ration. He came out of the effects of the anaesthetic with a con-
vulsion. When going under the effects of chloroform, he made
some movements which seemed very much like attempts to bite.
It was proposed by Dr. Wood to perform tracheotomy, and intro-
duce a tube through which the patient might breathe, instead of
through the irritated larynx ; but one of the medical gentlemen
rather opposed the operation, on the ground that patients with hv-
drophobia do not die with symptoms of asphyxia. During the
evening he said, to use his own words, that " the doctors wished to

288 Hydrophobia^ following the Bite of a Dog. [^aj,

make him out mad ; but he knew he was not, because he had killed
the dog, and his father had paid the doctor fifty cents for burning
out the bite. He had the " nerves." Another injection of lauda-
num was given, and also brandy by the mouth; he had already
taken about eight ounces of wine, and three pints of milk.

Ten P. M. Convulsions and vomiting increasing, and opistho-
tonos more marked. From the horizontal posture, he would sud-
denly spring upon his feet or knees, and stare wildly at some vision-
ary object, and attempt to get out of its way ; all the time spitting
a tenacious, ropy mucus ; head thrown back. About this time, he
imagined that he had a pig in his mouth, which he at last, with diffi-
culty, expectorated by the advice of the nurse; he also complained
of a sensation of hairs in his mouth.

Eleven P. M. He now became quite delirious, calling upon his
parents and friends, and at times complained of headache ; pulse too
frequent to count, and very irregular. Injections continued.

Half-past twelve A. M. He was now seen by Dr. Elliot. His
tongue was cracked transversely, but not dry; the saliva, being very
tenacious, and streaked with blood, was with great difficulty expec-
torated. The convulsions gradually increasing in frequency and
force, were now very violent, requiring two attendants to hold him;
for as soon as the paroxysms were over, he would immediately sink
upon the bed exhausted. He died very suddenly at quarter-past
one A. M., on Sunday December 14 ; living from thirty-three to
thirty-six hours after the disease showed itself plainly, and ten hours
after entering the hospital. His death w^as from exhaustion. The
thoracic walls w^ere immediately compressed ; the air within being
pressed out, and over the vocal cords, gave rise to a sound of very
high pitch ; so natural and shrill a shriek was it, as to startle all
present, showing the vocal cords to be in a state of tension. Arti-
ficial respiration being continued, the same sounds resulted, but less
markedly.

Post-inortem examination thirteen hours after death (dictated by
Dr. Metcalfe.) Rigor mortis well marked; body well developed;
foam escaping from mouth ; maiks of the dog bite on the left hand
at the root of thumb ; tendency to ecchymosis on dependent parts ;
scalp congested ; best marked on posterior part of left parietal bone
On making an incision along the back, about i iss of black fluid
blood escaped ; also blood between bones and membranes of cord ;
the spinal cord, on being removed, presented no morbid appearances ;
on opening the theca, there was considerable congestion of the vas-
cular membrane, the blood being fluid. On removing the calva-
rium, the vessels of the dura mater were very much engorged ; on
removing this membrane, the piamater was found congested ;
puncta vasculosa abundant ; contrast great between cortical and
medullary substance ; cortical darker than usual. The heart was
contracted, showing what formerly would be called a marked case
of concentric hypertrophy.

1857.] Treatment of Obstinate Habitual Constipation. 289

It is to be much regretted that a tube was not placed in his tra-
chea as soon as he entered the hospital. Although patients, as a
general rule, do not die by suflbcation, yet it is conceded that the
throat is the principal source of irritation, and from it arises many
of the most aggravated symptoms; and the involvement of other
parts of the system seems to be secondary, or at least to be aggra-
vated by the spasms of the throat. Now, by the insertion of a tube
in the trachea, one source of irritation, the continual passage of air
over the irritated parts is removed, and they are allowed to rest; one
of the most efficient of nature's means for the restoration of a part
to its normal state.

If I was so unfortunate as to be attacked by this awful disease,
I would insist upon the introduction of a tube into the trachea as
soon as the disease was recognized, and that all remedies should be
given per rectum. [_New York Jour, of Medicine.

Treatment of Obstinate Habitual Constipation.

Habitual constipation, although honored by a distinct name, is
really [says Dr. P. Phcebus of Giessen^) but a pathological symptom.
Yet from its frequent occurrence and its manifold relationship in
pathology, it has acquired for itself as much importance as if it
were a distinct affection.

Its grave effects upon the whole organization, and also the popu-
lar knowledge and recognition of the various remedies used for its
amelioration, make it difficult for a rational physician to keep from
administering purgatives proper.

Dr. Phcebus gives the following as the most frequent and potent
causes. 1st, Too sparing use of ingestathat have a laxative effect.
[Here particularly should be mentioned water. A great many per-
sons neglect to drink water to slack thirst unless when perfectly
convenient, and after a while such prompting of nature is not repro-
duced to a proper degree. Also from custom many exclude fruit,
milk, honey and oleaginous food from their dietary. Others from
poverty are unable to procure the above named sorts of food. 2d,
Too little exercise. 3d, Sluggishness of the large intestines. This
latter is a fruitful cause. As the sphincters of the rectum are un-
der the control of the will, so may the large intestine?: through the
effect of the will in opening the sphincters and moving the abdom-
inal muscles, be subjected to a certain extent to the same influence,
as also by direct volition. We of course do not have anything like
so direct a power over the large intestines, nor so ready as in the
case of the sphincters, and hence the will must act longer before it
produces its results. Once effected, however, it will be easier re-
peated. It will probably require efforts of the will to have a stool
through these different means, viz: contraction of the abdominal
muscles, and all rectal propulsion we may summon in moderation

290 Treatment of Obstinate Habitual Constipation. [May,

for fifteen to twenty minutes. But every time the will is exercised
in this way it acquires greater power. The movement of the colon
is independent to some extent of the abdominal muscles, and is no
doubt directly influenced by the will.

An especial sort of exercise should and may supercede all laxa-
tives. It consists, 1st, In the repeated upward and downward
movement of the rectum by the will ; 2d, Rapidly repeated draw-
ing in and out the abdominal walls. These should be practiced
together, and must be commenced before the patient leaves his room
with a determination to have a stool, and when once on the close
stool, never to leave it until he has an evacuation. There are other
kinds of movements that have a good effect, such as kneading the
abdomen, rubbincr it, moving^ the inferior extremities activelv for
some time; but the simplest and most effectual is the kind of exer-
cise of the parts immediately concerned above directed. An adult
ought to have one alvine evacuation every twenty-four hours, un-
less under special circumstances it is not desired. From costive-
ness many of the loner list of digestive maladies and disordered nu-
trition occur, and much bodily and mental suffering. The sufierer
should at a certain period in every twenty-four hours resort to the
exercise recommended, and go to the privy. In a short time, after
persevering in this sort of management, six or eight weeks for in-
stance, a person may acquire so much control over the colon that
he can expel its contests at will. This is so not only with the
young, but also with persons in advanced age. With this the pa-
tient may be directed and watched over, as to his ingesta. The
habit of drinking water enough may be established by using some
of the waters containing carb. acid gas at first, and diluting until
this is left entirely out.

A grown person ought in winter to drink in twenty-four hours
at least from four to six pounds of water, and in summer nearly i)
not twice as much. The half should be taken before and the othei
half after dinner. These potations operate better on an emptj
stomach.* To drink much during meal time generally disagree?
with most patients, and drinking should be avoided for two or thief
hours before bed time, as a full bladder during sleep is often th(
cause of semenorrhoea. Riding and foot exercise does much gooc
in getting rid of costiveness, but is not sufficient. Dr. Phoebus ha
had twenty-eight years experience in the above management o
constipation, and thinks that it is more effectual than all other plan
he has ever seen used. He has also seen all the diseases which s
often depend upon, and accompany this condition, spontaneous!
disappear under these m^Tins pari passu ^w'xih. the costiveness. I
cases where this procedure is not practicable, very old person:
those affected with prolapsus uteri, carcinoma recti, pregnancy, etc

*Tliis is contrary to my experience. I have known large potations of water c
a full stomach to produce' an mimediate desire to stool. In fact, this is a measu:
I frequently recommend. Trans.

1857.] On Phantom Tumours of the Abdomen, 291

1 he recommends injections of cold water. They should be preferred
I to laxatives internally, because they may be used for years without
injury. And when necessary cathartics themselves should be ad-
ministered per anum. He never recommends internal remedies of
a medicinal character. [Prager Viet^teljahrexchrijt. Nashville
Jour, of Medicine and Surgery.

On " Phantom Tumours^'' of the Abdomen. By E. He.adlam Green-
how, M. D., Lecturer on the Public Health at St. Thomas's
Hospital, Physician to the Western General Dispensary, etc.

I desire to bring under the notice of the Society a kind of ab-
dominal tumour, often most embarrassing to the practitioner and
very alarming to the patient, but of Avliich I have been unable to
find an account in any publication with which I am acquainted.
"We are indebted to Dr. Addison for the elucidation of the true
nature of these tumours, and, in speaking of them, I shall adopt
the name "phantom tumours," which he is accustomed to use in
his clinical teaching at Guy's Hospital. During an experience of
many years, I only remember to have met with seven or eight
cases of the kind, in each of which I was expressly consulted for
the tumour, and not for the derangement of health with which it
is invariably associated. Probably, as the disordered health on
which they depend is of very common occurrence, I should have
met with these tumours more frequently had I sought for them.
The five cases the main features of which I intend briefly to detail
had all but one been seen by other practitioners before I was
consulted. In the investigation of this excepted case, I had, as
will subsequently appear, the benefit of being assisted by a lead-
ing metropolitan physician.

The first case of the series came under my notice so long ago as

fifteen or sixteen years. The subject'of it, a married lady aged

'twenty-six, had already borne several childreu, was in delicate

^health, and suffered especially from uterine derangement. She

If was an^emiated, unable to take active exercise, and complained

^much of anomalous pains, and of tenderness along the course of

\'eral large nerves. The greatest source of anxiety, however,

^^ as the presence of a tumour in the right lumbar region, appar-

^*'ently about the size of a cricket-ball, but less regularly round. It

^'appeared to be movable, and if attached posteriorly, to be so only

^''by a narrow pedicle. The impresi^ion that it conveyed on a man-

1^'ual examination was that of a loose body floating upon or amongst

B^the viscera. In character, the tumour was firm and unyielding,

f free from tenderness, and somewhat changeable in site ; for al-

^^[though invariably to be found on examination, its precise relative

isitposition varied a little from day to day. I have neglected to note

how long the tumour had existed, but several opinions had been

N. S. VOL. XIU. NO. v. 19

292 On Phantom Tumours of the Abdomen. [^^J?

taken before I was consulted, and the lady had gone safely and
without inconvenience through a pregnancy since its discovery.
She had been recommended to place herself in the hands of an
eminent surgeon, with a view to the extirpation of the tumour a
procedure to which I most strenuously objected. I have not seen
the lady since, but I know that she 'has subsequently borne seve-
ral children, and I learnt several years ago that she was in better
health, and had undergone no operation ; she is, I believe, alive
at the present time. The treatment I adopted chalybeates, and
other means likely to improve the general health' was just what
I now believe to have been best suited to the case. It would,
however, have been most satisfactory to my patient and her family
and YQTj conducive to my own reputation, if I had been able ta
explain the cause of the tumour respecting which they were so
anxious, and to assure them that it was but a symptom, and an
unimportant one, of a troublesome and tedious but not dangerous
malady. Although I was unable to form any satisfactory diagno-
sis of the nature or connections of the tumour in this case, its his-
tory served to teach me that there is at least one kind of abdominal
tumour that leads to no ill result, and requires no interference
a lesson by no means devoid of practical value.

The next case, which did not present itself until aftef an inter
val of several years, was very similar to theprecediug one. It
also occurred in a married lady, about thirty years of age, who
had recovered imperfectly from her last confinement, suffered from
profuse leucorrhoea, and was very feeble and unequal to exertion.
The tongue was furred, the appetite bad, and the action of the
bowels irregular, diarrhoea alternating with constipation. " Has
occasional qualmishness and nausea, frequent occipital headache,
and suffers much from abdominal pains unaccompanied by tender
ness. She also complains of a contracted sensation across the ab-
domen." The tumour, which in this case was likewise on the right
side, appeared a good deal larger than that already described. Al
though at first disposed to view it as an ovarian tumour, I aban-
doned this idea upon a more careful examination, being partly
influenced by the circumstJmce that, although a tumour, apparent
ly as large as a full-sized foetal head, very plainly existed in the
right iliac region, the abdomen, on careful measurement, was founc
not to be really larger on that side. Another ver}^ remarkable
feature in the history of the case, of which I was assured by the
patient herself, but the correctness of which I confess to have
doubted, was that the tumour had entirely disappeared previous
to and during the period of her last pregnancy, notwithstandiug
she had been under treatment for it at an anterior time. Although
in a somewhat different situation, I at once referred this case tc
the same class as the last, and expressed a hope, based upon that
experience, that, however troublesome, the tumour would not prove
of any serious consequence. This lady is ahve, and in the enjoy

1857.] On Phantom Tumours of the Abdomen. 293

ment of very tolerable health. She has borne several children
since the time of my attendauce, but of the tumour I know nothing
beyond the fact that it has, as I predicted, led to no unpleasant
result.

The third case is that of an unmarried lady, aged between twen-
ty-five and thirty, who was believed to be in a state of hopeless ill-
health when she came under my care. The tumour closely resem-
bled both those already described; was more fixed in situation,
being in the right hypochondrium ; was less movable under ex-
imination, and seemed about the size of a> large orange. The
aiore prominent symptoms of illness were evidently referable to
pinal affection, and under treatment directed to it my jDatient
slowly and gradually recovered. Although I did not at that time
andcrstand the connexion between these tumours and spinal dis-
order, yet relying upon the harmlessness of the tumour in my two
previous cases, I treated it as of secondary importance.

The case to which I am now about to refer is, perhaps, the most
uteresting of the series, for it clearly shows the really unimpor-
:ant nature of these tumours, and yet how very easily they may

DC mistaken for examples of serious disease. Mrs. -, aged forty

bur, having borne a family, had suffered for several years from
nenorrhagia alternating with profuse leucorrhoea. She had also
mffered from a variety of other ailments referable to spinal irrita-
ion, itself due, I do not doubt, to the disarrangement of the uter-
ne system. I Avas consulted by her, somewhat more than three
r^ears ago, for a tumour in the left h3'pochondrium, the appearance
)f which had been long preceded by occasional attacks of pain in
-hat situation, of such intensity as to make her writhe about in bed,
md for the relief of which opiates, even in large doses, were of
ittle avail. This pain was of paroxysmal character, often coming
)n very suddenly, and sometimes without apparent cause, although
nore frequently as a consequence of over-exertion. It sometimes
asted for many days without intermission, but with variable in-
tensity. The employment of counter-irritation to the spine, and
)f tonic treatment calculated to improve the general health and
esson the uterine flux, were of essential service; and when, at a
lubsequent period, I sought for the tumour it was not discoverable,
^fter an interval of many months I was again consulted for the
umour, which sure enough, had very evidently returned, and is
lescribed in my notes of the case as " an ovoid movable tumour,
ree from tenderness, and apparently floating loose in the left hy-
)Ochondriac region ; it is difficult to estimate its size, but it appears
0 be somewhat reniform, and at least twice the natural size of a
ddney." It is further added that the patient was in all other res-
)ectsin good health; that no fulness, tenderness, or pain existed
Q the posterior lumbar region, and that the urine was normal.
^Notwithstanding that I believe the tumour to be of the same char-
^ter with those already related, I thought it desirable that the

294 On Phantom Tumours of the Abdomen. [^^Jj

patient should have the benefit of a second opinion, particularly
as I had been unable to find it on a previous occasion. An emi
nent physician who was called to my assistance devoted much
pains to its elucidation, but without arriving at any more satisfa
tory conclusion as to its nature than myself. We agreed that
could not be ovarian, from its position ; that it was too movable f(
an enlarged kidney, which was also discountenanced by the a'
sence of any unusual fulness, resistance, or tenderness posteriorly^
and that it had not the character, neither had the patient the ail
pect, of malignant disease. Although in great doubt on the sulj
ject, we treated it on the supposition that it might eventually prove
a hydatid groAvth. Some time afterwards other symptoms o:
spinal irritation manifested themselves ; and although I had neve?^
seen an avowed case of Dr. Addison's "phantom tumours,"
began to suspect that this would prove an example of them, as i
subsequently did. The patient, very shortly after the consultatior
went from under my immediate observation, although she contin
ued to act under my instructions. In the course of a few week
she wrote me word that the tumour had dispersed ; and a few month:
ago, being again in town, she afforded me several opportunitie
of satisfying myself that the tumour really was gone.

A few weeks since, I was called in to another case of the sam'
description, which has entirely removed any lingering doubt ii
my mind as to the nature of these tumours. The patient age<
thirty-nine, and married for many years w^ithout ever being pre^
nant, has suffered for sixteen or seventeen years from dysmeno]
rhoea and from several of the various anomolous affections so in
quently found in association with derangement of the uterine func
tions. She is very prone to attacks of what she calls spasms of th
heart ; but the ailments which causes most anxiety is a tumour i
the left side of the abdomen, just below the margin of the rib
The tumour is analogous to those already described; is movabl
firm, and free from tenderness ; but on a careful and somewhi
prolonged manipulation, partly frictional, partly kneading,
seems to melt away under the fingers. On examination, ver
considerable tenderness was found to exist for the space of an inc
and a half near the centre of the dorsal vertebrae, pressure by ti
sides of which produced pain in the chest, and also pain extendic
round to the left side. Entertaining not the slightest doubt th;
the tumour here is really a phantom, I have turned my patient
thoughts from its consideration, assuring her that it is unimpo
tan t, and am directing my treatment to the alleviation oftl
spinal irritation and to the improvement of the general health.

In considering the history of the the cases I have described,
is noticeable that all of them were females suffering from some di
turban ce of the uterine function; and that whilst spinal irritatic
unequivocally existed in three of the patients, its presence m;
not unfairly be inferred in both the others. Although I have ]

.857.] On Phantom Tumours of the Abdomen, 295

ajself seen any examples of these " phantom tumours" in the
nale subject, I can easily believe that they may occasionally occur
mdcr the influence of slight forms of spinal disease. I half sus-
)ect that a medical friend of mine, since dead, who had a tumour
h the right hypochondrium, which disappeared for many months,
iuring which he was in the enjo^^ment of good health, and reap-
)eared at a subsequent time pa?'t^a55i^ with a return of former bad
ealth, was really the subject of one of these "phantom tumours."
"hat such occurrences are much rarer in men, is readily explicable
/hen we recollect the rarity in them of spinal irritation, of the
nultifarious symptoms of which these tumorus are amongst the
lost important, since, if not understood, their presence may, as in
everal of the cases I have related, readily lead to the belief that
le patient labours under some very serious disease ovarian,
aalignant, or cystoid. The real nature of these tumours is spas-
Qodic ; their seat probably the abdominal muscles ; for although

every instance I have seen, the tumour appeared to be in the
bdominal cavity, the melting away of my last case under manipu-
ation is inconsistent with the belief that they are very deeply
eated. Their cause is spinal irritation, the irritated spinal nerves
roduciug spasm in the muscles to which they are distributed. I
eed scarcely observe how entirely this explanation of their char-
,cter is in keeping with the historj^ of the tumours in the forego-
Qg cases. Jf it be admitted that they are formed by the spasmodic
ontraction of portions of the abdominal muscles, it is no longer
aatter of surprise that patients suffering from their presence
hould pass safely through pregnancies ; that the tumours should
ause no actual enlargement of the abdomen ; that they should
ometimes disappear spontaneouslj^ ; that having thus disappear-

they should sometimes return ; that they should be removed
mder the use of remedies calculated to improve the general health,
nd to remedy the cause of the local irritation to which they ap-
eared referable ; that they should change their relative position
rom day to day ; or, lastly, that they should be temporarily dis-
>erscd under the manipulating hand of the physician. In confir-
lation of the apparent reality of their presence, and of my asser-
ion as to the embarrassment and anxiety they cause to the prac-
itioner who is ignorant of their true nature, I may point to the
\ct that the abdomen has been laid open by the surgeon at least
Ive times for the removal of abdominal tumours which were found
ot to exist. Most probably all of these Vv^ere really examples of
base "phantom tumours;" and yet the reality of their existence
aust, in each of these cases, have been impressed upon the minds
f the patients and their relatives, as well as upon that of the oper-
tor and his colleagues, before he would have proposed, or they
'cceded to, so very serious an operation.

I should have been unwilling to bring this subject before the
Society in so incomplete a form, and probably would have left it

296 Treatment of Tapeworm. [^iajj

to an abler hand, had I not learnt in conversation with several
friends of wide experience, that they had likewise met with exam-
ples of these puzzling tumours, without being aware of their true
character. I trust that even this imperfect sketch may lead to the
clearer elucidation of the subject, by directing the attention of other
observers towards its investigation, and may serve to avert some
of the anxiety and doubt felt by myself when the earlier cas- -
came under my care, as well as of the uneasiness experienced l
persons suffering from a disease apparently of a serious descriptie
but the precise character of which is unknown. [London Lanr_

Treatment of Tapeworm hy the Oil of Male Fern. By Dr. "WlLLlAM
Jenxee, Physician to University College Hospital.

In the treatment of tapeworm, we have to keep three objects in
view viz :

1. The expulsion of the entozoon ;

2. The prevention of the entrance of another scolex of tie:,
into the patient ;

3. The improvement of the health of the patient, so that his
intestines may no longer form a favorable nidus for the develop
ment of the scolex into a taenia.

The two last objects are to be attained by directing the patien
to live well, but to avoid pork and imperfectlj' cooked meats of a
kinds. Spices, onions, and garlic, should be used with the fooc
Spirits and wine are to be preferred to beer. Beer, especially i
it contains but little hop, is thought by some most experiencec
German physicians, to be highly favorable to the development o
tapeworm. Mild aperients, vegetable bitters, steel, and zinc, an
the medicines in which most confidence is to be placed. Out-doo
exercise is essential. For the expulsion of the worm, variou
agents have b^n employed with success. As the animal increase
in length, by the formation of new joints, at the neck, close to th
head, it is no matter how many yards are removed, provided th
head remains ; for, in that case, the worm quickly grows to it
original length. No remedy, then, is successful, which does no
expel the head. But, although this is true, and tapeworm is
common enough disease, many practitioners have never seen th
head of a tapeworm.

The anthelmintics chiefly emplojed in cases of tapeworm, i
this countr}^, are turpentine," kousso, pomegranate, and male fen
The objection to turpentine is its horribly nauseous flavor, and i1
very unpleasant effects on the head, and occasionally on the kic
neys. It is a remedy which should be used only as a last resouro
Kousso is expensive and bulky. Pomegranate is bulky and nai
seous, and, as ordinarily obtained in this countrv, not very certai
in its action. Male fern has the advantages of being inexpensiv

1S5T.] Treatment of Tapeworm. 297

only moderately disagreeable in flavor, so that children take it
readily, of small bulk, perfectly innocuous to the patient, and
more certain than the other agents in its action on the parasite.
It is one of the oldest of the remedies for tapeworm, and one of
the very best. The preparation I have used is the ethereal oil.

'An aperient was given in the morning, the patient was kept with-

,out food for sixteen or eighteen hours, and then one or two
drachms of the oil of male fern were administered on a little cin-
namon water.

I have noted twenty-four cases to which the oil of male fern was
given. Sixteen of these cases were cured by a single dose. In
three of these sixteen cases the head was found; three of the re-

; remaining thirteen were ascertained to be well two years after the
administration of the oil, one a year after, one seven months, two
six months, three four months, one three months; and before the

I other two ceased to be under observation, a second dose was given
by way of precaution, as it was to all the patients Avhen the head
was not found, without an}- taenia coming away with the stool.

Three required two doses of the drug; in one of these three
some yards of taenia were expelled by the first dose ; for two
months after this no joints were found in the stools, then a few
appeared, and a second dose was given, and was followed by the
expulsion of nine j^ards of teenia; the patient continued well two
years after this. In the second ease, three yards were exjDelled b}-
the first dose, and, a month after, five feet by a second dose ; at the
expiration of four months and a half, the patient continued well;
in the third case, five and a half yards of taenia were expelled by

; the first dose, and seven yards by the second^ given two months
after the first.

Three doses were required in two cases. The first dose of the
oil, however, given to one of these cases, was not of good qualitj^
In one of the two, three daj^s elapsed between the first and second
dose, and four hours between the second and third. In the other,
two da3'S elapsed between the first and second dose, and one be-
tween the second and third. In both cases the head was obtained.
In one case, viz., that of a child five years and six months
old, betAveen the 15th of July, and the 4th of August inclusive,
five doses of castor oil. and as many of oil of male fern, were ad-
ministered, without a decided effect a few joints of taenia only
being expelled. On the 17th of August, twenty grains of the ex-
tract of male fern, obtained from Duncan and Flockhart, of Edin-
burgh, were given without effect. On August 23d, one pint of

I infusion of pumpkin seeds; on September 1st, decoction of pome-
granate; and, on September 5th, infusion of kousso; all produced
copious evacuations, but no tapeworm. The child now left the
hospital. In is'ovember he was re-admitted, and during my ab-
sence was treated with success by my friend, Dr. Ballard, with the
oil of male fern. This time the child was kept for forty-eight

298 CircurK)jcision in Preventing the Sj^read of Syphilis. [May,

hours with, little if any food, before the oil was given. The child
was free from tapeworm some months after he left the hospital.

One man took the oil two or three times without any good ef-
fect, but then large quantities of solid faeces were discharged from
its action ; and before it could be administered in a more effectual
manner, the patient escaped observetion.

Among those cured by a single dose, and well two years after-
wards, was one man who had taken kousso three times, and oil of
turpentine twice. Several of the others had taken turpentine and
other remedies with permanent good effect. In three cases (child-
ren) the patients rejected the oil by vomiting ; with one exception,
all admitted that it was much less nauseous than castor oil. In no
case did it cause griping or other unpleasant symptom. The
shortest time after taking the oil, in which the worm was expelled,
was half an hour ; the longest twelve hours ; the ordinary time
four hours. A large quantity of tenacious yellow mucus was usu-
ally expelled, either with or before the worm, and often, also,
when no worm was present, as when the oil was given to ascertain
that no worm remained, the head not having been found.

In no case was the worm alive when expelled, and in no case
was it expelled entire.

The mode of administering the oil of male fern, I would recom-
mend, after the experience I have had of it, is as follows :

For an adult, two pills may be taken at bed-time, containing
three grains of calomel and eight of compound colocynth pill the
following morning a dose of castor oil. A little broth only should
be given till the bowels have been thoroughly cleared out. As
soon as that object is effected, one drachm and a half of male fern
is to be given on an ounce of some aromatic water; and the dose
of oil of male fern is to be repeated in six hours, if the first dose
has not proved effectual before the expiration of that time,
i For a child, calomel and jalap may be substituted for the colo-
cynth and calomel. The dose of the oil" of male fern must be as
large for the child as for the adult, seeing that its action is on the
parasite, and not on the patient. I have never seen any unpleas-
ant results follow its employment in the child. [Assoc. Med. Jour.

Influence of Circumcision in Preventing the Spread of Syphilis.

Dr. Pasner, editor of the All. Med. Cent. Zeitung, makes the fol-
lowing remarks on the above subject :

Every physician who has been engaged in a large practice
among the Jews knows that they are very seldom affected with
syphilis in utero, and that when thus affected the ulcers heal more
readily, and seldom give rise to the secondary form. In the nature
of things those chancres that occurred on the inner side of the pre-
puce and the covered portion of the glans, and by adhesion produ-

1857.] On Certain Symptomatic States of the Urine. 299

ced phymosis, or by constricting the anterior part of this covering
hiding deeply penetrating and dangerous ulcers, cannot occur.
Hence the treatment is more effective, and thus often prevents the
secondary and tertiary foniis. Dr. ilutchings was the first to our
knowledge, who made observations to precisely ascertain tlje com-
parative frequency of syphilis in Jews and Christians, and by statis-
tics settled this ajyriori supposition. He is physician to a hospital
in London, to which a dispensary is also attached, and which is
situated in a part of the city inhabited mostly by Jews, who resort
ingreat numbers to those institutions for medical aid. The whole
number of venereal patients treated there in 1855 was 330, of which
272 were Christians and 59 Jews. O'i the former, 107 were gon-
orrhoea and 165 syphilis; of the latter 47 were gonorrhoea and 11
syphilis. The relative difference between syphilis and gonorrhoea
was much greater in the Jews than the Christians, as may be seen
by the above figures. The great number of gonorrheeal cases
among the Jews treated there, shows that any shyness in applying
for medical advice cannot be the cause of the comparative inl're-
quency of venereal diseases among them.

During the same time there were admitted at the hospital 252
children under five years of age. Among them were 179 Christians,
and 73 Jewish ; of the last, 3 had congenital syphilis, and of the
former 27. Of women with venereal diseases there were 97 92
were Christians and 5 Jewish. 61 of the Christian .women had
chancres. Two-thirds of the 92 w^ere married, and appeared to
have contracted it from their husbands. The favorable comparison
for the Jewish women partly results no doubt from their strict prin-
ciples of religion, but may also be somewhat dependent upon the
supposition that they would not so readily expose themselves by-
acknowledging their disease. These facts confirm the wisdom of
the old Mosaic rite, and should be a stand point from which the leg-
islator should consider the subject as one of legal hygiene. \_Nasli-
ville Journal of Medicine and Surgery.

Clinical Lecture on Certain States of the Urine Symptomatic of Dis-
ease of the Kidney. By W. R. Barsham, M. D., Physician to
the Westminster Hospital, and Lecturer on the Practice of Med-
icine.

Ilcematuria : Blood in the Urine a Symptom or otherwise ?

The appearance of blood in the urine is always a source of anx-
iety and alarm to the patient, and if not rightly interpreted may-
become a source of serious error in treatment. Its importance as
a symptom must depend on the part of the urinary apparatus from
! which it is derived. Its significance, even when coming from the
kidneys, is momentous or otherwise according to the character of
the accompanying symptoms. It may indicate temporary condi-

-800 On Ceriaia Symptomatic States of the Urine. [^ay,

lions ot disease, to be easily removed by judicious measures ; or it
may atlbrd unequivocal evidence of incurable organic mischief.
Several cases liave of late been in the hospital, and they present the
opportunity ot explaining to you the force and value of the symp-
toms by vviiich a correct estimate may be formed of this state of the
urine. Haematuria may occur in the course of many different disea-
ses. It may be symptomatic of various diseases of the kidney: 1.
Simple inflammation or nephritis. 2. The early stage of Bright's
disease. 3. Scarlatinal dropsy. 4. Calculous pyelitis, including '
under this Ibrm gouty inflammation. 5. Tubercular pyelitis. 6.
Cancer of the kidney. Or, secondly, the haemorrhage proceeding
from the kidneys, may not imply any organic disease ot these or-
gans, being symptomatic only of a general hsemorrhagic condition,
in whicii the kidneys participate with other organs ; such is the
hcgmaturia in purpura and scurvy. It occurs also in some febrile
disorders, scarlet fever, variola, and typhus, and it is sometimes
prevalent in pyaemia. Moreover, the blood may be derivd from
the bladder, prostrate, or urethra, quite independent of the kidneys.
Again, haematuria has been noticed, occasionally occurring in
women, as vicarious of the menstrual flux, an example of w-hich was
lately under Mr. Guthrie, in Percy ward, in a woman suffering
from abscess in the manmia. In this case the catamenia had been
absent during the previous three months ; but for several consecu-
tive days at the menstrual period blood was passed with the urine.
There was no increased frequency of micturition, nor any pain or
irritability about the urinary passages. The urine, examined under
the microscope, presented blood-discs, amorphous fibrine highly
stained with haematuria, and a few epiihelial corpuscles, apparently
from the pelvis of the kidney and ureters. Rayer mentions instan-
ces of this vicarious haematuria.

There is yet another form of haematuria, which appears to be
miconnected with any of the preceding morbid conditions, and the
only exciting cause which can be detected is mental agitation. If,
in particular constitutions, there be this singular idiosyncrasy, that
mental inquietude or excitement can bring on attacks of haematuria,
temporary in their duration, innocent in their sequel, and unconnect-
ed with organic mischief in the kidney, it must be manifestly of
importance to ascertain if possible the symptoms by whicli such an
unexceptionable and rare form of haematuria can be distinguished
from the more serious cases arising from calculous or other organic
disease.

The case of Edward B , in Burdett ward, appears to me to

illustrate this rare form of haematuria, the recurrence of the attack
being invariably connected with mental disquietude. He is a
shoemaker, forty-three years of age, of spare habit of body. He
states that he is a tetotaller, and has been so for years ; that about
nine years since he first noticed his urine discolored with blood ; its
appearance was unaccompanied by any pain or constitutional dis-

1857,} Oil Certain Symptomatic /Stales of the Urine, oOl

turbance; it iilaniied him, and he sought advice. He was ordered
change of air, and cessation from his very sedentary employment.
He slates tliat he was leheved for the time, but that three years
afterwards he satlered another attack. On this occasion he recol-
lects that it was preceded by a sense of weight and pain in the loins.
He was treated at Charing-cross Hospital, and on subsequent oc-
casions at other hospitals, always with relief; the continuance of
the blood in his urine seldom exceeding ten or fourteen days. Du-
ring the last twelve months the haematuria has become more fre-
quent, and he has had two attacks in the course of the last six
months. On admission he complained of pain m the loins, and the
urine was highly charged with blood. He is tree irom all other
symptoms of disease: the chest is natural; heart sounds natural ;
the abdomen is tlat, soft, and elastic ; there is no fulness in the lum-
bar spaces, and no tenderness oji deep made pressure ; the region of
the liver does not exceed its natural limits. The appetite is good,
the tono^ue clean, the bowels natural. Micturition is not more fre-
quent than natural, nor is there any difficulty or pain. The urine
is of a dark-red colour, but is free from visible clois ; allowed to rest,
it deposites abundance of blood-discs. He was ordered to be cup-
ped to ten ounces from the loins; to take five grains of gallic acid
every four hours, and half a drachm of the compound jalap powder
every alternate morning, and a w^arm bath each alternate evening.
The urine was examined by the microscope: numerous blood corpus-
cles w^ere visible, and manv fibrinous casts entan^lino; blood discs
in their substance. These hbrinous coagula had the appearance of
having been moulded in the uriniferous tubes, and washed therefrom
by the escape of the urine ; their size suggested their formation ia
the straight tubes of Bellini. Ten days after adniission, the urine
was quite free from all vestiges of blood to the unassisted eye ; it
presented a faint albuminous cloud by heat and nitric acid, and, al-
lowed to rest, it deposited a flocculent preipitate, which, by the
microscope, w^as resolved into amorphous fibrinous masses, slightly
stained with haematin ; a few blood discs were seet, but no other
microscopic objects. The patient is free from all traces of lumbar
pain, and he thinks that his bodily strength is increasing. Three
weeks after admission, he presents the same favorable condition : no
trace of blood or albumen in the urine ; the same flocculent deposit
of minute amorphous coagula stained with haematin ; but no casts
ol the tubes, or any blood dises. The medicines w^ere discontinued.
On the fifth week from admission he complains of a return of the
lumbar pain, but there is no alteration in the natural appearance of
the urine, except that crystals of oxalate of lime were observed inter-
spersed amongst the minute amorphous coagula above noticed. He
was discharged in the month of August, 1855, and you have seen
him from time to time attending to report his freedom from any
return of hsematuria; but the last visit he complains of great in-
crease of pain in the left lumbar region, extending upwards to the

802. On Certain Sytrrptomaiic States of the Urine. IM^Ji

shoulder of the same side. In October he brings a sample of his
urine, and it is again blood-red, and possesses the same characters
as when we first examined it ; but it is unaccompanied by any con-
stitutional disturbance, and he states that he has no difficulty in
passing his urine, nor is there any undue frequency of micturition,
nor any local symptoms different from those when an in-patient.
He adds an important fact : that these recurrences of bloody urine
are always caused by some vexatious mental excitement. The
man, it appears, is quiet, sober, and industrious, and, upon principle,
totally abstains from all fermented drinks. His wife has no liking
for water, but possesses the common prejudice in favor of alcohol, and
whenever she can command the means, indulges to excess; her de-
meanour towards her husband at these times is somewhat at variance
with her marriage vows, and to avoid annoyance, our patient states
that he has endeavored to effect a voluntary separation ; that while
he is left to himself, undisturbed, his malady disappears ; but the
moment he is subjected to visits from an inebriate woman the hsema-
turia instantly returns. He has noticed this sequence to be so
uniform, that he firmly believes that the vexation and trouble to
which he is occasionally exposed are the sole causes of his disease.
I am inclined to think the man's inference not so far wrong or un-
intelligible as it may at first be considered. It may be readily grant-
ed that neither anatomically nor physiologically is the connexion
between renal haemorrhage and mental emotion very apparent. It
is true that certain mental emotions are known to excite, more
or less, the renal functions; but the cases are extremely rare in which
a morbid state like haemorrhage can be traced to a similar exciting
cause. The records of medicine, however, are not without such
cases. Rayer, in his work on " Diseases of the Kidney," in treating
of Renal Haemorrhage, mentions a case of hasmaturia (tom. iii. p.
359,) brought on apparently by no other cause than mental excite-
ment : " Survenu presque immediatement apres un violent acces de
colere." The accompanying symptoms were, severe hypogastric
pain, with heat and pain in the course of the ureters, and sensation
of weight and aching in the region of the kidneys. He was quickly
relieved by rest, warm baths, diet, and mucilaginous drinks. i

I saw a gentleman last spring, seventy years of age, who suffered
from occasional attacks of haematuria, traceable to no other cause *\
than mental excitement. There were no gouty symptoms, or the
least tendency thereto. He was a remarkably healthy, vigorous
country gentleman. He had consulted the most distinguished phy-
sician, of our day, and whose name is inseparably connected with
renal pathology, and whose opinion, as the patient informed me,
was in conformity with the views now expressed. This man,
B , has, in the course of the last summer, twice presented him-
self with a return of the complaint. You have seen him on several
occasions. The haematuria, when he appeared in June, lasted only
three days. On the fifth day, the urine was free from all trace of

1857.] Cases of Epilep^. 803

blood or albumen. Trouble and excitement preceded the attack.
In July, he had another attack ; and so dependent is the hajmatu-
' ria on mental excitement, that on this occasion a very trival cir-
cumstance seems to have induced it. It was a dispute with his
employer as to the rate of remuneration he should receive for work
done. On each ot^ these attacks, the symptoms exhibited the same
peculiarity ; a sense of weight and pain about the loins, but unac-
companied by any constitutional disturbance, greater frequency of
micturition, or inconvenience or difficulty in that act.

It is thus by the absence of all the usual symptoms of irritation of
the kidney, such as are ever present in gouty inflammation,
whether excited by the presence of calculus or not ; it is the absence
of constitutional disturbance, whether febrile or dropsical ; it is the
temporary character of the attacks, the urine in a few days return-
ing to a clear and natural state, without any trace of albumen, or
any morbid morphological element therein, that justify our exclud-
ing as the cause of hsematuria all those organic diseases of the kid-
ney in which haemorrhage occupies the position of a leading symp-
tom, and attributing the malady exclusively to the operation of
mental excitement. I confess that but for the authority of such an
observer as Rayer, or the support which my present views of this
case receives from the opinion expressed by the eminent physician
to whom I have previously alluded, that I had great difficulty in form-
ing a satisfactory diagnosis of the nature and cause of the haema-
turia in this case. It is only after a very careful observation of the
sum of the symptoms exhibited by the patient over a period of more
than eighteen months, and observing during that period the strictly
temporary morbid condition of the urine, the constant relation of
this state of hsematuria to mental emotion, that I came to the con-
clusion that the case might fairly be classed with those that Rayer
has spoken of under the name of haemorrhages renales essentielles
(sporadiques), and that we might attribute its exciting cause to the
rare and exceptionable agency of mental excitement. I am very
desirous of keeping this patient under observation, with a view of
testing the soundness of the opinion and diagnosis brought before
you in this lecture. [London Lancet.

Dr. Ediuard Broiun-Sequard's Experimental and Clinical Researches
applied to Physiology and Pathology.

Cases of Cure of Epilepsy by Cauterization and other Local Means
OF Modification of the Parts from which originates the Aura
Epileptica.

There are a great many cases of this kind. They bear out the

same conclusion as the cases of section of a nerve, in showing

that the fits were caused by a peculiar influence originating from

some part of the skin. Cauterization of the skin of the face and

, neck by the red-hot iron, in my animals, seems to cure them, as I

30i Cases of Epilepsy. V^^Ji

will show hereafter. It appears, therefore, that there is something
of the same kind in the condition of the skin of the neck and face
in these animals, and in the parts of the skin which are the seat of
a true aura epileptica in man.

The most varied modes of cauterization have been emplo3^ed with
success against the aura epileptica. Blisters, moxas, potential cau-
teries, issues, Dippel's oil. a decoction of ruta graveolus, and various
other rubefacients have been successful in cases reported by Loch-
er, Baster, Dovinetus, Brunner, Stuerhn, Henricus ab Heer, Benzi,
Portal, Kecamier, &c.

It is useless to mention any of these cases particularly, because
there are so many on record that every one knows some of them.

The application of a moxa or of the red-hot iron, is, I believe, the
best means of cauterization at least it is so for animals: and the
many cases in which epileptics have been cured bv a burn (see
Portal, loco cit. pp. 160 and 172,) agree in showing the power that
burning of the skin' possesses. In a case by Tulpius (see Herpin,
loco cit. p. 399.) the aura came from the big toe, and the patient was
cured by deep burnings of this toe with the red-hot iron.

Any kind of change in the skin may be the cause of tKe appear-
ance of epilepsy or of its disappearance. A man, says Esquirol
(loco cit. p. 304.) had an ulcer on one of his legs ; epilepsy came on
alter the cicatrization of the ulcer, and each fit was preceded by the
sensation of a cold wind in the cicatrix; a ligature above the knee-
joint stopped the fit. A young man, whose case is recorded by
Pouteau (quoted by Portal, loco cit. p. 875.) had received a blow on
the head, and the vround was cicatrized only a year after; he was
then attacked with epilepsy, and the fits gradually became more and
more frequent. After having been a year in this condition, he con-
sulted Pouteau, who opened the cicatrix by the application of the
cautery. From this day the fits disappeared; but the patient al-
lowed the wound to be healed again, and epilepsy returned. It
disappeared again, after another application of the caustic.

Perhaps various operations which had been followed by the cure
of epilepsy, are to be explained in the same way as the many cases
related in this paragraph. This is true, perhaps, for a case mentioned
by Delasiauve {Traite de V Epilepsie, p. 430,) and in which, after
the extirpation of an encephaloid tumor in the angle of the jaw, an
epileptic patient was cured. This explanation is probably good,
also, for some of the cases in which trepanning of the cranium has
been successful in epileptic patients. Among the cases of this kind
that I know, I take four, almost at random, to show the fitness of
this explanation. In one of them a circumscribed and permanent
pain in the head, led Dr. James Guild to apply the trephine. The
patient was cured (Delasiauve, loco cit. p. 4*22.) In another case.
Dr. Campbell {Annals Med- Psychols. Vol. XIII. p. 61^) applied the
trephine on the cranium of a man who had received a blow, and
who sufl^ered a great deal from the wound it had produced. Kq

I

1857.] Cases of Epilepsy. 30^

more fits took place, and four years after the ojxration the man was
still well. In a third case, recorded by Benjamin Travers {A far-
ther Inquiry concerning Constitutional Irritation and the Pathology
of the Nervous System, p. 285.) the trephine was applied in a place
where the cranium was depressed and painful to the touch. The
patient was cured. The fourth case I will give in full, as it has.
not yet been published, and also on account of its importance. I
owe the history of this case to Professor Van Buren, of Xew York^
and I give it just as it has been furnished to me by tliis distinguish-
ed surgeon :

Case IX. 'A healthy married woman, twenty-six years of age^
received a blow upon the side of her head from the clenched fist of
her husband, who was intoxicated. The seat of the injury remain-
ed permanently tender to the touch, and about five months after-
wards she had an epileptic fit for the first time. The fits recurred
from this time in gradually diminishing intervals, and when she
was admitted into the New York Hospital, in March, 1856, about
three years after the injury, they occurred almost every day.

' Over the centre of the pariental bone of the right side, a portion
of the scalp, about the size of a half dollar, was very sensitive on
pressure, but no appreciable lesion could be discovered, except per-
haps, - slight puffiness of the integuments at this point. She suffer-
ed much from headache, the pain always commencing here, and
seeming to radiate from this tender surface to the rest of the head.
Before a seizure of epilepsy this local pain, which was always pre-
sent, invariably became more intense.

'After watching the patient for some Vv'eeks, during which time
the fits were evidently becoming more frequent, it was observed
that she was worse at her catamenial period. In fact, upon the 5th
and 6th of April she had no less than twenty-seven distinct seizures.
Her memory and other intellectual faculties were observed to be
decidedly impaired. In other respects her health was good. Va-
lerianate of zinc was tried in doses of two and three grains three
times a day during a fortnight, but without benefit.

'It was then decided, in consultation, to explore the condition of
the scalp and cranial bone at the seat of pain, and to remove a por-
tion of the bone, if it showed any evidences of disease. This was
done on the lOth of May. The patient was etherized, and a free
crucial incision made through the scalp. The periosteum was
found more than naturally adherent to the bone, the surface of
which was somewhat elevated and roughened over a space an inch
and a half in diameter. This altered portion of the bone was re-
moved by two applications of the trephine ; its inner surface was
found to be perfectly normal, but its diplce was obliterated.

'The wound was closed accurately, except at the point where
the incisions crossed, and cold water dressings applied. No fit oc-
curred until the ISth of May, when she had three during the day

806 Cases of Epilepsy. {^^Ji

and evening, followed by active febrile symptoms with nausea, and
on the following day an erysipelatous blush appeared upon the fore-
head. On the 19th and 26th she had three fits, but they were not
very severe. The attack of erysipelas lasted the usual time, and
proved to be rather a severe one. The wound of the scalp healed
kindly and uninterruptedly, and at the end of the erysipelas was
entirely cicatrized (May 27th). After the seizure, which occurred
on the 20th, there was no return of the epilepsy. The patient was
retained in the Hospital until after a menstrual period, and as this
did not take place at the usual time approximate remedies were
employed, but it was not until the sixth v/eek that the catamenia
returned, so that the patient was not discharged from the Hospital
finally until July 10th, having had no fit meanwhile.

' The epileptic fits which occurred on the 19th, 19th, and 20th of
May, coincidently with the invasion of the erysipelas, seem to have
taken the place of the usual chill as her attack commenced without
one ; and they were the only fits which occurred after the opera-
tion of May 10th.

'I have seen the patient twice since her discharge from the Hos-
pital, once within the past month (November), and she is in perfect
health, having had no threatening whatever of an epileptic fit since
those which ushered in the attack of erysipelas.'

The extirpation of two pieces of altered bone in this case has cer-
tainly not been the cause of the cure of the patient, as there have
been fits after their removal. We are led, therefore, to admit that,
the cure was the consequence either of the influence of the erysipe-
las or of a change that took place in the skin while the wound was
healing. There are cases on record where either erysipelas, or
some other febrile disease, seems to have cured epilepsy; but this
is so ver}^ rare, that it is much more probable that in the patient of
Dr. Van Buren the cure has been effected by the change that the^
operation has produced in the skin, just where the blow which had
caused, the epilepsy had been received. The frequency of cures of
this convulsive disease by anything that may produce a change in-
a part of the skin, which, being injured or the seat of a pain, has
caused epilepsy, renders it very probable that in this case the cure
has been obtained by the change produced by the operation.

While I think that Dr. Van Buren deserves great eulogy for this
bold and successful operation, I nevertheless ought to say, that with
the knowledge I have now that epilepsy originates very frequently,
in the skin, it would be necessary in the future, in cases like those!
have just recorded, to employ various means of cauterization, and
particularly the application of a red-hot iron upon the injured skin
before making use of the trephine. Very likely cauterization, in a.
number of cases, will prove sufficient to cure.

Perhaps we are authorized to place the cases we will speak of
now, among those in which the skin was a source of an aura epH'
leptica.

1857.] Cases of Epilepsy. 307

J. Carrol {Journal General de Medecine, vol. xiii., p. 242) relates
the following case :

Case X. A child, eleven years old, had fits of epilepsy two or
three times a week, since he was two vears old. A feeling of cold,
coming from one of the upper extremities, preceded the fits. A lig-
ature having been applied around the arm, and tightened at each
threatening, the fits were avoided. A small tumor was then found
on the first phalanx of the thumb, and to ascertain if this tumor was
the cause of the fits, althous^h it did not produce pain, the ligature
was placed successively on the hand and on the thumb, and the fits
were prevented. An incision was then made upon the tumor, and
four very small bodies of hard sebaceous matter were taken out.
The wound was excited to give much pus, and healed after thirty
days. The child was completely cured, and has never had a fit
since.

Portal (Anatomie Medicale vol. iv., p. 247.) gives the case of a
woman whose fits began by a pain in the thumb. Leduc, a pupil of
Portal, extirpated a- hard portion of the skin (a bunion, very likely
un durillon), and the patient was cured.

' A strange body in the ear had caused epilepsy. Fabricius Hil-
danus extirpated it, and the patient was cured. (Esquirol, loco cit.
vol. i., p. 303.)

Esquirol says {loco cit. vol. i., p. 303) : 'Donat attended a nun
who felt, in the beginning of the fits, a pain in the right mamma,
ifrom which the aura ascended to the brain : if an ulceration took
iplace in the mamma the fit was prevented.'

^'Although the skin is more apt to produce epilepsy than the trunks
i of nerves, there are many cases where an injury to the trunk of a
r nerve has caused this disease. Such cases have been recorded by
De Haen, Henning, Larrey, Romberg {Nervenkrankheiten, 3d ed.,
vol. i., part 2, p. 689) and others. I will relate some cases of this
: kind to show that for them, as for those in which the aura epileptica
originates in the skin, the same principle is true, that an interrup-
tion between the injured part and the bi-ain is able to cure epilepsy.

Vovid\{Ohserv. sur V Epilepsie^ p. 210) gives the case of a man
uho had a nerve injured in the arm. Convulsions, with loss of con-
sciousness, came on many times. A greater incision was made
^vhere the wound existed, and the patient was cured.

The same writer {loco cit, p. 156) speaks of a man who had re-
3eived a pistol shot in the neck, and who had become epileptic.
After some time an abscess was formed in the neck; one of the shot
3ame out, and the patient was cured.

Dieffenbach (Die Operative Chirurgie, vol. i., p. 852) relates the
?ase of a young girl, whose hand had been wounded by a piece of
30ttle-glass. Neuralgic pains, epileptic fits, and contraction of the
imb, had been the results of the wound. The cicatrix w^as opened,
md a small bit of glass was found near a nerv^e which had been

N.S. VOL. XIII. NO. V. 20

S08 Belladonna in Diseases of the Eyes. [^^J?

divided by it, and which was swollen and hardened. After the
operation, the neuralgia, the epileps}-, and the contraction vanished,
and the girl was completely cured.

Fizes, according to Portal {loco cit.^ p. 157), has seen a man wha
had become epileptic after having been v/ounded by a sword near
the great angle of the eye, and w^io was cured after the extirpation
of a small part of the point of the sword which had staid in the-
wound.

Cases, more or less resembling the preceding, have been reported
by Lamotte, Van Swieten, Sauvages, De Haen, Burserius, Lamor-
ier, &c.

Darwin reports that he once saw a child who frequently fell down
in convulsions. A wart was found on the ankle, which was cut off,
and the fits never recurred.

Epilepsy caused by the irritation of the dental nerves, and cured
by the extirpation of some teeth, or by the lancing of the gums, iy
not uncommon. Some interesting cases of this kind have been re-
ported by Portal {loca cit.^ p. 205, and elsewhere).

I shall not speak here of the cases of epilepsy produced by an
irritation of a mucous membrane, or of a viscus, and which have
been cured by the removal of the irritation. These cases are very
numerous, and they also prove that epilepsy may be cured by the
suppression of the irritation of nerves, either in their peripheric rami-
fications or in their trunks. [Boston Med. and Surg. Journal.

On the Use of Belladonna in Diseases of the EyeSy especially in the
Medical Treatment of Cataract, Translated from the Revue dc
Therapeutique, by the Editor.

" There has always been (says Scarpa) physicians who pretended'
to cure cataract by medical means. The assertion has often been
denied, because not well understood. We have seen that the lens
rendered opaque by congelation becomes clear on the applications
of warm water ; it is, therefore, not impossible that certain forms of
opacity may disappear by proper treatment. But what are the
means to obtain this result in thehvingeye? We know nothing
of them."

This short extract from a man so eminent proves that it is notl
impossible to cure cataract without an operation. Naw to effect
this end two methods present themselves ; the one to restore trans- 1
parency to the lens, the other to remove it from the pupil or to ip-:
duce its absorption or resolution.

The first of these methods appears to us to be illusory, for we '
conceive it to be as difficult to restore an opaque lens as to renew
a necrosed bone or tissues affected with gangrene. The annals of
science do not, perhaps, present a single authentic instance of lenti-
cular cataract cured in this way.

As to the second mode, there is more reason in it.

1 1857.] Belladonna in Diseases of the Eyes. 809

This, in fact, is the way that nature proceeds in her* attempts to
cure the disease. We should then seek to find the modes which she
adopts to obtain this important result, in order to accomphsh the
same purpose by therapeutic agents at our disposal, that is by art,
which is nothing more than imitation of nature : ars imitatio naiurce.

Cases of spontaneous cure of cataract are now rare : a great
number may be found in the annals of medicine.

Doctor Ware reports several cases of traumatic cataract in
which the lenses were entirely absorbed, so that the patients were
afterwards obliged to use convex glasses. Percival Pott also (Sur-
gical Works translated into French 1777, vol. ii. p. 510.) Callisen
says he saw a cataract cease by absorption. Tenon reports in his
memoirs that the crystalline lens had been absorbed. M. M. Rennes,
P. Delmas, Manoury, Velpeau, &c., also cite cases of the same kind.

This phenomenon is explained by the rupture of the anterior cap-
sule, which permits the aqueous humor to dissolve the lens. Such
is the opinion of Mackenzie, Professor Rosas, of Viennn, &c. The
experiments made by Duterich, on wounds of the lens and its mem-
brane, and the analogy which exists between this spontaneous cure,
and that obtained by tearing the capsule with a needle passed
through the cornea, are in favor of this opinion.

M. Sichelle also says that traumatic cataracts cured without
operations had the capsule torn. But this is not all ; the lens is
sometimes detached from the ciliary processes and the hyaloid mem-
brane spontaneously, and the patient recovers vision suddenly
This displacement is observed after a violent concussion, but its
most common cause is softening of the vitreous body. This species
of trembling of the vitreous humor is communicated to the lens ; and
is followed at length by rupture of the union of the lens to the ciliary
zone.

The lens is depressed below the margin of the pupil as in cases
where the operation had been performed.

From this short review we see that the spontaneous cure of catar-
act may be effected under two conditions. The question occurs
whether, b}^ the aid of belladonna, we may not produce these two
Conditions, and obtain by its prolonged use, analagous results. It
is known that the most ordinary complications of cataract are ad-
hesions between the posterior surface of the iris and the interior of
the lens. Now, if in this particular case a dilating substance be
used for a length of time the anterior capsule will be broken. The
bns is then in immediate contact with the aqueous humor. This
rupture of the capsule would not appear impossible when we re-
member its delicate character, and the facility with which it is torn,
in the operation for extraction.

But the case which we proceed to examine is an exception. Let
us see if in ordinary cases the Belladonna may be used with pro-
' iety, If we place, for instance, this solution in an e3^e affected

ith cataract formed or forming, the expansion of the iris will affect

Belladonna in Diseases of the Eyes.

the capsule through the adhesions. We may thus understand
if the movements be continued for a long time the rupture of th<
connections between the capsule and the cilary zone may tak
place ; or, indeed, if not sufficient for this, they may be sufficient
change the normal relations of the opaque lens, and place it in
condition favorable to absorption. We were led to these refle
tions by the following case which we published in 1855. About
year before, a man applied to us, aged about 45 years, with cataract
in both eyes, of 6 months' duration. The cataract in the left eye
was very distinct ; the patient could see well enough to walk alone.
During the last few weeks the sight was diminished daily. We
directed him to put one drop of concentrated solution of belladonna
in the left eye every morning. Our object was to keep up vision
as long as possible before performing an operation, which we con-
sidered inevitable. The patient called upon us about a month
afterwards, and much to our surprise informed us not only that he
was not worse, but that the opacity was considerably diminished.
The vision was so much improved that he could attend to his ordi-
nary occupation, which was that of a miller. He had followed my
directions closely, and called to know if he should continue. We
did not see him afterwards. The Dr. reports another case, compli-
cated with neuralgia, in which the cataract appeared to be dissolv-
ed and vision restored. And still another where the lens was but
imperfectly depressed after an operation. After six months use of
the remedy the pupil was restored and the vision very good. He
mentions still another case, in which Yelpeau, after an operation-
for depression, and the lens had risen to its place, resorted to the
belladonna treatment until the lens was absorbed.

The Annales cT Occulistique, July 1855, reports the following case
of traumatic cataract cured by the application of Belladonna.
In November, 1850, M. Quadri was called to see a goldsmith who
had received a blow^ on the left eye while he was working, with a
blow pipe. This was eight days before ; violent pains in the head,
inflammation of the cornea, of the iris and of the choroid ; he was'^
nearly blind; by the use of baths, calomel, tartar emetic, leeches,;
arnica, collyria, and frictions of belladonna ointment on the upper
lid, the pain and inflammation ceased. M. Quadri used strong bel-
ladonna ointment (equal portions of extract and of lard) which
produced forced dilatation of the pupil. The cataract could thus
be seen to its full extent, and the displaced lens having lost its nu-
trition was nearly atrophied. M. Quadri postponed the extraction
of the lens to a more favorable period and recommended the use of
belladonna. After some days, the lens fell into the anterior chamber,
where it was rapidly absorbed : so that 22 days afterwards there re-
mained only a slight opacity on the posterior capsule, a small cica-
trix on the cornea, and a slight violet color on the schlerotic coat.
Vision was rather feeble. Having occasion to see the patient some-
time after, M. Quadri was surprised to find the eye restored to its

1857.] Cerd}ro- Spinal Meningitis^ BlI

natural appearance. This case proves that tlie use of belladonna by
causing movements of the iris may displace the lens, and place it in
condition favorable to absorption. Are we not authorized from the
above facts to try belladonna in all cases of cataract ? Whether
formed or forming, capsular or lenticular, spontaneous or traumatic,
complicated, or not, with adhesions. The practice presents the fol-
lowing advantages: 1st. It does not injure the eye. 2d. The
patient can make the application himself very easily. 3d. If per-
severed in regularly it will retard the progress of cataract, and in
favorable cases induce its absorption. 4th. It will always prolong
the vision of the patient, and sometimes give him light enough to
^dispense with the operation. 5th. In all cases, as we have seen, it
jwill prevent adhesions between the lens and the iris, or destroy them
when they exist. 6th and finally, resorted to sometimes before
lan operation, the latter is rendered easier, more prompt, and suc-
rcess is more constant, as is explained by Scarpa in the following
extract : " The most common obstacle to success, in any method
of operation for cataract, is not the lens, but its capsule, especially
the anterior capsule. It is desirable that art should possess some
easy method in all cases, of separating entirely the capsule with the
lens from the ciliary zone." Now we think that this view express-
ed by Scarpa may be realized by belladona. The following case
appears to demonstrate it.

" I operated towards the Spring of last year on double cataract
in a patient who had used belladonna for several months, which
Ipermitted him to walk alone, and attend to some slight business. I
operated by depression on both eyes in the presence of his family
physician who assisted me. I was struck with the facility with
which the lens went down, it almost went itself at the first touch of
the needle in both eyes ; but slight inflammation followed, and the
Success was good in both eyes. I have operated in a number of
double cataracts by depression, and know that the operation is not
always so simple. I am led to believe that the belladonna favored
the separation of the pupil from the lens." [Dr. Rouault. Phila-
delphia Med. and Surgical Journal.

Epidemic Cerebro- Spinal Meningitis^ in Elmira, Steuben Co.^ N. Y.
By Frank H. Hamilton.

Having occasion to visit Elmira, in Steuben Co., N. Y., during
the last w^eek, I was requested by Drs. Flood and Purdy, to see a
case of epidemic cerebro-spinal meningitis.

I found a lad, about eight years old, apparently dying, after an
illness of four days. He was lying with his head strongly drawn
back, as in opisthotonos; deglutition was difficult; the pupils of his
eyes possessed their natural impressibility to light, but he was una-
ble to speak. The functions of his mind seemed to be unimpaired.
His pulse was rapid, but not so feeble as: his dying appearance had

312 Etherization in Convulsions. [^^Jj

led me to think I should find it ; indeed, the very intelligent gentle-
men who were in attendance, said that this condition, of general
appearance was sometimes present a long time before death. Upon
his body were numerous petechise, now very much faded, but which
w^ere at first quite dark.

The father of this child had died a few^ days before, in the same
manner, after an illness of forty -eight hours.

This epidemic commenced in February, during the prevalence
of the south wind, and after the disappearance of the snow. Scar-
latina, in a mild form, had preceded it as an epidemic. It w^as, thus
far, confined to the valley in which the village of Elmira is situated,
and had occurred mostly among the poor, yet not entirely. The
family whose house I visited, was in a comfortable dwelling, andin
easy circumstances. The soil of this valley is composed chiefly, I
think, of sand and gravel, and allows the surface to become easily
drained. It is probable, however, that a substratum of frost has not
permitted this drainage to be complete during the period of the pre-
sent epidemic.

In all, twenty cases have occurred, of which only four had recov-
ered. It was not confined to any period of life.

The usual signs which characterize the disease, are a general
malaise, coldness of the extremities, and of the face, nose, chin, ear-
while the head is rather waimer than natural ; stupor, occasionally
delirium, and sometimes no cerebral disturbance whatever. The
head is gradually drawn back, and the muscles of the neck become
rigid. Often, no pulsation can be felt at the wrist, when the physi-
cian is first called. The stomach and bowels are not much, if at all,
disturbed. Petechise occur at an early period.

The plan of treatment adopted has generally been stimulating:
such as alone seemed to be indicated. Hot baths, medicated with
cayenne pepper, mustard, brandy, &c., also hot mustard cataplasms,
and frictions. Internally, the patients have taken brandy, camphor,
quinine, &c.

Since I have returned home, Dr. Flood has informed me that fif-
teen more cases have occurred, of which four terminated fatally
w^ithin from one to two hours after the accession of the disease; but
that under the plan of treatment described, four others, who were
seen within from twenty to thirty minutes after the attack, recov
ered. [Buffalo Medical Journal.

Etherization in Convulsions.

Dr. N. J. Knight communicates to the Boston Medical Journal
his experience with ether in controlling convulsions, and especially
the convulsions of children, as follows :

" I think etherization in cases of convulsions in children and adults,
is not fully known and appreciated. To every case of teething
convulsions, in my practice for the last three years, I have adminis-

1857.] On Fissure of the Anus. 313

teved the pure sulphuric ether, and immediate restoration has fol-
lowed with the most pleasing eflect.

"A severe case of puerperal convulsions occurred in my practice
last month. A lady who had, at three previous pregnancies, mis-
carried at periods varying from four to seven months, was taken
with the usual symptoms of abortion, and sent for me in haste. Per-
fect quiet and an anodyne were prescribed ; the alarming indications
-soon passed off, and I left. About three o'clock the next morning I
was sent for, and found the patient recovering from a convulsive
fit. Bleeding, a cathartic, cold to the head, sinapisms, to the neck,
legs, etc., did not prevent the recurrence of three more convulsions
in less than ten hours, when I commenced the administration of
sulphuric ether, and although no more convulsions occurred, it was
not until near the end of forty-eight hours that the nerves became
so calm as to allow the ether to be omitted altogether. Ten days
from the first attack the lady was delivered of a seven months' child,
which had evidently been dead from the time of the first convulsion.

" I have had a severe case of convulsions of a married lady, this
week, and etherization shortly restored the patient to a healthy con-
dition.

" I consider ether really the only safe and efficient remedy for
xjonvulsions of teething children, or adults, now known to the Pro-
fession Probably the half is not yet learned that etherization can
accomplish for suffering humanity." \_Cincinnati Med. Observer.

"On Fissure of the Anus^ and its Radical Cure^ without a Bloody
Operation. By Dr. Chapelle. (Read before the Academy of
Medicine, Paris. (Translated from the Gazette Hehdomu)

There is in this disease a neuralgic element which is its principal
constituent. This accounts for the inefficiency of the therapeutical
agents employed for the cure of the wound alone. All topical agents
which do not act vigorously upon the neuralgic element, have been
and cannot fail to be powerless. Among the curative means pre-
scribed for this affection, the incision of the sphincter, used by
Boyer, and since his time, adopted by most modern surgeons, has
been the most successful. This operation acts in the same manner

; the division of nerves in other neuralgias. Observation shows
that the therapeutical result is the same whether the section is made
at some distance from the muscle, or near to the fissure itself,
another proof that the erosion of the mucous membrane is of but
slight importance in this disease.

It was the decision as to the neuralgic character of this affection
which led me to the discovery of a means for curing fissure of the
anus, as simple as it is efficacious. Chloroform dissolved in alcohol
is the means with which I have invariably succeeded.

I diminish or increase the proportion of chloroform accordino- to

814 On Urticaria. [^s-Ji

the degree of sensitiveness of the patients. Ordinarily, I use the fol-
lowing: ^. Chlorolorm 1 part.
Alcohol 5 parts.

I proceed as follows : With the fingers of the left hand I separate
the borders of the anus, then 1 introduce deeply into this opening a
badgers hair brush, previously saturated in the chloroform solution,
and then withdraw the fingers. The sphincter naturally presses
upon the brush, expresses the liquid which it contains, which acts
rapidly upon the contracted tissues, produces a severe and penetra-
ting heat upon the contaminated surfaces, and particularly upon the
points w^here the fissure exists. Soon after the abnormal contrac-
tion ceases, and the patient only feels the effect of the liquid applied.

This mode of treatment is quite inoffensive. It has no other in-
convenience than the local and immediate pain which follows the
application of the chloroform liquid, but this disagreeable sensation
soon passes off. Fourteen cases of anal fissure are reported, in
which this means was used with constant success. Of these four-
teen cases, four were cured by a single application : six by two ; in
three others it was necessary to have recourse to it three times ;
and in one, only, four applications were necessary before a cure
was obtained. \_American Medical Monthly,

On Urticaria. By Professor Budd.

Nettle-rash may be produced in various ways; but its most fre^
quent cause, and that which especially concerns us at present, is
the imperfect digestion of particular articles of food. Among the
substances that have been observed to bring it on, are shell-fish, espe-
cially crabs and muscles, pork-pie, fish, when tainted or out of season;
honey, mushroons, cucumbers, almonds and oatmeal. The symp-
toms are too well known to require notice. The main object of
treatment is to expel as soon as possible the offending matter. The
stomach should first be emptied by an emetic of ipecacuanha or
sulphate of zinc, and the bowels then cleared by a w^arm but quick-
ly-acting purge. To allay the cutaneous irritation, Dr. Budd is in
the habit of prescribing a lotion, made by mixing half a drachm of
acetate of lead and half an ounce of tincture of opium with eight
ounces of water.

In those cases in which the nettle-rash seems to be referable to
several substances in common use, rather than to one special sub-
stance, it may sometimes be kept off by the administration (before
dinner) of the rhubarb and ipecacuanha pills, or of a few grains of
rhubarb. Dr. Budd gives a case which shows, very satisfactorily,
the occasional efficacy of rhubarb in this disorder.

" It sometimes happens (says he,) especially in women, that the
nettle-rash though depending immediately on the stomach, occurs
only when digestion is weakened by over-fatigue, or by profuse
monthly discharges, and that remedies of a different class are avail-

1S57.] Treatment Preventive of Puerperal Fever, 815

ing. In some such cases, when all the means 1 have before spoken
of had failed, I have known the eruption to disappear under the use
of carbonate of ammonia, alone or in conjunction with the tincture
of gentian." [British and Foreign Med. Review.

Upon a Method of Treatment Preventive of Puerperal Fever. By
M. PiEDAGNEL. (From the Gaz. Medicate^

M. Piedagnel communicated to the Academy of Sciences, Paris,
in its sitting of Nov. 24, 1856, the following note upon a method of
treatment preventive of puerperal fever :

During an epidemic of puerperal fever, at Paris, lying-in women
were distributed through the various hospitals, and a certain num-
ber were received into the w^ards at Hotel Dieu, under the charge
of M. Piedagnel. Conscious of the uncertainty of medication against
this disease, M. Piedagnel thought it might not be impossible to
prevent its occurrence, and forthwith endeavored to discover the
means.

Knowing that quinine had often been employed with advantage
in this disease, and that it prevented the access of pernicious inter-
mittent fever, a disease usually more severe than puerperal fever,
and recalling that during the cholera of 1853-54 he had obtained
undoubted preventive results from its use ; knowing also that iron,
which has a positive action upon all the economy, has also been
employed with advantage against puerperal fever, it seemed that by
associating them, good results might accrue from their administra-
tion. But as puerperal fever ordinarily commences suddenly, and
is not always preceded by any partial alteration, he thought the ad-
ministration of these medicaments, which could not produce any
injurious result, might be made before the appearance of the disease,
when its irruption was feared.

The patients he received were well watched, and kept carefully
clean. The windows of the wards were kept open almost all the
time, even at night, when the weather would permit ; fire was kept
day and night in the stoves, so as to produce currents of air, and the
treatment used was as follows :

As soon as a woman entered the wards to lie-in, or if she had
been delivered, she took two pills, each containing about one and a
half grains of quinine and fifteen grains of sub-carbonate of iron,
and in the evening the same quantity; and as long as she remained
in the hospital she took morning and evening the same dose, drink-
ing linden-flower water and a bottle of Spa water. All the functions
were watched and presei-ved as much as possible in their physiologi-
cal integrity. This was the treatment in simple cases, but in those
in whom the signs of the fever had become developed, the dose of
the medicament was increased progressively each day as high as 5,
10, and 15 grains of the sulphate of quinine, and of a 3j. to a 3iss.
of the iron. As soon as the symptoms became milder, the amount
of the medicaments were reduced.

316 Medicated Enemata. [May,

Of 94 women delivered under his care, only one died of puerperal
fever contracted in his wards. \_Ariierican Med. Monthly.

Medicinal Substances introduced into the Large Intestine hy Enemata.
By M. BRiauET. (From the Gazette Hebdomadaire.)

M. Briquet read before the Academy of Medicine, Paris, Session
of Dec. 30, 1856, a paper entitled "Upon the Absorption of Medi-
cinal Substances introduced into the Large Intestine under the form
of Enemata," from which he drew the following general conclu-
sions:

1. The liquid comprising the enema can easily reach thecoecum,
and consequently come in contact with a very extensive absorbing
surface.

2. The mucous membrane of the large intestine and the fluids
which cover its surface, have no chemical action upon the substan-
ces introduced into the large intestine, and that there is no absorp-
tion of anything which was not primitively in solution,

3. When any of the soluble salts of quinine are administered in
enema in doses below fifteen grains, a little more than a third of the
quantity administered is eliminated, and consequently has been ab-
sorbed.

4. When more than fifteen grains are administered it is not tol-
erated well, and only a fifth or a sixth of it absorbed.

5. At whatever dose the sulphate of quinine may be given, it
produces ordinarily the cerebral symptoms, very slowly and very
imperfectly.

6. Traces of elimination and consequently of absorption, are not
obsei-ved till an hour after the administration of an enema, and then
k is very slight.

7. The duration of the elimination is generally quite short, and
ordinarily from two to three days at the longest.

8. The greater or less quantity of the liquid, yet limited to a cer-
tain degree, the more or less viscid nature of the liquid, and finally
the addition of the salts of morphine to the alkaloids of cinchona,
<Jo not sensibly modify the absorption.

9. Young people absorb better than adults ; old people of both
sexes badly.

10. The alkaloids of cinchona administered in enemata in doses
below fifteen grains, can produce, in this way, all the effects to be
expected from the exhibition of these alkaloids in small doses, by the
mouth, and can very well take their place.

11. The same is not true of those cases where a large dose is
required ; there is not sufficient absorption to produce the severe
stupefying eflfects.

12. More than thirty grains of sulphate of quinine at a time can-
not generally be tolerated by the large intestine.

These conclusions are applicable, more* or less, exactly to the
diflerent substances employed in enemata. \_Ihid.

1867.] Ediicynal. 817

EDITORIAL kW^ MISCELLANEOUS.

STATE MEDICAL SOCIETY.

The annual meeting of the Medical Society of the State of Georgia was
held in this city on Wednesday, the 8th of April. We were pleased to see
so large a number of the membei's in attendance, and we are confident that
they had no cause to regret the sacrifices they may have made to be pre-
sent ; for the meeting was one of very considerable interest. Several very
able and instructive Essays were read, which were received with marked
attention. At the next meeting, we trust that the number of Essayists will
be greatly increased. The Society has many members who are in possess-
ion of rich stores of observation and reflection, the communication of which
would do honor to themselves, and prove highly advantageous to the Pro-
fession, and to mankind.

After the adjournment of the Society, the members partook of an elegant
entertainment which had been prepared for them by the Physicians of our
city, and then parted with feelings of mutual respect and good will, to meet
again at Madison on the second Wednesday in April, 1858.

The proceedings of the meeting, which have been promptly furnished us
by the Secretary, we, as the organ of the Society, herewith present.

Proceedings of the Annual Meeting of the Medical Society of the State of
Georgia^ held in Augusta^ Ajyril 8th and 9th, 1851.
The Society assembled at 10^ o'clock, in the Presbyterian Lecture room,
and was called to order by the 2nd Vice-President, Dr. S. W. Burney, of
Forsyth.

The Eecording Secretary being absent, Dr. Eben. Hilly er, of Atlanta,
was requested to act as Secretary, pro. tem.

The following regular members were present :
Dr. Richard D. Arno

" Joseph A. Eve,
' " Lewis D. Ford,
" M. H. Oliver,
" R. Q.Dickinson,
" W. S. Jones,
." J.G.Howard,

The proceedings of the last annual meeting, held in Macon April 9th,
1856, were read and approved.

On motion, the rules were suspended, and the following gentlemen, on
written application, were duly elected members of the Society :

Prof. Jesse Boring, of LaGrange ; Prof. Joseph P. Logan, of Atlanta ;

Prof. John W. Jones, of Atlanta ; Drs. Wm. S. Meiere, of Madison ; John

: B. Hendrick, of Covington ; G. L. McClesky, of ^Madison ; N. F. Powers,

of Thomson ; V. H. Taliaferro, of Atlanta; Olin S. Means, of Oxford ; T. C.

of Savannah.

Dr. L. A. Dugas,

of Augusta.

" Augusta.

" Henry F. Campbell, " "

u u

" R. C. Black,

u u

" Atlanta.

" Eben. Hillver,

" Atlanta.

Albany.

" J. M. Turner,

" Augusta.

" Augusta.

" A. Means,

" Oxford.

" Savannah.

" S. W. Burney,

" Forsyth.

318 Proceedings of the State Medical Society. [May,

H. Wilson, of Atlanta; E. J. Roacli, of Pulaski; W. H. Doughty, of Au-
gusta ; W. L. Felder, o-f Augusta ; W. T. Grant, of Columbia ; R. H. Eaton,
of LaurencevilUe ; M. J. Jones, of Warrenton ; A. T. Jenkins, of Greene Co.;
J. W. Gairdner, of Augusta ; J. T. Dickinson, of Albany ; S. S. Crawford,
of Augusta ; T. B. Ford, of Augusta ; De Saussure Ford, of Augusta i H. R.
Casey, of Columbia ; J. C. Carroll, of Lawrence Co.; E. B. Hook, of Augus-
ta; E. H. W. Hunter, of Louisville; D. W. Marks, of Augusta; D. W.
Young, of Augusta ; H. H. Steiner, of Augusta.

The election of officers being next in order, a ballot was ordered, and the
following gentlemen were duly elected for the ensuing year:
Dr. S. W. BuRNEY, of Forsyth, President.
" H. F. Campbell, of Augusta, 1st Vice-President.
" T. C. H. Wilson, of Atlanta, 2nd Vice-President

On motion of Dr. Arnold, of Savannah, the offices of Corresponding and
Recordmg Secretary, and Treasurer, were consolidated.

A ballot was then ordered, and Dr. Eben. Hillter, of Atlanta, was de-
-clared unanimously elected.

The selection of Delegates to the American Medical Association being
next in order, a Committee of five, consisting of the following gentlemen
Drs. Dickinson, Dugas, Arnold, Taliaferro and Means were appointed by
the President to select them, and report at their earliest convenience.

The Society then adjourned until 3 o'clock P. M.
Afternoon Session.

Society called to order by the President.

Reports from Auxiliary Societies being called for Dr. E. Hillyer pre-
sented a Report of the organization, officers and members of the Auxiliary
Society in the city of Atlanta, which, upon motion, was received and
adopted, and ordered to be put among the records of the Society.

The Committee to appoint Delegates to the American Medical Associa-
tion, reported the names of the following gentlemen :

Dr. W. S. Meiere, of Madison ; Dr. J. G. Howard, of Savannah ; Dr. Jesse
Boring, of LaGrange ; Dr. Joseph P. Logan, of Atlanta ; Dr. Wm. S. Jones,
of Augusta : Dr, George F. Cooper, of Americus ; Dr. N. F. Powers, of
Thomson; Dr. Eben. Hillyer, of Atlanta; Dr. T. S. Powell, of Sparta;
Dr. R. D. Arnold, of Savannah; Dr. H. R. Casey, of Appling; Dr. Henry
Gaither, of Oxford ; Dr. S. W. Burney, of Forsyth.

The Committee also reported the following : '

Resolved^ That should any of the gentlemen appointed be unable to at-
tend, that they be authorized to appoint their own alternate.

The report was received and unanimously adopted.

The reading of the Essays being next in order. Dr. Kollock, of Savannah,
read a very elaborate and interesting paper upon Vesico-A^aginal Fistula.

The Society then adjourned until ten o'clock Thursday morning. j

1857.] Proceedings of the State Medical Society. 81^

Thursday Morning, April 9th.

Society met pursuant to adjournnient. Minutes read and approved.

Upon a written application, the following gentlemen were duly elected
members : Dr. W. T. Hollingsworth, of Morgan ; Drs. Robert Southgate,
J. W. Dent, S. H. Lamar, C. R. Walton and Charles Palmedo, of Augusta ;
Dr. Thomas S. Powell, of Sparta.

On motion of Dr. Means, it was

Resolved^ That those gentlemen of the Society who were appointed to
read Essays, at the present meeting, and may have prepared them but who
have been unavoidably prevented from attending be requested to furnish
their papers, at their earliest convenience, to the Editors of the Southern
Medical and Surgical Journal for publication.

On motion, for the benefit of new members, the Secretary was required
to read the Constitution and amendments of the Society. Also, that the
Editors of the Southern Medical and Surgical Journal be requested to pub-
lish the same in the pages of said Journal.

Dr. Joseph A. Eve, by appointment, read a paper, upon the Diseases of
the Cervix Uteri, which was listened to with much interest by the Society.

Dr. L. A. Dugas contributed a full and interesting paper upon Fractures
of the Scapula.

Dr. Dickinson, of Albany, offered the following :

Resolved^ That the thanks of the Society be tendered Drs. Kollock, Eve,
and Dugas, for the Essays read by them before the Society ; and that they
be requested to furnish copies for publication in the Southern Medical and
Surgical Journal which was adopted.

The Society then adjourned until 3^ o'clock, P. M,
Afternoon Session.

Society called to order by the President.

Dr. Hunter offered the following resolution :

Resolved^ That 0. S. Proffit having been found to have been ineligible at
the time of his election to membership in this Society, the Secretary is
iiereby instructed to erase his name from the list of members which was
mnanimously adopted.

A Committee, consisting of Drs. Means, Grant, Ford, Jones and Camp-
WI, were appointed to select Subjects, and appoint Essayists, for the next
annual meeting.

The selection of the place for holding the next annual meeting being now
in order, a ballot was ordered, and upon counting the votes, it was found
that Madison, Morgan county, had received a majority.

Dr. Thomas S. Powell, of Sparta, was elected Orator, for the next aflnual

eeting, and Dr. W. S. Meiere, of Madison, his alternate, should he be un-
able to attend.

The Committee on Essays, made the following report of Subjects and
for the next meeting which was received and adopted :

820 Proceedings of the State Medical Society. \y^^Ji

Dr. J. G. Howard, of Savannah On Uterine Disease.

Dr. E. J. Roacli, of Pulaski On the Propriety of Surgical Operations about

the Joints.
Dr. H. F. Caropbell, of Augusta On the Rectal Administration of Medicine.
Di*. J. M. Green On the Value of Escharotics in the Treatment of Cancer.
Dr. R. D. Arnold, of Savannah On the Pathology and Treatment of Yel-
low Fever.
Dr. Ira E. Dupree, of Twiggs On the Treatment of Prolapsus.
Dr. Eben. Hillyer, of Atlanta On the Physiology of Menstruation,
Dr. V. H. Taliaferro, of Atlanta On Obstetrical Surgery.
Dr. N. F. Powders, of Thomson On Diseases of the Skin.
Dr. W. S. Meiere, of Madison On the Use of Alcohol in Typhoid Fever.
Di". R. Campbell, of Augusta On Wounds of the Abdomen.
Dr. I. P. Garvin, of Augusta On Nervous Irritation of the Stomach.

Voluntary Communications from any member of the Society are earnest-
ly requested, and will be gratefully received.

Tlie following, offered by Dr. W. T. Grant, was adopted :

Resolved^ 1st. That the Medical Society of the State of Georgia return^
their sincere thanks to the Trustees of the Presbyterian Church, for their
kindness in extending the convenience of their Lecture room to the Society.

2nd. That the thanks of the Society be extended to the Profession, and
the Citizens of Augusta, for their liberal hospitality and kind reception of
the members of the Society.

Dr. Campbell offered the following, which was adopted :

Resolved^ That the funds of the Society, now on hand, as by report of
the late Treasurer, be placed in the hands of the President and Treasurer,
to be used in procuring such Artistical Illustrations as may be deemed ne-
cessary for the Articles published under the auspices of the Society.

The following gentlemen were appointed on the Committee of xlrrange-
ments for the next meeting : Drs. H. J. Ogleby, E. E. Jones, John B. Craw-
ford, and G. L. McCleskey.

Dr. Hunter offered the following :

Resolved^ That the thanks of this Society be tendered the President and
Secretary, for the faithful manner in which they have discharged their re^
spective duties.

The following, by Dr. Arnold, which was adopted :

Resolved^ That the thanks of the Society be presented to the Press of the ,
city, for their courtesy extended to it as a body.

A motion was passed, instructing the Secretary to have published the
resolutions of thanks to the Trustees of the Presbyterian Church, the Phy- \
sicians, Citizens, and Press of Augusta, in the Augusta papers.

Dr. Grant offered the following, which was adopted '.

Resolved^ That this Society do now adjourn, until the second Wednes-
day in April, 1858, to re-assemble in the town of Madison, Morgan Co., Ga-
EBEN. HILLYER, M. D., Sec'ry and Treasurer,

I

1857.] Editorial and Miscellaneous. 321

As we are constantly importuned to send virus, we call the attention of
our readers to the following circular, by Dr. W. H. Ford, of Charleston,
South Carolina :

" Physicians wishing Vaccine Virus, l>y addressing Dr. William Hutson
Ford, City Vaccinator, Charleston, S. C, and enclosing one dollar, will re-
ceive, by return mail, ten points, or a set of glasses, charged with fresh
lymph, or, if particularly desired, a recent scab. Seventy -live points, or
seven sets of glasses will be sent for five dollars."

A Paper for the Profession. The " North Carolinian," (Fayetteville,)
edited by the spirited and talented W. F. Wightman, Esq., formerly of this
city, contains the following evidence of orthodoxy, which we quote as a
rare morceaufor the Profession. Quackeiy must evei' flourish while it can
command the power of the Power press, and will langiiisli in death when
she withdraws her influence ;

" We frequently receive proposals from quacks and other impostors, to
publish their medicines, or wares, at such rates as we would not allow to
our immediate patrons at home. And it is not uufrequently the case that
we receive some such a proposal as this r

" ' Will you publish the enclosed advertisement of my Philo-Sanative
Elixir for one year, and take twenty bottles of the Elixir in payment for the
same ? If so, please insert immediately and send m^ your paper regularly.'

" We usually put such documents in the fire, or devote them to other
uses not contemplated by their knansh authors."

Syphilisation. This is an attempt to saturate the system Avith the
syphilitic virus by repeated ittoculation, until the poisonous influence can
no longer be communicated, with a v^ew to the final relief of the constitu-
tional disease, or a prophylactic like vaccination for smallpox. The prac-
tice has been once condemned by the French Academy of Medicine, but
mibsequent experiments, made mostly upon children laboring under the
lereditary form of sy]:)hilis, have drawn attention to it again, and the pre-
Icription is made in both French and German hospitals. If its utihty
Should be established, it may aftbrd a hint as to the treatment of othec'
jbontagious diseases. [Memphis Med. Recorder.

Poisoning from Wafers. Dr. Vernon in the Union Medicale, detaife
the case of a young girl sixteen years of age, laboring under a depraved-
appetite, who ate a large quantity of wafers. In a few hours afterwards
she was attacked Tvith strong convulsions and torturing pains, and could'
with difficulty be held upon the bed. The countenance expressed great
suffering, and the breathing was laborious and somewhat stertorous. The
jaws were forcibly closed, the lips nolet red, the eyeballs prominent and
staring, and the pupils extremely dilated. Pulse 126-130 in the minute,
and the skin dry and hot. Tenderness upon pressure about the umbilicus,-
the abdomen hard, and the walls retracted, nausea, but no vomiting.
When the limbs were not firmly held the patient was constantly writhing,
twisting and throwing herself in every direction, and screamed violently.
In spite of all the remedies used for her recoveiy she expired in ten or twelve

822 Miscellaneous.

hours from the attack. Upon analyzing the wafers, it was ascertained that
they contained a large quantity of chromate of lead, hence it was inferred
to be the poisonous agent, and the case set down as one of the many cases
of lead poisoning. INaahville Jour, of Medicine and Surgery.

Chlorate of Potash. " The chlorate of potash possesses a peculiar influ-
ence over all inflammatory and ulcerative affections of the mouth. Although
these disorders may be dissimilar as to cause, nature, degree, tissue affected,
and common only in being situate in the mouth, they are all equally
amenable to its control. For infants of one year, five grains is an ordinary
dose ; for an adult, a scruple or half a drachm. If the disease be acute,
you may push it further by giving it more frequently ; if it be carried too
far, it will excite purging, but if given in smaller doses, disappointment will

only ensue. If property administered, its virtues and potency are indubita-
]51g^ ********

" The two ioWov^Ang conclusions appear to be warranted by the facts which
have been adduced:

" 1. That chlorate of potash possesses a peculiar influence over all in-
flammatory affections of the mouth. (The syphilitic, perhaps, excepted.)

" 2. That chlorate of potash possesses a peculiar influence over inflam-
mations attended with phagadaena or sloughing, on whatever part of the
body situated." [J. Hutchinson, Braithimiteh Retrospect.

Wounds of the Tongue. "When the tongue is wounded, for example,
by a tooth accidentally driven into it, the closeness of the tissue renders the
forceps useless. You must transfix the bleeding orifice of the vessel with
the tenaculum, and tie in a small portion of the surrounding texture." [Dr.
Knox, and Ihid.

Perchloride of Iron. " Dr. Dowler reported, in the N. Orleans Medical
and Surgical Journal for September, a case of a troublesome and alarmin-
hemorrhage following the extraction of a tooth. After trying various reme
dies, without success, he saturated some lint with the perchloride of iron
and placed it in the socket, when the bleeding ceased. [^College Journal.

Affection of the Tonsil. Dr. Andrew Clark related the case of a genth
man who, whilst at breakfast three weeks since, was seized with a violent
expiratory effort, attended by vomiting, consequent upon a particle of fooc
having escaped into the trachea. He shortly afterwards expectorated a
small body, having somewhat the appearance of a hydatid. A few days
afterwards he brought up a similar substance. Some doubt existing as to
the nature of the body. Dr. Clark was consulted. The patient was a stout,
healthy man, but rather thinner of late, on account of anxiety respecting
the nature of his malady. The chest was healthy, and the general health
good. On examining the throat carefully, he observed a small elongated
body attached to one of the tonsils, which, on removal, proved to be one of
the follicles of that gland, elongated, enlarged, and full of fluid. The sub-
stances formerly expectorated were of the same kind. The patient soon
recovered. \London Lancet.

SOUTHERN

MEDICAL AND SURGICAL JOURIAL.

(NEW SERIES.)

Vol. XIII.] AUGUSTA, GEORGIA, JUNE, 1857. [No. 6.

ORIGIML AND ECLECTIC.

ARTICLE XVII.

Fractures of the Scapula. By L. A. DtTGAS, M. D., Professor of
Surgery in the Medical College of Georgia. (Read before the
Medical Society of the State of Geqjgia, at the Annual meeting
in Augusta, April, 1857, and ordered to be 2:>rinted.)

.The object of this paper is to take a hasty view of the injuries
to which the Scapula may be subjected, to direct special attention
to fractures of the Neck of this bone, and to relate two cases pre-
senting important peculiarities hitherto, unnoticed by systematic
writers.

Fractures of thQ Scapula are comparatively rate t a fact that may
"be attributed alike to the security of its position and to the yield-
ing nature of its attachments. In consequence of its mobility,
shocks which might otherwise occasion serious fractures, are rare-

_ ly followed by anything more than a contusion of the soft parts.

1 A fracture of this bone may therefore be usually considered as in-
dicative of a very considerable degree of violence.

The relative frequency of Fractures of the Scapula may perhaps
be inferred from the statistics of Middlesex Hospital and of the
Hotel-Dieu. In the former of these institutions, according to Lons-
dale, out of nineteen hundred and one cases of Fracture there were
, eighteen of the Scapula, of which eight implicated the body, eio'ht

N. S. VOL. XIII. NO. VI. 21

824 Bjj GASj on Fractures of the Scapula, [June,

the acromion process, and two the neck of the bone. (Pirrie's Sy9>
of Surg., p. 146, Am. ed.) At the Hotel-Dieu there were but four
Fractures of the Scapula in twenty-three hundred and fifty-eight
cases. (Malgaigne, Tr, des Fract., &;c,, p. 498.) On the other
hand, I have seen, in my private practice alone, four cases of
Fracture of the Scapula, although the number of other fractures
has not been unusually great.

Fractures of the Scapula may implicate the body of the bone, its
spine, its processes, or its neck. Let us study them in each of
these regions.

The body of the scapula may be fractured bj violence directed
against the back of the thorax, such as blows with a club oi other
heavy missiles,, the kick of a horse, &c, I saw an accident of this
kind resulting from the fall of a portion of the plastering in the
ceiling of a high-pitched apartment. The person was seated, and
was probably leaning forwJ^rd when the heavy mass fell upon the-
scapula. In another instance that came under my observation^,
the body of the scapula was fractured by the hoof of a horse in
running over the man. In such cases the true nature of the injury
is considerably masked by the violence done to the soft parts,
which, are necessarily very^nch contused,- sometimes considera-
bly ecchymosed, and soon become the seat c^f tumefaction and
great soreness. The patient will soon find all attempts to use the
arm attended with pain overthe whole of the scapular region, and
the careless observer might easily overlook the deep-seated injury.
But if the surgeon will place the fingers of one hand upon the
inferior angle of the bone so as to fis it against the thorax, while
he seizes the shoulder with the other hand and imparts motion
in various directions to the humeral portion of the scapula^,
crepitation may be detected more or less distinctly. This may
sometimes be facilitated by elevating the humerus at the same time-
In the first case to which I just referred as having come under
my observation, the patient would herself occasionally feel the
crepitation on endeavoring to carry the elbow upwards or back-
wards, and would compare the^sensation to that which might be-
occasioned by one edge of the bone slipping over the other. Un-
der such circumstances, the hand of the surgeon applied flatly
upon the scapula, would enable him to perceive the crepitus. By
causing the patient to fold his arms across his breast, the scapula
becomes more prominent, its general shape may be better defined,

1857.J DuGAS, on Fractures of the Scapula, 325

and the surgeon may, by measuring its diameters, establish a com-
parison with that of the uninjured side. Malgaigne (Tom. 1, p.
502) advises the forearm to be flexed and the hand to be carried
forcibly back of the thorax, for the purpose of rendering the scapu-
la more prominent, and consequently thus to facilitate its inspec-
tion. It must be confessed, however, that although the judicious
surgeon will rarely fail to detect the existence of a fracture of the
body of the scapula, it is always diJSicult and often impossible for.
him to determine the precise locality, shape, and extent of the
injury.

The muscular masses between which the body of the scapula
lies will usually prevent much displacement of the fragments,
unless the inferior angle of the bone be alone separated, in which
case the displacement is sometimes very marked. There are, how-
ever, some cases cited by Malgaigne and by Lonsdale in which
the displacement of the fragments was very remarkable. In these
cases the fractures were below the spine and in the long diameter
of the bone, so that the action of the Teres major may have caused
the displacement of the lower fragment. But this state of things
may also be attributable to the combined influence of a laceration
of the muscular layers and of the inefficiency of the retentive
means subsequently used in the treatment.

In the treatment of these fractures, attention should be directed
to the injury of the soft parts, as well as to the solution of osseous
continuity. There may be a laceration of the skin alone, or of
this and the muscles, down to the bone, thus constituting a com-
pound fracture ; or the contusion may have affected the tissues so
seriously as to be followed by suppurative inflammation. If there
be a compound fracture the wound should be carefully explored,
and any detached fragment of bone immediately removed. The
3dges of the wound should then be approximated by means of
adhesive plaster, taking care, in bad cases, to place a small tent in
ilie wound for the escape of any pus that may be formed. In
short, this should be treated upon the general principles applica-
dIb to other compound fractures. If the laceration does not expose
ihebone, the case will be managed as other lacerated wounds: by
idhesive plasters and cold water dressings. In cases attended
^ith mere contusion, the application of cold water, or of evapora-
ing lotions, will usually suffice to abate the tendency to inflam-
paation. Leeching may sometimes become necessary. Should

DuGAS, on Fractures of the Scapula.

suppuration ensue, an exit should be made for the pus as early as
possible, in order to prevent its diffusion between the muscles.

At the same time that treatment is being thus directed to the
soft parts, measures should be taken to maintain the fragments in
their proper position and to prevent any motion between them.
Many plans, more or less complicated, have been devised for this
purpose. The simplest will^ however, be found to be the most
comfortable to the partient, and probably as effectual as any other,
I would therefore, with many of the best authorities^, advise a
sling to be placed under the elbow in such a manner as to bring
this close to the chest and slightly forwards, at the same time that
the force be so directed as to carry the shoulder upwards and a
little outwards. By attaching to the ends of the sling slips of
bandage, these may be carried around the thorax and arm so a
to prevent any motion of the limb. This apparatus is much the
same as that I usually apply for fractures of the clavicle,., with the-
single exception that the elbow should not be carried so far for-
wards in fractures of the scapula.

Fractures of the spine of the scapula ra^j accompany those of the
body of the bone, or may exist independently of these, Malgaigne
(T. 1,. p. 499) says,, that he knows of no instance in which the spine
alone has been broken. Yet they are mentioned by Paulas
Egineta, Ambrose Pare,, and modern writers of distinction. By
endeavoring to fix the scapula while motion is imparted to the
spine through the acromion process, or by more direct manipula-
tion, crepitation may be usually produced. In some cases the
prominence of the spine w411 be diminished more or less consider
ably ; but the tumefaction, which soon ensues, may prevent this,
from being apparent. I need scarcely add, that the treatment oi
such cases should be similar to that recommended for fractures oi
the body of the bone, properly so called.

Fractures of the Acromion Process. The acromion is generally
thought to be more frequently broken than any other portion o:
the scapula. Such is not the result of my observation, for out o;
the four cases of fracture of this bone which I have seen in m}
private practice, this process was found to be broken only once
According to the statistics above referred to, the acromion wa
fractured in eight out of eighteen cases of injury of the scapula
Malgaigne thinks the accident not so common as fractures of tb
body of the scapula. Yet, from its superficial and exposed posi,

1857.] Dug AS, on Fractures of the Scapula. 327

tion, it would seem to be natural that it should be more frequently
injured than any other portion of the bone.

The acromion may be fractured at any point, from its extremity
to its connexion with the spine of the scapula ; and although the
fracture is usually transverse, it may be more or less oblique. The
extent of displacement will vary according to the seat and com-
pleteness of the fracture. If this be near the extremity, and espe-
sially if the periosteum be but slightly torn, there may be very
little displacement, and the diagnosis will be correspondingly ob-
scure. The difficulty will be increased by tumefaction, and if the
patient be fleshy. But when the solution of continuity involves a
larger portion of the process, and the periosteum is completely
divided, the fragment will be drawn down by the weight of the
irm, there will be an obvious drooping of the shoulder, and the
Snger carried along the upper border of the acromion will more
Dr less readily detect the displacement and seat of fracture. The
iepression of the shoulder, which might at first induce the suspi-
3ion of a dislocation of the humerus, can be easily overcome by
Dushing up the elbow, and is again reproduced by allowing the
irm to hang down. Crepitation may be detected by the fingers
Dlaced upon the shoulder while the humerus is alternately forced
ip and down from the elbow, or carried horizontally, or rotated,
is circumstances may require, so as to rub the fractured edges
together.

The patient usually complains of the dragging weight of his
irm, and of soreness and pain in the affected region, which are
ncreased by efforts to elevate the arm. The inability of the pa-
rent to carry the hand to the head, or even to elevate the arm to
I less degree, will necessarily be more or less marked, according
o the seat and extent of injury to the bone, as well as of the contu-
iion of the soft parts. Indeed, a mere contusion of the deltoid
nay render these movements very painful, or impossible, in some
jases, and thus mislead the careless observer. The only reliable
lymptoms are the unevenness of the upper border of the acromion,
ihe mobility of the fragment, and crepitation.
* The injury may coincide with a dislocation of the acromial ex-
remity of the clavicle, or with a fracture of this bone also. This
5omplication will not materially obscure the diagnosis, unless the
letection of the accident to the clavicle be calculated to throw the
urgeon off his guard and to induce a neglect of the proper exam-

828 DuGAS, on Fractures of the Scapula. [June,

ination of the acromion itself. It is only in this way that we can
explain the unfortunate errors recorded by Sir Astley Cooper and
others.

It is generally conceded, that although a fracture of the acromion
maybe united by bone, it more frequently happens that the bond
of union is fibrous. Malgaigne thinks the osseous union more pro-
bable, when the periosteum is but little torn and the displacement
consequently slight, than in cases in which there is a complete
solution of continuity in the periosteum and considerable separa-
tion of the fragment.

Some deformity may therefore remain under the best manage-
ment, and with or without impairment of motion and power in the
limb. The danger of such results will, of course, be much in-
creased by any negligence on the part of the patient in seconding
the efforts of the surgeon.

Treatraent. In the management of this fracture, to use the
language of Sir A. Cooper, "the head of the os humeri is the
splint which is employed to keep the acromion in its natural situa-
tion." This distinguished surgeon advises the elbow to be main-
tained at a little distance from the thorax, by means of a cushion
placed between it and the side, at the same time that it is carried a
little backward and pressed upward by a roller-bandage. In this
manner the deltoid is somewhat relaxed, and the head of the hu-
merus keeps the fragment properly elevated. He objects, I think
very properly, to the axillary pad recommended by some. I
would prefer the sling bandage I am in the habit of using in frac-
tures of the clavicle. (See Southern Med. and Surg. Jour., for 1852,
p. 69.) This consists of a triangular bit of shirting, with three or
four yards of three inch roller-bandage sewed on to each of the
acute angles of the cloth. The elbow being placed in the position
above indicated, with a cushion between it and the side, is then,
by means of the sling carried under it, pressed upwards with the
force requisite to restore the fragment of the acromion to its proper
place ; and the limb is secured in this position by carrying tha
ends of the sling above and below the opposite shoulder, and the
rollers aroand the thorax, including the fore-arm.

A strip of adhesive plaster carried over the acromion is suggest-
ed by Dr. Brinton (Erichsen's Surgery, p. 207) as calculated to
assist in retaining the fragments in apposition. A mould might be
made with softened paste-board, or strips of linen coated with

1S57.] Bu GAS, on Fractures of tJie Scapula. 329

starch, to cover the deltoid muscle, and thus to furnish a medium
of resistance to the upward pressure of the humerus, which would
-effectually prevent .any displacement of the fracture by the means
used to keep up the shoulder.

Malgaigne, who seems to give the preference to an ordinary
sling with a roller-bandage to fix the limb against the chest, adds:
^' if, however, in certain cases it be found that the complete reduc-
tion can be better effected by carrying the elbow outwards, back-
wards, or in any other direction, such means of retention should
be adopted as will most effectually accomplish the object" The
treatment should be continued about one month.

Fractures of the Coracoid Process. From the deep-seated position
of this process and its protection by muscular masses, in addition
to the mobility of the scapula, its fracture is exceedingly rare, and
almost always attended with a very onsiderable degree of contu-
sion. Although few of the systematic writers seem to appreciate
the danger of such an accident, history teaches ns that it not un-
frequently proves fatal. Boyer, Malgaigne, South, Arnott and
others, relate cases in which the patients succumbed under the
influence of extensive suppurative inflammation beneath the pec-
toral muscles and in the axillary region, some in very few days-
others after more protracted suffering.

The diagnosis of these fractures is not always easily made out.
But, in addition to the local pain, we may expect to find the frag-
ment drawn down by the coraco-brachialis and other muscles
implanted into this process, unless it be still held up by its liga-
mentous connexions with the clavicle and acromion, in which
oase crepitation could be more easily produced than if the separa-
tion were considerable. Unless the tumefaction be great, the
situation of the fragment may sometimes be distinctly felt by
fixing the scapula against the body and carrying the elbow in
different directions. We may in the same way sometimes detect
crepitation.

Treatment. By placing the fore-arm in a sling, with the elbow
inclined forward, so as to relax the biceps, coraco-brachialis and
pectoralis minor, we shall accomplish all that can be done by
mechanical means. But the treatment should also be specially
directed to the prevention of suppurative inflammation. Cold
water dressings and evaporating lotions should be diligently ap-
plied for at least ten days, or until the danger has subsided.

330 DuGAS, on Fractures of the Scapula. [June,

Leeches may be sometimes advantageously applied. If suppura-
tion takes place an early outlet should be made at the most de-
pendent point.

It is doubted, by many, that ossific union ever takes place in
this fracture. Yet, if the ligamentous attachments be unbroken,
the displacement will not probably be great, and we see no good
reason why a bony imion may not occur. The degree of disabili-
ty consequent upon this accident will depend upon the firmness
of the adhesions the fragment may form.

Fractures of the. Neck of the Scapula. The written history of this
accident ofiers a singular illustration of the defects of anatomical
language, and of the evil of using terms whose meaning is liable
to various interpretations. When anatomists use the expression
cervix-scapulce^ or nech of the scapula^ they apply it to a line near
the circumference of the glenoid cavity and just beyond the at-
tachment of the capsular ligament. This line does not, therefore,
include the coracoid process. But surgical writers apply these
terms indifferently to the line just indicated and to another, which,
commencing at the notch in the superior costa of the scapula,
would follow the depression at the anterior termination of the
spine, and, running around this narrow portion of the bone, would
include the whole of the enlargement which supports the glenoid
cavity and the root of the coracoid process. In short, there is here
the same want of precision that we find with regard to the neck
of the humerus. In both cases anatomists regard the line of junc-
tion of the articular surface, or epiphysis with the body of the
bone, as the nech, while surgeons are in the habit of including
within the neck a much larger portion of the bone. Hence the
epithets anatoraical nech and surgical nech, used by writers who do
not wish to be misunderstood.

I am led to make these remarks, in consequence of an apparent
discrepancy between authors of acknowledged ability and experi-
ence. Sir A. Cooper, in his admirable work upon Dislocations
and Fractures, devotes a special and entire section to "Fractures
of the Neck of the Scapula," and relates three cases in illustration
of his views, But he sets out with the following declaration :
"When I speak of fracture of the cervix scapula, I mean a frac-
ture through the narrow part of the bone, immediately opposite
the notch of the superior costa." There can be no mistake then
as to his true meaning. Kow let us refer to Prof. Erichsen, and
\ye find only this short paragraph on the subject;

1857.] BuGAS, on Fractures of the Scajnda. 831

"Fracture of the neck of the scapula probably never occurs, and
there can be little doubt that Sir A. Cooper and Mr. South are
correct in stating that cases so described are in reality instances of
fracture of the upper end of tl>e humerus. There is, according to
Mr. South, no preparation in any museum in London illustrating
fracture of the neck of the scapula. Indeed, on looking at the
great strength of this portion of the bone, and the way in which
it is protected by the other parts about the shoulder, it is difEcult
to understand how it can be broken." Prof. Ericksen does not
anywhere indicate what he means by "the neck," and would
seem, from the above quotation, to have committed a singular error
in relation to Sir A. Cooper's views. But Dr. Brinton, the Ameri-
can Editor of Prof. E.'s work, without remarking upon this error,
adds: "A number of cases of fracture of the neck of the scapula
have been reported; in all instances, however, the line of fracture
passing behind the base of the coracoid process. (The Science and
Art of Surger3^ Am. Ed., p. 207-8.) It appears to me very evi-
dent that Prof. Ericksen has been misled by the Islotes appended
by Mr. South to the Translation of Chelius. (See the Am. Ed. of
Chelius, vol. 1, p. 601, and p. 606.)

ISTow the question presents itself: is there ever any fracture of
either the anatomical or the surgical neck of the scapula?

In reference to the occurrence of fractures of the anatomical neok.
of the scapula, I find that the celebrated Jean Louis Petit observes :
"Le col de I'omoplate ne pent se casser que tres difficilement . . .
cependant je I'ai vu casse pres du bord de la cavite : on le reduisit
facilement, mais ou ent beaucoup de peine a le contenir, et le
malade est demeure estropie." (Traite des Mai. des os. Paris,
. 1758. Tom. 2, p. 136.)

" The neck of the scapula is not broken without great dif&culty.
. . . Yet I have seen it broken near the edge of the glenoid cavity :
it was easily reduced, but very difficult to keep in place, and the
. patient remained crippled."

In Bell's Anatomy (Am. Ed., vol. 1, p. 78) is the following
language : " This head, or glenoid cavity of the scapula, is planted
upon a narrower part, which tends to a point, but is finished by
this flat head ; this narrower part is what is named the Neck of
the scapula^ which, no doubt, sometimes gives way and breaks."
In a foot-note, he adds: "I have met with the accident in prac-
tice, and have preparations of the fractured bone, so that there

332 DuGAS, on Fractures of the Scapula. [June,

can be no doubt of this accident sometimes occurring, yet it is
very rare."

Samuel Cooper says that '' sometimes great pains and a crepitus
are experienced on moving the shoulder-joint after an accident;
and yet the spine, the neck of the scapula" (the surgical neck),
" and all the above parts, are not broken. In this circumstance, it
is to be suspected either that a small portion of the head of the os
brachii, or a little piece of the glenoid cavity of the scapula, is bro-
ken off; which latter occurrence, I think, is not very uncommon."
(Diet, of Pract Surgery.)

Chelius treats of fractures of the neck of the shoulder blade, but
I cannot determine whether he alludes to the anatomical or the
surgical neck. Yidal evidently speaks of a fracture of the anatomi-
cal neck, when he tells us that if the neck of the scapula be broken
the glenoidal fragment will be drawn down by the long head of
the biceps. He refers to the action of none of the muscles im-
planted into the coracoid process. (Tr. de Pathol. Ext, Tom. 2,
p. 224.) Pergusson teaches that the glenoid cavity may be sepa-
rate'd from the body of the scapula, at either the surgical or the
anatomical neck and says that he thinks he has seen an instance
of the latter kind. (Op. cit, p. 212.) He even illustrates his po-
sition by a wood-cut, which is, however, evidently not copied
from nature.

While it is very evident from these quotations that some prac-
titioners not only believe in the possibility of a fracture of the
anatomical neck of the scapula, but also think that they have seen
cases of this accident, their language is not such as to remove all
doubt as to their true meaning in those cases in which they refer
to actual specimens examined after death. J. L. Petit thinks he
treated a case of fracture near the glenoid cavity ^but he made no
post-mortem inspection, and may therefore have been mistaken.
John Bell's language is too ambiguous to authorize us to conclude
positively that his specimen was one of this kind. Samuel Coop-
er, Chelius, Yidal, and Pergusson, have neither of them referred
to any specimen, but simply believe that this fracture has occurred.
I do not recollect ever seeing a specimen of this kind, and know
of no author who unequivocally describes any. We may there-
fore reasonably infer that if it does ever take place, it must be
exceedingly rare.

Let us now advert to the evidence in regard to fractures of the

1857.] DuGAS, on Fractures of the Scapula. 333

surgical neck of the scapula. We have already seen that Sir Astlcy
Cooper not only admits its existence, but even adduces the history
of three cases of the kind. We have likewise quoted Dr. Brinton
on the subject. Prof. Pirrie, after defining the surgical neck, and
referring to the doubts of some as to the possibility of its fracture,
adds : " Its occurrence has now been proved by dissection. I
have seen three examples of this fracture. One was in a woman
upwards of forty-five years of age ; another, in a man upwards of
fifty ; and a third, in a lad of sixteen." (Princ. and Pract. of Sur-
gery, Am. Ed. p. 149.) Samuel Cooper admits its occurrence, in
his Dictionary of Practical Surger3^ It is somewhat remarkable
that Malgaigne, in his elaborate work upon Fractures, makes no
allusion whatever, to fractures of the neck of the scapula, either
anatomical or surgical. Fractures of the surgical neck are distinct-
ly described by Druitt, Fergusson, Prof. Miller of Edinburgh, and
others. It is unnecessary to furnish any farther testimony to
prove that this fracture may occur, and that it has been studied.
But we cannot refrain from reproducing the graphic histories left
us by such authority as Sir Astley Cooper.

"Case CCXLIIL Mrs. R. in February, 1884, was thrown from
a gig by the wheel running upon a bank. She was stunned by the
fall, and remained insensible some little time ; she then found that
her head, shoulder, hip, and ankle, on the right side, were much
bruised, so much so that she was unable to move either of them,
from pain and swelling; the chief bruise on the shoulder was at the
upper and back part. Thinking that the stiffness of the shoulder, as
well as of the hip and ankle, arose merely from the bruise, no sur-
geon saw her until ten days after the accident, when she found that
notwithstanding the swelling had subsided, she was unable to move
her arm. The surgeon, mistaking the case for dislocation, placed
his knee in the axilla, and made violent extension ; finding, however,
that upon removing the knee, the shoulder again assumed its origin-
al flattened appearance, he said that there was a fracture somewhere,
but could not say exactly at what part ; he then placed a pad in the
axilla, and put on a figure-of-8 bandage, confining the arm to the
side by another bandage. Swelling and inflammation about the
shoulder-joint followed the use of the extending force, to such an
extent as to render the removal of the bandage immediately neces-
sary. Leeches, cold lotions, and strict antiphlogistic regimen re-
duced this, and in a week or ten days the bandages were again
applied, and continued for six weeks, being renewed several times
during that period. At the end of this time all the bandages were
removed, and the patient desired gradually to use the arm as much

334: DuGAS, on Fractures of the Scapula. [June,

as she was able ; she could not, however, use it in the slightest de-
gree, and even the passive motion made use of, greatly increased
her suffering, and produced several attacks of inflammation of the
part. These were reduced as before, and she continued the passive
motion, under the direction of her surgeon, (notwithstanding that
it much increased her suffering) until July, when the pain which
the slightest motion gave her had increased to such an extent that
she could bear it no longer. In the commencement of August, at
the request of her brother, she came to town for further advice,
when the state of the case was as follows.

"The right shoulder was flattened, the arm dropped, the coracoid
process of the affected side was on a plane nearly an inch lower than
the opposite, the head of the bone and edge of the glenoid cavity
might be felt in the axilla, and by placing the finger upon the under
edge of that cavity, and raising it, the whole arm was reduced to
its natural appearance, and at the same time a distinct crepitus was
felt. There was some deformity at the top of the shoulder, however
still remaining, from the clavicle having been fractured close to its
acromial extremity, and from its having united without being redu-
ced ; it Was the acromial portion which in this case rode over the
end of the sternal. A crepitus was also distinctly felt, by placing
the fore and middle finger upon the coracoid process, and the thumb
on the back part of the shoulder, and thus moving the glenoid cavity
from side to side, marking the case clearly to be one of non-united
fracture of the cervix of the scapula.

" A thick cushion was therefore placed in the axilla, and the shoul-
der being raised to its natural position, a bandage was passed under
the arm and over the shoulder, being at the same time passed once
or t\vice around the chest to prevent its slipping off the shoulder.

" The arm was confined to the side, and the elbow supported by a
pasteboard sling. In this way the patient was made comparatively
easy, the natural roundness of the shoulder restored, and she was,
enabled to turn and move in bed, which, before the shoulder was
fixed, she was unable to do, from the great pain it occasioned.

"Case CCXLIV. In the year 1829,1 was consulted by Mr. Al-
derman Partridge, of Colchester, respecting a case of this accident,
which he described in the following words :

" ' Mr. P., of Colchester, met with an accident about five months
since by a fall from his chaise. I was requested to meet Dr. Nunn,
who had been in attendance for two or three days ; and it then ap-
peared to have been a dislocation of the humerus into the axilla,
and I could see no reason to doubt but that Dr. Nunn had reduced
it ; but I must confess that the tumefaction and tension were so
considerable, that it became a diflicull matter to decide : however,
both from what he himself stated at the time, as well as from Dr.
Nunn's and my own personal observation, I gave it as my opinion
that it was reduced, although that shoulder appeared rather lower

1857.] DuGASj on Fractures of the Scapula. 335

than the other. This I had observed in other cases ; but in this
instance it struck me to be rather more than common, and led me
to conclude (which I stated at the time,) that a considerable portion
of the glenoid cavity had been fractured off. I saw him several
times afterwards; and although the swelling continued for several
weeks, still it became more and more observable that some very
serious injury had been done to the glenoid cnvity ; and when I
saw him at about a month or six weeks from the accident, I could,
by placing my hand in the axilla, and pushing at the elbow, bring
the head of the humerus up and rotate it in the glenoid cavity ; and
still persisted in my former opinion. I was again requested to see
him about a week since, w^ien 1 found the head of the bone resting,
where you will, I doubt not, find it ; and conveying to the feel a
certain crepitus, w-hich still leads me to suppose that the glenoid
cavity has received the injury 1 have described, and how far the
chances go for any benefit by an effort to replace it after such a
lapse of time I must leave to you.'

"The degree of deformity produced by this accident depends upon
the extent of laceration of a ligament which passes from the under
part of the spine of the scapula to the glenoid cavily, and which is
not generally described in anatomical books. If this be torn, the
glenoid cavity and the head of the os humeri fall deeply into the
axilla ; but the displacement is much less if this remain whole.

"Case CCXLV. A young lady w^as thrown from a gig, by the
fall of the horse, in the Strand ; and being carried to her house, a
surgeon in the neighborhood was sent for, who told her the should-
er was dislocated ; by extension all the appearances of dislocation
were removed, and he bound up the arm. On the following morning
he requested me to see the case, as the arm, he said, w^as again
dislocated. On examination, I found the head of the bone in the
axilla, and the shoulder so fallen and ffattened, as to give to the ac-
cident many of the characters of dislocation; however by elevating
the shoulder, and by raising the arm at the elbow, and the head of
the bone from the axilla, it was immediately replaced ; but when I
gave up this support the limb instantly sunk again. I then rotated
the elbow, and pressing the coracoid process of the scapula with my
fingers, by grasping the top of the shoulder, directly felt a crepitus.
Having satisfactorily ascertained the nature of the accident, I placed
a thick cushion in the axilla, and drawing the shoulder into its nat-
ural position, secured it by the application of a clavicle bandage,
and in seven weeks the part united without deformity."

The symptomatology deducible from the above cases, is very
plain: the shoulder droops, and the deltoid is flattened in conse-
quence of the falling of the head of the humerus which can be felt
in the axilla ; the coracoid process is lower than that of the other

336 DuGAS, on Fractures of the Scapula. [June,

side ; but the natural relation of the parts is readily restored by
pushing up the humerus, and again as readily displaced by allow-
ing the arm to hang down ; crepitation may also be distinctly felt
by imparting motion to the fragment, by means of the fingers ap-
plied to the coracoid process, while the body of the scapula is held
firmly by the other hand resting upon it ; or, it may be induced
by simply pushing up the humerus and glenoid cavity to their
proper position, and then rubbing the fragments together by va-
ried movements. In the language of Sir Astley Cooper, " the
diagnostic marks of this accident are three ; first, the facility with
which the parts are replaced ; secondly, the immediate fall of the
head of the bone into the axilla, when the extension (elevation ?)
is removed ; and thirdly, the crepitus which is felt at the extrem-
ity of the coracoid process of the scapula, when the arm is rotated.
The best method of discovering the crepitus is, for the surgeon's
hand to be placed over the top of the shoulder, and the point of
the fore-finger to be rested on the coracoid process ; the arm being
then rotated, the crepitus is directly perceived, because the cora-
coid process being attached to the glenoid cavity, and being bro-
ken off with it, although itself uninj ured, the crepitus is communi-
cated through the medium of that process." (Page 370.)

I will now proceed to give an account of two cases of this fi:ac-
ture which have come under my personal observation :

Case I. On the 7th of October, 1853, a stout negro man, about
nineteen years of age, called Ambrose, and belonging to Mr. Ave-
ry, of Columbia county, Ga., was sent to me with a note from my
friend Dr. H. E. Casey, who had seen the case. It seems that
three weeks previously, while at work in the field, a limb fell
from a tree upon the left shoulder of this man. The blow was
very severe, and, upon recovering from the shock, the man found
that he had entirely lost the use of his arm, but suffered excruciat-
ing pain in the shoulder, axilla, and even to the ends of his fin-
gers. The Doctor saw him a few hours after the accident, and
found him still suffering intensely and unable to move any portion
of the limb ; not even the fingers. xCo arterial pulsation whatever
could be felt at the wrist, the limb was rather cool, but sensibility
w*as not destroyed in it, for the patient would feel when pinched.
There were no symptoms of concussion of the brain nor of any
lesion about the head. The shoulder alone had been stricken,

! 1857.] DuGAS, on Fractures of the Scapula. 337

and this was very much swollen. Opiates were freely administer-
ed to relieve the pain, and the limb was placed in a sling.

The following copy of a letter, written to Dr. C, will explain
the condition in which I found the patient:

Augusta, 7th October, 1853.
Dear Doctor^

I have carefully examined the very interesting case sent me by
Mr. A., and think that the paralysis was induced by injury to the
axillary nerves and vessels which were jammed against the ribs by
the head of the humerus, when the blow was received. I think
there is a fracture of the neck of the scapula still existing.

I will briefly enumerate the symptoms I have observed: evi-
dent depression of the head of the humerus below the acromion ;
the head of the humerus rotates under the finger continuously with
the lower end of the bone, and without crepitation ; the depres-
sion of the head of the humerus is reduced by pressing up the
elbow; crepitation very audible, and easily felt by placing the-
left hand upon the shoulder, whilst with the right hand you seize
the elbow and work it freely, so as to force the shoulder up and
I down. No crepitus can be induced by acting upon the differenlJ

I parts of the body of the scapula, nor upon the acromion, nor upon

; the clavicle. By placing your ear, wnth or without the stetho-

i scope, upon the scapula, the crepitus is very loud. Now,- as to

! the suspended circulation and paralysis, I find no pulsation in the

i arteries, not even as high as the axilla, although the artery can be

ifelt with its accompanying nerve on the inside of the biceps. The

, I limb is cold, but especially so, below the elbow. Circulation in

, Lthe veins evident, but slow. The limb is insensible below the

; I elbow, and partially so above. The ulnar nerve may be com-

I I pressed behind the elbow without sensation.

, ( The patient says that he suffered dreadfully at fest^ and that the
. I whole limb down to the ends of his fingers was much swollen, as
1 1 well as that side of the chest, for some time after the injury ; and
1 1 that loss of motion was immediately induced. From these facts-,,
r'l think myself warranted in the inference above indicated,, and!
yjalso in the belief that the vessels have suffered so much from the-

contusion as to obliterate the axillary artery.

It is now three weeks since the accident what is to be done?

Suspend the elbow with a handkerchief shng, such as I advise in

838 DuGAS. on Fractures of the Scajmla. [June.

fractures of tlie clavicle, so as to keep the fractured edges in cot
tact, and to relieve the axillary nerves from compression. Giv.
electric shocks daily to the limb, passing the fluid from the back
of the neck down to the fingers. This stimulation of the nerves
may possibly be useful\ Let the man take exercise to brace the
system. Yours, in haste,

L. A. DuGAS.

Wishing to know the present state of the case, I addressed a
note to Dr. Casey, requesting him to see Ambrose, and to furnish
me the desired information. I make the subjoined extract from
the Doctor's reply, dated olst March, 1857 :

" I examined Ambrose with Dr. Baily to-day. We think that
the coracoid process is not in its proper place, but below this and
along with the glenoid cavity. The acromion is intact, and the
Kead of the humerus can be readily felt rotating below. We
thought we could detect a slight crepitus, but not very distinctly.
The limb is very much atrophied I should say not half as large
as the other. The atrophy extends to the muscles on that side of
the chest. The mammary region here is entirely shrunken, while
it is very prominent on the other side. Paralysis still extends to
the fingers. He still suffers pain occasionally."

Remarhs. I should here observe, that when I saw the patient^
I could not feel the coracoid process with sufficient distinctness ta
act upon it as advised by Sir A. Cooper. Yet the whole chain of
symptoms was sufficiently characteristic to leave no doubt as to
the true nature of the case. The head of the humerus was de-
pressed to such a degree, as to rest upon the axillary plexus, but
could be easily forced up into its proper position ; it rotated corti
tinuously with the shaft of the bone, and without crepitation ; ere
pitation was easily felt by forcing the elbow up and down so as to
bring the fragments against each other. Neither the clavicle, the
acromion, nor any portion of the body of the scapula was broken*
The seat of fracture could only be in the surgical neck of the sca-
pula.

The lesion of the axillary artery and nerves here noted deserves
especial attention, for I am not aware that it has been mentioned
by any author in connection with this accident. It is true, that
some of them allude to the disability sometimes experienced in the

1857.] DUGAS, on Fractures of the Scapula. 339

use of the limb, and which may even lead to loss of motion
in neglected cases; but, nowhere do I find any intimation of
the sudden production of paralysis, nor of the obliteration of
the arter}^ so remarkable in this case, and so evidently caused
by the immediate injury done to the nerves and blood-vessels of
the axilla.

Baron Boyer, who is perhaps more full in the description of
such accidents than any other writer, with the exception of Sir A.
Cooper, observes: "But the most serious of all these fractures
(fractures of the scapula), are those of the coracoid process and of
the neck of the bone : these are difficult to keep in place, and their
consolidation is frequently attended with considerable stiffness of
the arm, with an impossibility to elevate the limb, with atrophy,
and sometimes even with paralysis." (Translated from p. 166
Tom. 3 of Tr. des Med. Chir., Paris, 1831.) Boyer's remarks
here evidently refer to the effects of continued disuse, rather than
to any immediate injury to the nerves. The same may be said
with regard to the views of Sir A. Cooper.

Case IL In December last, (1856,) Mr. H. W. Daniel, of Jef-
ferson county, in this State, brought to me a negro man between
lifty and sixty years of age, who, in the month of March previous,
while felling trees was stricken down by a limb. The blow was
principally sustained by the right shoulder, and he immediately
lost the use of his arm and lingers. The physician who saw him
reports that no pulse could be felt at the wrist at his first visit.
My examination of the case, nine months after the accident, re-
vealed the following state of things :

The clavicle had been broken at about two and a half inches
from its acromial extremity, but the fracture was united, the ster-
nal fragment overlapping the other. The acromion process had
also been broken at its junction with the spine of the scapula, and
an uneven union had taken place. The connection between the
acromion and the clavicle appeared to have sustained some injury
as itj'Svas enlarged and uneven. The shoulder drooped so much
as to resemble very much at first sight a dislocation downwards.
The deltoid was flattened, and the head of the humerus could not
be found in its proper place, unless forced up by acting upon the
elbow, by which means it could be readily replaced, but would again
immediately fall upon releasing the elbow, and permitting the
limb to hang down. The coracoid process evidently followed the

y. S. VOL. XIII. NO. VI. 22

340 DuGAS, on Fractures of the Scapula. [June,

-^^., ., ^ ,- ,, ^^. ^. .. .., ,^, - ^.-^^^^^ , ^^^^^.^.,^^.^^^^.^^,....^^^^ -

upward and downward movements of the humerus. No crepitus
could be detected by rotating the humerus when hanging down,
but it became ver\^ audible when the elbow was forced up and
then moved in different directions. The elbow could be placed
against the chest Avhile the fingers rested upon tlie sound shoulder,
without any difficulty, so as to establish conclusively that there
was no dislocation of the humerus, according to the principle I
have established for some years back. (See Southern Med. and
Surg. Jl. for i8o(), \\ lol.)

The patient still siitiered almost continual pain along the arm
down to the fingers. He represented his sufterings as sometimes
excruciating. These were somewhat relieved by forcing u]) the
head of the humerus. He was entirely unable to move any mus-
cle from the shoulder down, and he said that his limb felt benumb-
ed, especially from the elbow to his fingers. He could, however,
feel Avhen pinched at any voint of the surfiace. No pulsation
Avhatever could be felt in any of the arteries of the limb, and the
temperature of the skin was lower than that of the other arm. The
pectoralis major, the muscles of the scapula, those of the shoulder,
and indeed of the whole limb were very much atrophied. The
man's general health had suffered from long continued pain and
want of accustomed active exercise.

The only prescription made in this case was, that the humerus
should be well forced up and sustained in this position by means
of a sling bandage carried beneath the elbow and well secured.

Dr. James Bell, who lives in the neighborhood, informs me in a
letter, (dated 18th March., 1857,) that the patient has been using
the sling since I advised it, that the shoulder appears to be a little
fuller, but that he still has no use of his limb, and occasionally
suffers extreme pain in the wj'ist. His fingers are dwindling away
and becoming stiff.

Remarks. It will be observed that, Avith the exception of the
fractures of the clavicle and aei-omion, this case presents a striking
analogy to the one just j)]'eceding. In both cases the injury re-
sulted from the fall of a tree, in both instances the blow was fol-
lowed immediately by paralysis and cessation of circulation in the
arterial trunks, and in both the injury to the nerves and blood-
vessels has persisted. Both have derived some relief by the sup-
port given to the limb, but they still suffer more or less. In

1857.] DuGAS, on Fractures of the Scapula. 841

neither case was a retentive bandage applied soon enough to pro-
mise union of the fragments, and none has taken place. Both
being ignorant and heedless negroes, have doubtless been more or
less remiss, in proper attentions to the application of the bandage,
and this may account in some measure for the persistence of pain.
Would a timely application of suitable bandages have allowed the
nerves and vessels to recover from the severe injury inflicted upon
them? The question cannot be satisfactorily answered without
additional facts and observations.

The deplorable condition of these men, who have not only lost
the use of an arm, but are also subject to harrassing pains, which
may continue indefinitely, would seem to demand at our hands
some measure of relief. Unable to think of anything better, the
propriet}' of amputation has presented itself to my mind as per-
haps justifiable under the circumstances.

By removing the weight of the limb which is continually press-
ing upon and chafing the nerves, it is probable that the pains with
which these patients are annoyed would cease. The usefulness of
the limb being irrecoverably lost, the only objection to amputa-
tion, since it may be done without pain under the influence of
anaesthesia, would be its danger to life. This danger would of
course be greater in amputation at the shoulder joint, than if it
were performed at the insertion of the deltoid muscle, and the lat-
ter would probably answer the indication. Amputations in the
upper portion of the arm are so rarely fatal in this section of coun-
try that the patient might well take the risk for the relief^ espe-
cially when we consider that the change from a life of laborious
exercise to one of even painless inactivity is in itself not without
danger. Under the influence of these considerations, I recently
proposed amputation to Ambrose, who has now been suffering
several years; but he objects to the experiment.

B42 KoLLOCK, on Vesico- Vaginal Fistula. [June,

AETICLE XVIII.

Vesico- Vaginal Fistula. A Report read before tlie Medical Society of'
the State of Georgia^ at their Annual Meeting^ at Augusta^ April
8tk 1857, By P. M. Kollock, M. D., Professor of Obstetrics
and Diseases of Women- and Children^ in the Savannah Medi-
cal College,

[Concluded from the May 'So., page 181. J

Dr. Sims claims that he has originated :

1st. A method by which the vagina can be thoroughly explor-
edy and the operation easily performed.

2Qd, That he has introduced a new suture apparatus, which lies
imbedded in the tissues for an indefinite period without danger of
cutting its w^ay out, as do silk ligatures.

3rd. That he has invented a self-retaining catheter^ which can
be worn with the greatest comfort by the patient during the whole
course of treatment.

Every surgeon who has faithfully studied the method of cure
which has been presented to the profession, by Dr. Sims, and the
apparatus which he has invented for effecting it and who has, at
the same time^ employed it must be prepared to accord him the
fullest meed of praise, as well as gratitude, for the industry and
ingenuity which he has displayed^ and the very convenient and
efficient means which he has placed at the disposal of the Profess-
ion, for the management of a disease which has been hitherto
found exceedingly incorrigible.

But^ while we are prepared to admit that, in the hands of Dr,
Sims^ and guided by his skill and experience, success may be the
rule, while failure the exception ; justice to him and others, com-
pels us to state with candour, that such has not been the result in
the practice of other surgeons.

The sources of failure are to be found in the suture apparatus.
The wires ivill cut themselves out in certain cases, however much
attention may be bestowed, in their introduction at a sufficient
distance from the edge of the raw surface, and sufficient depth into
the sub-mucous tissue : the lips included between the clamps,, will
slough, however much judgment may be exercised in drawing them
together^ and irregularities on the vaginal surface, rigidity from
cicatrices, and the situation of either a part, or whole of the fistu-

1857.] KoLLOCK, on Vesico- Vagina Fistula. 343

lous opening, may prevent the clamps from being evenly applied
and with sufficient parallelism, to secure their regular and efficient
action. In consequence of these occurrences, the patient has to
be subjected to a greater or less number of repetitions of the ope-
ration ; and, perhaps, other means have to be employed for the
perfection of the cure. The following case (among others,) will
prove the statement which has just beon made :

March 16th, 1855. I was requested by -Dr. Fickling to visit
with him, Chloe, a negro girl belonging to Mr. Baynard, of this
city (Savannah). I was informed that, in the month of December
previous, she had been delivered of a child after a very severe la-
bour, which lasted for two or three days ; since which time, she
had not been able to retain her urine. Without much difficulty,
an urinary fistula was diagnosed, accompanied with great contrac-
tion and rigidity of the vaginal canal.

The death of Dr. Fickling a few days after this, placed the case
entirely in my hands.

I had her removed from her owner's residence to my private
infirmary, where a more thorough exploration of the case revealed
the following condition of things :

The vaginal orifice contracted and rendered extremely rigid and
unjaelding by the formation of tough bands, on each side; a fistu-
lous orifice, three quarters of an inch in its longest (tran verse) di-
ameter, at the distance of one and a half or two inches from the
external orifice of the urethra ; one half inch above this, the finger
came in contact with an obstruction, or bridge in the centre of the
vagina, on each side of which a narrow passage extended upwards.

The finger, introduced into the rectum, detected what seemed to
be the cervix and body of the uterus ; but this could not be very
distinctly made out.

From the evidence thus obtained, I inferred that there was an
adhesion of the vaginal walls at the point of obstruction to the
farther passage of the finger upwards, and that the canal was obli-
terated from that point to the os uteri above.

The condition of this poor creature was most deplorable. The
urine passed from her involuntarily and without cessation ^bath-
ing the vagina, vulva, thighs and nates, and excoriating them by
its acrid properties; causing intense suffering and inability to
move about, and exhaling its intolerable stench, disgusting to
herself and all in her vicinity.

844 KoLLOCK, on Yesico- Vaginal Fistula. [June,

To rescue a fellow creature from such a state of wretchedness,
every generous and humane feeling was irresistibly appealed to ;
but the attempt seemed hopeless, and was so deemed by most of
those who saw her. Encouraged, however, by the results in some
verj^ unpromising cases reported by Dr. Sims where his opera-
tion was crowned with success after numerous repetitions I de-
termined not to be deterred by these very discouraging appearan-
ces, and accordingly undertook the treatment.

As the first step towards any operative procedure, it seemed to
be imperative that the vagina should be dilated. My attention,
therefore, was directed to this object. At this time, the vagina was
60 much contracted, that the smallest sized speculum could not be
introduced, and the fistulous orifice could not be brought into sight.

The patient was so intolerant of pain, that no manipulation of
any importance could be performed, without placing her com-
pletely under the influence of an aniesthetic agent. She was ac-
cordingly made to inhale a mixture of chloroform i, sulphuric
ether J ; and the rigid bridles, on each side of the vagina, incised
as freely as was deemed prudent. Dilatation was then attempted
by the daily introduction of sponges and gum elastic bougies, and
a catheter was retained in the bladder to conduct off the urine
from the inflamed and excoriated vagina.

On the 17th of April, the patient being etherized, the fistulous
orifice was brought into view by the introduction of Sims' specu-
lum; an incision was made with a long handled scalpel, through
the upper extremity of the blind pouch, into which the vagina
had been converted by the adhesion of its walls antero-posteriorly.
The incision was made transversely, and carefully extended on
either side so as to divide the lateral bridles as much as possible.
The finger was now passed up into the incision, and made use of
for tearing up the adhesions above, and separating the walls as
high as could be reached ; but no os uteri could be detected by the
end of the finger.

The fingers in the rectum and vagina at the same time, and af-
terwards, a finger in the vagina, and catheter in the bladder, proved
that the passage which had thus been effected was between the
bladder and rectum, and in the proper locality of the vagina.
Lint was now inserted into this passage in order to prevent re-
union. The operation was followed by considerable hemorrhage,
which continued for some hours,

1857.] KoLLOCK, on Vesica- Vaginal Fistula. 345

The process of dilatation was continued until May lOtb, when
I determined to make an attempt to close the fistulous opening.

The patient was placed on a table 3 feet by 4 feet, in a kneeling
position, her body being supported, the head inclined downwards,
the nates turned towards an open window, and the sunlight con-
centrated by a small looking glass on the vulva, so as to throw as
much light as possible, into the vagina. The hands, trunk and
lower extremities were secured by bandages to the table. As
soon as she was profoundly influenced by the anaesthetic, Sims'
speculum was introduced, which exhibited the fistula very much
obscured hj blood and urine, from the inflamed vagina and blad-
der. This was sponged out, and the mucous membrane raised by
the tenaculum, and dissected off by means of a knife and curved
scissors. The mucous membrane was removed by excoriation to
the distance of an inch in front, and the posterior lip of the fistula
was formed by a thick edge of the adherent tissue which had been
divided in the first operation.

With great difiiculty, owing to the contracted state of the va-
gina, the silk threads were passed by means of Sims' needle, and
the silver wires lodged in their proper places ; the leaden clamps
were then applied and the edges of the fistula brought into appo-
sition. Sims' catheter was introduced and the patient placed in
bed. The bowels, which had been freely purged by castor oil on
the day before the operation, were constipated, and patient kept
quiet by the free exhibition of opium in two grain pills, her diet
crackers and water. The catheter was removed once or twice a day
and water, either warm or cold, (according to the weather,) hberally
thrown upon the vulva and into vagina, by means of a syringe.

May 14th. Speculum introduced and parts examined. No
derangement of the sutures; lips of fistula well approximated in
centre, extremities doubtful.

May 17th. Examined : suture at left extremity of clamp torn
through anterior lip ; no adhesion at left extremity ; middle closed.

May 21st. Sutures removed ; adhesion of one-third at the cen-
tre; each extremity open, and urine passing through. These
points were so much concealed by the lateral columns of the va-
gina that it was nearly impossible to freshen the edges, or to apply
the clamps properly.

June 4th. Assisted by Drs. Bulloch, Mackall, and Mr. Grod-
frey a Student of medicine, the patient (Chloe) was again placed

846 KOLLOCK; on Vesico- Vaginal Fistula. [June,

upon the operating table, secured in the same manner as before
and etherized the bowels having been emptied, on the day pre-
vious, by castor oil.

In consequence of the extreme narrowness of the vagina, the
speculum which was found to be inconvenient, was dispensed
with, and the dilatation was effected as well as possible by my
own finger and those of my assistants.

It was ascertained that about one half of the original opening
had been closed by the former operation, at the centre, leaving an
orifice at each lateral extremity, through which air and urine bub-
bled. That, on the left side, was most difficult to reach, being
concealed by a rigid cicatrised fold of mucous membrane, which
lay parallel with the Ischio-pubic ramus. The paring of the edges
of the two openings, although attended with much difficulty, was
more easily performed than at the preceding operation.

The sutures (two in number), were passed through the edges of
the left opening, extreme di^culty being encountered in disen-
gaging the silk from the eye of the needle, after perforating the
posterior lip ; and on applying the clamps, the unyielding charac*
ter of the tissues rendered it impossible to push up the anterior
lamp as fairly and squarely as was desirable. The opening, how-
ever, a23peared to be pretty effectually closed.

Two sutures were also passed in the same manner, but with
less difficulty, through the opening on the right, and the clamps
were placed very gatisfactorily, so that the urine flowed entirely
through the urethra. The patient was then remanded to bed with
the catheter in the bladder, and the subsequent treatment was the
game as after the first operation.

June 8th. Examined : every thing looking well. The clamp
on the left side, which gave us so much trouble in the application,
seemed to have retired more within the vagina, and approximated
the posterior more nearly. The sutures were removed on the tenth
day ^it having been ascertained some days before, that those on
the right side had cut through the anterior lip. I was grieved to
find that no union had taken place on either side.

ISTo farther operative procedure was undertaken for closing the
fistula, until the X8th of October following. At that time it was
found that the upper part of the vaginal canal had reclosed, and
that the contraction of the lower portion had sensibly increased,
Witli extreme difficulty ^ dejiuded surface was obtained, by mean-

1857.] KoLLOCE, on Vesico- Vaginal Fistula. 347

of the kuife, arouud each fistulous orifice, and leaden wires were
passed bj means of Sims' needle, the upper thickened fold of
mucous membrane was drawn down as well as possible over the
openings, and the ends of the wires twisted together.

On the 20th October the parts were examined, and to my chagrin
I found the wires broken. They were, accordingly, removed.

October 25th. Patient being placed on the table and etherized,
a silk thread was passed, doubled, through the lips of each open-
ing on the distal end was secured a perforated buck-shot, which
w^as drawn up above the posterior lip ; the proximal ends of the
threads were then passed through three perforated buck-shot, trac-
tion made on the thread, and the lower end tied across a round
piece of wood about the size of a pencil or pen-holder. In this
manner the <edges seemed to be pretty well approximated, and it
was hoped that their adhesion would be effected.

On the third or fourth day after this last operation, it w^as ascer-
tained that the sutures had cut their way out, and they were
removed^

So much irritation of the bladder and vagina was the result of
these operations, that the patient was kept in bed, and the catheter
retained in her bladder. As soon as this subsided, she was allow-
ed to rise and move about.

On examination some days after, it was observed that she had
some incontioence, but no passage of urine through the vagina.

Dec. 1st. Her menses made their appearance for the first time
since the accouchement, at which this grave accident occurred.

Dec. 21st. The vagina is moistened slightly by a thin fluid of
urinous appearance, which flows from a minute point on each side
of the vagina. These points w^ere touched occasionally with Nit.
Argent, for several weeks. At length a galvanic spark w^as kin-
dled at each of these points, and in the course of some weeks,
every appearance of fistulous opening was obliterated, and the pa-
tient was discharged as cured.

Here, then, is a case which confirms what I have asserted that
Sims' suture, ingenious and beautiful as it is, has not proved, in
the hands of others, to be " all that could be desired." The reason
of its failure was found in the indurated and inelastic condition of
the altered vaginal tissues, which prevented the proper approxi-
mation of the olamps, and their "imbedding" themselves in the
mucous coat, as is represented by Dr. Sims,

3^8 KoLLOCK, on Vesico- Vaginal Fistula. [June,

Nevertheless, (the case just detailed, and two others which will
be mentioned, to the contrary notwithstandiDg,) until lately, I
have regarded Dr. Sims' method of suturization, as the most per-
fect yet discovei'ed, and the one most likely to succeed, and that
it would prove triumphant in a very large majority of cases.

During the last winter, I received a small pamphlet entitled,
^'Eemarks on Yesico- Vaginal Fistule, with an account of seven suc-
cessful operations. By N. Bozeman, M.D., of Montgomery, Ala."

In this pamphlet. Dr. Bozeman describes ''a new mode of su-
ture" original with himself which he offers to the notice of the
Profession, with a confidence founded on the results of the trials
which he has made of it. He ascribes the discovery of this new
suture to his repeated disappointments of the clamp suture of Dr.
Sims, even in cases where, from their favorable nature, failure was
not to be expected and particularlj^ in a case of double fistula,
to which it proved so utterly inapplicable, that he was about to
abandon the case in despair, when an accident, similar to that
which revealed to Xewton the Law of Gravitation, pointed out to
him the road to success.

In the case of double fistula, to which he alludes, he attributes
the failure of the clamps to the irritating effects of the urine on the
edges of the fistula ; and he saj^s, "I became satisfied that I should
never be able to cure the case, unless I could invent some contri-
vance by which either to close both openings at one operation, or
to afford complete protection to the denuded edges of one during
the healing process." "To contrive an apparatus that would fulfil
one or the other of these indications, required, I supposed, much
more inventive talent than I possessed; and after a little thought,
I abandoned all hope of providiug any thing that would answer
the purpose. Sometime afterwards, however, while buttoning my
vest, it occurred to me that a somewhat similar process might be
applied to such cases as the one above cited, and after turning the
matter over in my mind, I determined to put the idea in practice.
Accordiugly I made a contrivance on the button principle, and
applied it in a case where the clamp suture had failed three times.
The result was, as it has been in every trial since, as satisfactory
as could be desired."

In accordance with the manner of its discover}', and also its
mode of action. Dr. Bozeman has dubbed it the "Button Suture;"
and remarks, that it is "only a modification of the twisted" suture.

1857.]

KOLLOCK, on Yesico- Vaginal Fistula.

349

^* The essential parts of the apparatus consist of wire for the
sutures, a metalHc button, or plate, and perforated shot to retain
the latter in its place. The wire should be made of pure silver,
about the size usually marked No. 93, and properly annealed. A
length of about 18 inches should be allowed for each suture.

" The button possesses several peculiarities. It may be made
either of lead or silver. The former, hammered out to the thick-
ness of y g th of an inch, answers the purpose tolerably well. The
latter can be made still thinner, and does better, on several ac-
counts; it is lighter, less likely to yield under pressure, admits a
higher polish, and allows the wires to be drawn through the holes
without dragging."

The size and shape of the button will depend upon that of the
fistula. The most common shape is oval. It rnust be concave on
the under side, or that which lies in contact with the fistula; the
edges must be slightly turned up, to avoid irritating the vaginal
lining, and it must be perforated in the centre with holes propor-
tioned in number to the number of wires which it is found neces-
sary to introduce ; and the holes must be of suflQcient size to pass
the wires double,

Fis:. 1.

Full size.

End view.

Dr. Bozeman recommends that the sutures should be placed
about Wths of an inch apart. The size of the perforated shot,
should be Ko. 3 bird shot.

The first steps of the operation do not differ materially from
those of Dr. Sims. The position of the woman may be the same.
Sims' speculum answers every purpose. And the freshening of the
edges may be done in the same manner and with the same instru-
ments. The wires are passed only through the mucous coat of the
vagina, by means of silk threads. Dr. B. uses, for this purpose, a
stout, straight, spear-pointed needle, and introduces it about half
an inch from the freshened edge.

350

KOLLOCK, on Yesico- Vaginal Fistula.

[June

Fig.

Figure 2 is a representation of
the fistule of the most common
shape, Avith its edges pared in the
bevelled manner heretofore men-
tioned, and the silver wires drawn
through.

Fig. 3.

The wires being lodged in their places, the ends
are brought together, and the edges of the opening
approximated as accurately as possible. For this
purpose a steel rod, (Fig. 3,) fixed in a handle,
perforated and flattened and raised into a kind of
knob on one side at its distal extremity, (called by
Dr. B. the "suture adjuster,") is employed the
ends of the wires being passed through the hole at
its extremity, and the instrument run down (the
knob downwards) upon the edges of the opening
at each point where the wires have been inserted.

The doubled wires are then passed through the
holes in the button, and this last pushed down up-
on the approximated lips of the fistulous opening.

Fig. 4.

The appearance of the
parts after all the sutures
are adj usted is faithfully
represented in Fig. 4.

A perforated shot is then run on each doubled
wire until it comes in contact with the button,
against which it is held with sufiicient force by
strong forceps, and there pinched with the forceps,
so as to prevent their slipping back.

The wires are now cut off about a quarter of an
inch from the shot, and the ends may be separated
and bent down over the shot, which prevents their irritating the
vaginal wall as it collapses, and aids in securing the shot.

1857.] KoLLOCK, o?i Vesico- Vaginal Fistula.

Fig. 5.

851

Fig. 6.

Fig. 7,

Fig. 8.

Figures 5, 6, 7 &
8, represent differ-
ent stages of the ap-
plication 'of the but-
ton ^and the shot npon the wire, as
taken from Dr. Bozeman's pamphlet.

Sims' catheter may now be introduced into the bladder, the pa-
tient put to bed, and the after treatment is the same as that recom^
mended by Dr. Sims.

The sutures are not to be removed nntil the 10th or 12th day.

Dr. Bozeman's pamphlet gives the details of four cases of vesico-
vaginal fistula treated by him with his button suture.

Case Xo. 1, was of three years standing; the clamp suture had
failed after three trials. It was cured by one operation with the
button suture.

Case No. 2. Double fistula, of seren months standing cured
by two operations with the button suture.

Case Ko. 3. Double fistula, of eighteen years standing two
successful operations with the button.

Case xs'o. 4. Double fistula of nine years standing several fail-
ures with cla'mp suture ; cured by the button.

My own experience with the button suture may be illustrated
by the detail of two cases ; which will also show how much right
I have to express an opinion concerning its merits^ and to- how
much weight my testimoDy is entitled.

Case 1st. Dolly a negro belonging to Mr. Jacob "Wald^iirg,
of Savannah was brought from St. Catherine's Island, her resi--
dence^ to be treated for an incontinence of urine, which succeeded
a very severe and protracted labour. It was ascertained that she
had a fistulous communication between the bladder and Tagins^
about two inches from the vulva, its longest diameter one inch,

352 KoLLOCK, on Vesico- Vaginal Fistula. [June,

situated transversely to the vaginal axis. An attempt was made
to close the opening by Sims' method ; but although the case
seemed to be well adapted to this treatment, and promised a fa-
vorable result, such did not occur the sutures cut themselves out
in a very few days, and, if any thing, she was left in a worse con-
dition than before the operation. Her master, discouraged from
any farther attempts to cure her, sent her back to his plantation,
where she remained about eighteen months. At the end of that
time, she was brought up to Savannah again and placed in my
hands.

I found, on examining her, that the fistula was very much re-
duced in size, and that the longest diameter (about -^ inch) was
situated parallel with the axis of the vagina. The mucous mem-
brane was somewhat excoriated around the fistula.

On the 15th day of January, 1857, the bowels having been
purged on the day previous with castor oil, the patient was secured
on the operating table, in the kneeling position etherized Sims^
speculum introduced into the vagina, which was lighted up by
means of a looking-glass, as has already been described. My as-
sistants were Drs. Wrasfo; and Charlton, and Messrs. McFarlane
and Johnson, students of the Savannah Medical College. A semi-
lunar incision was made, with a small double-edged knife, curved
on the flat, at the distance of ^rd of an inch from the free edge
of the opening, on each side, and the mucous membrane of the
vagina dissected off. With a short, curved needle, armed with
silver wire, (without the intervention of silk thread,) and fixed in
Sims' grooved forceps, three points of suture were made the
needle being introduced ^ inch from the freshened edge, and pass-
ed only through the vaginal mucous coat. The ends of the wires
were then brought together, the edges of the wound placed in ap-
position, the double wires passed through perforations in a button
made of lead, and secured by the perforated shot. The wires were
cut off about I inch from the shot, the ends separated and turned
down over the shot.

Sims' catheter was introduced, and the patient was ordered
opium, in 2 grain pills, to be repeated sufficiently often to allay
pain, procure rest, and constipate the bowels. Diet crackers
and tea.

Jan. 16th. Complains of pain in the bowels and nausea, and
towards evening vomited, probably the effects of opium, having

1857.] KoLLOGK, on Vesico- Vaginal Fidiila. 353

taken it pretty freely. Prescribed poultice to bowels and cold wa-
ter to head stop opium and substitute paregoric.

Jan. 17tli and 18th. More comfortable ; anorexia.

Jan. 22nd. Speculam introduced and parts examined every
thing in satisfactory condition. Unusual difficulty in retaining
catheter in proper position it has a tendency to turn; to prevent
which, lint spread with cerate is packed around it, the catheter be-
ing passed through a hole in the lint, which also protects the vul-
va and perineum from the action of the urine as it flows from the
end of the catheter. Catheter removed once or twice a day, and
cleansed, and vulva and vagina well syringed with warm water.

Jan. 2oth. Sutures removed. Perfect union of the edges
throughout the whole length of the fistula; urine perfectly retain-
ed ; every part healthy in appearance. The catheter "was retained
in the bladder five or six days longer.

Jan. 27th. Bowels moved by a warm Avater enema; and she
was allowed to quit her bed on the 80th.

I have been very agreeablj' surprised at the very satisfactory
result of this case ; for I felt that my first attempt at manufactur-
ing the button must be rude; and, moreover, after its application^
several drops of urine were observed to pass through the middle
perforation of the button.

Case 2nd. Leah negro owned by a rice planter on Savan-
nah river; sent to town to be treated by Dr. J. A, Wragg, the
attending physician, for incontinence of urine, one of the seque-
lae of a difficult labour.

Yesico- vaginal fistula was diagnosed at the distance of 1| inches
from the external orifice of the urethra its longest diameter ra-
ther more than an inch, and situated transversely to the vaginal
axis ; hernial protrusion of vesical mucous coat, covered with red
vascular granulations, which interfered very much with the opera-
tions which were performed, and was on one occasion removed
with scissors. Her ability to retain her urine for a single moment
was almost null, and she experienced the usual amount of excoria-
tion and suffering.

An attempt was made to close the fistula, on Sims^ plan^ soon
' after her arrival in town, (during the spring of 1855,) by Dr.
Wragg, assisted by several medical friends and myself This
operation resulted unfavorably^ as well as a second and third.

354 KoLLOCK, on Vesico- Vaginal Fistula. [June^

The last operation was performed by myself, on the 4th day of
July, 1856. The case seemed to be every way favorable for the
operation, which was performed with great care and judgment
in each case, and the failure was as unexpected as it was vexa'
tious.

As very much depends in such cases, upon the treatment sub-
sequent to the operation, this was followed up faithfully and perse-
yeringly in ever}^ instance.

After the last operation, as the edges of the incision became
covered with granulations, and the flow of urine had ceased,
through the fistula, I was encouraged to hope that union had oc-
curred, and accordingly the catheter and recumbent position were
retained, and the constipation of the bowels not removed until the
end of fifteen days, when it became evident that the operation had
failed.

The patient was returned to her master's plantation for the re-
cuperation of her general health, which had suffered somewhat by
the confinement.

January 1st, 1857. Leah returned to town for the pu.rpose of
undergoing a fourth operation ; and having succeeded so satisfac-
torily in the other case, I determined to give her the chance of the
button suture of Dr. Bozeman.

The fistula was in very much the same condition as when I last
operated on her.

The mucous membrane of the vagina was somewhat inflamed
and excoriated, and there was calcareous deposits on the edges of
the opening, and on the hair of the vulva and perineum. Ac-
cordingly, the excoriations were repeatedly touched with nit. arg.
and a solution of sulph. zinc ( 3 j. to Aq. Oj.) was thrown into
the vagina twice a day ; also, she was put upon the internal use
of sulphuric acid ( 3 j, to Aq. Oj,, one wineglassful three times a
day,) for the purpose of altering the character of the urine, and
preventing farther deposition.

February 19th. The operation was performed, the patient
having been prepared as usual, by previous purging being ether-
ized and placed in the same position as in the previous operations^
Denudation having been properly effected by a transverse ellipti-
cal incision with the knife curved on the flat, at a sufficient dis-
tance from the anterior and posterior lips of the fistula, and only
through the vaginal mucous coat, &ye points of suture were estab-

1857i] KoLLOCK, on Yesico- Vaginal Fistula. 855

lished, by the introduction of silver wire, with a small curved
needle threaded directly with wire and not silk.

The edges having been carefully brought together, the ends of
the wires were passed through the perforated holes of a silver
plate, oval in shape, one inch in length, and five-eighths of an
inch wide ; the plate pressed down and secured by the shot upon
the listulous opening. The contact of the urine with the fistu-
la was prevented by the introduction of the catheter. Paregoric
was freely administered instead of opium.

Examination on the fourth day exhibited a satisfactory state of
everything. The sutures were removed on the tenth day, and a
perfect cure was witnessed. She was confined to bed, and the
catheter retained for six days longer, when the suture points be-
ing nearly obliterated, the catheter was removed and she was
allowed to leave her bed. I examined her for the last time, on
March 21st, and was enabled to pronounce her perfectly cured.

I have thus detailed three cases occurring in my own practice,
and treated by suture, on the two principles which may now be
regarded as most worthy of confidence ; and I think it will be
conceded that I ma}^ without very great presumption, claim the
right to testify in regard to their respective merits. It is to be re-
marked that in the treatment of these three cases, nine operations
by suture were performed seven, by the clamp suture of Dr.
Sims, and the other two, b}^ the button suture of Dr. Bozeman.

The clamp suture failed in every instance to effect a cure ; even
in the two cases which seemed as favorable for its success as could
be desired. The button suture succeeded perfec1:ly in both cases,
on the first trial. The preference must, therefore, be given . with-
out hesitation to the lattef. And I fully endorse the statement of
its discoverer, who claims for it the following advantages :

1st. It protects the edges of the fistulous opening against the
irritation of the urine, of the vaginal discharges and the atmos-
phere.

2nd. It prevents the wires from cutting out.

3rd, It acts the part of a splint, in keeping the approximated
edges in close contact, and at rest.

I consider this suture the greatest improvement that has ever
been made in the treatment of this class of cases. The surgeon
can now approach them with a confidence of success, before un-
known. The profession and the public, owe to Dr. Bozeman a

N.S. VOL. XIII. NO. VI. 23

356

KOLLOCK, on Vesica -Vaginal Fistula.

rjune.

debt of unspeakable gratitude. He has achieved an exploit, of
which he has more reason to be proud^ than if he were the hero of
an Austerlitz or a Waterloo.

It is probable that other surgeons may make some slight alter-
ations^ in the employment of this method of operating, to suit their
own convenience, and their own peculiar manner of manipnlating.
1 think that the silk ligature, wliich is used both bj Dt, Sims
and Dr. Bozeman, for convejnng the urine to its place, is an un-
necessary complication. I have observed no disadvantage to
result from threading the needle directly with the wire.

I prefer a needle smaller, and more curved at the point, than is
recommended by either of these surgeons.

I have observed no disadvantage to result from placing the pa-
tient under an anaesthetic agent ; it insures rest and freedom from
suffering. The patient^ Chloe, could not have been controlled
without it.

The urine very frequently deposits calcareous matter on the
edges of the fistulous opening,, which has a tendency to prevent
union. This may be prevented by medicating the urine, hj the
exhibition of sulphuric acid, for some days previous to the opera-
tion^ as was suggested to me by my friend Dr. James B. Eeid,. who
was one of my assistants in several of the operations.

I have had constructed a very convenient operating table, which
has served a good purpose in the treatment of the cases which I
have reported.

Its dime^nsions are S feet by 4, 80 inches high. On the
table is erected a square frame 2i by 2 feet, open in the mid-
dle, the side pieces 8 inches- wide, and | of an inch thick;
these are supported hj legs of the same shape and size as the

1857.] Coffee a Powerful Antidote. 357

sides, which are attached to the frame bj iron hinges, so that the
frame can be placed at any angle with the legs. The legs are let
into morticed holes in the top of the table, so that they can move
up and down, and elevate or depress the frame or platform which
supports the trunk of the patient's bod}^, and suit it to her height.
The extent of elevation is regulated by pegs inserted into holes in
the legs of the table.

In this mariner, the patient's trunk is supported in a kneeling
position a folded blanket having been thrown over the support-
ing frame-work, one end resting on the table, to protect the knees
from the hard surface of the table. The arms and legs of the pa-
tient are secured by straps to iron rings screwed into the table,
and her body by a saddle-girth to the supporting frame work; so,
that she is incapable of moving in case the aniesthetic does not
quiet her sufficiently, as sometimes occurs.

It is usual to allow the urine to dribble from the end of the ca-
theter, and be absorbed by cloths placed under the nates. With
all the care that can be exercised, inflammation and excoriation
of the vulva and nates will occur, and the patient is kept in a very
uncomfortable state.

I have no doubt that an apparatus may be so arranged for re-
ceiving the urine, made of some water-proof material, as to prevent
this inconvenience.

I prevented it in a measure, in the last two cases reported, by
passing the external end of the catheter through a hole in a piece
of patent lint spread with cerate, and sufficiently long to cover the
lower part of the vulva and perineum.

Coffee a Powerful Antidote. By Dr. Max LANGENscnWAiiz:.

A very few persons, and I believe but a small number of medical
men, know that Coffee is one of tlie most important antidotes to
many deadly poisons, and to a great many ordinary drugs. This
remarkable fact leads to serions considerations, many patients re-
ceiving the riglit reniedies, but not being prohibited from taking
Coffee, destro}^ the intended effects of their medicine, become worse,
and lead the physician to change the right treatment into a false
and perhaps unhappy one while the simple knowledge of the above
fact would have contributed to meliorate their state an;l to save
them. But far more important is it to know that the fatal results

358 ' Coffee a Powerful A^itidoie. [June,

of many accidental, spontaneous 04' criminal empoisonn^nts could
be stopped almost instantly by administering that simple antidote,
Coflee, while the loss of time in calling a physician, &c., is aften the
only cause of the loss of life.

The following is a list of the princip-al poisons which, out of a
number of less dangerous, find their powerful antidote in the sim-
ple coffee, prepared in the manner I shall explain below :

1. Laudanum or opium.

2. Atropin and Belladonna.

3. Aeonitine and Aconite.

4. Strychnine and A^omit nut, {nux vomica.)

5. Chelidoniu, and the herb chelidonium majus.

6. Caustic lime. 1 in i- i
_ p , ' V and all caustics m general.

8. Phosphorus and all phosphoric preparations.

9. Solanin. (Principal hasis contained in the germs and first shoots of potatoes,
and very often self developed, if potatoes remain moistening in humid cellars.)

IQ. Aron. (Caladium, oraron seguinum.)

11. Bix>\vnstane. (Manganum.)

12. Yeratrin and the white hellebore. (Yeratrum album.)

13. Tansy oil, (or the infusion of tincture of tanacetum vulgare.) The tansy oil
has been, and is still recommended by criminal persons, for the purpose of
abfortion, but it never produced aboi'tion, but frequently kills mother and
child together.

14. Borax.

15. Coloquints.

16. Poisonment and suffocation by charcoal vapor, and therefore, of course, alsou

17. Pyrocarbon, (the artificial or chemical development of the same poison.)

18. The spotte<3 hemlock. (Conium maculatum.) The Conein contained in the
seed is one of the most horrible poisons I am acquainted u-ith,

19. Iodine.

20. Lycopodium.

21. Cherry -laurel, (Laurocerasus.)

22. Poisonous Sumac, (Rhus Toxicodendron.)

23. Yaleriana.

24. Ignatia, (Tgnace beans.)

25. Fly Mushroom, (Agaricus Muscarius, and all kinds of poisonous mtishroomK.

All the effects of those substances are almost instantly destroyec
by administering what we call ''tincture of raw coffee," or ever
by a simple decoction of raw or green coffee, a preparation costinc
about nothing, and which, therefore, ought to be kept ready in ever}
house and in the poorest family. The following is the Tery simpk
way to get that tincture: Take a quarter of a pound of green coffef
(common Domingo the best,) and boil it with one quart ofwatei
till it is reduced to one pint ; then put the whole (berries and' liquid^
in a quart bottle, add one pint of strong alcohol, and shake it fron
time to time a little. That's all. This tincture gets stronger fron
day to da}^ and will, if the bottle is well corked, keep for man}
years without changing. If to the pint of alcohol (about ten minute
before mixing it with the coffee decoction) you add a little spirits o
camphor, say two table-spoonsful, you will not only double am
triple the anti-poisonous quality of the tincture, but this preparatioi
will then be an invaluable and certain antidote also to the followini
poisons :

1857,] Coffee a Powerful Antidote. 359

26. Garden Hemlock, r Dog's Pju-iley, (Aethusa Cynapium) particularly deadly
to f .ill-blooded persons, and producajtg (by confounding it with common Parsley)
almost every year, fatal poisonings Jai idl /countries.

57. Chalk.

28. Barytes,

29. Poisonous Lettuce (Lactua Yirosa.)

50. Capsicum, or Sj^auish pepper.

51. Animal Coal.

o2. Coculus (Meusipermum C^cculus.)
53. Drosera (RotundifoLia,) or Sun Dew,
34. Euphorbium, or th so-called Wolfs Milk-
So. BUick Hellebore.

36. Hen Bane (Ilyoscyamus Xiger.)

37. Hell Fig (latropha Curcas,) called also the black Vomit Xut; one of the most
teriible poisons.

38. Wild Rosemary (Ledum Pallustre.)

39. MoscLus (Music.)

40. iS'itric Acid.

41. Muriatic Aci A

42. Phosphoiic Acid.

43. Cocks-foot (Ranunculus) of every kind.

44. Poisonous Snow Rose, (Rhododendron chrysanthum.)
4o. Garden Ruta Graveolens.)

46. Sabina, (called also mother tea,)

47. Ergot, (secale cornutum.)

48. Silica.

49. Bittersweet, (Dulcamara.)

50- Common spunge, (Only the roasted one is employed as a remedy, but I sav
very grave accidents to children, having taken pieces of the raw spunge into
their mouths.)

51. Mice-pepper, (Staphysagria.)

52. Tobacco and the horrible ^Nicotine. (The patient can only be saved by our
composed antidote of raw coffee, tincture and camphor.)

53. Zinc preparations of everj- kind.

In a general toxicologie soon to be published, I shall give the
antidotes to all other poisons known at present, but it may be useful
to remark that, in about all cases of poisoning by metallic substan-
ces, (as for example nrsenic, copper, verdigris, etc..) the best and the
surest is to employ instantly a simple pap of common soap, that is,
pieces of soap stanaped with water to a kind of paste. A part of
this paste diluted with a larger quantify of water, will serve for
soap-clysters, v.hich in such cases must be administered every five
or ten minutes. If the jaw-bones are spasmodically closed, or the
swallowing of the thick paste proves impossible, the same thin or
diluted soap water must be administered through the mouth as well
as it can.

The compound saving-tincture (of green coffee and camphor) is
in the respective cases of poisoning, to be administered naturally
and by clyster; the internal dose about ten to twelve drops in a
teaspoonful of water every five minutes, and every fifteen minutes
when the patient begins io recover. Larger and even very large
doses may be given if the danger of life is imminent

The ordinary cooked coffee (roasted, ground, and boiled or filter-
ed) is in the most cases without any effect, and in some cases even
dangerous. In a very few cases only, and particularly as an anti-

B60 Coffee a Powerful Antidote. [June,

dote to opium, I found it highly useful. The principal substance
acting so powerfully in the green tincture, is a kind of coffee-oil de-
veloped in the raw berries, but almost entirely destroyed by roasting
the berries. This oil once withdrawn by roasting, the coflee only
contains its exciting principles, which are (without the counter-
balance of the oil) of little use. There are few cases where, the
nervous system being entirely paralyzed through strong narcotic
poisons, artificial excitement is necessary ; and this may be the
cause that I found large doses of common (roasted and boiled) cof- j
fee to act usefully agamst opium, tobacco, etc. '

That colTee, exercising such an astonishing power over strong
poisons, must be a poison itself cannot be doubted. If we take a
large quantity of boiled cotfee without suffering, it is only the habit
of taking it from childhood which saves us. People in Turkey take
without danger quantities of opium sufficient to kill a dozen of us,
because they are in the habit of using it from childhood. In Tyrol,
the general habit of hunters is, to take a good piece of pure white
arsenic upon their tongue ; to protect them (so they say) from get-
ting thirsty.

But a very curious fact is the following :

The celebrated Professor Liebig tells us that the chemical basis
^f coffee (cofein) is absolutely the same as the basis of tea (thein.)
Tea should then be an antidote acrainst the most powerful poisons,
the same as coffee. But not at all ! Tea has no annihilating power
wliatever upon them, nor has it upon any poison! It is evident,
therefore, that coffee must contain some particular chemical ingre-
dients unknow-n to the. great Chemist. Indeed, a long experience
and many experiments have proved to me that coffee acts almost
exclusively upon the blood, and has directly nothing to do with the
nervous system; while tea, in contrary, acts almost exclusively
upon the nerves, and has no direct influence at all upon the circula.
tion. Coffee, entering into direct relation to the blood vessels,
must, of course, be an agent upon poisonous material, having the
same relation; and the fact is, that about all poisons to which it is
an antidote, exercise their direct action equally upon the blood.
Besides, (and without speaking here more about the oily substance
in coffee, substance of which there is not to be found the slightest
trace in the tea plant, the coffee has an extraordinary force of vivi^
fying, while tea has only a blunting one.

I cannot believe, therefore, that cofein and ihein are one and the
same substance. Chemists mostly look at the form, but physicians
look at the effect ; and nothing but the effect can be decisive. If
nature takes the liberty to retain some secrets without leave of cer-
tain professors, we must submit. Give cofiee to a person poisoned
by laudanum, and you will save the patient. Administer tea, and
you loose your patient. Coffee is a truly invaluable remedy to re-
establish circulation and life in drowned, frozen, suffocated and
^iJirving persons, while teq, is of no use at all, Hundreds of experi'

1857.] Ilidirry of the Art of Emhalming. 861

ments show that lea, onl}' acting upon the nerves, acts as a resist-
ance, while coflee, removing and revifying the blood, caui:es re-
action. Unfortunately, botii resistance and re-iiction are common-
\y confounded with each other, even by many physicians, and this
is a principal cause of their being unsuccesstlil in thousands of
cases of poisoning.

If our dear fellow colleagues would study a little the antidotes in
general, they would, in jn'escribing certain poisonous ingredients
in lawful doses, at least interdict cofiee. If, for example, a patient
swallows at seven o'clock a spoonful of Iodine preparation, and then
takes, ten minutes after, only one spoonful of good coffee, he will at
half-past seven have no more Iodine in force in his system than he
has whalebone force in his hairs. But certainly the matter I speak
of must be coffee, and not that innocent and precious genuine coffee
article of certain New York merchants, consisting one half in roas-
ted carrots, another half in succory, and (excuse that new arithme-
tic) a third half in "smart merchant's tricks." I would prefer io
swallow a certain kind of genuine New York tea colored with true
Sohwein-further-green and containing the most genuine arsenic.
If Mr. Liebig will come and live in New York, I shall not quarrel
with him at least about the moral identity of certain Cofein and
Thein.

Meantime the public may, in case of fatal accidents, profit by the
above remarks. \_Amencan Med. Gaz. and Jour, of Health,

History of the art of Embalming from its origin to the ^present time.
(Translated from the Monileur des Hopitaux, April 19th, 1855.)

We must go back to the earliest ages, in order to find (he origin
of preserving bodies, but for its history we must confine ourselves
to those traditions which have been handed down to us in connec-
tion with the discovery of monuments which have escaped the des-
tructive effects of time. Among the nations of Asia and Africa,
"where embalming appears to have been a general custom, those
holding the first position were the Egyptians and the inhabitants of
India. The Egyptians particular]3\ who left such numerous traces
of ancient splendor, seemed to have wished to perpetuate themselves
even in death, in strewing upon their soil mummies as indestructi-
ble as the superb monuments which concealed them.

Historians and antiquarians still conjecture on the motive which
led these people to preserve the dead with so much care. Some at-
: tribute it to the belief that the soul, after escaping from the body,
i wandering about during 3000 years to re-enter it, and that there-
fore the destruction of the former would compel it to pass into the
body of an animal. The more rational believe the practice to have
arisen in connection with the principles of hygiene, one of the

862 History of the Art of Embalming. [June,

branches of medicine that the Egyptians cultivated with so much
success. For in these hot reo;ions, only receivinn^fertihtv from the
overflowing of the Nile, the decomposition of bodies deposited
in the earth would soon destroy the purity of the air and spread
among the population the seed of the most virulent disease. It is
true that the places destined for burial were above the inundations
of the river, but in these elevated places the putrefaction of bodies
would have been even more fatal ; for the winds which prevail in
these countries in bringing putrid miasms from a distance would
have transported also their disastrous effects. These considera-
tions were too intimately connected with the interests of the public
health to escape the enlightened spirit of those who had it under
care ; thus, Herodotus relates, that during a period of three thousand
years Egypt was one of the healthiest countries in the world. Now,
subject to the fatal yoke of Mahomedanism, it no longer enjoys this
immunity, but it has become the hot-bed of the plague. The various
modes of embalming in Egypt might be reduced to the following
operations :

1st. Remove from the body all fatty matters and mucous portions
by the prolonged action of soda.

2d. After having well washed the body, di-y it in the air or in a
stove.

3d. Preserve it by employing bitumen, balsams, resins, and salts.
4lh. Surrounding it with numerous strips of cloth, smeared with
gum or bitumen.

The aromatics employed by the rich, w^ere myrrh, aloes, cannella,
and cassia. For the inferior classes, cedar and the bitumen of Ju-
(dea.

The duration of embalming varied from forty to seventy days,
depending much on the drying of the bodies. When the operation
was finished, they were enclosed in sarcophagi, and deposited in se-
pulchral chambers, inaccessible to moisture, the temperature being
maintained at about 88 degrees, Fahr.

It is under these favoi-able conditions that a grent number of
mummies have been preserved through a long series of ages, and
now supply us with sufficiently accurate knowledge of the art of em-
balming among the jancient Egyptians.

The Indian mummies, exhibited at the Garden of Plants, appear
to have undergone an analogous preparation to those of Egypt.
After embalming, the bodies were sewed up in the skins of goats,
and deposited in catacombs.

In examining carefully the tissues of mummies, an analysis will
detect nitrate or carbonate of potash, or sometimes sulphate and
chloride of soda, or the iodides of lime and magnesia. During the
infancy of the art, drying and aromatic substance were alone em-
ployed ; later, saline matters entered among the ingredients. Ethi-
iopians, inhabiting a country richer in gum than the rest of the globe,
^^T^ accustomed to inclose their bodies m a molten mass of this

1857.] History of the Art of Eiuhalmwg. 303

transparent matter, while the Scythians and Persians covered them
with an envelope of wax.

Pliny speaks of the antiseptic properties of honey, and it is rela-
ted that Alexander the Great, after death, was rubbed with honey
before l>urial.

The Jewish custom was, after washing and perfuming the corpse,
to surround the body in the coffin with myrrlL aloes, and other aro-
nmtics in lai-ge quantities. Saint John tells us that Nicodemus
brought one hundred pounds of myrrh and aloes to embalm the body
of Christ, the object being to prevent putrefaction, which property
these aromatic substances possess in a high degree.

Modern nations following the example of the ancient Egyp-
tians have long practiced evisceration in connection with the use
of a number of solid and fluid substances to preserve bodies.
Alcohol, essential oils, and compound linament^ ai^ most conspicu-
ous; balsamic and aromatic powders with saline substances are
also used.

In the middle ages the art of embalming consisted in mixing
aromatic substances with salt, with which the bodies were filled.
Henrv I. of Endand, was thus embalmed in 1135. \or\cf incisions
were made in various pai'ts of the body, filled with this composition,
then sewed up, the body being then enveloped in a beef's skin and
enclosed in a coffin. The employment of salt for the preservation
of the bodies of kings, is well known in history, the sellers of salt
claiming as their' right to assist at the royal, funerals, and bear the
bodies of the kings.

In 1658, Louis C. Bils, a noble of Holland, well skilled in anato-
my, announced that he had found a way of preserving bodies from
putrefaction without evisceration, so that the form and flexibility of
the extremities being retained they could be used for dissection.
The announcement of this discovery on the part of the first noble
who had given up himself to the pursuit of anatomy made a great
sensation. At the height of his renown the States of Brabant bought
from him five embalmed subjects for 22,000 florins, Zipoeus, profes-
sor of anatomy at the University of Louvain, to whom they were
given, was appointed to receive the secret; but a few weeks had
hardly elapsed when the bodies became putrid. Bils, pretending
that such a result was owing to the jealousy of the professors who
placed his preparations in a damp situation, in order to promote
decomposition. Bils' treatment of bodies was with himself eminent-
ly successful ; the secret was buried with him.

Ruysch, also a Dutch physician and anatomist of celebrity, tried
to eclipse his adversary Bils. He succeeded in injecting pieces,
which preserved their softness, flexibility and color. His collection
so attracted general attention that it was visited by all the curious of
I Europe. It is said that Peter the Great, during a visit to this museum,
'was so attracted by the embalmed body of a little child which ap-
peared to invite him with a smile, that he kissed it. Euysch sold

3G4: llistory of the Art of Emhalming. [June,

his collection, at the entreaties of Peter the Great, for 80,000 flor-
ins- Althougli 79 years old, he immediately recommenced forming
a collection, which he succeeded in doing in two years. In dying,
in 1731, he also carried off with him the secret of his admirable in-
jections.

Darconville was the first who discovered, in 1702, the preserva-
tive properties of corrosive sublimate, but we are indebted to the
illustrious Chaussier for the practical use of this drug in preserving
animal matter. Beclard, chief of the anatomical works of the facul-
ty of medicine of Paris, applied the sublimate in embalming bodies.
Charged with preserving the body of a young man who died with
hectic fever, (the parents refusing to have the body opened,) after
making numerous punctui'es and incisions in every portion of the
body, he placed it in a solution of corrosive sublimate, in which it
was kept for two months. When taken out, it was dried for a few
days, and then eSclo'sed in a glass case where it remained for a year
without smell, or the slightest appearance of alteration. It was then
given to the family. The skin was discolored greyish, and the fea-
tures were somewhat changed from the thinning of the lips, cheeks,
eyelids and ears.

Bugliaretti, an Italian physician, united arsenic with sublimate.
He injected with this solution the primitive carotid artery, the right
jugular vein, the external iliac on both sides, and by using a trocar
he forced the fluid into the thorax and abdomen. The results ob-
tained, appeared to be very similar to the preceding.

Dr. Tranchina, of Naples, acquired a great reputation in Italy
for preserving bodies. His method consisted in an injection of a
solution composed of 4 lbs. of arsenic in 10 lbs. of water. This
mode of preservation, very dangerous for dissectors, did not serve
the purpose of embalming, for the body became livid and atrophied
in drying till only a skeleton remained, covered with skin from which
the cuticle had pealed.

In 1822, M. jannal, manufacturer of glue, discovered that a so-
lution of salt and alum would prevent fermentation. With this
mixture, in connection w'ith a small quantity of arsenite of soda, he
injected the body of a child, which was left on the tables of the
Morgue for three months, and from which he attained a great repu-
tation-
It is nearly fifty years since chloride of zinc was first used in
England for preserving animal matters. Sucquet^took out a patent
for preserving pieces, by first injecting them with sulphate of soda,
and then plunging them in a solution of chloride of zinc.

M. Granger had been previously acquainted with the antiseptic
properties of the sulphate of zinc, and a young savant, M. (iratiolet,
conservator of comparative anatomy at the Garden of Plants, had
tried it for preserving anatomical pieces. After numerous experi-^
ments he abandoned this salt, which did not preserve sufliciently, as"
the tissues became discolored. The skin resembled parchment, and

1857.] Strychnia: its Uses and Ahuscs. Z^b

the muscles diminished more than a third of thoir volume. Although
injections of thifi salt tried i\i the anatomical rooms in Paris were
unsuccessful, it \^ etill used \>y anatonjists in preserving subjects.

Dr. Roux, of Nimes, teaches the following system : It is impossi-
ble to find an antiseptic, which iviii preserve all subjects. The fol-
lowing circumstances should be taken into consideiation : 1st. The
constitution of the subject. 2d. 'i'he cause of death. 3d. The tem-
perature. Anatomists must have daily observed in the dissecting
room that putrefaction is differently produced : in some subjects it
;shows itself with extreme rapidity, in others some days elapse, and
n few might be kept tor even weeks, without much decomposition.
From this fact, Ke concludes that the choice of an antiseptic agent
upon the character of the substance which it is intended to preserve
that is to say, upon each subject should be chemically treated
according to the constitution, cause of death, and influence of tem-
perature. After long expeiience, this anatomist lays down the fol-
lowing rules:

A young anitrai is beet preserved by using a sulphate ; a sulphite
for an animal at puberty; and a chloride for an adult; and lastly
to prevent mould from appearing on the surface, pour over them
either some essential oil, aether, or chloroform. There is no univer-
sal antiseptic aijent. By following these rules, astonishing results
will be obtained. \_GJiarteston Med. Journal.

Stryclmia: its Uses and Abuses.

"This powerful alkali has figured very prominently of late before
the public ; and has, in certain instances, been handled, medically,
in a manner somewhat remarkably. It is certainly not from any
lack of caution as to its use by writers upon Pharmacy and Thera-
peutics that its powers have been at times \QYy strikingly and dan-
gerously manifested ; but it is rather owing to its reckless employ-
nnent, or to an over zeal in eliciting its effects, that accidents under
medical management have happened. Those in the habit of pre-
scribing it, if well instructed, know that it is second only to prussic
acid in energy, when given in sufficient quantity to affect the system
as a poison. A girl, 13 years old, died in about one hour from ta-
king, by mistake, three-fourths of a grain divided into three pills;
and it has ever been asserted that merely inhaling a little of it has
proved fatal. Moreover, administered remedially, it sometimes has
had an evidently cumulative action, and its effects are very likely
to break out suddenlv and uncontrollably, unless the greatest care
is taken not to give too large doses, continuously. Yet there are
instances where, from having long given it ineffectually, the practi-
tioner has become impatient and added, very slightly it may be, to
the usual dose, with the result of throwing his patient into strong
convulsions. At other times the increase of the dose has even been
more ra^h. Certainly this is an abuse of strychnia.

366 Strychnia: its Udes and Abuses. [June,

" We have lately heard of emplo3nng strychnia in some cases of
insanity. We do not deny that there may be instances where it is
demanded as perhaps in certain concomitant paralytic states; but
we are not ccjgriizant of any special action that is predicated of this
medicine likely to benefit the mental aberration. In a case of furi-
ous mania recently for a short time under our observation, we
Jearned i\\i\\. sirychnia had been administered on the outbreak of the
affection. We are aware that it has been recommended in certain
cases of maniacal aberration but, as we suppose, in such as exhi-
bited the moping melancholy form, and in hvpochondriacal states.
We fail to see the indication for its employment in violent, active
mania, in young vigorous persons. If we mistake not, there have
lately been reports of similar treatment in analogous cases; if ourdis-
trust be only ignorance, we beg to be enlightened upon the point.
Unless we are thus informed, we put this down as another abuse of
strychnia.

" It is needless to refer to the frightful and cold-blooded murders,
the detailed circumstances of which have made communities trem-
ble. In these cases, the abuse of strychnia has had its uses, in that
it has given to the world the elaborate chemical reports and investi-
gations required by the legal necessities of the case. These will
stand as invaluable evidence, and will be always looked upon as
mines of information. In connection wdth this part of our subject,
we consider it an aZ>?/5 of strychnia, as of a???/ subtle and potent
poison, to have it so easily procured. Druggists should not be
allowed to vend this medicine, any more than arsenic, opium, prus-
sic acid, &c., to all apphcants indiscriminately. Might not much
of this abuse be done away by refusing the sale to all who do not
present a physician's prescription or order? We are aw^are that
much has been written and said upon this point, and also that noth-
ing, of consequence, has been done. Often ihese deadly articles
are as heedlessly sold as the most simple remedies. The small pe-
cuniary gain to the apothecary, levies a large debt of responsibility
against him.

"The legitimate uses of strychnia are well known. A powerful
excitant of the nervous svstem, without any specific action on the
brain, it has been long acknowledged to be a very valuable remedy
in certain paralytic conditions. Combined in minute doses wath
purgatives, it hastens and increases their action ; and it has thus
been advantageously employed in some cases of amenorrhoea, or of
suspended menstruation. We can testify to good service done by
it in this way. As a tonic, hrucia, the other component alkaloid of
nux vomica, has been found perhaps more useful than strychnia.
The latter is often prescribed in dyspeptic states, such as are accom-
panied by pyrosis and gastrodynia. Testimony is strongly favora-
ble to its curative effects in spasmodic asthma. Externally, its
employment for amaurotic troubles has been extensive.

^' To recur once more to the abuses of strychnia, or, which

1

1857.] Secondary Eruption following Vaccination. 367

amounts to the same thing, ot" the nux vomica, we cannot refrain
from alluding to one which, in view of the stren<ith and unmanagea-
ble nature of the agent, should be represented to the too credulous
public in the way of a caution. There are those who by the neces-
sity of their position and avocations, cannot have that knowledge of
it, and familiarity \\\\.\\ this and other giaiats of the IMateria Medica,.
which fit them for advising or regulating their use. Still very many,,
in every communitv, are willing to take from- su-ch unskilled per-
sons, compounds containing unknown amounts of strychnia, &c.,.
&c. Thus we have soidisani or retired clergymen' advertising that
they will furnish a prescription for a preparation containing the
active principle of St. Ignatius's bean> and ihe direction for using:
the same. All such tamperers with human strength and life are ac-
countable to a higher tribunal than any earthly one, and those who'
aid and abet theui must bear them company thither. It being quite
sure that' the adoption of these miack remedies by the people, onlv
brings the honest physician more patients, we shall not be accused'
of covetousness in protesting against them. We do not aspiie tO'
coerce people, even by argument and the exposition of the bold and'
unwarrantable assumption that seeks to medicate or rather to-
poison them they are free agents, but certainly m no other affairs
do they act so inadvisedly or expose precious interest so recklessly
as in the care (as they understand it) of their health.

" The proper "uses of strychnia, as of all medicinal agents, are only
thoroughly know'n by the educated physician. Why does any one
desire or dare having the manifest peril in viev^which its impro-
per employment implies to intrust its administration to the un-
familiar the adventurer or still worse, if possible, to their own^
judgment?

"And we commend to legislative consideration the dangers con-
stantly attendant upon the unrestricted sale of medicinal articles, a
fractional part of a grain of which sometimes takes life more quick-
ly than the knife or the bullet. The facility of procuring such
materials, arms the unprofessional murdbrer quite as surely, if less
covertly, than it does a F.^x^tdr." [^Boston Med. and Surg.. Jour.

On Secondcr/'y Eruption following Yaecinai-ion..

Mr. Ross lately read' a paper on this subject before the Medical
Society of London, in which he contends that the secondary erup-
tion is a legitimate result of the true vaccine disease, and that ai
marked peculiarity of, this as a constitutional disease is a tendency
to periodicity.

After some general observations on the obscurity of the subject,
the author said : '' The propositions which I shall endeavor to es-
tablish are 1st. That there are various lorms of eruptive disease
consecutive to and caused by vaccination ; 2d. That these eruptions
appear at different periods, and are subordinate to the specific laws-

868 Secondary Eruption following Vaccination. [June,

of the vaccinous disease ; 3d. That these eruptions are not prejudi-
cial to the person vaccinated, but are rather evidences of the com-
plete impregnation of the system, and of the protective effica(?y of
the act of vaccination. Notvvithstandingr the assertions by sfi>e
authors that vaccination does not cause consecutive disease, th^e*
occurrence of such disease has been frequently noticed by medical
practitioners ; and even its varieties have been designated'. Mos^t
v^'orks on diseases of the skin have some reference to sucbaffeet!ii)ns\
There is not, however, any methodical analysis on record of sucb
maladies, and they have been regarded rather as unimportant casual-
ties than as lefjitimate sequences of vacination. The desire, prc-
bably, thoroughly to establish vaccination in the confidence of th
public has insensibly led to a depreciation of t^he after-symptomsv
whereas it would have been more philosophica-l to examine the fact*
themselves, and to trace their actual connection, if any, with' the
original disease. There need be no fear that the great value of
Jenner's immortal discovery will be impaired hj an accurate ac-
<juaintance with all its phenomena. The whole number of secon^-
dary eruptions noticed by me during the period* whilst I was eon"-
ducting these inquiries was nineteen, and of these the specific char-
acter was recorded in eleven ; the others were adverted to in gene-
ral terms as 'secondary eruption;' but I believe that the greater
number, or the whole of them, were of the vesicular type.. Of these-
eleven, one was a transient exanthem, three were papular, and"
seven vesicular. In three other cases an eruptio?i appeared at the
end of about tbr*e weeks, but whether these cases^ were attributable
to vaccination or not, the evidence is not decisive- The vesicular
eruptions varied m.uch in character, sometimes b-ging as small a&
millet-seeds, and few in number ; at other times as large as a crown-
piece, and lookincr as if one vesicle was comprised within the cir-
cle of another. The size of the eruption was frequently that of the
cow-pox at the eighth day, which, indeed it very much resembled',,
being a vesicle with a small central depression and circumferential
redness. These eruptions were always preceded by fever, whicb
was proportioned in degree to the number of vesicles thrown out).
This fact proves the constitutional character of the affection. On
this point 1 may remark that I have several times seen patients suf-
fering from pyrexia and general malaise on the day when in other
cases an eruption has usually appeared ; but of these I have taken
no account. The pyrexia, however, has convinced my mind, that
the activity of the virus does not always cease with the drying-up-
of the pock. Even after the local action has disappeared, there are
perifxfical changes going on in the constitution, which are, aGCord-
ing to circumstances, of greater or less energy, and which are m-ani-
fested by fever and secondary eruptions. The most important
point connected with these secondary affections is their periodicity.
In some of the cases the eruption appeared on the tenth day from
.the day of vaccination ; in others on the fifteenth day ; whilst, \xt

1857.] Arsenic a^a Caustic. 369

one case, the eruption was thrown out on the tcnih dny, it contin-
ued for a few days, then disapf)eared, and was o!)scrved again on
the fifteenth day. In other instances the eruption aj)poared both
on the fifteenth and twentieth days, or thereabouts. '^I'hese cases
1 further show the periodicity of tlie affection, and seem to reconcile
the discrepancies between the cases that occurred on the tenth and
fifteenth days respectively.''

A discussion of some lenc^th took place, in which several fellows
of the Society joined. The chief point discussed referred to the
question whether the secondary eruption was the direct result of the
vaccination or merely the consequence of the irritaton produced in
the system by the introduction of a foreign matter. It was general-
ly considered that the secondary eruption was the result of simple
irritation produced in the system by the vaccine virus, and that any
other source of irritation might have been followed by the same re-
sults ; that, in fact, the eruption was due to the developement of the
same latent disposition in the system to the eruptive disease which
manifested itself. None of the speakers had been enabled from ob-
servation to connect the eruption with any periodicity in its appear
ance.

Mr. Ross, in reply, stated that the whole gist of his paper depended
on this periodicity, of which he was certain, and without which his
paper advanced nothing new. He thought the subject open to inves-
tigation, and upon that point was worthy of the serious considera-
tion of the Society. [Lancet.

Arsenic as a Caustic,

In our preceding No. (p. 97.) we had occasion to comment on
the danger of the external application of arsenic. The following
remarks'from a recent paper {Med. Tunes and Gaz., .Tan. Hih J 857,)
by Prof. Simpson, strongly confirm the correctness of our caution.

'^Arsenic. The escharotic effects of arsenical preparations, when
locally applied, were known to the ancients, and are alluded to
by Dioscorides, Pliny, Celsus, and others. Arsenic is recommended
in the form of sulphuret, as a topical remedy in the cure of malignant
and recurrent ulcers by various old Greek and Roman physicians,.
as Galen, iEtius, Scnbonius, Largus, etc. In the 1 5th and IGth cen-
turies it was emplo3'ed by Fuchs, Yalescus, Fernel, and others in
the elimination of cancerous parts. They apphed it in the form of
white arsenic or arsenious acid, diluted and mixed with soot and
various vegetable and other powders. In later times it has been
used under the same form by many distinguished surgeons in the
extirpation of cancerous ulcers and structures. It has formed the
basis, also, of most of the secret topical remedies or caustics for the
cure of cancers that have at different times been in vogue; as for
example, those of Muller, Martin, VonCampen, Chonet, Katzenber-

370 Arsenic asjx Caustic. [June.

gen, Plunkett, Guy, etc. The form in which arsenic has chief! v
been employed in later times as an escharotic is an arsenious acid ;
and the caustic powder or paste employed has usually consisted of a
small percentage of this preparation, compounded and diluted with
various other materials. The celebrated anti-cancerous caustics of
Fre Come, Rousselot, Justamond, Hellmnnd, Heyfelder, Anthony
Dubois, etc, severally consi.sts of white arsenic, mixed up with cin-
nabar, dragon's blood, or the resin of the Pterocarpus draco, char-
coal, etc., aad made, before their application, into a paste or pomade
with water, saliva, mucilage, or white of egg. Dupuytren's arseni-
cal powder consisted of from one to five or six parts of arsenious
acid, mixed with a hundred parts of calomel. The caustic of M.
Manec, which is extensively employed in France at the present day,
is foriTi-ed of one part of arsenious acid, sev^en or eight parts of cinna-
bar, and four parts of burnt sponge, formed into a paste with a few
drops of water,

"One disadvantage connected with the topical' use of arsenic as a
caustic is the great amount and duration of local pain and irritation
which it often produces. INI. Lebert, who has had repeated occa-
sion, as he tells us, to witness and watch the successful employment
of IManec^s arsenical paste by M. Manec himself, and who believes,
this caustic to be the best yet suggested, nevertheless states, that
when used as an escharotic the iiumediate action of arsen-ic is 'one
of the most painful means in surgery. Already,' says he, ' at the end
of somft houre violent pains commenced in and all around the part,
tumefaction at first, and subsequently an erysipelatous-like inflam-
mation speedily succeeded the pains, and it is onlv towards the end
of five, six, or eight days that this general and extensive inflamma-
tion begins to diminish. During all this time,^ he adds, ' the suffer-
ings are sufficiently great to deprive some patients of all rest and'
sleep, and ten or fifteen days may elapse before these complications
disappear.' Traite Pratique des Maladies OancereuseSj. page 646.

"But a still graver objection exists to the use of arsenic as a
caustic, viz., the danger of its absorption into the system, and of its'
subsequent action as a poison upon the patient, particularly when,,
as an escharotic, it is applied either too frequently or too freely to a
surface of any considerable extent. Besides, there is singular un-
certaintv in the effects of arsenic when thus locally applied. A
patient of Professor Roux's was fatally poisoned by the application,
for a single night, of an arsenical paste containing four per cent, only
of arsenic, to a small mammary ulcer only one and a half inch in
diameter. Numerous instances have been observed in which vom-
iting, diarrhoea^ colic, and other symptoms of arsenical poisoning"
have followed the external application of arsenical preparations.
' Its use,' says Dr. Pereira, ' is always attended with some danger/
Sometimes the patient has, like Roux's, died after its topical applica-
tion as a caustic ; and with all the symptoms that followed the inter-
nal administration of the poison. Medical literature has on record

1857.] Tubercular Phthisis. 871

a large number of such fatal cases. In speaking of the occasional
danger attendant upon the local external use of arsenic as an escha*
rotic in cancer, Sir Benjamin Brodie observes, 'An old medical
practitioner, whom I knew in the early part of my professional life,
informed me, that it had fallen to his lot to see many of Miss Plun-
kett's patients, and that after the application of her caustics, mani/
of them died, from what seemed to be inflammation of the bowels/
\_Lectures on Various Subjects in Pathology and Surgery^ V^Q^ 335.'*
Amer. Jour, of Med. Science,

Tubercular Phthisis. By E. E. Haughton, M. D., of Hichmond,
Indiana.

I now offer for your Journal the views which I have formed
after a careful study and analysis of many cases of Tubercular
Phthisis, under the following head; The primary pathological
conditions of the system which finally terminate in scrofula and
tuberculosis. These forms of disease are prevalent to a great and
alarming extent in our country, and among our people, and the
effort to obtain the primary and exact pathological conditions, and
npoQ such a basis to erect a standard of treatment which will be
successful in arresting their progress, and effecting a cure of those
maladies, will be regarded as a benefaction to the race. ^N'ot that
I hope to be able to do so, but to offer my. mite to be cast into
the great field of pathological inquiry, and to be rejected as error,
or gathered up as important truths.

The first stage of phthisis is commonl}^ said to be that in which
the physical signs indicate a morbid deposite in the lung. But
we must go back in our investigations to an earlier period, when
there are undeniable evidences, and this long before the most
experienced observer can detect the sounds which indicate an
increasing solidity of structure in the lung. There is, prior to
this, a peculiar antecedent state of the general system, which acta
as a causative agent, originating the altered and pathologioal state
of the blood, and which not only acts as a predisposing cause of
tubercular deposits, but elaborates and prepares the material ere
it enters and becomes part and parcel of the blood, from which
tubercle is to be formed, and deposited in the lung. And here
let me say to your readers, to this part of m}' subject I ask your
careful attention, and your more careful and future study^ When
We go back and investigate the primar}' conditions of the system,
we shall find not only the real and pathological causes of the
disease, but in it a hopeful period of treatment, the Yerj period
in which we may arrest the most fatal of all the diseases which
afflict fallen humanity. It has always been my belief that if we
wait till a half organized cacoplastic deposit is made in the lung,

Is.S. VOL. XIII. NO. VI. 24

372 Tubercular Phthisis, [Juno,

before we are called to treat it, we shall do as we always have
done, most certainly fail ; we are beginning at the wrong point
and casting about u& for a remedy, when perhaps organic cl^an-
ges have doomed the patient to premature death. These forms of
disease are of two kinds, hereditary and acquired, or in other words
accidental. I hold that in tho&e different conditions we have a
law of cell growth, or cell developementy which is peculiar to the
patient alone,, whether bis disease be acquired or whether it be
hereditary. The law of cell growth is very different in the two,
though at last tuberculosis is the result.

There is a faulty cell developement established in the system,
and this exists in the imperfect and incomplete elaboration of the
chyle and lymph corpuscles, because the cell m-embrane fails to
exert its- transforming power upon the nutrient material, thus fur-
nished in these fluids,, and hence the vital operations here are
im.perfect ; and the next result is elaboration of the blood cells, and
hence imperfect blood. And in the blood as in; all other fluids,
its own cell developement is peculiar to itself, hence if the mate-
rials of nutrition are imperfectly transformed, we have im,perfect
blood, faulty in all its elements, and unfit to build up amd sustain
the vital actions which are so fully dependent upon, healthy
elements therein contained. The blood undergoes changes of its
own,, a process of growth: a process of developement peculiar to
itself, and in; addition to receiving new material from the food, it
gathers up the debris of the tissues, as the elements of their waste
and disintegration,. The new materials which are supplied to the
blood in the chyle and lymph cells are immature products, and if
their elaboration be faulty, the blood, though passing through a
course of growth and developement, cannot change their pre-
existing condition ; and hence, though this blood developement
is in progress, it cannot perfect that rich,, highly developed material
which is- demanded by all the tissues of the body,, and then we have
waste and decay^ because healthy elements are deficient.. The
oxygen of the air cannot replace those elements,, and therefore we
get an impaired vital energy,, and here we discover impaired
health without knowing what is about to^ be developed. But in
case of hereditary forms of disease,, there is inherited from the
parent or parents, that peculiar cell growth which thus has become
a law of the economy,, and will sooner or later produce its patholo-
gical result, viz.-, tuberculosis. We do not mean here that scrofu-
lous, or tuberculous material is to pass from parent to child, nor
that the child is born with tubercle already within its body,, but
tliat a disposition to form blood in such a manner as will produce
tubercle, and this law exists in the charter of life which descends
fro'm' parent to child. In the accidental or acquired forms of
disease, there maj^ be a primary derangement in the digestive sys-
tem, and this may grow^ out of extraneous circumstances; but the
primary trouble does not exist in the lungs, but it exists in the

1857.] Tubercular Phthisis. 37S

nutrient system, and may have its origin in impure air, loW damp
places of abode; and all this teaches a means more efficient in cure
than all the vaunted specifics which have ever been used as cura^
tive agents, viz., a return to exercise in the fresh air, which invig-
orates the whole economy^ repairs the injuries of the digestive
system^ and then the use of nutritious, healthy elements of food.

Also in those cases of hereditary taint, the same causes may act
as predisposing influences, and cell devclopement being regulated
by the same law, or engrafted as it were upon the inheritance of
life, thus becomes much more certainly and readily active, and the
morbid deposit is as surely a product of this cell devclopement as
the patient has sprung from a parent stock who has exhibited
either the scrofulous or tuberculous cachexia. An objector may
say, but the morbid deposit does not take place in all cases, nor is
the diathesis present in many such cases, one generation to which
this character of life,- this law of cell devclopement has descended^
escapes the dreadful fjitality. But look again, the next generation,-
or at farthest, the third or fourth generation exhibits the surest
evidence of inheritance;- and these tvpes of disease are presented
to the observer, leaving no doubt in the mind of the careful inves*
tigator as to the original taint, and that the law of type of devcl-
opement is as surely an organic law as any of the economy, thO"agh
not always so evident as some others. Summing up then, we
may say that the scrofulous diathesis has its primary existence in
the faulty forms of cell devclopement, which give rise to diseased
"blood,- and this disease of the blood mass is one affecting its growth
and devclopement, and this becomes a part of an organic law in
the transmission from parent to child; hence the hereditary suc-
cession, and it is perpetual as the famil}^ likeness. But what is
tubercle ? A deposit from the blood. This does not answer the
question^ and it is not easy to answer this question, as the opinions
of many eminent observers, who have expressed different opinions
in regard to its true character. Chemical analysis, however, gives
us an approximate character, or knowledge of it, though it is
not definitel}^ settled, because its character changes according to^
age, condition^ and the period of disease. Tubercle is not con --
fined to man alone^ but in all animals Subject to confinement and
deprived of fresh air and wholesome food, will exhibit tubercular
deposits in various organs. If this be true,- it furnishes us a singu-
lar fact, and one of much value in the hygienic treatment of those
diseases, and would lead us to look more to their prevention than
their cure after being fully developed.

I have stated that consumption and scrofula were induced pri-
marily by imperfect cell growth, which elaborates the nutrient
.material, which is furnished and emptied into the blood, and hence
Ithe blood is changed ; for how is a stream to be purer than its
jsource? But now we come to take another step in making out
a correct and reliable basis or pathology of these troubles.- Tlte

874 Tubercular Phthisis. [June,

"blood is sent to the lungs loaded with these impurities, which result
from imperfect elaboration. For what purpose? For aeration ;
to come in contact with the oxygen of pure air, that it may be
purified for the purposes of the general system. But what do we
lind ? The blood which is sent to the lungs is venous blood, con-
taining, in a healthy condition of the system, the waste products
of the tissues^ and now here is an increased amount of labor for the
lungs, in the increased products of imperfect cell developement;
viz., imperfect chyle and impure blood, and there is a fixed and
definite chemical relation between the elements of the blood and
the oxygen of the air, and only a certain amount of oxygen can
displace so much of the impurities of the blood, hence a failure is
the result in this important function, which added to the one des-
cribed in the imperfect elaboration of the primary fluids, increases
the difiiculty, and these impurities again pass the round of the
eirenlation. One of the elements contained in the blood is carbon,
as an element of the oxygenation of the tissues. This takes the
place of the oxygen which should pass the round of the systemic
circulation, and hence we have imperfect chyle,, imperfect blood,
imperfect aeration of bloody and next we have failure of all the vital
processes.

Here will begin more rapid wasting or emaciation, which is so
marked a symptom of consumption. This imperfectly vitalized
blood,, thus circulating through all the organs, deposits elements
in the glandular structures, which is soon seen in what is known
as the scrofulous cachexia. Defective aeration of the blood then
comes in to perpetuate the trouble already begun,, and is one of
the conditions, not first, as some modern writers have it, not singly
and alone as is thus taught by the same writers, but one of the
conditions, and only perpetuating a difficulty which begun in the
cells which furnish the papulum of life, and which this process of
aeration cannot remove. Taking the chain of events thus occurring,,
and we can erect a pathology and treatment which is more preven-
tive than curative, and which is indicated to us in the causes thus
brought to view. The doctrine of the inflammatory nature of
tubercles,, is now taught and believed by many, but it will not
bear the test of post obit, examinations, even in all eases, especial-
ly of those Avho have died from other diseases,^ while tubercles^
were present, revealing the fact that the pulmonary structure waff
perfectly healthy, and free from inflammation contiguous to these
deposits. Professor Gross, in his able work on Pathological Ana-
tomy, treating of tubercle, says : "In a former edition of this
work! expressed the opinion that tubercles are always of inflamma-
tory origin, and a more thorough investigation of the subject hasf
only tended to confirm this conclusion." We have no doubt but
what tubercle may be the result of inflammatory diseases which,
have enfeebled the body, impaired the vital elements of the fluids-
f the body ; but this will not account for all the cases which occur

1857.] Tubercular Phthisis. 375

without previous disease in any organs so far as observed, yet it
is developed, and so insiduously that the patient is hardly aware
of disease before he is a conlirnied consumptive. Carpenter, in
his late edition of Physiology, says: "that in persons who are of
the scrofulous or strumous constitution, have an imperfectly elabo-
rated librine, and contains an unusually large number of colorless
corpuscles, while the red corpuscles are in unusually small pro-
portion. We can understand then," says the same writer, " that
such a deficiencj^ in plasticitj^ arises from defect in the nutritive
processes, and thereby is made worse, and hence this great ten-
dency to cacoplastic deposits, without inflammation," This is my
own view of the nature of this deposit, but admit the influence of
inflammation in increasing the tendency to rapid deposits after the
cachexia once exists. My vie\v^ is strengthened as regards cell
transformation or cell growth, imperfectly elaborated fluids in
chyle, lymph, and blood, from this view taken from Carpenter;
''' The most frequent of all the degenerations of lymph," he says,
^' being when the lymph is placed in any unfavorable condition
from the first, for its development and result is a plastic, or caco-
plastic material, which again after finding its way into the blood,
is secreted and deposited by cell growth in the structure of the
lungs, and we have an irritation as the result of deposit, and final-
ly inflammation is set up locally around these deposits. Softening
takes place easily, being unorganized products, and pus and a
plastic material, which was contained in the crude tubercle as it
came from the blood, or from the admixture of blood and lymph,
originally very imperfectly elaborated.

Further evidence of the doctrine taught in this paper is this. The
material unorganized as it is, which is provided for the healthy
nutrition of all the different structures of the body, is converted
under the controlling influence of vital action into living cells, and
all those chemical and physical forces, by the operation of cell
force is converted into vital power. But Carpenter says again^
''It is inherent in the yqtj nature of the living organism, that this
instrumentality should exist but a limited time. The changes,"
he continues, " involved in the process of organization, have the
effect of renderiug the organic structure less and less instrumental
in determining this metamorphoses of force, and thus a timearrives
when the capacity of development is exhausted, and ^^ese forces
no longer turn to account in vital activity, begin to exert a destroy-
ing, disintegrating power," Hence, then in the process of cell
'growth these chemical forces are known to exert their influence,
and if the cell force is not active enough to resist the forces so
operating, we have imperfect nutrition, imperfect fluids as the re-
sult of this cell force, and we need have no doubt as to the orio-jn
of the disease which grow out of such conditions. The cell force
which is operating, may be perverted, nay, is so, by such influ-
ences, and this perversion ends in the deposit in many cases oi

B76 Tuhe-rcular Phthisis. [June,

these unorganized, cacoplastic deposits, which are frequently found
in many of the tissues of the body. Treatment, principally hy*
gienic.

If then these views, any of them, be correct in regard to the
pathological conditions of tuberculoses, wliat are we to expect
from the use of remedial agents ? So far, the curative agents have
proved abortive, and the mortality of consumption still increases.
This mortality grows out of causes before hinted at, and are not
single or alone. Hereditary taint, propagated by intermarriage
with those who are thus strumous, and strumous diathesis, indu-
ced in the same way by such ties between blood relations, are cau-
ses not to be slightly overlooked. Again, the habits and customs
of American society., are efficient causes, among which are fash'
ionable life^ the attendants of which, are poor ventilation, indolent,
inactive habits, gross abuse of the digestive organs, spending many
hours upon downy couches when day has called to active life,
habits and customs in regard to dress, especially among the female
portions of society, and a host of others which might be enumera^
ted, all enervating and depressing the vital force which steadily
diminishes in its resistance to the influence of such causes, and the
lungs among the vital organs are prone to suffer. But when the
disease is developed, what are the indications, presented to any
medical man who is honest and desires to do his patient the most
good ? The first indication, is to remove as many of these causes
as may be removed, and to instruct each and every sufferer in
reference to the violated physical laws of their being, so that
through ignorance, they shall not be guilty of violation of any
known law. Second, to invigorate the general health. How
ghall it be done? Attention to all the laws of health, exercise in
the open air, when there is ability to take it. These are among
the most prominent remedial influences, and when regulated under
judicious advice, Avill do more to arrest the progress of this fell
destroyer than all the remedial agents ever taken in the stomach.
Upon this point we have authority, Pr, Marshall Hall, Dr. Phy'
sick, and many others equally eminent, and the records of expe-
rience prove that this disease is thus arrested, and robust health
has been attained, I might cite cases in my own observation,
and from the medical records, but I will not. These influences-
change the action and the conditions of nutrition and respiration,
the two functions which are principally affected or which present
the primary lesions, nutrition leading first in the chain of events
and respiration next. By way of illustration of these things, I
will remark, that being connected by hereditary descent with a
family who have suffered much from consumption, and having
myself suffered, I have demonstrated, that in my own case the
forgoing remarks on exercise in the fresh air and free expansion
of the lungs are remedial. Three sons in as many years have fah
l^n victims to this disease, hereditary transmission easily traceable,

1S57.] Absorption of Roots of Permanent Teeth. 877

though leaping over as it were one generation to fasten its remorse-
iess grasp upon the next. I stood in the \QTy same relation to
that transmission that the brothers did who have fallen. I used the
means which I propose, I did not impair the functions of the
stomach with drugs; horse-back exercise, and counter-irritation,
free expansion, and that in the open air, are the means to which I
am indebted for vigorous health. But an objector may say you
did not have this disease. Then some eminent men have made
false diagnosis, and the symptoms which generally mark the dis-
ease betrayed us. Again the temperament of the individual exerts
an influence. Those brothers were all of them of the temperament
marked by fair skin, light hair, blue ej^es, the very subjects which
are the victims too commonly. I possess a very opposite tempera-
ament, and while they inherited the temperament also, I did not
Marriage relations then modified the strongly marked predisposing
causes, and I escaped and they were victims. But enough on this
point. [Nashville Jour, of lied, and Surgery.

Ahsorption of Roots of Permanent Teeth.

In the Austrian Journal of Practical Medicine, Dr. Heider gives
ihe following account of the absorption of the roots of the perma-
nent teeth.

The cause of the absorption of the roots of the deciduous teeth at
the period of the second dentition, has been the subject of many
observations and numerous hypotheses. All that we as yet know,
with certainty, in respect to it, is, ti\at there exists an intimate con-
nection between the development of the permanent teeth, and the
absorption of the roots of the deciduous teeth. In what, however,
this connection actually consists, is not yet clearly explained- This
much, however, is certain, that at the period of development of the
permanent teeth, their enveloping sacculi become more vascular,
and come in immediate contact with the roots of the deciduous
teeth, and consequently play a very important part in the absorp-
tion of the latter nay, in all probability, are the sole agents in effect-
ing it. A renewed examination of the surface of the deciduous
teeth, at which absorption takes place, shows that this is always on
the side that is inclined towards the advancing tooth ; and that when
not merely the compensatory tooth, but its neighbor, comes in con-
tact with the same deciduous tooth, two perfectly distinct surfaces
of absorption, corresponding to the points of contact of the new
teeth, are presented by the former, showing that both the advancing
teeth in contact with it had contributed to the absorption of its root.
Another fact places the correctness of this explanation of the means
by which the absorption of the deciduous tooth is effected beyond
^oubt. When the permanent tooth is not developed, or its devel-
opment takes place in a wrong situation, the corresponding decid-

878 Absorption of Roots of Permanent Teeth. [June,

uous tooth is not shed, but keeps its place in the jaw in after life.
This is often found to be the case with respect to what are known
popularly as the eye teeth. The deciduous teeth are consequently
shed one after the other, just in the order in which, by the develop-
ment of the corresponding permanent teeth, their roots are absorb-
ed by the latter.

The foregoing facts have been known to dentists for some time,
but much less familiar are they with the fact that the root of a sound
permanent tooth may be absorbed in the same manner as the root
of one of the deciduous teeth, by the abnormal development beneath
it of another permanent tooth.

In my collection I have six permanent teeth, the roots of which
have been in this manner entirely or partly absorbed. Five were
extracted by myself, and the persons from whose mouths they were
taken, remained under my observation; for one I am indebted to
my esteemed colleague, N. Terzer. These teeth are divisible into
two groups : the one, where the posterior root of the second inferior
molar tooth was absorbed in consequence of the expansion of the
crown of the adjoining wisdom tooth ; the other, in which the root
of the outer incisor was absorbed by the intruding crown of the so-
called eye tooth. In all the surfaces at which absorption has taken
place, present precisely the same appearance as those of the decidu-
ous teeth, when these have been cast at the usual period. Especial-
ly is this observable in the second inferior molar teeth. In one we
have the commencement of the absorption process, in a concave
semicircular depression on that pait of the root which was in con-
tact with one of the projections on the obliquely situated crown of
the adjoining wisdon tooth ; in another case, one half, and in a third,
the entire root is removed by the development beneath it of the
dens sapientia. In all these cases, the extraction of the affected
tooth was rendered necessary by the intense pain suffered by the
patients, connected in one with inflammation of the periosteum of
the root, and in the two others with exposure of the nerve.

Equally characteristic is the surface at which absorption had
occurred in the incisors. In one there is an oval depression on the
posterior surface of the root, near the neck ; and in the other two
the root is entirely removed, and one of them exhibits a cavity cor-
responding to the point of the encroaching eye tooth. The remo-
val of the affected tooth, which in one case was already very loose,
became necessary, in order to give room for the development of
the approaching eye teeth.

These observations show, conclusively, that the process by which,
at the period of the second dentition, the roots of the deciduous teeth
are removed, is neither specific nor restricted to the first set of teeth
but that it may be called into action in the case of the permanent
teeth, and cause the removal of their roots also, and that it is de-
pendent partly upon the structure of the dental tissue, and partly
upon the increased vascularity of the outer portion of the sacculi of

II

1857.] Morphia Suppositories. 879

the approaching teeth. The process has great similarity to that
which occasions the absorption of the bones in consequence of" the
development of tumors in contact with them, and the two are
probably identical. \^Ariierican Jour. Medical iSciencc.

Dr. Simpson^s Morphia Suppositories.
Mr. Spencer Wells has introduced into use at the Samaritan
Hospital, a form of morphia suppository, used with great advantage
by Dr. Simpson of Edinburgh. Mr. Wells has found it a most con-
venient form of suppository after operations on the vagina, rectum,
uterus, or perineum of women, both in hospital and private practice,
and especially so after operations on the male genito-urinary organs,
as lithotrity, in cases of retention of urine, irritable structure, &:c.,
and after division of fistula in ano, or the removal of piles or prolap-
sed mucous membrane of the rectum by the ecraseur. They act
much more efficiently than the soap and opium in common pill use
as a suppository, and are seldom or never expelled from the rectum
after their introduction above the sphincter. They are made ex-
tremely well by Messrs. Duncan and Flockhart, of Edinburgh, and
supplied by them at a very reasonable rate, of various strengths.
But as they are likely to come into more general use, we append the
formula on which tliey are prepared. The following is for the half
grain suppository: Take of acetate of morphia, 6 grains; sugar of
milk, I drachm ; simple cerate, half a drachm, or as much as may
be suiBcient to make a proper consistence, and divide the mass into
twelve suppositories. Then dip each suppository into the following
mixture, to form a coating: Take of v^'hite wax 1 part, lard plaster
2 parts ; melt together. The best way is to insert a needle into the
apex of the suppository, dip it into the melted wax and lard, and
immediately afterwards into cold water to harden it before it looses
its shape. The shape is conical, like a pastille. It is easily intro-
duced by the finger, or more nearly by the ordinary ivory supposito-
ry syringe. Mr. Coulson has also used these suppositories lately in
several lithotrity cases, and has found them of the greatest benefit
in allaying the irritation which often attends the passage of the
fragments of calculi through the urethra. \_Med. Times and Gaz.

Treatment of Erectile Tumors hy Nitrate of Potash. 'M. Mangenot,
having accidentally heard of the dispersion of a cutaneous congenital nae-
vus by means of the application of nitrate of potash, resolved to try its
efficacy in the case of his own infant ; the naevus in this case, though small,
increasing in size. The moistened finger was dipped in the powder, and
the nrevus gently rubbed with it. A small bulla, as observed in herpes
labialis, was formed, and the tumor shrank away, so that one other appli-
cation sufficed for its entire suspension. In four other cases the same
results have followed the use of the nitrate of potash for naivi of the face,
and in a fifth case, in which a nievus, four centimetres in diameter, existed
on the shoulder, the same application removed it in two months.

^Bulletin de Therap.^ and Vir, Med, Jour,

880 Editorial arid Miscellaneous. [June,

EDITORIAL ANl) MISCELLANEOUS.

Medical College of Georgia. At an adjourned meeting of the Board
of Trustees, May 2nd, 1857, on motion of Dr, Ford, tlie following preamble
and resolutions were unanimously passed;

The letter of Prof. G. M. Newton, resigning the Professorhip of Anatomy
being before the Board

Resolved, That his resignation be accepted, under the assurance that
any effort to induce his withdrawal of the same would be unavailing.

Resolved, That we here record our testimony to the faitlifulness, zeal,
and ability with which Prof. Newton has uniformly discharged the duties
of his chair.

Resolved^ That as a mark of personal regard, and of our high apprecia-
tion of his services, Prof. G. M. New^ton be, and he is hereby appointed,
Emeritus Professor of Anatomy, with the request that whilst exonerated
from formal and stated duty, he will yet continue to lecture to the classes
whenever his leisure and inclination may permit.

Resolved, That a copy of these resolutions be furnished Prof Newton.

It was then, on motion. Resolved to proceed to fill the vacancy occa-
sioned by the resignation of Prof. Newton :

Whereupon, Dr. Henry F. Campbell, was unanimously elected Professor
of Anatomy.

On motion of Dr. Garvin, it was

Resolved, That the Professorship of Surgical Comparative and Microsco-
pic Anatomy, heretofore held by Prof Campbell be, and it is hereby abol-
ished ; and that the title of the Professorship of Anatomy be changed to
that of "Anatomy, Special and Comparative."

The Board then adjourned.

L. A. DUG AS, Secretary pro tem.

Professor Newton. In giving place to the above kind expressions of
the Board of Trustees, it can scarcely be expected that we will refrain from
recording our own personal tribute to one, with whom for fifteen years,
we have been a co-worker in the same field, and whose place in the Faculty
we are now called to occupy. Sustaining towards him for many years, the
near relation of Prosector and Demonstrator, we have had ample opportu-
nity of knowing and appreciating his merit, as the perfect Anatomist
the urbane Teacher the erudite Lecturer, may he be as happy in retire-
ment, as he has been useful in public. Difficult, we are fully aware, will it
be for us to fill his place, but among our qualifications for the task, we do
highly value the advantage, of having had ever before us, such a model in
.the Art, as Professor George M. Newton.

1857.] Editorial and Miscellaneous. 381

iiibcr

Amerjcax Medical Association. Our present niininer comes forth,
without the minutes of the last meeting of this body. We have the prom-
ise of advance sheets, properly revised and corrected, but they will not
;arrive in time for our present issue, and we, therefore, defer any extended
iiotice of the m/?eting, until these promised paj^xjrs come to hand. But
there are c^rUiin things connected witli tlie sojourn of the delegates at
Nashville^ which require neither paj)er-record nor revision, because they
;are indited upon the hearts and memories of all, in characters which can
not be effaced, tor such impressions are ever genuine ; we refer to tlie bro-
therly kindness, tjie open-armed reception, and the genial hospitality of the
Profession and Citizens of Xashville, Long may the association live to enjoy
these pleasing recollections, among the graver ones, of such good cheer,
such gratulation and interchange of kind feeling; and, when in the course
iof time they again appoint Xa^hville as their place of meeting, "may we
be there to see," and mingle in an aunivergary celebration of the "good
time" enjoyed in May, 1857. *

On the Coustitutloiml Treatment of Female Diseases, By Edward Rigby,
M.D., etc., etc., Fellow of the Royal College of Physicians; Senior I'hy-
sician to the General Lying-in-Hospital ; Examiner in Midwifery at the
University of London. Philadelphia: Blanchaid tt Lea, 1857. 12mo,
pp. 25G. (For sale by T. Richards <&; Son.)

The above is the title of a compendious, but sufficiently comprehensive
treatise, on Female Diseases and their treatment; the subjects discussed,
and the high character of its author, will secure for it the favorable con-
sideration of the profession.

Lectures on the Principles and Methods of Medical Observation and Re^
search for the use of advanced Students and junior Practitioners. By
Thomas Laycock, M.D., F.R.S.E., F.R.C.P., Professor of the Practice of
Medicine, and of Clinical Medicine in the University of Edinburgh, etc.,
etc. Philadelphia: Blanchard i& Lea. 1857. 12mo. pp. 209. (For
sale by T. Richards k Son.)

This useful little work, just issued from the press of Blanchard &p Lea,
consists of a series of lectures upon subjects, most important to the student
and to the young practitioner. We consider such works not only import-
ant for the objects which they profess to accomplish, viz., to assist in cor*
rect observation and research, but their perusal and study more than any
other class of reading perhaps, add to the power of generalization, that
quality of mind which is so necessary to the Physician, and which, above
all others, is thought to fortify and dignify its possessor. We commend
the book to all ; it is of convenient size, and in our humble opinion should
be the pocket companion of every eaniest student of medicine, till all its
principles have been well conned, and thoroughly assumed as the very
habit of his medical reflections.

382 Miscellaneous. [June,

Treatment ofnooping-Congh by Enemata of Assafoetida, M. Ancelon,
fifter passing in review, in the Annales de la Flandre, other modes of treat-
ing hooping-cougli, on which occasion he greatly underrates the value of
Belladonna, among the narcotics, indicates his decided preference for assa-
foetida given per anum. He declares it to be a reliable and an heroic rem-
edy, in the second and third periods of the disease. Little can be expected
from it in the first period. Much of its efficacy will depend on the dose
and mode of administration. To infants eighteen months to two years old,
three injections should be directed, each of them containing, in the small-
est possible quantity of vehicle, fifteen grains of assafoetida and two drops
of Sydenham's Liquid Laudanum. The first of these is to be administered
in the evening ; the second on the following morning ; and the third in the
eveuing, iVom twelve to fifteen hours after the second enema. M. Ancelon
believes that in the second period the disease can be at once and entirely
arrested. The third period presents greater difficulties and requires longer
persistence in the use of the remedy, which must be continued twelve to fif-
teen days consecutisely, while we associate with it as adjuvant, frictions on
the skin with dry flannel or that which has imbibed oil of turpentine. M.
Ancelon directs attention to the fact of which he has satisfied himself, that
neither opium nor assafiDetid a, when given separately, produced any decided
effect. Having had, as he believed, a certain remedy at hand, he was not
disposed to make trials of sulphuric acid or of alum.

[Assafoetida has long been a familiar remedy in this country, in hooping-
cough, at least as far as the teachings and writings of Dr. Chapman exten-
ded. With him this medicine was a favorite in this disease, and especially
in combination with one of the alkalies ; but although no stranger to it use
as an enema, he did not so formally and emphatically recommend it in this
way as is done by M. Ancelon.

Some salutary hints are furnished by this writer in the impromptu treat-
ment of two infants in violent paroxysms of hooping-cough. The first was
six months old, and when visited it was in a room heated to an extreme
degree, and a prey to an epileptiform fit of coughing. Snatching it up
instinctively in his arms, M. Ancelon took it to the window, which he
opened ; the season, that of winter, was remarkable for its coldness, and
he exposed the little being to the air of a temperature of sixteen degrees
below^ freezing-point. A deep inspiration and some easy coughing soon
indicated a cessation of the fit. On the second occasion, the same good
result was obtained by dashing cold water on the foce of the little sufferer.
These, the author judiciously adds, are extreme palliatives, which give time
for recourse to regular treatment.] North American Med. Chir. Review.

Varicose Veins treated by Needles and Subcutaneous Section. Those
students who follow the practice of Mr. Erichsen, at University College
Hospital, must have seen him treat varicose veins, we may say, scores of
times, by passing pins under the veins, and then applying a figure of 8
uture over them, generally in three places. This produces obliteration of
the vein, and some days later the vein is divided subcutaneously, and in
three or four days the cure is complete. This was repeated on last Wednes-
day, on a young woman with this condition of the veins of the left leg. At
King's college Hospital, a few days back, we saw a case treated by Mr.
Henry Lee in the same manner. He passed the pins under the veins on
the 7th inst. ; on the 10th he divided the veins subcutaneously; on the

1857] Miscellaneous. 883

lltli he removed tliepins; and on the iVtli the patient was out, well. The
subdivision of the veins after obliteration is a process for which the profes-
sion is solely indebted to Mr. Lee as the first to recommend it, and tiie
advantages of sucli a proceedini;- cannot but strike the most superficial
observer. Mr. Erichsen's pi-actice in these cases differs from Mr. Lee's in that
he removes the pins altogether when he divides the vein between them.
We do not recollect any single instance, in the large number which we
have seen treated, of any bad eftects following this plan of treatment. The
great secret in the success is to avoid puncturing the vein, and this is eflfect-
ed by lifting it up, and parsing the ]>in well under it. [^Lancet.

Treatment of Xcevus. (John Colvan, hi DiibUit Medical Press.) I
read lately a discussion in the Medical I're'ss concerning vai'ious modes of
treating nievi of difterent parts; I beg to say that a plan adopted and used
at the county infirmary here, several years ago, has proved so successful,
and is attended with so little trouble, as to supersede either excision, liga-
ture, or indeed almost any other plan. The plan I alluded to is, to touch
the surface of the najvus with a pencil of the kali pur. c. ealce, tshich gener-
ally causes a slight eti'usion of dark grnmous blood ; the part is then covei'ed
with some pieces of dry lint previously ready, and if necessary, gentle pres-
sure applied for a short time ; this, however, is seldom necessMry. In a
few days, the part touched sloughs oflf, and it is again gently touched in the
same way, until all the unnatural part is removed, when the ulcer is healed
by a little simple ointment. This mode is equally efficaciotts in the case of
solitary na^vus, or when they are gregarious, as sometimes happens. There
^as a child in the infirmaiy lately, with a naivus occupying the lower lip,
and spreading to the gum ; I treated it as stated, and it left nearly quite
well in a fortnight or so. [jVashville Jour, of Med.

Phytolacca Decandra in Granular Conjunctiva. Dr. C. 8. Fenner, of
Memphis, Tenn., highly extols (N". A. Medico-Chirurg. Re-v., Jan. 1857) the
efficacy of the phytolacca in preventing relapses in inflarai'nation of grania-
lar lids :

" Regarding," he says, " these e-xacerbations, accomj'mnied with cifcum-
orbital pain, soreness of the periosteum and scalp, as of rheumatic oTiginy
about two years ago I was induced to give a trial to the phytolacca decan-
dra or poke, from its well known eiKcacy in relieving rheumatic affections,
and the result has far exceeded my most sanguine expectations. With the
aid of this remedy, I have been enabled to effectually cure cases of granular
conjunctiva, that, without it, would have resisted all my efforts ; indeed,
with me it has proved almost a specific for the exacerbations attending this
complaint. Patients fully under the influence of the phytolacca, often ex-
pose themselves and take a severe cold without affecting the eyes in the
least. I make use of the root, and prescribe it either in the form of a very
strong decoction, or tincture ; the former I prefer, as less liable to nauseate'
or act on the bowels. I direct a half peck of the root, cut in small pieces^
to be put into a kettle, to which is added four quarts of water, to be boilexi
down to one quart and strained. Of this a wineglassful may be taken
every two or three hours. Some patients require more than others. The
dose should be sufficient to produce a fulness of the temples and head a few
minutes after it is taken, and patients soon learn to know the quantity re-
quired to produce this effect. Besides the fulness of the head, it causes

384 Miscellaneous. [June,

flushing of the face, a general glow an<l perspiration over the entire surface'
of the body, often fuhiess of the stomach, and occasionally nausea. After
having been used four or five days, it usually acts oii the bowels, when an
opiate should be administered as occasion may require, and the quantity of
the decoction diminished for a time, tO' be increased, however, on every
unfavorable change of the weather, or the slightest symptom of a relapse.
Iliave not yet seen a severe recurrence of acute inflammation in this disease,
\vhere the patient was kept fully under tbe in-'flueTice of the phytolacca. If
there is ulceration of the cwnea, or much opacity, I usually prescribe a pill
composed of one grain^ o^calomel and the fourth of a gr^tin of opium, to be
taken eveiT night. I kno'w of na remedy so efiicacious in promoting ab-
sorption of lymph deposited in the texture of the coinea as mercury ; ekher
in the form of calomel or blue mass, or, if these reuKidies are fouiKl to" act
on the s?vlivary glands,. I u^e the corrosive chloi'ide, combined with the
compound syrup of sarsaparilla. The latter form of mercury rarely saii^
vates; it may be contin^ued for manths, and is particularly adapted to stru--
raous cases attended with severe photophobia.- If th-e system has beea
much reduced, and is in- an aniemic condition, the preparations of iron will
l)e of service.

Ampittation at the Hip-joint. Dr. Geo". C. Blackmax records a case of
osteo-cephaloma of the femur, involving two^-thirds of the shaft of the bone,
in which he performed amputation at the hip joint. At the date of the
report, fifty-four weeks after the 0|jeration, there were two or three fistulous
openings, probably cwmnunicating with the cotyloid cavity; but no ap-
pearance, as yet of a return of the disease. Western Lancet.

Ovari(ytomy. Dr. Nelson Wixxo'x recwds [Buffalo Med. Journal^ Dec-
1856 a case of ovarian tumor, successfully removed by extensive abdominal
section, with recovery ot'the patient.

Another case, alscy successful, is recorded {Peninsular Jour, of Medicine.,
Oct. 1856) by Dr. Edward Batwell, of Detroit.

Dr. Fries reported to' the Cincinnati 3kledical Society Xov. 10, 1856.) a
case of ovarian tumour in which he had made the small incision through
the abdominal ]>arietes, tapped and then withdrew the sac. Th-e woman
was rapidly convalescing. [Westei'n Lancet.

The Disdncfion betK'cn External and Internal Piles. It is a comAK)i!f
mistake with students to confound external with extruded ])iles, and to call
them internal ^^\nc\\ are out of sight, and those external which are visible.
We need not say that this is an utterly false nomenclature. External piles
are those which form without (extei-nal to) the circumferential margin of
the sphincter, and are consequently always covered with skin ; internal
ones are those which are within the sphincter, (not above it,) and are cov-
ered by mucous membrane. External piles consequently are always dry
and cuticular, internal ones moist and slimy. The external have a light
uniform bluish tinge, varying according to the density of the skin over
them ; internal ones are bright and florid, or from all the shades of florid
to those of livid and purple, according to the intensity of their congestion.
External piles almost never bleed ; internal ones almost always do so.
External piles are dilated hccmorrhoidal veins ; internal ones, as we shall
presently see, are of a very different nature. External piles may be cut
away with impunity, while to tie them would risk phlebitis and purulent

1857.] Miscellaneous. 385

absorption. Internal piles may be tied with safety, while to excise them
is to rif^kfeiuful, and, it may be, fatal hemorrhage. It is most important to
understand dearly th.it tlie difference fs one of kind and not of mere posi-
tion. \^I^ondon Jlosjjtial J^^ofes.

Ghjcerine and Borax in CmcJccd Toikjuc. Ih*. Briiiton lias under his
care an inveterate cracked tongue, which (like that of the late Charles Ma-
thews) had baffletl all attempts at alleviation for many years, it could \\(A
be referred to any syphilitic poison, and reralered eating, and especially
speaking, very painful. Or, Brinton made use of a favoiite remedy of his
in siicli cases, viz., borax dissolved in a lotion of glycerine (Price's Patent
Candle Company's) and water (two scru])les, one ounce, arid four ounces,
respectively). It at once gave marked relief; and after a fcnr days, dtiring
which it was the only remedial agent, the improvement seemnl increased by
iodide of potassium and bark, taken internally. The patient lias now con-
sidered himself well, and discontinued the lotion for some weeks, and the
cracks are only visible as depressions in the mucous membra'ne. \Lancet.

The Operation of Ovariotomy. Dr. E. P. Bennett, of D'anlniry, Conn.,
(Am. Jour. Med. Sciences) has the following e:xceedingly judicious remarks
on this subject ; " In regard to this operation, I would sug'gest a few re-
marks to those who may hereafter venture on ft. In the first place, let the
new beginner never venture cm a doubtful case ; but select, if possible, one
jn which there is a degree of constitutional vigor, not old, or reduced by
frequent tappings. If possible, always operate before your patient is tapped
at all, for two reasons. 1st. Tapping is apt to be followed by adhesions,
more en* less extensive, which of course increases the danger of subsequent
inflammation. 2nd. The fluid being usually albuminous, the patient is re-
duced in strength in direx:;t proportion to the number of tappings, and is
thei-efore less able to bear the shock of an operation of such severity. It
is generally easy to determine, by the progress of the case, whether it is an
encysted or abdominal dropsy ; but even if you cannot be certain, you lose
nothing by cntting carefully into the abdomen. If you find a sac, well and
good, go on ; if not, why you can let ont the water, and close- up the wound.
Operate early in the disease as possible. Evacnate the bowels freely the
day previous, then keep them closed by opium, or some of its preparations,
for five or six days. If the patient menstruates, operate two or three days
after. the menses cease. Enjoin sti-fct regimen and quiet. Keep the room
of uniform temperature. Draw of urine for the first ^v^ or six day??. Use
BuflBcient anodyne to allay all pain, and use as little chloroform as possible*
in the operation.'^

On Exploration hy Commotion, M. Cruveflhier observes that, in alT
cases of jaundice, as in all other diseases in which he suspects the liver to
"be afi'ected, he is in the habit of exploring this organ by " commotion."
For this purpose, the patient is placed on his seat, and the right side of the
thorax i percussed from above downwards, the patient being desired to
express himself when aware of unusual sensation or ])ain. It is very rare
in recent icterus, and especially in febrile icterus, for the patient not to an-
nounce a marked sensibility as soon as the percussion excites a shaking of
the liver. By this means too, an abscess of the liver, the consequenc-e of
a fall from a high place, has been diagnosticated. M. Cruveilhier has also

386 Miscellaneous.

applied this mode of exploration to the kidney, spleen, hea.., ^nd even the
uterus. For the brain, it may be put into force by suddenly pulling at a
handkerchief that is held closely between the teeth. In this way it has
been advantageously used in many cases of cerebral disease.-^fJdrcAzVe^
Generales, and Virginia Med. Journal,

Nux Vomica in the Treatment of Sick Headache: Br. J. B McCaw
(Virginia Medical Journal,) gives some interesting facts in regard to the
successful use of extract of nux vomica, and the igflatia amara, in those
distressing ailments, sick headache. Se began with a minimum dose,
which was increased to ofte-fourth of a grain every nigLt. In all the cases
in which he employed it the effect was gratifying. The effect of these
remedies should be closely watched. [Med. and Surg. Reporter,

Digitalis in certain Affections of the Bowels. Dr. Ware stated that he
had found this remedy of great benefit in the following case : The patient
was a woman who suffered from dyspepsia, and had become some^vhat re-
duced in strength by child-bearing. She had an affection of the bowels,-
which consisted in excruciating pain, coming on in paroxysms, together"
with diarrhoea and vomiting. The pulse was also extremely frequent, va-
rying from 120 to 140. She bore opium badly. i)r. Ware, thinking the
quickness of the circiilation might keep up the irriftability of the system^
ordered digitalis, and this remedy was continued until the pulse was re-
duced to 54 beats in the minute, where it was kept by the remedy for a
considerable time, and the patient recovered.

Habitual Constipation. Dr. Haugbton says: "In obstinate cases of this
kind you will find the fallowing a very capital pill : balf a drachm of ex-
tract of henbane, one scruple of extract of colocynth, and three grains (A
extract of nux vomica, made into twelve pills, one to be takeii night and

Alum as a Remedy in Croup. A correspondent of the New Hampshire
Journal of Medicine states that for three years he has used alum in croup,
and in all that time has not seen a fatal case which was treated with it from
the beginning. He usually gives about ten grains, once in ten minutes,
until vomiting is induced, using at the same time tartar emetic or the hive
syrup freely the latter subduing the inflammation, while alum has more
oi a repulsive action.

Ligature of the External Iliac for Aneurism of Femoral Artery. This
operation has recently been successfully performed by Dr. Mercier, of New
Orleans. [New Orleans Med. and Surg. Jour.

fiRRATA. The folioiring erroTs occurred in the May No. in the article on Vesico-Vaglnal iTistulay
By Dr. P. M. KoUock, Which the reader will please correct :

On page 269, llth line from top, for " cause," read CJ/rse.

" cunn'mgest" rea.d cunning^st,

"pond," rea.6 foiul.

" finally," read firmly.

"1S56," read 1S36.

"potosh," read potash.

" Rooerhnysen," read Roonhuysen.

" range," read Terge.

" known," read knovyn.

" aisistant," read assistant.

269,

llth line from top.

"

21st "

IC u

271,

13th "

' bottom,

272,

ISth "

" top,

274,

7th "

(( ik

275,

l:3th "

u u

"

12th "

" bottom,

279,

2nd "

" top

"

9th

" bottom,

280

5th "

top

SOUTHERN

MEDICAL AID SURGICAL JOUIIIAL,

(NEW SERIES.)

Yol. XIIL] AUGUSTA, CEORuIA, JULY, 187. [No. 7.

ORIGINAL A?{D ECLECTIC.

ARTICLE XIX.
LETTErvS FHOiT- SAML. D. HOLT, if. D., rrON SOilE POINTS OF GEXEKAL PATHOLOGY.

LETTER XO. 18.

Montgomery, Ala,, March 18th , 1857.
Messrs. Editors^ The nature of the non -cognizable causes of
disease, and their modes of operation in and upon the animal eco-
nomy, are involved in so much obscurity, as to render our know-
ledge upon the subject little less than a system of hj^pothetical
speculation. The discussion of these, I would willingly avoid;
3^et, as all diseases seem to be made up of a series, alternately of
cause and effect, which are, in a great measure, inseparable, one
from the other, it becomes in consequence a difficult matter to in-
vestigate their true and essential pathological character, without
examining at the same time their etiology. Indeed, so closely are
these links of cause and effect connected in the chain of morbid
actions, which follow the operation of the first cause, that it is
often difficult, and sometimes impossible to determine where one
begins and the other terminates; Avhat actions come within the
range of the etiological, and what the pathological character of
the disease ; or rather, what actions are referable to the operation
of the^/'6-^ cause^ and what to those which may be regarded as se-
condary. Hence, in inquiring into the patholosry of these diseases
(I mean typhus, typhoid, and other diseases of the zymotic class,)

K.S. VOL. IIII. KG. VII. 25

888 IIolt's Letters upon General PaiJwIogy. I'^^^Ji

I shall be compelled to examine at some length into the nature of
their causes and the mode of their operation, however obscure and
difficult of comprehension they may be. In doing so, however, I
do not expect, or even hope to be able to clear up any of the diffi-
culties, or remove the obscurity in which the subject is involved,
but merely to give expression to such views as I believe to be
the most reasonable, because most conformable to their nature and
mode of operation, as we are best able to understand them, from
observing their effects upon the animal system. By the non-cog-
nizable causes, I mean particularly those o^ amrnal origin , whether
solid, liquid, or aeriform, which, when taken into the circulation in
whatsoever manner, act as blood poisons, giving rise to contagious,
infectious, and some forms of epidemic diseases. Now, in order
to produce the diseases to wdiich these causes respectively give
rise, (for it must be received as an axiom that every disease must
have its peculiar and specific cause,) it is not sufiicient that the
blood should serve merely as the receptacle, and act as the vehicle
for conveying the poison to those parts of the system for which it
may have a special elective affinity; but it is essential that the
blood itself should become contaminated, undergoing changes in
its vital or chemical quality or properties, and furnishing a nidus
and a pabulum for the regeneration or reproduction of the poison.
To express the action or process by ^vhich these changes in the
condition or constitution of the blood are effected, which becomes
sooner or later manifest by the signs of excitement or depression,
and a corresponding increase or diminution of vascular action ^ giv-
ing evidence of ]is progress, and the actual invasion of the disease,
the term ^' Zymosis^ has been used. This term, is at least appro-
priate, inasmuch as the process is analogous to a ^''fermeni,^^ and is
not the less expressive, whether the action of these poisons ujx)n
the blood be, by a chemical or a vital process. A striking analogy
is found in the fact, thatthe /)roce.<?5 having once been co?/?jDZeiec/, can
not he renewed ; and the blood having been once subjected to the zy-
motic action of any one o^ these poisons, has its susceptibility to
their impression in a great measure destroyed, becoming, as a gen-
eral rule, incapable of having it the second time excited by the same
poison. This fact, and the immunity Avhich one attack of any of
the zymotic diseases secures against their recurrence, furnishes
conclusive evidence to ray mind of the existence of a separate and
distinct cause for each disease of this class. The separate, distinct

1857.] IIolt's Letters upon General Pathology. 389

and suigeneric character of all these diseases i?, at the same time,
as conclusively shown in the pathognomonic signs, or dingnostic
symptoms of each, whether they result from the direct operation
oiiliQ first cause, or belong to the regular concatenation of morbid
actions which make up the disease.

I have been led to these remarks from the fact, that the points
involved remain open and unsettled questions, many contending
still for the iinihj^ or rather the identlt)j of certain diseases and their
causes, such for instance as bilious and yellow fevers, or of typhus
and typhoid fevers, which they maintain are essentially the same
disease, differing onlj^ in degree and the intensity of the causes
which produce them. Such, I must confess, was at one time the
inclination of my own opinions, but a more intimate acquaintance
and careful study of their character, have satisfied me that such
views were erroneous. I have even gone further and entertained
for awhile, at least, the belief that some of these diseases possessed
the character of a duality^ that is, that they were made up oi two
distinct diseases blended into one, as for instance " intermittent ty-
plwid fever" and yellow fever. Such were my views, particularly
with regard to the yellow fever which appeared in Montgomery,
in 1S53, from wdiich opinions I have found, it somewhat a d.fBcult
matter to recede, in the face of the facts wdiich existed at the time,
(en passant^ I am not the first and OTily one who has had to ^^ craio-
^i'A '/^" in their views concerning these diseases,) which in short
were these: Yellow fever had never been known or recognized
previous to that time in the region of Montgonier}^,- except such
cases as were occasionally carried there from Mobile, Pensqcola, or
Xew-Orleans, notwithstanding it had been considered a hot-
hed for the most malignant forms of malarial fevers, and other dis-
eases, not excepting cholera: nor Avere the causes of sickness ap-
parently^ more rife, or even as much so as in former times, and
there existed but few cases, comparatively, of malarious diseases.
There Avere, however, prevailing, and had been for a length of
time, two distinct epidemic diseases^ one being jaundice^ and the
other typhoid fever, a coalescence of which two diseases, (and why
not?) if it did not give us ^^ typhus icterodes^^^' it would give us at
least an icterus typhoides^ furnishing most of the prominent and
characteristic features of yellow fever, and my belief was, that the
prevailing disease was a hybrid, and not genuine "Yellow Jack,"
between which and vellow fever a much closer relation existed.

390 Holt's Letters upon General Patholorjy. [J^V?

than between a " chebinut horse and a horse chestnut^ These views
received support from the fact, that tlie disease was characterised
by an extraordinary predominance of jaundice S3'mi)toms, Avhich
were often the first, and, in many instances, the onJu sym])toms
manifested the disease preserving the cliaracter of a pui-e, simple,
uncomplicated case of jaundice. That such was the character of
the disease as it prevailed elsewhere, I infer from some circum-
stances which came under my own observation, as well as from
general report:

Two men from Pensacola, via Mobile, arrived in Montgomery
on the 28th of August, both having been taken sick the day pre-
vious, on the boat. One of these cases presented clearly the most
prominent characteristic symptoms of yellow fever, (a case which
I shall notice hereafter, as it is my design to give cases illustrative
of the principles and views which I advocate,) while the other was
prominently marked by the characteristic symptoms of simple
jaundice without a single symptom, apart from existing and sur-
rounding circumstances, which would justify the belief that it 'was
anything more; or, that it had any relation with yellow fever.
And, if we are permitted to rely upon newspaper testimon}^, (?)
there prevailed about that time, in Loudon, Tenn., and the sur-
rounding neighborhood, (a place by-the-by, which has not found
its way into the gazetteers, or upon the mnps as I can perceive,
though it is certainly of sufficient importance to have done so, if
it can support a newspaper and get up an epidemic yellow fever,
an honor and a distinction which formerly the large seaport cities
only could aspire to,) an epidemic jaundice, as the report states,
*' which carried off many of the inhabitants, and which the physi-
cians would have pronounced yellow fever, but for the absence of
fever, many of the cases being attended with the characteristic blacTc
vomitr

There may be found in " Bell and Stokes," which I have not
now before me, under the head of epidemic jaundice, the descrip-
tion of a disease which once prevailed as an epidemic in London,
and described as "gastro-duodenitis," which if not yellow fever,
at least bears a very striking resemblance to the disease which
prevailed in Montgomery, in 1853, under that name. But fur-
ther: some years ago I proposed to the Medical Society of Mont-
gomery, as a subject of interest, an inquiry into the causes and the
nature of jaundice, which I had observed, more than once, to pre-

1857.] Holt's Letters upon General Patlwlogy. 391

vail in Montgomery iu an epidemic form, aud apparently as an
idiopathic disease; but, being before yellow fever times, the subject
was not deemed of sufficient importance, and some of the members
doubting whether it ever so prevailed, the subject was laid aside.
In 1852, however, it was so decidedly epidemic, not only in the
city but in the country around, that it attracted the attention of
the least observant, non-professional portions of the communitj^,
and in 1853, after yellow fever had made its appearance in Mont-
gomerj^, I called the attention of some of my professional brethren
to these facts, in support of the views which I i/ten entertained,
and they gave it as their opinion, that these jaundice epidemics
w.ere nothing more or less than the manifestations of a j^ellow fe-
ver epidemic influence. My views, with the facts, were submitted
also to my brother, Dr. David Holt, of Woodville, Miss., formerly
of New-Orleans, who has had an extensive experience in yellow
fever, and the diseases of the South, and in whose judgment and
opinions I have much confidence, and he did not hesitate in ex-
pressing the opinion, that the epidemics in Montgomery, as well
as that of Loudon, Avere genuine and bona fide yellow fever epi-
demics. Well, if it be so, though I do not feel like pushing the
matter too far, fur fear I should be accused of entertaining hereti-
cal notions, yet I would like to propound a few C]uestions, which
are neither idle or impertinent, hoping that some one who may
feel himself competent to the task will undertake to answer them,
which if satiiffactorily done will go a long waj's towards settling
many controversial points with regard both to the. causes and the
pathology of yellow fever. Is there then such a disease as idiopa-
thic jauJidice jaundice ^'^^erse?" What relation exists between
yellow fever and jaundice? Is the jaundice of yellow fever the
result of the essential and specific cause of yellow fever, oris it
the result of the operation of other and general causes? Is jaun-
dice an essential element in yellow fever? If jaundice is, under
any circumstances, idiopathic, or a disease ^^per se," how is the
fact to be known ? Now, I ask these questions in all earnestness
for I do not much like this plan of having to guess at matters, if
they can be got at in a more reliable way. How was I to know
that in the two Pensacola patients I had two cases of yellow fever?
And how was I to know when turning off mv jaundice patients
with a few rhubarb pills and a bottle of dogwood and wild cherry
bark bitters, that I was turning off so many cases of yellow fever?

892 Holt's Letters upon General Pailiohgy . [July,

But I must leave this subject and these inquiries, and return to
the subject wliicli I was discussing, name!}'', the separate and sui-
gencric character of the zj^motic diseases and their causes, and the
nature of the zymotic process; and I desire to impress upon the
mind of the reader, the necessit}' of separating and keeping in view
the phenomena which arise from the direct operation of the^ir^
essential and specific cause^ from those which arise from the opera^
tion o^ general causes: for wliile the former determines the disease,
and shapes its course and duration, and preserves its essential sui*
generic character, the latter furnish the phenomenn, which though
non- essentia], enter into and help to make up the morbid concate-
nation of each, and giving rise to the changes, modifications and
complications to which they are all liable. While, therefore, I
maintain that the prime, essential, and specific cause, whatever it
may be, operates from the beginning to the end of the disease, giving
rise to its true pathognomonic signs, I cannot be understood as
maintaining that all the phenomena which arise in their progress,
and which necessarily enter, as it were, into their composition,
are to be ascribed to the direct operation o^ the first cause, for many
of the causes of these p>re-exist in the sj'stem, and only await the
action of some specific cause to bring them into life, and give them
activity and direction. Thus/e^-e?- which is made up of an aggrC'
gation of morbid phenomena, and which may arise from almost
an infinite number and variet}- of causes, and which forms a pro-
minent trait in the character of a large number and variety of
diseases, can be regarded only as 2i general pathological condition,
without the operation of an essential and specific cause to give it
individuality, or '^a local habitation and a name." Hence, the
fever of small-pox, measles and scarlatina, or of typhus, typhoid,
or yellow fever, can with propriety be viewed only as a general
pathological condition, which is common to them all, and which is
identical in all, except so far as it is controled by the prime, essen-
tial and specific cause of each, which preserves to each throughout
its course, its essential and suigeneric character, notwithstanding
the changes and modifications which they are subject to from other
causes.

Though there may be a triteness in these remarks, if the proper
weight of importance be attached to them, they will lose that
character, and this importance is manifest in the necessity for a
QQrrect diagnosis, upon which alone the successful treatment of all

1857.] Holt's Letters upon General Paihologij. 893

diseases ia a great measure depends. In the analysis, therefore,
of these diseases, as well as in their treatment, too much care can
not be taken, to separate, and to keep separated, the causes, and
the symptoms which belong to them in their individual and sui-
generic character, which constitutes their special pathology, from
those, which by being common to, and entering into the composi-
tion of them all, constitutes their general pathology : for, accord-
ing to my observation and experience, it is unquestionably true,
that while each of these diseases requires a course of treatment,
which is best suited to them in their individual character, and
founded upon their special pathology; that treatment, whatever it
may be, is always more or less^ and often ivholly amenable to treat-
ment upon general principles^ founded upon the general jxdhological
condition^ wdiich is the result of the operation of general causes,
and not of the specific cause of the disease. It is unnecessary for
me to cite examples, as any and all the diseases which I have
named will furnish them in abundance, if viewed in the varied and
modified aspects to which they are constantly liable, from the
causes which I have stated, and though the principles wdiich are
involved, and which I am urging upon the attention of the pro-
fession have constituted the chief theme, and the ^^ burthen of my
song'''' from the beginning to the present time,* and upon which my
classification of fevers has been founded, I do not feel willing to
let the present opportunity pass without re-expressing the opinion,
that a want of proper ^attention to these matters, and not keeping
them at all times in view, has been the principal cause of the wnnt
of success which has 6ften attended the treatment of these diseases,
and which has led to the abuse, and finally to the rejection of re-
medies which, though improper or unnecessary under one aspect
or state of affairs, are under other aspects and circumstances most
appropriate and beneficial. To this fate, at one time or another,
have the lancet, opium, mercurj-, tartar emetic, and all the leading
articles of the materia medica been subjected, and to this fate will
they continue to be subjected as long as the treatment of these
diseases in a single aspect^ or in the character of their special patho-
logy^ '\s persisted in iciihont regard to the general pathological condi-
tion which surrounds and invests them.

AVell, I w^ill lay aside, for awhile at least, these generalities, and
come to the part of the subject, with which I started out in this
letter, which if not more interesting, is at least, more intricate,

894 Holt's Letters upon General Pathology. P^ilj?

namely, an inquiry into tlie nature and mode of operation of the
causes of the zymotic diseases. And to show what my ideas are
with regard to the zymotic process, as applied to the production
of disease, I will select for illustration the vaccine disease, or vac-
cination, premising that so far as concerns the zymosis merelj^, it
is essentially the same in the whole class of zymotic diseases,
while the results which depend upon the peculiar nature of tlie
zymotic cause, are often widely different, and belong to these dis-
eases in their individual character. An atom, of vaccine or vario-
lous virus introduced under the cuticle by means of a prick or
scratch, so slight as S3arc3ly to create a sensation, will remain
several days without producing any sensible or perceptible im-
pression, and sometimes all traces of the prick or scratch will dis-
appear, during which lime there is no evidence of the work which
is going on within, there being no manifestation either general or
local, of nervous disorder or of vascular disturbance. But pre-
sently a little speck of inflammation shows itself at the point ofihe
insertion of the virus, where a vesicle forms, which goes on to
enlarge, and is surrounded with an areola of inflammation, which
increases until the pustule is fully and maturely formed. And
this is what I understand to be the zymotic process, which requires
for its accomplishment the time from the reception of the zymotic
cause, through the period necessary for the regeneration or repro-
duction in the S3'steni of the same zymotic cause, up to the time of
its maturation, which will require a longeor shorter time accord-
ing to the specific nature of the cause; the vaccine virus requires
about ten daj^s, the variolous in inoculation a little longer. But I
have not stated all which occurs during the zymotic period, for
about the seventh day from the insertion of the virus, a febrile
movement is set up, showing that it is no longer a local affection,
but tliat the whole system has been brought under the influence of
the local affection, or is laboring under the influence of the zymo-
tic cause, which latter is the most reasonable supposition, as Avhen
the variolous virus has been used, the febrile movement is soon
followed by a crop of vesicles which appear in various and remote
parts of the bod}^, which mature about the time of the parent pus-
tule about which time we may suppose the zymotic process to
have been completed, and about which time the febrile movement
generall}' ceases. When the disease is taken in the natural wa}'',
iiixG febrile movement furnishes the first evidences of the existence

1857J noLT's Letters upon General Pathology. 395

of the disease, and it is gen era! I3' two or three days, befoie the
eruption shows itself. In this instance, there is no local affection,
as in the other, to get up a febrile rnoven^ent in tlie system, and
the only reasonable inference is, that the fever is the residt of the
specific virus, undergoing the zymolic process. This question, how-
ever, belongs more pro})erly to small-{)ox, in its individual char-
acter, and I wish to confine myself to zymosis merely, which is
confined to no o?2e disease, but belongs ahke to small-pox, measles,
scarlatina, typhus, tj^phoitl, and yellow fever, and many other
diseases ^some having a specific virus as their cause, and recog-
nized as contagious^ while others, of an infectious character, have
their origin in a specific animal effluvium which arises from excre-
mentitioLis substances, and diseased bodies; and others, again,
originate from sjiecific effluvia and atrial poisons^ requiring for their
production an atmospheric contamination, as in the case of epi-
demics generally. Of the first, we have an example in small-pox,
which is both contagious and infectious of the second, in mea-
sles, scarlatina, typhus, and probably t3'phoid fever; and of the
third, in yellow fever; between some of which diseases there are
many striking points of resemblance, and of some relationship
and in one respect, they all belong to one famil}', that is, they are
all zymotic diseases.

Now, in exaniining into the manner in v.-hich these causes oper-
ate, and the relation which they bear to the di.^ eases to wdiich they
give rise, and to other causes which enter into their composition,
I shall have to adopt an aphoristical and catechetical style of argu-
ment, more, however, for the sake of convenience, than from an
apj)reciation of its elegance and beauty.

Having seen fi'om the example or illustration given, that the
zymosis, or ferment, commences with the insertion or introduc-
tion of the virus or poison into the system, we are led to the in-
quiry as to hov/ a disease is thus produced, when and where the
disease commences, and what part the zymosis sustains in the
disease, whether as an element in the disease, or as an active agent
merely in its production. The answering one of these questions
would perhaps suffice for them all ; but I will not attempt such a
wholesale manner of disj^osing of them. I do not hesitate how-
ever to express the belief that it is the first link in the morbid
concatenation, and consequently is an essential as well as a prima-
ry element in all the diseases of the class, haying its origin and

396 IIolt's Letters upon General Pathology. [JuIJt

seat in ihe hlood. When the poison is introduced, we mny sup-
pose the process of its absorption to commence, and its ditfnsion
to go on, until the whole mass of the circulating fluid becomes
tainted or contaminated with the poison. It is not, however, to
be understood that this diffusion and contamination constitutes
thezj^mosis, but that wliilethis operation is progressing, the blood
itself is undergoing those changes in its constitution, which con-
stitute the z3'motic process, namel}^ in the regeneration or repro-
duction of the poison in the blood, from materials furnished hy the
blood. Some idea of the extent of this reproduction may be formed,
hy the supposition, which is a reasonable one, that a single atom
of variolous virus having undergone zymosis in one man would
probably furnish material sufficient to poison the blood, and excite
zymosis in every human being on the face of the earth; such is
not the case with all the zymotic diseases, some being of doubtful
contagious character, some imperfectly eruptive, and few furnishing
a palpable virus, which however does not alter them with regard
to their zymotic character. From the fiict that the zymotic action
furnishes no ostensive evidence of its existence, and progress, it
has been denied that it is entitled to be considered as one of the
stages of disease, but the formation of the vaccine pustule shows
from the beginning to the end, not oxiXy its existence, its ])rogress
and its termination, but, that it is an essential element in the dis-
ease, if not the disease itself Yacination is often successful without
the presence of any fever, or other constitutional symptoms and
shows itself to be nothing more than a /ocaZ affection ; yet this
local affection or pustule, is not really the disease, but rather the
result and consequence of the efforts of nature to relieve the sys-
tem of the new pi'oducts as they are generated by the zymotic
process. And so it is with all the zymotic diseases ; as the zj^motic
products accumulate, they become obnoxious and offensive to the
system and the vital processes, and are thrown off by the natural
emunctories, or through channels which are determined by their
elective affinities, depending upon the peculiar and specific nature
of each poison. Thus the zymotic products of vaccination seem to
seek an exit, at the point of the insertion ofthe virus as shown
by ihQ formation of a pustule at that point. The j^roducts of small-
pox, measles-, scarlatina, &:c., make their way through the skin,
and some of the mucous surfaces, in the shape of eruptions, each
peculiar in character to itself, and each manifesting a preference for

1857.] Holt's Letters upon General Pathology. 397

particular orgas or parts of the system by tlie irritation ^hich
llicy kindle uj^i those organs or parts. While the zymotic pro*
ducts of ty];)hoid fever whiiih, though not strictly an eruptive
disease, is, as Avell as typhus and 3'ellow fever, often attended with
eruptions peculiar to the tyjohus family find an outlet through
the follicles and solitar^^ glands of tlie small intestines; while tlio
pi'oducts of the zymotic process in typhus and yellow fever, seem
to have no other means of escape than through the natural emunc-
tories.

This -would seem to bring us to an examination of the conse-
quences of the elimination or non-elimination of these products;
but I am not prepared for that yet, having other questions of im-
portance yet unsettled. But finding that I shall not be able to get
through with all which I have to say on these subjects, Iwillbiing
this letter to a close, by remarking that I do not wish to be under-
stood as entertaining the opinion, that the zymotic stage of these
diseases, (or the stage or period of incubation, as some writers term
it,) is of chief or paramount consideration and importance, but that
as ^primary dement in these diseases, it is important in reference
to their special joathology to the manner in which the causes operate
to produce them, and especiallj^ as showing the agency which the
blood has in their production.

If I have not succeeded in proving that zjrmosis constitutes an
essential part in these diseases, I have at least shown that it is en-
titled to more attention than is generally given to what is termed
the period of incuhaiion ; a term, however, which I confess I do not
exacily understand in a figurative sense, though I am somewhat
p)ractically familiar with it in a literal sense, about this time hav-
ing quit physic^ and taken to the honorable calling of a farmer.

As ever, yours, &c. Saml. P. IIolt,

398 Paris Correspondence, [J^ly

PARIS CORRESPONDENCE.

ARTICLE XX.

Extract of a Letter from Dr. Thomas A. Means, of Georgia^ now in Paris.

Numerous experiments with the new anaesthetic Amylen (H, ^
C, o) first introduced into the profession by Professor Snow, of the
English school, and now attracting the attention of the Medical
world in Paris. It does not "take," however, with the leading
surgeons, such as Yelpeau, Nelaton, Malgaigne, Chassaignac, Mai-
sonneuve, etc. Much of this apparent opposition might, I fear,
Le traced to an overweening jealousy for the claims of French
science, and a tardiness to admit pretensions from beyond the
channel. I have seen many patients under its influence, and find
its action characterised by a freedom from that unpleasant sensa-
tion which always attends the administration of chloroform, i.e.
nausea. Yet, the quantity, necessary to produce anaesthesia, is
considerably more than that of the latter agent. What the parti-
cular results of these professional experiments may be, I cannot
pretend to foretell.

M. Chassaignac has now in his hospital, some fort}- patients
under treatment for abscess, by a new system which he terras
"Drainage." It is simple, rational, and effective. lie employs a
gum elastic tube about one-eighth of an inch in diameter, perfor-
ated along it sides with small holes, at intervals of two or three
inches. When called to operate, he thrusts a trochar and canula
entirely through the abscess at its base withdraws the trochar,
inserts the tube in the canula, passes it through, and then removes
the canula itself leaving only the flexible tube to perform its
work of drainage. The gum elastic tube may be of any length
required, and can be readily cut, at any point, with scissors.
After it has been introduced, the oj^posite ends are approximated
and confined together by a small cord, and the operation is com-
plete. All can be done in ten minutes, or less time. Some two
or three times per day, the tube should be moved, one or two
inches, so as to allow a free exit of pus through the openings.
This method is particularly applicable in diffusive abscesses, but
may be used in other forms. I herewith enclose you a sketch,
drawn under the e3^e, from a patient who entered the hospital
with an extensive abscess, involving the whole upper portion of

1857.] Paris Correspondence. 399

the thigh, and extending itself to the iliac region. After this
operation for drainage, two weeks onl}^ elapsed until a cure was
effected. No other treatment was adopted, save regimen and diet.
Indeed, it is astonishing to witness the man}^ rapid, easy, and
effeciual cures which follow from the practice of this simple me-
thod of Chassaignac. It is proper to say, however, that it is not
yet generally adopted by the surgeons having charge of the va-
rious hospitals ; yet it will, I think, ultimately take the lead in the
treatment of these affcictions.

ARTICLE XXI.

Extract of a Letter, under date ith of March ult., from Br. THOMAS
A. Means, now in the French Capitol.

On Monday morning last, I visited the Ilopital Lariboissiere
some two and a half miles distant from my residence^ to witness
two operations with the Ecraseur, in the hands of Chassaignac
himself, A description of this surgical instrument, now so popu-
lar with French surgeons, was furnished in a letter to my father^
Dr. A. M.y of Oxford, Ga.,) and which I find published in the
February number of your excellent journal. No further particu-
lars, therefore, as to the construction of that instrument will be
necessarj^.

The cases which now demanded the skill and dexterity of the
distinguished surgeon, w^re h^emorrhoidal tumors, one of which
was very large, but which under his admirable manipulations,
required but fourteen minutes for its complete extraction, from
the moment in which the chain was attached; while the o//?er was
but the work of a few seconds. Both operations were beautiful
and sim])le, as well as efficacious.

M. Maisonneuve, perceiving some imperfections m the instru-
ment of Chassaignac, read before the Academy of Medicine, some
time last week, a paper of considerable length, in which he de-
scribes and proposes modifications and improvements, which he
conceived would vastly enhance its practical value, and extend
the range of its application. He suggests::-

1st. The substitution of a screw and tablet^ for the crank now
employed by that surgeon.

400 Paris Correspondence. [July^

2iicl. A point o^ disardculaiion, so as to allow of the application^
of crotcljcts of various shapes and sizes, adapted to tlie kind of
ligature used.

Sid, A curved shaft, and chain, desigtied' expressly for the
uterus.

Some of the defects in Chassaignac's instrument m^y be thus*
enumerated:

1st Its limited /eyer^oi{;er.

2nd. The difficulty of attaching the chain;: and-

8rd. Its closed cylinder.

In ope4-xiting with that form of Ecraseur, upon cancerous tumors'-
of the breast, for example, an incision must first be made through-
the skin, to the subcutaneous cellular tissue, before a sufficient
force can be exerted to crush the dense mass below. Indeed, it
becomes necessary, in all cases where the skin is involved, to in--
cise the whole circumference, befure anything can be satisfactorily
accomplished.

And here, we may be permitted to say, " en-' passant," that in na
case can the "Ecraseur Lineaire" of Chassaignac be used with de-
cided advantage, unless in exceedingly soft tumors, such as hosm-
orrlioids, or bloody excrescences. And yet, even in this limited
field of operation, much vatij be effected by it.

With Maisouneuve's modifications, however, there seems to bcr
no limit, either to its motive power, its leverage,- or its application.-
For this surgeon has extirpated with a simple thread of phitinum,.
(one of any flexible metallic wire may be used,) and within the
lapse of a few minutes without hcemorrhage, the inferior lip,
diseased with a cancerous affection. He has' also removed volu-
minous hiemorrhoidal bourrellets, patches of detached skin,
tumors of various forms ganglionic, carcinomatous, &;c., &c., tO'
gether with uterine polypi diversified excrescences 'the prepuce^
&c. While upon the dea^d body he has satisfactorily illustrated its
action upon the tongue, the round ligaments of the uterus, the iu'
teguments of tlie scrotum, and the various other parts, whether
involving the skin, or otherwise. Both the instruments above
referred to are from the celebrated establishment of Charriere &
Son of this city, and are but modifications of the old Serre-Noeud
ofGrafe, the ^a/^e?- suj-geon retaining the old name with "nou-
veau" attached, while t\iQ former dispenses entirely with the "an-

^

1857.] Campbell. Gunshot Wound of the Hand. 401

JACKSOX-STREET HOSPITAL REPORTS,

ARTICLE XXII.

GunsJiot Wound of the Hand; Amputation of a portion ; preserva^
tion of the Tliumh and Index Finger; liecovery. By EoBERT
Campbell, M. D., Demonstrator of Anatomy in the Medical
College of Georgia.

Jim, a colored man, aged 80 year?, the property of Mr. George
Robinson, of Hamburg, S. C, was admitted into our Hospital, Dec,
24th, 1854, having, an hour previous, received the charge of a
pistol through the palm of the left hand, while the palm was over
the muzzle. Upon examination, I found the tissues extensively
lacerated and the three inner or ulnar meta-earpal bones denuded
and dislocated from the carpal row, one of them being fractured.
The ulnar side of the index finger was also bare; but the flesh on
the inner border of the haiid, apart from having the corresponding
meta-carpal bone, which supports the little finger, separated at its-
proximal extremit}', seemed to have escaped destruction.

In consultation, an immediate operation was determined upon^
to save the patient farther loss of blood and suffering, which weie
beco-jning excessive, to the rapid deterioration of his strength. I
accordingly removed, under chloroform, the middle, ring and
little fingers, with their corresponding meta-carpal bones, entire
carrying my scalpel around the head of the meta-carpal bone, and
base of the first phalanx, of the little finger^ so as to prolong the
extent of the flesh on the inner border of the hand, into a flap of
sufiicient length, to bend over and cover the front of the carpus
and the whole of the denuded side of the meta-carpal bone of the
index finger thus bringing the skin of the radial and ulnar bor-
ders of the hand in apposition, having extirpated the intervening
bones- except that of the index, and cut out the disorganized flesh.

After cleansing the wound as well as possible, controlling hem-
orrhage by ligature and adjusting one or two of the carpal bones,,
which were somewhat displaced, a few interrupted sutures, behind
and before, served to retain the flap in position, when the stump
was dressed with the cold-wet-bandage, as being the most appro-
priate treatment under circumstances so well calculated to induce
igh inflammatory action. An anodyne having been administer-

L, the patient was put to bed.

402 Campbell. Gunshot Wound of the Hand. [Jul j^

It would be tedious and unprofitable for the reader to be obliged
to wade through the monotonous annotation of the daily progress
of this case, as he is too often compelled to do, in order to gather
its few important features which have a practical interest. Suffice
it to say, that notwithstanding the precautionary measures against
inflammation, so extensive and aggravating was the injury, in this
sensitive and susceptible part, thut on the fourth dressing, an in-
tense inflammation was discovered in the hand, wrist and forearm^
requiring the employment of still more energetic means, both local
and constitutional, for its subjugation.

The margins of the wound appeared to be sound and to have
united, alm.ost entirel}^, by the first intention; but the wrist was
the principal seat of action, the tumefaction extending nearly to
the shoulder-joint. On the 25th of January, a large quantity of
pus Avas discharged, on lancing the dorsum of the wrist. This
discharge continued to increase to such an extent, as to cause the
patient, already enervated by suffering, to faint on getting up. One
other lancing had to be resorted to in the forearm.

From this time, upon the administration of the crystalized tar-
trate of iron and potash, 5 grs. three times a day, a generous diet,
beef tea, chicken, &c., and Port wine ad libitum, the case progressed
to a favorable termination the strength of the patient improving
and the suppuration diminishing until Feb. 25th, when the patient
was discharged, well; but with a somewhat stiffened wrist-joint
and index finger.

A year^after, I saw Jim, and had the opportunity of presenting
Lis case to the Class of that Session, at Jackson -street HospitaL
He had for a long time since the operation been engaged in active
service as a whitewasher, &c., earning good wages: free use hav-
ing, in a great measure, overcome the stiffness of the wrist and
finger and his left hand, or its most essential elements, the thumb
and index finger, remain to him, an efficient and valuable mcm-
l>er the satisfaction of this result fully compensating for the regret
entertained at one stage of the case, that the amputation had not
been performed above the wrist-joint, at the point of selection.

The similarity between the above and the following case, quoted
from the London Lancet,* suggested to me the publication of the
former.

* American Edition for May, 1857, page 417, " Hospital Reports."

1857.] Campbell. Gunshot Wound of the Hand. 403

" Commimded Fracture of the Bones and extensive Laceration of the
Integanients of lite Hand; Amputation of a Portion; Preservation
of the ring and little Fingers ; Recovery. (Under the care of Mr,
Weedon Cooke.)'^'

*'D. E , aged sixteen, was admitted Sept 30th, 1856, in a

collapsed condition, caused partly by the shock of an injury just
sustained, and partly by loss of blood. He had been assisting at
a factory for biscuit-baking by steam apparatus, when the right
hand became entangled in the machinery, and much laceration was
the result. Upon examination, it appeared that the thumb was
torn from its attachments, and hung loose ; that the meta-carpal
bones of the index and middle fingers were much crushed, and
broken up into small fragments, and the integuments both of the
back and palm of tlie hand, including the muscles of the thumb,
were most severely lacerated. When first admitted, there was
free arterial haemorrhage, which was checked by pressure with dry
lint and bandage. After consultation with his colleague?, Mr.
Cooke decided neither to attempt to save the fingers, nor to ampu-
tate the hand, but to remove only the thumb, index atid middle
fingers, nipping off the corresponding fractured ends of the meta-
carpal bones, and obtaining as good a flap as possible from the
palm of the hand. This he did, and ev^ry thing progressed favor-
abl V. The boy was extremel}^ weak, and required high feeding.
The healing process went on partly b}^ adhesion and partly by
granulation, and was complete on the 1st of December. The two
remaining fingers admit of flexion and extension, and Avhen edu-
cated, and aided, perhaps, by an artificial thumb, will be of the
greatest service to the poor youth in writing and even prehension."

The two cases above detailed, agreeing in several of their promi-
nent features, unite their accordant testimony in favor of the
rationality and justice of the general precept in Surgery, which
enjoins forbearance and moderation upon the decision of its coun-
cils, as regards the amount of permanent injurj^, which shall be
inflicted, to remedy the misfortunes occasioned by violence or dis-
ease; when at the same time a course has to be determined upon,
which shall not compromit the more immediate and vital consid-
erations in the welfare of the sufferer. Yet it is too often the fact,
as regards the interests involved in the contemplation of these
cases, that this cunningly fashioned and most invaluable mechan-
ico-vital instrument ^^ i\i\?> chef<Vceuvre of mechanism, which some
of the philosophers of antiquitj' regarded as the distinctive char-
lacter of man, and even as the source of his intellectual superiori-

* Ro^i^l Free Hospital, London.
N.S. VOL. XIII. NO. VII. 26

404 Periodic vs. Typhoid Fever. [J^V?

ty,"* is unhesitatingly devoted^ by common consent, to be sacri-
ficed, entire, to the over-wrought apprehension of that fearful
maLidy Tetanus, the liability to which is, to some extent, entail-
ed upon it, by its peculiar p)bysical endowments.

Periodic vs. Typhoid Fever, By Jonx Herbert Claiborn, A. M.,
M. D., Petersburg, Virginia..

During the latter part of the summer, and throughout the autum-
nal months of the year, there occurs in some sections of this cit}-,
in its suburbs, and in the surrounding country, an endemic fever,
identical, we beheve, with the fev^er often prevalent at the same
season in various localities in the whole of Tide-water, if not Pied-
mont Virginia, and which is designated, by different practitioners of
medicine, as typhoid fever, slow fever, nervous fever, remittent fever,
continued fever, and perhnps one or tuo other expletives, indicating
a want of accuracy and agi'eement in nomenclature, that is some-
times, we fear, an exponent of uncertninty as to the true character
of the disease. Following Dr. Bartlett.f we propose to call it peri-
odic fever a name which, while it is sufficiently comprehensive,
does not suggest an erroneous patholojry ; a charge that might be
well fastened on several of the prefixes before mentioned. We desire
to draw an especial distinction between it and typhoid fever proper,
confident that though typhoid fever is sometimes found in our midst,
it is not the fever in question, and persuaded that any uncertainty
with regard to this fact in the mind of the physician attendant may
lead to results in praciice not only inconvenient but fatal.

We believe this endemic fever to be undoubtedly the analogue
of the old fashioned bilious remittent fever of this latitude, familiar
to our fathers in medicine fifty years ago, but so changed withal,
with the times, that we suspect it would not add to their posthumous
fame, could they revisit these places, which once knew them so well,
and attempt a dingnosis or conduct a treatment. It is indeed so
unlike bilious remittent fever, even of some few years past, not only
in the absence of severe constitutional symptoms attendant on its
inception, but in the general absence of any special biliary disorder
that unprofessional people, who have seen much of " bilious fever,^'
in its unmistakable type, soon lose confidence in a physician who
asserts that tbis is their old enemy. lie must have some new nanje
for them, and typJioid fever is the most fashionable and the most
imposing. This tide we regard particularly unfortunate, if the
practitioner honestly apply it as indicative of the nature of the dis-
ease, and one that must inculcate erroneous pathology. Any fever
or any disease mav assume a typhoid type, etymologically speaking,

* Cruveilhier. f Fcver of tlie United States.

1857.] Periodic vs. Typhoid Fever. 405

but remittent fever cnnnot become in any stnge of it, typhoid fever,
considered as a special disease, originating in a specific poison, and
according to Louis and his sch(A:>l, establishing its entity in a pecu-
liar form of intestinal lesion.

The object of this paper is to endeavor to attract the attention of
the profession, particularly of this portion of Virginia, to the want
of technical precision wfiich prevails as regaids the use of the terin
typhoid tever, and to attempt to draw as m;ii ked a distinction as we
may be able, between it and the autumnal endemic fever.

Autumnal endemic fever we regard as essentially a periodic fever
of the remittent variety, but it has displayed some difference in its
features as it occurs in the earlier or latter parts of the season. We
will endeavor to detail its symptoms, not frojn authorities, but from
our remembrance of individual instances, and from cases collated
from our note book

The first cases of the season are usually mild, both as regards inten-
sity and duration of abn.')rmal action. These usually occur about
the first of August. A physician will perhaps be summoned to a
gentleman who will tell him that he is not sick much, but that he
l)plieves he has taken cold from sleepin^r under an open window.
He will complain of pains anri soreness in the limbs and back, of a
want of appetite and spirits, and of a general feeling of malaise. He
has been attend inix to his business, though with some discomfort for
several days, and has at length been compelled to remain at home,
and is probably in bed. He will remark that he is very weak
unaccountably so. His bowels are in good condition, unless he has
disturbed the.-o with cathartics. His tongue is moist and clean, ex-
cept near its root, where it is slightly furred, and it is large and often
indentated by the teeth. His skin is warm, not unpleasant, and
dry or moist, as he is seen at the period of exacei'bation or remis-
sion. His pulse is rarely 109. is not lull, but quick. His countenance
is natural, except on exertion, when it exhibits great languor. In
the exacerbation it is perhaps a little flushed, and his eyes are little
injected. He has had a slight pain in the head occasionally for a
day or two, and his nose has once or twice bled a few drops or
more, and there is also some cough, but unimportant.

Sometimes there will be more disturbance of the sanguiniferous
system that is noted in this case, and the face will be flushed and the
pulse full and bounding, and there will be marked and distressing
ce[)halalgia, and perhaps a little incoherency or quickness of speech.
But in such instances we have usually found some other source of
irritation beside the original disease, as a meal of undigested food,
or improper tamperin<z with drastic medicine, or some moral cause.
And these are generally the only cases occurring early in the sea-
son which are apt to be prolonged and troublesome.

Now, the existence of what pathological condition do the svmp-
toms which we have enumerated indicate ? There is no important
capiliary congestion in the original and uncomplicated case. There

406 Periodic vs. Typhoid Fever. [J^b'j

is no anatomical lesion to attract attention. There is no digestive
or hepatic or other visceral disorder. The nervous system is chiefly
at fault. There is perversion of innervation. And this is confes-
sedly the primffry action of the poison of mahiria. There is no ne-
cessity for secondary derangements of other functions of the body.
We have an antidote for the poison a specific for the disease at
this stage cinchona. Peruvian hark has scarcely ever disappoint-
ed us in its anticipated effects. In the language of an attractive
author, quoted from memory "Amidst the manifold uncertainties
of medical science, it is gratifying to know that there is at least one
important therapeutical relationship established, which defies alike
the assaults of quackery and the machinations of skepticism." A
full dose of the sulphate of quinine, exhibited at the first appearance
of remission, will generally prevent or materially modily the suc-
ceeding exacerbation. We say, given at the iemission, because
we think it acts more happily when given at this period; but we
are not averse to giving it at any stage, when it is necessary it
should be administered. We do not believe it will act as an exci-
tant in any dose, except in peculiar idiosyncracies nor do we give
it as a pure sedative, as w^e would digitalis, but we give it as an
aniiperiodic. In this light alone we use it in such cases. It is se-
dative in them in view of this property. It neutralizes that poison
the irritation of which is manifested in the reaction of fever. A
few doses, combined or not with a mercurial or an opiate, as special
eases ma}^ indicate, usually cut short the disease. It never ''runs
into typhoid fever.'^

Incases occurring later in the season, the symptoms are apt to
be graver and more serious from the beginning. The exciting cause
seems to have acquired concentration and malignancy, with not
so much of premonition, as exhibited in malaise, languor, debility,
&c. The patient will be taken usually about noon or early in the
afternoon wnth a marked chill, lasting some fifteen or thirty minutes,
with pains in the back, head and limbs, and accompanied with a
good deal of thirst. To this there will succeed a fever, lasting some
five or six hours^ then subsiding into a distinct remission. In
which stage there is often considerable diaphoresis, and a much
more comfortable condition for a few hours. After this, spontane-
ously, or consequent upon another period of vital depression, there
will occur another rise of fever, to be followed by another period of
remission, only less marked than the first; and the same phenomena
will be repeated if the disease be unchecked, until in a few days it
becomes difficult to perceive, without close observation, any period
of remission in the twenty-four hours. It is in such cases the idea
prevails that the disease is a continued or typhoid fever. In almost
all of the cases occurring later in the season, there are evidences of
visceral disorder sometimes hepatic sometimes congestion of the
spleen, and of the whole portal circulation evinced by fullness and
tenderness over the bowels. The tonsfue is smaller and less moist

1857.] .Periodic vs. Typlwid Fever. 407

coated more or less with fur, and disposed to be red at tlie point
and edges. There is I'requently complained of too, that ahnost pa-
thognomonic symptom of bihous remittent an annoying, tenacious
mucus in the fauces. The pulse is usually more frequent as high
as 120, and i'uller and harder. The iace is flushed sometimes
dusky and there are oftener symptoms of cerebral congestion, as
evinced by dullness or delirium. There is the same tendancy to
bleeding at the nose, and oftener cephalalgia.

It is in the treatment of these cases the "triple base" of Maillot
so accurately expresses the indications to be fulfilled, viz: "To
combat the viscei'al lesions; to opposa the return of the paroxysms;
to prevent the occurrence of relapses." To carry out the first, it
may be only necessary, if the patient be seen in the paroxysm, to
administer six or eight grains of the mild chloride with as many of
Dover's powder, and one or two of ipecac, applying a dozen or two
leeches to the head or stomach, according to the force of the reac-
tion and its concentration at either point. The early occurrence
of the remission will afford opportunity to exhibit the antiperiodic,
which will efiectually meet the two latter. Ffteen or twenty grains
of sulphate of quinine given in one dose at this time, or in two
doses of a few hours interval between them, will actually cut short
an attack. Indeed, I have seen it succeed, in summarily effecting
this end, after the disease had already continued unabated for more
than a week, and when a dry tongue, nervous tremors and incohe-
rency of language had apparently usheied in the typhoid stage.
After two or three days of treatment, if the fever still continue,
which is sometimes the case, we have found smaller doses of quinine,
five or six grains, exhibited in the remission, to answer a very good
effect gradually neutralizing the poison of the disease, and hasten-
ing convalescence, without inducing any of the disagreeable symp-
toms of cinchonism. We sometimes combine the quinine with
calomel, ipecac, and opium, at its first administration; and where
there is much visceral engorgement, the antiperiodic is often thus
more effectual.

Cases subjected to this treatment in their early stages have not
generally in our experience "run into typhoid fever." Of nineteen
cases, not selected, but transcribed from our note book of last Sep-
tember, the average duration of treatment was six days. Six more
days would cover the average period of convalescence. And this
large average was chiefiv owing to the inclusion of tw'o cases, which
were sick four and eight weeks, and which finally assumed so much
of the typhoid type as to lead us at one time seriously to doul>t the
accuracy of our original diagnosis. These were two young men,
aged 19 and 21, respectively, occupying the same room, and who
lived in a section of the city where typhoid fever, as it is called,
prevails every summer. They both had been treated pretty active-
ly with purgatives and without quinine, for several days before I
saw them. During their convalescence two other young men.

408 Periodic vs. Typhoid Fever. [July,

living on the opposite side of the street, and who had nursed them
occasionally during their siciiness, were taken in precisely a similar
manner as the two former, and recovered under the treatment
which 1 have detailed one in three days and the other in less than
a week. Now, I am sure tf.at all four of my patients had the same
maladv, and I am reduced to the altenalive of deciding that quinia
cured the ty])hoid fever in the two latter cases, or that the two lormer
were sick with a diilerent disease, viz: periodic remittent fever.
This I believe to be the proper conclusion.

When the fever has persisted i'or one or two weeks, in spite of
the treatment adopted, and the tongue begins to be dry and brown,
and fissured, and the bowels are irritable, we usually recommend,
about once in 24 hours, four or five grains of Dover's powder, with
as much of hyd. c. creta, if there should be a necessity for the latter
in the condition of the secretions, and apply at the same time a
mild vesicatory over the abdomen. We continue the use of the
antiperodic, however, exhibiting three grains of quinine or an ounce
of the infusion of cinchona and serpentaria every six hours, alterna-
ting sometimes with fifteen or twenty drops of oil of turpentine.

\yith regard to the use of purgatives. We have found them
generally not only unnecessary, but positively prejudicial at any
staore of the disease, and evincing, even the mildest of them, aptness
to induce irritation of the bowels.

If the first dose of calomel which we adujinister does not operate
of itself in twelve hours, we then, not sooner, follow it witli half
ounce of cold pressed ol. ricini, or a Seidlitz powder, and relying
upon the simplest laxatives or upon enemas during the remainder of
the attack. Sometimes, in a case sick for a week or ten days, we
have not used more thanone gentle purgative. Occasionally we have
regretted the use of this never its omission. The farinaceous arti-
cles of diet, which are allowed, together with the cold acidulous
drinks, so grateful to the patient, are generally sufficiently laxative ;
and in protracted cases, these latter haveoften to be forbidden, owing
to the great tendency to diarrhoea.

The 2^rognosis of this fever, as it occurs in this city and its vicin-
itv, is favorable. Yery few cases prove fatal. Perhaps not one in
thirty. Its cause and its nature are shrowded in the same obscurity
that 'masks our knowledge with regard to the essential character of
all other fevers. When we shall have certainly determined and
accuratelv nnalvzedthe one, we may then possibly be able to eluci-
date the other. We are in the habit of attributing its exciting cause
to the influence of malaria, whatever this subtle agent may be. We
nssicrn to the disease this origin, because it prevails exclusively in
those portions of the city, and in the surrounding country, \^'here
the sole or main conditions for the generation of this poison abound,
v^iz : * a porous, eartliy surface, capable of absorbing moisture, oc-
casionally soaked with water, and subsequently exposed to a drying

* Watson's Lectures. Martin on Climate.

1S57-] Periodic vs. Typlwid Fever. 409

process, under a certain degree of heat. We believe this description
well represents the character of the soil in the suburbs nnd vicinity
of the city, if not in a considerable part of Eastern Virginia. The
fever, when entlemic within the precincts of the city, almost invaria-
l)lv occurs upon unpaved streets, and large and illy drained lots.
We know of certain localities ihat are almost always visited with
cases of it some time during the autumn. Unless in the instances
of persons who have been infected elsewhere, I have very rarely
met with it on anv paved street of the city, except one Boling-
brook street; and this runs adjacent to and parallel with the south
bank of the Appomattox river, andexposed, tl\erefore, on its northern
sides, to the malaria arising from the unpaved lots between it and
the river, and on the opposite bank of the river. The healthfulness
of the residences on the south side of the street, when compared
with those on the north side, is a matter of common remark.

We think it sufficiently well established that the fever in question
originates in malaria. Of this malaria we do not propose to give
any definition. We knovv' but little of it, except its name and abode.
We suppose that it is i\ 'poison, disseminated in the atmosphere
about the localities of its origin; that it is inhaled into the lungs;
that it operates primarily upon the nerves, secondarily upon the
capillaries, and that the fever is but a reaction of the system in its
efforts to reject or eliminate the disturbing agent. And in briefly
saying this, which of itself cannot be demonstrated to be more than
conjecture, we say all, as far as we are apprised, that is known of
the nature of periodic fever.

T[\Q diagnosis \?, a practical question one involving most impor-
tant issues in the treatment, and one, therefore, which cannot be
too critically examined. Remittent periodic fever we regard as
curable it may be jugulated it may be cut short. Whatever may
be our uncertainty with regard to the essential nature of the mala-
dy, Heaven has not left us ignorant of the antidote. We have this
in its most convenient form, in the sulphate of quinia. We may
be incompetent to determine the mode of action of this medicine,
but its benefits are a matter of observation, and are const^ntlv sub-
jected to the test of the senses. They are unmistakable. Dr. Head-
land in his "Action of Remedies," has concocted a very pretty and
a very plausible theory, showing how it cures. But tiiis is only
theory its effects are facts. Typhoid fever, on the other hand, is
incurable. A distinguished lecturer and physician,*' speaking of
the Irish typhus, remarks, " We cannot cure fever. No man has
ever cured it." So of typhoid fever, v.hich, if not identical in na-
ture with typhus, has a similar origin and many things in common.
The man is not born who can cure it. There is no specific which
will cut it short. The antidote for its poison has not vet been dis-
covered. An effort to jugulate it may be productive of the worst
consequences. It is proper that certain symptoms, arisincr durin"-

* Wm. Stokes, M. D. Clinical lectures in the Meatii hospital

410 Periodic vs. Typhoid Fever. P^^Ji

its progress, should be combatted, and that obstructions in the way
of" recovery should be removed when it can be safely attempted ; but
nature must finally conduct the treatment and eflect the cure, if" at
all effected. Hence the importance to tlie physician of" an early and
accurate diagnosis. Since the minute researches ofLouis, Gerhard,
Chomel, J. B. S. Jackson and others, into the pathology and symp^
tom of" typhoid fever, it has not been generally considered a very
difficult matter to diagnose this disease, But there are very many
cases of the endemic fever, which we have endeavored to describe,
that are not at all dissimilar in some importantfeatures ; from typhoid
fever and we have seen some very good observers evidently mistake
the one for the other. The diseases are often alike in their mode of
attack in lurking each about a neighborhood or vicinity in the fre-
quent succession of cases in a f"aniily, or in going through a family as
it is termed, Both, too oftener attack the young ; and to both new resi-
dents are most susceptible. Both are commonly attended in the
early stages with buzzing in the ears and with epistaxis; and in both
there is slight bronchitis. In both the bowels are very susceptible
to the action of purgative physic, if not in a state of diarrhoea. And
in both, if prolonged, there is remarked the same dusky hue of the
countenance, and the sanie dullness of intellect, or delirium. They
are unlike, however, in their relative gravity or mortality. I do
not think that the deaths from endemic fever in this city and its
vicinity would average one in forty. This is about the proportion
shown from the imperfect statistical tables to which I have* had
access. In typhoid fever, on the contrary, wherever occurring, the
average mortality is always much higher. In the iMassachusetts
general hospital in 1829, tlie average was only one in twenty-five,
but in the same institution in 1830, it was one in three and a half;
and the average in it for fourteen years was one in seven. Of 140
cases observed by Louis, more than one-third died. According to
M. Piedagnel, the mortality is about one in seven. According to
Chomel this varies ver}- much with season, age, acclimation, &c.;
but in all instances his average was much higher than in any ende-
mic autumnal fever which I have known in this latitude.
But again. The two diseases dit!er in this respect. The endemio
fever of which we are treating is essentially a fever of the summer
and autumn, and never prevails endemically at any other season;
while typhoid fever, according to the experience of some of the best
observers, is by preference a disease of winter ; or at the least, ac-
cording to Dr, Bartlett, does not occur in any one season more
frequently than another. The diseases differ moreover in the
absence, in remittent periodic fever, of the rose colored spots, one of
the most remarkable phenomena of typhoid fever, occurring gener-
ally about the 14th day, on the abdomen of the patient, and accord-
ing to Chomel and Genest, wanting in only 16 out of 70 cases
observed by them. We rec^ard this as a verv essential difference,
not only elucidating the diagnosis of remittent periodic fever, but

1857.] Periodic vs. Typhoid Fever. 411

defining its specific nature, and establishing the fact of its malarious
origin. There is no similar eruption in remittent fever, in inter-
mittent fever, in malignant congestion, in yellow lever, or in any
other lever, we believe, attributed to malarious poison. Whilst in
every other form of fever having its supposed origin in the poison
or infection of animal effluvia, there is either some disease of tlie sub-
cutaneous glands or some eruption uj)on the dermoid tissue, parta-
kmg more or less of the character of the petechia? of typhoid lever.
Anil we instance, in support of our assertion, typhus, plague, syphi-
lis, small[K)x, measles, &c., &:c. We consider, therefore, the absence
of any eruption in the endemic fever of this section as an important
point in the differential diagnosis.

W^ith I'egard to the abdominal lesions demonstrable after death,
our opportunities for examination have been so limited as to render
their results of but little avail. We have made a few neci'opsies in
view of this special question, and one of them was on a patient of
one of the most distinguished medical nien of the state, who diag^
nosed the disease to be certainly typhoid fever. In it we found no
ulceration, engorgement or other affection of the glands of Peyer.
Dr. Bartlett, in his work, before quoted, page 152, declares that
lesion of the elliptical plates '' invariahhj occurs in fated cases of
typhoid fever." Could this fact-be undoubtedly established, and
would physicians use a little more diligence in their post-mortem
investigations, the diagnosis of the disease after death would be defi-
nitely settled. Apart, however, from the inconvenience accruing to
the patient from the doctor having to rely on information so tardily
obtained, we must confess that we are not entirely converted to the
doctrine of the duality of typhoid and typhus fevers, and therefore
do not recognize the lesions of the aggregate glands as pathogno-
monic of one more than another of these diseases. But it does not
form one oi the purposes of this paper to open so vexed a question.

We do not wish to be understood as affirming that typhoid fever
never occurs in this city or in this section of the state. On the
contrary, we think we have seen undoubted cases ot it. More :
We have sometimes thought that there were intimations of the pos-
sibility of our malarious fevers being entirely replaced by it, in
view of the iact that improvements in drainage, sewerage, &c., are
gradually diminishing the causes of the former, while the increase
of population, even to redundancy, in our cities, furnishes material
for the enlarged developement of the causes of the latter. But in
none of the endemics of remittent fever, slow fever, continued fever,
&c., as it is called, whether in town or country, which have come
under our observation, have we been persuaded that the disease was
typhoid fever proper. I have been assured by some excellent phy-
sicians of those sections of our state where the slow fever is almost
yearly endemic, and occasionally makes devastation upon a planta-
tion, and where it is regarded as contagious or infectious, that the
disease was undoubtedly typhoid fever. But these same gentlemien

412 On the MeasJe of ihe Fvj, &c. [July,

with practical good sense have also assured me that quinine was
the treatment that they often cut short their cases with it, and that
they rarely lost a patient if called in time.

Now, while theory and experience both unite in declaring typhoid
fever to be incurable even by quinine and calomel, these gentlemen
must excuse us if we urge that they have applied to their disease a
misnomer. And though we confess that it were scarcely wise to
divert their attention by a new name, when they already combat
their enemy so skillfully and so faithfully, yet as we advise no
change in the armory, we hope they will allow us to insist on accu-
racy of nomenclature as essentially important to any intelligible
record of the character and habits of disease. Virjinia Med. Jour.

On the Meash of the Pirj ; and on tJie W holesomeness, as Food for
Man, of Measly Pork. By Alexander Fleming, M. D., Pro-
fessor of Materia Medica, Queen's University, Ireland.

The following Report was furnished to the Committee of the
provision merchants of Cork, who applied to me for mformation on
the subject to which it refers, in January, 1853. Stated brief!}",
the questions submitted by the Committee weie: 1. What is the
nature and origin of measle in the pig? 2. Are all pigs measly?
3. Can pork be measly, and that condition be invisible to the naked
eye ? 4. Is there any analogy between measles in the pig, and the
disease known by that name in man ? i>. Is fresh measly pork
wholesome? G. Is cured measly porK wholesome? 7. What is
the chemical composition of the measle?*

Twent3"-one specimens were supplied to us, viz. :

Seven of fresh healthy pork, from different parts of different pigs ;
six of fresh poik, slightly measled ; seven of fresh pork, badly meas-
led ; one of cured pork, badly measled.

"The measle of the pig is an animal parasite, the Cysticercus cel-
lulosce, or bladder liesh-worm. It infects the muscles of all parts of
the body, but is found most frequently in those of the tongue, loin,
and neck, and is often seen in the muscular substance of the heart,
lyin<T between the fibres of the muscle. It is seen as an ovoid
bladder, from two to four lines in length, formed by a thin, transpa-
rent membrane, and enclosing at one extremity an opaque body, of
a white color. This is the worm coiled up, but which, when unfold-
ed, exhibits a head, neck, and pear-shaped vesicular tail. The
head is armed by a crown of barbed booklets, around which are

"*I was requested to associate with me in this inquiry my colleagues in the Chairs
of Natural History and of Agriculture, and the Report in tiie text was pi-epared by
me to embod}' the joint results of our investigations. It -was signed by me and Pro-
fessor Smith. Mr. Mur|ihy sent in a separate Report, but his views are substantially
the same. Drawings of the Cysticercus, and of its several parts, referred to in our
Report, arc given by Professor Smith in the ]Microscoi)ical Journal for January,
3857. See also, Huxley's Lecture on the 2'ceniadce, in Medical Times for August,
1856 : and the Brit, and For. Med. Chir. Review for January, 1857.

1857.] On the Measle of ihe Pig, &c. 413

placed four sucking mouths, and the neck is formed of a series of
rin<is, which gradually lose themselves posteriorly on the dilated and
bladder-like tail. In the interior of the worm are a number of mi-
croscopic corpuscles. The average diameter of these bodies is
l-15()0th of an inch, and their usual form that of a ilattennd, circu-
lar disc; but they vary both in form and size.* During the life of
the pig, the bladder enclosing the worm is fully distended with a
pellucid iluid, but after the pig's death, a portion or all, of the con-
tained iluid escapes into the surrounding tissues.

'Jnthe specimen of cured pork sent to us, the bladders were
empty of fluid, and the microsco])ic corpuscles in the body of the
worm presented a central granular opacity, instead of being clear
and transparent, as in the fresh specimens. We hdicve that the life
of tlie parasite is destroyed by tJte process of curing.

" It is now maintained by several eminent physiologists, that this
lleshworm is the scolex or imperfect condition of the tapeworm or
Ttenia solium, and that when passed alive into the intestinal canal
of man and other mammalia, it assumes there a higher degree of
developement, and becomes a tapeworm a troublesome parasite
often causing distressing symptoms, and inpairing the health. The
organization of tlie fleshworm, as now described, goes far to estab-
lish this opinion, if indeed, it be not already placed beyond doubt by
the results of experiments in which it was shown that dogs. fed on
fresh measly pork became affected with tapeworm. With us the
parasite is killed by cooking, but where the flesh is eaten raw, as in
Abyssinia, tapeworm is very common.

''All pork is not measly. In the specimens of healthy poik we
found Ho trace whatever of the parasite in any stage of develop-
ment.

"In the specimens of both slight and badly measled pork submit-
ted to us, the wornis were all visible to the naked eye. All appear-
ed to have reached the same degree of organic growth, and in none
of the specimens, healthy or otherwise, could we find eggs or the
slightest trace of the parasite in an earlier stage of development.

" Tliis parasite has been found in the muscle, brain and eye of
man ; but thereis no analogy ic/uitever between measles in tlie pig, and
tlie disease known by that name in man.

' It is highly probable if not quite established, that measles origin-
ate in the eggs of the tapeworm which infests the bowels of the
dog. Each mature joint of the last parasite contains many thousand
eggs. These, when voided by the dog, are resolved into a fine
I dust, and are scattered by the wind, and thus, mixing with the food
or drink of the pig, enter its body, and are there converted into the
measle or fleshworm, which, as already stated, is an imperfect condi-
tion of the tapeworm. Measles may not foim in every hog that
has swallowed tapeworm eggs; while a feeble digestion and consti-
tutional debility may especially favor their hatching in some pigs.

* These cellules were erroneously regarded as eggs by Klencke and Gulliver.

41-i On the Measle of the Pig^ cDc. [J^V>

" If this view of the origin of measles be correct, it will be an im-
portant and rational guide to the prevention of the disease, and
which will consist in irroviding Hie pig witJi tliorougldy clean food
and drink^ promoting its general healthy and removing it from the
neiglthorliood of dogs affected iciih tapeworm.

" When only a few of the parasites are scattered in the body of
the pig, the flesh does not differ from that of healthy pork in its
ordinary character or minute structure, and the general health of
the pig is not affected. When used as food, it must be so rare that
the vitality of the worm can escape cooking, mastication and diges-
tion, that we believe the risk of tapeworm from its employment to
be very small ; and on the whole, we see no valid reason for regard-
ing slightly nieasled pork as unwholesome ; but it must be well cooked,
and never eaten raw or undone.*

'"On the other hand when the parasite is thickly distributed
throughout the muscle, the flesh is pale, soft and watery, and the
muscular fibre near the worm loses its healthy structure, and exhib-
its evidence of the condition known to pathologists as fatty de-
generation. The health of the pig is much impaired, and in the
worse forms of the affection we may have inflammation and suppu-
ration in one or more parts of the body, with general fever, wasting
and weakness. The pig is seldom permitted to see this stage, and
almost never to survive it.

"When the disease proves fatal, according to Mr. Martin, the
animal loses appetite, blisters form under the swollen tonsiue, the
skin ulcerates, and death occurs amidst extreme debility and ema-
elation. t

" Badly measled pork is insipid when cooked, and in boiling loses
more weight than healthy poik. It is more difficult to dry, and ex-
hibits greater proneness to putrescence ;J while, respecting its use
as food, we must not forget the possibility of its causing tapeworm,
nor the risk of some portion of the animal having undergone during
life changes of a truly morbid nature, as inflammation and suppura-
tion. Taking account of all these circumstances, we cannot regard
bad measly pork, fresh or cured, as wholesome food for man.

" This opinion may be assailed on the ground that bad measly
pork is consumed to a large extent, and that no hurtful effects have
been traced to its employment. But we cannot trust to common
experience in a question of this nature. Putting aside the ordinary
sources of fallacy, the poor consumer of such meat is rarely capable
of tracing the relation of cause and effect between bad food and its
evil consequences. He would conclude meat to be wholesome
which ffiiled to produce some striking bad symptoms soon after a
meal, and would be unable to refer to its true cause the iijjurious

* The process of curirg is fatal to the parasite, and removes all risk of tapeworm,
f Fainier's Library, vol. ii. p. 491.

X These facts were determined b\- repeated comparative obrervations with heal-
thy pork.

<f

1857.] ' On the Measle of ilie Pig, d:c. 415

influence, slowly and silently, but not less certainly, wrought upon
his system by the long continued use of an unwhulesome article of
diet.'

"Chemical analysis could not aid much in this inquiry, but were
it otherwise, the time allowed us did not permit of its employment."

The measle in the hog is more observed in Cork than elsewhere
in these islands. This is in part due to its being more carefully
sought for; but chiefly to its greater frequency, caused, I apprehend
by inattention to the cleanlines of the pig's food and drink, and by
the circumstance of its being reared in the peasant's cabin, where
it has very generally a dog (untaxed in Ireland) lor a companion.
This dog for the most part, has tapeworm. Nor must we forget the
influence of our low marshy grounds and warm humid climate, in
favoring the production of parasites, and especially of worms. These
conditions may induce a state of constitution in the pig favorable
to the reception of the parasite, and we can readily understand that
a warm and moist air should favor the incubation of the tapeworm
egcr and development of the young taenia outside the body.

I am informed that in Cincinnati, the largest pork market in the
States, the measle is unknown. If this be the fact it would be inter-
esting to know whether the pigs brought to that city, and which are
fed chiefly in the forests of Ohio, Kentucky, and West Virginia, are
kept apart from dogs having tapeworm. Perhaps some of our
American readers could inform us on this point. Dr. Wood, of
Philadelphia, says that tapeworm is comparatively rare in the natives
of the Union.

The researches of Kiichen'meister, Roll, Leuckart, Von Siebold,
and Van Beneden, leave no doubt of the connexion between the
cystic and cestoid entozoa. Experiment shows that the meazle is
generated in the muscle of the pig by feeding it with ripe joints of
the dog's tapeworm (the Ttenia serrata, now considered to be the
same as the Tcenia soUuni, or human tapeworm,) and that the same
tapeworm is developed in the intestines of a dog fed with fresh
measly pork. The measle is not generated in the dog by feeding
it with the tapeworm eggs.

Leuckart has traced in the rabbit the passage of the embryo tape-
worm into the blood vessels. 1 he eggs are quickly hatched in the
stomach, and the young taenia bore their way with their lancet-
armed heads thiough the mucous membrane, into a blood vessel.
With the blood they are carried in the rabbit to the liver, to be
there arrested and developed into hydatids or Cysticerci. In the
lamb, the young tcEnia are carried with the blood to the brain, where
they fix and grow into the cystic parasite named Ccenuriis cerehralis,
and within two weeks of the commencement of the experiment the
lamb is afl^ected with the " staggers."

The cystic entozoa or hydatids do not form a separate class of
parasites, but are merely the cestoid entozoa or intestinal worms in
an imperfect state. Each species of tapeworm has its correspond-

416 On. the Measle of the Pig, &c. ' [July,

ing cystworm, but the same embryo tapeworm may produce two
or three forms of hydatid, according to tlie species of animal and
part of the body in which it may chance or rather, J should say,
mischance to be developed, for the hydatid is essentially abnormal
both in form and site, and these entozoa obtain tlieir perfect growth
only in the intestinal canal their proper dwellin.fr place. The
youn2^ tapeworm, swimming in the blood, is fixed probably by get-
tincT into a capilliary too small for its passage ; and the reason of its
being irrested by preference in the muscle of the pig, brain of the
sheep, and the liver of the rabbit, may perhaps be found in the rela-
tively small size of their capillaries.

As the esrg of the same tapeworm develops both the measle in the
p!g and tlie stagcrers in the sheep, the means ol prevention suggested
in the Report, for tfie former disease, will apply equally to the latter.*
In addition to the means of prevention there mentioned, it might be
w'ell to reduce the number of dogs in the country, and to diminish
the frequency of tapeworm among them by not feedinfT the healthy
with raw flesh, and bv the vigorous treatment of the diseased. The
excrement of dogs should not be mixed with the manure for pasture
fields.

There is more hope of preventinfr measle than of their cure. I
made many inquiries as to the treatment of the disease, but with-
out obtaininir information of much value. The farmers generally
are skeptical as to cures being ever obtained, but a few have faith
in treatment; and, of the several remedies emploved, the internal
use of sulphur is most relied on. Two or three cases were men-
tioned to me by trustworthy persons in which cures appeared to
have been made by this druf^. It is probably converted in the pig's
body into sulphurous acid, and poisons the measle. This acid is a
most efficient parasite-killer. Alcohol, iodine, camphor, turpentine,
and nitrate of silver, are activelv poisonous to the cystic parasites,
and their internal use mav be tried.

In Cork the pig is examined for measles bv official persons, both
in the living and the dead markets. The parasite shows itself at a
vejT early stage of the disease in the tonfrue, and this orfran is in-
spected in the livinc^ market. The pig is placed on its side and the
mouth opened. The tongue is then drawn forward and pressed
firmly between the fingers in its whole length. The measle if pre-
sent, is felt by the finger, and withdrawn through a scratch in the
mucous membrane. If none are felt, the pig is passed as healthy.
This test is the best known, and is very useful, but the worm may
be absent from the tongue and present elsewhere in the body ; and
a more certain means of detecting the disease in the living animal
is to be desired.

In the wholesale dead market, the inspection is made by making

* According to Kiichenmeister, the hydatid of the sheep's brain, causing staggers,
is produced from the enibi-yo of a peculiar tapeworm, uamed Tania ccenurus, also
found in the bowels of the dog.

1857.] On the Maisle of tlte Puj, d'c. 417

a free cut lengthways into the inner loin muscle at the side of the
spine, and by cutting across the neck. And, sliould the purchaser
desire it, cuts are made into the flesh elsewfiere, as the back of the
neck and shoulder. If one measle only is found, the price is lowered
5s. per cwt., and if n^ore are seen, a larger reduction is made, vary-
ing in aniount according to the number. The worse forms are not
sold in this market.

The oiigin of tapeworm in man l>om the measle was rendered
probable by the greater irequency of the disease among the consu-
mers of raw flesh, and particularly of raw pork, as the Abyssinians,
the natives of Nordhausen, and the operatives of Lancashire ; but
KiJchenmeister has given a high degree of certainty to the connec-
tion by experiment. He fed a condemned person with measles, and
found tapeworms in his body after execution. The parasites were
given during the three days before death, in five doses of about a
d(;zen each time, disguised in soup. Ten voung tapeworms were
found in the intestinal canal, attached to the mucous membrane in
the usual way.

.The process of c?n'?'??^ destroys, as we have shown, the vitality
of the parasite, and to this circumstance the immunity from tape-
worm, enjoyed by the inhabitants of Cork, must be attributed. The
poor of this city, among whom tapeworm is very rare, undoubtedly
consume a large quantity of measly pork, but always salted. Ths
freedom of seamen in the navy from tapeworm admits of the same
explanation. Much of the pork formerly used in the navy was
measly, but it was well cured. At the present time, the naval con-
tracts are inspected with care, and measly pork is rejected.*

The use of raw, measlv flesh, cannot, however, be the only source
of tapeworm in man. This parasite occurs among the very poor
who scarcely eat flesh of any kind, and it plagues the Hindoo, who
lives almost exclusively on rice. It may, perhaps, originate from the
direct introduction of the tapeworm eggs or young tsenia with the
food or drink into tfie stomach. Klencke, many years ago, asserted
that he had found microscopic young taenia in ditch water, and the
frequency of tapeworm in Vienna has been attributed to the water
oflhatcit3% in which young tapeworms have been detected.

Why, when thus introduced into the stomach of man, the dog, pig
and sheep, respectively, they should cause tapeworm in the first and
second, and pass into the blood of the third and fourth to grow cvst-
worms, may be explained by supposing that in the carnivor's stomach
the mucous membrane is tougher, or that the young taenia are dis-
solved by the strong acid, gastric juice, except on rare occasions,
when they slip alive into the intestines to grow tapeworms; while

* While engaged in tlris inquiry, my friend. Dr. John Biirns, of H. M. S. Uas-
Ungs, communicated witli several of his brother medical officers to learn their ex-
perience of the use of measly pork in the navy. Tapeworm had not been traced to
Its employment. During the summer of 1855, Dr. Burns states that the provisions
issued were uniformly of good quality.

418 Abstracts of Reports of Hospitals^ Dispensaries^ &c, [July,

in the herbivorous* stomach, where the food lies lorrg, tbey escape
digestion, the gastric Huid acting feebly on animal matter, nod, pierc-
ing the softer mucous coat, make their way into the circulation.

These remarks have brought me to difficult, and as yet obscure
ground, and, in truth, although great progress has been made of late
years in our knowledge of intestinal worms, much remains to be
done as well for their natural history as for those iinportant ques-
tions in hygiene and pathology to which they give rise, before we
can attain to clear views and definite conclusions. \^New Orleans
Med. News and Qazettee.

Abstracts of Reports of Hospitals^ Dispensaries^ dec, in Austria.

On the 30th December, 1858, Dr. A. E. Flechner gave in hii?
report to the Medical Asf:ociation of Vienna, upon the monthly and
annual Sanitary Reports of the different Hospitals, Alms Houses,
Dispensaries, Penal Institutions, Asylums, &c., of Austria for the
past year. The number received and examined exceeded two hun-
dred, and embrace res^ults from September, 1855, to October, 1856.

The following facts and items, gleaned by Dr. Flechner in his-
examination of these Reports, and interesting in their therapeutic
and pathological relations, we translate from the (Esterreichische
Zeitscliriftfdr Praciische Heilkunde.

It appears from the monthly reports of General Hospitals, that, in
traumatic tetanus wine was administered with favorable results,
accompanied at the same tinie by the use of carbonate of potash
baths, followed by early use of opium and carbonate of potash. The
autopsy, in a severe case o( tetanus often days duration, disclosed
in the body no material pathological changes. A case of chronic
lead poisoning, accompanied with violent headache, and complica-
ted with paralysis, was cured after nineteen days use of four drops
daily of chlorbrora in two ounces of water. Diabetes melitus was-
treated successfully by strict flesh diet, iron, tannin, and carbonic
^cid water. Tannin was of no avail in intermittents ; on the other
hand, berberin was employed with advantage in non-gastric diar-
rhoeas. Glycerine did good service in bed-sores. A caustic agent,
much esteemed in France, was experimentally tried with good re-
sults, viz: one part of pure liquor ammoniac to two parts of oil.
Poured upon cotton and laid upon the skin, lentil-sized blisters were
raised in five minutes, M'hich, being pricked, w^ere sprinkled with
morphia. Iodide of potassium repeatedly proved itself useful in
cases of mercurial poisoning, and croton oil in cases of lumbago and
sciatica, externally applied. Upon trial of Fleming's method for
the itch, less favorable results were obtained than by that usually

*Cysticerci infest the flesh of several vegetable feeders, as the ox, deer, sheep,
hare, rabbit and mouse.

1857.] Abstracts of Reports of Ilosjnials, Dispensaries, dx. 419

employed in General Ilospitnls. Favorable results follow the use
of strychnia in parn])legia, and cantharides in incontinence.

Among other things, typhus deposits were found wholly wanting
in exanlhematous typhus; while on the other hand, in an old apo-
plexy, with a slow pulse, in the course of which all the usual symp-
toms of typhus were absent, the body, upon examination, first showed
the typhus process. Ulcerations of the larynx were often observed
following typhus. A metastatic abscess developed itself in the up-
])er arm of a patient convalescing from severe typhus, which being
opened, showed a healthy disposition, but suddenly chills occurred,
icterus, with pain in the liver, and very soon death. Upon exam-
ination of the body, the liver showed numerous abscesses of the size
of a walnut. A fungus melanodes, appearing externally at first, in
eighteen months extended inwardly, and invaded most of the inter-
nal organs. Melanotic formations were found in the pleura, perito-
neum, and even in the muscular tissue. An apparently hysterical
patient died with comatose symptoms, and the body showed, upon
examination, melanotic degenerations in both hemispheres of the
brain, as well as in the right lung, and several formations of the same
kind in the omentum and mesentery. In an epileptic, whose par-
oxysms were accompanied by violent vomiting and diarrhosa, sixty
hydatids were found., of the size of grapes, in the cortical substance
of the hemispheres of the brain, and one in the right corpus striatum.
A tubercle of the size of a hazelnut was found in the right hemis-
phere of the cerebrum, the patient having exhibited no cephalic
symptoms of disease during life. Fatal cases of puerperal fever,
accompanied with icterus, left no traces of any affection of the liver.
Union of the pia mater with the substance of the brain resulted in
epileptic convulsions, loss of memory, and finally death ; hypertro-
phy of the cerebrum was accompanied with loss of the. sense of smell
and taste, while that of sight was little disturbed. Cancer and tu-
bercle were found together in the same individual. These two
diseases are thorefore considered not incompatible. Fatty liver
and fatty spleen were found following secondary syphilis. An evi-
dently increasing frequency was obseiwed in reference to the last.

We select a few of the numerous observations made at the
Wieden Disti-ict Hospital, and interesting among these was a case
diagnosticated as phrenic neuritis, which, with extremely violent
and painful hiccough, sensitiveness of the epigastrium, and pain in
the points of attachment of the diaphragm, appeared in a young
man, twenty years old, of good constitution, who had t\\ice before
suffered from the same affection, but of a milder form. Sulphate of
quinine, in doses of five grains, morning and night, was exhibited
with the most favorable results. The attacks, which at first seldom
i ceased longer than a few minutes, became from day to day milder
and rarer. They wholly disappeared on the sixth day of treatment.
Ulcerations of the larynx sometimes followed typhus; once, also,
there was observed an extensive crop in the summit and posterior

N.S. VOL. XIII. >'0. VII. 27

420 Abstracts of Reports of Hospitals^ Dispensaries^ &c. [July,

walls of the throat, and posterior nasal fossa?. Durins: the cholera
epidemic typhus cases ran their course with intermitting paroxysms.
In one case, cystitis developed itself after cholera, followed by an
extensive furunculnr eruption, and death from exhaustion A stub-
born tertian, the pai'oxysms of which were accompanied by vomit-
ing and diarrhoea, and which had been battled in vain for two
two weeks, at honie, was cured in the Hospital by the use of cor-
responding doses of quinine and opium. A case of Bright's disease
terminated with symptoms of cholera. In the body were found
haenorrhagic ulcerations of the stomach, and a pleuritic exudation.
A drunkard liv^ed twelve days after an apoplectic attack, althouirh
a clot of the size of one's nst was found in his brain after death.
Veratria in increasing doses was successfully ernployed in facial
neuralgia.

The reports of the Lyins: in and Foundling Hospitals, including
those of institutions for vaccination, deserve every acknowIedgir)ent.
We here also make but a few selections, since the most important
results, aside from these, are published in the yearly report. An
accurate preliminary investigation into the etiology of the pueiperal
processes, in the first named, would be desirable, since with some
fluctuations in regard to the number of cases, they disappeared en-
tirely at no time during the year. Not less desirable would be an
accurate account of their course and treatment. The lying-in
wards differed strikingly in regard to the frequency of puerperal
fever. The Foundling Hospitals number alwavs, of out door and
in-door patients, about 15,000, of which from 450 to 500 die month-
ly. The great mortality of the in-patients arises principally from
an3emia, diarrhoea and pneumonia. The frequently prevalent oph-
thalmia neonatorum is now successfully treated by applications of
pounded ice; in its further progress bv solutions of lapis divinus
and sulphate of zinc; and in ulcerative conditions by solutions of
corrosive sublimate and tr. opii. The not uncoinmon cancrum oris
of children was treated by muriatic acid washes for the mouth, slices
of lemon, and by touching the gangrenous spots with tr. opii.; and,
indeed, with better success than bv glvcerine, which has been re-
commended and employed in Children's Hospitals, in this affecfion.
The experiments made during the course of the vear, with original
vaccine lymph, were twice successful, but the development of the
vaccine matter so procured is alwavs slower.

In the report of the Roval Asylum for the Insane are cjiven items
of etiological interest, and also pathological results in a field hitherto
truly barren. The prevailing type of disease is mentioned for each
month, and several prom'nent cases of disease are accurately de-
scribed. In reference to the former, the abuse of alcoholic drinks,
whereby, through impj'egnntion of the nervous centres by aldehyde,
arise hallucinations of sight and hearing, furthermore, sexual ex-
cesses, and finally, in women, menstruation and lactation, as well as
climacteric periods of life, all play important parts. Post-mortem

1S57.] Ahstr acts of Reports of Hospitals^ Dispensaries^ &c. 421

examinations frequently disclosed chronic hydrocephnlus; atrophy
of the brain; more or less extensive softeninG^, especially in demen-
tia; then hardening of the brain, nnd fmally loss of elasticity and
ossification of the arteries and maltoi-niations of the heart. It is
remarkable how other diseases are sometimes obscured by insanity;
for instance, in a case of cholera, where in life the usual symptoms
of vomiting and diarrhoea were not developed, and yet the body
phiinly showed the cause of death to have been this disease. In
two other cases, during the course of the cholera, there was observ-
ed a striking improvement in mental activity; and in one case of a
teacher, twenty-six years old, the mental disease completely ceased
upon the development of pulmonary tuberculosis. In a similar way,
a previously existing epilepsy wholly ceased with development of
pulmonary tuberculosis. Aside from other intermittent forms of
mental disease there was observed, following a case of cholero-
typhus, a periodically returning mania of a monthly type; and in
the case of a woman, already for the third time pregnant, melancholy
and a suicidal pi'opensity were noticed each time in the sixth month
of her pregnancy. A wet nurse became insane through anaemia,
from nursing three children at the same time. In the case of
an insane patient refusingr food, instead of using the usual feeding
tube, nourishment in a liquid form was sought to be introduced
through the nose by the aid of a spoon only. It did not, however,
succeed.

Ilich in materials, also, are the reports of the Elizabethinerinnen
Infirmary, since in addition to the prevailing type of disease, its course
and treatment, they contain accounts of prominent cases. General
and local blood-letting was employed in this institution in the graver
inflammatory diseases more ftequently than in other hospitals, and
indeed with very average satisfactory results. At the Wahrincjer-
gasse House of Refuge, in Vienna, the more stimulating method in
the treatment of cholera, by the use of camphor, sweet spirits of
nitre, and tincture of juniper, was found far more beneficial than
opium and other remedies. A periodically recurring chorera was
here observed.

In the reports of three Penitentiaries which came to hand, scorbu-
tus forms a subject worthy of especial attention. The remark of
the physician of these institutions. Dr. Lunzer, appears to us de-
serving of much consideration. Reported observations have taught
him that when scoi-btitus accompanies tuberculosis, pulmonary af-
fections, and especially 'the symptoms of tuberculosis, recede; fur-
thermore, that scorbutus does not appear so severely in an individual
having tuberculosis, as in one previously healthy ; and that not rarely
after the cure of the scorbutus in such cases, the tuberculosis appears
to be cured. Hence scorbutus is good as a curative measure in
tuberculosis a proposition which needs for its acceptance further
unbiassed observations. In connection with the Penitentiarv Hos-
pital was mentioned a case of extremely ichorous eczema, which,

422 Abstracts of Reports of Uospitals^ Dispensaries^ &c. [July,

having withstood for a month the use of a soap of glycerine nnd
carbonate of potash and lunar caustic, finally yielded completely
through a month's continuous use of collodion.

Only five reports were given in upon epidemics prevailing in
Austria, outside Vienna, during the course of the year, of which
four were upon scarlatina and one typhus.

The first of the scarlatina epidemics appeared at Himburg, in the
fall of 1855. There were 32 cases and 3 deaths of girls; no boys
died. Two of the fatal cases terminated in the first stage from con-
vulsions, and the other upon supervening anasarca. The source of
the disease could not be established, since no scarlatina was present
in all the neighborhood.

The second occurred in the four cantons of the ITangsdorfer d's-
trict in the last month of 1855, and lasted until the 20th of February,
1856. There were 277 cases and 43 deaths. Many milder cases,
however, did not come under the notice of the physicians. The
fatal cases were also most numerous aiuong girls. Death was caused
by inflammation of the internal organs, especially the membranei
of the brain, then through inflammatory discharges from the ears,
and finally through anasarca. Jt is worthy of mention that scarla-
tina patients lying in the same room with cholera patients, were
nevor attacked by cholera. The march of the epidemic in the four
cantons was plainly from East to West. Its oriiiin was not known,
and its spread was not always ascertained to have been ihrtmgh
contagion. Belladonna was shown to be useless as a prophylactic,
and the results from rubbing the body with fat bacon appeared
problematical.

The third epidemic of scarlet fever appeared at Mannersdorf, In
the district of Bruck, on the Leitha, and lasted from April to July,
1856. Out of 69 cases 11 died, a part thi-ough angina crouposa,
and a part from pneumonia and atrophy of the brain. The sick
were most numerous at the beginning and end of the epidemic.
There occurred also cases without the rash, followed by desquama-
tion of the cuticle and anasarca. Among the sequelae were observed
ulcerations of the mouth, and discharges fiom the ears. Tepid baths
were found beneficial in cases showing albuminuria.

The fourth epidemic appeared at Hainburgand Hundsheim, last-
ing in the first from the end of April to August, 1856, and fuinishing
96 cases, of which 26 were fatal. ^^and in the second 2tt cases, of
which 5 were fatal. The mortality among girls was also in this
epidemic greater than among boys. Suppurations of the glands of
the neck, ulceration of the mouth and tongue, discharges from the
ears, and ophthalmias accompanied and followed the disease. Bel-
ladonna was useless as a prophylactic in this epidemic.

The remaining report upon the fifth epidemic, that of typhus, at
Zistersdorf. presents nothing specially worthy of mention. [Ameri'
call Medical Monthly.

1857.] Lecture on Chronic Orchitis. 423

Lecture on Chronic Orchitis. By Professor Nelaton. Transla-
ted from the Gazette des Ilop.taux, (Paris.)

The patient avIio occupies bed No. 27 in the male ward, is
affjcted with a longstanding and chronic disease of the testicle.
On account of the obscure phenomena attending this case, it pre-
sents many points which render the diagnosis somewhat ohscure.

By reviewing the symptoms which, characterize the different
diseases of the testis, this case will appear to be curious in itself, as
illustrating one of the rarest and least known of these affections,
viz: chronic engorgement of the testis.

The patient is aged twentj'-six years; he appears to be power-
fully made: in fact, his profc^ssion, that of a mountebank, requires
considerable strength; for his principal feat consists in ascending
an incline plane on a large ball weighing twenty-five or thirty
pounds.

About four years ago he contracted a gonorrheal affection, and
we here mention it in order that it may be taken into account with
the other attending circumstances. The gonorrhea lasted about
four weeks, and was followed by inflammation of the epididymis.
Since this time the testicle has remained much larger than before,
and the patient, though not again affected with gonorrhea has,
nevertheless, constantly felt some pain in urinating: afterwards,
this pain was greatly increased, and several times the act of micturi-
tion was followed by a few drops of blood. About a month ago,
an exiernal injury was superadded to the previously existing-
disease. It appears that in the establishment to which he belongs,
some animals are also exhibited. While attending on an Ostrich,
he received a severe kick from this bird in the hypograstric region.
Kow a kick from such an animal would certainly give rise to
severe accidents, and the patient attributes to this cause an exa-
ceibation of his disease. He adds that about a year ago, he fell
and injured his scrotum. All of this must be taken into consider-
ation when considering the nature of such an obscure organic
affection ; that it is obscure will appear from a description of the
diseased part.

The right testis, which is tlie only one affected, has increased
in size, but not very materially, being about the size of a hen egg.
On first examination it a};pears smooth, but when carefullj^ felt,
it can be readily found to- be somewhat irregular in shape. Nor
is its consistency perfectly uiiiform, being hard in some points,
and soft in others, but the limit between these two conditions is
not distinctly marked, and the most careful investigation does not
reveal any specific point of engorgement. Both in the epididy-
mis and in the testicle itself, these indurated ]>laccs can be felt.
In front, the bo;ly of the organ presents a well marked flnctuatino-
point, which apj^ears to be owing to a fissure in the tunica vatrin-
alls. The spermatic cord retains its natural consistency, and i;3 not

424 Lecture on Chronic Orclnlis. [J^lj*

at all iiifiltrated or enlarged. The sensibility of the testis is great-
ly increased, and the slightest compression produces great pain.

Now, what can be the nature of an engorgement which has
lasted three years and a half? This is ceitainly not the oidinary
course of gonorrheal orchitis. There is no doubt that this species
of orchitis existed at the beginning, but it cannot be maintained
that it could have persisted all this time.

Perhaps this might be a case of hypertrophy of the testis: for
the symptoms of the latter have some analogy to those which are
presented by this case. But we must remember that hypertrophy
of the testis generally affects both sides at once, and moreovci,
the organ is uniformly increased in size! Besides, hypertroph\
of the testis is exceedingly rare in this country. By my reseai'ch-
es on the subject, I have ascertained that this affection is seldom,
if ever seen in France, whereas it is very common in the other
hemisphere, and especially in South America. By looking over
the published records on this subject, we find fifteen cases in that
part of the world to one in Europe ! Alone, this reason would not
be sufficient, but combined with the physical appearances, we
must unhesitatingly reject the supposition of hypertrophy of the
testis. AYe must remember again, that thelatter disease generally
manifests itself in the period of growth, in the transition fron
youth to manhood.

Could this be a tubercular affection of the testis? Nothing in
the examination of this 3'oung m.an, either in his general condition
or in the particular diseased part would lead us to adopt this sup-
position ; his robust frame, his herculean strength at once refut '
the hypothesis, his general health is excellent, he presents no
symptoms whatever of the tuberculous diathesis, neither the cough
nor the expectoration, no sign whatever. Look at the life which
he leads, marked by excesses of every kind, yet he bears it all very
w^ell. If it were not for the pain and difficulty in urinating, his
disease would not affect him in the least. The local appearance
of the organ is also very different from that presented by the
tuberculous testis. The latter disease affects two forms which are
entirely distinct: The tuberculous deposits are either, 1st. i\ccum-
ulated in isolated masses of a certain size, and situated in different
parts of the organ; or, 2d. Of miliary granulations in the sub-
stance of the organ : these granulations of about the size of a pin
head, accumulate in enormous quantities, and by their increase
may gradually give to the organ an exagorerated volume.

Could we have here either of these varieties? We can at once
reject the latter form : for this kind of tuberculous testis generally
develops itself with extreme rapidity, like galloping consumption,
which is also characterized by the appearance of innumerable
quantities of tubercles in the miliary state.

This rapid and abundant growth of tubercles is very rare, but
when it does happen, it is very apt to mislead the observer. It

I

1S57.] Lecture on Chronic Orchitis. 425

will generally be taken for a case of acute orchitis, and some cla3'S
may elapse bjfore it assumes its distinguishing characteristics.
But in this case the engorgement has lasted three years and a half
so that this form of tuberculous degenei'ation is entirely out of
question. Could it be the lirst variety? Certainly not! For
when we meet those lai-ge turburcular masses in the testis the
health of the patient is generally far fj'om good; and it is very
rare to see persons subject to this disease having sucti a good con-
stitution, or retain the ph\'sical appearance of this man. Moreo-
ver, these turberculous masses would not remain three years and
a half without softening, suppuration and ulceration. For these
reasons we cannot hesitate to nject the idea of a tuberculous aft'ec-
tion, in the same way that we eliminated the blennorrhagic cause
and hypertrophy of the testis.

"We have still three alternatives left.

It could be either a syphilitic affection, or an encephaloid tumor
or chronic orchitis. Let us now examine these different morbid
species.

In the first place would it be possible for this to be a syphilitic
manifestation ? It does not present the symptoms of the syphilitic
testis.

In those tertiary forms of venereal disease which affect the testis
there is generally some effusion in the tuniisa vaginalis; in fact,
the universality of the presence of liquor is such as to amount to a
law ! Moreover, when the testis is examined, either with the liquid
when tlie effusion is not too great, or after puncturing, if the quan-
tity- of liquid require this step ; then it will be ascertained that the
surface of the testis is n^ugh and uneven on account of numerous
small elevations about the size of a grain of wheat, which are
deposited all over the surface of the tunica albuginea. And then
the testis presents that shape which is characteristic of the venereal
affection ; the testis being completely surrounded and overlapped
by the epididymis, something like an egg-cup, or an acorn in its
cupula ! But in this case we have none of these symptoms, neither
hydrocele, nor uneven surface, nor enlargement of the epididymis.
And, moreover, it is extremely rare to see a syphilitic aft'ection
remain confined to one testis during this space of time ; for gener-
ally after four, six or eight months, at the fathest, the other
testicle will become affected in the same way. There is another
sign which is very important. You will observe that in the tes-
tiary form of s^qjhilitic testis, this gland loses its peculiar sensibili-
ty ; and the patient can bear an amount of compression which in
the healthy slate would be utterly impossible. In fact, 3-0U would
be astonished at the degree of compression which can be exercised
on the gland without giving the patient any uneasiness. But here
we have seen the sensibility of the diseased organ is greatly exag-
gerated. The man himself says he has never had any venereal
symptoms, either primary or sccondarj', and this is certainly

426 Lecture on Chronic Orchitis. [J^tyj

not a tertiary manifestatiou. Not that we should put any great
fiiith in these assertions on the part of patients as a general
thing, but wlien tliej confirm tlie results of analytical investigation,
it is well to give them some little weight in the pathological scale.
We can therefore affirm that this is not a venereal affection.

Is it a cancerous degeneration ? This is certain possible at
first sight. But this disease generally progresses with exceeding
rapidity. An encephaloid tumor, will, in tliree or four months,
attain four times the size which this case has reached. This fact
alone, should make us reject the supposition of an encephaloid
affection ! Moreover, these tumors are more uneven and nodula-
ted than the present case, and are often accompanied by thicken-
ing of the cord with engorgement of the neighboring lymphatics.
"We now come to the last supposition.

Is this a case of chronic orchitis? And first, what is chronic
orchitis? This is one of the most obscure questions in pathology,
and on which the latest writers still leave many doubts and dis-
crepancies. Look at Curling's treatise on the Testis, and you will
find that what he describes as chronic orchitis, is nothing more
than a turberculous disease of that organ. The principal anatom-
ical character of this form of inflammation, says he, is the deposi-
tion of a peculiar yellowish product, homogeneous in appearance
and devoid of any organic element. He describes two forms which
this abnormal product affects, and these are nothing more than the
two varieties which we described above as appertaining to the
tuberculous affection. He discusses the primitive seat of this
disease, and concludes that it originates in the tubuli seminiferi.
He adds that in one case where he excised the diseased organ, the
epididymis was also considerably affected, that the globus major
was filled with a soft though concrete mass, filling an irregular
sinus into which opened a fistulous communication. The globus
minor contained a similar deposit, but without external opening.
He has, moreover, illustrated his description, by a good engraving.
The author himself, foresees the objections which might be raised,
and says that this is not tuberculous matter, but something entire-
ly different! He admits that the term of yellow tuberculous
(leposite has been api)lied to this disease, but he condemns the
term because it is apt to mislead one as to the true nature of this
affection. But with all this, his description of the case is a faithful
picture of the tuberculous affection of the testis; for he speaks of
the diseased organ of the softening of the tuberculous matters
retaining, though he reprobates the expression ; he describes the
fistulous communications which are so characteristic of this disease,
and also the adhesions which take place between the testis and the
scrotum.

Unfortunately Curling has not confined his description to the
tuberculous affection of the testis; he has mixed up with it the
symptoms of the testiary venereal affection, viz: the syphilitic

1857.] Lecture on Chronic Orchitis, 427

testis. Thus he speaks of loss of sensibility in the organ, and efFu-
sion in the tunica vaginalis.

But this is not all he also combines with it a description of
what has generally been designated under the name of i'ungus of
the testis, this being an aft'eetion in which the inlianmiatoiy pro-
cess causes the rupture of the tunica albuginea, and consequently
protrusion of the vasa senimiferi; the vegetation which thus takts
place externally producing the fungoid growth. So that in his
description we find a little of every thing: tuberculosis, syphilitic
testis and fungus of the same organ, all of which, certainly tend to
obscure the question instead of elucidating the subject matter.
Thus it is that in all which has been written on chronic orchitis,
there is nmch confusion, and nothing characteristic of the disease.
Nevertheless, I still believe in the existence of this disease, though,
it is undoubtedly wQry rare. In these cases the testicle becomes
inflamed, and an exudation of plastic lymph takes place, quite dif-
feient fiom tuberculous degeneration, 'ihis infiltration deposit
may be absorbed without suppuration, but on the other hand it
may continue during a considerable time, as we see in inflamma-
tion of the epididymis, and then the whole organ continues in a
state of permanent engorgement.

I think that the case under consideration is an example of this
kind. The inflammatory action has been kept up in the testicle
by the irritation of the urethra, and this state has finall\^ brought
on the chronic engorgement of the gland which is cognizable by
the touch.

In relation with this subject, a single fact has been observed
among those patients who are affected with this disease. The
spermatic secretion is sometimes altered in its physical properties ;
it assumes a reddish or roseate hue, resembling gooseberry jelly.
Tiiis circumstance being somewhat curious, I have attentively
observed some of these ]iatients, in order to see the result of the
disease ; I have been thereby enabled to ascertain that the change
of color in the spermatic secretion may continue duiing three or
four months without preventing sexual intercourse; then it grad-
ually disappears, and the sperm resumes its normal appearance.
Kor does this change affect their virile powers, for some patients
wdio did not renounce their marital rights, have begotten children
while their seminal fluid presented this abnormal condition. It
has been said that children begotten under those circumstances
generally present some peculiarities, such as red marks on the
skin, etc. But these are idle stories entirely devoid of foundation.
I have made some investigation in order to ascertain if this cir-
cumstance has been observed by other writers, and I found that
Sweidour met with some patients who presented this peculiaritv,
and they were much frightened bv the circunistance.

What is the treatment to be followed in this case? The first
indication is to remove the cause of engorgement, viz: inflamma-

423 Glycerine as a Topical Therapcuikal Agent. [Jiilj,

tion of the urethra. There does not appear to be any stricture,
only a little pain in micturition. The bhidJer is not much affect-
ed, the urine presents no abnormal di-posits.

Leeches have been applied to tiie perineum in order to diminish
the local engorgement; we have also given him tepid baths to be
repeated daily. After that, the treatment should be continued by
revulsive a])plications, and among these the Tartar Emetic oint-
ment is to be preferred to Canthaj'ides, for the latter might act oa
the bladder, and produce inflammation of that organ.

We can vqtj confidently expect that this course of treatment
will relieve the inflammation of the urethra, and consequently tlK5
chronic iri-itation of the testicle which is dependant upon it. \^Kew
Orleans Med. Aeivs and Gaz.

Upon ilie Use of Glycerine as a Topical Therapeutical Agent. By
M. Lu ro\. from the Comptes liendus de la Suciete de Biologie.

Glycerine is an unctuous liquid not susceptible of evaporation.
Although it has the appearance of an oil, it has the physical char-
acteristics of a svrup; it is also soluble in water. By its first two
properties, it prevents, as well as cerate and other fatty substances,
the dressings from adhering to wounds. By its solubility in water,
an extremely important quality, it permits wounds to be kept clean
without the necessity of washing them a great deal. Indeed wounds
dressed with glycerine, never have those crusts of pus and cerate
ibnned over them, which can only be raised by means of a spatula,
and with pain to the patient. It is ascertained, too, by observation
that it is seldom necessary to wash the wound, all that is needed is
to cleanse it gently by means of a sponge.

We shall see that glycerine evidently modifies the abundance oi
the suppuration, and again, being a very hygometrical substance,
it keeps the parts in a constant state of humidity and prevents the
products of exudation fiom becoming dry and hard. To obtain
this it is indispensable to employ the glycerine in abundance, and
to saturate the charpie and the perforated linen with it, while in
order to avoid the inconvenience arising from the use of the cerate,
when the latter is used, the dressings are hardly covered by it.

It is asked if glycerine preserves wounds from the contact of
nir as well as fatty bodies. The action of hitty bodies in this rela-
tion, is very imperfect ; they cannot cover a bloody surface. Glycer-
ine, on the contrary, from the quality the reverse of this, comes
more directly in contact with the denuded part. It protects it
against the air as well as a wet cloth or a cataplasm. It softens
the charpie more readily, and is absorbed better, and with it the
exuded fluids which it ddutes, land which the cerate under the same
circumstances cannot do, for it rather opposes the absorption of the
vvaterv fluids.

I

1S57.] Glycerine as a Topical Therapeutical Agent. 429

Fatty bodies, preventing the evaporation ofllie humors upon the de-
nuded surfaces, or even upon the skin, keep up a high temperature.

lilycerine, liom its atfinity lor water, also arrests evaporation by
retaining the exuded liquids, and accomplishes equally well this
object. To prove this, it is only necessary to cover the lips cracked
by cold, with glycerine; a decided heat is soon felt in them, even
when you are in the air, and the pain is greatly relieved.

Glycerine then, from its peculiar physical properties, triumphs
over fatty bodies as a dressing of wounds.

But the advantages of glycerine in the dressing of wounds are
not thus limited. It possesses, independently of the qualities we
liave just indicated, a very remarkable topical action, which should
seriously interest the surgeon. To show this action, the author
points out the different cases in which it has been applied, in the
service of j\r. Demarquay at the St. Louis Hospital, limiting himself
simply to announcing generallvits salutarv effects.

Tlie first elVect of the application of glycerine upon a denuded
surface is a slight pricking, which sometimes produces an itching
sensation, but which soon passes off, and is never complained of by
the patient.

In simple ordinary wounds, accidental, or surgical, and exempt
from complications, glycerine employed like cerate has no very
manifest action. It conducts to a cure quite as rapidly as most of
the neutral topical agents, and is only remarkable in its action by
the sl:ght suppuration which ensues, which, however, is one of the
essential and general qualities of glycerine. Besides it has been
observed that it never produces an exuberance of unhealthy granu-
lations.

In the different degrees of burns, glycerine is of extremely easy
application, and has also a very efficacious action. We have seen
patients upon whom cauterization had been employed for white
swelling, sciatica, &cc., object to the glycerine dressing because it
healed, as they said, too quick, and did not draw enough.

Jn the diptherite of wounds, in that bad aspect which wounds
sometimes takeon in Paris Hospitals duringthe first few days, dress-
ings with glycerine are of essential service. Instead of assuming
and preserving a grayish diptheritic appearance, they look red, and
there is no exuberance of granulations.

In Hospital gangrene it proved of most marked benefit in one
case following an extensive burn, in which quinine, lemon juice,
moho-hydrated nitric acid, and the cautery had failed. It also suc-
ceeded in two other cases occurring in the hospital at the same time.

In deep wounds, in sinuous abscesses, glycerine was also used.
It was introduced by means of a pledget of lint, or as an injection.
Thesuppuration wasdiminished and the period of cicatrization short-
er. Injections were made into cold abscesses; into abscesses by
congestion, and into abscesses in contact with inflamed bones, and
the happiest results attended its use.

430 Case of Late Dentiiim. [July,

Glycerine also succeeded admlrabl}- in tlie dressin^c of ulcers;
chronic ulcers, varicose, grangrenous, &c., cleaned rapidly under
its influence, the unhealthy granulated surface gradually filled up,
and cicatrized. Rest is always a powerful and necessary auxiliary.

Glycerine has no [)roperty antagonistic to the specific nature of
chancres, but their surfaces ra[)idly become clean and take on a
good aspect from its use, and although there are no positive data to
be given upon the specific action in this class of ulcers, yet there is
no dressing so convenient for chancres of the prepuce as lint satura-
ted with glycerine.

This topical ajrent has also been employed in diseases of the neck
of the womb. MAI. Trousseau and Aran have ti-ied it, but never
with very satislactory results. M. Demarquay has reaped great
advantages from its use in simple or granular ulcei'ations of the
neck. ]n chronic cases, or wh^re the neck was large and tumefied,
the different caustic s were used, and among others, the cautery.
Then the glycerine employed as a dressing, modified essentially the
quantity of the secretions, which ordinarily follow the fall of the
eschars.

It has also been employed in vaginitis, but the results are so in-
conclusive that they are not reported.

From this review of its application, it follows that the topical
application of glycerine diminishes the abundance of the suppuration.
It possesses a styptic influence, difficult to determine, but which by
this virtue changes an impure and complicated wound into a simple
wound, and consequently hastens its cure. lAmerican Med. Monthly.

Case of Late Dentition,

Dr. Deutsch w^as called in consultation to a man, 84 years of age,
who for some weeks past had been the prey of intense pains in the
head and face, the origin of which he had at first attributed to sever-
al decayed molars, the crowns of which were desti'oyed. There was
very great swelling of the neck and lace, abundant discharge of
saliva, and difficulty of deglutition. But the most remarkable thing
was the appearance of several new teeth. Thus, somewhat in front
of the incisors of the upper jaw, four new^ incisors were found irreg-
ularly disposed, two in hke manner presenting themselves in front
of the two middle incisions of the lower jaw. New canine teetli
also appeared in the upper jaw, between the incisors and the canines.
In the lower jaw the new canines sprung up from below and in front
of the old ones. The two bicuspids in each jaw and on both sides
were pressed backwards by new bicuspids. With respect to the
second molars of the upper and under jaw of the right side, and of
the. upper jaw of the left side, the new teeth appeared in the midst
of the decayed molars without displacins these, and in such a man-
ner that the remains of the old toothwalls formed partial envelops

1857.] Treatment of Cancer, 431

for the new. No new teeth were founrl corresponding to the first
niohirs, nlthou^h the old ones were carious, or to the second niohir
of the lower jaw of the left side. All the third molars were broken
awny. All the old teeth were so fii-n)ly placed as to be removable
only by force. The new teeth were very fine ones. From the
time of their appeainnce the patient's suffering ceased, althoup^h the
effects of this continued some time to be apparent. A skillful den-
tist gradually removed all the old teeth, and those of the new which
had grown out amidst the old were removed with these latter.
Some months afterwards, the new teeth had assumed a very orderly
position, the separations between them being very slight. The
patient does not remember losing teeth at the usual period of the
second dentition. The author adds, that in his own case two
molars of the lower jaw, which were extracted in his twenty-fifth
year, were in the course of a year replaced bv two new, 2:ood, and
durable teeth. [lUed. Times and Gaz., from Berlin Med. Zeitung.

Treatment of Cancer by Dilute Solutions of the Chloride of Zinc.

The Medical Times and Gazette (April 25, 1857) contains the
particulars of some cases in which iMr. Stanley has pursued the ))lan
of treating cancers by much diluted solutions of chloride of zinc.
"Their lesults," says the reporter, " certainly prove that the des-
truction and enucleation of an ulcerated cancerous tumour may
be efi^ected by the use of solutions so weak as to be all but painless,
and without necessitating the confinement of the patient to bed for
a single day. Without venturing at present to assert that this plan,
when ])ersevered in, in a great number of cases in various conditions
of health, will be found to be absolutely void of danger, yet most
will doubtless admit that the risk attaching to it will prove to be
infinitely small, far less than that of excision, and that which attend-
ed the use of arsenical pastes. As far as we know, chloride of
zinc, when used in its most rlilute solutions, never causes deleterious
effects from its absorption into the system, nor does its application
ever tend to excite erysipelatous inflammation of the part. An
operation for the removal of a cancer, involving as it does the ex-
hibition of chloroform, a considerable loss of blood, a period of a
week or so in which the patient is feverish and ill, and takes little
food, and subsequently a considerable suppuration, must be granted
to be likely, even in those cases in which the patients recovered
well, not to have exerted any beneficial influence on the subsequent
health. And such indeed is but too frequently observed by those
who follow up their cases after disuiissal.- It is not at all uncom-
mon to find patients who have never regained such health as they
had prior to the excision, although their recovery from its immedi-
ate eflfects may have been as satisfactory as usual. Without, there-
fore, saying anything whatever as to the probability of the return of

432 Belladonna in Incontinence of Urine. [J^^Vj

the disease being greater or less after one or the other method of
removal for as to this we have as yet no facts, and to speculate
would ha worse than useless we may safely assert that the plan
\vhich Mr. Stanley is trying possesses some very important advan-
tages. Nor is it among the least of these that it may be expected
to prove useful in certain cases not well suited for the knife, as, for
instance, where the cancer is deeply ulcerated and borders upon
important parts. In some regions of the body it will be particular-
ly appropriate for it. On the tongue, in the cheeks, on the lips, etc.,
it can manifestly be ussd but ver}^ imperfectly, and will probably
never supersede the knife; while it may be applied with ease and
efficiency to cancers of the breast, or indeed of any well-exposed
surface, and particularly to those of the penis or of the extremities.

" While on this subject we may just notice as an additional fact
a case in which Mr. Hutchinson has been employing a solution of
the strength recommended by Mr. Stanley against a large recurrent
fibroid tumour of the uterus. The woman an out-patient at the
Metropolitan Free, had been twice operated upon during the past
year, but after each the tumour had again appeared and incieased
with great rapidity. At the time the trial of the solution was madt
it had grown' to the size of an infant's head, and filled the uterus,
projecting a little at the open os. The plan adopted was to pass a
small catheter into the middle of its structure, and gradually inject
into different parts about two ounces of the solution (one ounce of
Sir \V, Burnett's fluid to eight of water.) This was repeated every
third day for about three weeks, and had the effect of causing some
fragments of the growth to slough and come away. They were,
however, of but small size when compared with what remained;
and as the tumor went on increasing it was at length desisted from.
No ill symptoms had been caused, although a good deal of smarting
would generally follow the injections." [_Med. News and Library.

Belladonna in Incontinence of Urine.

L. B., arjed 8 years, was admitted as an out-patient at the Hos-
pital for Sick Children, under the care of Mr. Athol Johnson, in
July last, on account of incontinence of urine*. This infirmity had
existed since birth, and she had frequently been under treatment for
it, both in private and at St. Bartholomew's Hospital, without
however, deriving any material benefit. At the time of her admis-
sion, the urine was acid, and nothing particular was observed as to
its composition. She used to pass it frequently in the day, and
usually wetted her bed two or three times rluring the night. She
was treated at first, up to October 29th, with purgatives, alkalies,
and blisters to the sacrum, but without any improvement being
thereby obtained. It may be observed that there was no worms..
At the above date, she was ordered one-eighth of a grain of extract

1857.] Editorial 433

of bellndonnn night and morning^. On November 22d, it is noted
that the child had been (Joing verv well since the use of the belladon-
na, and that she only passed urine in bed about once in a week.
After this, she did not attend regularly ; and on February 11th,
after an absence of more than a month, she again presented herself
in much the same state as at first, the urine being a<xain passed fre-
quently. The belladonna was resumed, and the incontinence again
materially checke(i, especially at night. On February 25th, the
quantity of the drug was increased to one-sixth of a gi'ain ; and on
March 18th, when last seen, she had not passed water in bed since
the previous date.

Beniarks. This case, though it cannot be said to be perfect, in
conseq-ience mainly of the inattention of those who had care of the
child, illustrates forcibly the good effect which the use of belladonna
unquestionably has, in many cases, of irritability of the bladder.
The affection appears to have been congenital ; all kinds of other
remedies had been adopted without effect, and the impi'ovement
f(llowing on the administration of belladonna was as marked as
the relapse which ensued on the omission of the treatment. It is
offered, not as an instance of perfect cure, but as a well marked
exam[)le of the power of the drug over this ])articu1ar symptom.
]\o other effect was observed to follow its administration. [British
Medical Journal.

EDITORIAL A^'D MISCELLAXEOUS.

We here present to our readers the minutes of the 10th Annual Meet-
ing of the American Medical Association, copied from extra sheets of tlie
Nashville Journal of Medicine and Surgery, kindly forwai'ded to us by the
Editors. To allow space for our Original and Eclectic departments, we
have been constrained to leave out the excellent address of Dr. Pitcher, the
retiring President, but hope to give it in a futuie number.

Special Reports. Infant Mortality. It will be seen by reference to
the proceedings, that an unusual member of special committees have writ-
ten after them " No report" " Continued." We may, therefore, expect the
Dext volume of American Transactions to be one of small size, and we do
not altogether regret it, as, from tlie abstracts, read in our hearing, of several
of the forthcoming reports, we have every reason to expect that quality

II more than compensate for any deficiency in quantity.

The repojt of D. Meredith Reese, M.D., LL. D., of New York, on the
momentous subject of Infant Mortality, was decidedly the report of our
last meeting, and will go far to vindicate the next volume of our Transac-
tions from the charge, made by the British Reviewers, of being " a big

434 Editorial and Miscellaneous [J^^^Jj

book with nothing in't." Dr. Reese's conclusions are based upon careful
statistical observations, and the developments are truly startling. lie lias
examined the subject in all its bearings, from the causes which are inimical
embrionic as Avell as extra-uterine infs^mtile exist^ce, and his report,
when published, must necessaiily awaken attention in a field of observation
comparatively new, and heretofore very much neglected. We hope that
this report will be given to the profession in a separate form, in order that
it may fall in the hands of a o-reater number, than the readers of the
Transactions.

Dr. R. D. Arnold, presented an abstract of a highly creditable report from
Dr. J. F. Posey, of Savannah, which we hope to notice more fully hereafter.

Voluntary Contributions. The report of " A new principle of Diag-
nosis in dislocations of the shoulder joint," by our colleague. Professor L.
A. Dugas, recommended as first among the voluntaiy contributions, we.
hope to present shortly to our readers, together with the artistic illustra-
tions furnished in photograph by the reporter to the Association.

AMERICAN MEDICAL ASSOCIATION.

TENTH ANNUAL SESSION.

Nashville, May 5, 1857.

The Association met at 11 o'clock, in the Representative Hall of the
State Capitol, the Piesident, Dr. Zina Pitcher, of Michigan, in the chair,
and upon his right. Dr. W. K. Bowling, of Tennessee, one of the Vice-Pre-
sidents. Dr. AVm. Biodie, of Michigan, and Dr. R. C. Foster, of this city,
Secretaries, were present.

The meeting having been duly organized, the first business in order was
stated by the chair to be the reception of the report of the Committee of
Arrangements.

Dr. C. K. Winston, chairman of the Committee of Arrangements, on be-
half of tliB committee and of the medical profession of the city generally,
extended a sincere and cordial welconje to the members of the Association,
in a few pertinent and appropriate remarks, as follows:

Mr. President and Gentlemen of the American Medical Association :

This, I believe, is the Tenth Annual meeting of this Association, As ohairman of
the Committee of Arrangements and Reception, I am charged with the agreeable
duty of welcoming you to the State of Tennessee and the City of Nashville I regret
that I have not language to express this sentiment with sufficient cordiality, louly
add, gentlemen, in common phrase, "You are more than welcome."

You are the representatives of a profession, distinguished alike for its antiquity,
its scientitic attainments, and its usefulness. It constitutes the true link between
science and philanthropy science and philanthi'opy, moral, intellectual and ])]iysic-
al. You come from every portion of this glorious republic from the Kennebec to
the Rio Grande from orange groves and golden sands from mountains clad ia
eternal snow, and valleys smiling in perpetual verdure. You come not for pur|")08e8
of self-aggrandizement or personal ambition, nor yet to advance the schemes of par-
ties or stir up the antipathies of sections. " You know no North, no South, no East,
no West;" but you come as a company of philanthropists, a baud of brethren, that
you may pour the acquisitions of another year into a common treasury, kneel side
by side at a common altar and drink the living water as it gushes from a commoa
fountain. Y'ou have come to maintain the dignity, to elevate the ensign of a pro*

1857.]

Miscellaneous. 435

fession, to which you have devoted your lives, and to which you have linked your
fortunes.

You are the cultivators of a profession eminently progressive, ndmitting to the
fullest extent the spirit niid genius of enterprise. So much may not be so fully said
of others. Who could expect at this or any otlier day, to embellish the Conmienta-
ries of Blackstone, or improve the pleadings of Chitty, or re-poise the scales of jus-
tice? Where are the men with commissions never so divine, who would attempt to
re-cast the logic which made Felix tremble, or adorn the doctrines of justification by
faith? Who hopes now to shed additional light on the pathway to the skies, or sing
in strains more immortal than the triumphs of tlie cross? Not so with Medicine.
Youi-s is a rising orb magnificent in its proportions while others have reached the
zenith, youi-s has but begun to mount the heavens while others have begun to
fade, yours knows no eclipse nor decline. You revere the names of Hippocrates
and Sydenham, of Brown and Cullen, with a host of others; you treasure up their
maxims, and admire the genius with which they struck out new truths, but you
acknowledge no master, you fall down at the feet of no Gamaliel. You have come
to the day of free thought, of free investigation and free speech. You call in ques-
tion the most hoary, as well as the most recent fact, and you are daily revealing ia
floods of light, principles hid from the foundation of the world.

You are eminently the students of nature. While others may be led along dubi-
ous paths by mortal pedagogues, your teacher dwells in the realms of eternal light,
and guides witli hand unseen and unerring to essences and first causes. The forma-
tive chrystal and germinal dot are alike transpai-ent before you. You are taught
the mysteries of the living principle; the scalpel and retort are your companions^
while you revel in the wonders of the microscopic world. You understand, some-
what, the laws by which a mote or a mountain is formed, a monad or a man is
made. The spear of grass which lifts its head in the distant solitude, the lordly oak
and imperial cedar, instruct you, while air, and earth, and sea, with the creeping
multitude, yield treasures at your command.

You are the veterans of a thousand battle fields, not of mortal strife where man
meets man in sanguinary conflict; but where a secret and impalpable foe a tyrant
who has reigned from Adam till now disposes his secret forces and directs their
deadly shafts. When others have turned back affrighted and aghast, you, single-
lianded and alone, have met " the pestilence which walketh in darkness," and the
destruction *' which wasteth at noonday," despoiled them of " the armor wherein
they trusted," and have driven them ignominimis, from the field.

Were the victories which you have won, the conquests which you have achieved
known, you would be crowned Avith laurels more unfading than those which en-
twined the brows of Greek or Roman conquerors. g

But more and better than all, you are the lovers of your race, the friends of hu-
manity. Scattered about all over this happy land, you emphatically "go about
doing good." Your hearts beat in unison witli human woe your ears are open to
the cry of distress, whether it come from hovel or palace you *' wipe away the
orphan's tear and cause the widow's heart to sing for joy," upon your heads daily
descend "the blessings of those who were ready to perish."

To such a body of men thus actuated, thus coming, we extend a cordial welcome.
We feel honored by your presence, and expect to be improved and elevated by j-our
intercourse. We throw wide our doors and invite you to the hospitalities of our
homes, and to the kinder affections of our hearts.

Dr. Winston then proposed that the roll of delegates, who had register-
ed their names, should be read, llie roll having been called, it appeared
that twenty States wore represented.

Upon the suggestion of Dr. C. K. Winston, our venerable fellow-citizens,
Drs. Felix Robertson, John Shelby, and James Overton were made perma-
nent members of the Association.

The following list comprises the names of all delegates, permanent mem-
bers, and members by invitation in attendance during the session :

Cormecticut Charles Hooker.

New Hampshire ^Adoniram Smalley.

N.S. VOL. XIII. NO. VII. 28

4

436 Micellancous. [Jul

New York James R. "Wood, D. M. Reese, Geo. N. Burwell, Alden March, Samuel
St John.

New Jersey Richard M. Cooper.

Pennsylvania R. Duiiglisoii, B. F. Schneck, Casper "Wlster, P. Cassidy.

Georgia Henry F. Campbell, C R. Walton, N. F. l*owers, A. II. Means, Joseph P.
Logan, M. II. Oliver. Thomas S Powell, J. Gordon Howard, R. D. Arnold, Geo. P.,
Padelford, Pike Brown, Jesse Boring.

AlahonnaV^. M. Meniwether, W. P. Reese, A. F. Alexander, S. W. Clanton, W.
JI. Thornton, P. C. Winn, T. Stith Malone, W. J. Bass, G. D. Xorris, J. F. Sowell,
J. W. Morris.

Tennessee Frank xV. Rams^v, James Rodsjerg. R. 0. Currey. B. B. Lenoir, J. L. C.
Johnston, J. M. Bovd, Geo. R.' Grant. T. A. Atchison, S. S. Maviield, J. D. Kellev, T.
L. Maddin, J. 1>. Winston, J. E. Manlove, G. A. J. Mayfield, Richard Owen, W. P.
Jones, J. P. Ford, Robert C. Foster, Jno. H. Callender.'^Jno. H. Morton, A. II. Bucha-
nan, James W. Ilovte, X. C. Perkins, J. Berrien Lindsley. C. K. Winston, Paul F
Eve, W. P. Moore,' Milo Smith, Wallace Estill, B. W. Avent, H. II. Clayton, II. M.
Whitaker, II. B. Malone, T. M. Woodson, A. B. Ewing, Robert Martin, W. K. Bo^vl.
ing, P. S. Woodward, R. F. Evans. Thomas Lipscomb, M. Ransom, J. A. Long, John
M. Watson, W. D. Haggard, Jno. S. Park.D. B. Cliff, T. G. Kennetly, T. R. Jennings.
Ira Conwell, J. S. Burford, W. II. Childress, W. A. Cheatham, J. F. Towns, J. M.
Brannock, B. C. Jillson, P. W. Davis, G. F. Smith, W. D. Senter, J. W. McXutt, R. G.
P. White, J. P. Epperson, S. L. Wharton, T. C. Murrell.

L'tuisiaaa S. O. Scruggs, Robert A. Xew, Cornelius Beard, E. D. Fenner.

Kentucky Samuel Annan, R. W. Gaines, .F. B. Flint, J. W. Singleton, R. J. Breck-
inridge, S.'C. Porter. W. S. Chipley, S. M. Bemiss, L. G. Ray, W.""A. Atchison, K G.
Davis, L. E. Almon, Jno. T. Fleming, C. P. Mattinirby, D. ^\. Yandell.

Indiana \y. II. Byford, W. W\''llitt, Isaac Mendenhall, T. Bullard, N. Johnson.

ILliuois f. C. H. liobbs, A. II. Luce, James M. Steel, E. K. Crothers, T. K. Edmis-
ton, W\ A. Hillis.

Missouri S. Pollak, E. S. Eraser, Jno. S. Moore, C. A. Pope.

Michigan A. B. Palmer, L. G. Robinson, Zina Pitcher, W. Brodie, L. U. Cobb,
M. Gunn, Lewis Davenport, P. Cline, M. D. Stebbins.

/o,^,fl Asa Ilorr, Wm. Watson, D. L. McGugin, J. C. Hughes.

Ohio Henry F. Koehne, J. M. Mosgrove, B. S. Brown, D. Ferris, A. W. Munson.

Wisconsin Mii\^ McKinley, J. K. Bartlett.

South- Carolina?.. R. Henderson, M. S. Moore, R. W. Gibbes, R. S. Bailey.

Mississippi F. B. Shuford, J. S. Cain, J. T. Lowe.

Arkansas F. Grundy McGavock.

After a customary recess of fifteen minutes, the Association was called
to order. The State Delegations then reported their choice respectiyely of
delegates to serve on the Nominating Committee, which was constituted
as follows:

Connecticut, Chas. Hooker; Xew Hampshire, A. Smalley; Indiana, W. W. Hitt;
Wisconsin, J. K. Bartlett; New York, Jas. R. Wood; Michigan. A. B. Palmer;
Missouri, J.S.Moore; Illinois, T. K. Edmiston ; Kentucky, R. J. Breckinridge;
Arkansas, F. G. McGavock; Ohio, B. S. Brown; South Carolina, R. W. Gibbes;
Alabama, W. P. Reese; Mississippi, F. B. Shuford; 2sew Jersey, R. M. Cooper;
Louisiana, S. O.Scruggs; Pennsylvania, P. Cassidy ; Geoigia, Thomas S. Powell:
Tennessee, J. B. Lindsley ; Iowa, Asa Ilorr.

On motion of Dr. Hooker, of Connecticut, it was rosoJyed that the Pres-
ident Dr. Pitcher, be now requested to deliver his annual addiess.

[This excellent address we will present to our readers in a future number.]

On motion of Dr. Flint, of Ky., the thanks of the Association were ten-
dered to the President for his very able address, and the same was referred
to the Committee on Publication.

The chairman of the Committee of Arrangements announced that the
sessions of the Association would be from 9 A. M. to 2 P. M.

1857.] Miscellaneous. 437

Judire Catron, of the U. S. Supreme Court, being present, was invited
to a seat on the stand.

The Nominating Committee then retired for tlie purpose of nominating
officers for the ensuing year.

The report of the Committee on Publication being called for, it was read
by l.)r. Casper Wister, of Pennsylvania, and on motion, was accepted and
referred to the committee on publication.

l>r. Wister also read his report as Treasurer, which was received and
adopted.

On motion of Dr. Flint, of Ky., Dr. R. T. Fleminir, of Ky., was admitted
as a member of the Association by invitation.

The committee on Prize Essays being called upon to report, requested
further time, because of the late hour at which the essays were handed in,
which was granted.

The President informed the Association that Dr. F. Campbell Stewart,
of New York, Dr. Alden March, of New York, Dr. Isador Gluck, of New
York, and Dr. Pancoast, of Penn., had been appointed to represent this
Assoc-iation in foreign scientific bodies.

The committee on Medical Education was called, but made no report.*

The committee on Medical Literature was called no repoit.

The committee on Medical Topography and Epidemics being called, a
communication from Dr. J. C. AVatson, of Maine, was read, asking for fur-
ther time to make a report, which was granted.

Dr. Arnold of Georgia, offered the following resolution, which was adopt,
ed:

Resolved, That the Committee on Nominations be constituted a standing commit-
tee during the ])resent session of the Association, to whicli sliall be referred all busi-
ness of the Association ou which an immediate vote is not required.

Dr. Jas. Mauran, of the committee on Medical Topogi-aphy and Epidem-
ics for Rhode Island, being called for, the Secretary read his apology, which
was accepted.

Dr. Peregrine Wroth, of same committee for Maryland, sent in his report
with accompanying reports of Drs. A. M. White and Edmund E. Waters,
which were received and referred to the Committee on Publications.

Dr. W. L. Sutton, of same committee for Kentucky, sent an apology and
asked for further time, which was granted.

The members of the same committee for the States of New Hampshire,
Vermont, Massachusetts, New York, New Jersey, Pennsylvania, Delaware,
Virginia, District of Columbia, South Carolina, North Carolina, Tennessee,
and Minnesota being called, no reports were made.

The delegates from Connecticut and Louisiana being absent for the time,
the consideration of their reports was postponed until to-morrow.

A' report from Dr. J. F. Posey, of Georgia, was presented by Dr. Arnold,
and subsequently withdrawn by him for the purpose of preparing an ab-
stract of it.

OFFICERS FOR THE ENSUING YEAR.

Tlie committee on Nominations then appeared, and through their chair-
man, Dr. J. B. Lindsley, reported the following officers of the Association
for the ensuing year, viz :

* Received after the adjournment

438 Miscellaneous. [J^^Jj

President Dr. Paul F. Eve, of* Tennessee.

Vice-Presidents R.J. Breckiniiclg-e, of Kentucky; D. M. Keese, of New
York ; W. II. Byford, of Indiana, and Henry F. Campbell, of Georgia.

On motion of Dr. Arnold, of Georgia, the repoil was accepted.

The chairman stated that the Secretaries will he selected wlien it is as-
certained where the next meeting of the Association will be held.

Dr. Wister, of PennsylvaTiia, moved that a committee of three be ap-
pointed by the President to conduct the newly elected officers to the chair,
which was carj-ied.

Tlie President appointed as such committee, Drs. Wister, Arnold and
McGugin.

The President elect being absent, the Association adjourned to meet at
9 o'clock, A.M., to-morrow.

SECO^'D DAY.

Nashville, May 6th, 7857.

The Association met pursuant to adjournment. The minutes of yester-
day were read and adopted.

The committee appointed on yesterday, Drs. Wister, Arnold and McGu-
gin, were then requested to conduct the newly elected officers to their
respective seats.

DR. eve's salutatory.

Dr. Eve, of Tennessee, in taking the chair, addressed the Association in
a few pertinent remarks, as follows :

Gentlemen of the American Medical Association :

It is with deep emotion that I attempt to retnm yon my heart-felt thanks for this
distinguished honor. In elevating one so luiworthy of this station, so ill-prepared
to preside over your deliberations, or carry out tlie great designs of this body, I
must express the apprehension that yon have done yourselves injustice, and, it mny
"be, not advanced its hest interests. But, believing that this office shonld neither be
sought nor declined, when tendered as it has been, after wjy State had declined to
take any part in the nomination of a presiding officer, I enter upon the discharge
of its onerous duties with much diffidence, and shall have frequent occasion to
throw myself tvpon your considerate indulgence.

We are engaged, gentlemen, in a good and noble work. Life, the greatest of
human blessings, and health, the sweetest stimulus to earthly enjoj'ments, are our
end and aim. We live to secure the one and to preserve the other. To promote
these all important objects, the medical pi-ofession of our country hare, during the
past twelve j'enrs, aunualh' appointed delegates to jvssemble and counsel how this
may be effected. And Ave are here to-day on one of these great festive occasions,
and, amidst our mutual congratulations, these gloi-ious re-unions of good-will and
fellowship among the brotherhood, must not forget that to us is committed the
health and lives of others. In maintaining the honor and increasing the usefuhiess
of medical science, we become the best contributors to the welfare and happiness of
those around ns. You have come up hither from the JN'orth and from the South,
from the East and fiom the West, and have done well neithei' to count the cost nor
calculate thesaci-ifice; for the cause in which you are engaged is worthy of you.
You present again the sublime spectacle of brethren from sections of this widely
extended Union, congregated to devise the best means to relieve suffering human-
ity^ and may I not add, we are here with

" Our souls by love together knit,
Cemented, mixed in one ;
One hope, one heart, one mind, one voice."

1857.] Miscellaneous. 439

Dr. Winston, of Tennessee, read the names of additional delegates to
the Association.

Dr. Hooker, from -the committee on Medical Topography and Epidemics
for the State of Connecticut, beino- called on for his report, arose and ex-
plained that it was his understanding that the committee were to have
three years in which to make their report, and at the end of that time he
would either be prepared or ask the indulgence of the Association for fur-
ther time.

The President, under a resolution passed at the last meeting, appointed
Drs. Ourrey, Grant and Evans, a committee on Voluntary Contributions.

Reports now being in order, the report of Dr. Posey, of Georgia, was
called for; Dr. Arnold, of Geoj'gia, read an abstract of the report of Dr. Po-
sey; all of which, on ujotion of Dr. Palmer, of Michigan, was referred to
the committee on Publication, under a suspension of the rule.

On motion of Dr. "Wood, of New York, the reports which were present-
ed yestei'day were also referred to the committee on Publication, under a
suspension of tlie lule.

The State of Ohio being called upon for a report u})on its ^fedical To-
pogrjiphy and Epidemics, the Secretary read an apology from Dr. G. Men-
denhall, who asked further time in which to make a report, which was
granted.

The States of Mississippi, Missouri, Michigan, Illinois, Indiana, Wiscon-
sin, Iowa, California, and the U. S. Navy, being called, no response was
made.

A telegraphic dispatch from Dr. J. M, Sims, of New York, who was to
report on the Treatment of the Results of Obstructed Labor, was received
and referred to the appropriate connnittee.

A communication was received from the Southern Methodist Publishing
House, inviting the members of the Association to visit that establishment,
which was accepted.

A communication was read by Dr. Lindsley, of Tennessee, from the Med-
ical Association of Washington City, inviting the National Association to
bold their next annual meeting in that city. On motion, the communica-
tion was referred to the committee on Nominations,

A resolution was ofteied by Dr. liartlett, of Wisconsin, tendering a vote
of thanks to the late President, Zina Pitcher, for the able manner in which
lie has presided over the deliberations of this body, which was unanimous-
'ly adojtted.

The reports of Special Committees for 1856-7, being next in order, they
were called in order as follows :

Inflammation Its Pathology^ etc. Dr. E. R. Peaslee, Maine ; asked fur-
ther tinie. Referred.

Anatomy and Histology of the Cervix Uteri. Drs. H. Hutchinson and
Charles E. Isaacs, New York ; no report.

Treatment of Cholera. Dr. J. Taylor Bradford, Kentucky; no report.

Treatment best adapted to each variety cf Cataract^ etc. Dr. Mark Ste-
phenson, New York ; further time asked. Referred.

Causes of the Impulse of the Heart, etc. Dr. J. W. Corson, of New
York ; a communication was received, and on motion of Dr. Brodie, he was
continued.

Causes of Infant Mortality, etc. Dr. D. Meredith Reese, of New Yorki

440 Miscellaneous. [July,

read an abstract of Lis report, which was referred to the committee on
Pdblication.

The venerable Dr. Slielby, of Tennessee, being present, was invited to a
seat on the stand. Ills ap])earance was warmly acknowledged.

Dr. Ilobbs, of Illinois, ofered the following resolution :

Resolved, That a committee on Essays, (not including Prize Essay's,) be appointed,
to whom all essay's jn-epaied for publication by this Association shall be referred,
which committee shall transfer to the committee on Publication, all Essaj's they
judge worth publishing. That said committee on essays make a full report of their
proceedings to the Association at its next annual session ; provided, authors of re-
jected essaj's being informed of said rejection by said committee, shall have the
privilege of withdrawing their essays from the report of the committee to the
Association.

On motion of Dr. Palmer, of Michigan, the resolution was indefinitely
postponed.

The Secretary read a protest signed by Drs, Arnold, J. Gordon Howard,
Pike Brown, and Geo. P. Padelford, against admitting the delegates from
Oglethorpe Medical College, as follows :

Xashville, May 6, 1857.
The imdersigned, members of the American Medical Association, })rotest against
the admission of delegates from the Oglethorpe Medical College of Savannah, on the
ground that it is not a regulai-ly organized college, it being a matter of public noto-
riety in Savannah, that dui-ing neither of the two sessions of its existence, have all
the chairs been regularly filled. During its first session the chairs of Physiology and
Materia Medica were not filled, except by a very few lectures, by the genti'emaa
appointed to them, and the same thing occurred during its last session as to the
cbiiirs of Materia Medica and Chemistry. All of which is respectfully submitted.

IIICIIARD D. ARNOLD, M. D.

J. GORDOX HOWARD, M. D.

PIKE BROWX. M. D.

GEO. P. PADELFORD, M.D.

After several resolutions were offered and some discussion,

On motion of Dr. Palmer, the whole subject was referred to a committee
of three to be appointed by the chair.

Dr. Brodie, of Mit^higan, moved as an amendment, that no Faculty Mem-
ber of a Medical College be appointed upon the committee, which was
accepte<l by the mover.

The chair appointed as such committee, Drs, Wister, of Pennsylvania,
Bemiss, of Kentucky, and Gibbes, of South Carolina.

Dr. Felix Robertson, the oldest physician in Tennessee, being present,
was invited to a seat on the stand, lie was greeted with marked consider-
ation by the Association.

The Committee on Nominations was convened to transact important
business.

The calling of Special Committees was resumed :

Spontanems Umbilical Hemorrhage^ etc. Dr. J. Foster Jenkins, New
York. Further time asked. Referred.

Use of Instrwnents in Obstetrical Practice. Dr. Henry Carpenter, of
Pennsylvania. No report.

Measures to he adopted to Remedy the Evils existing in the present
mode of holding Coroner^'s Inquests. Dr. Alexander J. Semraes, D, C,
Report presented, with the following resolution attached:

1857.] Miscellaneous. 441

JiesoliM^d, That committees of three, in each State, Territory and the District of
Columbia, be appointed, and that said committee be, and they are hereby author-
ized in tiie name of this Association, to memorialize tlieir respective Legit^latures, to
pass suclx hiws as will best carry into effect the objects of the foregoii;g re[ort.

The report was referred to the Committee on Publications, and the ac-
companying report adopted and referred to the Committee on Nomina-
tions.

True Position and Value of Operative Surgery^ etc. Dr. J. B. Flint, of
Kentucky. Further time asked ; granted.

Causea and Cure of Indigestion, etc. Dr. G. Volney Dorsey, of Ohio,
No rej)ort.

Medical Jurisprudeiice of Insanity, etc. Dr. C. B. Coventiy, of New
York. Further time granted.

Human., Animal, and Vegetable Parasites. Dr. Joseph Leidy, of J^enn-
sjlvania. No re}K)rt

Value of strict attention to position in the Treatment of Diseases of the
Abdomen. Dy. M. D. Darnall, of Indiana. No report.

Milk Sickness. Dr. George Sutton, of Indiana. No report.
Blending and Conversion of the Tijpes of Fever. Dr. Clark G. Pease,
Wisconsin. Conimunication sent, but not received. Postponed.

Best Substitutes of Cinchona, etc. Dr. B. S. A\'ood\voith, Indiana. No
report.

Use of Cinchona in Malarious Diseases. Dr. Franklin Ilinkle, Pennsyl-
vania. Report furnislied. Keferi-ed to Committee on Publication.

Nervous System in Febrile Disease. Dr. Henry F. Campbell, Georgia.
Verbal abstract of report given. lieferred to Committee on Pul)lication.

Ija.ws Governing the absorption and Deposit of Bone. Dr. Jno. Neil),
Pennsylvania. No report.

Intimate Effects of Certain Toxicological Agents in the Animal Tissues
and Fluids. Dr. John W. Green, New York. No repoi't.

Intimate Structure and P athology of the Kidrieys. Dr. Charles E. Isaacs,
New York. Further time g'ranted.

Diseases Incidental to Emigrants, etc. Dr. Israel Moses, New York. No
report

Etiology and Pathology of Epidemic Cholera. Dr. T. W. Gordon, Ohio.
Partial report presented and refei-red.

Excretions us an Index to the Changes going on in the System. Dr. II. A.
Johnson, Illinois. No report.

Remedial Effects of Chloroform. Dr. D. D. Thompson, Kentucky. No
report.

Best MetJiod of Causing an Increase in the numbers of Essays, etc.
Couimittees : Drs. Leidy, Wood and Meigs, Pennsylvania. No report.
Committee continued.

Changes j^roduced in Composition and Propersies of Milk, etc. Dr. N. S.
Davis, Illinois. Communication read and further time granted.

Stomatitis Materna. Dr. McGugin, Iowa. Further time granted.*
An abstract of the report,of Dr. Fcnner, of Louisiana, upon the Medical
Topography of that State, was then read and referred.

Dr. Singleton, of Ke*ntucky, otlered the following resolution, which was
unanimously adopted :

Resolved, That in the death of Dr. Grafton, of Mississippi, the American MedicaJ
Assooiatioa has lost a talented and useful member, and society a lM.'mn'"actor.

442 Miscellaneous. [Julj>

On motion of Dr. Whitaker, of Tennessee, Dr. II. Ronalds was expelled
from the Association for giving certiticate contrary to the rules of the
Association.

Dr. Caspar Wister, chairman of the committee upon the admission of
the delegates from Oglethorpe Medical College, reported as follows :

Dr. W. Benson asserts that for the past session tlie Oglethorpe school has been
fully organized, that six professorships have been regularly filled, and that the occu-
pants of these chairs have been in the constant fulhlment of their duties, except in
cases of illness; such instances having, hoAvever, at no time interrupted the regular
course of lectures, the pi'ofessor absent having had his ])lace supplied by his col-
leagues. The seventh chair is admitted to have been vacant; the duties were dis-
charged however, fully by other members of the faculty.

Dr. R. D. Arnold prefers no charges beyond those admitted above.
Therefore, your committee finding nothing that infringes upon the strict letter of
the law of the American Medical Association, in reference to the admission of mem.-
bers, we recommend that all furthur action in this question be suspended.

CASPAR WISTER,
R. W. GIBBES,
A. M. BEMISS.

The Secretary read the following preamble and resolutions, which were
unanimously adopted :

"Whebeas, It has pleased God to remove by death our fellow-member, Robert M.
Porter, and because of his devotion to tlie inteiests of the Profession of Medicine,
and his steady support of the American Medical Association,

Resolved, That this Association learned with unfeigned sorrow of his decease ; and
that they have lost a firm and intelligent supporter, and society a benefactor and
friend.

Dr. T. BuUard, of Indiana, offered the following :

Resolved, That in the death of Dr. John L. Mothersett, this Association has lost a
useful member, and society a benefactor.

The Secretary read a communication fi'om the Connecticut Medical Socie-
ty, asking that the time for holding the meetings of the Association in
northern cities be changed to a later period in the year. Referred over to
the next meeting by the Constitution. Adjourned to meet at 9 o'clock,
A. M., to-morrow.

THIRD DAY.

Nasiivtlle, May 7, 1857.

The Association met pursuant to adjournment. The minutes of yester-
day were read and adopted.

Dr. IToyte, from the Committee of Arrangements, read the names of ad-
ditional delegates to the Association, who had arrived since the meeting
of the Association yesterday.

The Secretary read a communication from Dr. Clark G. Pease, of Wis-
consin, which accompanied his report on " Blendiny and Conversion of the
Types of Fever y

Dr. Hooker, of Connecticut, moved that the report be referred to the
Committee on Voluntary Contiibutions.

Dr. McKinley moved to amend by having a portion of the report read,
which was lost, and the motion recurring to refer the report, it was carried.

1

1857.]

MiscellaneoKS. 44i

VOLUNTARY CONTRIBUTIONS ACCEPTED.

Dr. Currey, from the Committee on Voluntary Contributions, submitted
the following report, which was accepted :

The Committee on Voluntary Contributions has examined the following papers,
and reoomaieiiil them for publication in the Transactions of the Association:

1st. A new Principle of Diagnosis in Dislocations of the Shoulder Joint. By L.
A, Dugas, M.D., Professor of Surgery in the Medical College of Geoigia, Argusta;
accompanied by four photogi-aphic plates illustrating the princijile.

2nd. Medical Statistics ot Washii.gton Tenitorj-, r)y Geoige Suckley. M.D., U.
S. A., embracing, 1st, Geological Divisions of the Territory ; its Geology, Meteorolo-
gy, Fauna. 2nd, AVhile population and its diseases. 3rd, J\ative'])opulation ; Dis-
eases; Medical Piactice; causes of their rapid disa|)pcai-ance ; concluding remarks,

3rd. Medical Flora ot Washii.gton and Oiegon leifitoiies. By J. G. Cou] er,M.D.

All of which is respectfully submitted, E. 'U. CL'RKLY,

R. T. EVA.NS,
.GEO. 11. GRAXT.

Dr. Yandell offered the following resolution :

Resolved, That this Association re-affirm the principles respecting the rights of
constituent bodies announced iu a report contained in Vol. \., of its Transactions,
in the following terms:

The Faculty of every Medical College, shall have the privilege of sending two
delegates to this Association, provided, that the said Faculty contain not less than six
Professors, who give one course of instruction annually, of not less than six weeks,
on Anatom}-, Materia Medica, Theory and Practice of Medicine and of Suigery, Mid-

ifery, and Chemistry; and also that said Faculty requires that its candidates for
graduation, among other requisites, shall have attended two full courses of lectures
with an interval of not less than six months between them, one of which courses
must have been in their institution."

Dr. Breckinridge in the Chair.

Dr. Buchanan proceeded to discuss the resolution, and at the close of
his remarks, moyed to lay it on the table, which \vas subsequently with-
drawn.

Dr. Boring offered the follo\ying resolutions in lieu, which he proceeded
to discuss :

Resolved, That this Association has nc^t the power to control the subject of Medical
Education.

Resolved, That the great objects of this Association are the advancement of Medi-
cal Science, and the promotion of harmony in the profession.

Resolved, That the attempt upon the part of this bod}^ to regulate Medical Educa-
tion, having most signally failed in its object, and already introduced elements of
discord, any fui-ther interference with this subject would not only be useless, but
calculated to distuib and distract the deliberations of this Association.

Dr. Currey offered the following resolutions in lieu of the whole:

Mliereas, The subject of Medical Education has been committed at each annual
Session to Standing Committees, and various suggestions have teen proposed, which
the Association has adopted, and recommended to private instructors and to the
Medical Colleges.

Resolved, That a committee of five be appointed by the Committee of Nomina-
tions, as a Special Committee, to be composed of members who are in no respect
connected with any Medical School, to devise a System of Medical Ivstrnction, to be
presented for the consideration of this Association at its annual session in 1858.

Resolved, That the proposed system shall set forth a uniform basis, ujion which
our Medical Institutions shall be organized, as well as have reference to the best
njode of securing the Preparatory ^Medical Instruction to the Student, and that con-
sequently the legitimate subjects to be embraced in said system, will include Primary
Medical Schools the number of Professorships in Medical Colleges, the length and

4-14 Miscellaneous. [J^lj)

number of terms during the year, the requisite qualifit-ations for graduation, and
such other subjects of a geiieial character as to give uniformity to our Medical sys-
tem, and preserve harmony and fiiendly intercourse in the ranks of the profesion.

Resolved, That, upon the adoption of the proi)osed system by the Association, all
Institutions which may eonfonu to it shall be entitled to representation at the an-
nual sessions of this Association and none others.

The subject was further discussed by several members of the Association.

Dr. Reese, after some remarks, moved the indefinite postponement of the
whole subject; which was lost.

Dr. Arnold moved the previous question, which was lost, and the discus-
sion proceeded at considei-able length, when

Dr. Hooker moved the previous question on the resolutions of Dr. Currey.

The reading of the various resolutions being called for, they were read
to the Association.

Tiie motion of Dr. Hooker being in order, the previous question was
called, and the resolutions of Dr. Currey were adopted.

D.-. Lindsley, from the Nominating Committee, submitted the following
report : *

Secretaries. Robert C. Foster, of Tennessee, A. J. Semmes, of Wash-
ington City.

Treasurer. Caspar Wister, of Philadelphia.

For the next place of meeting, Washington City.

STANDTXG COMMITTEES.

CommHtee of PuhUcation. Francis G. Smith, of Philadelphia, chairman ;
Caspar Wister, of Philadelphia ; R. C. Foster, of Nashville ; A. J. Semmes,
of Washington City; Samuel L. Hollingsworth, of Philadelphia; Samuel
Lewis, of Pennsylvania ; H. F. Askew, of Delaware.

Committee on Prize Essays. Grafton Tylei', of (jcoro-etown, D.C , chair-
man ; J. C. Hall, of D. C ; J. F. May, of D C ; Tho.ims Miller, of D. C;
A. J. Semmes, of D C; Joshua Riley, of D C; W. J. C. Duhamel, of D.C.

Committee of Arrangements. Ilaivey Lindsly, chairman; AV. J. C.
Duhamel, Cornelius Bovle, P. H. Coolidge, G. M. Dove, A. Y. P. Garnett,
Wm. P. Johnston, of lie.

Committee on.Mcdical Education. G. W. Norris, of Philadelphia, chair-
man ; A. H. Luce, of Illinois; E. R Henderson, of South Carolina; G. R.
Grant, of Tennessee; T. S. Powell, of Geoi-gia.

Committee on Medical Literature A. B. Palmer, of Detroit, chairman ;
A. F. Alexander, of Alabama; J. M. Mosgrove, of Ohio; P. Cassidy, of
Pennsylvania; S Pollak, of Missouri

Vacancies in Committee on Medical Topography and Epidemics T. B.
Shuford, to fill the vacancy caused by the death of Dr. Grafton, of Missis-
sippi. C. AV. Parsons, to fill the vacancy caused by the resignation of
Joseph Mauran, of Rhode Island.

SPECIAL COMMITTEES.

Spontaneous Umbilical Hemorrhage of the newly horn. J. Foster Jen-
kins, of New York.

Influence of Marriages of Consanguinity upon Offspring. Dr. Bemiss,
of Kentucky.

Functions of the Different Portions of the Ccrehellum. E. Andrews, of
Illinois.

1857.] Miscellaneous. 445

Causes of the Impulse of the Heart ami the Acfencies which Influence it
in Htalth and Disease. J. W. Corson, of New York city.

Treat ment of the Hcsults of Obstructed Labor. J. Marion Sims, of New
Jork.

Treatment best adapted to each variety of Cataract., with the method of
operation., place of election, time, age, etc, Mark Ste})lienson, of New York.
Human, Animal, and Vegetable Parasites. Jos. Leidy, of Philadelphia.
Best substitute for Cinchona and its preparations in the treatment of In-
termittent Fever, etc. 13. S. ^Voodward, of Lidiana.

Intimate structure and pathology of the Kidney. Charles E. Isaacs, of
New York.

Etiology and Pathology of Epidemic Cholera. T W. Gordon, of Ohio.
Inflammation of Cervix Uteri. Henry 11. Miller, of Louisville, Ky.
On Milk Sickness -W. 11. Byford, of Indiana.

Best means of causing an increase of the number of Essays. Drs. Leidy,
Wood and Meigs, of I'ennsylvania.

Changes produced in Composition and Properties of Milk. N. S. Davis,
of Illinois.

Stomatitis Materna. D. C. McGug-in, of Iowa.

On Criminal Abortion, with a view to its general sup>pression. 11. N.
Storer, of Boston.

The committee recommend that the committees ordered by the adop-
tion of the resolutions accompanying Dr. A. J. Semmes' report, be filled
by the several State Societies.

On motion of Dr. Brodie, amended so as to refer the same to the officers
of several State Societies. Carried.

The committee also recommend the amendment of the thii-d article of
the constitution, in relation to meetings, by inserting after the woi'ds ''first
Tuesday in May," the words, or the first Tuesday in June, and also by in-
serting after the words "sliall be determined," the words, with the time of
meeting.

Special Committee on the P resent state of Science, as regards the Patholo-
gy and Therapeutics of the Re-productive Organs of the Female. D. For-
dyce Baiker, of New York.

On Moral Insanity. D. M. Reese, of New York.

On Calculi and the Diseases of the Urinary Organs, in Iowa, Minnesota^
and Nebraska. Dr. J. C. lluglies, of Keokuk, Iowa.

On the nature, tendency and general treatment of Syphilitic Bubo.
Moses Gunn, of Detroit, Michigan.

Organic Chemistry its progress and relations to Physiology and Pathol-
ogy. Professor Samuel St. John, of New Y'ork.

On Medical Education. (By Dr. Currey's resolution,) James R. Wood,
of New York; Geo. R. Grant, of Memphis, Tennessee; John Watson, of
New Y^ork ; C. B. Nottingham, of Macon, Georgia ; Rene La Roche, of
Philadelphia, Pennsylvania.

To fill a vacancy in the Committee on Medical Topography and Epidem-
ics. Dr. J. L. Cabell, of Charlottsville, Vii-o-inia.

Dr. March moved that the Report of the Nominating Committee be taken

up, and each subject to which it refers, be consideied sepai'atelv, which

motion prevailed. That portion relating to nominations was then adopte*!.

The place of the next annual meeting of the Association being the next

446 Miscellaneous. [J^^lj)

subject in order, after some discussion, on motion of Dr. March, the report
of the committee was adopted.

Dr. Lindsley moved that, as Dr. Semmes, one of the newly elected Se-
cretaries was absent, Dr. Brodie, of Mitchigan, be elected Secretary pro-
te?n, which was carried.

Dr. Pitcher oftered the following resolution, ^Yhich was unanimously
adopted :

Resolved, That a oomrnittee of three be appointed, of which the President of the
Association sliall be chairman, to communicate with the iSuigeon Genei-al of the
Army, the chief of the Medical I3areau of the Navy, and the Secretary of the Treasu-
ry of the United States, with a view to secure the concurrence of these departments
of the Fedei-al Government, so that its contributions to tlie Medical Topography,
the Vital Statistics, and the Sanitary Police of the nation may be made tributary
to the labors of this Association.

The Chair appointed as such committee, Drs. Z. Pitcher, of Michigan,
and R. H. Coolidge, of Kansas.

Dr. Boling, Chairman of the Committee on Prize Essays, submitted the
report of said Committee, as follows :

PEIZE ESSAYS.

The Committee on Prize Essays report that four essays have been re-
ceived, each possessing great merit.

The Committee selected the following two Essays for the two prizes, pro-
.vided for at the last meeting of this Association.

1st. One entitled " The Excito-Secretory System of Nerves. Its relation
to Physiology and Pathology," with the following motto:

" Observation becomes Experiment when used in severe processes of Induc-
tion,^^ and signed Henry Eraser Cam})bell, Georgia.

2nd. " Expei'imental researches relative to the Nutrition, Value and
Physiological Effects of Albumen, Starch and Gum, when singly and exclu-
sively used as Food," with the following motto :

" Quum sequimur? quove injubes ? ubi ponere sedis?

Da pater angurium, atque animis illabere nostris .'" and signed, William
A. Hammond, M. D., Assistant Surgeon, U. S. Army.

The President read an invitation to the membei's of the Association, to
visit the University of Nashville, in its Military, Literary and Medical De-
partments.

The Committee on Voluntary Contributions, reported in favor of tlie pub-
lication in the Tjansactions of the Association, of the following paper.
"On the blending and conversion of Types in Fevers." By C. S. Pease,
M. I)., of Wisconsin. Tbe report was adopted.

Dr. McMurray oftered the following resolution, which was adopted :

Resolved, By this Association, that the Committee on Publications be instructe
to append the Code of Ethics of the American Medical Association to each volume
of its present and future Annual Transactions.

The amendments to the Constitution proposed by Dr. Stocker, of Pa.,
at the last Annual Session, were lahen up and laid on the table.

Dr. Lindsley offered the following amendment to the Constitution, which
was seconded by Dr. Gunn :

" In Art. II, omit the words ' Medical Colleges,' and also the words ' Tho

m

1857.] Miscellaneous. 447

Faculty of every regular constituted Medical College, or chartered School
of Medicine, shall have the privilege of sending two delegates '"

The auien linent lies over until the next meeting of the x\sso;;i;ition, under
a rule of the organization.

On motion of Dr. Palmer, the resolutions reported at the last Annual
meeting of the Association, by the Committees on Plans of Organization
for State and County Medical Societies, were taken uj) and adopted.

Tile following resolutions were ottered and adopted :

By Dr. Pitcher

Besolved, That the inembers C7f this Association, as recipients of the cordial, gener-
ous, and elegant hospitalities extended to them by tlie profession and the citizens of
Kashville, in placing on record an expression of thanks for the social amenities they
have enjo^-ed during its tenth annual session, wish also to leave behind them the
assurance, that the recollection of their short sojourn in Tennessee, will be cherished
as dearly as the remembrance of the far off sound of water, by the exhausted and
way-worn traveller.

By Dr. Means

Resolved, That the earnest thants of this body be presented to the authorities
of the State and City, who have tendered this raagaificeat State Capitol for their
sittings during the j>reseut session.

By Dr. Currey

Resolved, That the thanks of this Association be tendered to the Reporters of the
City Press, for the accuracy and promptness with which they have reported the
proceedings of the Association, and to the Publishers, for the liberal suppl}' of their
morning papers during the Sessions of the Association.

By Dr. Wister

Resolved, That the thanks of this meeting be presented to Dr. "Wm. Brodie, for
the efficiency wdth which he has discharged his duties of Secretary.

By Dr. Byford

Resolved, That the State and County Societies throughout the Union be requested
to recommend their members to purchase the Transactions of the American Medical
\ Association, and that their officers act as agents for the same.

On motion of Dr. Gunn, of Micdiigan, the Association recognized the
presentation of a pamphlet by Henry Fra.<*er Campbell, M.D., claiming
" Priority in the Discovery and Naming of the Excito-Secretory System of
Kerves "

On motion of Dr. Byford, the Association then adjourned sine die.

Professor Daniel F. Wright. AVe are gratified and obliged at find-
ing in the last number (May) of the Memphis Medical Recorder a very
favorable and elaborate review of our contributions to the Physiology of
the Nervous System, over the initials of this distinguished gentleman. His
was the first and the fullest e.xamination which our Ganglionic Theory of
Typhoidal Fevers has received. We regret that our space will not allow ns
to consider certain important suggestions embodied in his review of the
Excito-secretory System, in the present number, nor to introduce a valuable
I case of Tetanus therein reported ; but we hope, at an early date, to give our
readers a fi^l discussion of Dr. W.'s views, which we at once see will serve
to illustrate an extensive body of phenomena in relation to the new func-

i

418 Editorial. [J^ly?

tion of the nervous system. Our space, at present, only allows us to state
tliat we fully appreciate the approbation of a reviewer whose opinion we
so highly value.

Dr. Marshall Hall. Tl.ivino^ had frequent inquiries made in relation
to our communication to this gentleman, on the subject of the Excito-secre-
tory System of Nerves, we venture to quote the following from the private
letter of a distinguished Surgeon of London, knowing that it will explain to
our readers, as it satisfies us, as to the probable cause of our not having re^
ceived a reply to our communication to this time.

London, May 20th, 1857.
* * * * J have read your paper on the EKcito-Secreto"y System
of Nerves, which certainly fully establishes your claim to originality in this
investic^ation. I have had no opportunity of seeing Dr. Marshall Hall since
I received your communication. I believe that he is staying at the sea-
side, and I am sorry to add that he is laboring under very serious disease.
*******

To Dr. 11. F. Campbell,

Augusta, Georgia, United States of America.

The above is the only intimation, we have as yet, that our communica-
tion has been received in Europe. The London Lancet " makes no sign."

Excito-Secretory System ClaIxM admitted in London, Since the
above was in type, we have just received the July number (in advance,)
of the North American Medico- Chirurgical Review, and we are gratified io
find, that notwithstanding his absence from home, and his impaired health,
Dr Marshall Hall has generously acknowledged our claim, and secured
the publication of all the essential parts of our Letter, in the pages of the
London Lancet, even as early as May 2nd. This is certainly making the
amende nobly and promptly. When we wrote, " the Londo-n Lancet has
made no sign," we referred of course to the American reprint, which we sup-
pose cannot furnish the same matter simultaneously with the original work.
AV^e have not yet seen Dr. Hall's note, but quote fi'om the North American
Review, edited by Professors Gross and Richardson :

"The recent announcement of the discovery of the Excito-Secretory su"
system of the Spinal Nerves by Dr. Marshall Hall, of London, has call
forth a letter, and various accompanying documents, addressed to that gen-
tleman, from Dr. H. F. Campbell, of Augusta, Georgia, who clearly sets
forth his own claims to the discovery in question. The essential portions
of Dr. Campbell's communication are copied into the London Lancet (May
2,) by the request of Dr. Marshall Hall, who gracefully yields the credit of
the idea and the designation of the Excito-Secretory action to ^r country-

I

.857.] Editorial and Miscellaneous. 410

Resignations and new appointments in the \ew Orleans School of
Medicine. Dr. A.Foster Axson lins retired fioin tlie Chair of Pliysioloiry, in
consequence of impaired liealtli. Dr. Anthotiy Peniston, formerly Adjunct
to the Chair of Anatomy^ has been promoted to the Chair of Physiology;
"vvhileDr. Theodore S. Clapp becomes Adjunct to Anatomy, vice Dr. Pen-
iston promoted.

A Manual on the Detection of Poisons hy Medico-chemical Analysis. By
Dr. Fi{. Jul. Otto, I'rofessor of Chemistry in Caroline Colleo:e, Bruns-
wi(;k. Translated from the German, Avith notes and additions, by Wm.
Elderiiokst, M.D., Professor of Chemistry in the Rensselaer Polytecdinic
Institute, Troy, N. Y. Xew York: II. Baillieie. 1857. Pp. 178, 12mo.

This is a most convenient and practical little Manual on the subject of
which it professes to treat, viz., various methods for the Detection of Arse-
nic; 2ndly, Detection of Antimony, Tin, Mercury, Copper, Lead and Zinc ;
3rdly, Hydrocyanic Acid ; 4thly, Oxalic Acid ; otlily. Detection of Phos-
phorus ; 6thly, To detect Alcohol and Chloroform ; 7thly, On the Detection
of the Poisonous Alkaloids, as Xarcotine, Strychnine, Morphine, Aconitine,
Veratrine, <tc., (fee; 8thly, On the Examination and Detection of Blood-
stains, for the determination of the value of evidence in leofal cases. It is
evidently a valuable little work, and of such a size and fair print, as to be
readable by all who may desire an acquaintance with subjects therein dis-
cussed. It was kindly sent to us by II. Baillie, 290 Broadway, New Y^ork.

Books for Review. We are forced to leave out several notices of valu-
able works sent us for review, in consequence of so much of our space
Laving been devoted to the minutes of the Association.

On the Ligature of Arteries in Suppurating Wounds. By M. Xelaton.
(Gazette des llopitaux, 1857. No 1.) In one of his most recent clinical
lectures, M. Nelaton made the following observations, the occasion being a
secondary hemorrhage in the palm of the hand. Nothing is more difficult,
he observed, than to arrest a hemorrhage of the hand, especially when this
is consecutive that is, when the wound is covered by pyogeni granula-
tions. If not previously instructed as to the proper management of these
secondary hemorrhages, you will be extremely embarrassed The blood
flows, you employ compression, and it cea.'^es ; but the hemorrhage will
not be long before it returns, and will then be uninfluenced by compres-
sion. If compression be made above the wound, oedema takes place in all
the subjacent parts, and the hemorrhage soon returns. The radial, or the
ulnar, or the brachial may be tried, and yet the bleeding does not stop.
Meeting such a case, M. Nelaton formerly was quite at a losstoknow^ what
to do, impressed as he was with Dupuytren's dictum, that arteries in a
suppurating wound will not bear the ligature, the premature fall of this in-

450 Miscellaneous.

fallibility giving rise to a return of the liemorrliafre. Nevertheless, ho
ventured to tie the two ends of the bleeding vessel of the palmer arch ; and
although the ligature fell sooner than usual, no hemon-hage followed, lie
has fi-equently since then tied vessels under analogous ciicumstances, and
has never seen hemorrhage as a result of the fall of the ligature. Although,
therefore, this fall takes place earlier (usually about the third or fourth
day,) than is the case with a* ligature applied to a healthy artery, it is not
piemature, for bleeding does not follow. Examining the matter experi-
mentally, upon the dead body, M. Nelaton has found that ligatures applied to
arteries in a state of suppuration (as in patients Avho have died after ampu-
tation) produce identically the same effects upon the coats of tliese vessels
as upon arteries remote from the seat of inflammation ; the same division
of the inner coats and preservation of the outer taking place in the two
cases, lie feels, therefore, perfect confidence in the soundness of the prac-
tice, supported as it is by numerous cases that have occurred to him, both
in private and hospital practice. Brit. <& For. Med. Chir. Review.

Apojylectic Ophthamia Under this name Dr. Quadri, of Naples, states
a fact worthy of attention. It is, that persons predisposed to apoplexy,
present ordinarily a species cf ophthalmia, characterised by the presence
of varicose vessels, muddiness of the eye, and intolerance of astringent col-
lyria a little strong. In the second foi-m the eye secretes a yellowish
mucus, very abundant and viscid, and presents a high degree of photoplio-
bia : the cornea may then become the seat of abscess, ulcers, or more fre-
quently of pannus. Sometimes also, iritis succeeds to keratitis. The
tendency to muddiness, sensibility to astringents, etc , are found in this
second form : both forms precede apoplexy one or two years. The import-
ance of these symptoms is equal to the danger of the disease, which must
be met in time to be successfully combatted. [Phil. Med. and Surg,
Jour.^ from Revue Therapeutique.

Facial and Dental Neui-algias. Doctor Michel Andre recommends the
following mixture for prompt relief: Extracts of opium, of Belladonna, and
of stramonium, each one part ; laurel water twelve parts. A few drops
are placed in the meatus auditorius, and cotton is placed in the passage,
taking the precaution to hold the head on the opposite side for a few mo-
ments, that the fluid may pass freely into the canal. [lb.

Night Sweats. Dr. Abbot, of Boston, publishes a series of cases of
phthisis to show the decided influence of the oxide of zinc in relieving the
niixht sweats, which are so troublesome in the latter stages of this disease.
Ilis favorite prescription is four grains of the oxide of zinc with three of
extract of conium, in two pills, at bed-time. Ilyoscyamus and opium are
sometimes used in combination with the zinc. One of the good eff*ects is
the preservation of a soluble state of the bowels. Dr. A. prefers the oxide
to the sulphate of zinc. [Memphis Med. Recorder.

Chloroform in Sea-Sickness It is said to have been discovered that
chloroform in doses often to twelve drops, repeated as occasion requires, is
a specific for sea-sickness. Out of twenty passengers, eighteen were cured
by a single dose, and the two others by two doses each. [lb.

SOUTHERN

MEDICAL AND SURGICAL JOUHML.

(NEW SERIES.)

Vol. XIII.] AUGUSTA, GEORGIA, AUGUST, 1857. [No. 8.

OIIIGIML AND ECLECTIC.

ARTICLE XXIII.

Some of the Effects of Alcohol upon the Physical Constitution of Man,
By J. P. Stevens, M. D., of AYalthourville, Liberty County,
Georgia.

" Alcoliol is arj inflammable liquor lighter than water, of a warm
acrid taste, colorless, transparent and of a pungent, aromatic odor/*

It is the product of the fermentation of various grains, vegeta-
bles, and fruits. For commercial purposes it is chiefly obtained
from grapes, molasses, corn, rye, and cider. The various kinds of
wine and malt liquors have, each, a certain proportion of alcohoL
The popular notion then, that the use of beer, and malt liquors
generally is innocuous, upon the assumption that they contain
none of this agent, is erroneous. According to the analysis of
Brande, a large number of the most popular wines contain from
12 to 24 per cent, of alcohol ; cider, porter, and ale, each from 4
to 8 per cent.; brandy 53, whiskey 54, and gin 57 per cent. Malt
liquors differ from what are usually denominated as alcoholic and
vinous preparations, in their possessing an intensely bitter, some-
what nutritious and narcotic principle, derived from the hop,
which is employed for preserving them. The astringency of this
agent, it is said, precipitates the vegetable mucilage, and prevents
the fermentation which is apt to follow transportation to a warm
climate. All animal and vegetable substances are composed of

N.S. VOL. XIII. NO. VIII. 29

452 Stevens. Some of the Effects of Alcohol [August,

four elementary principles in nature carbon, hydrogen, oxygen,
and nitrogen. Four parts of carbon, six of hydrogen, and two of
oxygen, form alcohol. As is well known, it is a highly inflam-
mable substance; it resists the process of putrefaction in vegetable
and animal substances, and is destitute of an essential element of
all organized bodies, namely, nitrogen. Its effects upon the vital
organism more especially demands our attention.

According to the quantity introduced into the stomach within
a limited time, dcohol acts as a virulent poison, or a local and
diffusible stimulant. When taken in large quantities, its sedative
effects resemble those of prussic acid. It expends its force upon
the nervous system, creating scarcely any antecedent stimulation,
but almost immediately extinguishing the innate life-principle.
Pr. Percy introduced a considerable quantity into the stomach of
a dog, and death followed in two minutes. The post-mortem ap-
pearances of the blood, in such circumstances, are analogous to
those following death by lightning; it loses its power of coagulat-
ing. Alcohol cannot be digested by the stomach. That peculiar
digestive solvent in combination with the gastric acids is called
pepsin. l^o\Y^ the presence of alcohol is said to precipitate pep-
sin ; to separate it from the gastric acids, and render it inert. The
modus operandi of alcoholic stimulants is by direct imbibition into
the blood. The absorbent veins drink them up, and quickly dif-
fuse them, through the medium of the circulation, into every part
of the system.

Alcohol is essentially a brain stimulant } it seems to have a spe-
cial affinity for this important organ. In moderate quantities,, it
brightens the poetic talent, quickens the imagination and fancy,,
but does not appear to improve the reflective faculties, whereby a.
severe logical, or mathematical deduction is to-be made after intense
concentration of thought upon a given subject. The first impres-
sion of alcohol invokes a sensation of perfect self-complacence^ as
well as of general benevolence. It paralyses the tongue of slan-
der, brightens th^ flashes of wit and humor, dispels the clouds of
gloom and sorrow, demolishes by a single blow the barrieis to
reputation,, fortune and glory, aod encircles the future with a
bright halaof hope, joy, and perpetual blfes. Another sparkling
julep beclouds tbe mental vision; ideas confused and indistinct
run into each other, objects are seen as if veiled with a mist ; si-
lence and moroseness, or brawlings and clamor, take the place of

1S57.] Upon tJie Physical Constitution of Man. 453

jocund mirthfulness and warm afTection, language becomes inco-
lierent and silly, and the fixcultj of memory is blotted out.

The cerebrellum is next invaded: the motions of the body are
unsteady, first one side and then the other, like a water-logged
junk, without a helm, it is tossed upon the surging billows, and
finally .becomes engulphed in the abyss of lethean stupidity.
There he lies: the vessels and sinuses of his brain filled with a
poison which not only extinguishes every scintillation of intellect,
but almost annihilates the faculties of volition and sensation.

In another phase of his career, we see the inebriate the victim
of a delusion more torturing than that of beastly degradation.
With glaring eyes and ceaseless vigils, he beholds the Piince of
Darkness, with clanking chains and fiery imps tracking his every
step, and ready to take him a prisoner to those realms, where the
devotes of Bacchus render obeisance to their liege lord. The
brain has been known to be so completely saturated by constant
immersion in alcohol during life, that this fluid has been extracted
from its pulp, so that the organ has been brought into a condition
capable of resisting the process of putrefaction, and admirably pre-
pared for the scalpel of the demonstrator of anatomy. AYe will
further pursue this subject by inquiring into the validity of a ^Qvr
of, what we deem, popular fallacies concerning the uses of alcohoL

Does alcohol contribute to the nutrition of the body, and does
it increase man's ph3'sical strength and power of endurance? The
ialimentary principles of food are divided into two classes, the
nitrogenous and the non-nitrogenous; or the flesh-producing and
the heat-producing. It is a proposition generally conceded by
chemical philosophers, that the albuminous tissues are maintained
chiefly by those alimentary substances which contain the elements
similar to those which enter into their own composition. What
Jlre called the nitrogen ized compounds are transformed into the
tissues of the body. They are called albumen, fibrin, gluten, and
casein. Albumen abounds in lean meats, various cereal grains,
and a variety of vegetables and grasses.

To the mind of the philosopher, then, truly "all flesh is grass."
The muscles which move our limbs, the internal organs which sup-
port life, and the very seat of intelligence, owe their existence and
integrity to a regular supply of the alimentary principles above
mentioned. Lean meats, we all know, are easy of digestion, and
become rapidly assimilated to the wants of the animal economy.

454 Stevens. Some of the Effects of Alcohol [August,

Oily and fatty substances are diflScult of digestion. They are de-
void of albumen. Oil, starch, gum, sugar, and the vegetable acids
and fruits, supply us with heat-produeing elements. They are
incapable of transformation into flesh. How beautifully and sig-
nally are the wants of man supplied by the hand of a munificent
Providence!

The inhabitants of the polar regions trap the bear aiid beaver,
and lay in store an abundance of oil and blubber^ from the whale
and other animals. Under the burning heat of the torrid zone,
the air is fragrant with the sweet perfume of many flowers, and
the senses are ravished with the rich luxuriance of luscious fruits,
endlessly diversified in qualities, exactly suited to the physical
wants of man.

The non -nitrogenous substances abound in hydrogen and car-
bon, highly combustible; hence they are appropriated in the ani-
mal economy to the sustenance of heat and inspiration. We call
them, therefore, the fuel whereby the steam is generated which
keeps the machinery in motion. Thus, we see tha* the hybernat-
ing animals, the polar bear, for instance, which remain dormant
in winter, become excessively fat during the autumnal months.
This deposit is slowly absorbed into the circulation, supplies the
lungs with the materials for respiration, and thus it sustains life
during the long state of his apparent inebriation. When the,
warm spring months impart their genial influence, he creeps out
of his den a poor, lean, decrepid creature, the mere shadow of his
former self, ''Currie mentions the case of an individual who was
unable to swallow, and whose body lost 100 lbs, in weight duiing
a month."

We are well aware that alcohol is highly inffaramable; it being
entirely destitute of nitrogen is not convertible into flesh and
blood, and, therefore, not a source of nutrition tO' the body. The
Indian hunter, with his limited supply of parched corn and jerked
venison, is almost a stranger to disease and fatigue. Through the
trackless forest, he pursues the bo^mding deer, or with relentless
ire the blood of his enemy, and yields neither repose to his limbs,,
nor slumber to his eyes, until avarice or vengeance is fully satis-
fied. It is said that among the trainers for prize-fighting, three-
essential points are observed : *' 1st, the requisite amount of exer-
cise; 2nd, a diet of lean meats and stale bread; and, 3rd, an entire
absiinmce from alcoholic potations." In an extensive brick-mak-

1857.] Upon the Physical Constitution of Man. 455

ing establishment, which employment is regarded as being suffi-
ciently laborious to test the capability of physical endurance, we
Lave tho following statistics:

Says a gentleman, residing in Uxbridge, England, " I obtained
the amouiit of bricks made by the largest maker, and the result in
favor of the tee-totaller was very satisfactory. Out of 23,000,000
of bricks made, the average per man, made by the beer- drinker
in the season was 760,269, while the average for the tee-totaller
was 795,400, which is 35,131 in favor of the latter. The highest
number made by a beer-drinker was 880,000; the highest number
made by a tee-totaller was 890,000; the lowest number made by
a tee-totaller was 746,000; the lowest number made by a beer-
drinker was 659,000, leaving 87,000 in favor of the former."*

Equally striking comparisons were made in an extensive ma-
chine shop. In the report of the proprietor, where between one
and two thousand workmen were employed, he affirms, that in
ike summer-time, the men engaged as strikers to the forge who
drink largely of water, are more active, can do more work, and
are more healthy than those who make use of fermented liquors.
Among agriculturists, wdiere comparisons have been made by se-
iecting equal numbers from the ranks of tee-totalism and moderate
drinking, for the purpose of testing the capability of the two
classes to endure protracted labor, in every instance the former
have come off victorious.

As a familiar illustration of the influence of those substances like
alcohol, which are deficient in strength producing elements, let us
recur to our observation of facts in every day life. AVho, when
about to undertake a long journey, especially in warm weather,
.would confine his horse to a preparatory diet of potatoes, or con-
tinue this diet during the progress of his journey? His animal
might become sleek and rotund while idle, laying up deposits of
Ifat from his highly carbonaceous food, but after a few days of se-
[Vere labor he would become dull and sluggish, and from loss of
flesh and strength incapable of further exertion. Experience di-
jrects that his manger shall be well supplied with corn, hay, and

its. The article first mentioned abounds in fat-producing ele-

lents, while the latter afford those constituents which impart
strength to the body, and by a slow process of assimilation to the
liflPerent tissues they maintain an adequate proportion of heat, as
* Medico-Chirurgical Review.

456 Stevens. Some of tlie Effects of Alcohol [August,

well as a due supply of albumen to the muscles and bones, there-
by affording the true source of nervous and muscular power.

Does alcohol protect against extremes of heat or cold?

The first impression of cold upon the body is exhilarating. It
quickens muscular motion, increases the number of respirations,
and imparts an electrifying influence to the whole nervous system.
Extreme cold, protracted for a length of time, powerfullj^ depress-
es the vital energies. We would suppose, then, that any agent
loaded with carbon and hydrogen, which could be appropriated
by the animal organism, would be peculiarly fitted for counteract-
ing this depressing influence. It will be remembered that the
modus operandi of alcohol, is by direct imbibition into the blood,
and by its impression upon the nervous system. It is not suscep-
tible of a gradual process of digestion, whereby its heat-producing
qualities are slowly supplied to the lungs for the elaboration of
heat, but its highly inflammatory nature produces intense plethora
of the blood-vessels, and great general excitement. In proportion
to the degree of excitement will then be a corresponding stage of
depression ; increased sensibility to cold must follow the subsi
dence of the impression made by a single potation. The toper,
therefore, by frequent alternations of those opposite states of the
system, loses his physical appliances to resist the effects of cold,
and he either relapses into the fatal stupor of intoxication, or into
that slumber which is the inevitable precursor of the freezing of
the very fountain of life.

Kaval commanders, who have wintered crews in high polar
latitudes, give abundant testimony in confirmation of the views
just expressed. "In 1619, the crew of a Danish ship of 60 men,
well supplied with provisions and ardent spirits, attempted to pass
the winter at Honduras Bay, but 58 of them died before spring;
while in the case of an English crew of 22 men, in the same cir-
cumstances, but destitute of distilled spirits, only two died. In
the winter of 1796, a vessel was wrecked on an island off the coast
of Massachusetts; there were seven persons on board ; it was night;
five of them resolved to quit the wreck and seek shelter on shore.
To prepare for the attempt, four of them drank freely of spirituous
liquors, the. fifth would drink none. They all leaped into tho
water; one was drowned before he reached the shore, the other
four came to land, and in a deep snow and piercing cold directed
their steps to a distant light. All who drank spirits failed, and

1857.] Upon the Physical Constitution of Man. 457

jstopped, and froze one after another; the man who drank none
reached tlie house in safety." {Youmans^ on Alcohol.)

Ilot coffee and tea are much to be preferred as heat producing
agents, being equally as prompt in imparting warmth to the body,
and their effects are much more protracted. The ingestion of so-
lid food, more especially lean and fat meats, keeps up a regular
supply of heat, for it is, during the process of digestion and assim-
ilation, imparting warmth to the bod}^, and strength to the muscles
and bones. In excessively cold countries, Lapland for instance,
you will see the inhabitants luxuriating upon adinner of train oil
and tallow candles. Disgusting as this repast may appear to us,
lie, nevertheless, enjoys it; for the excessive demand made upon
his blood for those materials which aid in resisting the external
temperature, sharpens his appetite and affords him transporting
pleasure. But it is asserted that in hot climates where the system
becomes enervated by long-continued and elevated temperature,
some stimulus is necessary to give appetite for food, and to brace
up the relaxed fibre. It is a well established fact, that the inhabi-
tants of hot climates require less food, particularly of a stimulating
nature, than those inhabiting cold regions ; and for the very obvi-
ous reason that there is less fuel required. As has been already
remarked, a good portion of our aliment, during the winter, is ex-
hausted in maintaining the natural temperature of the body;
during the summer, the surrounding air being heated, the demand
made by the respiratory system is withdrawn, and food of that
kind and quality is called for which supplies the natural waste of
the tissues. The hard laboring man will perceive YQvy little dif-
ference in his appetite during this season, for the process of com-
bustion is continuing at a rapid rate, and he would soon be con-
sumed, did not the amount of surplus heat find exit in the form
of watery vapor from the lungs, and through the skin in copious
torrents of perspiration. It is the man of idle and sedentary hab-
its who is troubled with a disgust for food. " A drop of comfort"
immediately before dinner is solicited to spur up the languid sto-
mach, and stimulate the drooping energies. But at such times,
the individual pursuing an occupation wherein there is compara-
tively a passive condition of the muscles, nature is competent to
dispose of but little food, and her demands are made accordingly.
Instead of swallowing fire at such times, you must pour on water.
At such an hour as you are in the habit of visiting the ale or por-

458 Stevens. Some of the Effects of Alcohol [August,

ter fount, wake up your sleeping muscles in the varied exercises
of the gymnasium, and then indulge in the glorious luxury of a
cold bath, and in lieu of temporary hilarity, and a morbid relish
for the tempting viands of the table, whereby your stomach is
forced to receive double as much food as it can digest with case
and comfort, inducing a sensation of heaviness and stupidity after
dinner, there will be an electrical influence imparted to the mus-
cular fibre, a moderate increase of your appetite, an elasticity of
step and feeling, that impart life and vigor to the digestive appa-
ratus, and ease and comfort to the soul. Dr. Leibig, than whom
I could not cite higher authority, thus discourses: "The English-
man, in Jamaica, sees with regi-et the disappearance of his appetite,
previously a source of frequently recurring enjoyment; and he
succeeds by the use of cayenne pepper and the most powerful sti-
mulants, in enabling himself to take as much food as he was
accustomed to at home. But the whole of the carbon thus intro-
duced into the system is not consumed; the temperature of the
air is too high, and the oppressive heat does not allow him to in-
crease the number of respirations by active exercise, and thus to
proportion the waste to the amount of food taken ; disease of some
kind must necessarily ensue." Thus, we see, that an individual
in the enjoyment of health requires no aid from this despotic sov-
ereign for the performance of the most protracted and laborious
demands upon his physical and mental energies. Temperance in
diet, properly regulated exercise, and "Nature's sweet restorer,
balmy. sleep," and ablutions and draughts from the pure fountain,
unadulterated as it issues from the bosom of earth, afford the mo-
live and sustaining power by which the most complex and perfect
of all machinery is maintained in a state of perfect integrity.

Does alcohol protect from contagion ?

The mosV perfect state of physical health, that in which the or-
gans perform their functions naturally, when each discharges its
duty in faithful obedience to those physiological laws which a kind
Providence has placed over the body physical, ensures the most
ef&cient and successful resistance against the encroachments of dis-
ease. The successful military chieftain enforces that rigid, yet
wholesome discipline, whereby the most implicit obedience is en-
sured. In anticipation of a collision with an approaching enemy,
lie marshals his forces, so that each division will act in concert,
and with one grand object in view, to render reciprocal assistance

1857,] Upon the Physical Constitution of Man. 459

ill repelling an attack. From a commanding position, with one
sweep of his telescope, his practical and mathematical eye discov-
ers the most vulnerable points of his army, and every faculty of
his mind is brought into requisition in adjusting the whole into
perfect harmony and symmetry. So with the animal economy.
A\^lien this delicate organism is subject to such extremes of excite-
ment and depression, at one time an important organ almost par-
alyzed by over stimulation and exertion, and at another from a
d liciency of nervous energy, "the pestilence that walketh in
darkness," steals upon the sentinels at the outposts, and victory
])crchcs upon his standard. The testimony of hospital reports,
and the records of benevolent associations, physicians and sur-
geons, give ample confirmation to this lamentable fact.

Writes Dr. Carpenter: "The nurses in the cholera hospital at
Manchester, were at first worked six hours, and allowed to go
Lome the other six, and the mortality was so great among them
that there were fears of the failure of a supply. It was found,
however, that they were much given to alcoholic potations (with
the idea probably of better resisting the malady,) during their
Leisure hours, and they were, therefore, confined to the hospital
and debarred from obtaining more than a small allowance of alco-
liolic drink; after which, not a single case occurred among them."

In the history of the ravages of pestilence, whether yellow fever,
cholera, or dysentery, all reports agree that the bacchanalian, the
debauchee, or even he who is habitually accustomed to the daily
use of alcoholic potations in considerable quantities, is among the
first to fall beneath the scythe of the Destroying Angel. The
mechanism of the human frame is so complex, yet so complete in
all its arrangements, exhibiting such beautiful harmony and con-
cert in the movements of its different parts, that at the same time
.that we adore the wisdom and beneficence of the Divine Architect,
'we wonder that it can be maintained in motion, for even the mean
duration of human life, under an observance of the most rigid
rules of health. In the processes of digestion, assimilation, secre-
tion, and the reproduction of the tissues, any agent, the tendency
of which is to interrupt the nice counterpoise between the assimi-
lating and depurating organs, must necessarily derange the opera-
tions of the whole machinery. An excess of carbon in the blood,
independent of the local effects of alcohol upon the stomach, and
the general plethoric condition of the circulation, demands extra-

460 Stevens. Some of the Effects of Alcohol [August,

ordinary efforts on the part of the lungs, the liver, and the kidneys
for the elimination of the poison, and the maintenance of the
healthful functions of these organs. The insidious nature of this
poison, stealthy in its march yet unerring in its aim, renders it
peculiarly formidable. The case of Alexis St. Martin, upon whom
Dr. Beaumont made some interesting physiological experiments
upon the digestion of food, reads an instructive lesson :

Says, Dr. Beaumont "St. Martin has been drinking spirits,
for eight or ten days, pretty freely; complains of no pain nor
shows symptoms of general indisposition ; says he feels well and
has a good appetite. August 1st. Inner membrane of the stom-
ach unusually morbid; appearance of inflammation more exten-
sive, and spots more livid than usual, from the surface of which
exuded small drops of ihich^ clotted blood. '^ * * The gastric
fluids extracted this morning were mixed with a large proportion
of thick, ropy mucus, slightly tinged with blood. The free use of
ardent spirits, wine, beer, or any intoxicating liquor, when con-1
tinned for some days, has invariahly produced these morhid changes.''^

Ilere, then, w^e have ocular demonstration of the morbific tenden-
cy of this agent. The subject complained of no pain, nor symp-
toms of general indisposition, excepting an. uneasy sensation and
slight tenderness over the epigastrium, and slight vertigo and
dimness of vision on stooping down and rising up, and yet the .
mucous membrane was the seat of intense congestion, to such a
degree, as to cause the exudation of blood upon its surface. When
the inordinate use of alcoholic drinks has been habitual for a
length of time, the mucous membrane of the stomach becomes
thickened, the organ in a measure loses its power of contracting
upon food, the pit of the stomach becomes distended, and malig-
nant disease not unfrequently ensues. " It is incoutrovertibly es-
tablished by a collection of many facts, that this disease (cancer of
the stomach,) is frequently brought on in those who become ad-
dicted to the inordinate use of spirituous liquor." (Cyclop. Pract.
Med., vol. iv. p. 260.) The close proximity of the stomach to the
liver, and the direct sympathy existing between them, persistent
derangement in the function of the former almost necessarily in-
volves that of the latter : hence, seated pain over ihe region of the
liver, swelling, and entire perversion of the hepatic secretion, are
frequently concomitant of gastric disorders. Constant irritation
sometimes induces excessive enlargement of the liver, but most

1Sj7.] Upon the Physical Consiituiton of Man. 461

generally it becomes hard, small, with few traces of blood vessels,
and au entire arrest of the healthy secretion of bile is the necessary
result. The experience of almost every physician will attest tho
depressing cffecls of alcohol in acute disease. External appear-
ances may indicate the enjoyment of high health ; the blood circu-
lates with freedom through the capillaries, lighting up the cheek
with the color of the rose, but it is carrying along with it a y)oison
which is slowly consuming the vital energies. When disease
atttacks the internal organs, where are the innate recuperative
]>o\veis of the system? Paralysed, as if by the weight of some
"unmovable incubus. The blood, deficient in oxygen, is deprived
of its stimulating and health-giving iniluence. Depleting reme-
dies, the most potent in states of high inflammation, are powerless,
nay, directly injurious. The sj^stem succumbs from the abstrac-
tiun of even a small quantity of blood, or under the operation of
brisk cathartics, and disease, in a majority of cases, makes a tri-
umphal march with his victim an easy captive.

The inebriate transmits a desire for stimulants to his offspring.

Examples of hereditary transmission of disease occur within tho
observation of almost every one. Consumption, scrofula, insanit}',
deafness, and various other disordejs, descend from one genera-
tion to another. Peculiarities of individual character in the parent
are exemplified in the child. When the brain and nervous sj-s-
tem have been the subject of such torturing persecution ; at one
time lashed into fury, and at another, sunk to the lowest depths
of depression, is it wonderful that the offspring of such parents
should inherit a weak and perverted nervous system overthrown
by the least unusual exciting cause, subject to spasms, convul-
sions, and falling readily into attacks of epilepsy or idiocy ? Not
only is this peculiarly delicate and irritable temperament trans-
missible from parent to child, but descends even to the third gen-
eration ; and in many instances, where the influence of parental
example has been withdrawn by reformation or death, even the
subduing power of matei-nal affection, and the unqualified con-
demnation of society have proven entirely inadequate to extin-
guish the latent spark. In a report on Idiocy, by Dr. Uowe,'^ to
the Legislature of Massachusetts, we have the following statistics:
** The habits of 300 of the idiots were learned, and l-lo, or nearly
one half are reported as known to be drunkards. Such parents,
* Youmans, on Alcohol.

462 Walker. Flesh Wm-m, {Filaria Uedinensis.) [August,

it is affirmed, give a weak and sickly constitution to their children,

who are consequently deficient in bodily and vital energy, and
predisposed by their very organization to have cravings for alco-
holic stimulants." I believe that the records of hospitals for the
insane, will exhibit comparisons equally as striking as the above.
Within the field of his own observation, almost every physician
can recur to the fact of whole lines of ancestry, extending through
several successive generations, having been consigned to prema*
tare graves, if not by debauching and profligacy, by the exhaust-
ing etfects of alcohol upon the physical system, causing them
readily to fall a prey to acute disease.

But the most revolting condition into which the human body is
brought, is, that which favors its spontaneous combustion. Many
well attested instances are recorded, where the bodies of individu-
als, entirely isolated, and removed from an}^ ordinary inflammable
material, have spontaneously taken fire and been, at least, partial-
ly, if not wholly consumed. I am not aware that that peculiar
chemical condition of the solids and fluids which predisposes to
such a catastrophe, has ever been clearly and satisfactorily defined,
but I believe that the victims have been in the daily habit, during
life, of indulging liberally in the use of alcoholic stimulants.

Thus have we taken a cursory glance at a few of the effects of
alcoholic stimulants upon man's physical constitution in a state cf
health. Their value, as remedial agents in a diseased condition
of the body, cannot be questioned, but it would take us beyond
the limits of our present purpose to protract this article to greater
length.

I

AKTICLE XXIY

Flesh Worm, {Filaria Medinensis.) By N. S. Walkeb, M.D., of
Arlona, Putnam county, Ga.

Two years since, I saw and treated a singular case of what I at
last pronounced a living animal, and perhaps of the above name.
The history of the case is this :

The parents seemed healthy, though in very indigent circum-
stances. The only child was apparently healthy, until about
three months after its birth, when a small red speck was noticed

1857.] Walker. Flesh Worin^ {Filaria Medlnensis.) 463

on the gluteal muscles, at or near the rim of the pelvis, which
gradually enlarged, to the size of a small pea, of oval shape; and
ill about two weeks after its first discovery, it gradually began to
elongate and to descend the thigh, making perhaps the distance of
two lines a day at first, but gradually increasing in speed and in
length. The cord-like object was well defined under the skin,
and could be seen as well as felt.

The worm, as I shall call it, went on in a zig-zag course down-
wards, nearly passing around the limb, but mostly confined to the
outer, and under surface. The anterior part, for perhaps an inch,
was of a bright scarlet color, and grew paler upwards, until the
skin, immediately over the track, assumed a dark yellow cast.
The child showed symptoms of uneasiness, especially at night,
when it was feverish and restless. When the head had reached
the lower half of the leg, I cut across it in several places, and one
cut was made half an inch from the head, and from this cut there
oozed out a few drops of a light, thin, yellow fluid.

This operation, contrary to the advice of most writers, put a
stop to the train, all, except the half inch, or more, of the head,
which went on, though slower than formerly, and when it had
reached the ankle joint, I again cut it up in small bits, but could
not extract any part of it though I did not persist in trying.
This last operation put a final stop to it, and the skin assumed its
natural color. At the time the worm was cut first, it progressed
at least a half inch in twenty-four hours; and from the time it
was first seen, until it reached the foot, there intervened at least
four months.

This certainly must have been a Guinea worm, {Filaria Medinen-
sis of the books,) and is altogether interesting, from its novelty in
this country. The parents were filthy in their habits, and the
'floor of the house was of dirt. The length of the worm could not
well be ascertained, as the latter end was not well defined, though
I supposed it to be, at one time, at least ten inches long,

[Professor Kichard Owen gives the following description of the
Guinea-worm, which we append as corroborative of the above re-
I port; ""The Medina or Guinea- worm {Filaria medinensis, Gmel.)
is developed in the subcutaneous cellular texture, generally in the
lower extremities, especially the feet, sometimes in the scrotum,
and also, but very rarely, beneath the tunica conjunctiva of the

I

461 Brown's Case of Puerperal Convulsions. [August,

cj'e. It appears to be endemic in the tropical regions of Asia and '

Africa.

"The length of this worm varies from six inches, to two, eight
or twelve feet; its thickness is from half to two-thirds of a line;
it is of a whitish color in general, bat sometimes of a dark brown
hue. The body is round and sub-equal, a little attenuated towards
the anterior extremity. In a recent specimen of small size, we
have observed that the orbicular mouth was surrounded by three
slightly raised swellings, wnich were continued a litile way along
the body and gradually lost ; the body is traversed by two longi-
tudinal lines corresponding to the intervalsof the two well-marked
fasciculi of longitudinal muscular fibres. The caudal extremity of
the male is obtuse, and admits a single spiculum ; in the female it
is acute, and suddenly inflected." Hanterian Lectures^ Lect, vi.,
p. 9().] [Edts. I

ARTICLE XXY.

Treatment of a Case of Puerperal Convulsions hy ilie internal admin*
istration.of Chloroform. Eeported by JosiAn BR0W2r, M. D., of
Gaylesville, Alabama.

Wednesday, 24th December, 1853. Called to see INfrs. Grubbs
at 7 o'clock P. M, age 19: good constitution, plethoric habit, and
seven months advanced in lirst pregnancy. She had been suffer-
ing with headache a fortnight or more, accompanied with an
cedematous condition of the lower extremities.

I found her in one of those horrible convulsions of the epileptic
form, such as none but the most experienced physician can witness
with any degree of composure. This being the first case of the
kmd with which I had ever met, and presenting, as I thought,
many unfavorable and fatal symptoms, I resolved at once to put
her upon a somewhat heroic treatment.

I first abstracted 40 oz. of blood, which did not appear to have
the least effect in arresting the paroxysms ; I then exhibited chlo-
roform, by inhalation, as far as seemed judicious : all to no pur-
pose the spasms recurring with equal severity every twelve or
fifteen minutes. It then occurred to me that I had recently seen
a statement of its being given internally for Cramp Colic, with
the most happy effects. The question suggested itself, why it
might not be a safe and effectual remedy in this case.

1S57.] Brown's Case of Puerperal Convulsions. 465

After waiting from a lialf to three quarters of an hour, to ob-
aerve the effect of what had already been done, I administered an
ordinary sized teaspoon ful of chloroform by the mouth, every two
hours, until four doses were given. This had the desired effect
not a symptom of the convulsions recurring after administering
the first dose.

Three hours after the last dose was given, Mrs. G. was delivered
of a dead foetus. I then left for home, leaving a vial of chloroform,
with directions to give a half teaspoonful every four hours, until
four more doses were taken. Also, for her bowels to be moved
by castor oil at night; after the action of which, 15 gra. Dover's
powders to be given atone dose.

Friday raorninrj. Again visited Mrs. G. Found her doing well ;
free from fever, bowels having been moved, and she was feeling
Tcry much refreshed by a good night's sleep.

This constitutes the whole of the treatment for this case, with
the exception of five grains Iron by Hydrogen, which was given
morning and evening, for ten days after; since which time Mrs.
Grubbs has enjoyed excellent health.

[However happily chloroform, in the above doses, may have
acted in the isolated case of Dr. B., we feel constrained to state, in
connection with it, that our own experience has been rather
against large doses, internally administered. On one occasion,
we, by accident, gave a patient (a strong negro man) about \\ tea-
spoon fals of chloroform, for chloric aether ; the effect was truly
atlarming it required hours of the most energetic exertions, with
lemeticp, cold douche and revulsives, to keep him alive ; at the end
of which time, he slowly recovered. Anthony, our own office
servant, while suffering from cramp colic, during our absence,
took one tablespoonful of chloric aether, which happening to be
the concentrated preparation used in surgical eases, the effect wa3
more alarming than in the above case, even to the apparent suspen-
sion of life. For nearly ten minutes of the time, he was without
perceptible pulse and respiration was extremely embarrassed.
Since these cases, we have a species of horror for large doses of
chloroform, internally administered. It must be recollected, how-
ever, that the doses recommended by Doctor Brown were but one
teaspoonful, while in our accidental cases, the quantity given was
nearly double that amount.] Edts.

466 Treatment of Scarlatina. [August^

On the Treatment of Scarlatina hy the Diluted Acetic Add. By B.
F. ScHNECK, M. D., of Lebanon, Pa.

During the past twelve or fourteen months a severe epidemic
of scarlatina has prevailed in my neighborhood. Of 190 cases of
the disease treated by me in accordance with the method recom-
mended by our best authorities, I lost 1 in 8| to 9.

Dissatislied with this result, I was induced to try the diluted
acetic acid as recommended by Dr. I. B. Brown, whose w^ork* I
had the good fortune to meet with at the commencement of the
present year. Of 60 cases treated subsequently by this plan, I
did not lose one. The disease at this time had not undergone any
abatement from its former violence; for among the sixty recove-
ries thore were cases of such malignancy, as would inevitably have
perished under the best directed previous efforts. It is true that
two of the sixty afterwards died of thoracic and cerebral dropsy ;
and one, after a nearly two Aveeks' convalescence, from purpura
haemorrhagica, with epistaxis, haematuria, (fee; but these cases
cannot be regarded as affecting the integrity of the plan in ques-
tion. I am thus enabled to bear a flattering testimony to the
success of Dr. B.'s method.

Many medical men, after unsatisfactory trials of all the ordinary
modes of treatment, now declare that the less there is done for
scarlatina the better. All such will be apt to think lightly of Dr.
Brown's method; if, indeed, they do not condemn what they may
choose to call his nimia cura medici. Let such rest assured, how-
ever, that this is a disease which, like weeds, flourishes most when
least attended to; and further, that the character of medical advi-
ser must be merged, for the time, in that of nurse also, to a certain
extent, if his ministrations are to be successful. He should see
liis patients several times in a day the often er the better ; and
following the example of our author, he should even be found
holding nightly vigils by the bedside, if the urgency of the case
required it. The daily dressings of the fauces with caustic should,
if possible, be made by himself; he should direct the frequency of
the repetition of stimulants; and even the minutest details should
ever be under his immediate cognizance. Thus fully occupied,
although he may be able to take charge of fewer patients, he will
save more lives; and only thus will he be able to realize the truth
of the otherwise almost incredible statement of a friend of the
author's engaged in extensive practice, who writes, "that the
number of fatal cases occurring to him under this treatment did
not exceed yb^/r." This gratifying result, it is the writer's iirra
conviction, will be the reward of all who will adopt and faithfully
carry out the plan.

*0n the Treatment, of Scarlatina by the Acidum Aceticum Dilutum of the Phar-
macopoeia. By L B. Blown, M. D., London, 1846.

1857.] Treatment of Scarlatina. 467

The following is a synopsis of Dr. Brown's views:

1. Scarlatina is always and essentially a disease of debility, or
tending to debility, and not of an inflammatory nature. Its poi-
son acts primarily and most fatally upon the blood, producing a
dissolved, semi-vitalized and putrescible condition of that fluid ; so
that it possesses more serum and less fibrin tlian in its normal state.
"Consequently the serum percolates, oris effused into the cellular
tissue and cavities, through the coats of the vessels. Salines
favour this dissolved state of the blood; but acetic acid prevents
the separation of the serum from the fibrin.

2. Acetic acid is an excellent antiseptic; "it gives tone to tlie
blood in scarlatina, and prevents the separation of the serum from
the fibrin." It also "acts as an astringent upon the lymphatic
system and serous membranes, andso eflectually prevents dropsy."

3. It is a grateful refrigerant.

4. No medicine has a more decided influence in promoting di-
-gestion than this acid. We are further directed, while adminis-
tering it, to "allow patients almost anything they fancy; it will
seldom hurt them in severe and even dangerous disease."

These lour points lie at the foundation of Dr. Brown's very
simple and very successful treatment. The specialities of his
method will not be given, as applicable to ^the several forms of
the disease.

Whatever may be the type, be prepares the system for the acid,
by giving

1. An aperient of 8 to 5 grs. of calomel, to be followed in two
hours by castor oil. All saline aperients are condemned ; " salines
favour a dissolved state of the blood." If from great gastric irri-
tability, the oil is rejected, he recommends an ajoerient mixture
(rhubarb and magnesia,) which contains no saline substaiice.

2. Apply a piece of flannel round the throat from ear to ear, sa-
turated with soap lin. f j; camphor lin., laudanum, aa 3ij. M.

8. After the operation of the oil, give for a patient nine years
old distilled vinegar, dilated^^ f!j; syrup f3iv; distilled water
fSiv. M. Two tablespoon fuls every four hours. This mixture
is to be continued throughout the entire duration of the case,
whatever the form of the disease; and for one or two weeks after-
wards, or until desquamation is well over. "It acts as an astrin-
gent upon the lymphatic system and serous membranes, and so
effectually prevents dropsy."

4. Whenever, in scarlatina simplex, there is slight delirium in
the beginning, with a thick, viscid phlegm on the tonsils, apply
daily nitr. silver grs. x ; distilled water f 3J. M. You thus pre- '
vent s. anginosa. If the throat require it, a linseed poultice may
be placed over the flannel, and kept there constantly.

, * R. Distilled vinegar, OiHc, one part ; water seven parts. M.
i N.S. VOL. XIII. NO. VIII. 30

468 Treatment of Scarlatina. [August,

5. On the third or fourth day^ in simple cases, allow mutton- .
broth.

6. As soon as desquamation comes on, order a warm bath or
two, and keep the patient strictly in bed during the whole proceps.

aS'. Anginoaa. Ilere the treatment is the same, exce])t tliat tlie
caustic must be used more frequently, and the proportion of acid
in the solution must be increased. A good rule is to increase the
strength according to the violence of the attack, in bad cases giving
it as strong as the patient can take it. Poultices to throat. Should
symptoms of adynamia come on, give arrow-root, with a spoonful
of brandy in it; add comp. sp. ether to acid solution; wash fac^,
hand?!, legs, and chest with tepid vinegar (|) and water (|). If
restless at night, give tinct. hyoscj^am., or (|) to (|) gr. morphia,
according to age. The decoction of bark may also be added ta
the acid mixture. Whenever, in s. anginosa, symptoms of adyna-
mia come on, dress the throat frequently with caustic, and in-/
crease the quantity of acid from day to day, you thus prevent s.-^
maligna. , ,

For adults, in cases partaking of the nature of s. maligna, tho^
following formula is given : ^. Distilled vinegar f 5iv ; syr. rod'^
poppies f 3 iv ; distilled water f^iv. M. One-fourth part to bo
taken every four hours. ;

In 5. maligna the same course of treatment is to be pursued^,
calomel, oil, caustic, acid mixture (strong,) liniment or sinapism
to throat, followed by poultices; brandy or port wine every four*'
to six hours, with arrowroot, beef tea, or mutton-broth; morphia
at bedtime, or whenever restless, and sponging with tepid vinegar
and water. All the bed furniture, carpets, &c., to be removed
from the room, and chloride of lime to be sprinkled about the
floor. During desquamation, the patient is not to sit up at all.
Give at this time one or more warm baths. Use wine and brandy
in s. maligna, even in the febrile stage; when combined with the
acid, which so powerfully assists digestion, no harm will ever
accrue from their use.

This is a brief statement of Dr. Brown's views and practice in
this terrible malady. To the work itself we must refer lor a num-
ber of valuable cases, illustrating most happily the treatment
which he advocates, and interspersed with many highly practical
remarks. I cannot help transcribing at length, as a fitting close
to this portion of the subject, the following observations, which I
have copied from his work :

"Very much depends orr careful watching^ in this disease; tliore is
always in one or tlie other of the stages, a critical mome-nt. For instance,
in tlie ernptive stage, even in s. simplex, delirium will come on, and the
lliroat will become more clogged with viscid secietion in a few Lours ; and
if attention he not piomptly given, and this phlegm, which impedes free ;
respiration, be not lemoved, the delirium and laborious breathing will in- -

1S57.] Treatment of Scarlatina, 409

crease, and the disease will soon run into the second or anginose form. In
this case, the throat must be projnptly cleansed, and some g;entle nourish-
ment be given. Again, in s. anginosa, it will not seldom happen t'liat the
tonsils and fauces will suddenly become worse, or great sickness or sudden
piostration will come on; now, unless the throat be instantly attended to,
delirium, laborious breathing, ditiicult deglutition, and restlessness will
make serious ravages upon the patient, and ail remedies will quickly become
unavailing; or wliere sudden prostration should arise, then we must
promptly and unsparingly administer stimulants and cordials till the pulse
exhibits more steadiness and power."

; ' The practical importance of these directions cannot be over es-
timated. As assisting the cleansing of the fauces from viscid secre-
tions, I have, for several years past, been in the habit of injecting.
tlie diluted chlorinated soda into the nares, with the happiest effects.
Extensive ulceration, not only of the posterior nares, but of the en-
tire nasal tract, with an abundant secretion of a peculiar tenacious
mucus, are an attendant on every bad case; and these passages can-
not be long obstructed without great distress and imminent danger.
Thedaily^ or bi-dailj injection of Labarraque's solution, therelbre,
"while it effectuall}' clears away the obstruction (as any other liquid
would as well,) exerts besides an alterative and healing influence
upon the ulcerated surface itself; and it destroys, while it removes,
the morbid products which, if swallowed, as they are otherwise
sure to be, disturb so seriously the intestinal canal ; and last, but
pot least, it corrects the fetor which is so disagreeable a concomi-
tant of such cases. So signal is the relief derived from tliis proce-
dure, that, unpleasant though the sensation must be, I have seen
the little patients, instead of shrinking from the operation, in-
stinctively court the repetition of it, and if old enough,, ask for it.
It is a measure which, in the class of cases referred to, cannot be
dispensed with, without loss. But as it may happen that a con-
siderable quantity of the injection may be swallowed, and the blood
be thereby impaired, it will be proper always to precede or follow
the injection with a strong dose of acetic acid, so as to neutralize
the saline incrredient.

The preparation of the acetic acid solution may be varied some-
what from the formulas given above, and so simplified, without in
the least affecting the result. Instead of first diluting the concentra-
ted aeid to the stren.gth of vinegar, and then using the dilution
fur the preparation of the solution, I have been accustomed merely
to add from f3j to f 3iv of the officinal acid to f!iv w^ater and
ordering a tablespoonful every few hours, sweetening at the time of
administering it. We must, iiowever, never forget to increase the
strength in proportion to the threatening nature of the symptoms.

In the use of stimulants, also, a little license has been taken
with our author's directions. Ilaving ventured upon the guarded
employment of brandy, beef-essence, &;c., as a precautionary step,

470 Treatment of Scarlatina, [August,

earlier in the attack than he allows, without detriment, I now ad-
minister brandy in graduated doses, two or three times a day frovi
ihehejinning in the maHgnant form, or on the second or third day
in an gin use cases; and I have seen no reason to regret this course.
If the tongue becomes red like a strawberry, with the papillae as
large as a pin^s head, or on the contrary, brown, dry, -fissured, with
fiordes on the teeth ; and if there be, besides, a recession of the
eruption, a pulse fluttering and not to be counted, or even deliri-
um, "then we must unsparingly administer stimulants and cor-
dials, until the pulse exhibits more steadiness and power." Carb.
anmionia, quinia, and even capsicum, have here all failed me ; this
last having proved alike ineffectual as an arterial stimulant, and
as a local application to the fauces.

If scarlatina were an inflammatory disease, as the advocates of
bleeding and antiphlogistics would have us to believe, such a sti-
mulant course could not fail to result disastrously in nearly every
instance; but the reverse is actually the fact. The violent excite-
ment in severe attacks, as indicated by burning skin, rapid pulse,
delirium, etc., is not an evidence of phlogosis, but of irritation.
And when death takes place in such cases, it is not so much from
inflammatory disorganization of any vital part, as from sheer ex-
haustion ; the inevitable consequence of the excitement into which
the system had worked itself, in its vain struggles against the fatal
poison which was oppressing it.

Dr. Brown's silence in regard to the use of emetics is a signifi-
cant flict; althou.Q^h more celebrated authorities than he, recommend
them highly. Their adoption at all, as part of the treatment, was
probably suggested by the nausea and vomiting which almost al-
ways usher in the attack; under the supposition of the presence of
acrid ingesta, which they were designed to remove. It may be,
that when the mildest article is selected, solely with this view,
they may do no harm; but when administered indiscriminately,
fatal results must occasionally follow the practice.

Dentition, improper food, the hot months, and a hereditary pre-
disposition, may all, in scarlatina, fjivor the occurrence of serious
gastro-intestinal disease, from the least exciting cause; and an
emetic, especially if containing tart, antimony as advised by some,
jn^y be this cause. In the month of Jul}^, 1856, I was called to
see a child aged twenty months, ill with s. anginosa, ininni ng into
maligna, with scarcely any eruption. NcHwithstanding the child
had vamited, an emetic of ipecacuanha with calomel was given,
after a warm bath ; to be followed by sp. nitric ether and bicarb,
soda in solution, with capsicum infusion. The vomiting became
unmanageable, attended with a copious diarrhoea; gastritis super-
vened, with peritonitis and enormous abdominal distension ; and -
on the fourth day the child died in convulsions. The emetic most
probably had killed it.

What, let us ask, does the gastric irritability of this disease

1S57.] Treatmmt of Scarlatina. 471

mean ? Is it not the first appreciable alarm given by nature of
the introduction of the poison, and an ineffjciaal atttmpt on the
system, to get rid of it at the outset? But as the morbilic matter
is introduced, and the blood saturated with it, man^- da^^s it may
be before it actually develops itself, how can we expect emesis,
whether spontaneous or artiticial, to dislodge it? IfJ instead of
vomiting, scarlatina began with diarrhoea, would we be justified
in giving an active purgative, with the same object? Assuming
Dr. Brown's view to be correct, would it not be malpractice to
bring to bear the depressing effects of a nauseating emetic upon a
disease whose tendency from the beginning is towards debility?
The unfortunate result above related has convinced me that the
use of emetics, as a matter of routine, is fraught with great danger;
and that their employment is indicated in very few, and very spe-
cial cases, if at all.

The following cases, representing the worst forms of s. anginosa
and maligna, are selected out of a number of similar ones, from
my case-book, as illustrating the gratifying success of the acetic
acid treatment, even when under the most unfavorable circum-
Btances.

Case I. Dec. 27, 185G. Saw a girl of Jos. Ileilnian, aged 13, in an
attack oi s.ang. tkreateiung maiigiia. On the evening of the 28tb, found
more fever, ver^- frequent, angry pulse, constant sighing and heaving of the
breath, with increased pulse of heart. Suspicion of pericarditis, and tempt-
ed to bleed. Concluded to postpone till next morning; ordering sinapisms
to extremities, and dose calomel. Was prevented from seeing her until
next day towards evening.

29th. Pericarditis now clear. Bled viii. oz.; epispastic to left chest ; cal.
and op. aa \ gr. every 2 hours ; sinapisms to extremities. Eruption well
out. I'^aspoonful brandy at one, to be continued 3 or 4 times a day, with
beef essence.

30th. Effusion around heart; impulse scarcely perceptible to hand, or
audible; at times delirious; eruption well out; slight epistaxis. Inunction
with mercurial oint, and same to blister. Continue remedies.

31st. Morning. Pulse more full, and a shade lower; impulse of heart
more perceptible, and less muffled ; had 3 or 4 evacuations. Continue
treatment, with alternate doses of pulv. scillie and digital., aa \ gr., cal. |-
grain.

Evening. Cardiac trouble decidedly better; but alarming prostration,
from epistaxis to the extent of a pint. Partial coma; tongue dry, and pa-
pillae very much elevated ; four alvine discharges. Cold cloths to head
and neck; Dover's p. 3 grs., digital. \ ^v., acet. lead \ gr. every 2 hours
(having omitted former powders); 10 drops elix. vitriol every 2 hours,
binapisms to extremities; iced lemonade for a drink; may die to-night.

Jan. 1, 1857. Morning. Bled a pint or more at two several times, to-
oiglit ; extremely exhausted; but one dose of the medicines ordered last
evening was given ; family expecting her death hourly. This being con-
trary to my express orders, I at once directed a resumption of the treat-
ment, including brandy and essence of beef.

472 Treatment of Scarlatina. [August,

Evening. Has taken remedies all day ; no bleeding. Pulse a little ful-
ler, and slightly slower. Tongue dry, and covered with crusts of blood.
Eruption apparently about to decline on upper part of body, but well out
on lower extremities. Continue treatment, at three liours' interval.

2nd. Noon. Pulse a little slower; circumscribed Hush on each cheek;
face sunken ; tongue very dry ; skin dusky, and whole case typhoid. Tur-
pentine emulsion and elix. vitriol, with beef essence, and brandy and milk.

3rd. Tongue a little more moist. Continue remedies.

4th. Improving; pulse a little slower. Will recover.

5th to 6th. Has great appetite. Slowly convalescent.

Bemarhs Bleeding, in scarlet fever, is not necessarily an inju-
rious measure, especially if its otherwise depressing effect be guard-
ed against, immediately afterwards, by suitable doses of stimulants
and nourishment. In this instance, the venesection most assured-
ly saved life, by moderating and favoring the resolution of the
cardiac inflammation; which, although it had gone on to the eifu-
sion of serum, was nevertheless relieved by it, and by the subse-
quent use of squill, digitalis, and calomel. The recession of the
eruption, which might otherwise have followed the bleeding, was
also prevented by the prompt adnninistration of small doses of
brandy. In a similar case of pericarditis in the course of scarlati-
na, I should feel emboldened to bleed largely, giving stimulants
and beef-tea generouslj^, immediately afterwards, as tlie only mode
promising success.

Case II. >S^. Anginosa running into Maligna. Dec. 30, 1850. Girl of
Geo. Strohm, aged 4 years. Vomiting; very rapid, irritable pulse; erup-
tion of a vivid red colour; tonsils greatly onlaig-ed, and covered with lymphy
exudations. Solid caustic to throat; cal. oil, and strong acid solution.

Jan. 1, 1857 Morning. Symptoms of gi-eat malignancy; fauces of a
dark purple hue; face mottled with white patches, Avliere the eruption
showed a disposition to recede; excessive restlessness all night, getting out
of bed in the delirium ; surface of an intensely deep red colour ; pulse rather
feeble, and slow. Solid caustic to throat; sinapism externally, to be fol-
lowed by poultices. Teaspoonful of brandy every five or six hours, if not
gone to sleep. Beef-essence ; acid solution stronger.

Evenini?. Has slept some hours; face more unifoiTnly red ; pulse more
fi'equent ;"surface hot. Sol. 10 gi's. nitr. silver to 5j water, to fauces twice
a dav; chlorinated soda injections into nares. Continue remedies.

2nd. Same as last evening. Comp. camph. Hn. to throat, which is much
swollen ; caustic, injections, brandy, and beef-tea.

3rd. Desquamation already beginning on different parts of the body,
being only the fifth day a bad sign. Continue remedies.

4th. Throat very much swollen externally; tonsils deeply ulcerated ; caso
verv malignant; sinking, and very restless; suiface pale and cool.

10 P. M. Was sent for; supposed to be dying. Prognosis very bad.
Solid caustic to throat ; injection into nares ; brandy every two or three
hours, and continue remedies.

5th. Pulse a shade lower. Family did not attend to throat this morn-

1857.] Treatment of Scarlatina, 473

ing. Applied caustic at once, and injected clilor. soda into nares, bringing
nwaj large masses of viscid soci'ctions, with great relief. Quite ratiouaL
Otli to lOtli. Pulse slower. Gradually convalescent.

Remarks. This case exhibited what I have repeatedly seen in.
this epidemic a succession of pure white patches in the midst of
the eruption, on the face most generally; appearing in the course
of a few minutes, and persisting sometimes lor half a day, or long-
er. Having met with this symptom only in cases of a malignant
character, with a cool skin, and other signs of adynamia, I have
come to regard it as an indication for the prompt use of stimulants.

The early occurrence of desquamation in this case on {\iq fifth
day of the eruj)tion is also worthy of note, as indicating great
pravity of system. In September, 1856, I met with a case in
which desquamation began, all over the body, in extensive potch-
es, on the fourth day of the eruption. The skin was as though it
Lad been seethed or scalded; the cuticle separating first at the
points of pressure from the motions of the patient, incident to her
changes of posture in the delirium as the elbows, hips, etc. but
finally coining away wherever the clothing lay in contact with it.
These denuded surfaces were literally raw; when recent, serum
standing upon them in minute drops. The patient, a girl of 15
years, died rapidly of pericarditis.

Case III. Purpura following S. Anginosa and Malir/na. Feb. 23rd
1857. In this instance, as in a considerable number of others in this epi-
demic, I observed that the eruption on the arms was most fully out alono"
the course of the nervous trunks, there being a broad belt, of an intensely
red colour, in the line of the blood-vessels and lymphatics, from the Land
to the axilla. Having never seen this symptom noticed, and havino- ob-
served it only in the worst forms of the disease, I have been led to regard
it as indicating either phlebitis, or inflammation of the absorbents, and as
sucli, a serious complication of the case. The details of this case are very
Bimilar to those previously given, and hence need not be gone over. It is
sufficient to say that the child recovered with the greatest diffi(;ultv; but by
the end of the first week o'i March he was clearly convalescent, aitl)0U2:h
greatly reduced, and very fole. lie, however, took nourishment, with acid
mixtures, and it was hoped he would do well.

March 13th. I was informed this morning that his mouth bled slij^htlv,
and that the blood appeared to ooze from the gums. Sent him tinctuie
<ihlorid. iron, and saw^ him in the afternoon. Found that epistaxis had set
in ; the blood looking pale red in colour, like a mixture of currant-juice
and water. Purpura patches had api)eared over the whole of the lower
extremities. Prognosis very unfavorable. Beef-essence and elixir vitriol
at short intervals, alternating with sol. potassio-tartr. iron.

l-ith. Getting worse rapidly. Purpura on arms and breast. In the

.course of the day, vomiting of coagulated blood, which had evidently passed

into the stomach from posterior nares. Vomiting continued ; everythinir

was rejected ; and in the afternoon, after having passed some blood\^ urine

the child died, perfectly blanched.

474 Treatment of Scarlatina. [August,

Remarks. This case is interesting, as confirming, to some ex-
tent, Dr. Brown's views of the pathology of scarlatina. Ilere was,
first, a deficiency of red globules in the blood, as was evident from
its pale red colour. We infer, also, an increased tenuity in this
fluid, as manifested by the hemorrhagic tendency, and which may
have been caused either by a deficiency of fibrin, or a preponder-
ance of serum, from paucity of red corpuscles. However we may
explain the morbid result, the occurreiice of purpura is almost in-
explicable under the constant administration of the strongest nour-
ishment and acid solution, unless we admit the coexistence of the
scarlatina poison, acting upon the blood to bring it into this dis-
solved state. At least, this was not congestive or inflammatory
purpura.

AVould it not be advisable, in every case of s. anginosa and
maligna, especially the latter, to administer, as soon as the disease
has subsided, and desquamation is beginning, a mild preparation
of iron? Might not the fatal termination in this case, })erhnps,
have been averted by the earlier emploj'ment of a ferruginous
tonic? Further, would not also the iron, by increasing the crasis
of the blood, lessen the chance of dropsy ? Or, on the other
hand, would the iron be capable of increasing the tendency to
dropsy, by rendering the blood inflammatory, and so favoring the
renal disease, which is so prominent a symptom (if not the cause)
of the dropsy? This is quite possible, regarding, as I do, the
condition of the kidney in the dropsy of scarlatina as a real,
though temporary, acute Bright's disease.

Supposing, however, as does Dr. Brown, that the watery con-
dition of the blood after scarlatina is the cause of the effusion, how
can we reconcile with this the benefit derived from venesection in
dropsy ? If this supposition be correct, are we not, by the abstrac-
tion of blood, and the consequent still further impoverishment of
that fluid, increasing the tendency to efl'usion ? Instead of which,
we find the swelling mostly soon to disappear rapidly after blood-
letting. At least, such has been my experience, repeatedly, in
bad cases of cerebral and cardiac dropsy; and Watson, in similar
cases, gives bleeding his unqualified approval.

These facts militate strongly against the causation of dropsy, as
explained by Dr. Brown. For the present, then, we know of no
solution of the difficulties presented to us above, and mustbecon-
t3nt to follow apparently opposite indications, if correct and suc-
cessful, without being able to reconcile differences.

Case IV. Scarlatina in Childbed. Scarlatina Neonati. On the 2nd
of July, 1856, I was requested to see the wife of Fred. Schaffer, in an at-
tack of s. ano'iiiosa. She was at the end of her pregnancy, and expected
hur confinement daily. Both of her children had bodi passed through a
severe attack of the disease, and she had been their only nurse. Knowing
the disastrous consequences to be apprehended from scarlatina during con-

18j7.] Treatment of Scarlatina. 475

finemeiit, I undertook the case with no little anxiety. On the 4lh, the
premonitory symptoms of labour a})peared, which I treated with anodynes,
hoping to put ati the evil day as lou^ as possible. Moreover, dreading- ihe
.exhaustion which would be likely, in such a ease, to follow the exciteuient
of labour, and still more the debility consequent upon the lochia, (which
would act as a drain upon the system,) I sought to prepare the patient for
the crisis by moderate doses of carbonate of ammonia, serpentaria, and
Leef-essence. liy a cautious use of opiates, the labour was ke})t ott" until
the afternoon of the Gth, when the woman was delivered of a mature fe-
male child, which, however, lived only three or four hours. This child
Avas covered from head to foot with the ei'uption, of an intensely red colour ;
and, lest I might have mistaken the naturally florid colour of many newly
Loiii children for scarlatina, I examined the fauces, and was surprised to
find prominent anginose symptoms, and the soft palate thickly studded
with red points. The infant soon became cold, and the eruption changed
to a purple hue, which, before death, gave place to an almost indigo colour.
My p.ecautions in regard to the mother prov'ed to be well-timed. In
addition to the supporting plan adopted before confinement, she now bore
well a generous sujjply of wine. Siie made a good recovery ; but, a week
afterwards, was attacked with subacute rheumatism of the wrists, which
yielded to Dover's powders and viimm colchici.

Remarks. Ramsbotliam, in his work on Parturition, highly re-
comnieiids a stiinulaiiiig and supporting treatment of the scarlatina
of fiuerperal women, as the only method likely to prove successful ;
and the above case is interesting, as confirming not only Ids own
views, but also those of Dr. Brown, Morris, in his Lectures on
>Sca//e/ i'ei;e?-, says that "to pregnant and puerperal Avomen it is
almost inevitably fatal. I have known several cases which proved
mortal, but never heard of a recovery."

These cases., from my own observation, must suffice for my pre-
sent purpose. They confirm and correspond with, Dr. Brown's
teachings and cases very fully ; and this correspondence between
two epidemics thus widely separated as to time and space is cer-
tainl}^ more than a mere coincidence. It seems to indicate a
certain general principle, which underlies, and so essentially de-
termines the nature of this, as of every other affection, through all
the variations of climate, localitj^, and prevailing type of disease.
Whether this principle, which Dr. Brown professes to have dis-
covered as regards scarlatina, be the correct one, can only be
determined after extensive and frequently repeated experiments.

Finally, to all the evidence adduced by Dr. Brown in favor of
the preservative effects of acetic acid upon the blood, it is proper
to oppose the testimony of our best American authority, as to its
injurious effects in large and long continued doses. Dr. Wood, in
his liter apeutics^ says that, thus administered, besides producing
gastric and intestinal irritation, " it lowers the organic functions
of the system generally, impairing nutrition, depraving the blood,
producing anaemia and emaciation, and ultimately, it is said, in-

476 Si/pliillzation. [August,

ducing a conditinn analogous to the scorbutic." The same writer
refers to its liability to develop the tubercular diathesis, when
taken habitually, as it sometimes is, with a view to obviate i'at-
ncss. Wliether, and to what extent, Dr. Brown's use of the article
should be considered toxical, it would be difficult to say ; but pro-
bably the diluted state in which it is given, and the comparatively
short time that it is administered, will save it from being so
regarded, except in so far as many of our best remedies are poisons
in over-doses. \_Amtr. Jour, of Med. Sciences.

Syphiliza iion.'^

Two or three years ago, a bold young French physician startled
the grave dehberations of the Patres Conscripti in the French
Academy of Medicine, by the announcement of his having discov-
ered a new metfiod of the treatment of syphilis, with which he pro-
posed to extirpate that wide-spread malady from our nosology. JVot
only did Auzias Turenne aim at the cure of syphilis in persons
already affected with the disease, but he shocked morality by the
proposal to render individuals hitherto untainted with sy^thilis
totally unsusceptible of the venereal virus. The French Academy
of Medicine met, and an acrimonious discui-'sion ensued. The
moral and hygienic objections seem to have been those which were
discanted upon; the facts do not seem to have been very carefully
inquired into; no experiments were made to test the truth or false-
hood of the new mode of treatment, and under the powerful influ-
ence ofllicord it was rejected by the Academy, in spite of the
protest of Malgaigne and others against this summary decision. In
this country, the subject seems to have excited very little interest.
One or two journals briefly alluded to it in terms of unqualified con-
demnation, and the only notice of the controversy from an impar-
tial point of view is given in "Rankimr's Abstract of the Medical
Sciences,''" p. 333, vol. xvi., by Dr. Radclilfe. Since then, with
the exception of two papers by Victor de Meric, in the "Lancet"
for 1853, no notice has been taken oi"lhe subject, and the medical
public in this countiy seem to regard the question as finally settled
by the fiat of the French Academy. Not so, however, our i)rethren
on tfie continent. In Norway, in Sweden, in Turin, and elsewhere,
the bold empiricism of Auzias Turenne has been carefully put to
the only test capable of deciding the question at issue viz., that
of experiment. Not content with merely declaiminir against sypfid-
izaiion as unheard-of and unjustifiable, Professor Boeck in Christi-
ana, D.mielson in Bergen, Carlsson in Stockholm, ani Sperino in
Turin, have for some \ears past been eno;nged in a series of careful

* This ai-ticle, so extraoi'dinary in its facts and doctrines, consists of brief extracts,
which liowever will be sufficient to develop the fundamental, and it may bo added,
almost incredible principles recently deduced from numerous experiments made by
a, geutlemau of distinguished reputation aud reputed competency. Ed.

18C>7.] Sypliilizaiion, 4^77

experiments and observations to determine the truih or fallncy of
Turenne's practice. It is jilain that experiment alone can decide
the (juestion ; tneory here is but of little avail, and would be ot" no
more use in disprovmg stubborn iacts if such they really be than
il it vvei'e directed agamst the efficacy of mercury in primary syphdis,
or of quinine as an antidote to ague. The French Academy seems
to iiave rejected the practice ot Turenne without ])utting it to the
proof; indeed, as we observed before, the moi-al question alone was
tried, and found wanting, while the actual facts seem hardly to
have been discussed at all.

Auzias Turenne, a young French physician, commenced about
the year 1844, a series of experiments, with the view of testing the
validity of John Hunter's doctrines of the non-communicability of
syphilis to the lower animals. After many experiments and several
failures, he succeeded in producing in monkeys inoculated with
chancre matter a disease which had all the characteristics of true
chancre. This was at first admitted in the French Academy, but
at a latter period was denied. However this may be, it is quite
certain that a contagious disease was communicated to the poor
animals, and that from these it was transferred to rabbits, cats, and
horses. The malady was again from these returned by inoculation
to the human species, the first trials in this regard having been
naade by Dr. Robert Weltz, of W^iirzburg, on his own peison. On
four separate occasions. Dr. Weltz succeeded in producing an nn-
n)istakable chancre on his own person, by inoculation from animals,
and this was acknowledged even by Ricord.

Wlule Auzias Turenne was thus engaged in researches on the
transmission of syphilis to animals, he became aware of the curious
fact, that each succeeding chancre produced by inoculation became
less and less in each animal, until at length a period arrived when
inoculation apparently lost all its power, and no chancres or sores
of any kind iollowed the application of the venereal virus. From
these facts he drew (he inference, that by prolonged inoculation
with the syphilitic poison, a constitutional state or diathesis was at
length produced in which the system was no longer capable of
being atlected by syphilis. This condition he terms "syphilization,"
and upon this asserted discovery all the subsequent experiments and
peculiar mode of treatment are based. Auzias Turenne and his
lollowers contend that by such a process of prolonged inoculation
the system becomes protected for the future against the venereal
poison, just as an individual who has had small-pox cannot take the
disease a second time. To obtain perfect syphilization or immuni-
ty, the individual uiust undergo constitutional syphilis ; but he niust
be forced rapidly through this disease by repeated inoculations, in
order that it may not injure the constitution.

The abortive experiments of Diday in 1849, require but little

notice. He proposed to inoculate with blood drawn from a person

laboring under tertiary syphilitic symptoms, so as to prevent, as he

473 SypliiUzatlon. [August,

imagined, the poison from entering into the constitution at all.
Although this [)roposal was apparently based on one of llicord's
supposed " laws" viz., that constitutional syphilis never affects
an individual but once in [lis lifetime, it was also indirect contra-
diction with llicord's positive opinion, "that tertiary syphilis could
not be communicated by the parent to the child." After a series
of experiments, Auzias Turenne's doctrines were lairi before the
French Academy of Medicine (November 18th) in 1850; and as
might be expected, opinions so novel and so startling met with the
most vehement opposition. Turenne had, it seems, only recently
commenced at that time his experiments on sy[)hilization in the
human subject; he had, therefore, few or no data for the support of
his opinions, and he not only proposed to employ sy[)hilization for the
primary and secondary forms of venereal diseases, but suggested
the use of this treatment as a prophylactic against the contagion of
syphilis in persons as yet untainted with that malady. It was upon
th.s latter point that the discussion mainly turned, and here the in-
dignation of his opponents was unbounded at the audacity and im-
niorality of such a proposal. We cannot deny that they had right
on their side ; the proposal was not only immoral, for the disease is
one to which an individual voluntarily subjects himself by a lapse
fi-om the rules of morality, but it was also most injudicious to subject
a perfectly healthy person to the danger of incurring a malady from
which he might never again be able to free himself. The true niode
of determining the question that of experiment, carefully conduct-
ed and often repeated was not adopted, and an application by
Turenne for leave to prosecute his researches in the Ht)pital St.
Lazare was negatived by the Commission. Hitheto, not being
permitted to pursue his investigations in a hospital, he had only
experimented on a few cases in private practice, and these were ne-
cessarily too few and two scanty in the details to be implicitly relied
upon. The real question at issue, that of the reality or non reality
of syphilization, was left untouched. Malgaigne, Depaul, and others
in vain protested against the sweeping condemnation of these pro-
posals before the tiuth or falsehood of the doctrine had been deter-
mined by experiment; the great influence of llicord and his parti-
sans prevailed, and the proposals by Auzias Turenne were unequiv-
ocally condemned. Shortly after, a strong case appeared in favor

of the opponents of syphilization, in the person of a Dr. L , wlio

had allowed himself to be inoculated to produce syphilization, and
was now covered with venereal sores. While matters thus proceeded
in Paris most unfavorably for the advocates of syphilization, the
question was being investigated on a large scale, and in a more com-
])lete manner, by Sperino of Turin. This physician had great
advantages for the prosecution of his researches, as he was attached
to the Syphilicomo, or Venereal Hospital, of the city of Turin. He
had long remarked that large suppurating buboes healed more rapid-
ly when their syphilitic character was tested according to Ricord's

1857.] SijphiUzaUon, 479

plnn, by inoculation of the surrounding parts; and moreover, thnt
when the jirimary chancres were large and obstinnte, the inguinal
buboes were sninller and less freely developed. The longer the
local d:S3ase lasted, the less chance there seemed to be of constitu-
tional sy[)hilis. Sperino made his first report on the subject to the
Medico-Chirurgical Academy of Turin on the 23d of May, 1851.
In this report he gives the full details of fifty two cases treated by
liim in the tSyphilicomo of that city. If Spermo was not the first to
employ syphilization for the cure of venereal disease in the human
subject, he at all events first performed a regular series of experi-
nnents and observations to test the truth or fallacy of Turenne's
doctrines.

"The subject of M. Sperino's experiments were fifty-two hospital
patients, all prostitutes, and all suffering from aggravated forms of
primary or secondary syphilis. The virus was taken from the per-
son syphilizsd, or from a comrade -from the first if possible. The
inoculations were repeated once or twice a week in three or four
distinct places, usually in the abdomen. The time required for the
establishment of the artificial chancres was from two to three days.
The effects of the second inoculations were less serious than the
first, the third than the second, the fourth than the third, and so on,
until the virus ceased to produce any effect whatsoever; contempo-
raneously with which epoch all former ulcers had healed, and buboes,
recent nodular enlargement of bones, and cutaneous stains or blotch-
es, had either disappeared altogether, or were rapidly going away."

The virus also, which made no impression at that time, was
found to retain all its virulence when tried on an unprotected per-
son.*

Sperino's observations were confirmed by similar results obtained
by Dr. Gamberini at Bologna, and by Gulligo at Florence. The
report of the Commission appointed in this case, as at Paris, was
unfavorable, but it did not extend to the prohibition of further ex-
periments, and Sperino has ever since followed up this treatment
in the hospital under his charfre. In 1853 he published a detailed
account of ninetv-six cases of svphilization in a bulky volume of
903 pages. "* * ^ # * * *

JNot only are certain cases ill fitted for sypbilization from previ-
ous mercurial treatment, but the state of health of the patient must
be taken into consideration before subinitting him to this prolonged
and painful treatment. Dr. Boeck advises that we should not
syphilize when any inflammatory diathesis exist in the system, as
ins uch cases the artificial chancres may take on a malignant action.
Habitual spirit drinkers, and persons of very weakly constitution,
should not be subjected to this treatnient. The bowels should be
regulated, and the digestive organs should be brought into good
order: but it is not necessary to enforce any strict rules of diet. In

*See Dr. Radcliflfe's Report on Surgery ; Ranking's Abstract, voL xvi., p. 334.

4S0 Syphilization. [August,

the hospitals of Bergen and Christianla, the ordinary full diet of the
hospital was always allowed. With regard to obtaining the pa-
tient's consent to the treatment, no difficulty seems to be founl
cither in the Scandinavian or the Italian hospitals. Both Sperino
and Dr. Boeck mentioned the readiness with which patients submit-
ted to, and even sought for the mode of cure which they had seen
to be so successful in their fellow sufferers.

Various methods of inoculating the venereal virus have been
adopted by the advocates of this system. Auzias Turenne at Hrst
kept up a succession of single chancres; while Sperino made three
or four separate inoculations at once, and repeated tiiese two or
three times in the week. After having in this way reached the
number of twenty-four or thirty inoculations in all, he found that
the chancres last produced were exceedingly small, and he then
diminished the intervals, and made more inoculations at e 'ch sit-
ting. He found that the first chancres were deeper, larger, and
more inflammed than those which succeeded them; and that by-
diminishing the intervals and increasing the number of inoculations,
the earliest chancres visible diminished, and were less painful and
inflamed. To test this still further, Sperino ventured upon as many
as sixty inoculations at once upon the same individual; but the
result obtained was that immuniiy to further inoculation set in be-
fore the syphilitic symptoms were cured, and relapses of the disease
frequently ensued. He therefore returned to his former plan, and
now inoculates for six to ten chancres at each sitting. While these
chancres are progressing, it is neither necessary nor advisable to in-
oculate afresh, nor should this be done until the former chancres
are developed. Should the chancres be developed too freely, and
threaten to produce active inflammation, or to extend as phage-
daenic sores, he checks their progress by inoculating afresh at
shorter intervals.

The practice of Dr. Boeck differs very little from that of Sperino.
At first afraid of producing too serious an impression upon the
system, Dr. Boeck inoculated for two chancres only every six days,
selecting that period of time, because he found fi'om experience,
that it required about five days to produce induration in a chancre;
although he does not, as we have already seen, considere this
latter circumstance absolutely essential. Subsequently he has
shortened his intervals to three days, and increased the number of
inoculations to eight or ten. Less time is thus required to produce
immunity; but Dr. Boeck has a wholesome distrust of those cases
which are pushed too rapidlv through their course of svphilization.

With regard to the most favorable points in the body for inocula-
tion. Sperino placed his punctures on the lower part of the abdomen,
while Dr. Boeck prefers inoculating on the arms and thighs. Ac-
companying each of his observations in the volume before us is a
lithographed outline plate of the human figure, with the points of
inoculation, and the date of each; while lines drawn from the arms

1837.] Si/phiUzaiion. 481

to the thighs enable us to follow the trnn^positions of the virus from
one chancre to another. By this simple fiirure it is easy to trace
the proijress of the treatment, to see the number of inoculations at
each sittinix. and the source from which they are derived. * *

We think that the advocates of syphilization fiave established a
claim on the profession to a (air trial of their system. It is evident
that its emplovment is not fraught with danger, as is the case with
so fnany reniedies proposed from time to tune ; and the investigntion
of the subject seems to open up a new field for the further study of
one of the most malignnnt and most lastinc: and destructive poisons
that affect the human frame. Brit, and For. Med. Chtr. litv. for
April 1857.

Professor Boech on SijphiUzaiion .\^ it be evident, as I think it is,
that the remedies hitherto used against syphilis are uncertain, and
even pernicious, then it is not only allowable, it is our duty to try
the new one that is offered to us. To me the only question was
in what cases syphilizalion might be used. I have already men-
tioned that I always thought jrf'ophylaciic syphilization to be an
absurdity. Therefore, I shall not dwell any longer on it. The
question is whether svphilization ought to be used in all cases
\\ here syphilis exists ? This question is easily answered. I cannot
predicate wilh certainty if all those who get primary syphilis will
get constitutional disease. The simple chancre is not in general
accompanied by any constitutional affection. The Hunterian one
is certainly a consequence of a constitutional syphilis, but we may
easily deceive ourselves in respect to the induration. Therefore, I
never use syphilization where there is merely primary syphilis.
It is not until the constitutional symptoms have appeared that I con-
sider this method allowable, for then I am convinced tliat I do not
introduce anything into the organism but what is there before. I
cannot double a malady already present. So I am quite certain
not to do any harm to the patient.

This may be the fit place for mentioning shortly how I produce
syphilization. Without any other preparation than a bath, or in
my private practice even M'ithout this, I applv on each thigh, and
on each arm, or on the sides only, three inoculations in every one
of those places, with matter taken from a primary ulcer, or from an
artificially produced one in a person who has been syphilized. I
choose the first named i')laces for those \\ho are lying in the hospital,
but I inoculate the sides of those who, during syphilization, are
going out attending to their business. However, I must add, that
I never confine my inoculations exclusively to the sides. If they
do not prove efTectui 1 there, I apply them on the thighs, on which
we shall almost always find the ulcers to be larger, deeper, and of a
longer duration. Therefore, I think this place the best, and never
fail inoculating there. Every third day I inoculate anew. As long
as the last inoculations produce pustules, I take the matter from

482 SyphiUzation. [August,

these. In some cases I have always tried to take the virus from
the first made inoculations, thinking to find there the strongest mat-
ter, and therehy, perhaps, be able to achieve the cure in less time;
but the cases in which the treatment has been acct)mplished in this
manner are so few, that I should not venture to draw deductions
from them, in syphilized children, J have only applied one inocu-
lation on each thigh, and generally also on each side, every third
day, or perhaps at longer intervals. The ulcerations produced in
this manner may occasionally become phagedeenic in grown-up
persons. Many wounds may be united into one, and lorm a large
ulcerating surface. This, however, does not signify in the least,
provided the treatment be continued without being alarmed. The
inoculations are a certain remedy against the phageda:'nic ulcera-
tion. In children, the ulcers are generally so small as not to cause
any inconvenience. It is only in cases which have been mercuri-
alized before that I have sometimes seen the artificial ulcerations
enlarge, yet never to an alarming degree.

Jn some instances the inoculated person becomes proof to one
sort of virus. I then take the matter for inoculat'on from another,
preferring a case which has had a different origin. This then proves
effectual. But sometimes they become proof to this also, and I then
seek for a third source ; and thus I go on as long as any matter at
all will operate.

Moreover, it is worth noticing that immunity does not occur, and
the syphilitic phenomena do not vanish, earlier in children than in
grown-up persons. The time necessary to produce immunity is
about three months. However, it depends upon the number of
inoculations that may be employed upon the symptoms that have
taken place ; and in children it seems to depend upon their syphilis
having been acquired or inherited. The quality of the virus even
may not be without influence. When immunit}" is attained, the
syphilitic- phenomena generally vanish. However, should this not
be the case, it should cause no uneasiness, as they will certainly
vanish within a short time, without any remedy beinor used.

It is not uncommonly the case, that during syphilizafion a new
eruption takes place; but this always exhibits sym[)toms of the same
nature as were observed at the beginnmg of the process of syphil-
ization. These eruptions need not cause any anxiety. The opera-
tor may quietiv go on inoculating, and things will proceed as in
other cases. One phenomena that I have often seen develop itself
under syphilization is iritis. This has been very intense in some
cases; but I do not make it the subject of any special treatment,
either antiphloiristic or derivative, and the result has hitherto been
always favorable.

The syphilitic poison does not run a rapid course, as was known
a lons^ time before we heard anything of syphilization. We often
see the constitutional symptoms not to show themselves until after
some months. Therefore, there is nothing astonishing in the fact,

II

1857.] SyphiUzation. 483

thnt the curative results of inoculation do not show ihenaselves until
after some time.

l>ut if even by svphilizalion nlons we cannot efiect a cure in all
cases, it is, nevertheless an indispensable remed\\ Patients who
have been nearly destroyed by syphilis and mercury may be restored
by it to health. The cases belonging to this class may present very
difierent aspects, and the efiect of syphilization on them, of course,
nlso difierent. I therefore think the best way to give my view of
the matter is to arrange them in separate groups, viz :

1st. The early constitutional cases recently tieated with mercury,
in which the same symptoms have reappeared. Here syphdization
will, in some cases, produce as certain an efl^ect as in cases not
treated before, but we oftener find some ii-regularity. The phe-
nomena vanish and return again. That which I have said takes
place in the individuals not mercurialized is repeated here ; namely,
it is always the same f(.)rms which existed at the beginning of the
syphilization that return.

2nd. The afl^ection may still be confined to the cutaneous system
nnd the pituitous membranes, but the tubercular forms may be pre-
dominant, ulcerations on mucous membranes may go deeper, or the
affection mav be in the subcutaneous areolar tissue. We may even
have the tuherculai' serpigenous syphilide.^ These affections are
more slowly acted upon. The reason for this may partly be found
in the fact, that these forms are often rather of old standing. JMer-
curial treatment, iodine, etc., have been used against them, and we
also often see bad forms show themselves within a year after the
primary affection. This seems to depend on individual constitution,
for it often has no relation to the quantity of mercury, or the care
taken of the patient during the treatment.

If in these cases, new eruptions come out during syphilization,
we shall always find them to be more superficial than the earlier
afl'ecticn, if even they have the same form as that which existed at
(he beginning of the svphilization treatment. It happens in these
cases, espeoiallv, that the inoculations, after a small number of them
liave been made, do not produce any effect, then we must give
iodine, atfer which again we shall have larfjcr pustules and ulcers.

3rd. Aflfections of the osseous system. Here syphilization hardly
ever seems to produce any eflTect. But when iodine has been used
earlier, producing results ofonlyashort duration, then syphilization,
united with iodine, seems to relieve the nocturnal pains more cer-
tainlv: but osseous tumors remain unaltered by syphilization.

4th. Afl'ections of the nervous system hyperaethesia and incom-
plete and complete paralysis may occur : First, in combination
with other syphilitic svmptoms, and in those cases I have seen them
diminish under the influence of syphilization. Secondly, they may
be the only phenomena left as the result of the mercurials used
against the primary syphilis ; and, under these circumstances, we
I - -

* Radesyge.

N.S. VOL. Xni. KO. VIII. 31

484: Observations on Dysentenj. [August,

see little or no effect from syphilization. However, I must observe,
thcat all the cases of that sort which I have hitherto treated have
been of old standing, and have for a long time been treated with
iodine, etc.

5th. Mental maladies, finally, m??y be the result of the mercurial
treatment. I have had no opportunity of employing syphilization in
such cases, but I consider it well worth trying. The idea that
syphilization should be the last refage, seems to be quite as if quina
should not be given in the beginning of an intermittent, but that the
system should be first injured by different other medicines, and then
quina given afterwards.

As the result of the great many observations made with syphil-
ization, it seems sufficiently proved that the syphilitic virus heals
constitutional syphilis, and that it cures the malady without doing
any harm whatever to the organism. On the contrary, we see that
the uneasiness, the rheumatic pains which often accompany consti-
tutional syphilis, vanish under continued inoculations.

The immediate effect of syphilization upon the organism is gener-
ally also very favorable, but there are some wbo have thought that
it may, perhaps, operate perniciously in future time. To this J have
only to say, that I can show many individuals discharged from hos-
pital more than three years ago, who have remained in uninteiTupt-
ed good health, and that in not one of the persons treated in this
manner, can T point out any unfortunate result whatever, which
could be ascribed to syphilization.

If, finally, I were to comprehend, in a few words, my o-pinion
about syphilization used as a curative remedy, I should say

1. Syphilization is undoubtedly useful against syphilis ; it is the
only certain remedy that we know, and it is not pernicious to the
organism: mercury, therefore, ought to be banished as a curative
remedy.

2. Syphilization is not so certainly useful against mercurialized
syphilis, but it ought always to be tried. It often does cure it en-
tirely, and it at least does not fail to do some good in the greatest
nun)l)er of cases.

8. The application of syphilization against other maladies than
svphilis ought to be tried with the greatest possible care aad exact
observation. \_Glasjow Med. Jour.^ from Dublin Quarterly^

Observations on Dysentery. By J. L. Abernethy, M. D., of Con-
cord, Tennessee.

What is Dysentery ? This interrogatory has, doubtTess, propound-
ed itself to the mind of every scientific member of our profession,
yet the problem has never been explained, so as to be of practical
importance to the medical fraternity, or of benefit to suffering hu-
manity. The theories existing are too numerous to relate. Patholo-
gists, liowever, harmonize more in regard to its nature than its

1S57.] Observations on Dysentery. 4S5

therapeutics. There is no disease in ihe wliole catalogue of human
C()rn[)hiints, that has received as varied a treatment, as the one under
consuieration. No two authors agree, in every respect ; no two
practitioners coincide in every particular; and many eminent ones
occupy antagonistic positions.

They tell us on the other side of the Atlantic, that dysentery is
"purely an inflammation," and the theory, in this indefinite condi-
tion, has been endorsed, to some degree, on this side of the "Great
Waters." The expression of the above quotation, is very vague
and meaningless. Gonorrhoea is " purely inflammation," and, so is
gastritis, yet theydifl^er wide in their pathology, etiology and thera-
peutics. In general terms, dysentery is "purely an iniiammation;"
but what kind of an inflammation is it?

There ai'e two kinds of inflammation common and specific.
They differ in respect to the causation, and the tissue complicated.
The causes of common inflammation are traceable, definite and
direct, while the causes of specific inflammation are obscure, inde-
finite and indirect. The common phlogosis is mostly confined to
deep-seated tissues, while the specific variety is generallv situated
on the skin and mucous membranes. Erysipelatous inflammation
is the general nomenclature for inflammatory affections of a specKic
character, of the skin and mucous membranes.

Is dysentery a specific inflammation ? Our answer is in the af-
firmative. Now for the proof. We will take up and examine the
different phases of the disease, and see if the theory advanced can
be sustained.

Dysentery is situated, or located, generally in the sigmoid flexure
of the colon, or the adjacent intestine, below or above, more fre-
, quently below. Why is it that it always attacks this part in pre-
ference to any other portion of the alimentary canal, or any other
canal with a mucous membrane? Let us make four divisions of
the alimentary tube, and briefly examine their anatomical structure
separately, and then compare the result. First, the a3Sophagus, is
composed of three coats, layers or membranes. They occupy the
following relation to each other: 1st, mucous; 2nd, cellular ; 3rd,
muscular. The first, or mucous membrane, has a basement mem-
brane which is profusely supplied with bloodvessels and nerves.
The second, or cellular coat, connects the muscular with the mu-
cous membrane, and transmits the bloodvessels ai.d nerves, from
the muscular to the basement of the mucous membrane, consists of
two layers; the fibres of the external are longitudinal, and those of
the internal are circular. 'J'he stomach is of the same structure,
exceptinor the addition of a fourth or serous coat. The small intes-
tines, like the stomach, possess four membranes. The mucous
membrane is longer than either of the other layers, and hence must
bo thrown into numerous folds, which are called valvulae cf>nni ventes.
They difler from other folds of mucous membrane in being fixed or
permanent. The surface of the mucous membrane, is covered with

4:86 Chservatlons on Dysentery, [August,

a number of papillary projections, called villi, which impart a soft
end velvety feeling to it. In the small intestines are found the folli-
cles of Lieberkuhn, glands of Peyer and Brunner, and the solitary
glands. Let us now descend to the large intestines, anr] examine
their construction. Here we find a mucous membrane, not unlike
that ot the small intestines, excepting the absence of the valvulae
conniventes and villi ; it is whiter, thicker and coarser than the
mucous coat of the small intestines. The follicles or crypts are
numerous. The cellular layer is the same as found elsewhere in
the alimentary canal. The muscular membrane, like that of other
portions of the intestines, consists of two fibres, longitudinal and
circular. The serous coat is the same as found everywhere, only it
has numerous folds of fat, which are called appendices epiploicae.

We have briefly run over the anatomy of the ahmentary tube,
and find its structure pretty much the same, from the mouth to the
anus. We have examined in vain, for a reason why dysentery
should be located where it is. There is no rational or explicable
reason revealed by anatomy, why it should be situated in the sig-
moid flexure of the colon ; if there was, then there would be one
argument less in favor of the theory advanced.

Pathologists, who call dysentery "puiely an inflammation," in-
form us that there is none of that redness and softening, revealed by
pathological investigation, that is so characteristic of gastritis and
enteritis; but that there is always more or less ulceration, and in
manv cases, the diseased bowel is an "irregular, confused and tat-
tered mass of disorganization." Why is it that in enteritis or gas-
tritis there is redness and softening, and in dysentery the bowel is
ulcerated, and is often an "irregular, confused and tattered mass of
disorganization?" Pathologists explain why this difiTerence in pa-
thological lesions, and another argument is crushed.

The danger to be apprehended in typhoid fever, is peritonitis re-
sulting from perforation of the intestines, and in this fever every
organ and tissue of the system is in an unfavorable condition to
take an inflammation, because the very elements, or, at least, the
concomitants of inflammation, are below the normal standard ; yet,
in dysenterv, when, according to the common hypothesis, the ele-
ments of inflammation are in the excess, and the bowel ulcerated,
and often an "irregular, confused and tattered mass of disorganiza-
tion," extensive peritonitis rarely supervenes. Why is this? Be-
cause inflammations diflfer in respect to the tissue diseased, an;f
specific inflammations never attack serous membranes have no
affinity for them.

The most important and pathognomonic sign connected with the
symptomatology of dysentery, are the haemorrhagic discharcres. Js
haemorrhage a natural consequence, and concomitant of inflamma-
tion of mucous membranes ? Most assuredly not. Inflammation
of the mouth and oesophagus is not attended with haemorrhage.
Ilaematemesis is no indication of gastritis.

1857.] Observations on Dysentery, 487

In enteritis, there are no haemorrhngic evacuations. And all
these diseased organs have their cellular membrane profusely sup-
plied with bloodvessels and nerves, afferent and efferent, direct and
indirect from the spinal cord. The bleeding, which is sometimes
excessive and alarming, that occurs in dysenter}', establishes be-
yond all cavil, the specific cliaracter of" the disease.

'I'he period of the year in which dysentery prevails, and commits
its desolating ravages, indicates much in favor of the theory advoca-
ted. All common inflammations are most rife in the cold, dreary
and desolalinjT winter, and the ever vascillatino^ vernal months.
1 hey are more frequent at these periods, because their causes are
more abundant, direct and definite, than at any of the other seasons
of the year. The disease under consideration, makes its appearance
in the jatter part of summer, and generally disappears at the ap-
proach of cold weather. These facts are unquestionable evidence,
that the cause or causes of dysentery arc quite different from the
etiology of common inflammations; and inflammations are classifi-
ed, common or specific, according to their causes. Cold is one
among the chief causes of inflammation, but it cannot produce dys-
entery, for then the disease would be mostly confined to the period
when ordinary local phlegmasia exists. Imprudencies of every
kind are a prolific source of common inflammations. It is true, the
violation of the laws of nature is detrimental to health, and may
liasten on, and aggravate the symptoms of any disease, epidemic or
endemic; but to suppose that dysenteiy is dependent upon impru-
dencies of any description for its existence is the very height of
supererrogation. It is no respecter of persons. Its frequency is as
great in the affluent mansion, as in poverty's hovel. It is found as
often, and its mortality is as great, on the mountain's top, where
Jiealth-disseminating breezes waft, as along the river shore, or in the
low and marshy lands, whose poisonous efl[luvia pervade the atmos-
phere.

The etiology of dysentery, Kke that of those terrible scourges,
algide cholera and yellow fev^er, is much in obscurity. The chief
cause the predisposing cause is essentially epidemic. It exists
in the atmosphere, manufactured or brought about in some manner,
by unnatural changes or conditions of the summer and autumnal
seasons. The exciting causes are any and everyiliing, that has a
tendency to undermine the normal foundation of the whole system
of organs of the human economy.

If dvsen^ery was a common inflammation, venesection to de-
crease the volume of blood, mercury to diminish the amount of, and
check the formation of fibrine, tartar emetic to reduce the action of
the heart, and equalize the circulation, and numerous other antiphlo-
gistic acients, would check the disease as quick as they would pleu-
jisy. Will antiphlogistics cure common inflammation ? Thev wilL
Do they cure dysentery? Would to God they could, but they can't!
Experience has taught that we may bleed, mercurialize and antimo-

488 Pathology of Milh Sickness. [August,

nialize, ani the tormina, tenesmus and haemorrhage will continue
unabated, if not, in many cases, aggravated. In man}' cases of a
very acute nature, in a plethoric patient, the judicious employment
of the lancet is of great advantage; but in a large majority of cases
the prostration contraindicates it. Experience has taught that
bloodletting has no influence over the duration of the disease. Mer-
cury as a sialagogue not as a defibrinizing agent is generally
beneficial, because the secretion of the liver is invariably checked.
Tartar emetic is of no advantage.

Anodynes and cathartics are the remedies most successfully and
generally employed. Injections of nitrate of silver through long
lubes are thought to be good. The treatment that is generally em-
ployed at this time, and the fatality of the disease, point distinctly
to a specific disease. But to tell what kind of treatment is best, is
not the object of these " obf.'ervations." That is reserved for a fu-
ture paper.

It is admitted, with regret, that the profession knows but little in
regard to dysentery. But the science of medicine, like everything
in this fast age, is rapidly advancing, and it is confidently anticipa-
ted, that bef(jre many years will have passed away, some Jenner-like
mind will rise up ami throw off the mantle of obscurity that is sus-
pended around this disease. * ^ * * ^ * *
[jSouihern Journ. Med. and Phys. Sciences, .

The Pathology of Milh Sickness^ in Parhe County^ Ind. By Dr.
John Pickard.

Thinking the pathology of milk sickness^ as it appears in Parke
County, Ind., taken from observations of citizens who have been
acquainted with it for thirty years, might be interesting to some of
the readers of the Journal, I have })repared the following imper-
fect article. So little is known b}' our book making physicians,
that they give ns no information worthy of note; and so contra-
dictory are the investigations of phj-sicians, who have come in
contact with it, that it is impossible to come to any definite con-
clusions, from the reports we find in the journals. The views
given in the April No. of the Journal, relating to the Etiology
of the disease under consideration, very nearly correspond with
the following experiments, which conclusively show that it is not
vegetable, animal, or malarial. A farmer living about a mile
f om where the disease is known to exist, allowed his cattle to
run out, but they never reached the infested district until the
dew evaporated from the vegetation ; the result was, his cattle
nor his flimily were ever attacked by the disease; were it a
vegetable, the absence of the dew would not destroy its poisonous
qualities.

Another family having suffered from its ravages, ploughed up

I

I

1857.] Pathology of Milk Sickness. 489

ii pasture field, digged around the stumps, thoroughly turning all
the soil, and sowed the field in grass, upon which tlit^y have kept
their stock for twenty years, and at no time has milk sickness
made its appearance; wliile on other portions of the farm uncul-
tivated, it is as fatal as ever. Whether the poison is a mineral or
a gas is yet to be tested; but I am inclined to believe it a gas
much heavier than the atmosphere, consequently resting upon the
vegetation; dry weather seems to favor its production. Last
season it was prevalent in many districts, where it had not made
its af)pearance for a number of years, bat in no iiistance did it
attack animals kept upon cultivated ground. It may be in the
water, but we are not acquainted with any district where this has
positively been proven. It, however, seems improbable when the
disease prevails upon the neplands, and the springs from which
the stock drink flow through the bottom lands, and is used there
by other stock, yet the disease never makes its appearance among
them.

All species of animals are liable to be attacked by milk sickness,
thegraminivera, first and among those the sheep appears to be the
most easily affected; thecarnivera always obtain it from the flesh
of animals that have died with the disease. It is often concentra-
, ted in ihe milk of the cow, and the calf will be attacked when the
cow shows no sj-niptoms of disease. Animals well fatted are not
liable to be attacked. A farmer in this vicinit}^, kept his horses
on a lot of one acre, and fed them on hay and oats, the disease soon
made its appearance among them; he then turned his hogs upon
the same lot, fed them all the corn they would eat, and they
showed no symptoms of the malady. Fiom the observations and
experiments which have been made where the citizens have suf-
fei'ed severely from the loss of property, and the lives of those
still denrer to them, we deduce the following conclusions. 1st.
Milk sickness is caused by a poison, this poison is generated near
the surface of the earth, from some p'^culiarity in the soil or the
soil and atmosphere combined. 2d. That the poison is a mineral
or heavy gas, which appears to be produced in the liightand des-
troyed by the rays of the sun. Sd. A thorough culiivation of the
soil will destroy it 4th. That it may be communicated fi'om one
animal to another by the flesh or milk. And 5th, that oleagin-
ous substances act as a preventative, and will often cure animals
affected with the disease. There is no difiiculty in the diagnosis,
the patient invariably complains of great weakness, inability to
peribrm labor, a small amount of exercise produces trembling and
fainting sensations; as the disease advances, vomiting, and obsti-
nate costiveness are invariable accompaniments, and during the
whole time a peculiar odor pervades the room, unlike anything
we have ever met with.

The treatment of milk sickness is simple ; we have previously
Btated, that oleaginous substances are preventives, and we have

490 Puerperal Convulsions treated with Chloroform. [August,

found no remedy so efficient as Oleum Eicini, by the stomach, if
possible, if not, give entmata. Apply sinapisms to the stomach,
give cooling mucilaginous drinks, overcome the costiveness as
soon as the nature oithe case will admit, and you have conquered
the main obstacle to successful cure. [^Norik- Western Mtd. and
Surgical Journal.

A Case of Puerperal Convulsions^ treated with Chloroform. By Wm.
Dickey, M. D., of Centerville, Wayne county, Indiana.

I was summoned on the evening of the 26th of April. 1S53, to

attend Mrs. B. T , a robust woman, in labor with her first

child. Being informed, on my arrival, thatslie had had two con-
vulsions, I immediately examined her per vaginam, and found the
OS uteri pretty well dilated. Iler pulse was rather lull, but did
not indicate any great degree of arterial excitement. As the labor
was progressing rapidl}^, nothing was done to alleviate her suffer-
ings, until after the delivery of the child, which took place in about
one hour and a half after mj' arrival. Up to this time she had had
six convulsions. The pulse was not so lull, but more frequent
the carotids beat violently, and the convulsions occurred at short
intervals. The face was quite livid, and consciousness did not
return during the intervals of the convulsions. As I had but lit-
tle confidence in the efficacy of blood-letting, I told Dr. Isaac
Carej^, who was in attendance prior to my arrival, that I would
\SY the influence of chloroform. The Doctor yielded to my pro-
position. Having no chloroform with us, we had to send lour
miles to procure it. When we had obtained the medicine she had
had twenty-three convulsions. They were recurring every few
minutes, and she Avas black in the face and comatose the pulse
more feeble and frequent, and to ail appearance the case seemed
likely to terminate iatally. The chloroform was administered for
three quarters of an hour, the amount inhaled being governed by
its influence on the circulation. She did not have a single con-
vulsion after the administration of the chloroform, although the
coma lasted for two days. I do not know the subsequent treat-
ment, as she was in the hands of Dr. Carey.

I regard puerperal convulsions as the result of depressed inner*
vation, and engorgement of the venous and capillary systems;
either of these may be first affected, but in the end both become
involved. Medical writers have taught that puerperal convulsions
are associated with a tremendous rush of blood to the brain, and a
state of conipression of that organ ; so that blood-letting has been
considered as almost the only agent capable of arrestmg such a
formidable disease. And it is not to be wondered at when the
physician is called to witness an attack of the disease; the quickly
repeated spasms; the flushed face become even livid and black j

1857.] Puerperal Convulsions treated with Chloroform. 491

tlie violent beating of the carotids, and the distended juguhus,
Avilli a full and li-cquent pulse that he is almost certain lo con-
clude that blood-letting is the sheet anchor. And now, as he has
been previously tauglit, he bleeds his patient without regard to
quantity; he bleeds her at short intervals until the convulsions
cease, or his patient dies. A true representative of this practice is
Dr. Uewecs. See case second and third, in his work on the prac-
tice of Midwifery, pages 4d4: 'ob. In the second case " the patient
lost one hundred and twenty ounces of blood in the space of six
or seven hours, and about one hundred and forty altogether."
From case third, was taken during the lirst live hours, one hun-
dred and twenty nine ounces. ''The convulsions now ceased fur
twelve hours. At the end of that time the Doctor was calkd
in suddenly, on account of her breathing becoming more labori-
ous and loud; the face more flushed, with some convulsive agita-
tions; the Doctor thought best to abstract ten ounces more by
cups, nnd the woman lived." And truly this is astonishing,
especially if she lust much blood by floodmg after the delivery of
the child.

No doubt blood-letting may sometimes prove a valuable remed}'.
It is, htnvever, believed to be, either in vtnous engorgement of the
capillaries, or depressed nervous function, nothing more than a
preparative measure to more efficient remedies. The casts in
which it may be employed, are, where theie is strong action of
the heart, great throbbing of the carotids, and general plethora.

There can be no question that at the full term of utero gestation,
and especially Avhen the uterus has commenced its vigorous con-
tractions, that it acts by sending a sudden shock to the nerve-
centers, and the impulse transmitted to the circulatory system,
gives a determining course of the blood to the brain. In this con-
dition it is very probable blood-letting is essential, more, however,
as a palliative than curative means.

If we are correct in our conclusions, it is obvious that the ab-
straction of blood can do but little to remedy a toxic condition of
the blood, and still less, will it be adequate to remove a lesion of
innervation.

The object of the writer in penning these thoughts was not to
write a systematic treatise on tlie disease, and discuss the cficacy
or inefficienc}" of the different articles of medicine used, or means
employed in the management of the affection but to condemn the
pernicious practice ofc{;pious depletion, and to draw the attention
of the profession to the emplojmicnt of chloroform in the manage-
ment of this disease.

The condition in the disease being a loss of innervation, where-
by the capillaries lose their tone, the circulation becomes interrup-
ted, and venous engorgement follows. If we are correct in our
tiotions of the modus optrandi of chloroform, it fulfils the indica-
tions. The first impression is probably gently stimulating, thus

492 Some of the Effects 'produced hy Carious Teeth. [August,

equalizing the nervous energy. And as the congested capillaries
are under the direct control of the nerve centers, it is very likely
the new stimulus gives tonicity to the capillary vessels, and a bet-
ter circulation. And as we continue the remedy, and obtain a
stronger anaesthetic influence, insensibility follows, and the spasms
cease. A sufficient number of cases have been reported, that ter-
minated fjivorably under the use of this remedy to entitle the pro-
fession to some confidence in its virtues. \_Wedern Lancet..

On some of the Effects produced by Carious Teeth.

To the Editor of the Lancet :

>SVr, The perusal in the Lancet of the interesting practical lec-
ture by Mr. Smith, of Leeds, on the above subject, recalled to my
mind three cases somewhat analogous to those related in Mr.
Smith's lecture, which have come under my own notice during
the last two years. Their true nature and obvious treatment did
not occur to myself, and a statement of them may be useful to
some of your readers. The three patients were all young men,
between the age of twenty-five and thirty years, and, curiously
enough, they were all affected on the left side of the face.

1. R. S , by occupation a coachman, footman, etc., to an

old gentleman, called upon me two years ago to get something
done for a sore on the centre of his left cheek, lie said it liad
been a boil, which su})purated and broke about two months })re-
viously. His face was much swollen, and as he had to wait at his
master's table, it rendered him unfit for his work. The patient had
consulted another surgeon, and had tried various remedies, but
could not get it healed. He was otherwise the picture of health.
I thought it might be some chronic affection of the parotid gland,
strumous or otherwise. I gave him some zinc lotion to inject into
the opening, and to apply a bit of rag dipped in the same, and
covered witli oiled silk. In about three weeks he came to tell me
that the sore w^as healed, but his cheek was swollen. I gave him
iodine to apply over it. There was an ugly cicatrix where the
sore had been. In the course of another month the patient came
again, presenting an abscess ready to burst in the old })lace. I
opened it, told him to poultice it for a few days, and then use the
former treatment. In about three months he called again, and
told me that after he last saw me, being useless in his situation,
he went home to Edinburgh, where he saw Professor Syme, who
gave him something to use, and that the sore did not heal for six
weeks after I opened it. The Professor told him that the sore
arose from a wisdom tooth conung up, for which there was not
room in the jaw, and advised him, if the sore did not heal, or
should trouble him again, to have the adjacent tooth extracted.
His face was now much swollen, and an abscess was evidently
forming again. I examined his mouth, and saw that he had got

18 j7.] Treatment of Hooping- Coy gh. 493

the upper wisdom teeth only, and there was evidently a want of
space for those below. I accordingly extracted the second molar
looth, a'^ter which the swelling gradually subsided, and the wis-
dom tooth soon filled up the vacaut space. lie was now perma-
nantly cured.

2. Some months before I saAv the last case, R, T , a forester

by occupation, came to me with a large abscess on the left check,
about an inch above the angle of the jaw. I opened the abscess,
and by using poultices for some days, and water dressing after-
wards, the sore healed in about two weeks. Shortly after I ex-
tracted the tooth from case No. 1, I was aojain visited by No. 2.
The abscess was now the same as before; but observing the simi-
larity between the appearance of this case and the former, I exam-
ined his mouth, and saw that he still wanted the wisdom tooth in
the left lower jaw, for which there was evidently no room, and
the gum round about was a good deal inflamed. It so happened
tiiat a 3"ear or so before he came to me with the first abscess, I had
extracted the second molar tooth in the right lower jaw for tooth-
ache, the place of which was now filled up b}^ the wisdom tooth.
I now extracted the same tooth on the left side, when the abscess
broke into the mouth, and the wisdom tooth replaced the removed
one as before. lie has not been troubled since.

3. A. T , a dealer in tea, consulted me four months ago for

a swelling on his cheek. I found that an abscess was forming.
The treatment and results were the same as in the other cases,
with the important exception that, having recognized the nature
of the case before the abscess broke on the cheek, I saved this pa-
tient from having an ugly cicatrix, as the other two unfortunately
had, and will have as long as they live.

I am, sir, your obedient sei'vant,
Peebles^ 1807. Egbert Cea^vfoed, M. D.

Oil the comh'ned Local and ConUitutional Treatment of Hooping-
Cough. By Ravenhill Pieece, M.D.

As I consider it the duty of every medical practitioner to bear
testimou}" to any successful method of treating any peculiar dis-
ease which may have fallen particularly under his notice, I beg to
press upon the profession the plan I have adopted in that trouble-
some and painful-to-witness disease Hooping-cough. In sevenhj-
five cases, (thirty-two boys and forty -three girls,) varying in age
from two to eight years, which came under my care during last
autumn, in a school containing over a thousand children, I used
the local treatment recommended by Dr. Eben Watson, viz.,
sporging the glottis once a day with a strong solution of nitrate
of silver, (one scruple to one ounce of distilled water,) by means
of a curbed probang ; and in combination with this I ordered Dr.

49^ Camphor and Epilepsy. [August,

Gibb's nitric-acid mixture (dilute nitric acid, twelve drachms;
coifjp. tincture of cardamoms, three drachms; water, one ounce;
simple syrup, three ounces and a hall), a teaspoonful every three
liours. I also from the commencement gave a teaspoonful of cod-
liver oil twice a day, and at the same time kept the patients ou
generous diet and in warm yet well-ventilated rooms.

Now, this treatment has in my hands been invariably success-
ful, and the little sufferers have not only escaped all those trouble-
some and dangerous complications which so frequently attend and
follow hooping-cough, but have at the termination of their illness,
in numerous cases, gained both flesh and stamina. I am perfectly
aware that both the nitrate-of-silver and nitric-ncid plans have
been used separately, but I have not heard of the two methods
being combined.

I am desirous of calling particular notice to the fact of my hav-
ing given cod-liver oil from the very commencement of the attack,
instead of waiting till the period of convalescence; and to this as
well as to the generous diet, I, in a great measure, attribute the
satisfactory and non-debilitated state of the patients at the time of
their recovery.

I would also mention that after a few applications of the solution
of nitrate of silver I have found that the force of the peculiar
spasmodic cough has been diminished in frequency and intensity,
and the shock to the sj^stem caused by the straining and convul-
sive eiforts of the patient consequently much lessened. If any of
the numerous readers of Tlie Lancet have already pursued a similar
plaa of treatment, I should be very glad to learn the result.

\^London Lancet.

Camphor and Epilepsy. By Joseph 0. Brookhouse, M. R. C. S.

The following case occurred to me in the practice of Guy's
Lying-in Charity:

E. P , aged thirty -two, a multipara, and apparently healthy

woman, after a natural labour, was ordered the usual after-paia
mixture, consisting of spirit of camphor and tincture of hyoscya-
mus, of each twenty minims, in mucilage, repeated every three or
four hours, as might be necessary. About five minutes after
taking the first dose she was seized with vertigo, impairment of
vision, and almost immediately became insensible. She foamed
at the mouth, and there were general twitchings of the muscles,
more especially those of expression. ISTo urine or faeces were ex-
pelled during the fit, which lasted nearly six minutes. On recov-
ering consciousness, she was quite ignorant of what had transpired,
did not complain of inconvenience, and convalesced without any
unpleasant symptoms. The above circumstances brought to her
mind the fiict of her having been affected in a somewhat similar
manner eleven or twelve years ago, after eating a piece of cam-

lSo7.] Simple mode of Eeducing a Dislocated Elbow. 4C5

phor about the size of a nut, the only difference between the two
attacks being the duration of time with reference to the develop-
ment of symptoms as well as period of recovery a difference
"which m;iy probably be exj)lained by cousiJcring the form in
"which ihe drug was taken. [Ibid.

On a Simple Mode ofEedacinrj a Dislocated Elbow, Ey M. ElDAKD,
of Ari-as.

In a recent communication to the Societe deChirurgie de Paris,
^[. Bidard relates a case in which a dislocated elbow was reduced
in a very simple manner, after the ordinary means had failed. A
child, aged 13, had dislocated his elbow, and the dislocation had
been reduced in the ordinary way. A month later the elbow was
again dislocated. On this occasion the child said nothing about
the accident, and five weeks passed before the mischief was dis-
covered, and the attempts at reduction repeated. These attempts
failed. It then occurred to Mr. Bidard to persuade the child to
swing himself by both hands from a cross beam of wood, and to
allow his hands to be held in this position by another person when
he became tired. These swingings were continued for fifteen or
twenty minutes at a time, and repeated every morning and even-
ing; and the result was that the displacement had entirely disap-
j^eared on the seventh daj^ It appears from the account, that the
displacement diminished progressmg between the first and nint!i
sus])ension ; and that the rest of the deformity disappeared sud-
denly daring the fourteenth suspension.

Tin's method, us Mr. Larrey observed afterwards, possesses some
analog}^ to that of the door, as formerly practiced by some sur-
geons, but with this difference, that the reduction is effected grad-
ually in this case and suddenly in that.

As to the rest we are disposed to think there need have been
no difficulty if the chloroform had been employed; for, unques-
tionably, dislocations of much older standing are easily reducible
with the help of this agent. [Gaz. Hebdom. de Med. et Chir.
Buffalo Med. Journal.

Idiopathic Dysentery treated by Bismuth and Astringents.

"We all know the value of bismuth in the dysentery and diar-
rhoea of phthisis in fact, its importance cannot be over-estimated
in that particular affection. We have had the opportunity of
watching a case of idiopathic dysentery, which is at present in the
Eoyal Free Uospital, ujder Dr. Brinton's (;are, of a young man
who was admitted, on the 4th of February, with as many as
twenty dysenteric motions per diem. Its origin was due to cold,

496 Nitrate of Potash in Ascites with Anasarca. [August,

while working in a gas factory by niglit; there was no evidence
of the existence of putrefying matter in the neighborhood. Un-
der the influence of a mixture consisting of a scruple of bismuth,
ten grains of com[)Ound powder of kino, two drachms of mucilnge,
and an ounce of infusion of krameria, every six hours, conjoined
afterwards with enemata every night, of twenty minims of tmcture
of opium, two drachms of tincture of catechu, nnd two ounces of
decoction of starch, the stools gTadually diminished to only one
daily for the last fortnight ; the last three days he has had none.
At the same time, the most careful attention hns been paid to his
diet, which consists at this moment (March I6tli) offish. lie has
been a voracious eater, and is now only kept in hospital for the
purpose of regulating his diet. The treatment pursued here
])roved highly satisfactory, and is well worthy an extended trial
in dysenteric complaints. We will not say the good effects were
solely due to the bismuth. Of late years, it has been specially
recommended, not only in the diarrhoea of phthisis, but also that
of enteric or typhoid fever, and the chronic diarrhoea of children.

{^London Lancet.

Kitrate of Potash in Large Doses in Ascites with Anasarca,

"We read in the Eev. de Ther. Med. Chir. (Jan. 15lh, 1857,) an
interesting account, translated from the Chronica de las Bospilules,
of the case of a man who, in eighteen days, was entirely relieved
of ascites and anasarca by the use of 1 ^rge doses of the above remedy.
On the first day of treatment, which was, as near as we can ascer-
tain, about six weeks fi'orn the coming on of the dropsy, and up-
wards of seven weeks from the beginning of an attack of remit-
tent fever which preceded the dropsy, the new medical attendant,
M. Angulo, directed for his patient two drachms of nitrate of
potash dissolved in a sacchoro-mucilaginous vehicle, which was
to be taken in a period of thirty hours. On the first day of treat-
ment there was a slight increase of the urinary secretion; the
stomach bore the medicine very well. On the following day the
nitre was increased to a little more than three drachms. The
patient had some alvine evacuations ; the urine was more abundant
than on the preceeding day. On the third day the patient was
much better. At his request the same medicine was given, the
doses of which were successively raised until, on the eleventh day
of treatment, they had reached eleven drachms and two scruples,
or nearly an ounce and a half in twenty-four hours. On the twelfth
day the body had resumed its customary size, after an excessive
uniary discharge, which had supervened on the fifth, sixth and
seventh days.

In proportion as the serous effusion was absorbed, the appetite
and strength were resorted, and dating from the seventh day's
adininistratiori of the nitrate of potash, the patient was able to walk

18 j7.] Cldorate of Potash in Mercurial Stomatitis. 497

about bis room. At tbe time be came under tbe cbarge ofM.
Angulo, ibis man was unable to leave his bed, and so great was
tbe anasarca and swelling of the eyelids that tbe globe of the eye
"was no longer visible.

The regimen consisted of preserved fruits, baked apples, panada,
vermicelli soup, a little good wine, and at a later period a more
abundant alimentation. After tbe twelfth day the dose of the
nitrate of potash was diminished, and on the nineteenth it was
abandoned. On the 8th of January, 1856, or seven weeks and
two days from the beginning of the nitre treatment, the man was
so entirely restored to health, that he resumed his business on the
mad in trading in wine, wbicb be transported by mules. Mempliis
Med. Recoi'dtr.

THERAPEUTIC APPLICATIONS OF CHLORATE OF POTASH.

Chlorate of Potash in Mercurial Stomatitis. By TllOiNFAS J. Galla-
HER, M.l)., one of tbe Physicians to tbe Western Pennsylvania
Uospital, Pittsburg.

Mercurial stomatitis is a most loathsome and obstinate complaint.
Slight attacks of this affection are com})aratively of but little
consequence, for, wnth proper precautions as to exposure, they will
mostly disappear in a short time without remedial measures being
resorted to. More grave forms, however, in which the gums be-
come very sore, the tongue swollen, tbe mucous membrane of the
mouth ulcerated, the salivary and other glands in the vicinity of
the neck enlarged and tender, the breath fetid, the jaws stiffened,
deglutition difficult, salivary secretion increased, etc., are of more
serious import, and demand the attention of the physician. If a
case of this kind be left to itself, or if merely palliatives be em-
ployed, it will generally last some weeks, and it may be months
before its complete removal by nature is effected.

Many remedies have been suggested and various plans of treat-
ment tried for the removal of this artificial malady; but none,
until the chlorate of potasb w^as })roposed, met the wants of the
profession, and none gave general satisfaction. Recent authors
bave generally contented tbemselves with recommending exposure
to a warm dry air, cathartic medicines, topical depletion, and tbe
local application of numerous wasbes demulcent, astringent, and
stimulating to the inflamed parts. Dow uncertain and unsatis-
factory these means have been, tbe profession everywhere can
answer. For my part, I may say that I have often been so dissa-
tisfied with the slowness with which mercurial sore throat disap-
peared under this treatment, that I thought that no good was
derived from it further than temporary amelioration of disagreea-
ble symptoms and preservation from external injurious influences.

493 Cldor ate of Potash in Mercurial Stomatitis. [August,

This treatment is eminently palliative not specific. Present re-
lief is afforded while the affection is allowed, in a great measure,
to run its own course.

Eecently, a new remedy has been proposed which, from a pretty
extensive employment of it, I now regard as much a specidc for
mercurial stomatitis as quinia is for intermittent fever.

Ihr was the first to recommend the use of the chlorate of potash
in ulceration of the mouth following salivation, but to Messrs.
Ilerpin and Blache, of Geneva, arc we indebted for a more full
and satisfactory account of the beneficial effects of this salt in
mercurial stomatitis in all its forms and stages. The first account
of the discovery of these eminent physicians which appeared in
this country, was published, I believe, in the April No. of the
American Journal for 1855. Since that time I have had frequent
opportunities for employing it, and uniformly with success. I
have seen ordinary mercurial stomatitis disappear under its use in
a few days, while the most loathsome forms have been observed
to yield in ten. Judging from past experience, I now, with the
use of this salt, can remove a mercurial disease of the mouth in
from six to ton days, which, under any other proposed plan of
treatment, Avould last from four to six week. I may say that
have found it equally beneficial in all stages and degrees of sali-
vation, as well as in ulceration of the mucous membrane of the
mouth, which sometimes remains after the other symptoms have
disa])peared.

My method of treating a patient affected with this disease is as
follows: He is placed in a warm and comfortable apartment, and
made to live on gruel. I then order him ten grains of the chlorate
of potash, dissolved in a tablespoonfal of cold water, three or four
times a day, according to the severity of the affection. Should
there be ulceration of any portion of the mucous membrane of the
mouth, I direct a weak solution of the salt to be applied to the
denuded part several times a da}^. Generally, nothin^: else is re-
quired the cure being accomplished in a few days. To illustrate
more fully the effect of this remedy, I have appended a few cases,
which have been selected from quite a number that have fallen
under my notice.

Case I. The first case in wliioh I had an opportunity of employing this
remedy, was in May, 1855, on the person of a young lady, aged 26 years.
Blue mass pills bad been given her pretty liberally, by the family, for some
imagined illness, until her gums and mouth became so sore that it was with
difficulty she could swallow food. After suffering some days under these
symptoms, I was called to visit her. I found her breath fetid, gums sore,
mucous membrane of the mouth partially ulcerated, and other unmistnka-
b'e evidences of confirmed salivation. For a few days, I gave the usual
mouth washes, a gentle cathartic, and required her to remain confined to
her room. For about one week she used the means I suggested, widi but
little advantage. At this time I was made acquainted with the good effects

i

IS J 7.] Chlorate of Potash ill Mercurial Stomatitis. 499

of chlorate of potash in mercurial stomatitis, aiul at once determined to put
it to the test. I accordiiiijjly prescribed it as follows: li. Pota.ss. chlornt.
3j; aquje 3 vj. M. One tablespoonful of this solution to be taken three
times a day. I saw tlie patient two days afterwards, and found her much
better, ller mouth had commenced to heal, the mercurial fetor of the
breath had diminished, and she felt able to swallow food. In a week from
. this time the disease was entirely removed.

The speedy relief obtained in this case gave me some confidence
in the new remedy, and satisfied me that it was worthy of further
trial. An opportunity soon occurred.

Case II. Miss C , ao^ed 23 years, while employed in the capacit} of

a dry nurse, was attacked in the spring of 1856, with severe neuralgia of
the right side of the head and upper part of the face. The physician to
the family in which she for the present resided, was called to sec her, wlio
pronounced it disease of the brain. Pow^ders containing calomel were
ordered. She took the medicine a few days, but her mouth becoming
very sore, and her sufleiingsnot being alleviated but rather increased, her
friends determined to take her home and send for iheir family physician.
I found the patient labouring under remittent hemicrania of most excrutiat-
ing severity, accompanied with mercurial salivation. The severity of the
symptoms required active medication, I ordered at once remedies both for
the neuralgia and sore mouth. A liniment composed of chloroform and
olive oil, was ordered to be applied to the head and temples, and ten grains
of the sulph. ofquiniato be given night and morning, for the former,
wdiile ten gi-ains of the chlorate of potash, three times a day, was pre-
scribed for the latter atiection. In thi-ee days the hemicranial pain had sub-
sided, when the quinia was suspended. The sore mouth had, in the mean
time, improved. Four days' more employment of the chlorate stopped the
saliyaiy discharge, and healed up the mouth. The cure was prompt and
decisive.

Case III. In January, 1857,1 was called to visit a Mrs. M , who

complained of a bad breath, sore mouth, loss of appetite, &c. I learnt that,
about one Aveek previous to my visit, she had taken some anti-bilious pills,
which were supposed to contain mercuiy. An examination of the mouth
told at once the caue of her sufferings. She was severely salivated. Noth-
ing had been done, further that a Dover's powder liad been taken at bed-
time, to work the cold off, as she expressed it, and an alum wash for the
mouth had been used freely. It may not be improper to state that no ad-
vantage was derived from these. The patient was directed to remain in
her room, Hve on spoon diet, and take tliC chlorate in ten grain doses, three
times a day. On my visit the following day, she was much better, and
declared the first dose helped her. A continuance in the remedy effected
a perfect cure in a few days.

Case IV. This was a case of ulceration of the mouth following salivation.
It was of nearly three weeks' continuance, and many local applications, in-
cluding nitrate of silver, had been ineffectually made to it. I gave the
chlorate in the usual form and frequency, and ordered the ulcer which
was situated beneath the tongue, of large size and very painful to be
washed several times a day with a weak solution of the same, and had the
satisfaction of seeing it heal up in five days. [^Am. Jour. Med. Sciences.

N.S. VOL. XIIL NO. VIII. 32

500 Chlorate of Potash in Leucorrhcea^ etc. [August,

Ch^Draf^ of Potash Injections in Leucorrhcea and Ulceration of (he
Os Uteri. By Bedford Brown, M. D., Caswell Count3^, N. C.

Knowing the peculiar and happy curative influence exerted by
chlorate of potash in external ulcerations attended wiih vitiated
discharges, and having been so often disappointed by the usu:.l
modes of treating such cases, the great difficulty of w^hich all
medical men acknowledge, I determined to experiment with in-
jections of a solution of that salt in ulceration of the os literi and
cervical canal attended with leucorrhcea.

The discovery of some simple and efficient means as a substi-
tute for the uncertain astringent injections in common use, and
the tedious and often unsuccessful caustic and speculum, would
relieve the physiciaii of an extremely disagreeable datj^^ and the
patient of an almost intolerable necessity.

In those cases of leucorrhcea attended with ulceration of the os
uteri or cervical canal, and enlargement of the muciparous glands
of the vagina, or sim^ple ulceration without leucorrlioen, I believe
the injections of the chlorate far more certain and eihcient than
the ordinary astringent injections, or the local application of
caustic. In these cases I have not thought proper to give detailed
reports of their symptoms and progress.

Case I. A colored woman, ag-ed 30, wLo Lad never borne cLildren, and
had, from early life, complained of symptoms of uterine disease. At the
time she came under my charge, she had profuse leucorrhcea. On exam-
ination with the speculum, the entire vaginal canal was seen hio-hly infla-
jned the os uteri very tumid, with numerous large ulcers. This woman
used, bv injection, a solution of the chlorate, in the proportion of 3j of the
salt, dissolved in gviij of rain water. As much of this as an ordinary
female svrini>-e contains was used twice daily. Under the influence the
ulceration and inflammation, with the attendant leucorrhcea, diminished
rapidly, and in two weeks all indications of disease liad disa])pcared. In
this case, the locality of the disease was confined to the vagina and the os
uteri.

Case II. To digress from the subject, I would report the present ca?e
as illustrating the equal powers of the chlorate of potash in gonorrhoea of
the female. "This patient an unmanied female had suflered f.om gonor-
rhoea! disease, until the vaginal inflammation had become excessive with
Terv copious, purulent, and exhausting discharges, accompanied by so
much tenderness and pain as entirely to preclude the use of the speculum.
The diflScultv and pain of uiination were such as to compel me to use the
catheter frequently. The same treatment as in the previous case was
adopted, and with equal success. In fact, this patient (servant) who hati
been perfectly disabled, in ten days after using the chlorate injections, was
attending to her ordinary duties.

I strongly conjecture that gonorrhoea of the male would be equally
amenable to the same treatment; and, as soon as the first opportunity
presents, I design testing it. If so, a new era will be introduced in the
management of that intractable disease.

1857.] Editorial and Miscellaneous. 501

Case III. This was an example of leucorrhopaonginatinfj from ulceration
of the OS uteri and intlammation of the cervical canal. The woman was
married, and had been confined prematurely three months previous. She
used the chlorate of potash injections, and remained in the recnmhent
position for some hours after each injection. She found ecpial benefit f.om
the remedy, and is now attending to her customary duties, without any of
her former symptoms.

Case IV^. and V. In these cases there was ulceration of the os uteri and
cervix, with very slight leucorrhoea, though sulTering fiom the ordinary
annoying symptoms of uterine afl:ection. In both cases, the chlorate in
solution healed tlie ulcerations in between two and three weeks, with signal
relief to the patient.

To sum up briefly, tlioss conditions to which the chlorate of
potash injections are applicable, I would say those cases are ap-
propriate, wherein ulceration an<l inflammation are confined to
t'le OS uteri and cervical canal and vagina, either with or without
leucorrhoea. [_Lb.

EDITORIAL AXD MISCELLAA'EOUS.

t)R. Marshall Hall's Reply to our Letter. Through the kind atten-
tion of Messrs. T. K. & P. G. Collins, of Philadelphia, and of Professor A.
Stille, who courteously placed at their disposal his May number for our
use, we are enabled, at last, to lay before our readers, all which has appear-
ed in the London edition of the Lancet, in relation to our claim.

It will be recollected, that Dr. Marshall IlalTs article, making the an*
nouncement of an excito-secretory system of nerves, first met our eye early
last March, our letter was forwarded to him, we think, about the 20th of
that month ; his reply, it will be seen, is dated "April," and the essential
parts of our letter are found in the pages of the May number. We cer-
tainly have no reason to complain of any want of promptness, either on the
part of Dr. Marshall Hall, or the London Lancet. It will be seen that the
Editor excuses himself, for not complying fully with Dr. Ilall's request, "to
let our paper appear in the Lancet," on the ground, that our letter is too
long, and contains "needless repetitions." The paper is certainly lengthy
and contains repetitions, but it must be conceded, that under the circum-
stances, they cannot be considered needless. It was necessary to present
to Dr. Marshall Hall in England^ the vaiious proofs we had, that we were
the first propounder of an important doctrine in physiology; these proofs
were scattered through a number of American publications, which, from
his announcement of the doctrine as kin own, we had the best reason to
believe were not accessible to him a mere reference to the works would
not have been sufficient, the articles, themselves, had to be presented sen-

502 Editorial and Miscellaneous. [August,

atim with the dates and circumstances of their original bringing forth.
As our protest, against the claim of M. Claude Bernard, was but a reitera-
tion of what had been presented in the original paper, of course, when we
presented this in regular order to Dr. Hall, after the paper on Dentition, it
constituted a repetition, but certainly not a needless one. We think
this repetition only served to pile proof upon proof, and as, in a legal in-
strument, the advocate never sacrifices definiteness and clearness to ele-
gance, we, having but one object in view, viz., pro..lucing conviction in the
mind of Dr. Hall and other readers, that our announcements were prior to
his, used repetition, and even tautology, whenever we thought it would
add force to our argument. This result has been obtained, our claim has
been fully yielded, and we do not complain if the Editor of the Lancet does
differ with us as to the mere rhetoric used in the presentation of our proofs.
We thank him for the large space he has given to our paper, and the en-
tire fairness with which he has presented our arguments. We certainly
would have preferred that the courtesy and spirit of kindness, which we
endeavored to breathe through our letter to Dr. Hall, had been allow^ed to
meet the eye of his European readers, but his valuable weekly journal, we
presume, could not afford so n)uch space.

Dr. Ilall's admission of our claim is, as he properly terras it, an " adju-
dication," for, in yielding to us the merit of priority in the announcement
and naming, he could not ignore the claims of M. Claude Bernard, as one
who had subsequently jorayec? our doctiine by experimental demonstration.

As the relative value of observation and experiment has been fully discuss-
ed and illustrated, in our subsequent paper to the American Med.iVssociation,
(Prize Essay,) we make no further reference to his award to M. Bernard, in
this place. The substance of our claim, viz., that the theory of an excito-
secretory action was a deduction of our own, has been promptly, courteous-
ly, and fully yielded by Dr. Mai shall Ilall, and henceforth we are satisfied
with his acknowledgement. The generalization of the doctrine, and the
extended application of the principle throughout the organism, we cheer-
fully yield to Dr. Marshall Hall; although in our assertion of the excito-
secretory action in 1850 and '53, we by no means restricted it to patholo-
gy and dentition, but said, " that there existed between the cerebro- spinal
and the ganglionic system of nerv^es, a relation similar to that between the
sensitive and motor branches of the cerebro-spinal, &c."

Occupying the exalted position in the field of Reflex Action, Dr. Marshall
Ilall does, he can well afford to yield any just claim to those who have
come after him, to work out the detail of his grand induction. When he
decides between M. Claude Bernard and his humble American correspond-
ent, when he smiles approvingly upon the labors of Dr. Tyler Smith, andp
many other physiologists and pathologists, in their application of the reflex
doctrine to physiology and pathology, he is really but the Parent-arbiter,

1857.] Editorial and Miscellaneous. COS

dispensing even justice among his own children, and encouraging them to
cultivate and enrich a domain which he, himself, has deeded to them and
to the world. Happy has he been to live to see such noble results from
an induction entirely his own ! Long may he yet live to opert new fields,
and incite others to higher attainments; each one of which will only add
a new chaplet to his own resplendent brow.

THE EXCITO-SECRETORY SYSTEM;

Claims of ITenry Eraser Campbell, M.T)., of Augvsta, Gcoryia, JJ. S.
By Marshall Hall, M.D., F.lv.S., of the Institute of France, etc., etc.

To the Editor of the Lancet:

Sir^ I have received a printed letter, addressed to me by Dr. Campbell,
cf Augusta, Georgia, U. S., stating his claims to priority in the detection of
the excito-secretory sub-system of the spinal system, and requesting me to
use my influence to obtain its insertion in The Lancet. May 1 therefore
beg that it may, if possible, appear in that publication ?*

"^ Claim of Priority in the Discovery of, and also the naming of Excito-
Secretory System of Nerves. By Henry Eraser Campbell, M.D., of
Augusta, Ga., U.S.A., Member of the Americnn Medical Association,
Professor of Comparative Anatomy, &c., in the Medical College of Geor-
gia, and Senior Editor of the Southern Medical and Surgical Journal.

"EXCITO-SECRETORY SYSTE^^I OF NERVES,

" letter to dr. MARSHALL HALL, OF LONDON.

" Augusta, Ga., U.S.A., March 2, 1857.

^^ My dear Sir, In the number of the London Lancet, republished in
this country, for March, 1857, I have just read a paper from your distin-
guished pen ; and in this paper you announce a system of Excito-Secretory
nerves, in the following connexion and in the following terms :

"In a menioirread al the Royal Society in February, 1837, 1 announc-
ed the existence of an excito-motory system of nerves.

"'I believe I may now announce a system or sub-system of excito-secre-
tory nerves, not less extensive.'

" As the above announcement is here made in close relation with a dis-
covery long admitted to be your own viz., that of the excho-inotory system
of nerves, and inasmuch as in your subsequent remarks you attribute the
proposition to no one else, I am left to infer that it is deemed by you an
original deduction from the admitted facts of anatomical and physiological
science, as developed by observations and experiments during the last and
the picsent century. Some of these last viz., the experiments of M. Claude
])ernard, of Paris you adduce, with the apparent intention of fortifying
the views you here express.

''Finding in none of your communications upon this interesting topic,
any mention made of m)'- name or of my records, I am, with regret, im-

* Dr. Campbell's letter consists of sixteen dense octavo pages, is verv diffuse, and
contains needless repetitions, as the whole of p. 7 9, and p. 11 13. We have
therefore inserted it in a form suited to our space. We have omitted no important
^paragraph. [Ed. L.]

504 Miscellaneous. [August,

pelled, fi'om considerations of courtesy to you, and of justice to myself, to
call your attention to the registration of iny own labours in the same im-
portant field. I will, however, direct you particularly, tliougli briefly, to
several portions of your own communication, in order that they may be
placed in convenient juxtaposition with my own records, without giving
the trouble of each time referring to the pages of The Lancet:

"*But the most remarkable proof of the doctrine which I am endeavor-
inq to unfold is furnished by the brilliant discovery and skilful experiments
of'M. Cl.'Bernard'

"And you here refer to his well-knov^m experiments on the pneumogas-
tric nerve in its relation to the secretions of the liver, published in his
Le:;tures on Experimental Physiology during the winter session of 1854
and 1855.*

" In the earlier part of your communication [March, 1857,] you thns
announce the addition of this, as you suppose, new sub-system, to what you
term the ' Diastaltic Nervous System,' the term 'henceforth' apparently
being used to date the initial moment of an era :

" ' Henceforth the diastaltic nervous system must be divided into two
sub-systems ,

I. The Excito-motory.
II. The Excito-secretory.

'" The former is extended to the entire muscular system; the latter is
diffused over the genei-al system as the blood is diffused over the system.'

" Again, in reference to the pathological relations of the excito-secretory
system, you remark,

" ' The pathology of the excito-secretory sub-system remains to be inves-
tigated and traced. A partial keen current of air falling on any portion of
the skin may induce intiamraation in any susceptible internal organ. Au
extensive burn or scald is apt to produce pneumonia.'

^' And as my last quotation for the pi-esent :

** * But here I close this brief communication. My present object is only to
draw the merest sketch of this vant subject^ which demands a most extensive
and cautious seiies of experiments and observations. The efforts of many la-
bourers, through many years, will be required fully to develop the two
sub-systems of the diastaltic nervous system.

" ' I propose shortly to treat this important subject at greater length,
and with more details.'

" Now, my dear Sir, by a reference to the following series of records,
running through a pei-iod of nearly seven years, you will at once perceivo
that the excito-secretory function of the nervous system has been the sub-
ject of earnest and diligent inquiry, and also o^ plain record, with me, for a
length of time far antei'ior to that at which either yourself or M. Bernard
had published anything on the subject.

^'You will herein also perceive that this system of nerves has been p\iin-
ly recognised and set forth, as considered in its relations to pathology^
through which, indeed, its physiology has been mainly deduced by me.
And lastly, that this system of nerves, before plainly stated an 1 amply dis-
cussed, was, as early as May 5th, 1853, in the presence of the Americ-aa
Medical Association, the highest tribunal in the medical sciences within
jjiy reach, publicly named by me, the Excito-Secretoiy, and that too, in

* Lcsons de Pliysiologie, p. 325. Paris, 1855.

1S57.] Miscellaneous, 505

juxtaposition with, and contradistinction to, your own discovery viz., the
Excito-Motory function." (pp. 1 3.)

''Juno, 1850. Permit nie now, respected Sir, to refer you to tlie pages
of the Southern Medical and Surgical Journal (new series), vol. vi. No. 6,
June, 1850. Part I. Original Communications. Article XV., page 321.
You will in this place find the paper just cited, published viz., 'An Essay
on the Influence of Dentition in producing Disease. By Henry F. Camp-
bell, M.D., Demonstrator of Anatomy in the Medical College of Georgia.*
Here you will find that I have in th-e beginning sketched prominently the
two orders of phenomena which occur during the period of dentition,
viz., the convuhive and the secretory, explaining the first easily enough by
a reference to the principles of excito-??io/or?/ action laid down by yourself;
whilst the other set of phenomena I presented in such a manner as that,
fiOm them, the excito-secretor?/ function of the nervous system became an
obvious and an unavoidable deduction : by this means mutually establishing
a physiological principle before scarcely ever broached or hinted at; and,
in the second place, leaving no chance to escape the necessary admission
that this set of phenomena, before perfectly inexplicable to the profession,
could only be rationally interpreted by the admission of that very physio-
logical principle. In doing this, the 'two sub -systems,' as you now tei'm
them, were, throughout, kept in close relation, but in decided contrast, the
one being used occasionally, it is ti'ue, to illustrate the otlier, but never for
fi moment becoming confounded with the other : thus ^ Now let us inquire
how far these phenomena are dependent upon dentition; and analogy with
the EXCITO-MOTORY system will much assist us in our argument. We have
seen that local irritation can, tlirough this system, produce convulsions by
the reflex function of the nerves, the sensitive branches of the fifth pair
becoming excitor to the motory-spinol nerves ; and so, may we justly infer,
do these sajue branches, under certain circumstances, become ^:rn tor to the
SECRETORY filaments of the sympathetic, distributed so abundantly to the
intestinal canal, by a transmission of this irritation through the various
ganglia with which it is connected.'"

" Without further remark at present, I will lay before you that portion
of this Essay which embodies my first record upon the ex<;ito secretory
function of the nervous system :

'"From the above considei-ations we are induced to conclud<3 that the
convulsions are often produced by the irritation of dentition, and can bo
dii'ectlv referred to this as the sole cause.

"' We arrive now at a point in this somew-hat obscure and much dis-
puted question which, perhaps, affords more ground for douht than any of
the foreiroing, viz., a consideration of the pathogenic influence of dentition
in the chokra infantum, or diarrhoea, so uniformly co-existent witii this
process. Unlike the convulsions, the analogy between which and certain
known and established phenomena of the excito-motoiy system, wjjich it
is only necessary to refer to, and their operation is plain and intelligible,
this new set of symptoms, if we I'efer them to the process of dentition, re-
quires us to look yet deeper into the mysteries of our nervous organization,
and to venture still one step further on the terra incerta of sympathetic in-
terpretation.

"' In order to apply our arguments, let us hastily review the foregoino-
investigation, that they may bear more fully upon this part of our question ;
and, fii'stly, we have seen that inflammation, pain, and irritation are pro-

506 Miscellaneous. [August,

duced locally by the process of dentition, evinced by restlessness, biting,
etc. Secondly, we have seen that this local irritation can be transmitted
by excito-motory influence to other and distant parts of* the body, mani-
fested by convulsions. We have also endeavoured to corroborate this
latter opinion by a reference to the order of succession in the nerves in
which this irritation occurs, and also by a comparison of these phenomena
with other well-understood and established analogous phenomena. Here-
tofore we have had to deal entirely with functions of the cerebro (?)* -spi-
nal system of nerves ; but to account for this second and more obscure
part of our problem, we must look in vain to any direct anatomical con-
nexion between the fifth pair and the rest of this system of nerves. We
are forced to seek out other connexions, indeed somewhat more intricate
and indirect, but fortunately no less legitimate and definable. We have
now to consider a set of oigans which, unlike the voluntary muscles, have
no connexion, or rather, we would say, emphatically, they have a connex-
ion, though indirectly, with the cerebro-spinal system. We mean the ab-
dominal viscera, which we know are almost altogether supplied from the
great sympathetic system' of nerves. Now, in the prosecution of our in-
quiry it becomes necessary, to the elucidation of the question, to trace out
the same connexion between the fifth pair and the sympathetic or secretory,
as we did between the fifth pair and the cerebro-spinal and motory nerves ;
and then, should we succeed, we will briefly iuquire into the bearing which
this connexion and its possible results may have upon our question.'"

"At the fifth annual meeting of the American Medical Association,
(1852) held in Richmond, Virginia, not being present myself, I was ap-
])ointed by a special committee, to prepare an essay on the subject of
' Typhoid Fever,' which essay was read before that body in New York, in
May, 1853. In this paper, 1 took occasion to consider carefully the gan-
glioniii system, in the support of the position therein assumed, that all
tijphoidal fevers were manifestations of disease through the secretory system
of nerves. While thus engaged, my attention was called to certain experi-
ments performed by Mons. Claude Bernard, of Paris, and made public
through the Gazette Medicale, and translated in the I^ew Orleans Mtdicul
Register^ together with his deductions therefrom.

" On examination, finding that they contained what at that time appear-
ed to me the germ of a theory similar to mine, recorded in June, 1850,
though he refers to them as 'a set of phenomena identical with those oc-
curring in the cerebro-spinal system of nerves, denominated excito-motoiy
by Dr. Marshall Hall,' while 1 had deduced this exci to-secretory system (in
1850), saying ^analogy with, the excito-motory system will much assist us
in our argument ;' and further, inasmuch as this distinguished gentleman's
report piesented itself to my mind at that time, somewhat in the form of
an announcement, I deemed it advisable to appeal to our National Medical
Congress, in the following brief memoir, praying permission to record before
them, MY CLAIM TO PRIORITY, and also my protest against the palm of ori-
ginality attaching to Mons. Claude Bernard :

* After all, it appears that we did not quote quite enough to be understood,
hence this interrogation point. Our article on Dentition, from which this is quoted,
was a review of all the troubles of dentition. In the eailier pait, we had been
Bpeakii;g of the convulsive diseases Avhich were excito-motoi-y phenomena, and just
at this point we were beginning to consider the secretory phenomena, and thus we
Bay; "heretofore we have," etc. [Ed. S. M. <fe S. Jour.

18j7.] Miscellaneous. tjOl

[^^ Abstract from the Transactions of the American Medical Association :
M.etim; held in the City of New York, May 2rd, 1853.]

"Dr. Campbell, of Gcoro-ia, submitted a paper on a (jucf^tlon of priority
in reference to the discovery of the reHex relations subsisting between the
cerebro-sj)inal and sympathetic system of nerves. See Minutes of the Sixth
Annual Meetiny, vol vi., p. 89." (pp. 9, 10.)

'' In conclusion, let us define the j)osition which, at the end of our invcs-
tip-ation, we feel warranted in assuming. It is the followiiio-; That in the
anatomy and j^hysiology, as well as in the dependent analogies of the pro-
cess of dentition, we tind ample ground for the opinion tJiat the diseases
pertaining to this period may be dependent, and, in many instances, are
entirely so, upon the local irritation attendiny the process, heiny transmitted
throuyh the cerebro-spinal system of nerves, producing convulsive diseases
in the motory apparatus, or throuyh the sympathetic, causiny deranyement
of the secretory oryans, particularly of the alimentary canal, bv the sway
wliich it exercises over the arterial system from wbicii these secretions aro
eliminated.'

"In the above brief quotation, it will be observed that the doctrine of
the reflex function between the cerebro spinal and sympathetic systems is
plainly enunciated, and not only is the physiological fact noted, but we
there also liave surmised the transmission oi permanent irritation, or of pa-
ralysis from the cerebro-spinal to the sympathetic system, giving rise to
various aberrations in nutrition and secietion. Tliis opinion we have held
for years, leaching to our classes that there existed between the cerebro-spi-
iial and the yanylionic system of nerTes, a relation similar to that between
the sensitive and motor branches of the cerebro spinal, and which Marshall
Hall terms excito-motory ; while we have termed that between the cerebro-
spinal and sympathetic systems excito-secretory.''^ (p. 13.)

"And now, my dear Sir, I will close this ali-eady too prolonged commu-
nication : as courtesy to you, and justice to myself, were piofessedly the
instigating causes of its indictment, I do most sincerely hope, that in the
too earnest establishment of the latter, I have not at any moment even
appeared to have forgotten the former.

I am. Sir, with feelings of great respect,

Your obedient servant,

IIenuy F. Campbell."
"To Marsh A.LL Hall, M.D., F.R.S., &c.

It would be unjust to deny that Dr. Campbell has the merit of having
first called attention to the excito-secretoiy sub-system in the year 1850,
and that he imposed this very designation in 1853.

So far. Dr. Campbell's claims are undeniable, and I would say "palmam
qui meruit ferat."

But Dr. Campbell's observations will be seen to be limited \o pathology^
and indeed to dentition, and are the results of mere observation, with an
occasional glance at physio'ogy ; no physiological instance of the latter be-
ing adduced distinctly or emphatically.

Now M. Claude Bernard's labours are exp}erime7ital, and of the most re-
condite character :

"If the pneumogastric nerves be divided in the neck, the formation of
sugar in the liver is arrested ; if the lower portion of these divided nerves

COS EdUorial and Miscellaneous. [August,

be galvanized, no effect is produced; hut if tlieir upper portion be galvan-
ized, the formation of sugar is restored" !

Tlie fact that a profound interior physiological secretion is one of reflex
action is demonstrated !

Other physiolof/ical instances are freely adduced.

I arrive at tliis conclusion : the idea and tlie designation of the excito-
secretory action belong to Dr. Campbell, but his details are limited to
pathology and observation. The elaborate experimental demonstration of
reflex excito-secretory action is the result of the experimental labours of
M. Claude Bernard. And now I say "suum cuique."

My own claim is of a very different character, and I renounce every other.
It consists in the vast generalization of excito-secretory action throughout
the system

"There is, perhaps, not a point in the general cutaneous surface in v^'hich
tetanus an excito 7?io^or efl'ect may not oiiginate ; there is scarcely a
point in which internal inflammation an exi^ho-secretorg effect may not
be excited."

Every point of the animal economy is in soUdaritc by a reflex excito-
secretory action with every other !

I here observe that this excito-secretory action cannot be designated dia-
staltic. It is certainly dia-energetic ; but it dues not assume the form ex-
pressed by the Greek term, d-zWzs. A new designation is required, and'
I propose at once the plain aud simple one of dia-centric. Thus the in-going
nevwQ^ SiVQ centripetal ; their influence traverses the spinal marrow, and is
dia-centric ; it is reflected along centrifugal nerves.

One remark more. The diastaltic system extends to the internal mus-
cular organs, as well as the external. I would therefore speak of

1. External diastaltic action^ and of

2. Internal diastaltic action.

The former has been amply elaborated and traced in ray various publi-
cations; the latter remains for new investigation.

The former applies to all orifices and exits, and all tubular structures
leading to them ; the latter to all internal muscular organs the heart, the
stomach, the intestines, (fee.

I trust Dr. Campbell will be satisfied with my adjudication. There is in
the excito-secretory function, as applied to pathology, an ample field of in-
quiry for his life's career, and it is indisputably his ow^v. lie first detected
it, gave it its designation, and saw its vast importance.

I am, Sir, your obedient servant,

April, 1857. Marshall IIall.

The American Journal of Medical Sciences.

AVe refer our readers to the July number of this valuable quarterly, for
a clear, concise, and able presentation of the entire discussion lately sub-
sisting, in relat'.on to the pAci to-secretory system, over the well-known
initials D.F.(i This journal has ever proved itself a zealous defender of
American claims in matters of science, and yet with that catholic spirit
which breathes through all its pages, it deals even-handed justice to all.
Its able Editor, the Nestor of American Medical Peiiodical Literature, al-
lows nothing to escape which can add one valuable grain to the garner of

1857.] Editorial and Miscellaneous, 509

science, and long experience has given him and his able collaborators an
amount of discrimination which renders them almost infallible. In mak-
ing up the chain of evidence for our "letter," it was to the pages of this
journal that we turned for editorial records, which served as a bulwark of
defence in its establishment. These were signatured " D.F.C." AVe thank
Dr. Condie for the care he has taken to present our claim in so fair and
pertinent a manner. We thank him too, that, in all his remarks, he has
evinced such a spirit of courtesy, kindness, and confidence towards Dr.
rial I, so entirely in keeping with our own feelings.

The Physiological Anatomy and Phyaiology of Man. Ply Robert T^ent-
LEY Todd, M.D., F.R.S., Fellow of the College of Physicians, and Pliy-
sician to King's College Ilosj^ital : and William Bowman, F.U.S., Fellow
of the College of Surgeons, Surgeon to King's College Ilospiral and the
Koyal London Ophthalmic Hospital; late Professors of Physiology antl
General and Morbid Anatomy in King's College, London. Complete in
one volume. With two hundred and ninety-eight illustrations. Phila-
delphia: Blanchard & Lea. 1857. Pp. 926, 8vo.

Clinical Lectures on Paralysis, Disease of the Brain, and other Affections
of the Nervous System. By Robert Bextley Todd, M.D., F.R.8., Phy-
sician to King's College nospital. Philadelphia : Lindsay & Blakiston.
1855. Pp. 311, 8vo.

Clinical Lectures on certain Diseases of the Urinary Organs : and on
Dropsies. l>y Robert Bentley Todd, M.1>., F.R.S., Physician to King's
College Hospital. Philadelphia: Blanchard & Lea. 1857. Pp. 283, 8vo.

AVe have received from the publishers, Messrs. Lindsay & Blakiston,
and Messrs. Blanchard & Lea, through Messrs. Richards & Son, Booksel-
lers in this city, the above valuable American reprints, from the English
edition. Time and space will not allow us now more than to acknowledge
the receipt of them ; but we most cordially commend these three books,
by our favoi'ite authors, to our readers. We commend them, not blindly
nor hastily, but upon the most careful reading. We have read them
studied them page by page and line by line. Our copies, of the lectures,
are all noted in pencil on the margins, and the fly leaves indexed for future
reference on special subjects. No man can safely write on Pathology un-
less he understands Phvsiolofjv well. No man can Q^ive safe instruction in
Therapeutics unless he has thoroughly investigated Pathology, " the Physi-
ology of Disease." L^r. Todd's Physiology is of the most recondite and
reliable character : an earnest and honest investigator for many years,
experiment anJ observation have been the basis of every doctrine he pro-
mu^ges, and every precept he offers; no one will rise from reading his
clinical lectures without feeling that " now my opinion is worth more than
it ever was before." We know of no more improving course for a practi-
tioner, old or young, than to read these three works, beginning with the
Physiology and ending with the work on Dropsy and Urinary Diseases.

^10 Editorial and Miscellaneous. [August,

The Physician^s Pocket Dose and Symj^tom Book : containing the Doses
and Uses of all the principal articles of the Materia Medina and chief
othcinal preparations, etc., etc. l>y Joseph II. AVythes, A.M., M.D.,
author of '^ The Microscopist," "Curiosities in the Microscope," etc., etc.
2d edition. Philadelphia: Lindsay & Blakiston. 1857. Pp. 230, ISmo.
(For sale by T. Richards & Son, Augusta.)

This is a valuable little pocket manual of medicines and their doses,
modes of preparation, action, etc. Its author has done good service in an
elementary Avay to American science. Ilis two other works, "The Micro-
scopist," and "The Curiosities of the Microscope," are the best of their
kind, and we see by the North American Medico-Chirurgical Review, June
number, that one of them is highly appreciated in England, (thoroughly
plagiarized.) The present work we recommend, especially to young prac-
titioners. There is much labor in getting up such a work, and the reward
is mostly in the patronage it gains. We hope the profession will let it
have its reward.

A Sketch of the Geology of Tennessee : embracing a description of its Min-
erals and Ores, their variety and quality, modes of assaying and value:
with a description of its Soils and productiveness, and Palaeontology.
By Richard O. Currey, A.M., M.D., late Professor of Chemistry and
Geology in East Tennessee University. Knoxville, Tenn.: Kinsloe &
Rice. 1857. Pp. 128, 8vo.

This is an excellent work on the subjects indicated on title page, pre-
pared with great labor, research, and ability, by our confrere of the South-
ern Journal of the Medical and Physical Sciences. It is accompanied by
a very complete geological map of the State of Tennessee, by James M.
SafFord, A.M., State Geologist. The work of Dr. Currey is well calculated
to excite an interest in the development of the mineral resources of his
State, and her citizens owe him much for his labors. Similar scientific
investigations in our own State of Georgia would enhance the value of our
lands, and develop our mineral resources, more than a hundred fold. AVe
thank the author for our copy of his valuable work.

Dr. J. S. CoLEMAx, OF Augusta. We are pleased to see the name of our
young friend among those who are spoken of in terms of high commenda-
tion, in reference to the late resignations at Blockley Hospital. We are not

perhaps sufficiently posted as to all the merits of the case between Dr.

and the Faculty, but it ever speaks well for a young member, to

see him acting in concert with the body of the Profession in all questions
of Medical Ethics. It is a safe course, because most apt to be right, and
we congratulate our promising young friend in having adopted it, at what-
ever hazard or sacrifice. It was wise to act on the responsibility of the
conservative body of the Profession, they discountenanced the new ap-
pointee on ethical grounds, and for the sake of right, the younger gentle-
men did well to act with them.

1857.] Editorial and Miscellaneous. 511

Traumatic Tetanus. In a review of a clinical lecture on Traumatic
Tetanus, recently delivered at Jackson Street Hospital, Prof. D. F. AV right,
of Memphis, Tennessee, thus embodies our views, and reports a liig'hly
corroborative case, which occurred in liis own practice :

"The first of the two works is a lecture before the Medical Students of
his College upon the pathology of traumatic tetanus. His explanation of
its phenomena is grounded upon the doctrines of reflex nervous action as
now established in nervous physiology. Assuming that the ganglia of the
spinal column are chiefly concerned in those motions which liave bcome
habitual, and are performed with but little attention or mental cognizance,
and that the brain exercises but little influence over them, except when
any unusual circumstances so atJ'ect the occasions which call them forth as
to demand the corre^-tive and controlling influence of the ganglia of the
cerebral hemispheres, he suggests that the phenomena of tetanus are occa-
sioned by these cerebral ganglia losing the power of controlling these
ordinarily automatic motions; the peripheral irritant having produced a
morbid excitement in the inferior centres which at once places them be-
yond the control of the superior ganglia, and piodacess in excess the motions
Avhich it is the function of the various spinal ganglia to eftect. In other
words, (to use an elegant illustration of our author,) the spinal column re-
bels against the brain, and in its agitation dethrones its proper sovereign,
and then in the tumultuous and spasmodic motions which ensue, manifests
its own abnormal condition of excitement.

''We could wish that Dr. Campbell had discussed the relations of

tetanus and hydrophobia, especially with reference to the existence of a
specific virus in the latter disease, a question in relation to which Me have
long entertained serious doubts. Giving, as we do, a free assent to his
rational explanation of the phenomena of tetanus, we can neither see any
point in which this explanation fails to apply to hydi'ophobia, nor do we
know of any symptom attending the one which is not also incidental to the
other. Both seem to arise fiom an irritant applied to some poilion of a
nerve trunk, both to be attended with the production of those automatic
motions which are ordinarily attributed to excitement of the spinal ganglia,
and in both the customary controlling influence of the cerebral centres
seems to be suspended. We have seen even the peculiar spasms of the
muscles concerned in deglutition, from which hydrophobia has derived its
name, excited in traumatic tetanus exactly as is described in hydrophobia,
(of which we bave never seen a case) as may be illustrated by the follow-
ing case :

" In the summer of 1855, we were called u]>on to visit an Irish boy, ao'ed
about 12, who was suftering as follows: Ue had, about four or five days
before, received a lacerated wound by stei)ping, barefoot, on a rusty nail
this was situated in front of and a little below the internal malleolus; in
short, imnjediately upon the track of the posterior tibial nerve. When we
first saw him, the wound was inflamed and ulcerated, presenting a jagged
and excavated centre, witb periphery of inflamed surface, of dark, livid,
red colour. The lower extremities were occasionally convulsed with a
slight jerking movement, the extensor muscles seeming to be principally
concerned. No affection of the upper extremities, or of the maxillary
muscles, except that slight trismus was occasionally observed. The con-

Miscellaneous, [August,

vulsions of the lower extremities seemed to be rythmically repeated at the
rate of about four times in the minute, but were liastened and intensified
by the sudden contact of any substance, especially cold water. So mut-h
was this the case that, altlioug'h we at first ordered water dressings to the
wound, we found it np':-cssary to replace them by a poultice of slippery
elm. This, with a saline calliartic, was followed by iaW doses of morpijine
as soon as the bowels had been well evacuated. The morphine for a while
seeemed to control the nervous symptoms, but the morning of the second
day they were suddenly aggravated to an alarming extent. Their repeti-
tions first became much more rapid, and shortly were replaced by a con-
tinued spasm, Avhich afiected all the mus(;les of the lower extremities, as
well as those of the back and abdomen, but especially the former, the po-
sition of the patient being that of opisthotonos. Exx:itability from external
contact was much increased, so much so that even the contact of clothing
was the source of intense irritation, and we assented to the mother's pro-
posal, as the weather was intensely hot, of divesting him entirely of cloth-
ing, and from this time until his death, he continued entirely intolerant of
any covering, except, for a few minutes, that of a light sheet. We now
(about 8, A. M., of our second day's attendance,) had recourse to the irrflu-
ence of chloroform. We at first ordered m. xv., to be administered inter-
nally every quarter of an hour, and the pillow, etc., around his head, to be
occasionally sprinkled with ether, and staid to watch the efi"ect of our pre-
scription. Very considerable reduction of all the symptoms followed the
second dose, and then ordering it to be repeated, in doses of m. xx., eveiy
half hour, we left him, and made our next visit at 12 M. We then found
tliat all the symptoms had returned, the irritability being even aggravated
the slightest touch producing the most violent convulsions. We deterrain-
e'i now, as a dernier resort, to put him completely under the influence of
chloroform as might be found })0ssible, and without limiting tlie quantity
nsed, kept him inhaling it till, to the astonishment of all his friends, (our-
self included) he sank into a tranquil sleep, every muscle previously strained
to a degree which threatened spontaneous nipture, being now relaxed and
flexible. Having indispensable avocations in another part of the city, we
now gave instructions, that if on awaking the patient should exliibit any
convulsive symptoms, the chloroform should be administered in the same
manner. We relinquished our attendance till 5 P. M. On our arrival
we found every thing changed for the worse ; the opisthotonos was so great
that, as he refused to He any other way but face upwards, a pile of pillows
had to be placed beneath his back ; not only contacts, but the ap])roach of
a person to the bed excited the most violent spasms, accompanied with in-
tense suffering, the jaws were now firmly clenched, and the muscular con-
traction of the features gave the countenance a singularly weird appearance.
Nevertherless, the mind seemed untouched. On inquiry we found that he
had waked about half an hour after we left him, that convulsions, at first
slight, had commenced almost immediately; that, contrary to our instruc-
tions chloroform had not been administered, the people having a sort of
half superstitious dread of the drug, but that when things had got to tlieir
worst, the attempts had been made to administer some by the mouth, whith
the patient was unable to swallow. We had now very slight hopes of the
case, but determined that if anything could be done it would be with
chloroform. The father of the boy told us it could not be administered,
and he was right this time. A teaspoonful being held to the lips, such

1857.] Edttorial and Miscellaneous. 513

spasms were excited in tlie throat and fauces that instant suffocation was
apprehended, even the sound of pourhifj the mcdic'nie into the glass excited
these sjiasms^ ii:hich were accompanied by a rattle in the throat, and the
forcimi of some frothy mucus through the clenched teeth. Attempts at ad-
ministering tlie drug by inhahition were equally unsuccessful, and we iiad
to leave our patient to the inevitable termination of his calamity which
Occurred about 8 P. M.

Our object in stating this case was twofold. First, to sup])ly Dr. Camp-
bell witii an instance confirming the benefits of chloroform in this affection,
the recommendation of this agent being one of the purposes of his lecture,
and secondly, to show tlie great similarity of some of the symptoms to
those of " liydrophobia," had the wound been given by a dog's tooth in-
stead of a rusty nail, the cry of n)ad-dog would liave been raised, and a
regular dog killing organized on the spot, and if hydrophobia be a disease
distinct from t<:^tanus, who could blame the proceedings ? It is our own belief,
however, that there is nothing peculiar in tlie bite of a dog as the exciting
cause of these symptoms, nothing specific, nothing more effi-.-ient than a
lacerated wound from any other cause. To return to the subject of the
chloroform, we think no phyician will read this statement without coming
to the conclusion, that if the chloroform had been administered, during our
absence, according to our directions, the life of the patient, already pro-
longed by its agency, might have been saved altogether."

We think, with the reporter, that had his directions been fully carried
out, perhaps, the life of the patient would have been saved. In our opin-
ion, a primary object in the treatment of an acute attack of tetanus is, not
so much to cure the disease immediately^ (this we cannot often expect.)
but by the obtunding influence of remedies, addressed to the nei'vous sys-
tem, of which chloroform 18 the principal one, so far to keep the devasta-
ting effects of the disease in abeyance^ as to allow^ the case to become what
is usually termed chronic tetanus. It is the general opinion, that where
the patient survives the tenth day, his chances of ultimate recovery are
greatly increased. This object of supporting the patient through the acute
stage has not, it appears to us, been sufficiently kept in view by most wri-
ters on this fearful disease, the idea most prominent ever seems to be, that
this is a disease which must terminate fatally very shortly, if not speedily
cured, and consequently, the most active, and oftentimes the most exhaust-
ing remedies, are successively and rapidly crowded upon the patient, which,
as they do not abate the violence of the paroxysms, only hasten the fatal
issue. Beyond gentle purgation in the beginning of the attack, with a free
evacuation of the bowels once in two or three days after, we are opposed to
any measure which savors of a depleting course. Bleeding, while it de-
presses the vascular system and exhausts the strength of the patient, accord-
ing to our observation, exalts the irritability of the nervous system, and
thus favors the frequency of the paroxysms. We cannot conceive of a
case in which it would be indicated as a remedy for tetanus.

51-1 Editorial and Miscellaneous. [August,

Ohio State Medical Society. The twelfth annual session of the Ohio
State Medical Society was lield on the 2nd, 3rd, 4th and 5th of June, at
Sandusky. The number of deleorates in attendance was 130. Dr. Isaac
J. Ilays, of Philadeli)hia, and Dr. J. C. Blackbujn, of Kentucky, wlio were
present, were elected honorary members of the Society. Dr. D. Tilden was
chosen President. Many interesting reports were presented, and were re-
ferred to the Committee on Publication. Dr. llolston related a case of
death which he thought could be traced to the action of veratrum, and
expressed his doubts of the safety of using this article as a remedial
agent. The only effect produced by it in his practice was the reduction of
the pulse. Dr. Ilarmon had found it beneficial ; but Dr. Brennan consid-
ered a general prostration the only result. \^Boston Med. and Snrg.Jour.

Spiritualism in Boston Conclusions of thk Harvard College Fa-
culty. Professors Agassiz, Pierce, and Uorsford, of Uarvard College, and
Dr. Gould, (says the South Carolinian,) the committee selected to pass
upon the controversy between the Boston Courier and Dr. II. F. Gardner,
respecting the alleged phenomena of spiritualism, after a week's investiga-
tion, made the following report :

"The committee award that Dr. Gardner having failed to produce before
them an agent or medium who 'communicated a word imparted to the
spirits in an adjoining room,' 'who read a word in English written inside a
hook, or folded sheet of paper,' who answered any question ' which the
superior intelligence must be able to answer,' who ' tilted a piano without
touching it, or caused a chair to move a foot;' and having failed to exhibit
to the committee any phenomenon, which, under the widest latitude of
interpretation, could be regarded as equivalent to either of these proposed
tests; or any phenomenon which required for its production, or in any
manner indicated a force which could technically be denominated spiitual, "
or which was hitherto unknown to science, or a ])henomenon of which the
cause was not palpable to the committee, is, therefore, not entitled to claim
fxOm the Boston Courier the proposed premium of five hundred dollars.

''It is the opinion of the committee, derived from observation, that any
connection with Spiritualistic Circles, so called, corrupts the morals and
degrades the intellect. They, therefore, deem it their solemn duty to warn
the community against this contaminating influence, which surely tends to
lessen the truth of man, and the purity of woman.

"The committee will publish a report of their proceedings, together with
the results of additional investigations, and other evidence independent of
the special case submitted to them, but bearing upon the subject of this
stupendous delusion."

Benjamin Pierce, Chairman.
Ls. Agassiz,
B. A. Gould, Jr.

E. N. IIORSFORD.

Camhridje^ Jane 23, lSu7.

SOUTHERN

MEDICAL AID SUEGICAL JOUMAL.

(NEW SERIES.)

Vol. XIIL] AUGUSTA, GEORGIA, SEPTEMBER, 1857. [No. 9.

OEIGIML AND ECLECTIC.

ARTICLE XXVI.

A Report on Diseases of the Cervix Uteri. B j JOSEPH A. EvE, M.B.,
Professor of Obstetrics and Diseases of Women and Children, in
the Medical College of Greorgia. (Eead before the Medical So-

. ciety of the State of Georgia, at the Annual meeting in Augusta,
April, 1857, and ordered to be printed.)

The subject proposed bv the Society for a Eeport "The
Diseases of the Cervix Uteri," in its unlimited aod widest
sense is indeed extensive, admitting of numerous divisions and
sub-divisions, comprehending a large number and variety of struc-
tural lesions, simple and malignant, as well as displacements, or
mal-positions, such as, descensus, prolapsus, procidentia, retrover-
sion, ante- version, latero-version, retro-flexion, and ante-flexion :
it also properly comprises what are generally styled functional
affections, amenorrhoea, dj^smenorrhoea, menorrhagia, and leucor-
rhoea, inasmuch as they often depend upon, or result from a morbid
condition of the cervical portion of the uterus, and ai'e most ration-
ally and successfully treated, by remedies addressed directly to that
part. These are indeed so numerous, that to do justice to them
all, would require to write a volume, which is certainly not the
design, or desire of the Society, and for which we have neither
time nor disposition at present.

N.S. VOL. XIII. NO. IX. 33

516 Eve, on Diseases of the Cervix Uteri. [September,

Besides inflammation and ulceration ; simple, syphilitic and can-
cerous, the cervix may be the seat, of various kinds of tumor,
mucous, cellular, fibrous, or malignant, increscent or excrescent,
pediculated or sessile.

As we must restrict ourselves to narrow limits, and in accord-
ance with what we believe to be the wishes and views of the
Society, our report will be confined to simple inflammation
and ulceration, which have of late years commanded so large a
share of the attention of the profession, and have been the subject
of so much sharp and often bitter controversy. Other affections
will only be referred to incidentally, as they may have a relation
to, or bearing on these.

In discussing these subjects authors differ principally on three
points the frequency of their occurrence, their pathological im-
portance, and the most appropriate and successful treatment.

With respect to the first their frequency the difference is
more apparent than real ; depending, in the first place, in consid-
ering ulceration to be the important and essential condition, and
then in disputing about the meaning of the term ; whereas inflam-
mation is the essential affection, and ulceration only a consequence
or result of comparatively minor importance the effects, local
and general, depend on the existence of inflammation, and are
very little, if at all, modified by the presence of an ulcer. Too
much stress has, by some authors, been laid on the importance of
ulceration.

According to my own observation, the frequency of ulceration
depends on what it is coosidered to consist of if epithelial abra-
sion constitutes ulceration, it occurs in a large proportion of cases
of inflammation, while ulcers of much depth are rare. I have not
kept such a registry of cases as to enable me to determine the re-
lative proportion of cases with or without ulceration nor do I
consider it an important point. Sometimes, when there is no ex-
ternal ulcer, not even superficial abrasion, it is quite possible a
concealed ulcer may exist in the cervical canal, not discoverable
even by the speculum of the os uteri, an ingenious instrument,
invented by Mr. Tiemann of New York, for the purpose of ex-
ploring the interior of that canal, and by which it is exposed to
view as thoroughly as perhaps is practicable ; but I cannot say-
that I have found it is as satisfactory in its application as some of
his other valuable inventions.

1857.] Eve, on Diseases of the Cervix Uteri. 517

According to my own experience, inflammation of the cervix,
with or without ulceration, is of very frequent occurrence ; and I
fearlessly appeal to every candid observer who is in the habit of
employing the speculum, in the investigation of uterine diseases,
for confirmation of this opinion.

If we would refer to the most reliable and accurate statistical
tables, made by those who have enjoyed the very best opportuni-
ties for making them, we find that simple ulceration is of very
frequent occurrence, including all degrees, from slight epithelial
abrasion, to deep and extensive erosion, or loss of substance, in
those subjects who have presented symptoms of uterine disease.

By reference to the tables of Dr. Charles West, of St. Bartholo-
mew's Hospital, London than whom there could be no more
candid observer it appears that ulceration is of very frequent oc-
currence, not only in those who have had previous symptoms of
uterine disease, but in those who have died of other diseases,
without any particular indication of uterine affection.

In examination with the speculum of 268 patients at the Mid-
dlesex and St. Bartholomew's Hospital, Dr. West found ulceration
of some degree in 125; of the remaining 143, 110 presented some
affection of the cervix or body, some of which were, most proba-
bly, if not certainly, the consequences or sequelae of pre-existing
inflammation. "In only 29 the uterus was apparently healthy.'^
The 268 patients all had symptoms of uterine disease sufficient
to justify a specular examination; they would not otherwise
have been subjected to it. As Dr. West's mind appears to be
fixed on ulceration, is it not highly probable that he may have
overlooked or ignored some of the lighter cases of simple inflam-
mation? cases which, nevertheless, in susceptible individuals,
might have produced the symptoms which led to the examination.
Might he not also have failed to discover some affections of the
body of the uterus, which, when limited, are often not much
more perceptible to touch than to sight ? Some cases, indeed,
might have been rheumatic or neuralgic, exhibiting no signs of
inflammation or any of its sequelae.

In another table Dr. West found, on examining the bodies of
62 women who had died of other diseases, without uterine disease
being known or suspected, that in 29 there was uterine disease,
and in 17 ulceration, although 19 were supposed to be virgins.

Of 300 patients, with symptoms of uterine disease, examined by

618 Eve, on Diseases of the Cervix Uteri. [September,

Dr. James H. Bennett, at the Western General Dispensary, there
was ulceration of some grade in 222 about three-fonrths.

The testimony of Dr. Tyler Smith and Dr. Rigby strongly cor-
roborates the statement of the frequency of ulceration of the cervix.
Indeed, we believe, on this point, there is comparatively little
difference of opinion among the principal authors who have re-
cently written on the subject. Dr. Robert Lee, however, professes
scarcely ever to have seen inflammation or ulceration of the cervix,
specific and malignant ulcers excepted. We can only account
for Dr. Lee's singular assertion, in one of three ways either he
has not employed the speculum in investigating such diseases, or
he has a peculiar definition for inflammation and ulceration, or
else he is wilfully blind and will not see.

Dr. Meigs asserts that ulcers of the cervix are not frequent; but
lie evidently refers to ulcers with decided loss of substance, which
accords with my own experience, indeed it is highly probable
that ulceration, deep and extensive, would be much oftener found
in the class of patients, from whom Dr. West's, Dr. Bennett's, and
Dr. Tyler Smith's tables were made up paupers in Hospital and
Dispensary practice than in such patients as Dr. Meigs, myself,
and others, in private practice, are generally called on to treat
ladies in respectable life and comfortable circumstances, who gen-
erally apply for assistance sooner, and in whom inflammation of the
cervix is very much moderated in its intensity, and kept from
producing ulceration by frequent ablutions, which are very much
neglected among the lower classes.

Dr. West's tables than which nothing could be a more fair and
candid statement of facts observed would alone, without corrobo-
rating testimony, be sufficient proof of the frequency of the ulcera-
tion of the cervix. But when Dr. West comes to reason from the
facts stated, his conclusions are far from what would appear to me,
rational and legitimate inductions from the premises.

There is, I believe, great unanimity of opinion in the profession
with reference to the frequency of inflammation and ulceration of
the cervix, but in reference to the second and third points their
pathological importance and therapeutical indications authors
differ very much. To a calm and dispassionate difference of opin-
ion, there can be no objection ; but, unfortunately for the cause of
science and humanity, passion too often usurps the place of rea-
son, and vilification is substituted for argument.

1857.] Eve, on Diseases of the Cervix Uteri. 519

Dr. West contends that the very frequency of the occurrence of
inflammatory ulceration is a proof that it is of slight pathological
importance, rarely requiring special treatment; and farther, he
regards the fact that, in 62 women who had died of other diseases,
uterine disease was found in 29, a strong argument in favor of
this opinion ; but how much more rational is the inference of Dr.
Bennett, who says, '' I, on the contrary, see in it a positive proof
of what I have often stated, viz., that the existence, unrecognized
and untreated, of a large amount of uterine disease in the female
population, is an indirect cause of death. Inflammatory diseases
of the uterus and of its neck are essentially debilitating affections,
through their reactions on the functions of digestion and nutrition.
When, therefore, as so generally occurs, they are not treated, they
gradually induce a state of debility and anaemia, and of deficient
vital energy, which may render the female unable to resist the
attack of intercurrent disease, to which she becomes an easy prey.
Such at least is my interpretation of this pathological revelation."
How often is the failure to recognise uterine disease due to the
ignorance or carelessness of the practitioner? the sufferings and
death of the patient never having been traced to the proper cause,
or the influence that uterine disease may have exercised, in rend-
ering other diseases more serious and often mortal, overlooked
entirely, or not properly appreciated?

Is it not probable, that many patients die of cardiac diseases,
without the true pathology ever having been suspected? but are
they of less pathological importance on that account?

If time would allow, it would be an agreeable task for your re-
porter, and might be interesting to the Society, to examine and
comment on the opinions of those who deny the pathological im-
portance of inflammation and ulceration of the cervix; but this
would be to transcend our prescribed limits.

Without invoking the corroborative support of those who en-
tertain views similar to our own, we do not hesitate to express the
opinion, based upon our own observation and experience, that
inflammation of the cervix and its sequelae are of great patholo-
gical importance, whether considered locally or generally, in their
bearing on the uterus itself, in its different conditions, unimpreg-
nated, pregnant and parturient; or in their effects on the general
system, exciting, by nervous communication, disease in other and
often distant organs.

520 Eve, on Diseases of the Cervix Uteri. [September,

It must be admitted that inflammation, and even ulceration,
sometimes exist for a long time, without materially affecting the
general health, or in a great degree deranging the functions of the
uterus ; for we meet with cases in which menstruation continues
with surprising regularity, as respects time, quantity, and freedom
from pain, without causing sterility, or inducing abortion, and in
which the general system does not appear to be cognizant of the
local suffering, the disease only evinced by symptoms referrible to
the uterus itself; but these are exceptional cases. In a large ma-
jority of cases, menstruation is deranged, either as respects regu-
larity of recurrence, in being deficient, or excessive, or in being
attended with pain.

Scanty menstruation, or an entire suppression, is frequently at-
tendant on long standing cases of inflammation of the cervix
often persisting after the inflammation has been subdued. It is
more difficult to account for amenorrhoea than menorrhagia con-
sequent on inflammation and ulceration of the cervix ; it may,
perhaps, depend on extension of disease to the body of the uterus,
or on involvement of, or co-incident disease in the ovaria ; or it may
be a consequence of the impairment of general health, consequent
on the cervical disease. '

Kothing could be more reasonable than to expect that the pre-
sence of inflammation would increase the normal hyperaemia, at-
tendant on ovulation, to a morbid degree, requiring for its relief a
correspondingly greater amount of effusion which the presence of
an ulcer, superficial or deep-seated, would render freer and more
protracted, sometimes almost constant ; it is now, I believe, gen-
erally conceded, that the most excessive and obstinate cases of
menorrhagia are connected with, or dependant on, inflammation
or ulceration of the cervix, and only to be certainly cured by lo-
cal applications to that part.

It is so easy to conceive how inflam^mation, ulceration, hyper-
trophy, induration, and displacement, may render menstruation
difficult and painful, that any explanation would be superfluous.

ISTotwithstanding Dr. Tyler Smith's learned labors, and very
scientific and elaborate treatise, it is impossible, on mature reflec-
tion, to regard leucorrhoea, in at least a large number of cases, as
anything more than a symptom and effect of inflammation of the
mucous membrane of the cervical canal and Nabothian glands.
Leucorrhoea may proceed from the cavity of the body of the ute-

1857.] Eve, on Diseases of the Cervix Uteri, 521

rus, or from the vagina, as well as from the cervix ; but, as Dr.
Eigby remarks, it would just be as rational and proper to call ex-
pectoration a disease.

The various mal -positions, whether in reference to the pelvis,
or the different parts to each other, as in retro-flexion, etc., are
generally consequent on inflammation, and are most frequently
corrected when the inflammation is removed; such, at least, has
been the result of our own observation and experience: inflam-
mation and displacement are generally found to exist and disap-
pear together.

Of late years, pessaries are seldom found necessary, although I
am not prepared to subscribe fully to Dr. Bennett's theory of the
almost universal causation of displacement by inflammation, or to
agree with him in repudiating the use of pessaries. His views, in
the main correct, are I believe too exclusive. Cases of prolapsus
are occasionally found unaccompanied with inflammation, although
it may have preceded and subsided spontaneously; but sometimes
though rarely, after inflammation has been subdued, the displace-
ment continues and produces distressing symptoms, which require
for their relief artificial support.

Inflammation of the cervix generallj^ causes or predisposes to
abortion or premature deliverj^.

Some women, it is true, are so susceptible that they will con-
ceive, although inflammation, ulceration, or profuse leucorrhoea
maybe present; they generally, however, have repeated abor-
tions, and if they are fortunate enough to go to full term, thej
usually suffer very much during pregnancy and parturition, and
often subsequently.

But generally such patients fail to conceive, or conceiving, are
liable to frequent abortions, usually at the same period of gesta-
tion, by which the general health is still farther impaired, and
often totally broken down ; this is the pathology and explanation
of what is termed a habit of aborting habit being assigned as the
cause, than which nothing could be more unphilosophical. After
the cervical inflammation has been subdued, these patients, if ste-
rile, generally become fruitful ; or if addicted to abortion, pass
safely through gestation.

These cases, which were formerly the annoyance and reproach
of phj^sicians, are now often most satisfactorily and successfully
managed by substituting the surgical for the medical treatment of
inflammation and ulceration of the cervix.

522 Eve, on Diseases of the Cervix Uteri. [September,

The following case illustrates this and several other important
results from this mode of practice, so strongly, that its introduc-
tion here may not be deemed inappropriate :

Sarah, a mulatto woman, about 35 j^ears of age the property
of Mr. L. Hopkins, of this county for several years past had had
repeated abortions or premature labors, attended with frequent
profuse haemorrhages ; she was also subject to menorrhagia and
leucorrhoea between her pregnancies. Specular examination re-
vealed inflammation and superficial ulceration of the cervix.

Treatment by cauterization with nitrate of silver and astringent
vaginal injections was commenced, in January, 1855 ; but as she
proved to be pregnant it was discontinued the same month, from
the mistaken apprehension that it might hasten miscarriage, which
was threatened. After repeated dangerous haemorrhages, she
miscarried the foetus survived a short time. After her conva-
lescence, I advised cauterization to be commenced and continued,
notwithstanding pregnancy might again occur, believing that, so
far from endangering gestation, it would be the most likely means
to prevent another miscarriage. She had no recurrence of men-
orrhagia; her general health and strength improved; in a short
time, however, she ceased to menstruate, which surprised her
very much, for she believed it impossible that she could be preg-
nant, as she had experienced none of the distressing affections
usually attendant on pregnancy, from which she had always be-
fore suffered very much ; nor could she be convinced, until strong
foetal movements left no room for doubt. She enjoyed excellent
health until quite near the end of gestation, when she accidentally
fell and struck her abdomen against some hard body, after which
she suffered considerably from false pains, but had no haemorrhage*
At full term she had a natural and comparatively easy labor : her
child, which appeared to have sustained an injury, at the time of
the fall, w^as very puny and weak, breathed promptly, but did not
survive long. The feeble health and subsequent death of the- '
child were unquestionably attributable to the accident. This wo-
man had a favorable convalescence, and has since enjoyed good
health.

Treatment was recommenced November 14:th, 1855, and con-
tinued, but with great irregularity, (in consequence of living in,
the country,) until the 8th of July, 1856, during which the cervix

1857.] Eve, on Diseases of the Cervix Uteri. 523

was cauterized nine times, in about seven months nearly a month
on an average intervening between each cauterization. Could
the treatment have been pursued with regularity at proper inter-
vals, it is probable that a third, or perhaps a fourth of the time,
and fewer applications, would have sufficed. August the 9th,
specular examination shewed the cervix free from every vestige
of disease.

In this case, besides the removal of every trace of inflammation,
the meoorrhagia and leucorrhoea ceased the predisposition to
abortion was corrected pregnancy divested of its usual annoy-
ances, and labor itself rendered more easy and natural.

Many of the lighter haemorrhages, that occur during gestation
and after parturition, are doubtless referrible to inflammation and
ulceration of the cervix. I believe, also, that some diseases of
pregnancy, as excessive vomiting, cardialgia, etc., are often only
symptomatic affections, depending on, or greatly aggravated by
inflammation of the cervix. A very valuable article on this sub-
ject appeared in a recent journal. The author gives a number of
interesting cases, in which the severe sufferings of the patients,
during pregnancy, were fairly attributable to disease of the cervix,
and promptly relieved by remedies addressed to that part. Dr.
Green of Macon, in his excellent treatise on inflammation and
ulceration of the cervix, says "inflammatory disease of the cervix
has a powerful effect in aggravating the nausea and other dis-
tresses of pregnancy." It is well known, that when the uterus
has become incarcerated in the hollow of the sacrum from retro-
version during pregnancy, uncontrollable vomiting has been pro-
duced, which has been as promptly relieved by replacement. It
has also been satisfactorily demonstrated that congestion, inflam-
mation, and even ulceration of the os and cervix, may sometimes
exist during gestation, without any important reaction on the
general system; but it is equally certain, that in some cases dis-
tressing consequences result.

I have no doubt but that parturition is sometimes rendered
more painful and protracted, after-pains more tormenting, and
convalescence from labor far less rapid and favorable.

The influence on the general health, as already remarked, is
very different in different cases : in some, it becomes soon and
seriously affected ; in others, very slowly and slightly. It may be

524 ^Y'E.^ on Diseases of the Cervix Uteri. [September,

that in the former, the body becomes more or less involved by an
extension of inflammation from the cervix, while in the latter, the
disease is confined to the cervix.

It is reasonable to suppose this would be the result, from the
fact that the body is principally supplied by nerves from the sym-
pathetic, and the neck from the cerebro-spinal system ; in conse-
quence of which distribution, the body is more closely associated
with other organs, and exercises more influence over them, both
in health and disease : the neck is said, by some authors, to be
more sensitive, but this is, to say the least, extremely doubtful ;
it is indeed contrary to the observation of those who have muck
experience in making examinations of, and applications to, the
the body and cervix.

Although I may differ from some who have enjoyed superior
opportunities for observation, and have done much for the im-
provement of uterine pathology, I cannot subscribe to the opinion
that inflammation of the cervix rarely extends to the body: I
believe it frequently does ; and it is then that the general system
becomes most affected ; but by this I do not mean to express the
opinion, that the general system never suffers except when the
body becomes involved. There can, however, be no doubt but
that the cervical portion is most disposed to become diseased, most
exposed to morbific influences, and does most frequently become
affected first, and that such affection often continues a long time,
without extending to, or involving the body.

The state of the general system is, most frequently, that of de-
bility or anaemia, most probably resulting from the deranged state
of the digestive organs, and defective innervation very frequently
attendant on uterine disease, or perhaps in some cases from the
profuse menorrhagia or leucorrhoea present.

The nervous system very often becomes materially involved,

as evinced in the development of various nervous affections,

such as the different forms of hysteria, chorea, and eventually

epilepsy.

My experience has been, that while in their incipiency or in

their early stages, especially when only hysterical phenomena are
present, nervous affections dependent on inflammation of the cer-
vix will promptly and permanently disappear, after the primary
disease has been subdued by appropriate treatment; but if neg-
lected long, they will continue and resist all remedies, however

1857.] Eve, on Diseases of the Cervix Uteri. 525

judiciously and perse veringlj'- employed, although every trace of
uterine inflammation has been permanently removed.

Cases might be adduced, in proof of the happy results of prompt
treatment, and the disastrous consequences of delay. Unfortu-
nately observation much more frequently records the latter than
the former. Medical treatment alone is generally relied on until
it is too late for local and special to avail. One instance of each
may suffice for illustration :

In the spring of 1854, Miss , a very amiable and interesting

young lady, fifteen years of age, who had been subject for about
a year, at each menstrual period, to most distressing paroxysms of
hysteria, attended with convulsions and temporary mental de-
rangement, was brought to this city for medical treatment.

As she had been already subjected to very active and perse-
vering medical treatment by an intelligent and skilful physician,
without the least amelioration in her condition, it seemed perfectly
useless to repeat the same, especially as the symptoms so plainly
indicated uterine disease.

A careful digital and then a very cautious specular examination
was made by means of Whitehead's small bivalve speculum, which
is well adapted for making examinations in cases of virgins. As
considerable inflammation and engorgement of the cervix were
discovered, the solid nitrate of silver, by means of the speculum
forceps, was applied directly to that part, and a blister directed to
be placed over the sacral region. The following pills were also
prescribed, one to be taken three times a day.
^. Proto-Iodid. Hydrarg., grs. xxiv.
Ext. Hyosciami., " Ixxij.

Iron by Hydrogen, 3iss. Make 86 pills.

After these pills had been taken about a fortnight, one grain of
Iodide of silver was substituted for the portion of Proto-iodide of
mercury in each pill, for fear of salivation. As it was so extreme-
ly unpleasant to subject so young a female to the repeated use of
the speculum, after the nature of the case had been determined
and one application made of the solid nitrate, I determined, for a
while at least, to try the solution, which was administered with a
glass syringe by an intelligent and excellent lady who attended
on her with truly maternal kindness and tenderness. The solu-
tion was used of different degrees of strength, from one to three

526 Eve, on Diseases of Oie Cervix Uteri. [September,

drams to tbe pint of water. This patient never had a paroxysm
after the treatment was commenced rapidly regained her general
health in three months returned home perfectly well has never
had any recurrence, but has since married, and is, I have been
informed, in a fair way to become a mother.

The extreme severity of this case, its long persistence and the
length of time she had been previously treated by a respectable
physician, alone justified so early a recourse to an instrumental
or even a manual examination, which otherwise would have been
deferred until after the failure of other plans of treatment: her
rapid restoration to perfect health rendered a repetition unneces-
sary.

Another case occurs which presents a very different picture :
Some fifteen or twenty years ago, Mrs. labored under pro-
lapsus with inflammation of the cervix; treatment, though advised,
was neglected for many years, until her nervous system became
very seriously affected at first she had slight nervous seizures
with very transient abolition of mind and very slight spasmodic
movements, only sufficient to make her stop for a moment when
walking, to cease conversing, or to suspend sewing or any other
occupation for an instant such were these fits in their incipiency,
but they gradually became more intense, amounting to decided
epileptic convulsions. When her family became alarmed, her case
was thoroughly treated nitrate of silver was applied repeatedly
through the speculum to the os and cervix ; all vestiges of inflam-
mation and ulceration were entirely removed, and did not recur,
at any rate, for a year or two after, for the speculum was employ-
ed to determine the fact.

Blisters were repeatedly applied to the spine, setons were intro-
duced and kept discharging for months, without avail.

For several years she tried tonics, antispasmodics, nervine stimu-
lants, shower baths, change of air, travel and every remedy that
promised the slightest hope of benefit ; but all without efieet.

Uninfluenced, by all the efforts made to relieve it, her disease
constantly increased in intensity, until death kindly released her
from a condition most pitiable and deplorable her mind a wreck
and her once comely person sadly changed and disfigured by dis-
ease.

Had this case been treated before the nervous system had become

1857.] Eve, on Diseases of the Cervix Uteri. 527

involved, she would doubtless have avoided the epileptic affection
altogether, and lived long to enjoy life and make others happy,
for she was blessed with a good constitution and an excellent dis-
position.

Several other cases might be adduced to prove that, after the
nervous system has become gravely aftected, although the uterine
disease maybe perfectly and permanently cured, the nervous affec-
tion will continue.

These may be considered extreme cases the result is seldom
as favorable as it was in the former, or as disastrous as in the lat-
ter most frequently after the uterine affection has been corrected,
the general health has improved, and the nervous disease, although
not removed, has become moderated in intensity or diminished in
frequency of recurrence.

The appearance of my friend, Dr. Wm. E. Dearing, who has
just taken his seat, recalls to my mind another very interesting
case which I saw in consultation with him. A very intelligent
and respectable married lady, from Charleston, had for some time
been suffering from very severe hysterical paroxysms which
threatened not only to destroy her physical health, but seriously
to affect her mind. The speculum revealed inflammation of the
cervix ; this we regarded as the primary affection from which the
nervous disease originated. Seven cauterizations, in about two
months, removed the cervical inflammation, and with it all her
nervous symptoms disappeared.

Time will not allow us to enquire farther into the effects of cer-
vical disease on the general health the morbid complications
most frequently demanding attention and modifying treatment,
are anaemia, gastric and hepatic diseases, hemorrhoids, hysteria,
epilepsy and various other nervous affections.

\To be concluded in the October No.\

528 Tate, on the Treatment of Intestinal Obstructions. [September,

ARTICLE XXVII.

The Gaseous Treatment of Intestinal Obstructions. By HoRATIO Gr.
Tate, M. D., of West Point, Ga.

Speculation in philosophy, and especially in Medical philosophy,
is carried to such an extent, that it is not at all an uncommon oc-
currence for it to amount to a positive evil ; it frequently takes the
placeof scientific facts which bear directly upon natural phenome-
na, and leads the mind away from the contemplation and study of
agents, to the grander subjects of systems and laws. It is far more
pleasant to give a loose rein to the imagination, to deal in abstract
theories, to study the poetry of science, than curb our fancy down to
the stern, unyielding realities of life, and deal with material things
as they are, and not as we would wish them to be. It is upon this
basis, we wish to invite the attention of the profession to the too
frequent occurrence of obstinate constipation of the intestinal ca-
nal by intussusception or other mechanical obstructions. The often
unfavorable termination in such cases should induce the honest
and candid physician to record and publish every thing he may
meet with in his practice bearing upon this point.

The writer is aware that, while he presents something new to
the profession, his remedy may, like others, soon be consigned to
oblivion ; but all he asks of his brethren in physic is to give it a
fair and impartial trial. We will not weary the patience of the
reader farther, but give the report of our case.

March 15th. Called at night to see Will, a negro man, aged 27
years, suffering from constipation of the bowels. Had taken a
dose of castor oil before visit. Complains of soreness and pain
over the abdomen ; pulse 120 to the minute ; considerable tym-
panitis, with eructations and anorexia ; frequently cries out with
pain. Prescribed, at 10 o'clock P. M., 40 grs. calomel, with In.
castor oil; warm poultices to the abdomen and salt-water injec-
tions the injections and poultices to be continued through the
night, or until the bowels were freely opened.

March 16th, 7 o'clock A. M. Patient no better. Prescibed four
pills, composed of calomel 4 grs., rhei 2 grs., jalap 2 grs. The
pills were given in the above dose every three hours, until twelve -
were taken. During the whole time, at intervals, enemas were
used, but returned without either color or odor. At 1 o'clock

1857.] Tate, on ifie Treatment of Intestinal Obstructions. 629

P. M., discovered the existence of Inguinal Hernia of the riSht
side: attempted its reduction by taxis, but failed; required the
boy to attempt its reduction he failed. Prescribed tartar emetic
until patient vomited freely. Attempted its reduction again by
taxis, and again foiled. After having failed by the use of tartar
emetic, we determined to bleed to syncope^ which was done, but
again failed in our attempts at reduction.

5 o'clock P. M. Dr. D sent for, with the view to operate

for Strangulated Inguinal Hernia, who could not arrive in time to
perform the operation that evening ; consequently Will was doom-
ed to another night's agony. At 10 o'clock P. M., patient com-
menced to hiccough, which was almost incessant. Soon after this
new symptom occurred, stercoraceous vomiting commenced ,- in-
deed, the quantity ejected per orem was enormous. Had no
evacuation downward from the intestines. Symptoms continued
pretty much the same through the night.

March 17th, 8 o'clock A.M. Dr. D arrives. Upon being

informed of what had been done, proposed putting the patient
under the influence of chloroform, and again attempting the re-
duction of the hernia. The suggestion was adopted. Dr. D

failed in his attempts at reduction. Whereupon I proceeded to
operate for Strangulated Inguinal Hernia, and accomplished in
this way the reduction of the strangulated portion of intestine.

At noon, two hours after the operation, patient still continues
to vomit and hiccough says he is relieved of pain at the point of
strangulation, but suffers intensely near the umbilicus (to the right
of umbilicus). Prescribed I iss. of castor oil, and renewal of the
injections of warm water, using no salt. This treatment was con-
tinued until 10 o'clock at night, at which time I procured a pump
syringe, and with it threw into the bowels six pounds of warm
water, which was soon ejected without either smell or color; I
then proceeded, after the lapse of an hour, to inject water slowly
into the bowels, until they retained the enormous amount of one
gallon.

Croton oil had been given since 6 o^clock A. M., in 4 drops at a-
dose, repeated every hour until 16 drops were given, without the
least effect upon the bowels being manifested.

March 18th, 2 o'clock A. M. Being well satisfied that an intus-
susception, or other mechanical obstruction, existed above the
strangulated point, and having, as I conceived, used every remedy

530 Tate, on the Treatment of Intestinal Obstructions. [September,

worthy of trial in such a case, I determined to proceed upon my
own responsibility, let consequences be as they might; therefore,
I began again the use of warm water enemas, throwing them into
the bowels slowly and cautiously ; and after having introduced,
by a pump syringe, one gallon of water, I next dissolved 40 grs.
of tartaric acid in I iv. of water, introduced that into the intestine;
had a large compress prepared and placed in the hands of a strong
negro fellow, with instructions to apply it to the anus^ and hold it
there, so as effectually to prevent the escape of either gas or water
after I should introduce 40 grs. of hi-carh. of soda^ dissolved also
in !iv. of water. The soda was introduced, the compress used
admirably, and poor Will rolling on the floor, crying at the top
of his voice, "I shall burst, I shall burst take that thing away,
my bowels are tearing in two." The compress was removed ; gas,
water and fecal matter escape freely, to the astonishment of all by-^
standers. In half an hour the same amount of warm water, tar-
taric acid and soda were used again, and with the same happy
effect.

The only medicine given after this, was calcined charcoal, which
passed through his bowels with no diflSculty. All being well sat-"
isfied that the obstruction was fully overcome, and Will declaring
himself cured, he was discharged on the 20th.

Kow, as to the rationale of the treatment, we presume all who
are at all familiar with the anatomy of the intestines, or the gen-
eration of gases and their expansibility, will readily understand.

In order that the gaseous treatment may be fairly appreciated,
it becomes necessary that a partial recapitulation of the treatment
be here introduced. By reference, it will be seen that the boy had
taken of castor oil ^vss. ; calomel 88 grs.; jalap 24 grs,; rhubarb
24 grs. and Croton oil 16 drops all of which proved totally inef-
fectual.

In the successful treatment of this most fatal and alarming dis-
ease, I consider the pump syringe an indispensable implement,
because more than double the amount of water can be thrown
into the intestine with it, than can possibly be introduced with
the ordinary syringe. After having distended the bowels to their
utmost capacity by warm water and the syringe, then by the
introduction of the acid and soda you become possessed of another
distending power, well nigh incalculable not sufiieient, however,
to rupture the intestine, but amply calculated, in my humble opin-

1857.] Lecture on Frequent Micturition, 531

.^^-'w^^

ion, to overcome any stricture or intussusception of this canal.
The amount of carbonic acid gas evolved from 40 grs. of tartaric
acid and an equal portion of carb. of soda will occupy about the
space of a half gallon, and Avhen this gas evolves, acquires the
temperature of the human body, (and it should be retained in the
intestine long enough for this to be effected,) it will inevitably
acquire double its bulk at the time of evolution.

Thus we perceive, the gaseous treatment in combination with
the warm water, is well calculated to accomplish more in over-
coming this dreadful difficulty than all other remedies combined ;
for by it, we first avail ourselves of the relaxing influence of ivarm
water and all the force of the pump syringe ; next, we avail our-
selves of the power of chemical agents in the evolution of gas ;
and lastly, but not least in importance, is the expansibility of car-
bonic acid gas in acquiring the temperature of the human body
which forces, if brought to bear instanter upon the muscular coats
of the intestine, might possibly rupture the same, but when ap-
plied in the gradual manner, as set forth in this article, it is well
adapted to the overcoming and unfolding of any mechanical ob-
struction of the human intestines known to the medical profession,
except permanent adhesions.

Croonian Lectures, delivered before the Royal College of Physicians^
1857. By G. Owen Eees, M.D., F.RS., Physician to, and
Lecturer on the Practice of Medicine at Guy's Hospital.

LECTUEE I.

OK FREQUENT MICTURITION.

Mr. President, In teaching our art, the plan usually adopted
by professors consists in describing each disease in full: symptoms
are collected, post-mortem appearances detailed, and the appropri-
ate treatment and diagnosis dilated upon.

This method is valuable in affording us the means of comparing
any particular case with the type of the class to which it may
belong ; imparting a kind of knowledge which all must acquire
who are desirous of becoming good diagnostic physicians. There
is another method of instruction, however, which may be most use-
fully combined with that just described.

It consist in selecting for consideration some symptom which
experience teaches us to have an important meaning, and to trace
it up to each of the causes to which it may possibly be due. At the

N.S. VOL. XIIL ^^0. IX. 34

532 Lecture on Frequent Micturition. [September,

bedside we meet with symptorr^ not only of varying character, but
of varying value; and the more important are sometimes the least
regarded by the uninitiated, inasmuch as they may not be amongst
the more painful.

There are some symptoms which, if they be properly studied,
restrict the inquiry within narrow limits, while others bear so gen-
eral a relation to disease that the mind fails to accomplish the analy-
sis which it easily makes where the less general question is involved.
It may be asked, how can we acquire this valuable quality of fixing
on these more important symptoms these indications which direct
us more immediately to the truth ? This is to be attained by expe-
rience only, and it is by its possession that some practitioners are
enabled (unconscious of the intermediate mental processes) to detect
apparently at a glance that which others may have sought for in
vain. The physician's diagnosis is the result of a study of symp-
toms; one by one he values them, and compares them with some
set or class of symptoms which he knov<^s constitutes an especial
form of disease. Some inconsistency, perhaps, arises while com-
paring the symptom he has first selected ; in a moment, the train of
thought changes. The question, then, arises whether it be consis-
tent in its adjoined phenomena with some other class. The com-
parison is made again ; and eventually an accordance is established
leading to the detection of the true nature of the case. Rapidly as
this must take place in some minds, still it must needs occur; and
this reasoning back from symptoms is what the experts are constant-
ly practising. This method I shall now adopt as the most natural
in treating of disease before an auditory already well versed in its
general history ; and I have selected for consideration, on the pre-
sent occasion, the symptoms of frequent micturition. This indica-
tion, which, under the name of "irritable bladder," is not always
so carefully considered as it should be, is productive of extreme
misery when present in a marked degree ; but there are minor
degrees which do not greatly interfere with comfort. The acces-
sion of the symptoms may be gradual, and the habits of life of the
patient not such as to be materially interfered with by frequent
calls to pass urine. On the other hand where social habits or occu-
pation make it desirable that the urine should be held for a few
hours, the symptom assumes considerable importance to the patient^
however trival the cause mav happen to be, or however easy the
cure. According as distress may be produced or not, so we may
become acquainted with the symptom, either as the prominent com-
plaint of the patient, or as an incidental circumstance to which he
attaches but little importance. Owing to the latter condition, it very
frequently happens that this indication is overlooked by the practi-
tioner, so that an obscurity hangs about the case which would at once
have been dissipated had the symptom caused more suffering.

1 must premise that, in treating this subject, it is not my intention
to enter upon the various diseased states of the prostate gland, which

1857.] Lecture on Frequent Micturition, 533

we know may produce irritable bladder. This part of the subject
is rather in the province of the surgeon than the physician; and
digital examination, in many cases will suffice to determine the
diagnosis. As compared with the bladder and the kidney, however,
the prostate is far I'rom a common cause of the symptom ; and the
same may be said of the uterus, which, under certain condition of
misplacement, produces great bladder irritation.

Frequent micturition, while it may indicate severe inflammato-
ry mischief in the bladder, may, on the other hand, be a purely
sympathetic affection, and it is in this latter case that most diffi-
culty occurs in tracing the symptom to its cause. The separation
of the subject into these two divisions is not difficult, since inflam-
matory disease shows a condition of urine not observed when the
purely sympathetic affection exists. When frequent calls to pass
urine is connected with cystitis, by whatever cause produced, the
urine contains excess of mucus, and nearly always pus, and this
latter exists in the excreted urine, partly transformed into adhesive
or ropy mucus. Blood may be seen also, under some conditions,
colouring the adhesive mass in the chamber vessels. When the
frequent micturition is merely sympathetic, and indicative of some
diseased state in a distant part, the urine is not of this character. It
is often clear, or merely deposits the urates, and if any other sedi-
ment occur, it is not ropy mucus. The long-continued irritation
may, however, eventually involve the bladder ; then, of course, the
first described set of appearances will be observed. We will assume
that we have a case showing the symptom of frequent micturition,
and on examining the urine, we find ropy mucus as a deposit. This
is occasionally coloured by blood. Albumen is also dissolved in
the urine, owing to the presence of pus.

When the condition has been recognised, we may conclude that
the bladder is inflamed, and that one of the three following causes is
in action :

1. Calculus in the bladder.

2. Gonorrhceal inflammation of the bladder.

3. Partial paralysis of the bladder.

The symptoms connected with the first-named cause are so famil-
iar to the profession, that they need not be enumerated here. The
points of difference between them, and the symptom.s characterizing
the two other states are obvious enough when calculus in the blad-
der produces its full effect. Fortunately, however, for suffering hu-
manity, this is not alwa3^s so, and then the practitioner may find
difficulty in forming a diagnosis. Exploration by sounding by no
means sets the question at rest if a negative result be obtained.
Calculi, as we all know, may escape detection, even when the most
skilful and practised hands hold the sound, and yet at no very remote
date from such an exploration, may be easily demonstrated, both
to the touch and to the ear, by any one who may have the opportu-
inity of making an examination.

584 Lecture on Frequent Micturition. [September,

A calculus in the bladder sometimes produces scarcely any symp-
tom whatever, save frequent micturition, with occasional pain at
the end of the penis. Again, sometimes, even these symptoms exist
but in slight degree, and we have haematuria complained of, with
scarcely any other indication, the patient being able to bear a good
deal of jolting without such pain as usually attends vesical calculus.
This is especially observed wnth mulberry or oxalate of lime concre-
tions. But the state to which I would especially draw attention is
that in which the calculus causes hardly any symptoms. Such
instances are rare, but we now and then hear persons complaining
of frequent call to pass urine, and little else ; and on examining the
urine the indications of cystitis are sufficiently obvious. The fre-
quent micturition is evidently, then, caused by inflammation of the
bladder, but on what this depends is by no means so easily deter-
mined- If the patient be sounded, a calculus may perhaps be detect-
ed, but if it be not found other causes for the cystitis are sought for,
and of course sought for in vain. It becomes of the greatest import-
ance, then, to acquire the power of discriminating in these cases.
May it not still be a case of calculus, notwithstanding that no cal-
culous has been found ? Much depends on our answering this
question correctly. In order to do so w^e must look to the history
of our case, and if we can exclude the two other causes for cystitis
viz., the remains of gonorrhceal inflammation, and the presence of
irritating urine, owing to the existence of partial paralysis, we may
feel great confidence in declaring it probable that calculus exists,
and that the exploration by sounding has not done all it may here-.
after accomplish.

Of the two other states above alluded to as capable of producing
like symptoms, that of gonorrhceal infection is generally easily ascer-
tained by inquiry into the more early history of the case. I am not
here speakingof gonorrhoea with discharge, spreading inflammation
to the neck of the bladder, and causing acute suffering. This state
of matters cannot well be mistaken; but I allude to cases which
arise after many weeks' cessation of gonorrhoea, when, with little or
no discharge, gonorrhceal inflammation attacks the bladder. The
history here might tell us all, but it so happens that the history is not
always forthcoming, and the indications may be, and often are, re-
garded with anxiety, as possibly connected with a calculous tenden-
cy, frequent micturition and ropy mucus in the urine being the
prominent symptoms.

A case of this kind occurred to me not long ago. A gentleman
who had been the subject of gonorrhoea, and who had recovered
from all the first effects of the complaint got married. Shortly
after he became the subject of imtable bladder; ropy mucus ap-
peared in the urine, occasionally tinged with blood, and this with
a slight loin pain, was all we had to guide our diagnosis. The his-
tory, however, sufficed to place the disease before us in the true
Hght.

1857.] Lecture on Frequent Micturition. 535

I shall now notice the third condition giving rise to frequent mic-
turition, and to urine impregnated with the results of inflamma-
tion viz., partial paralysis of the bladder. This is a state which
very often comn^nces insidiously. The patient does not feel that
he has but partially evacuated his urine, and it is only when the
bladder becomes inflamed, owing to the irritation produced by re-
tained and stale urine, that frequent micturition causes him to feel
anxiety. He now, perhaps, examines, and finds his urine is passed
in an opaque, instead of a transparent state, and that a layer of
mucus settles in the chamber vessel. It constantly happens that
these cases are not diagnosed correctly for some little time, and
instruments may be passed in the belief that the cystitis arises from
calculus.

Here we depend almost entirely upon history, and on inquiry
we may learn that before the appearance of symptoms our patient
had been obliged, on occasion, to hold his urine for a great length of
time. He may not have observed after this that he passed but little
urine when he had an opportunity of emptying the bladder, nor may
he have connected any symptom whatever with the above condition.
Sometimes the history is more suggestive. Complete retention
may have existed at some remote date, owing to a distended state
of the bladder. An instrument may have been passed, and the
urine drawn off*, and the patient may not have suffered any symp-
toms for many months. Then the complaints arise which we are
now considering. If the case be neglected, another inconvenience
occurs which should at once determine us. This consists in the
urine dribbling away in small quantities, but yet incessantly.

Frequent micturition and the urine of inflamed bladder, if taken
in connexion with the above history, will serve at once to distin-
guish these cases both from calculus and from gonorrhceal cystitis.
They are often at first mistaken for the former, and nearly all the
patients I have seen with this affection have had the sound passed,
and sometimes by more hands than one, without any light being
thrown upon the subject.

Before proceeding to the second division of my subject, I would
say a few words respecting two forms of cystitis noticed by authors.
First, as to cystitis occurring more or less in the character of an
idiopathic affection, as caused in 'irritable constitutions by exposure
to cold. This disease has been described, I believe, only because
some mechanical or chemical cause has been overlooked. Second-
ly, we hear of a gouty cystitis. This, which has been described as
immediate consequence of the gouty diathesis, may, I believe,

more correctly regarded as secondarily produced by calculous
flfection. The irritable bladder in' some gouty persons may be
learly traced to sympathetic irritation produced by renal calculus,

d cystitis may eventually occur ; but I am by no means inclined
ip believe the bladder liable to a specific gouty inflammation. One

rgument which has been used in favor of the specific nature of this

536 Lecture on Frequent Micturition. [September,

inflammatory state, is founded on the fact that rehef has been ob-
tained by the administration of colchicum ; and were this drug
quite inefficacious in all other inflammations, and invariably suc-
cessful in relieving gout, some weight might be attached to the
argument ; but in the present state of therapeutical science it bears
but little on the question.

Before considering the causes of sympathetic irritation producing
frequent micturition, I must refer to a question which may very
possibl)^ suggest itself to some of my hearers. It maybe thought
that though sympathetic affections may require analysis with I'egard
to the symptoms under consideration, frequent micturition must be
expected in every disease connected with an inflammatory state of
the urinary apparatus: in point of fact that it is a necessary con-
comitant. This, however, is by no means the case ; and there is
one cause for this form of urine indicative of inflammation requir-
ing more especial notice, as not the slightest irritability of bladder
need exist, though the urinary symptoms are otherwise closely allied
to those just described. This happens when a calculus becomes
fixed in the ureter. Under these circumstances there may be
merely such sensations about the urethra as are easily accounted
for by the altered nature of the urine, which is generally highly
alkaline, and deposits the earthy phosphates if kept. We are well
aware how irritating the presence of calculous matter is in the kidney,
and in the bladder ; and so long as the inflammatory state of the
urine is observed we always expect frequent micturition. In the
case I now refer to, however, the calculus gives little inconvenience.
The history of its first leaving the kidney may be remote, but inqui-
ry will lead to the point, and severe pain be described as having
occurred at some date antecedent to the appearance of mucus and
pus in the urine. I doubt not that some of my hearers may have
seen a case or more in which post-mortem examination has shown
the ureter of one side blocked up by calculus, the ureter above
greatly distended, and the organ probably undergoing gradual des*
truction.

Having now spoken of cases of frequent micturition in which the
urine gives indications of cystitis, I will proceed to consider the
other division of the subject, including those cases in which the
secretion is not so materially aflected, and which arises from sym-
pathetic irritation of the bladder. This class is a somewhat numer-
ous one. One of the most common causes for the symptom exists
in the presence of kidney disease, and especially that known as
morbus Brightii. Here the frequent micturition for the most part
occurs at night, and the patient may disregard the inconvenience
for a length of time. Scarcely any other symptom of the disease'
may be present, and if this one be not sufficiently valued by the
practitioner the malady may escape detection altogether. There
may be slight dyspepsia, and perhaps a somewhat anaemiated look.
The urine may be clear, and no deposit indicating cystitis present;

1857J Lecture on Frequent Micturition. 637

but the bladder is irritable. Under these circumstances, the ques-
tion as to the possible albuminous condition of the urine should at
once suggest itself. If this be detected, then it becomes necessary
to deal with the question of albuminous urine in its relations to
disease, and to determine whether we may refer it in this particular
instance to granular degeneration of the kidney. What is it neces-
sary to do in order to effect this? I need not remind my hearers
that albumen may be present in the urine merely as a concomitant
with pus or with blood. The first step, therefore, should be to ascer-
tain whether or not either or both these be present, and microscopic
examination is rarely necessary in order to effect this, as far more
than a microscopic quantity of the corpuscles of these fluids must be
mingled with the urine to render it albuminous in any marked de-
gree. We will assume that these sources of fallacy are removed,
that the urine contains the serous part only of the blood, as in mor-
bus Brightii, and now the question may be asked, upon what other
states may this depend? This is an old query. It was the difli-
culty which occurred to the minds of practitioners when Dr. Bright's
'discoveries were promulgated. It was thought unlikely that albu-
minous urine should possess such especial and exclusive significance.
iMany assertions were made tending to lessen tlie value of the indi-
cation; and had there been any amount of truth in the allegations,
albuminuria would long since have been recognised as a very
common symptom, existing in numerous diseases, and even occur-
ring under conditions scarcely to be distinguished from perfect
health. Thus it has been said that eating pastry or drinking milk
in quantity will cause albumen to appear in the urine, and a mercu-
rial course has been supposed to produce the same effect. Some
believe it a common concomitant of ordinary colds, and as easily
produced by any interference with the function of the skin. The
attention I have paid to the subject, with ample opportunities for
experience, enables me very confidently to contradict the above
statements; but it may not be out of place to mention one or two
other objections to the exclusive nature of this indication, posses-
sing more claims to notice.

Albumen appears occasionally in the urine during gestation.
Some women have been known to excrete it during every pregnan-
cy, and no evidence has subsequently appeared to prove the exist-
ence of diseased kidney. This fact was first noticed by Dr. Lever.
Albumen, again, may nearly always be detected in the urine of
women suffering from puerperal convulsions. Again, during the
progress of cholera asphvxia, the urine frequently becomes albumin-
ous. It is said to assume this state also in typhus; but if this ever
occur it is a rare concomitant of that fever, and if it be present it
will be well to look to the kidney.

The conditions just described are obviously such as but little in-
terfere with the diagnostic value of albuminous urine, inasmuch as
they are easily recognised.

588 Lecture on Frequent Micturition. [September,

I would, lastly, notice those statements which, were they proved
by the facts adduced, would entirely destroy the value of albumin-
ous urine as a guide to diagnosis. A writer of considerable chemi-
cal acumen, but evidently ill-informed in the phenomena of disease,
and who, like many other chemists who have meddled with pathol-
ogy, has done much to confuse a very important subject, has de-
clared that " albuminous urine has now been so frequently observ-
ed in numerous diseased states of the organism, independent of '
Bright's disease, that the idea has long been abandoned that gran-
ular degeneration of the kidneys always occurs where we have
albuminous urine." So far so good. If we except the word nu-
merous, what I have already said is quite in accordance with the
view propounded ; but our author goes on to say, that albumen exists
in the urine of blooming health, and without giving us the sequel,
contents himself with describing albuminuria and robustness. The
case (if correctly reported) is that of a confirmed, but perhaps early,
stage of morbus Brightii. While suffering from a mild catarrho-
rheumatic affection, the author found a trace of albumen in his own
urine. Next we have a case quoted in which the presence of albu-
men may have been simulated by phosphates ; but even if we allow
that albumen was present, there is no account of the after-history,
nor of the post-mortem, to set the question at rest as to the existence
of morbus Brightii. The patient, in this last case, was the subject
of pneumonia, a disease which often complicates chronic albumin-
ous nephritis, and in all probability, if albumen really existed in
the urine, this patient had a degenerated kidney.

We next have two cases which are almost certainly true morbus
Brightii ; the one regarded by the author as rheumatism, the other
as dropsy with albuminous urine, but not with kidney disease, be-
cause as he wTites, " the patient complained of no pain (even on
pressure) in the lumbar region.^''

These statements, which are to be found in the writings of the
late Professor Simon, of Berlin, have done much to interfere with
progress. The merest tyro of our schools could have told our
author that patients with morbus Brightii scarcely ever complain of
lumbar pain that it is by no means to be expected, even in the
severest cases that its presence is the exception, its absence the
rule ; and that the same remark applies to pain produced hy pressure
over the region of the kidneys.

The carefully collected records of hospitals have now satisfacto-
rily determined this question; and it may be confidently stated, that
albuminous urine indicates either a degenerated kidney, or some '
state of the organ preceding degeneration ; and that the sources of
fallacy are not material, consisting as they do of conditions which
can be easily recognised such as pregnancy, puerperal convulsions,
and cholera asphyxia. I would add a precaution here, however
viz.. not to draw any inference from the examination of urine ob-
tained after death, w-hen albumen may be often detected as a result
of transudation.

1857.] Lecture on Frequent Micturition. 539

Among the causes for frequent micturition (irritable bladder) we
find brain atfection has been enumerated ; but from the accounts
we read of these cases it appears highly probable the cerebral con-
dition described was merely one of the concomitants of kidney
disease, which it was not possible to recognise before medical liter-
ature had been enriched by the writings of Dr. Bright, and before
his discoveries had been promulgated. Surgical writers have spoken
of this form of irritability,

There is a state of urine to which I would now direct attention,
as occasionally productive of frequent micturition but which easily
admits of relief. It consists in an increased acidity generally observ-
ed in gouty subjects. Uric acid is occasionally seen as a deposit,
but not always so at the commencement of the malady. These
cases sometimes occur in connexion with albuminuria, and the fact
is an important one, because it seems to constitute a point of differ-
ence in the views of those whose acquaintance with the subject of
albuminuria is profound, and whose experience has been most extend-
ed. The question lies thus : If a patient passing uric acid pass
also albuminous urine, and if these conditions continue many
months, is the case necessarily one of kidney degeneration ? M.
Rayer, with whom I had a most interesting consuhation last sum-
mer, holds that the gouty or uric acid diathesis may affect the
kidney, causing a degeneration of its structure (Bright's disease
*' nephrite chronique albumineuse" of the French,) or it may, on
the other hand, cause a discharge of albuminous urine (in conse-
quence of the uric acid crystals irritating the tubules,) without any
degeneration of the kidney occurring as a consequence. This lat-
ter state may last, it is said, for months, and, according to this
doctrine, even after some year or two, the case is not to be condemn-
ed as necessarily connected with degenerate kidney. The concur-
rence of uric acid deposit with albuminous urine was noticed by
Dr. Prout, who even went so far as to believe in a necessary con-
nexion between the two. Uric acid, however, is so familiar to us
as a deposit without albuminous urine that this necessary relation
cannot possibly exist. When, however, the two happen to occur
together, we have a condition admitting of the two interpretations
just given.

The persistence of albumen month after month has been consid-
ered by Dr. Bright and his followers as necessarily indicative of
organic change in the kidney, and that this is generally the case
cannot be denied. We see the fact constantly proved in our hos-
pitals ; but the question still lies open as to whether the uric acid
crystals may not cause albuminous urine to appear for many months,
or even longer, by irritating the tubules. We frequently hear of
cases of albuminous urine going on for years and years without
any very serious inconvenience to the patient. We hear also of
cases which have been cured, the patient remaining well for years.
Let us consider whether we are to believe in this less hurtful albu-

5-10 Lecture on Frequent Micturition. [September,

minuria, and whether the cases vvhich appear to admit of relief are
those in which the irritation of uric acid crystals is causing the
albuminous discharge, without any organic disease being necessari-
ly present in the kidney. Since my attention has been directed
to the point, I have had two opportunities of observing albuminuria
in connexion with the uric diathesis. The albumen was present
in abundance, but disappeared under alkaline treatment in one
case almost immediately.

Here we may have had an early case of Bright's disease in a
gouty subject, which was relieved by treatment, or, it may have
been a case of irritation of the tubules by uric acid, as described by
M. Rayer. For my own part, the rapid relief from alkaline treat-
ment inclines my belief strongly to the latter view, and it appears
probable, that though gouty subjects are prone to Bright's disease,
they yet may pass albuminous urine from another cause.

But what are we to say to cases in which the albuminuria per-
sists for months or years ? Are we to believe in the possibility of
this discharge of albumen continuing, without the kidney being
organically diseased ? My conviction was strongly against such
a belief, but that opinion has been somewhat shaken of late.

It has always been a puzzle to explain the old case referred to, in
which morbus Brightii is born with apparent immunity, and I am
by no means satisfied but that an explanation may be found for this
apparent anomaly in the condition noticed by M. Rayer.

I have at present a patient under care, who has passed albuminous
urine for six. years and more, whose state of health, so far as we can
judge, is perfect. Strong, active, and energetic, she repudiates the
idea that she is an invalid. She is of a gouty family, and has occa-
sionally passed uric acid. The urine has never been of low specific
gravity, no fibrinous casts have ever been detected, and there is no
evidence whatever that the blood or other fluids have become de-
generated in any way. Alkaline treatment has answered well in
this case. Under its use, the albumen has disappeared for days and
days together, and though it is still occasionally found, it is always
in very small quantity.

If ever a case existed capable of clearing up the difficulty I have
alluded to, this is the one. Can the gouty diathesis, with its uric
acid crystals, be causing the albuminous urine, or have we a case
of true morbus Brightii? Post mortem examination alone can de-
termine this.

The next cause for frequent micturition which I shall notice con-
sists in the presence of calculus in the kidney. Here the irritation ^i
is often most excessive, and there is the greatest difficulty in persuad- i *
ing the patient that his bladder is not diseased. These cases are
generally amongst the most satisfactory that can fall under our
care. Little is to be done, and doing little or nothing is often a
hazardous step as regards the fame of the practitioner. You can-
not expect the sufTering and ignorant patient to believe in your

1857.] Lecture on Frequent Micturition. 541

declaration that he must still sufler on till some lucky accident
either expel the calculus or enable it to become encysted, and he
will fly to those who in accordance with his own views, may proceed
to treat him lor disease of the bladder. I have known these cases
regarded as dependent on irritation of the neck of the bladder caused
by stricture, and have seen the most lamentable results brought
about by the violent measures resorted to for relief.

The correct diagnosis is not very difficult. The history general-
ly tells of haematuria, probably at some remote date, and of occa-
sional loin pains and uneasiness. The general health at first is but
little disturbed. The urine shows none of the indications of cysti-
tis, is generally clear at first, but in old cases it becomes slightly
clouded. This cloudiness is dependent on the presence of pus,
which exist in small quantity. We must not expect to find haema-
turia a warning symptom. In many instances it is certainly present,
and our diagnosis is then more easily made, but if haematuria do
not exist at the time of our seeing the patient, and when we have
an imperfect history to guide us, the case cannot be determined so
easily.

Frequent micturition, with small quantities of pus in the urine,
loin pain, and lassitude, if we have an early history of hsematuria,
should guide us to diagnose renal calculus ; and even if frequent
micturition and a small quantity of pus be the only symptoms, we
shall generally be right in giving the above opinion, even if history
fail to afford us evidence of haematuria. The presence of a small
quantity of pus in the urine would appear easily explained in its
relations to renal calculus.

The hollowing out of the nephritic structure, which w^e find oc-
curring in order to make room for calculi about to become encysted
in kidneys, must have been effected by a gradual process of disin-
tegration, and this we know is preceded by inflammation. The
purulent discharge would thus seem to attend the formation of a
convenient cavity for the lodgement of the calculus. So long as
this action is going on, the patient will pass pus in the urine, and it
may be some years before matters are adjusted. The constitution
has much to go through. A scrofulous taint leads to abscess in the
kidney and death. The more fortunately constituted generally do
well, provided they can be induced to avoid the catheter and the
sound.

In speaking of the condition of the urine in this calculous afTec-
tion of the kidney, I have made use of a somewhat indefinite expres-
sion viz., " a small quantity of pus." By this I would wish my
readers to understand an urine depositing a yellowish-white sedi-
ment, but not in such quantity that the patient's attention need be
attracted by it. It renders the urine but slightly turbid as it is
passed, or when the deposit is shaken up in it.

This is the general state of things when nephritic calculus is en-
cysting, or when it fails to find its way down the ureter, provided

54:2 Lecture on Frequent Micturition, [September,

constitutional causes do not interfere to produce suppurative disease
which may appear in the form of pyeHtis or of general abscess of
the kidney. This purulent impregnation is constant, and if it fail
to show itself, so as to be evident to the unassisted eye, the micro-
scope rarely fails to demonstrate the presence of pus so long as the
bladder is irritable.

There is a cause for frequent micturition so nearly connected in
its symptoms with that last noticed, that it naturally j:uggests itself
in this place. It consists in a state of kidney known as strumous
kidney, or phthisical kidney, as some authors have designated it.
If calculous disease develope itself in a strumous subject, we find
very early that abscess results, but in all subjects some amount of
pus may be expected during the time of encysting. In phthisis of
the kidney, however, the bladder becomes irritable, without any
evidence of a calculous disposition; and we find that pus can be
clearly proved in the urine. The symptoms are generally at first
considered to depend on calculus, and it too often happens that the
disease has made great progress before the real state of the case
becomes evident. The symptoms are at first nearly identical with
those of nephritic calculus. The same degree of sharp lumbar pain,
however, is not present, and there is no history of hsematuria ; but
the symptoms presenting themselves at the time of examination bear
a striking similarity ; and if the previous history be not ascertained,
a diagnosis is next to impossible. It is both for the advantage of
the practitioner and of the patient that this distinction should be
early made ; for if calculus be the exciting cause, of course our
prognosis will be more favorable.

The two points for consideration are 1st. The diathesis of the
patient. 2nd. The history as to haematuria. If frequent micturi-
tion and purulent urine, such as I have described, be present in a
strumous person, and we have no history of haematuria, we may
diagnose phthisis of the kidney. If frequent micturition and puru-
lent urine co-exist with a history of haematuria, then, in all probabil-
ity, there is calculus. We must not conclude, however, that because
calculus is present we have no fear of the worst results, for if the
patient be of strumous habit, abscess may result as a consequence.
In all cases, however, the history of haematuria is an advantage, in-
asmuch as even should the patient be strumous, the calculus may
be voided, and the exciting cause of mischief being thus removed,
the kidney may recover itself, and the patient do well.

It is not many months ago that I saw a remarkable strong young
man suffering from loin pains and general malaise, in whose urine
small quantities of pus were nearly always present. The case inter-
ested me much, and I looked with some anxiety for the previous his-
tory. There was a strumous diathesis ; and from the moment I
made my examination, I felt certain that all depended on the history
involving haematuria or not. In any case, the strumous diathesis
made it a serious affair ; but in the absence of haematuria, the only

1857.] Cases of Early Catamenia. 543

.conclusion which could be arrived at was that the nephritic mis-
chief had resulted purely frorti struma. As phthisis of the kidney
progresses, we may have enormous quantities of pus evacuated. It
is only therefore, to the commencement of the disease that my
remarks apply ; when, with frequent micturition, we have the
slightly purulent secretion simulating calculous mischief. \_London
Lancet,

Cases of Early Catamenia. By John T. Marable, M.D., of Mem-
phis, Tennessee.

Case I. As I was passing by the house of Mrs. C, living in
Montgomery County, Tennessee, during the Spring of 1853, I was
called in and consulted by the lady, in regard to a negro girl,
eleven years old, who, she stated, had been troubled with a regu-
lar discharge resembling, more than anything else, the monthly
sickness. She had been troubled with the discharge nearly two
years. At first it was pale, and of a yellowish hue, small in quan-
tity, but coming on very regularly. In the course of a few
months the quantity became increased considerably, and assumed
a more florid color. The girl was called in, but could give but
little information about it. She said about two days before it
came on, she felt a little sick in the stomach, and that her back
ached a little, and her head felt giddy, but after the discharge
came on, all of the above symptoms subsided, and she then felt as
well as she ever did in her life. It generally lasted from two to
three days. Her breast and organs of generation were not larger
than ordinary girls of her age.

We concluded to leave her entirely in the hands of nature, and
watch the case as strictly as we could. Her mistress informed me
occasionally that she was doing very well, and that the discharge
still continued.

During her twelfth year she grew very rapidly indeed, so much
so, that I hardly knew her after the lapse of a few months. Her
breast had grown considerably, and her genital organs had taken
on all the characteristics of womanhood. The latter part of ^bb^ I
was summoned to see her about 9 o'clock at night, and found her
in the second stage of labor. In the course of an hour and a half
she was delivered of a full grown, healthy, female child. She
resumed her accustomed work, about the usual time, and enjoyed
perfectly good health for nearly twelve months, at which time
she died very suddenly, perhaps from apoplexy or disease of the
heart. Her child is still living, and appears to be in the full
enjoyment of perfect health. Notwithstanding she was a mother,
she retained up to her death many of the plays and notions of a
child.

544 Cases of Early Catamenia. [September,

Case II. June 7, 1854. I was called to see a negro girl, ten
years of age, belonging to Mr. B., of Montgomery County, Tenn.,
and learned from her mistress, that the mother of the girl had
called her attention to a discharge that the girl had been troubled
with for the last eight or ten months previously, comiug on, as
she thought, very regularly, every month. She appeared to be
very well grown for her age, and remarkably healthy. There
was but little pain or uneasiness, if any, about the back, abdomen
or head, previous to the appearance of the discharge, as is general-
ly the case, notwithstanding the discharge was tolerably copious,
and lasted for four or five days. Upon examination we found her
breast not at all enlarged, nor her genital organs in any way larger
than common. She was left entirely to nature. The discharge
kept up until the following October, at which time she had an
attack of typhoid fever, lasting some six or seven weeks. During
the progress of the fever the discharge failed to make its appear-
ance ; after her recovery it again appeared, and has kept up reglar-
ly ever since I having received a letter from her mistress to that
effect and also that she has grown very much within the last six
months.

Case III. September 9, 1855. I was called to see a negro girl,
eight years old, belonging to Mr. T., of Montgomery County, Ten-
nessee. The mother of the girl becoming alarmed, owing to the
absence of her mistress, sent for me. I enquired into the history
of the case, as well as I could under the circumstances, and learn-
ed from the mother that the little girl had had a slight discharge
from the vagina for some considerable time ; that the first time she
noticed it was about a year previously, but she did not think
much was the matter with her, and it would soon pass off, but it
had come on that morning, and was so much more than common,
and her mistress being absent from home she thought she had
better send for me. She had but little appetite for a few days be-
fore and after its return, but made no other complaint. She was
examined as minutely as possible, but we could find nothing un-
usual about her size, or the growth of her organs of generation.
The discharge lasted three or four days, and passed off gradually,
assuming a pale yellowish color. The fifth of November she was
taken with a peculiar form of fever, which prevailed in a great
portion of the above country in 1855 and 1856, which appeared
to be "mongrel" in character, and taking on both the symptoms
of bilious and typhoid fevers. She was confined to her bed for
about five weeks, the discharge failing to come on at its regular
period. The latter part of December she had an attack of pneu-
monia in the left lung, which lasted ten or twelve days. She re-
covered very slowly, being worn down very low in flesh from the
severe, continued fever she had labored under. The discharge
did not present itself until the following June, at which time she

1857.] Cases of Early Cataraenia. 545

had regained her flesh. From this time she grew very rapidly,
and is now putting on all the characteristics of womanhood. Her
disposition in many things, however, still continues that of a child.

Case IV. June 3, 1854. I was attending the family of Mr;
P., of Montgomery County, Tennessee, and was consulted by Mrs.
P. in regard to a negro girl, twelve years of age, who had been
troubled with a discharge from the vagina, resembling the menses,
for some ten or eleven months. The mistress felt some degree of
uneasiness about it, thinking surely it could not be her monthly
sickness making its appearance at so early an age. She desired
something done for her, if possible, stating that she was an excel-
i lent nurse and house-girl, and one with whom she could trust her
[ children at all times, without any degree of uneasiness, and of
I course, would dislike very much to lose her. I relieved her un-
easiness of mind, as Avell as I could, by telling her that I supposed
it was her monthly sickness coming on naturally, but at a much
earlier age than is usually the case. No treatment at all was pre-
scribed for her, leaving her entirely in the hands of nature. A
few months afterwards I was called to see her at night, in haste,
the messenger stating that she had had a fit late in the evening,
and they thought she was dying when he left home. When I
arrived I found her to all appearance insensible to all around her ;
her pulse was feeble and frequent, her respiration panting and la-
borious, with an occasional deep sigh, with the escape of some
frothy mucus from the mouth and nose ; her pupils unaffected as
far as we could discover. After examining her as minutely as we
could, we supposed it to be a case of hysteria, and treated her ac-
cordingly. After a short time the distressing symptoms disap-
peared, and in a few days she resumed her accustomed labor. It
is proper to state, however, that her catamenial period had passed
off some four or five days previous to her attack, and was quite
scant in quantity and of a pale yellowish color. Two months
afterwards she had a second attack, which lasted but a few hours,
was very light in its character, and passed through it without any
medical aid; seven months afterwards she miscarried with a male
foetus, at about the fourth month. Nothing unusual occurred
after her confinement. The discharge made its appearance again
in about three months, and she has since been in the enjoyment
of perfectly good health.

All the cases of Early Catamenia that I have seen, have occur-
red in negroes. An interesting question arises, whether these
were idiosyncracies, or whether they arose from a recurrence to
the original constitutional type of the race, early menstruation be-
ing a characteristic of the native African tribes; if the latter, then
a return to generic peculiarities, long obliterated by a change of
slimate and habits may possibly have some bearing on abstruse
ethnological speculations. [Memphis Med. Recorder,

546 On Contagious Furunculoid. [September,

On Contagious Furunculoid. By Dr. Laycock, Professor of the
Practice of Medicine in the University of Edinburgh.

In this lecture Professor Laycock says he was the first to point
out that boils were ever epidemic, and that they were associated,
as to cause, with other eruptive diseases. This he did in a clinical
lecture he delivered at York, in February,1851, and published at
the time. At the same time he laid much stress on the conta-
giousness of this affection. He now adduces some interesting facts
in relation to these points observing that up to 1851, the epidem-
ical relation of the materies morhi to malignant pustule, phlegmon,
and onychia, had not been manifested. Dr. Laycock proceeds :

" In my published lecture of February 25th, 1851, I illustrated
several varieties of the disease by cases, and indicated the follow-
ing principal forms : 1. Simple furuncle. 2. Effusive inflamma-
tion of the derma., manifested in the form of eczema, pemphigus,
and phlyctenoe. 3. Suppurative inflammation of the derma, re-
sembling impetigo and ecthyma. 4. Carbuncular inflammation.
5. Two or more of these occurring coincidentally. More recent
observation shows that we may add to these 6. Sloughing gan-
grene of the lip, eye, tongue, vagina, scrotum, etc. 7. A diffused
inflammation of the cellular tissue, returned to the registrars, as a
cause of death of late years, under the term phlegmon. 8. An-
other form, seldom fatal, that of whitlow. I will now refer to
each of these specially.

" 1. Simple furuncle. The course of the simple furuncle is very.
definite. An itching is usually first experienced, and then a small
hard pimple may be felt in the skin, not larger commonly than a
small pea. This enlarges from day to day, and the skin becomes
red over it. About the fourth day the centre softens, and on the
fifth suppuration is established, with partial destruction of the
subcutaneous cellular tissue (the slough or ' core'). By the seventh
day there is commencing cicatrization. Barely more than four or
five of these occur at once.

"2. The furuncle^ with vesication or pemphigus. In the furuncle
with vesication, the inflammation is preceded by a vesicle ; the
pruritus is greater, the erysipelatous redness more extended, and,
in bad cases, true phlyctense form. These may be prolonged tc
the fourteenth day. In a few rarely occurring cases there is a
phlyctenas only.

" 3. Ecthyma. In the impetiginous and ecthymatous form, the
boils are usually interspersed with ecthyma, impetigo, or eczema.
It is not uncommon to find this variety preceded by a pemphigoid
eruption, in which the serum is opaque and purulent, and termin-
ating in crusts. This sometimes attacks the eye, constituting a
stye.

"4. The Carhuncular form. When the disease is carbuncular,
it may appear as true carbuncle, or as a spurious form, in which

1857.] Oil Contagious Furunculoid. 547

there is, in fact, a confluence or blending of furuncles. Both these
are usually seen on the nucha, back, or loins. The true carbun-
cle may be either solitary, or, as is common, may arise amoDgst a
number of furuncles.

" The eruption in all these forms is usually seen on the back^
nates, thighs less frequently on the legs and face, still less so on
the trunk. The bend of the joints, or the ends of the fingers (as
in whitlow,) are not unusual situations. The seat of the disease
will, however, depend upon the nature and locality of the exciting
cause. Wherever a local irritation is induced, there will most
probably be the seat of the specific inflammation. A blister is
one of the commonest of the exciting causes ; the application of a
poultice, or of an irritant ointment, a slight blow, and the like,
v/ill also act as exciting causes of the disease. A crop of boils is
a not unfrequent occurrence after an eruptive fever, as variola,
jscarlatina, the ' dengue," etc. In these cases the cutaneous inflam-
mation operates as an exciting cause, in the same >vay as the in-
flammation consequent upon a blister.

" The accompanying constitutional disturbance varies much.
In healthy individuals it is not at all well marked in the cachec-
tic the tongue is usually coated, sometimes brown, the appetite
impaired, the bowels constipated : occasionally rigors and febrile
reaction are manifested, and great debility felt. This disease be-
came prevalent in the clinical wards of the Boyal Infirmary of
Edinburgh during June, July, and August last, subsequently to
the admission of a Dane, resident in Leith for nine months, who
was affected with the pemphigoid and impetiginous form. In him
it appeared principally over the sacrum, as a vesicle, followed by
a superficial ulceration, surrounded by an inflamed areola, and
covered by a thick crust. Interspersed among these were isolated
pustules, with an indurated inflamed base. Under the use of
quinine, with mineral acids and warm baths, the pemphigoid
characteristic disappeared, but the impetiginoid furunculi were more
numerous and larger. Unfortunately, other patients in the ward
used the same bath in which this patient bathed, and when some
of the crusts from his body (it was reported) were floating upon
the water. Several of these were attacked with the same furun-
culoid eruption. The following history illustrates the origin and
varied forms of the disease: on the 3d June, George Stewart,
Ward 11, had a blister applied between his shoulders, which ran
the usual course. On lith June he complained of a pain in the
seat of the blister, and on examination it was found that a number
of pustules, with an indurated base, had appeared there, principal-
ly upon the upper and right edges of the space which the blister
had occupied. They varied in size from a pin's head to a four-
penny piece; some got no larger, but others increased in size, and
suppurated, so that a whitish tenacious fluid could be squeezed
from them. On the evening of the 16th June a large poultice was

N.8. VOL. XIII. NO. IX. 35

548 On Contagious Furunculoid. [September,

applied; next day blebs, like those seen on the Dane, were ob-
served to be intermingled among the faruncles, containing an
opaque purulent fluid, while near the angle of the right scapula,
one of the furuncles was fully an inch in diameter. This at last
became a large carbuncle, about three inches in diameter, contain-
ing the usual sloughy tissue. Another large boil also showed
itself on the back, lower down, which, on being incised, was found
to contain blood only. The treatment ordered in this case was
the water-dressing to each separate boil, the careful removal of
their contents, and the most sedulous attention to cleanliness. The
result was a check to any further formation of furunculi.

" 5. The pli legmonous^ phagoedenic^ and gangrenous forms. These
seem to occur in individuals who, from some pre-existent morbid
state of the blood and of the nutrient forces, are already in such a
condition thjit the ordinary sloughing inflammation of the phlyc-
tena, furuncle, or carbuncle, becomes exaggerated into rapid death
of the tissue. The lip and vagina in children are specially prone
to become the seat of phagedcenic inflammation, not unlike hospi-
tal gangrene; more rarely, the scrotum and perineeum in the aged.
The late Mr. Harvey Ludlow (when house-surgeon to St. Bar-
tholomew's) called the attention of the profession, in 18o2, more
particularly to carbuncular inflammation of the lips and other
parts of the face ; Mr. Stanley and Mr. Lloyd have also observed
the affection, and noted its alliance to carbuncular and furuneular
inflammation. Happily, these c^ses are comparatively rare, for
the destruction of the tissues is frightful as to extent and character.

" 6. Onychia or tuhitlow^ and suppurative inflammation of the
fingers and palms ^ and the palmar and digital sheaths of tendons.
These forms seem to be of rarer occurrence in the L^nited King-
dom than in the L^nited States and on the Continent. They are
not unfrequently followed by contractions of the Angers, caries,
etc. They are probably due to circumstances which bring the
poison into immediate contact with the hand and fingers. I shall
shortly adduce facts in illustration of this view. Dr. Hamilton
Kingiake, of Taunton, has specially recorded the prevalence of

whitlow in Somersetshire, in conjunction with boils and carbuncles.
* * -5^ * * * * -ss- -x- *

" Before entering upon the etiology, it wfll be useful to exam-
ine the pathological anatomy of the disease. It is primarily an
inflammation of the derma and of the subjacent cellular tissue,
ending variously,, in accordance with varying conditions. When
it attacks the surface of the derma, eflusion of serum, of a sero-
purulent fluid or of a bloody ichor, is the result ; when it attacks-
the derma proper, the various forms of furuncle, carbuncle, or
anthrax, occur. It is an almost universally accepted theory, that
the ' core' of the suppurating tumor known by these names con-
sists of sloughing cellular tissue, combined with exudative deposit;
and that the slough is consequent upon strangulation of the blood-

1857.] On Contagious Furunculoid, 549

vessels of the part by the distended and resisting tissues that sur-
round them. There are various reasons for adopting this theory,
if it were only necessary to explain the simple furuncular or car-
bunctilar form of the disease. For example, it is in accordance
with the theory that carbuncles and large furuncles are the most
prevalent in those portions of the surface where the skin is the
most dense, as the neck, back, nates. It is also in accordance
with the theory, that the sloughing should be most extensive in
those individuals in whom the vital energy is feeble, and a cachec-
tic state is present which predisposes to inflammation of an asthe-
nic type, such as that complicating nephria. But there are various
phenomena which the theory does not explain. It does not ex-
plain the more diffuse inflammation and suppuration of the cellu-
lar tissue known as phlegmon^ or that gangrenous form which
attacks portions of the skin not at all dense, as the lip, vagina, and
scrotum ; and above all, it gives no explanation of that rapid and
fatal gangrenous form of carbuncle known as the pestis carbuncu-
laris of horned cattle, and which, when that disease is communi-
cated to man, is cliarhon or the malignant pustule.

"These residual phenomena point, therefore, to another cause
of the characteristic inflammation. This is probably a specific and
communicable materies morbi, the operation of which, upon the
living tissues, is to devitalize them. Experience and observation
as to the spread of the epidemic, have convinced me that this
doctrine is so important an element in the etiology, that without
it we have in fact no trustworthy clue to the pathology and
treatment.

"I have observed that the materies morhi of the contagious fu-
runculoid is communicable 1, from one individual to another ;
2, from one portion of the skin \o another portion, in the same
individual ; and 3, that if this communication be thoroughly pre-
vented, the progress of the disease in a family or in an individual
is arrested.

"I have already mentioned examples of the probable commU'
nication of the disease from one individual to another, as having
occurred in the clinical wards of the Koyal Infirmary of Edin-
burgh. In a similar way, it has been repeatedly observed to
spread through families, schools, asylums, etc., where no precau-
tions have been taken to prevent contagion. In such examples,
it will usually be found that the affection, although slow in its
progress through the population, attacks equally in succession the
strong and the feeble, going on unmodified by diet, temperature^
seasons, etc. Often, on inquiry, it will be found that the mem-
bers of a family have had the disease subsequently to the admis-
sion into the family circle of a person affected with it. And inas-
much as no other reason can be assigned for its spread, which
shall with equal comprehensiveness explain it (all theories as to
peculiar atmospheric conditions, peculiarities of diet, etc., proving

550 On Contagious Furunculoid. [September,

insufficient), it is a reasonable and philosophical conclusion, that
it is communicated from person to person.

" The recent furuncular epidemic appears to have been general-
ly prevalent throughout the world certainly in the European
and American continents, throughout the United Kingdom, and
in all the British colonies. In England and the United States its
appearance has been coincident with various epidemics. Typhus,
influenza, cholera, small-pox, scarlatina, measles, hooping-cough,
and croup, were epidemic in London, in successive years, coinci-
dently with a largely increased mortality from phlegmon and car-
buncle. In the years of the maximum mortality' namely, 1853
and 1854, the prevailing epidemics were cholera, scarlatina,
measles, hooping-cough, and croup.

''In the summer of 1850, boils were widely epidemic through-
out the United States; they were described as being 'almost uni-
versal,' and carbuncles as being common. The epidemic was
co-extensive with a lichenous febrile eruption, termed 'prickly
heat,' and with the 'dengue' an eruptive fever, having points of
similarity with both influenza and scarlatina. In this epidemic
the furuncular eruption was often a substitute for the ordinary
cutaneous inflammation.

"The etiology of the ordinary, sporadic form of the cutaneous
inflammations I have considered, does not throw much light upon
the etiology of the epidemic. The recognized pathology of boils
is, I am inclined to think, in a great degree erroneous; it is cer-
tainly a fallacy that they are depurative. Those which occasion-
ally supervene in persons undergoing a rigid course of hydriatics,
are usually mentioned as illustrations of this theory ; but it ap-
pears just as reasonable a conclusion that the copious imbibition
of water induces such a cachectic state as constitutes a highly pre-
disposing cause of this peculiar form of inflammation. I certainly
think that a patient is free from a fertile source of depressing irri-
tation when he is free from them, and that if they occur, the
sooner they are cured the better. One great fact, however, stands
out distinctly, the severe forms of furunculoid, are constantly as-
sociated with cachectic states."

Dr. Laycock adds in conclusion: "I have already indicated
some of the sources of the materies morhi, but it is certain. I think,
that these are not all. The local inflammation is of a kind induc-
ed by various septic poisons. Of these, that which appears to be
generated during a severe and prolonged parturition, is one ; pro-
bably the poison of puerperal fever is another, and of the Levant
plague another. It remains to be determined whether the vario-
lous poison may not, under certain circumstances, be the materies
morhi: it may be equally a question whether the flesh of animals,
dead of dysentery, typhus, pleuropneumonia, etc., may not, when

1857.] Circwm&crihed Atrophy of tJte Skin. 561

used even as food, be a means of communicating the disease. As
to all these points, there are analogies in the natural history and
behaviour of epidemical and communicable fever-poisons, such as
to warrant cautious and careful inquiry."' \_EdinhuTgJi Med. Jour.
and RaaJcing's Abstract

On Circumscribed Atrophy of Hie Skin, By Dr. Keuss.

Dr. Reuss reports two cases of a disease of which he states he
has found no description in authors, and which appears to be al-
most identical in its characters with what we ourselves witnessed
in April, 1856, in a young woman.

A lad, aet. 15, at the end of 1855, had typhus, and while at its
acme several parts of the skin were observed to undergo a peculiar
change. They assumed a reddish-blue or reddish-brown color ;
under a slanting light appeared whitish, as an asbestine or satiny
gloss, and sharply cut off from the surrounding skin. They form-
ed elongated streaks of half an inch to three inches in length, and
were from one to four lines broad, and were all directed vertically
or obliquely to the axis of the body. They were symmetrically
arranged in both lower extremities below the trochanter major,
above the patella, above the internal condyle of the femur, and
across the outer side of the leg; altogether there were from twenty
to thirty such streaks on each leg. The affected parts were sunk
below the level of the surrounding skin ; and when pressed the
bluish color disappeared, and one could see the blood return into
the subjacent dilated capillaries. The sensibility of the parts
was diminished. Three months later, the appearances had some-
what faded, but were essentially the same. The second case re-
sembled the last, but was not so well marked; it occurred in a
young woman, aged twenty-eight. The one we ourselves observ-
ed occurred in a servant girl, aged twenty nine, who, after suffer-
ing from some severe abscesses, found that small white spots
formed on the left side of the neck, extending from the sternum
over the clavicle towards the spine like zoster. The spots were
sharply defined, very smooth, and bloodless ; and looked as if
the sub-epidermic tissue had been punched out. There had never
been any elevation of the tissues or secretion. The outline was
generally circular ; or, where two or more spots had coalesced,
the outline became oval. They varied in size irom the point of a
pin to a split pea. There was a small patch of similar white spots
on the right hypochondrium. Her general health, at the time we
saw her, was good.

Like Dr. Reuss, we failed at the time in meeting with anything
analogous in works on skin diseases. In the fourth edition of
Mr. Wilson's works " On Diseases of the Skin", (p. 878,) which
has just appeared, the affection is described under the name of
Morphaea Alba. [ Vierordt's Archiv. and Med. Chir. Review.

552 Amylene : History of its Discovery^ &c. [September,

Amylene, a condensed history of its discovery as an anceesthetic agent^
with an account of the Experiments in the Hospitals of London^
Paris^ Strasbourg^ and Brussels. Translated and abridged for
the Monthly from the Eevue de Therapeutique.

Anaesthesia is a conquest which will endure notwithstanding
the accidents which now and then occur to surgeons. But yester-
day this method counted two agents, sulphuric ether, now seldom
used, and chloroform, almost universally adopted. A third is now
being tried.

On account of the deaths which have occurred during the use
of inhalation in the hospitals of London, and which seem to have
been more numerous there than elsewhere, the English physicians
have eagerly sought for a substance less dangerous than chloro-
form, and one of them, Dr. Snow, has arrived at a result in the
discovery of the anaesthetic properties of amylene which merits
being recorded.

Dr. Snow after many experiments upon animals, after having
respired the vapors of amylene himself, decided to employ it upon
man. The 10th November, 1856, he employed it for the extrac-
tion of teeth in two young persons fourteen years of age. In
these cases he was not perfectly successful, but from what he had
observed he felt authorized in continuing his experiments, and so
on the 4th of December he used it upon four new patients with
complete success. The 18th of December it was again employed
in some more severe cases ; and in one, operated upon by Mr.
Fergusson for fungus of the testicle, and in another, operated
upon by Mr. Bowman for the removal of tumors in the region of
the groin, and in two cases of section of tendons. The 27th of
December, M. Snow used it in the case of a young girl three years
and a half old. She breathed the vapors for two minutes only.
She did not give the least manifestation of pain, and awoke at the
very moment that the operator finished the section of the tendons
of the muscles of the foot.

January 3d, Mr. Fergusson operated upon three patients sub-
lected to the vapors of amylene. In one a rhinoplastic operation
was to be completed. The inspiration continued six minutes. It
was observed that the amylene produced less rigidity and less
convulsions than chloroform administered a few days before.

January 7th, Mr. Henry Lee employed amylene upon a young
girl whose thigh he was to amputate. The anesthesia was main-
tained during the whole of the operation, three ounces of amylene
were employed. The young patient felt no pain and was very
well afterwards. The same day Mr. Fergusson operated upon
three patients under the aniesthetic efiect of amylene. In all the
auc^sthesia was obtained in two or three minutes. In two the in-
telligence was not completely abolished.

Mr. Tyler Smith, surgeon to St. Mary's Hospital, has employed

1857.] Amylene: History of its Discovery^ &c. 5BS

araylene with success in accouchincnts. Upon the approach of
each pain, he caused 80, 40, 50 drops of amylene poured upon a
compress folded several times, to be inhaled. These inhalations
constantly and rapidly determined a state of insensibility to the
pain, the uterine contractions lost nothing in force or frequency.
The return of sensibility was almost instantaneous, from the mo-
ment that the pain ceased, and the compress was removed. At
the time of the birth of the infant the insensibility was as complete
as if chloroform had been used. The placenta was detached and
expelled with rapidity, and the uterus contracted well afterwards;
the infant was healthy and vigorous.

Mr. Tyler Smith, as well as the other surgeons already men-
tioned, accord to amylene, compared with chloroform, the advan-
tage of a prompt action 'probahly without danger, and what is not
less important, the rapid disappearance of the insensibility as soon
as the inhalations are suspended. The only disadvantages are, the
disagreeable odor of this substance, and the necessity of employing
^ great quantity in order to produce sufficient anaesthetic effects.

Up to the close of January, sixty-nine operations had been per-
formed in England under the action of amylene.

In Paris amylene was first employed in the early part of Febru-
ary, at Hospital St. Antoine, in the wards under the charge of M.'
Aran, upon patients who had come to have some teeth extracted.
Three young women were subjected to the vapors of amylene.
The duration of the inhalation Vv^as twent}^ minutes for each of
them without producing complete insensibility. The instrument
M. Debout invented for chloroform was used, which did not per-
mit the vapor of amylene to pass off in sufficient quantity in a
given time. This and the limited quantity of amylene used was
supposed to be the cause of the failure.

At a second sitting, the apparatus of M. Charriere for chloro-
form was used, and a larger quantity of amylene was secured.
According to Mr. Snow, the patient should respire twenty grains
of amylene a minute, which produces insensibility in three min-
.utes, and sometimes less, which was the result in this case. From
3i to 3iss of amylene was poured into Charriere's apparatus, and
in less than three minutes the patient, a young female with a large
decayed molar tooth, was fully asleep. Not being ready for the
extraction of the tooth, the patient was allowed to awake, which
she did in kss than a minute, her face was gay and laughing,
:she thought she had just returned from a walk. Everything pre-
pared, about a drachm of the amylene was again poured into the
apparatus, and the anaesthesia was again as prompt as before, the
third minute had hardly elapsed when the mouth of the patient
was opened without resistance and the tooth extracted without the
patient manifesting the least sign of pain.

At the same time M. Geraldes, Surgeon to the Foundlino- Hos-
.piial, made some experiments. He had operated at the time of

554 Amylene : History of its Discovery^ &c. [September,

his report (March 4th) upon twenty -five patients, children from
three months to ten years old. In all, with a single exception,
the ana3sthesia was produced in a very short space of time, the
minimum of which was one minute, and the maximum three.
We cite two observations :

A little patient about six years old was submitted to the action
of amylene, in order to examine more easily its eyes. The child
breathed the vapors with evident repugnance, it showed no signa
of suffocation, it had not that abundant salivation which is some-
times produced by chloroform, but a sudden and very marked
weeping was produced, as when vapors of ammonia are respired.
This infant reacted very slightly however, against the vapors of
amylene ; in a few moments, hardly a minute, it remained im-
movable, insensibility was obtained. The inspirations were sus-
pended. From 5i to 3iss of amylene was employed. The infant
awoke with the same rapidity, it did not complain, and willingly
9,ccepted food.

The second observation is the exception mentioned above. The
patient was a girl four years old. The apparatus for inhalation
fitted badly to the face, so that compresses were used. The child
at first pushed away the hand of the operator, saying that it smelt
badly. Soon, however, she became immovable, the weeping was
as marked as in the case just cited. At the end of about two
minutes she showed a rigidity and contraction of the limbs which
is contrary to the assertion of Pr. Snow,

Soon, however, relaxation commenced, and in three minutes
anesthesia was obtained. Still, it was easy to see that the sleep
did z^ot resemble that produced by chloroform. It was evidently
less profound ; the child opened its eyes, made a few movements,
and spoke as though dreaming, yet without showing any pain
while the operation was going on.*^ The pulse and respiration was
as in the normal state, Amylene being volatile the whole of it
was soon consumed, that is to say 5 v in about eight minutes, be-
fore the operation was terminated. Eecourse was had to chloro-
form, and it was soon easy to judge how much more rapid and
active in actiox; this substance is. In a few seconds the child was
completely comatose, and appeared much more profoundly asleep
than before, This sleep was prolonged several minutes after the
operation was terminated, while the child woke up the minute she
ceased to breathe the vapors of amylene. The operation contin-
ued twelve minutes. With this exception M. Giraldes observes
that all the children respired the amylene without effort, without
much resistance ; in all the respiration was calm as normally ; the
anaesthesia was obtained without convulsion, without muscular
contractions, without rigidity, without being accompanied or fol-
lowed by nausea or vomiting, although the amylene was given
soon after eating. In all the awakening was rapid, complete ;
they preserved their gaiety, were not incommoded, innervated,
irritated, or disagreeable during the rest of the day. .

1

1857.] Amylene: History of its Discovery^ <l'c. 655

As soon as the anassthesia is complete M. Giraldes suspends tlie
inhalations. The explorations and the operations requiring but
little time, he has not thought proper to prolong the inhalations
too long. He gives no opinion upon the probable duration of
anaesthesia, yet he believes that amylenic anaesthesia can be long
enough for performing the great operations of surgery.

M. Giraldes adds, in terminating, that the vapors of amylene,
even when they have a marked odor, are respired without effort,
without producing any efforts of cough, any convulsive movements
of the larynx, nor those contractions of the jaws, those cephalic
congestions which are sometimes observed after the inhalation of
chloroform.

Experiments upon children and in the surgical clinique of M.
Bigaud in the hospitals of Strasbourg, have led to the same results
as those of M. Giraldes, In some observations of M. Kigaud, as
well as in those of M. Giraldes, it is shown that the exhibition of
amylene without an apparatus leads to a tardiness in the result.

Two cases of amylenation have been tried in Strasbourg in the
obstetrical clinique of Professor Stoltz.

A woman twenty-six years old entered the clinique in labour.
After a few hours, the neck being effaced, the orifice dilated, and
the head passing the superior straight, she was submitted to the
action of amylene. It was commenced at the moment when the
head was engaged in the brim of the pelvis. Some amylene was
poured into a bag closed with a compress and covered over exte-
riorly with oiled cloth. The woman gave a few cries and became
stiff. After five minutes of inhalation a commencement of anaes-
thesia wa^ observed. A contraction of the womb then took place,
and the woman made a few complaints, but much less loud than
is usual. At half-past one new application of amylene; in five
minutes the woman lost consciousness, a contraction followed and
excited a few moanings. At two o'clock the head was engaged
during a third inhalation which also produced a beginning of loss
of consciousness ; the woman uttered a cry at the moment that the
labour was finished.

Interrogated as to her sensations, she said .^he had experienced
vertigo, ringing in the ears, a burning feeling in the pharynx.
She recalled all that passed, but had felt no pain. The child is
living and healthy. The uterine contractions were not affected
by the amylene.

The second case was one of premature delivery. The amylene
was given to lessen the pain of the last efforts of labour. ISTo
contraction of the uterus took place during the whole duration of
amylenation ; friction over that organ induced no expulsive effort;
the w^omb hardened one moment to relax the next. The beatings
of the foetal heart diminished to sixty pulsations. M. Stoltz de-
cided to terminate the labor by the application of forceps. The
woman did not feel the introduction of the instrument, nor the

556 Amylene : History of its Dsscovery^ &c. [September,

tractions which were necessary. During amylenation she had
vertigo, and experienced a dryness of the month. The infant was
living, but feeble, half aphyxiated, not at full term.

M. Stoltz thinks that the amylene had probably nothing to do
with the slowness of the uterine contractions, nor with the as-
phyxia of the infant. Other facts will relieve the doubts upon
that point.

M. Tourdes resumes the results of his observations and experi-
ments upon children as follows:

Children receive amylene without any repugnance. The odor
of this substance neither irritates nor fatigues the air-passages. No
apparatus is necessary for putting to sleep the little patients; a
sponge in a cone of oiled-cloth opened at the bottom is suffi.cient.

The anaesthetic action is rapid ; the resistance rarely surpasses
one or two minutes.

The insensibility is complete without carrying it so far as to
produce muscular resolution. It is much easier not to exceed the
effects you wish with amylene than with chloroform, to limit
yourself to a transient and superficial anaesthesia proportioned to
the end to be attained.

With chloroform a greater action is produced than is desired, a
profound anaesthesia is determined, a complete resolution of the
limbs, whilst with amylene you are almost certain of not obtain-
ing them unless you desire to do so by persistent inhalation.

If you desire a profound anaesthesia accompanied with muscular
resolution, this result can be attained by means of amylene, by
prolonging sufficiently its action. This is an important difference
between this substance and chloroform. From the moment that
the patient ceases to respire amylene, the effects of this agent
diminish with rapidity. The absolute insolubility, and the exces-
sive volatility of this body result in a rapid elimination and a
prompt diminution of the symptoms.

With chloroform, on the contrary, of which the volatility is
much less, the effects are more prolonged ; sometimes they are in-
creased after the inhalations have ceased.

The recovery is complete and rapid. From an anaesthesia of
short duration, not surpassing eight or ten minutes, two or three
minutes is all that is necessary for a child to regain all its facul-
ties. A little longer time is required when the sleep has contin-
ued longer. The elimination is rapid and the traces of amylene
are promptly effaced.

Finally, M. Tourdes designates as a great advantage of amylene
over chloroform the absence, or at least the great infrequency, of
nausea and vomitings.

M. Duroy, a pharmaceutist, presented to the Academy of Medi-
cine of Paris, at its sitting of March 31, a memoir upon amylene,
its purification and its characteristics. At a previous sitting of the
10th of March, M. Debout had read a paper upon the innocuous-

1857.] Amylene : History of its Discovery^ d'c. 657

ness and the value of amylene considered as an anaesthetic agent.
This latter paper gave rise to a commission composed of MM.-
Eobert, Velpeau, and Malgaigne, who reported upon it at the
sitting of the same body, May 12th last, through the chairman of
the committee, M. Eobert.

The paper of M. Debout repeats the statements already made by
Mr. Snow, MM. Giraldes and Tourdes, that amylene produces
anaesthesia very promptly without any painful sensation, without
provoking any cough, or the necessity of spitting, as is often ob-
served in the use of chloroform. During the whole of amylena-
tion the pulse continues large, full, and very frequent, the respira-
tory movements ample, the skin warm, the face colored; in a
word, there is absence of those symptoms which show that the
new agent affects easily the phenomena of organic life. Without
entirely substituting amylene for chloroform, this new anassthetic,
says M. Debout, should be inscribed among the useful medicinal
agents. M. Robert, in preparing his report, used amylene forty-
four times upon adults, male and female, and for various opera-
tions.

In these several experiments, M. Robert says he did not witness
any symptoms of irritation about the mucous membrane of the
mouth and bronchial tubes, exhibiting itself by salivation and
cough. Generally, the patients became insensible in from one to
three minutes, rarely after six or seven. Three became refractory
and necessitated the use of chloroform after ten or twelve minutes
of inhalation. The anaesthesia was produced without being pre-
ceded by the symptoms of agitation which chloroform frequently
produces. The face was more or less red; the eyelids remained
wide open ; the eyes fixed, frequently turned up under the upper
eyelid ; the head was thrown back ; sometimes the limbs were
extended, becoming stiff. The pulse became frequent; in one
case it became intermittent and thready. The respiration was
free, and I never observed that spasmodic tightening of the jaws
with threatened suffocation which chloroform sometimes provokes.
It never produces muscular relaxation, and the insensibility it
causes would last but a short time if the amylene in the apparatus
was not renewed every five or six minutes. The operation con-
cluded, the recovery is prompt, and the patients sustain no ill
effects.

This succinct review of the effects produced by amylene proves
that this body possesses with ether and chloroform the power of
preventing pain, but that it differs from them, especially from
chloroform, by the instantaneousness of its action, which ceases
the moment inhalations are suspended, and in the fact that it has
no effect upon the muscular contractility.

M. Robert reports upon the perfect harmlessness of amylene, by
citing the fatal case which singularly enough occurred to the dis-
coverer of the anaesthetic property of amylene to Mr. Snow him-

558 Amylene : History of its Discovery^ &c. [September,

self. This disaster occurred April 7th, to a patient upon whom
Mr. Fergusson was to operate for fistula of the anus, Mr. Snow
being invited to aid in the operation, and administer the aucESthe-
tic. The quantity used was quite small, and at the end of two
minutes loss of consciousness was produced. The operation was
performed, the inhalation was suspended, but recovery not taking
place immediately, the pulse was examined, was absent upon the
left side, and very feeble upon the right, and soon disappeared al-
together Eespiration soon ceased, when artificial respiration was
continued according to Marshall Hall's plan, and insufilation from
mouth to moath, but without success. The autopsy revealed no
cause of sudden death, so that Dr. Snow was forced to attribute it
to the action of amylene. This patient was the one hundred and
forty-fourth to whom he had administered amylene.

The next question taken up by the commission is, whether it
offers less danger than ether or chloroform. Various comparative
experiments were undertaken by M. Debout to resolve this ques-
tion, and which were repeated by M. Eobert. The first writer
says, if it is necessary to double the quantity of chloroform to
convert the ansesthetic dose into a poisonous one, it is necessary
to quadruple that of ether and quintuple that of amylene. M. Eo-
bert in his experiments on animals found that they became as it
were accustomed to the use of amylene, and recovered even a part
of the sensibility. The reporter agrees with M. Debout in consid-
ering it poisonous but much less active than chloroform, but he
differs from him in drawing the conclusion that consequently it is
much less dangerous in practice. An important fact, he says, in
the history of ansesihesia is, that it is not from the successive and
progressive evolution of the phenomena of intoxication that death
occurs in man, but in a sudden and imexpected manner, as though
in consequence of a predisposition in the organism, the nature of
which is unknown. I have shown this to be the case with chlo-
roform, in a work published several years since, and the case of
Mr. Snow proves it to be the same with amylene. The danger
lies in anaesthesia, which, according to the expression of M.
Tourdes, is a diminution of life^ and a stej^ taken towards death.
Notwithstanding the fact that it is not harmless, it should be re-
tained in practice because its action is prompt, of short duration,
and its effects rapidly pass away without leaving behind that gen-
eral malaise which occasionally persists for a long time after the
use of chloroform. It is preferable to the other anaesthetic sub-
stances for very short operations, when one intends only to anni-
hilate the pains, or simply to blunt it. It is peculiarly applicable
for children and patients affected with disease of the air-passages.
It should be rejected for long and painful operations, and especi-
ally for those in which it is necessary to overcome the contraction
of muscles as in luxations and hernias.

M. Kobert's report closes by proposing a vote of thanks to M.

1857.] Amylene: History of its Discovery^ cCrc. 660

Debout, and that his memoir should be pubhshed in the Archives
of the Academy.

M. Yelpeau, as soon as the reading of the report was finished,
arose and said :

"Though I am a member of the committee which had to judge
M. Robert's work, and though I have signed the report which has
just been read to you, I declare I am not a cjjreat admirer of amy-
lene. I have several times tried it at my service at the Charite,
and sincerely believe that the successor of chloroform has not yet
been found, and that it is, in my opinion, still the best of all anes-
thetic substances, I find fault with amylene for its detestable
smell, as inconvenient for the assistants as for the patient, the little
certainty and constancy of its action, the two short continuance of
its effect ; and the necessity in using it to employ a special inhaler.
Finally, the accident which happened to Dr. Snow, and related
by M. Eobert, destroys the hopes which had been founded on its
innocuousness. As to chloroform, I do not say it is quite innocu-
ous, but I believe the dangers of its use have been very much
magnified. I will even willingly say it has been calumniated.
For the last ten 3^ears I have used chloroform about five or six
thousand times for different operations, and on patients of differ-
ent age and sex; never have I had to lament any accident. I am
not the only one in this case amongst the surgeons of Paris. I do
not know that any misfortune caused by chloroform has ever hap-
pened in all our large hospitals ; besides, when death occurs dur-
ing or after a surgical operation, is it just in all cases to accuse the
anogsthetic agent ? M. Robert has, I believe, lost a patient with
an amputation of the thigh, to whom he had given chloroform.
This last substance has been accused. I am not sure whether it
was right. I think this angesthetic substance is not more danger-
ous than amylene if it is used with proper precaution. It has the
advantage over its rival of not disseminating a disagreeable odor ;
of being easily manageable, without the need of a special inhaler.
It is quite sufficient to pour some drachms of the liquid on a
sponge; its action is generally pretty quick, and always lasting;
besides, the inhalation can be prolonged without inconvenience,
the degree of anaesthesia shows the quantity which it is necessary
to employ. The awakening which succeeds to the effects of chlo-
roform is generally pretty quick.

" I sum up by sa3dng that amylene can be introduced into prac-
tice, but that it does not deserve to be substituted for chloroform,
which still remains the most powerful and most certain of anaes-
thetic agents."

M. Robert then said: The advantages of amylene consist in the
rapidity and the short duration of its action ; on this account it is
proper in slight operations which are very painful. I would call
the attention of M. Yelpeau to this fact^ that we use chloroform
now only in serious cases, when it is necessary to continue insen-

S60 On the Patfiology of Mellituria. [September,

sibility for some time. It sometimes happens with chloroform that
the insensibility is preceded with a certam agitation, which is man-
ifested by a cough, desire to vomit ; the next day there is often
gastric embarrassment ; and still more, the insensibility produced
is of long duration. Chloroform is indispensable when it is ne-
cessary to obtain muscular relaxation ; but notwithstanding its
disagreeable odor, to which one becomes easily accustomed (I
speak from experience), amylene has its advantages. Its greatest
inconvenience is, to require a special apparatus. Amylene puts
to sleep in an instant. For instance, this morning a man came to
my consultation with a narrow preputial opening. I operated
upon him after having subjected him to the inhalation of amylene f
in less than a minute be was asleep, and as soon as the operation
was performed he took his hat and left. I do not believe that^
amylene has any special prerogative of harmlessness, but there
are cases where this agent should be preferred to chloroform in
operations of short duration, for example, the incisions, opening
of abscesses, etc. Without desiring to depreciate chloroform, I
think that it is well to leave a little place beside it for amylene.

[Amer. Med. Monthly,

On the Pathology of Mellituria. By Dr. Garrod^ Physician to
University College Hospital.

" As to diabetes being dependent, not upon any increased form-
ation of saccharine matter, but on an imperfect destructive power
existing in the blood, although most of the phenomena are ex-
plainable on this hypothesis, still it is by no means satisfactory,
as at present there is no proof of this absence of power to effect the
ulterior changes. And certain facts, besides those which I have
already brought forward, appear to militate against the exis-tence
of this deficiency ; for there is no marked difference in tempera-
ture between diabetic and other subjects ; and, in certain experi-
ments made some years since by Professor Grraham, no peculiarity
was discovered in the amount of carbonic acid which they expire.
Upon the whole, I should be disposed, at present^ to regard dia-
betes as due, in the first place, to an increased formation of sugar
by the liver, produced by some alteration of function in the organ ;
and at the same time that its glycogenic power becomes abnor-
mally increased, I should consider that it loses the property, which
exists in health, of arresting and changing into new principles
(as fatty substance, &;c.) those saccharine matters which are brought
to it by means of the portal blood. If we view diabetes in this
light, we shall, I believe, be able to explain all the phenomena
which the disease presents ; at the same time I am aware of no
facts which can be brought forward in opposition to it. It ex-
plains, for example, why sugar can generally be detected in the

1857.] New Mode of Treating Saccharine Diabetes. 561

urine of diabetic patients, when subjected to the most rigorous
animal diet, and, at the same time, why amylaceous matters usual-
ly so greatly augment this saccharine impregnation." [British
Med. Jour, and Rayiking^s Abstract.

On a neiv Mode of Treatment in Saccharine Diabetes. By M. PiOERY.

M. Piorry is of o])inion that sugar is indispensable to the main-
tenance of life (he founds this opinion upon the researches of MM.
Dumas and CI. Bernard), and on this account he thinks that dia-
betic patients ought to be supplied with sugar, and substances
which are transformable into sugar, in order that they may repair
that unnatural waste which is consequent upon their malady.
With this view^ he has brought the following case before the
French Academy of Medicine :

Case. The patient is only described as being under M. Piorry's
care in La Charite (No. 19 Salle St. Anne), and as sufiering from
1 diabetes, with very copious secretion of sugar. All the viscera
were sound, with the exception of some slight hyperthrophy in
I the spleen. From the 2d to the 12th of January, ten litres of
urine were passed daily. During this time, certain feverish symp-
I toms, which came on in the evening, subsided under the influence
of quinine. On the 12th, the patient was directed to abstain as
much as possible from all fluids, and to have a dail}' double quan-
tity of meat^ icith 125 grammes of sugar <andy. This treatment
was persevered in on the following days, and the result was that
the quantity of urine fell to two and a half litres in the day the
specific gravity remaining the same, namely 1.060. On the 2d of
January, 500 grammes of sugar had been lost in the twenty -four
hours ; from the 12th to the 24th, notwithstanding the addition of
the sugar-candy, the daily loss of sugar was not more than 185
grammes.

This case was referred to a commissioB, consisting of MM. An-
dral, Eayer, and CI. Bernard; and in the meantime it is only
baldly stated^ as we have given it. Gaz. Hebdovi. de Med. et Chir,
and Ibid.

Good Effects of Guaiacum in Cynanche Tonsillaris,

Dr. Brinton has been treating several cases of cynanche tonsil-
laris at the Royal Free Hospital, on what he informs us has been
his usual plan for many years a plan so simple and so eflicacioug
to deserve mention. He regards the tonsils as an offshoot of
the intestinal canal, and considers that not only is constipation, in
most cases an element of the malady, but that, on the above view,
the inflamed structures are best relieved by free purging, and per-
petual gargling and fomentations with hot water. For the first of
these indications he relies chiefly on powdered guaiacum, which

562 Medical Treatmmt of Insanity. [September,

he gives in large (one scruple to one drachm) doses, every four
hours ; often in combination with opium, aloes, and jalap, and sus-
pended in mucilage. He finds that, if commenced tolerably early,
this treatment generally averts all abscess, and even later, rapidly
removes the malady, while it allows of a rapid recovery, very
unlike the long convalescence which often follows bleeding, blisters,
and tartar emetic. [^Lancet.

The Medical Treatment of Insanity. By M. H. EaxNey, M.D,,
Eesident Physician of the New York City Lunatic Asylum,
Blackwell's Island. (Read before the Association of Medical
Superintendents of American Institutions for the Insane^ May,
1857.)

In presenting my views relative to the medical treatment of
insanity, I shall be very brief, tracing only the general outlines of
the course pursued by me in a few of the best marked forms of
this disease.

The object of the report is to obtain an expression of the views
of the different members of the Association on this subject, to at- 1
tain which it is necessary that there be no misunderstanding as to >
the particular disease described. The treatment of insanity is the
great desideratum, although in fact subjects of secondary import-
ance are much more frequently discussed. The peculiar ideas en-
tertained by the members as to ventilation, the construction of
water-closets, &;c., are generally understood ; but I am unable to
say that there is an unanimity of opinion as to a mode of practice
in any one of the various forms of insanity. It may be, perhaps,
impossible to determine the exact treatment which should be pur-
sued in a particular case, but the general principles, at least, that
govern our course in a certain defined form of mental derange-
ment, can be given as well as in the treatment of physical diseases
generally. I assume that there are conventional terms, which
convey to the mind definite ideas of certain forms of diseases
which, when referred to, suggest a group of associated symptoms
that, taken collectively^ constitute a distinct variety. It is only to
a few of such well-known and recognized forms that reference will
be made.

In insanity no new faculties are created, but those already ex-
isting are modified by the conditions of exaltation, depression, or
perversion. The type of the different varieties of disease may be
found in the normal state of the mind. This consideration affords
important aid in distinguishing one form of mental disease from
another.

I shall first refer to Acute Mania. The physiological type of
this disease is given more nearly in anger marked by violence
than in any other state of mind. The leading characteristics are^

1857.] Medical Treatment of Insanity. 563

impassioned moral and intellectual exaltation (the one exhibited
by perversion, the other by delusion), the rapid flow of ideas, vio-
lent gesticulation, disposition to overthrow or destroy the furniture
of the room, sleeplessness, and wild expression of the eye and
countenance, betraying great disquiet of mind. Undoubtedly the
term acute mania recalls a certain grouping of symptoms, and
conveys more accurate notions of the condition than would the
minute description of an individual case, since by abstraction the
essentials in particular instances have been selected and combined
to form the general idea. Taking it as granted that the form re-
ferred to is fully recognized, the medical treatment will be briefly
considered. A careful examination must be made into the gene-
ral condition of the system, as well as of the functional disturb-
ance of any organ that might affect the brain. The success follow-
ing treatment depends much upon the care exercised in the duty.
The patient should, as far as possible, be excluded from all excite-
ment. In most cases the condition of the stomach and bowels is
disordered, to correct ^vhich an active cathartic should be pre-
scribed. For this purpose the combination, hydrarg. sub. mur,
gr. x. pulv. jalap gr. xx. may be administered, and if the patient
be of full habit a grain of tartarized antimony may be added. The
skin is often dry and unclean requiring, after catharsis, a warm
bath, and pulv. ipecac, c. gr. x, the following night. On the suc-
ceeding day, if the patient be plethoric and there seem to be a
determination of blood to the brain, commence with ant. et potass,
tart., gr. ss. ter in die^ which should be gradually increased until
nausea follows ; cold applications may be made to the head, and
spts. ammon. acetat., or spts. seth. nit. to act upon the secretions.
If there be unnatural rapidity in the pulsations of the heart still
persisting, tinct. verat. virid. gtt. v, ad x, his in die^ may be sub-
stituted for the tartar emetic. If for several days the patient con-
tinue violent, ol. tiglii. is to be applied to the back of the neck
and behind the ears ; selecting for this a proper time in the advance
of the disease, a full eruption is usually followed by marked im-
provement. As soon as the prominent symptoms of violence
yield, morph. sulph., gr. ss. ter in die^ is substituted for the reme-
dies before specified, or if, at the time of admission, the patient be
emaciated and apparently prostrated, either morphia or opium is
given directly after the warm bath. Under these circumstances a
full diet is urged, and if with restlessness and high excitement an
anaemic state of the brain is believed to exist, a supply of meat
rich in fat is liberally furnished. Beer and milk-punch take the
place of other drinks. Tonics, such as ferri carb., potass, iodid.,
&c., have a favorable action, and even quinine is occasionally ad-
missible. When violent parolysms are separated by lucid inter*
vals, as in recurrent mania, quinine^ in doses three times a day
during the quiet period, has been found highly beneficial.

My attention was first called to the use of this article by a paper

N.S. VOL. XIII. NO. IX. 36

564 Medical Treatment of Insanity. [September,

read before this Association three years ago, by Dr. Tyler. Since
then I have often used quinine in cases of the recurrent form of
insanity with decided success. In many the lucid interval was
prolonged, the paroxysm less severe, and in a few instances com-
plete recovery was the result. If masturbation was suspected as
a cause, free applications of croton oil were made to the penis and
scrotum.

Amenorrhoea is a frequent cause of mania in girls between the
ages of 15 and 25, while in later life menstrual disturbances usu-
ally produce melancholia. Mania from this source yields readily
to proper treatment. The tr. ah et myrrh, to remove constipation,
Lugol's solution, or some other fo-rm of iodine, with stimulating
applications to the mammae, effect, ordinarily, a cure in two or
three months. In that form of mania in which little violence ex-
ists the patient seeming like one inebriated, yet moved by that
same mischievous propensity that i-s found in a variety of nymph-
omania, opium in large doses controls quite effectually the undue
exhilaration of spirits. The common course is to commence with
tinct. opii. 1 dr. ter in die^ which is doubled at the expiration of
the first, or even increased to three drachms, if found necessary,
at the end of the second week. From the peculiar state of the
brain and nervous system^ these large doses are not only tolerated,
but produce little sensible effect aside from allaying the excitement
and occasioning active emcsis and catharsis. These last condi-
tions render it often necessary to omit the medicine for a day.

Melancholia, the Ij^pemania of Esquirol, is another form of men-
tal disease readily recognized. The elementary type is found in
fear, sorrow, or grief, as exhibited by a mother in the loss of her
child, or in impending calamity. The peculiar marks which dis-
tinguish this affection are exhaltation of the sentiment of sorrow,
entire concentration of mind in one idea or class of ideas, and an
inability to direct the attention to anything not immediately con-
nected with that which wholly absorbs the mind. It is frequently
dependent on some bilious or uterine derangement, and in the
selection of medicines attention should be directed particular!}' to
this fact. To correct the secretions mass, hydrarg., or the hydrarg,
cum creta, may be used. Where a sufficient alterative effect has
been produced, opiates in small doses are indicated. The object
is to partially remove the intense grief or fear which character-
izes this form of disease. Morphia in small doses may for a long
time be continued. During its administration gentle laxatives
will be required ; for, aside from the effect of the opiate, there is
a tendency to constipation. The patient generally refuses a proper
amount of nourishment, lea\dng the vital powers greatly reduced,
and requiring tonics and simulants such as ferri carb., porter,.
&c. If a propensity to commit suicide exist, the occasional appli-
cation of bhsters, or ung. antimon. to the back of the neck, lessens
much the danger )i such an occurrence. It may afford benefit, in

1857.] Medical Treatment of Insanity. 565

part, by relieving congestion of the vessels of the brain, but prin-
cipally from the substitution of a real for an imaginary trouble.

Of the remaining forms of insanity Dementia alone is that which
I now shall consider. Its fundamental type or analogue exists in
natural dullness of intellect. The leading characteristic is an en-
feeblement of the intellectual faculties, or even a complete obliter-
ation of their manifestations. Dementia is usually a sequel of
mania or sotiie acute affection of the brain ; rarely an idiopathic
disease. Moral treatment ijs of much more importance than in
mania or melancholia, yet a judicious use of medicines will aid
much in the restoration of reason. To relieve anosmia, nutritious
diet and the free use of chalybeates are requisite. The object is
to supply the brain its proper stimulus by enriching the blood,
and thus arousing its dormant excitability. As the muscle loses
its contractile power from long inaction, so may the brain, although
unchanged in structure, cease to perform its proper functions, from
previous long-continued disease. The phosphates of iron and
manganese become valuable in this disease by furnishing the ne-
cessary amount of phosphorus for generating the nervous force.
In a few instances rapid improvement has followed the use of
cannabis indica, which seems to have a special tendency to stimu-
late the senses, and excite the moral qualities. Those cases in
which dullness of intellect depends on a congestive condition of
the brain are benefited by counter irritants, such as blisters, ung.
antimon., or ol. tiglii applied to the back of the neck. The most
favorable results occasionally follow accidental sloughing from the
application of tartarized antimony, while the same effect may oc-
cur from an extensive abscess.

Such are my views in regard to the ordinary course to be pur-
sued in treating the foregoing forms of insanity, each individual
case requiring, however, modifications of treatment corresponding
to the particular causes, age, sex, temperament, condition of sys-
tem, &c. Adopting the somatic theory as to the proximate cause
of insanity, that the material part, the brain, is the seat of disorder,
while the immaterial is not subject to change, there can be no
reason why medicines should not exert a controlling influence
over this disease. Kot only is the physical organization directly
affected by medicinal agents, but over the mind itself the mani-
festation of the immaterial through the medium of the brain is
subjected to their restoring influence. Narcotics, especially, seem
to act immediately on the brain, producing a marked physical
effect. Some excite the senses, others produce in the intellect the
most brilliant images, and a few exert their influence over the
moral faculties. The first effect of opium is to allay the passions,
not only by lessening directly the most violent anger and poignant
grief, but also by occupying the attention with fanciful and pleas-
ant imagery, tending to induce cheerfulness and contentment.
Hyoscyamus, on the contrary, is supposed to arouse anger and

566 Vesico- Vaginal Fistula, [September,

jealousy, while belladonna, in large doses, occasions gloomy
thoughts and dejection of mind. Stramonium affects the senses
primarily, and, in moderate quantities, disposes to convulsive mer-
riment. From the use of cannabis the activity of the senses is in-
creased, and the most surprising delusions follow, which may
continue long after the immediate stimulus has passed away. The
effects of narcotics are not fully understood, but sufficient is known
of them to call for a careful discrimination in their use. It is well
settled that they act on the mind, and that each has some peculiar
characteristic distinguishing its action. If this be granted, it ne-
cessarily follows that with a knowledge of the change produced
by this class of remedies on the different faculties of the mind, a
prior selection for the individual case must be attended with good
results.

In thus presenting my views it must not be understood that I
advocate entire reliance on medicinal agents in the treatment of
insanity. The adoption of proper h3'gienic rules is essential,, as in
phj^sical disease generally. Moral treatment, including employ-
ment, amusements, the establishment of regular habits, kc.^ is also
a most important auxiliary to recovery, This is particularly true
where derangement of mind has existed for years. But while ad-
mitting the importance of moral treatment, I would avoid an over
estimate of its mechanical part, and carefully investigate not only
the laws of physical action, but the influences of medicine on the
manifestations of mind, that our noble profession may not become
simply an art. [Amer. Jour, of Insanity,

Vesica- Vaginal Fistula,

We condense from the American Journal of the Medical Sciences
the following : In a case of this terrible accident, Dr, James H.
Sawyer thus describes the mode of procedure which he calls the
plan of Mr. Maurice Collis.

The patient was a young woman, 24 years of age, injured in;
her first labor. The labor was greatly protracted,, and the per-
forator was used in embryotomy. Incontinence of urine declared
itself on the fifth day after the operation ; but as th patient's
health was much impaired, she was advised ta seek vigor by
change of air in the country,, after her confi,nement. On her re-
admission, it was found that the narrowed condition of the vagina
made it necessary to dilate it with sponge tents.

" After trying different positions, I found the lithotomy posture
the most convenient, and accordingly, on the 25th, having previ-
ously cleared out the bowels, and secured the hands and feet, I

1857.] Vesico- Vaginal Fistula. 567

proceeded to the operation. It was intended to operate under
chloroform, but after a few inspirations, the sudden irregularity of
the hearths action compelled us to desist.

"Two dilators were passed, and pressed obliquely upwards and
outwards; then the third, pressing down on the recto- vaginal sep-
tum, enabled me to get a view of the fistula. A full-sized catheter
passed through the urethra, and pressed downwards and forwards,
kept firm the posterior margin, and prevented the bladder from
coming in contact with the knife. With Baker Brown's knife I
carefully split the vesico-vaginal septum at the posterior lip to the
extent of three lines, carrying the knife carefully around the com-
missure, and keeping close to the vesical surface. I then did the
same to the lower and anterior lip, but with greater dijB&culty, as
its aspect was turned from me. The constant welling of blood
and urine compelled me to work very slowly. I then syringed
with cold water, which in some degree repressed the bleeding;
and with the same needles used by Mr. Collis I introduced
four ligatures of ordinary housewife- thread at intervals of three
lines, carefully avoiding penetrating the vesical mucous surface.
I secured the ligatures over two bars of gutta percha, instead of
gum elastic, as used by Mr. C, as it is not corroded by the vagi-
nal secretion. I was most cautious not to draw^ the threads too
tight, and thus prevented strangulation of the lips embraced be-
tween the bars. The operation lasted about half an hour. She
was then placed in bed on her face, her body well supported by
pillows. A long gum-elastic catheter was passed and secured, and
one grain of opium was directed to be given every third hour.
On the fourth day I examined, and was gratified to find the mar-
gins of the wound in perfect apposition, and no suppuration. I
cut the ligatures, but did not remove them until the following day,
that is, the fifth from the operaiion. The union was complete,
but I did not venture to withdraw the catheter or act on the bow-
els until the eighth, when the following mixture was directed:
Olei ricini 3vj; tincture rhei 3iij; confect. amygd. 3iv; aquae
cinnamomi ad !vi. st. !i. 2dis horis. This acted gently. On
the eighteenth day she was walking about, able to retain the urine,
and her only annoyance was a tendency to pass water frequently.
This gradually subsided, and on the 14:th August she was dis-
charged in perfect health, and is at present in a good situation,
and, as she declares, as well as ever she was in all her life."

Dr. Sawyer claims for Mr. Collis's plan the following advan-
tages :

^' First Facility of execution. Secondly Probability of spee-
dy union by the first intention. Thirdly The prominence of the
I vesical flaps forming an admirable barrier to the urine insinuatino^
itself Fourthly Comparative freedom from hemorrhage. And
lastly If it does not succeed, there will be no increase of the fis-
tulous aperture, as after other plans." [Dublin Hospital Gaz.

568 Employment of the PyropJiosphate of Iron. [September,

In reading the above case, we are filled with surprise that the
propriety of Bozeman's Button Suture did not suggest itself to
any one of the gentlemen mentioned in the article from which we
extract it. We regard his operation as preferable to any other,
beyond all comparison, and Dr. Sawyer must either have been
ignorant of it or did not understand it, that he would use any
other. We see no force whatever in the advantages he claims for
what he calls " Collis's plan," over Bozeman's. The difficulty of
splitting the edges of the fistula must have been extreme, and in
most cases will be found impracticable, while the plan of denuding
the vaginal mucous surface, proposed by Drs. Sims and Bozeman,
is comparatively easy. In conclusion we will say, that we wish
to hear of no other plan than those of Bozeman and Sims they
have solved the difficulty, and, so far as we can see, their opera-
tions are the ne plus ultra in this department of Surgery.

Therapeutic Employment of the Pyrophosphate of Iron.

We condense from the American Journal of the Medical Sciences^
the following account of a new and valuable preparation of Iron :

M. E. Bobiquet read (Feb. 10th, 1857) an interesting memoir
on this subject before the Imperial Academy of Medicine of
France.

" Industry has already derived great advantage from the pro-
perty possessed by pyrophosphoric acid of combining with soda,
and with gold or silver. In medicine, the pyrophosphate of iron
has often been tried, and this might be expected, for oxide of iron
undoubtedly reacts on the functions of the blood, and the elements
of pyrophosphoric acid are found in the bones ; but it has soon
been given up on account of its liability to change, and of the
great quantity of pyrophosphate of soda necessary to retain it in
solution in water. It struck me that these inconveniences might
be easily avoided without depriving the ferruginous salt of any
of its essential properties.

"In medicine the essential characters of a good preparation of
iron are, that it shall readily dissolve in the fluids of the stomach
without impairing their digestive functions, that it shall be com-
pletely assimilated in the system, and that it shall not act as an
astringent. The pyrophosphate of iron possesses all these proper-
ties ; its resistance to solvents is the sole difficulty which remains
to be overcome to entitle it to the first rank among the prepara-
tions of iron.

" Tlie solution of pyrophosphate of iron in a citro-ammoniacal
liquor keeps for whole months without undergoing any change,

Ji

1857 .J Sulphate cf Alropia in Diseases of tJie Eye, 560

and yields to a syrup free from the iutolerable taste of ferruginous
compounds. Potash, ammonia, luid the alkahne carbonates, do
not give, with pyrophosphate of iron so dissolved, the reaction
peculiar to the saltcs of iron.

" The process of solution being once found, nothing is easier than
to transform the pyrophosphate of iron into comfits, syrup, or loz-
enges ; the latent state in which it exists in this new salt enables
us to mix it with wine of bark, and to obtain from it a powerful
tonic, witliout having to fear the blackish discoloration and inky
taste which are alwaj's produced when a salt of iron is brought into
contact with fluids more or less highly charged with tannin.

"In whatever mode the citro-ammoniacal pyrophosphate of iron
be administered, it has absolutely no taste, and patients not only
bear it readily, but feel the best effects from its use. I have seen
it particularly useful in well marked cases of anicmia, chlorosis,
and chronic urethritis.

'' To recapitulate, the pyrophosphate of iron, chemically consid-
ered, is polymorphous salt, in which the metallic atom is concealed
from reagents; it contains, by weight, 21.11 per cent, of iron. In
a therapeutic point of view, the facility with which it is assimila-
ted by the system, the absence of all styptic taste, its perfect solu-
bility in water, the influences, finally, which it exercises on the
composition of the bones and the functions of the blood, entitle it
to the first rank among ferruginous compounds.

" FoRMULiE. Syrup of Iron. Pyrophosphate of iron, two and
a half drachms ; simple syrup, twenty -n me ounces; syrup of orange
flowers, three ounces : make a syrnp by simple solution, and color
with a sufiicient quantity of tincture of cochineal or alkanet. Each
drachm of the syrup contains about six-tenths of a grain, and a
tablespoonful, about three grains, of the salt of iron.

u ferruginous Comfits. Pyrophosphate of iron, one ounce and
five drachms ; divide into 600 comfits, each of which shall contain
a grain and a half of the salt.

'''Ferruginous Wine of Barh. Pyrophosphate of iron, two and
a half drachms ; extract of pale bark, seventy -seven grains ; white
wine, thirty two ounces ; to be made secundum artem^ [Jour, des
Connaissances Med. et Pharm. *

On the Use of Sulphate of Atropia in Diseases of the Eye. By Dr.
Friedrich Mosler.

As the result of practical investigations upon the use of sulphate
of atropia in ophthalmic medicine, Dr. Mosler arrives at the fol-
lowing conclusions: 1. That the sulphate of atropia is preferable
to the pure alkaloid for therapeutic purposes. In a state of purity
the sulphate, employed with the necessary precautions, even in
large doses (such as five grammes to an ounce of distilled water),
produced no unfavorable effects upon the eye. In using it, care

570 Dental and Facial Neuralgia. [September,

must be taken of the absorption of the tears running from the eye
and mixing with the solution, and the absorption of the solution
itself is to be guarded against. 2. In ophthalmoscopic investiga-
tions, atropia has rendered especial services in many cases ; in or-
der to diminish as much as possible the inconvenience felt by the
patient in its use, attention must be paid to the investigations of
Donders, upon the more or less enduring operation of the different
strong solutions. The employment of atropia is not a priori to be
recommended in every ophthalmoscopic investigation. 3. In in^
flammatory states of the eye, especially those characterized by
violent pain, intolerance of light, and abundant lachrymation, as
particularly in injuries of the eye, with or without affection of the
iris, we have been acquainted with atropia as an essentially sooth-
ing agent, as by its operation on the sensitive nerves of the eye it
possesses the power of removing rapidly the state of excessive irri-
tation. As a decided remedial agent, it appears moreover to act
by its operation upon the motor nerves in the eye, inasmuch as,
according to the explanations of Dr. Yon Grrafe, it paralyzes the
muscles which are found in and about the eye, and which in such
cases exercise an excessive pressure upon the internal structures
of the eye, and in consequence of a return of the blood being im-
peded, give rise to accumulation of blood in those structures. It
^ thus explained why abscesses of the cornea under its use are less
perforating and more easily healed, and why hypopyon is more
rapidly absorbed. 4. Astringent eye-waters, especially the strong-
er cauterizing fluids, are better borne, and are attended with more
rapid success, when the excessively heightened sensibility of the
eye, which exists in the cases where this remedy is applicable, has
been previously deadened by atropia. 5. Cauterization of the eye,
emyloyed only once daily with all necessary precautions, is better
borne in many cases than the more frequent instillation of eye-
waters, which every time appear to induce a new and well-marked
irritation. \^Arc]uv des Vereinsfur Gemeinschaftliche Arheiten^ 1856,
iand British and Foreign Med. Cliir. Rev.

Method of Proraptly Relieving ^Dental and Facial Neuralgias. By
Michael Andre.

This method consists in turning into the meatus auditorius from
four to ten drops (according to the age and sensibility of the pa^
tient) of. the following fluid ; then to close the opening of the ear
by means of a little cotton, and to cause the patient to hold the
head inclined for some minutes to the side opposite to the seat of
the pain, so that the liquid may remain in the bottom of the ear.
This preparation is thus made : ^. Take of the extract of opium,
of belladonna, and of stramonium, esich one part ; of distilled cher-
ry laurel water, tivelve parts. Dissolve and filter.

Although this preparation may be only extemporaneous, it may

1857.] EdiUmal 571

nevertheless be preserved if care is taken to keep it cool, and to
pour on its surface from two to four drops of sweet almond oil.

It is very rare that with the use of this liquid relief is not ob-
tained in a few minutes; indeed, the patient is almost always
asleep in half an hour, whatever may have been the severity of the
pains, and that without having been in the least danger.

Absorption takes place almost as rapidly as from a denuded
surface, and it is therefore unnecessary to blister the patient when
we wish to use narcotics, since they act almost as rapidly by the
auditory passage.

If it should happen that, at the end of eight or ten minutes, the
pain does not yield to the remedy (which sometimes happens when
the quantity used has been too small, or when we have to treat a
neuralgia which has already required the use of narcotics in any
way), it is necessary then to use a second dose, at least equal to
the first, but in the opposite ear, in order to obtain promptly that
relief which is only too frequently momentary in facial neuralgias
of long standing.

The preference which I give to this aqueous solution over those
which contain alcohol, such as laudanum and other narcotic tinc-
tures, arises from having used both upon myself for several years
for a facial neuralgia, and observing that the latter produce a sen-
sation of quite acute pain at the moment of their use, and not
being always as successful as the former, which causes neither heat
nor smarting, and is more certain in its effects. [Revue de Tliera'
ipeutique^ and American Med, Monthly.

EDITORIAL AND MISCELLANEOUS.

Valerianate of Ammonia as a Remedy for Neuralgia. It will be
recollected that in the first number of our present volume we pubhshed an
article, from the Montreal Medical Chronicle, reporting- very remarkable
success, by Dr. Declat, in the treatment of Neuralgia with the above named
medicine. We have seen as yet no report of cases in our American ex-
changes but have received many private letters asking how the article
should be administered, and what is the dose ? Hanng had recently under
our treatment two obstinate cases of temporal and facial Neuralgia, and
having failed to aiford rehef by any of the ordinaiy means ; revulsives,
tonics, quinine, and even opium failing to abate the pain, we referred to the
report of Dr. Declat, with the view of resorting to this new remedy. It
was now that we were able to appreciate the embarrassment of our corres-
pondents about the dose. The cases in Dr. D.'s paper are carefully reported,
apparently, but the dose certainly very indefinitely stated.

" A teaspoonful taken in the evening modified the pain at night and
rendered it bearable. Two teaspoonfuls next day gave complete rehef."

572 Editorial [September,

Now this "teaspoonful" we supjmse was a solution, but of what strength?^-
Was the original preparation used by Dr. Declat in fluid form, or was it, a-
we now receive it from the chemists, in the form of a salt. No definil-
dose is given, and hence the embarrassment in its administration. Wish-
ing to try the efficacy of the article, we made a solution at first, of 10 grains
to the ounce of water. Of this, we directed our patient to take one tea-
spoonful three times a-day, till the two ounce solution was exhausted. At
the end of the second day, he increased the dose 1^ teaspoonful, and report-
ed a slight amelioration in his sufi"erings.

On preparing for this patient a second vial, we dissolved 32 grains of the
Salt of Valerianate of Ammonia in two ounces of water, (two grains to the
drachm,) directing the dose as before, viz. l-i- teasponful three times a-day.
When this was exhausted, we prepared a solution which contained 3 grains
to each drachm of water, still advisino- the above doses.

Case 2nd. This was a negro woman, who had sufi'ered from severe
neuralgic pains in the temporal and- occipital regions for six weeks. Quin-
ine and other remedies failing, we administered tlie valerianate of ammonia
in doses of 4 grains to the teaspoonful of water, three times a-day. On the
second day the pains were much abated, and under the continued admin-
istration of the remedy, in similar doses, the distressing symptom has dis-
appeared.

Valerianate of Ammonia, as we have seen it, presents the characters of a
dirty-looking deliquescent salt, emitting a strong odor of valerian, and we
may add, for the information of our readers, costing four dollars an ounce.

In relation to our success with this remedy in the above cases, we have
to report that it has been very satisfactory, but at the same time we must
say we would have been greatly disappointed did we not measure our
jcredulity in this remedy by the good, old, safe rule " of believing just about
one half of what we hear " in relation to the effect of remedies.

When we read Dr. Declat's article, the case of " Madame the Marchioness
of Fontanelle, who had been attacked six years ago with facial neuralgia of
the most severe description," and had passed through the hands of Legrand,
Jobert (de Lamballe), Sedillot and Velpeau, besides a residence at mineral
springs, and the best alterative and tonic treatment, unreHeved, and "when
the agony was unendurable and the patient in despair," relief came sud-
denly, from three teaspoonfuls of a new remedy, we must confess, that we
measured our belief rather, by what would satisfy us than by what we saw
written in the report. If the relief was half as prompt in all cases, even
with double the amount of medicine, we would be satisfied.

In making the above remarks, we would have it fully understood that we
do not wish to doubt, in the least, the correctness of the statement of the
reporter ; far from that we give full credence to the report, so far as re-
lates to the two cases mentioned there ; but two cases were too small a

1857.] Editorial 673

number to judge of the general efficacy of a specific remedy, the effect
might be attributable to accident or coincidence, ^ post hoc merely and not
. propter hoc ; so, in the end, we were not disappointed mucli, when our
patient was only parfiallj/ relieved after taking the remedy for about ten
daijs. Our conclusion in relation to the remedy, after this partial trial, is,
that it is a very useful article in the treatment of this form of neuralgia, so
far as can be determined by the observation of these two cases and the tes-
timony of the original favorable report of it : and we can further say, to
those who wish to administer it, that our own careful experimental adminis-
tration of it, gradually increasing the dose, proves that in doses oi four grains
of the salt to the teaspoonful of water, the remedy has no injurious effect
upon the system, but its effects have been highly satisfactory. Whether
or not we have yet reached the full dose used by Dr. Declat, we cannot
say ; that must be determined either by farther experiment or by a more
definite statement from that distinguished gentleman himself.

Fracture of the Clavicle. " I believe, that were surgeons to cease in-
venting apparatus for broken clavicles, and return to the simple method
recommended by Hippocrates, and adopted by both Celsus and Dupuytren,
viz., to lay the patient horizontally upon his back, they would save both
themselves and their patients much trouble, and obtain much more satis-
factory results. Such, at least, has been my own experience of late : and
I observe that it corresponds wdth the experience of Drs. Eastman, of
Broome Co., N. Y. ; Eve, of Nashville, Tenn. ; Buck and Post, of New
York.

''Buffalo, June 20th, 1857. Frank H. Hamilton."

" Break a Leg !" The mention of Professor Paul F. Eve's name in the
above connection, whose case was one of Fractured Clavicle, complicated
with an injury of the arm, and which recovered without treatment, further
than the quiet necessary to cure the arm, induces us to relate briefly a
case of our own, which occurred a few months ago.

E , a young man, aged about 25 years, received injuries which

caused a fracture of the clavicle, and a fracture of the leg, just above the
ankle. He also had a serious stab-wound in the face. These injuries re-
quired, of course, his strict confinement to bed for a considerable length of
time. We adjusted the fractured leg and dressed the wound in the face
but on examining the clavicle, found that it fell into p)osition and retained
its place, w^hile in the recumbent posture, better than we could accomplish
by any bandaging or dressing whatever. There w^as much tumefaction
from effusion of blood at the point of fracture. To this part, we kept ice-
water constantly applied on wetted pads. The case did remarkably well,
and the fractured clavicle healed before the fractured leg.

We are told by a lady, formerly a patient of Dr. L. A. Dugas, that when
a child, (it must be understood the lady is still goung,) she fractured her

574 Editorial. [September,

clavicle. Dr. D. set it, and it had nearly united, when, in childlike exuber-
ance of spirits, she imprudently fractured it again and it was again adjust-
ed. The Surgeon, however, took occasion to make the following suggestion :
" My Dear, the next time you are so unfortunate as to break your collar
bone, I would advise you to break your leg too, and then you will not have
to undergo the pain of having the collar bone re-set." This bit of advice,
so jocosely given by our kind-hearted colleague years ago to the child, it
seems, is now becoming the accepted doctrine of the Profession in the
treatment of fractured clavicle. Verily, there seems to be a truth in the
terse old proverb " Many a true word, spoken in jest."

Salt in Intermittent Fever. A reference to the pages of a back vol-
ume of the Southern Medical and Sur^iical Journal will show that, as early as
April, 1852, Dr. L. A. Dugas, Professor of Surgery in the Medical College of
Georgia, read a paper before the State Medical Society, in which he report-
ed the efficacy of Table Salt in the Treatment of Intermittent fever : hence
the suggestion of Dr. Moroschkin is not novel, and finds its original on our

"We learn from the Medical Times and Gazette of Dec, 1856," says the
Peninsular Journal of Medicine, " that a Dr. Moroschkin, practicing in one
of the provinces of the Black Sea, states that, during the prevalence of
scorbutus and ague in that region, Quinine sometimes entirely lost its pow-
er, and that, when no very prominent scorbutic affection was present, he
gave 1 oz. of common salt in water, in two doses daily. In patients in whom
the paroxysms were incomplete, very abundant sweating followed ; the skin
became natural, and other signs of amendment appeared ; and the dose
having been diminished, the cases came to a favorable termination in a few
days. If the improvement was but partial. Quinine then became more
efficacious. 70 out of 103 were completely cured, the others meliorated.
These results correspond with our own observations in other forms of irre-
gular and imperfect intermittents. Less Quinine will usually suffice com-
bined with salt, especially in chronic cases."

Eve's Surgical Cases. Messrs. J. B. Lippincott & Co., of Philadelphia,
have now in press and nearly completed, a work by our friend. Professor
Paul F. Eve, of the Medical Department of Nashville University. This
work will consist of a collection of rare cases in Surgery, selected chiefly
from American and foreign publications. We have not yet seen the con-
tents of the work, but judging from the extensive experience and thorough
acquaintance of its distinguished author in all matters relating to his branch,
we are walling to endorse it beforehand, as an interesting and valuable
book of reference. The work will be ready for distribution to its subscri-
bers next month. We withhold further remark until we can review the
work more at lengrh.

1857.] Mitonal 575

Foreign Honors coni^rrbd upon Dr. W. J. Holt, of Augusta.
Dr. Holt, while still in the Russian service in the Crimea, was appointed a
Member of the Order of St. Anne. He has just received, through the Rus-
sian minister in this country, the "Decoration" of Commander of the
Imperial Order of St. Stanislaus, in consideration of his services in the
Crimea. This last is a cross of massive gold, elaborately wrought, and is a
marked testimonial of the Czars appreciation of the ability with which the
surgeon's duties were discharged.

We are gxatified to call attention to our original department. Professor
Joseph A. Eve's article on Diseases of the Cervix Uteri, will be read with
much interest by our subscribers, on account of the great reliability of the
opinions and precepts of one so experienced, and withal, so recondite in his
important department. An earnest w^orker and teacher in Obstetrics for
nearly twenty years, as Dr. Eve has been, must have arrived at such truth
in the Art, as to render his words "apples of gold in pictures of silver," to
the young practitioner. His truly practical paper will be completed in
our next number. Several of ooir Faculty are engaged in preparing valua-
ble papers, all of which w^ill find issue in our pages.

Medical College of Georgia. This Institution will begin its 26th
annual session on the first Monday in November, with an Introductory
Lecture from Professor H. V. M. Miller. The prospects for an increased
class are most encouraging. Relying upon the experience of our Faculty,
the completeness of our arrangements and appliances for the teaching of
the true principles of Medicine, and above all, upon the faithful spirit which
moves ev^ery member of our corps to do well his part we proudly refer to
our influential alumni, now nearly one thousand in number, to vindicate
the claims of Augusta, as an efficient school of Southern Medicine. We call
the attention of our readers to the Circular published under cover of our
July number.

Memphis Medical Recorder. Editorial change. This excellent Jour-
nal comes to us in the present number under an entirely new and much
improved form. Its late editor. Prof. A. P. Merrill, has devoted five years
most laboriously and successfully to its interests, and now resigns the work
into the hands of Daniel F. Wright, M. D., Professor of Physiology and
Pathology in the Memphis Medical College. Professor Wright is by no
means, a stranger to the duties of the Editorial office, and still less is he a
stranger to the readers of that Journal or to the Profession. He has been
long known as one of its ablest contributors an^ most astute reviewers.
We welcome him most cordially into the fraternity, and we wish his read-
ers, as well as the editor, well, when yve desire for this Journal an extended

576 Editorial and Miscellaneous. [September,

circulation. The present number contains an elaborate and valuable arti-
cle, by the new editor, on the Pathology of Zymotic Fevers an Appendix
to the Report on the Nosology and Meteorology of Memphis, Tenn. These
views (ire stiiking, and we intend to present them shortly to our readers.

The typogi-aphical execution of this Journal is very creditable. It is
published every two months by the Memphis Bulletin Company.

The Medical Independent a new acquaintance. We have received
three numbers (June, July and August) of this new monthly Journal, and
are pleased to place it upon the list of our Exchanges. Each of the num-
bers we have seen contain much valuable original matter, and well selected
articles from domestic and foreign Journals. The Independent is edited by
Moses Gunn, A. M., M. D., Professor of Surgery in the University of Michi-
gan, and L. G. Robinson, M. D., and is published in Detroit, by H. Bums.
A personal acquaintance with its editors, formed during the last meeting
of the Association at ]S'ashville, renders it a welcome comer to our sanc-
tum. We wish them a wide circulation, and a long, happy and useful
career.

" Woe worth the chase, woe ^vortli the day
That cost thy Hfc my gallant Bay."

" We notice in one of onr exchanges," says the Western Lancet, the

recent death of a horse owned by Dr. Edward Dorsey, of Hagerstown, Md.,

in the 45th year of his age. The Doctor had used him in his practice for

thirty-seven years. He well deserves an obituary.

On the Cutaneous Degeneration of Wartij Excrescences. By Mr. Butcher,
Surgeon to Mercer's Hospital. In this paper, Mr. Butcher relates seven
cases which illustrate that association between warty excrescences and
cancerous degeneration, which has not met with all the careful attention
from writers to which it is entitled. These cases show very clearly that,
when once the ulcerative process is set up, there is never any amelioration,
ever so temporary, no attempt at cicatrization ; and that there is in addi-
tion a great liability to the appearance of encephaloid disease, either on
the site of the original tumor or in the line of absorbents connected there-
with.

In the same paper, moreover, Mr. Butcher relates four cases of encepha-
loid cancer occurring as an isolated manifestation of malignant disease.

[^Dublin Quarterly Journal of Med. Science.

Ergotine in Epidemic Diarrhoea. By M. Massola. In a communica- ^r
lion to the Academy of Medicine in Paris, M. Massola states that he found l
great benefit from tlie use of ergotine in the fatal epidemic diarrhoea, which fcr^
prevailed so extensively among the Sardinian troops in the recent cam-
paign in the Crimea. From fifteen to twenty grains were added to |viii of
water, and a tablespoonful of this mixture was given eveiy half hour. M.

, J

1857.] Miscellaneous. 677

Massola states that astringentvS, tonics, opiates or stimuli, were of little avail
as compared with the ergotine. \^Gaz. Hvhdom. de Med. et Chirurg.^ and
Rankinifs Abstract.

On the Removal of Tumors. By Dr. Simpson, of Eciinburgh. Dr. Simp-
son's plan is to introduce a hollow acujnuicture needle or very small trocar
into the tissue of the tunior, and inject a small quantity of chloride of zinc,
perchloride of iron, creasote, or some other irritating sohition. The effect
of this operation is to destroy the vitality of the tumor, and to allow it to
be separated by a process of enucleation, \^Med. Times and Gaz.

Costly Medlcene. A London (Eng.) paper says ', " The consumption of
wines in our public hospitals constitutes one of the heaviest items of their
expenditure. The wine account a Guy's Hospital last year was 1083 ;
;the spirit account, 376 total, 1459. At St. Thomas's the Avine account
was 629; spirit account, 521 total, 1150; or 2609 in one year in
the borough hospitals alone. [^Boston Med. and Surg. Journal.

Medical Eihics. A letter of advice equivalent to a consultation^ and
should be in like manner remunerated.

Messrs. Editors, Suppose you were to receive a letter, filling full three
pages of fair foolscap, and reciting all the facts (to the writer) of a case, re-
porting the treatment, and finally asking an opinion and an advice but
containing neither fee nor postage stamp. What would you do ? Would
you read it? Suppose you do read it, but can really mate no opinion,
either of diagnosis, prognosis or treatment. Would you answer it?

Again : Suppose you receive another letter from another source, without
any enclosure. Suppose you can form an opinion about the disease, and
might recommend a treatmeat. Do you feel bound to answer it ?

One largely afflicted brother in this way, impatiently waits an answer.

Xenophon.

With regard to Xenophon's first question, we think the practitioner is
not bound to take notice of a letter ccmtaining neither fee, postage stamp,
nor an intelligible account of the case. He may, if he pleases, put the let-
ter in the fire. We should read it, but should not, under ordinary circum-
stances, answer it.

As to the second queiy, we should withhold an opinion until the fee were
paid, if the request came from an unknown party. We should not feel
Dound to answer it.

A person writing a description of a case, and requesting in answer an
[>pinion or advice, is bound to enclose in his letter the usual fee, or to ask
he amount owing, and to transmit it by return mail. (The fee for a letter
rf advice, established by the Boston Medical Association, is h'oin five io ten
iollars.) It is always understood that a business letter requiiing an an-
5wer (except between regular correspondents), should contain a postage
itamp.

We state our opinion in general ; of course there are exceptions. A
brmer pupil or a personal friend has a right to ask an opinion without be-
ng expected to pay for it ; but this pri\nlege is not to be abused, especially

a case really requiring a consultation, the patient being able to pay.
^hen the patient is too poor to pay the fee, if this is distinctly stated, the

578 Miscellaneous,

party giving the opinion will ask no compensation. In short, a letter oi
advice is the same thing as a consultation, and the writer is not only enti-
tled to his fee, but ought to insist on receiving it, where the adnce is regu-
larly sought, and the patient able to pay. [^Bostam Med. and Surg. Jour.

Frizes far the Massachusetts Medical Society. The Massachusetts Medi-
cal Society is authorized, by a donation from one its members, to offer the
sum oi one hundred dollars for the best dissertation adjudged worthy of a
prize on the following theme, viz : " To what affection of the lungs does
bronchitis give origin ?" The above is open to physicians of every country.
The latest article on the relations of bronchitis to other diseases of the
lungs was written by Dr. W. F. Gairdner, of Edinburgh, in 1850. A re-
view of the paper can be found in the British and Foreign Medico- Chirur-
gical Review ioY April, 1852. Each dissertation should be designated by a
motto, and accompanied by an envelope, superscribed with the motto, and
containing the writers name and address. The sealed packet, accompany-
ing the successful dissertation, will be broken and the author's name an-
nounced at the annual meeting of the Society in May, 1858.

Dissertations for the above prize must be sent (post paid) to the Corres-
ponding Secretary, Di-. Benj. E. Cotting, Koxbury, Mass., on or before
April 15th, 1858.

YoTirs truly, J. B. Alley, M. D.

Fee. Secretary.

HoMCEOPATHr. T\nien all the world elsewhere seem to have abandoned
this apostacism, what a pity that in certain parts of our country it should
still exist !.

Death of Homoeopathy. I have another death to record, but with feel-
ings very different from those which prompted me to do so in Scoresby's
case. It is the death, not of an individual, but of one of the instruments
of a system which is fast on the wane, and will shortly be reckotied as one
of the " strange things that were." The London Homoeopathic Hospital^
devoted to this delusion in London^ has closed its doors/ The Lancet says,
while recording the melancholy event, that, '' like all quackeries, it had its
day; like all quackeries, it has been supported by the shallow, weak and
credulous, on the one side, and the charlatan and the rogue on the other.
Such alliances are invariably broken when either the eyes of the one are
opened, or the rapacity of the other is not gratified." Poor Lord Robert
Grosvenor, the champion of Homoeopathy, has confessed himself diddled,
and declares he has been humbugged from first to last. He now employs
a regular practitioner. \_London Cor. of the Montreal Med. CJironicle,

Lcmdon Homoeopathic Hospital. The last hospital devoted to this delu-
sion in London has closed its doors. It has dwindled down into a " tempo-
rary office " and a '' dispensary for out-patients. We hear much of the
success of Homoeopathy, and yet the friends of the humbug cannot subscribe
sufficient funds to support a ''hospital" even at a private house. Like all
quackeries, it has been supported by the shallow, weak and credulous on
one side, and the charlatan and the rogue on the other. Such alliances
are invariably broken when either the eyes of the one are opened, or the
rapacity of the other is not gratified. [Lancet, April 4, 1857. Med. News
and Library.

SOUTHERN

MEDICAL AID SUEGICAL JOUllIAL.

(NEW SERIES.)

Vol. XIII.] AUGDSTA, GEORGIA, OCTOBER, 18^7. [No. 10.

ORIGIML AND ECLECTIC.

ARTICLE XXVIII.

Creosote in Dysentery^ with Cases. By WiLLIAM H. McMatH,
M.D., of Lewisville, Lafayette County, Arkansas.

Having for the last two years been witnessing the effects of
Creosote in Dysentery, I feel that I should be recreant to my re-
sponsible trust as a physician, did I not make the same public
through the pages of some medical journal, to the profession gen-
erally. Hence, I send this article to the Southern Medical and Sur*
gical Journal. Whether this remedy will prove to be as valuable
as my experience seems to indicate, remains yet to be proved ; and
it is with the view to elicit such evidence, that I make this publi-
cation. This is the formula that I am in the habit of using :
^. Creosote, - - - - gttse. x.
Acetic acid, - - - " xx.
Morphia sulph., - - grs. ii.
Water, pure or distilled, I i.
Of the above mixture, I am in the habit of giving to an adult,
a teaspoonfal every two or three hours, until it checks the blood
and mucus in the evacuations from the bowels. It is sometimes
the case, in a very irritable state of the bowels, that yellow, green
or dark serous evacuations will continue after the blood and mucus
have been checked, which the creosote appears not to be so effectu-

N.S. VOL. XIII. NO. X. 37

580 McMath, on Creosote in Dysentery. [October.

al in checking, as anodynes and astringents; though, in nine outol
ten cases, it will check and completely hold at bay, the discharges
of every character from the bowels in this disease.

Furthermore,, I will state, that in my hands, I find it to be per-
fectly^ admissible in every case. It matters not to what extent the
febrile excitement may be raging, or how ]ow the nervous system
may be depressed, it is the same in its mission, perfectly safe and
admissible at any and every stage of the disease, and has, in my
hands, as certainly cured d3'sentery, when properly combined with
other agents as quinine has cured periodic diseases. I admit
that there are collateral agents necessary, in some protracted cases,
to effect a radical cure. I can at least claim for this agent, that it
will hold the drain in complete abeyance until the necessarj^ aux-
iliaries can be brought into action, and completely eradicate qyqvj
trace of the disease from the system : this it will certainly do. In
mild cases, I have found it neceessary, only to give a few doses of
the above prescription to produce a cure.

That I may be better understood, I will record a fev;" cases
whilst under treatment.

June 11th. Called to see Mr. F., aged 20 years, of plethoric
habit. He informed me that he was attacked during the night
with flux. For the last eight hours, he has had ten or fifteen
evacuations from the bowels of clear blood, with a little mucus
floating therein. Skin hot and dry ; tongue dry, with a brown
eoating, red around the tip and edges ; pulse 120 ; very tender on
pressure over the bowels.

Treatment Calomel and Dover^s powder, broken doses, alter-
nated with creosote mixture, every two or three hours ; warm
poultices to the bowels.

June 12th. Sent for in haste ; found patient with extremities
co-Id ;. pulse scarcely perceptible at the wrist ; had frequent bloody
actions during tke night, and much nausea ; tormina excruciating,
tenesmus constant and harrassing.

Treatment. Sinapisms to the extremities and stomach, and wine
whey. Prescribed one teaspoonful of creosote mixture evsry
three hours.

13th. Tongue still furred and dry, red around the edges and
tip; great thirst ;: pulse 110 skin hot and dry. Had from the
bowels three actions only. Directed the creosote to be continued^
and blae pill at 8 o'clock at night.

1857.] McMath, on Creosote in Dysentery, 581

14th. Patient rested well last night ; has had two or three bil-
ious evacuations during the night. All symptoms much improv-
ed. Directed the creosote to be continued. From this time on,
the patient continued steadily to improve, and recovered with no
other medicine, save creosote and tonics. I would here state that
the above patient had been for two weeks frequently annoyed
with diarrhoea, irregular fevers, etc.

Case II. June 12th. Called to see Miss R., attacked on the
11th, with dysentery; frequent small bloody and mucous evacua-
tions, with a great deal of tormina and tenesmus; tongue coated,
red around the edges and tip ; pulse 110 in a minute ; pain in the
head had taken castor oil.

Treatment. Calomel and Dover's powder, in broken doses;
warm poultices to the bowels; injection, starch and laudanum.

13th. Symptoms the same ; skin hot and dry. Mercury con-
tinued ; injections of nitrate of silver in solution.

14th, 7 o'clock, A.M. Pulse 120 ; great thirst ; skin hot and
dry ; great deal of tenderness over the bowqjs ; frequent bloody
and mucous evacuations; tongue red around the tip and edges;
fur adherent; some nausea and occasional vomiting.

Treatment. Hydrarg. cum creta and opium ; blister to the bow-
els, sinapism to the stomach, and starch water injections.

5 o'clock, P.M. Found patient almost with continued vomit-
ing ; evacuations, pure blood. 100 drops of laudanum in starch
water ; commencing half an hour afterward giving a teaspoonful
of the creosote mixture every two or three hours, until the bloody
eVacuations ceased.

15th, 7 o'clock, A.M. Patient appears more cheerful ; rested
well duriug the latter part of the night; only five evacuations
from the bowels since last visit ; complains this morning of pain
in the right shoulder ; eyes yellow, tongue dry, pulse 115.

Treatment. 'Kqiquyj in alterative doses, alternated with the
3reosote mixture every three hours, with a large blister over the
hepatic region.

16th. Skin still hot and dry ; has had during the night only
:hree evacuations from the bowels, of blood and mucus; very
iiirsty, bowels tender, pulse weak, 120, and pain in the head and
jhoulders. Blister drew well ; dressed blister with mercurial oint-
nent. Gave calomel and creosote mixture.

17th. Patient rested well during the night ; has had no evacu-

582 McMath, on Creosote in Dysentery. [October,

ation from the bowels in six hours ; a good deal of tormina and
sickness of the stomach. Prescribed effervescing draught.

8 o'clock, P.M. Has bad but one small action of blood and
mucus ; a good deal of tenesmus ; patient very restless. Prescrib-
ed oil, laudanum^ and spirits turpentine.

18th, 7 o'clock^ A.M. Tongue more moist, pulse 110; has hao
four fcecal actions, with some bile ; rested well during the night:
bowels still tender on pressure.

Treatment. Calomel, opium and ipecac in alterative doses.

19th, 7 o^clock, A.M. Pulse 95; has had no action from the
bowels during night. Treatment continued.

5 o'clock, P.M. Has had no action still. Prescribed castor oil,
spirits turpentine and laudanum.

20th. Patient this morning appears much improved, has had
during the night some three or four dark bilious evacuations.

21st, 8 o'clock, A.M. Patient since last visit has bad one ac
tion from the bowels only, and that of a dark bilious character.
Other symptoms all much improved ; patient quite emaciated anc
very feeble ; tongue moist and cleaning ; appetite returning rapid
ly. Prescribed elixir vitriol 15 drops^ three times a day.

24th, 6 o'clock, P.M. Having been absent since the above date,
on my return I was called in great haste to my patient. Found
her with extremities cold, no perceptible pulse at the wrist ; face
blanched. Patient very restless ; profuse cold, clammy sweat. Pa-
tient complains of blindness. On inquiry, on the first day aftei
my absence, I learned that the dysenteric actions had returned,
after having been checked with the creosote mixture. Immediately
from that time to the present date, the discharges had been of a
healthy character and not too frequent. Furthermore, I ascer-
tained that my patient had been afiSicted with menorrhagia foi
several months prior to her sickness. During the last thirty-six
tours she had been suffering, to a frightful extent, with uterine
hemorrhage^ and for twelve hours prior to my visit, cold applica-
tions to the bowels had been used, without benefit. Sinapisms to
the extremities^ acetate of lead and opium had been given interal-
ly, without benefit. Ergot was given also without any good result.

12 o'clock, P.M. Patient no better. Consultation requested.
Dr. J. R. Wilder was called in, who directed the use of sulphate
bebeerine in five grain doses, every two hours^ with stimulants^-
which checked the hemorrhage in a short time.

1857.] McMath, on Creosote in Dysentery, 583

25th, 10 o'clock, A.M. Found patient very much improved,
reaction fully established, and hemorrhage entirely ceased.

Nothing further worthy of note occurred in this case. This
patient, after a very protracted convalescence, recovered entirely.

During the last three years, dysentery or flux has prevailed oa
Red River to an alarming extent As regards the treatment, there
is less unanimity of sentiment than in any other disease we have
to contend with. Standing foremost among the remedies general-
ly used, may be ranked mercury. Used too as this article has
been, by every member of the profession, from the merest quack
to the most exalted genius, there is, nevertheless, a humiliating
deficiency in our knowledge of its utility in diseases generally,
and this disease in particular, that seems almost unpardonable.
While some practitioners inculcate the propriety of giving and
xelying upon it, with a degree of enthusiasm bordering almost
upon the belief that it is a specific, others, there are, who withhold
it entirely, and look upon its use in any stage of the disease as
very injurious. Now, that this should be the case, after so much
research into the nature of this disease, and so much experience
as regards the most successful plan of treatment, is certainly very
strange. In most other disorders the profession, by general con-
sent, have agreed either upon the indications this agent is calcu-
ated to fulfil, or upon the particular circumstances regulating its
employment, but in flux or dysentery we have opinions, recorded
and unrecorded, both for and against it. But this is not all : these
practitioners, alike, when called upon to sustain their positions,
forestal all opposition to their views, by appealing for evidence to
the success of their modes of treatment. In all of this there is
something wrong, and the truth to some extent lies between the
extremes. Among the majority of practitioners in dysentery
there is a concurrence of opinion, especially on Red River, that
the liver, in a large number of cases, is involved; this being the
ase, mercury, in many cases, is indispensably necessary. This
remedy, if we have any clear conception of its effects, cannot act
otherwise than beneficially, applied as these remarks are intended
X) be, to cases, where there is evidently considerable derangement
Df the liver.

As the disease frequently commences with discharges of pure
olood, many physicians extol the use of the lancet; those who
lave adopted this practice have been very unsuccessful. This,

I

584 McMath, on Creosote in Dysentery. [October,

with the saline practice, has been extensively used in this section
of country. We will not say that patients being treated in this
manner, in some cases, do not often recover with apparent facility.
We know that in some cases there is a great tolerance of the loss
of blood ; but the use of the lancet in nine cases out of twelve,
to make an antiphlogistic impression on the system, or to attempt
to prevent or subdue an inflammation of the bowels, by the use
of salines, we think to be of very doubtful propriety, and we are
fally satisfied from observation, a very unsuccessful practice. I
am fully of the opinion they would do better without any medi-
cation whatever. We can see no more propriety in the hemor-
rhage from the orifice of a lancet, than from the mucus membrane
of the bowels. If one is prejudicial, so must be the other, and I
do not believe that the position is at all strengthened by appeal-
ing to the fact, that in the one case the blood is abstracted in the
commencement, in the other, after the disease is fully established ;
for, if the presence of blood is necessary to keep up and maintain '
the vital resistance against the encroachments of the malady, it '
must, therefore, be kept in view as the ultimate and most powerful
cause of vital resistance^ which if ever of any importance^ is certainly
so in this disease^ in which, throughout its whole course, the vital .
resistance of the system is primarily impaired. \

Concerning the availability of stimulants in this disease, there
is a great difference of opinion. We have steamers in an abund- j
ance who use pepper, number six, brandy, red oak bark, &c.l
Some of our most intelligent practitioners use brandy, opium and!
camphor throughout the whole disease. Our own views, together
with what we have gathered from experience, induce us to favor
the stimulant more, at any rate, than the contra- stimulant plans
of treatment ; they are generally, to say the least of them, produc-1
tive of little good ; we are compelled sometimes to hold up the
system of a debilitated patient with stimulants, while we unloose)
the fangs of an inflammation in some vital organ ; but it is very
probable that the good and bad effects of such a plan are pretty
equally balanced.

Of the value of blisters we are, from extensive use, well con
vinced.

There is still another course of treatment that has many advo*
cates, which consists in the use of Ipecac throughout the disease,;
In the commencement of the attack the period of incubation--*:;

1857.] Brandon, on an A^iomalous Nervous Disease. 585

this medicine given in doses sufficiently large to produce eraesis,
will in some cases break up the train of morbid symptoms, and
make such an impression on the system as will entirely subvert
all diseased action ; to this stage of the disease the usefulness of
this agent is mostly confined. I do not think it will do to rely
on, as I have frequently seen great injury result from its indis-
-criminate use.

To explain the modus operandi of creosote in dysentery, I shall
not attempt. Suffice it to say, that during the present year, I
have used it in over a hundred cases; out of that number, a good
many cases were treated in the outset after the usual course laid
down by our standard works. In eight out of twelve cases I
was compelled to resort to the .creosote or lose my patients. I am
thoroughly convinced from experience, that if not a specific in this
disease, it will, beyond the shadow of a doubt, do more in effi^cting
a cure, than any other agent, or combination of agents I have
ever tried, or have known to be tried. I am sure that it only re-
quires a trial to convince all who may use it, that I do not claim
as much for it, as it is justly entitled to at the hands of the pro-
fession.

ARTICLE XXIX,

An Anomalous Nervous Disease. By TV. C. Brandon, M. D., of
Floyd county, Gra.

The novelty of the case which I am about to lay before the
reader, will be apology sufficient for its publication.

On the 4th of April last, I saw Mrs. E , aetat 74: of sanguine

nervous temperament ; of active habits, for a woman of her age.
Found her in the following condition ;

The muscles of the left extremities were in a constant, rapid and
powerful convulsion ; the limbs were thrown into all possible po-
sitions flexion, extension, rotation, abduction, adduction, prona-
tion, supination; not a muscle in either arm or leg, but what
seemed to be in action almost every moment. Except during
sleep, these convulsive movements were incessant, and so power-
ful that they could not be restrained by the aid of the attendants,
without resorting to force incompatible with the comfort and safe-
ty of the patient.

The muscles of the trunk, neck and face of this side (the left)

586 Brandon, on an Anomalous Nervous Disease. [October,

were, to an extent, similarly affected ; but as the muscles of these
regions are more limited in their movements, of course the symp-
toms were less prominent than in the extremities. All volition
over the muscle of that side was paralyzed. The patient seemed
frequently to make great effort to bring the will to bear upon the
muscles, but without effect. Upon the right side there appeared
nothing abnormal ; but the limbs were fully under the control of
the patient, and she would frequently seize the left with the right
hand, and endeavor to restrain its spasmodic movements, or pro-
tect it from abrasion, &c. She suffers no pain, sensation perfect,
intellectual faculties unimpaired ; pulse 85 to 90 ; tongue slightly
furred ; appetite good ; thirst rather inordinate* not intense ; face
somewhat flushed ; skin natural ; bowels regular. Upon enquiry,
the patient gave me the following, which seemed to be a very
intelligible account of her attack :

For two or three daj^s before the convulsions came on, she had
had vertigo, with some slight headache. Her appetite had been
craving had indulged freely. On the day preceding the attack,
at night, she had ridden on horseback two or three miles. That
afternoon could hardly sit up, owing to the vertigo; but ate
freely of meats, &c., at night. Soon after lying down she felt a
lancinating pain in the region of the cerebellum or medulla oblon-
gata, which continued, at intervals, for several hours, and then
ceased. About tbe time she experienced the pain, she became
very restless, a general malaise pervading the system, and in a
short time the convulsions set in. For some years she had had
very frequent attacks of diarrhoea ; but for the last six or eight
months, her bowels had been in a better ^tate ; rather disposed to
constipation.

Her father and a sister had died of paralysis, of short duration,
(perhaps appoplexy?)

I first saw her thirty- six hours after the attack, and found her
as above described. After observing her condition for a time, I
find that she sleeps occasionally, from five minutes to three hours.
During sleep, qyqtj convulsive movement ceases ; not the twitch-
ing of a muscle visible ; and she, to all appearances, rests as com-
fortably and sleeps as quietly as in health. But upon the very in-
stant of waking, the terrible agitation of the muscles begins anew,
which continues until sleep again interposes for its temporary
cessation. The intervals between sleep are from one to six hours.

1857.] Brandon, on an Anomalous Nervous Disease. 587

After the case had progressed several days, she suffered from
what she termed, cramp in the side : caused, I presume, from the
spasms of the muscles in this region. I should have stated, that
there were none of the ordinary evidences of Epiual irritation
that is, no tenderness from pressure. While I frankly confess the
difficulty of arriving at a perfectly satisfactory diagnosis, I venture
to give the reader my conclusions in the case viz., that it was an
irregular form of apoplexy.

I will not claim the patience of the reader, and the space here,
for the useless detail of the condition of my patient, and the pre-
scriptions made, day after da}-, during the Avhole progress of the
case; but v/ill give, briefly, the plan pursued.

In the first place, cups and blistering to the nucha, sinapisms to
the spine, hot mustard foot-bath, cold to the head, and active ca-
tharsis with aloes, rhubarb and calomel were employed. This
treatment proving of no utility, opiates and antispasmodics, cam-
phor, chloroform, internally, &c., were then resorted to ; counter-
irritation continued. These remedies, with cathartics, when re-
quired, were kept up for several days. But the means employed
produced no modification of the symptoms whatever, only so far
as the opiates induced sleep, and gave the patient longer periods
of rest than she otherwise would have obtained ; this being the
only means that rendered her case tolerable.

At my second visit. Dr. M. E. Ballenger saw the case ; whose
opinion was consulted, and acquiescence obtained in the treat-
ment.

On the eleventh day of the attack Dr. H. Y. M. Miller saw the
case with me.

Other remedies having failed, we determined to try the effects
of blood-letting, and nausea, by tart, emetic. Whatever benefit
these means might have produced at an earlier period, in the case,
"we cannot say : at this time, they were as nugatory as those that
had preceded them.

The symptoms continued the same, except that the convulsions
were less vigorous, as the general muscular strength gave way
which it did by slow degrees, almost from the inception of the
disease. There was considerable abrasion of the more exposed
portions of the affected limbs, for which ordinary remedies were
used. For three or four days preceding death there was some
delirium, but for the greater portion of the time there was no

588 Brandon, on an Anomalous Nervous Disease. [October,

mental aberration apparent. Death occurred on the fifteenth day
from the attack.

Death seemed to be the result of sheer exhaustion, from the
long-continued and powerful muscular action. As the general
strength yielded, the convulsions became less and less violent,
until the last hours of life the movements amounted to little more
than a slight twitching of the muscles.

Here we have a disease preceded or ushered in by vertigo ;
severe, but temporary, pains in the region of the cerebellum ; ra-
pid, involuntary movement of the muscles of one half the body,
with paralysis of volition on that side ; sensation perfect. The
other side unaffected. No morbid mental manifestations. What
is it? Was my diagnosis correct? I am free to acknowledge that
there were no truly pathognomonic symptoms of apoplexy ; but
the same difficulty obtains in the probability of it being any other
disease.

While the reader may not agree with me in diagnosis, he will
readily consent to the singularity of the case, and that it bears but
little analogy to any disease, as described in the books, at least in
such as I have access to. As stated in the outset, the singularity
of the case has induced me to give this brief and imperfect account
to the profession, and not from any practical benefit that might
result from its publication.

[A private letter from the reporter of the above interesting case,
has induced us to attempt some investigation for its explanation.
Were it not for the advanced age of the patient, we might, at first
glance, suspect that here, we had a case of chorea; it presents, in
a marked manner, some of the characteristics of that fearful dis-
ease ; but we think that it more nearly simulates what Dr. Todd,
in his Clinical Lectures, terms " choreic hemiplegia." K such is its
nature, it is an extremely rare case of a rare disease ; for every
one of the few cases reported by him have occurred in children or
persons in early life. There can be little doubt, that there are
states of the nervous centres approaching the apoplectic, in which,
while the control of volition is null, yet the polarity of the motor
centre is exalted. This is doubtless the ordinary pathological con-
dition in true chorea, and we have but little doubt, that it is such
in what Dr. Todd terms choreic hemiplegia, of which we feel con-
strained to recognize a case in the one above reported.]

1857.] Walker, in Defence of Veratrum Viride. 58 -i

ARTICLE XXX.

A few ivords in Defence of Veratrum Viride. By U. G. MITCHELL
Walker, M.D., of Cahawba, Alabama.

In this short communication, I propose to make a few remarks
upon the virtues of Veratrum Viride, in the treatment of inflam-
matory aflections, particularly those involving the lungs and
pleurae : not that I beheve, I can add anything new, to what is
already known upon the subject, but only hope that these remarks
may induce some one who is disposed to be skeptical and unwill-
ing to use a new remedy^ to make a fair and impartial trial of it.
I have very little doubt that if such a one will judiciously use it,
under favorable circumstances, that he will be convinced of its
usefulness and well deserved merit.

Now, w^hen inflammatory action is going on in the ''capillary
structure" of the lung, and high inflatnmatory fever prevails, with
the symptoms consequent upon the inflammation, to relieve this
excitement and bring about resolution, to restore a perfect physio-
logical action without exhausting or carrying the patient through
a severe depletory course, from which he takes weeks, and in
some instances months, to recover, surely the physician achieves
a great end when he can do it by milder means, and with greater
safety to his patients. In veratrum viride, I believe, to a great
extent, we have a remedy capable of accomplishing such an end.
Though not ignoring the lancet, when properly used, or believing
that veratrum viride has rendered it entirely useless, I believe ve-
ratrum to be a great adjuvant when we wish to keep up the sed-
ative influence produced by the lancet.

Veratrum viride has probably done as much good in the treat-
ment of pneumonia, and exerts as much control over this disease,
under certain circumstances, as any drug in the Materia Medica;
and without wishing in this article to speak of its general appli-
cation, I shall confine my remarks to its use in the relief and cure
of pneumonia.

Of late years, this disease seems to have undergone a modifica-
tion, and does not demand the use of those active depleting evac-
uants once so much in vogue for its relief, and without which no
judicious practitioner would consider his patient safe. But at the
same time that it has lost, as it seems, the former severe inflam-

590 Walker, in Defence of Veratrum Yiride. [October,

matorj action, still vascular excitement is sufficiently high to call
for a medication, of a depletive, or more strictly speaking, a seda-
tive character. Inasmuch as the pneumonia seems to assume
a type intermediate between a sthenic and an asthenic character,
it does not demand the active depletion which true sthenic pneu-
monia calls for, and, on the other hand, it is not sufficiently asthe-
nic to require a stimulant or active stimulating treatment, at least
in its first stage. Now, for the management of this form of the
disease, veratrum viride seems especially adapted. Whatever
may be its precise modus operandi, and whether it exerts a change
over the constitution of the blood, which favors a convalescence,
yet remains to be proved. But it is evident that patients recover
very rapidly, and without any of the unpleasant symptoms often
noticed after active cathartics and bloodletting have been employ-
ed. At the same time that it exerts so powerful a controling in-
fluence over the excited action of the heart and vessels, and con-
trols the excessive supply of 'blood sent to the inflamed part, by
the sedative action of the remedy, we allay too, to a great degree,
the exalted nervous action frequently noticed in many cases, with-
out the use of opiates, which, under some circumstances, may be
injurious. Again, at the same time too, that we see it exerts this
happy tranquilizing and sedative effect upon the nervous and cir-
culatory systems, it excites the secretions and favors the rapid
convalescence by thus aiding expectoration and diaphoresis. And
this happy effect upon the system can be attained without pro-
ducing the least unpleasant symptom. Many, I believe, abstain
from making use of the remedy, when their better judgment would
dictate its use, from fear of the unpleasant effects its opponents
urge against its use. To such, I think they need have not the
slightest ground of fenT, if it is properly and judiciously adminis-
tered. A remedy possessing such decided power, common judg-
ment at once says " use it cautiously," and when thus used, I re-
peat, no one need entertain fear of evil consequences from its
administration. When through the urgency of the case, we are
obliged to make a free use of the medicine, and nausea and slight
prostration supervene upon its application, it is immediately over-
come by the administration of a few drops of laudanum, or essence
of ginger, or brandy and water.

Some oppose its use by saying owing to certain ''abortivant
effects" it possesses, it cannot be given when pregnancy compli-

1857.] Walker, in Defence of Veratrum Viride. 591

cates the pneumonia, but these objections, so far as I have been
able to ascertain, are entirely groundless. When excessive nau-
sea and powerful emesis occur from a heroic administration of it,
I dare say, owing to the great disturbance of the whole economy,
miscarriage in some instances may have occurred ; but would not
the same result have followed an over-dose of tartar emetic, or
any powerful emetic and depressor? Again: and coming from
such high sources too, which makes me tremble, almost, to assail
in the most delicate manner, lest I should be severely handled by
them who have grown grey in the profession some say, "yes,
we admit you can control and bring down your rapid and bound-
ing pulse from 130 or 140 beats per minute, to 75 or 80, or even
as low as -45 or 50 ; but at the same time you control your pulse,
you do not control your disease, and thus, by taking away the
index you cannot tell what the true condition of the circulation
is, and leave you in doubt relating to the true condition of the
patient." IS'ow, at first, this seems to partake of philosophy, but
let us examine and see if theory, or what is better than all specu-
lation, if actual experience will sustain it. Kow, when we have
this excessive action in the circulation going on, with this high
bounding pulse, owing to the powerful action of the heart, we
have an inflamed surface where this constant rush of blood is
continually going on, keeping up the congestive and inflammato-
ry state in the capillaries, and producing stasis when it is sufficient-
ly long kept up, which results in destruction of the parts; now,
when we bring to bear a force which exerts a sedative influence
over the organ which acts as propeller, does it not seem rational
to suppose that when we bring about this sedation, that a resolu-
tion of the inflammation is at all events likely to ensue when we
withdraw the excessive action ? analogical reasoning would seem
to draw such a deduction. But in addition to this, we have the
testimony of experienced physicians, and those men too, practical
in the extreme, who, with sound judgment, never allow beautiful
theory, or anything partaking of the flight of fancy, to allure them
away. Those who are practical in an eminent degree, give us
their testimony to the effect, that when such a state of things exist,
they have seen veratrum viride work wonders.

But lest I seem to laud too much the virtues of a valuable rem-
edy and weary my readers, I will desist, and close this article by
recommending the mode and dose, from which the happiest effects

592 Use of Water in the Treatment of Fever. [October,

result, unaccompanied with any unpleasant symptoms : Commence
with 4 or 5 drops, or when you have reason to believe your pa-
tient easily affected, as low as 2 or 3 drops, with a little sweetened
water, repeat this dose every hour with an increase of a drop at
each dose, until the patient is brought under its influence.

By thus using it, we have perfect control of the medicine, and
by the time we attain to 10 or 12 drops, the patient usually be-
comes tolerant to the medicine, and we can keep him under the
full effect, either by increasing or diminishing the dose, according
to circumstances.

The Use of Water in the Treatment of Fever. By ISAAC Cassel-
BEREY, M.D., of Evansville, Indiana.

We find in the American Journal of Medical Sciences, July
number, of the present year, an article on the above snbject,
which we regret that our space will not allow us to present in full
to our readers. Any discussion of this important question which
is calculated to bring before the profession the judicious use of
this powerful therapeutic agent, in the treatment of fevers,- we re-
gard as valuable, for we have ever regarded it rather in the light
of a reproach to us, that we owe so much of the attention it now re-
ceives to specialists and ultraisls the Hydropathists. Dr. CasseL
berry's discussion, however, has proceeded upon entirely different
principles from those which result from empiricism, and we are
pleased to see true physiological reasoning so well applied in the
investigation of a therapeutic measure which, until recently, has
only received an empirical recommendation.

Starting with a careful consideration of the anatomical, physio-
logical, and pathological relations of the cutaneous and mucous
surfaces of the body, and applying them carefully in reference to
the phenomena of fever, he seems to have omitted none of the
bearings which these multifarious facts sustain to each other, and
as one of the* grand results of his induction, he educes the conclu-
sion, if we understand him aright, that in febrile conditions of the
system, there obtains generally, a superabundance of oxygen in the
tissues of the free surfaces of the body, and that the predominance
of this element contributes largely to the discomfort of the patient,
the heat, the imperfect and abnormal nutrition in these various sur-
faces, and the body generally. He then considers the subject in its

1857.] Use of Water in the Treatment of Fever, 698

ctemico-vital relations, and in its relations to the two nervous sjs-
tems, both ccrebro-spinal and secretory or ganglionic, (which we
prefer to his term, "automatic,") and finally comes to the practical
view of the subject, and to the various methods of practically apply-
ing the mode of treatment his essay is intended to advovocate.

"The diminished quantity of the organizing force in the exter-
nal capillaries, caused by recession of blood from these vessels into
the portal venous system chiefly, the superior intensity of the
chemical force in the blood, thus accumulated in this system in
augmented quantity but perverted quality, and the consuming
force of the imperfectly combined oxygen of the atmosphere, in-
troduced into the blood at each inspiration, resist the fulfilment
of this restorative indication. The imperfectly combined oxygen
is not only consuming, by molecular combination, the nutritive
elements of the blood, but also the solid tissues.

"A complete lesion of nutrition is soon produced; the chemical
force, in its multiplied forms, rapidly augments in intensity by
superior quantity ; the sensations of thirst and of increased heat are
urgent and agonizing; pain is felt; oxygen is consuming the sen-
sitive nervous branches.

"Theyi7-s^ indication to be fulfilled is the removal of this oxygen.
This must be done by molecular combination.

"As vacuity always favours absorption and repletion retards it;
and as the external capillaries are comparatively in the former
condition, while the hepatic and renal capillaries are strictly in
the latter, it follows that absorption would take place with much,
more celerity in the former. When this abnormal state of the
circulation is associated with the physiological fact, that the differ-
ent forms of the automatic nervous force maintain and control the
elements of the blood in the external capillaries, while pathology
as plainly indicates that those of the chemical predominate more
or less over these elements in the visceral capillaries, a compre-
hensive appreciation of the varied functions of the organism and
of the compensatory assistance they afford each other, most con-
clusively show, that curative means should be addressed to the
external capillaries commensurate with their depurative and com-
pensatory functions.

" This proposition is supported by the anatomy and physiology
of the cutaneous tissues as well as their physiological relation of
function and pathological compensatory assistance. We have
abundant evidence that the sensitive and excito-motory nervous
branches are largely distributed to the tissues, through which the
external capillaries are ramified, by which these nervous branches
are supplied with nourishment, and receive the disturbing impres-
sion of the chemical force ; that the tissues to which the visceral
.capillaries are distributed have no sensitive and excito-motory

594 Use of Water in Ute Treatment of Fever. [October,

endowments; that the sensitive nervous system, is the agent the
automatic employs to bring the organism into relation with the
external world ; that the excito-motory is the agent it uses to pro-
tect the organism from external objects; and that these two nerv-
ous systems often lend a compensatory aid to the automatic. Their
restoration and conservation should, therefore, always be a prima-
ry object.

" The existence of imperfectly combined oxygen in the external
capillaries will, for this physiological reason, be instantly evinced
by the sensation of pain and increased heat of the skin and the
manifestation of involuntary muscular motions, while a propor-
tionate quantity of uncombined oxygen in the visceral capillaries,
which have not these nervous endowments, would only excite the
sensation of thirst and oppression. The imperfectly combined oxy-
gen should, thereforCj be consumed by molecular combination in
the external capillaries and be removed by secretion, so that the
sensitive and excito-motory systems would be in a condition to
lend compensatory assistance to the automatic in the depuration
of the blood in the other depuratory glands. How can th remo-
val of the imperfectly combined oxygen of the atmosphere in the
external capillaries be accomplished? By the W5e oi water. Its
temperature and its mode of application must be governed by the
state of the different forms of the automatic nervous force. This
is indicated by the augmented or diminished quantity of blood in
the external capillaries ; by the temperature of the skin ; by the
mechanical force of the muscular action of the heart and arteries;
by the state of the venous system, whether congestion exists in
any of the great depuratory glands or not; by the decreased and
perverted, or the increased and perverted, sensibility of the sensi-
tive nervous system; by the irregular and involuntary muscular
motions of the excito-motory system ; by the lesion of the nutri-
tive process ; and by that of those of secretion.

"When warm water is properly applied to tho cool skin, a
certain quantity of its heat is instantly transmuted into animal
electricity. This gives increased intensity to all the forms of the
automatic nervous force ; the molecular changes of the blood are
augmented and accelerated ; w^ater is absorbed ; the imperfectly
combined oxygen in the blood attracts the hydrogen of the water,
combines w^ith it, and is secreted in the form of sweat ; the oxygen
of the water combines with the carbon of the blood, evolves heat,
and is secreted in the form of carbonic acid gas. A comfortably
soothing sensation reigns supremely through the tissues endowed
with sensitive nervous branches. The external capillary circula-
tion is greatly augmented and accelerated; an increased quantity
of arterial blood is attracted and introduced into these vessels by
the superior intensity of the molecular changes of its elements;
the mechanical force of the muscular action of the heart and arte-
ries is stronger and more tranquil ; respiration is freer and less

1857.] Use of Water in the Treatment of Fever, 695

hurried; copious sweating ensues; and a large quantity of effete
elements are depurated from the blood.

*' When the skin is hot and dry the water used should be cool.
Why? Because there is an abnormal quantity of animal heat
and electricity retained in the external capillaries by deficient
secretion.

" The low temperature of the water increases its capacity for
animal heat and electricity, and promotes the affinity of its ele-
ments for each other. When it is applied and retained upon the
skin, it attracts animal heat and electricity, and causes the secre-
tion of an increased quantity by the cutaneous glands. When
the aggregated heat and electricity are thus removed, the different
forms of tbe organizing force assume increased activity; water is
absorbed and decomposed ; the molecular changes, which then
ensue, are the same as those that transpire when Avarm water is
employed.

" Sweating may, and often does transpire freely without any
considerable diminution of the temperature of the skin ; because it
is only one of the processes of the secretion which takes place in
the cutaneous glands. In this state of the skin, the indications
for the employment of cool water are nearly the same as when it
is hot and dry." * -;f ^- ^ ^ * ^. ^

*'I have shown that the hepatic, renal, and intestinal capillaries
are more or less replete according to the degree of portal conges-
tion; that repletion retards absorption ; that the different forms of
the chemical force predominate over those of the automatic, when
this congestion exists; and that this predominance alwaj^s de-
creases and alters, or augments and perverts absorption and secre-
tion in a proportion of equivalence to its degree of prevalence.
Hence it is an obvious fallacy to endeavor to restore the normal
secretory action of the hepatic, renal, and intestinal glands by the
introduction of large quantities of water into the alimentary canah
It is not only erroneous, but often positively injurious, because
the mechanical force of distension by an elastic substance like
water always favors absorption, while it proportionately retards
secretion. The capillaries of these glands are already too much
distended by the aggregated blood; why increase their distension
by the introduction of water? The blood is so altered in quality,
and so perverted in elementary arrangement and chemical com-
position, that it cannot undergo normal molecular changes. Will
not the additional water introduced by abnormal absorption aug-
ment the perversion of the cellular mutations between the elements
of the blood by the superior intensity of an increased quantity?

'' The sensation of thirst is urgent and agonizing. Will the

Sdrinking of copious portion of cold water allay it? The experi-

lence of every physician answers that it will not; but, on the con-

Itrary, it will do a positive injury so soon as the quantity is suffi-

leient to distend the stomach, and, by the mechanical force of its

1 N.S. VOL. XIII. NO. X. 39

596 TJse of Water in the Treatment of Fever. [October,

pressure on the raucous coat, accelerate its absorption, unless it be
happily ejected by vomiting, when the s^ufferer will feel joyously
relieved. A few moments' sweet repose will follow, when the
sensation of thirst will return, if possible, more agonizing than
before. If copious draughts of cold water afford no relief, if it
often be a positive injury, what must be done ? Do what pathol-
ogy imperiously demands.

^'^ Neutralize, by molecular emnhination^ the imperfectly co7)iibined
oxygen of the atmosphere in the blood by the proper use of water.
How can this be done? Appease the urgent thirst by the use of
ice, broken into small pieces and swallowed; and when ice can-
not be obtained, by small quantities of cold water. Ice is more
efi&cacioos than water ; it is much more slowly absorbed, and sel-
dom or never does injury by distension. Its hydrogen is- at first
feebly attracted by the imperfectly combined oxygen in the blood ;
only a small portion is combined and forms a component part
of the water of the blood, while its oxygen has a feeble affinity
for the carbon of the blood, in consequence of the imperfect
elementary arrangement of the molecular combination of the
carbon. As but a small quantity of the water of the ice is ab-
sorbed and decomposed, its hydrogen neutralizes by combination
an equally limited amount of the imperfectly combined oxygen in
the blood; and as this oxygen is introduced in ample quantities
at each inspiration, it follows that its consumption should be com-
mensurate with the quantity introduced. Hence the necessity for
the employment of water externally. The skin presents a surface
of about fifteen square feet, and is liberally endowed with absorb-
ent and secretory glands. These have the same tissual endow-
ments as the same kind of glands in the abdominal and thoracic
organs, and associated in intimate structural arrangement are
sensitive and excito-motory nervous branches. As pile upon pile
increases the intensity of the electric current, so endowment upon
endowment augments the resistance of any particular class of tis-
sues to the force of a disturbing cause.

The mode in which water should be employed when the design
is to remove imperfectly combined oxj'gen from the blood, is
plainly indicated by the anato-my and physiology of the skin. The
cuticle is of firm structure,, and in a greater or less degree covered
by an unctuons secretion, which resists the introduction of water
by absorption; and, although it is penetrated by a vast multitude
of openings or pores, yet these are oblique and often filled by the-
unctuous secretion, commingled with other secretions and dust so-
as to resist the admission of water.

"Physiology teaches that cells are the agents the automatic
nervous force employs to produce molecular changes in the blood ;;
that they generate and develop, control and distribute animal heat ^e
and electricity ; that a tissue is a good or a bad conductor of these a
forms of matter according to the facility and rapidity with which |l

1857.] Use of Water in the Treament of Fever. 597

this force can produce molecular changes; and tliat the capacity
of every tissue for the geueratioii, development, and distribution
of animal heat and electricity always bears a relation of equiva-
lence to the quantity and the degree of rapidity which the cellular
changes of its nutritive materials may transpire. Ilence the fluids
and tlie soft solids produce more of these forms of force or matter,
and are better conductors of them than the skin.

" When it is designed to relieve the blood in the external ca-
pillaries from aggregated heat and electricity, and imperfectly
combined oxygen, it is therefore necessary that the molecular
changes should be augmented among the elements of the blood,
and that a conducting medium should be applied and retained
upon the skin for some time, that the requisite molecular muta-
tions may be produced in the cutaneous capillaries, and that the
product of these changes may be conveyed to the surface of the
skin. Water is the best medium for this purpose, because the
imperfectly combined oxygen in the blood has a strong affinity
for its h3^drogen, while its oxygen has an equally strong affinity
for the carbon of the blood. These reciprocal affinities accelerate
the molecular changes of the elements of the blood, and thereby
promote the absorption and molecular combination of the water."

* -X- vJ -x- vt *

" The local use of water often contributes greatly to the comfort
of the patient, and assists essentially in the fulfilment of important
indications of cure by consuming the impeifectly combined oxy-
gen, by which the sensitive nervous branches are soothed ; the
excito-motor}^, tranquillized ; and the automic invigorated. Dur-
ing fever, especially Avlien the skin is hot and dry, three or four
folds of linen, wet in cold water and laid upon the forehead, often
confers a boon of relief from agonizing pain and burning heat,
and thereby contributes essentially to restoring the diseased trans-
formation of the tissues to a normal state by eliciting the compen-
satory assistance of the sensitive and excito-motory nervous sys-
tems. Relieved of the excess of the imperfectly combined oxygen
locally manifested by the sensation of pain and burning heat in
the external capillaries of the head, these nervous S3^stems impart
increased intensity to the different forms of the automatic, aug-
ment and accelerate the molecular changes of the blood, and pro-
mote the secretion of additional quantities of the effete elements
of the blood by the depuratory glands. Congestion of the brain
is often only simulative not actual. This state of the brain is often
observed; and I apprehend it is fequently mistaken in our West-
tm alluvion districts, in which individuals are exposed to all the
atmospheric vicissitudes incident to a climate, whose physical
geography is chiefly composed of rich alluvial soil, clothed in for-
est trees and vegetation luxuriating in gorgeously exuberant foli-
age, variegated by winding and often sluggish streams, stagnant
bayous, and deep, silent lagoons, which, in the summer and a part

598 Use of Water in the Treatment of Fever. [October,

of the autumn, are exposed to a high temperature during the day,

and a low temperature during the night, causing the atmosphere

to be more or less loaded with warm moisture during the former

period, and a cool^ dense vapor during the latter.

K- * ^ -H- ^ *

*' Pathology teaches that the sensitive and excito-motory nervous
S3'stems often lend a compensatory aid to the automatic; and that
without them the latter could not maintain all the attributes of
the human organism ; for although the automatic elaborates and
appropriates the material to sustain and perpetuate these; yet it
must employ one of them as an agent to bring it into relation
with the external world, and the other for the production of mus-
cular motion. The automic supplies the creative^ sensitive^ and
mo^iVe power; the sensitive and excito-motory are ewdowments
which it employs for the manifestation of the higher and nobler
attributes of intellectual beings. Hence all these nervous systems
maintain a relation of mutual dependence on each other. They
all perform functions indispensable to the conservation of the hu-
man organism. The imperative necessity for eliciting the recipro-
cal aid of these nervo-us systems in simulative congestion of the
brain is, therefore, obviously manifest. How can this be best
accomplished ?

"The automatic system is endowed with the creative and dis-
tinctive agencies of the organism. These are no longer equal to
each other; the destructive predominates. How can this predom-
inance be subverted? The molecular changes of the blood are
not normal. The blood is becoming more and more contaminat-
ed by effete elements. Normal nutritive elements cannot be
introduced. Those which exist must be depurated. The depu-
rative glands of the skin and lungs have sensitive and excito-mo-
tory nervous branches in intimate relation with them, while those
of the liver and kidneys are without those efficient endowments
which always give increased intensity to the different forms of
the automatic nervous force. This combination of nervous en-
dowments, which are ever ready to compensate for the deficient
functions of each other, bestows upon the tissues to which they
are distributed a much more durable resistance to the force of a
disturbing cause than that possessed by those which are endowed

with automatic nervous branches onlv."

* * * "^^ * *

" The molecular changes of the blood in the minute capillaries
about the origin of the excito-motory nerves, and that of the sen-
sitive nerves which arise from the medulla oblongata, are increased
in intensity, augmented in quantity, and altered in quality; the
elements of the blood are formed and transformed, coalesced and
rearranged with multiplied celerity; the nervous roots and adja-
cent tissues are supplied with additional quantities of nutritive-
material; more powerful reffexed actions are transmitted; the-

1857.] Use of Water in the Treatment of Fever. 599

compensatoiy aid of these nervous systems begins to be manifest-
ed. Now apply a folded napkin, wet in hot water, over the epi-
gastric region ; inspiration is fiver; an increased quantity of oxy-
gen is absorbed,, and an additional quantity of carbon is secreted
by the augmented molecular changes of the blood in the pulmonic
capillaries. The mechanical force of the muscular action of the
heart and arteries soon receives increased power from the altered
quality of the blood conveyed to their muscular tissue by their
nutritive arteries, and an augmented quantity of blood is propell-
ed and conducted to the external capillaries, in which the different
forms of the automatic nervous force have received increased in-
tensity by reflexed action. This intensity ma}'- be greatl}^ aug-
mented, and the reflex action made much more conducive to its
integrity by enveloping the arms and legs in three or four double
of linen or domestic, wet in hot water, and retained for at least
half an hour; because the imperfectl}^ combined oxygen of the
atmosphere, conducted along with the blood into the external ca-
pillaries, would then attract the hydrogen of the water, combine
with it, and constitute water, which would be removed and depo-
sited on the skin in the form of sweat; while the carbon of the
blood would combine with the oxygen of the water, evolve heat,
and be removed in the form of carbonic acid gas. Freed of the
consuming force of the imperfectly combined oxygen, the sensa-
tion of pain and burning Avould not be experienced; the compen-
satory Ibrce of reflexed action would be more manifest, because it
would be consumed chiefly by imparting increased intensit}^ to
that of the different forms of the automatic, and not by the mani-
festation of perverted sensation and involuntary muscular motions.
It would, therefore, contribute to the molecular changes of the
blood, and accelerate its depuration in the external capillaries by
favouring absorption and promoting secretion. When we review
the immense extent of the skin, when we contemplate the magni-
tude and wisdom of its endowments, we can appreciate the advan-
tages of its agenc}^ in the restoration of the organism, when the
varied forms of the automatic nervous force are disturbed and
ready to invite the oxygen of the atmosphere into the citadel of
life. The arms and legs may be constituted into four fields for
the subjection of the rebellious elements of the blood; the com-
manding officer must be selected and nurtured in the cerebro-
spinal region ; while new recruits must be trained and mustered
into the service of the organism along the course of the alimentary
canal.

i "Copious injections of water should never be omitted in the
treatment of fever, as it prevails in the southwest; because there
[is always more or less biliary derangement ; and there is no more
(efficacious means for the removal of bile and other perverted se-
cretions from the alimentary canal. When the functions of the
btomach are so perverted that it will not retain medicine, copious

600 Use of Water in the Treatment of Fever. [October,

injections of water often have a very salutary effect by removing
the altered secretions and other foecal matters from the bowels,
by which they promote the tranquillization of the disturbed re-
flexed actions of the sensitive and cxcito-motory nervous systems.
This state of the stomach often constitutes a most troublesome
complication in the treatment of fever. It is frequently observed
in persons who suffer of fever during the hot days of August and
September. Copious injections of warm water should be frequent-
ly employed; a towel, wet in cold water, should be folded and
laid over the entire epigastric region; three or four folds of do-
mestic or linen about six inches in width, wet in cold water,
should also be applied over the whole length of the spine and re-
tained for an hour or two ; a folded napkin, wet in cold water,
may often be advantageously applied over the larynx, especially
when the vomiting is persistent. The application of water in this
manner, is of peculiar advantage in controlling the persistent vo-
miting of children during the period of dentition, because of its
eflO-cacious influence in tranquillizing the reflexed actions which
the evolution of teeth so gi^eatly augments. Both the colliquative
diarrhoea and the persistent vomiting which so frequently afflict
children during this tender period are chiefly dependent upon,
and often are perpetuated by, this perverted nervous action.

" Unless the individual is of intemperate habits the use of wa-
ter, as here directed, seldom fails to tranquillize the stomach, re-
move the perverted secretions from the bowels, and prepare the
organism for the favorable reception of other remedial agents.

'^ Dr. Henry F. Campbell, of Augusta, Ga., has published two
very able and interesting essays on the pathology of reflexed ner-
vous actions during dentition and during fever, with certain com-
plications. These are invaluable contributions to medical science,
and they will serve as beacon lights to every pathologist. {South.
Med. Jour., for June, 1850, and Irons. Amer. Med. Ass. for 1853.)

" After the bowels are freely moved and the stomach nearly
tranquillized, great advantage may often be derived by enveloping
the patient in sheets wet in cold water. Dry sheets should be
rolled neatly around the wet ones, and the whole allowed to re-
main until the sensation of heat and pain is removed. From half
an hour to an hour will generally be sufficient to produce this ef-
fect. The prompt and judicious administration of quinine will
generally prevent the recurrence of these symptoms. During the
forming state of fever, and often during the first day or two of its
progress, obstinate constipation is frequently observed. For the
removal of this complication large injections of warm water are
peculiarly efficacious, because they neither offend the stomach nor
delay the administration of other appropriate agents. They pro-
mote the dejection of the accumulated foecal mass and depraved
secretions, and contribute to the normal restoration of the pervert-
ed nervous functions.

1857.] Use of Water in the Treatment of Fever. 601

"Diarrhoea is a very troublesome complication of fever, because
it greatly promotes the debility consequent upon the fever, causes
nutritive material to be voided before it is assimilated, and renders
remedial agents much less efficacious. It is often present during
the progress of a fever; but it is much more frequently observed
during the protracted continuance of a fever as it prevails in our
.alluvion river bottoms, with a vast multiplicity of complications.
Ko remedial agent is more efficacious in the removal of the cause
of this diarrhoea than large injections of cold water. These should
generally be employed twice or three times a day; but they may
often be advantageously used after each evacuation of the bowels.
The long continued recession of the blood from the external capil-
laries and its persistent lodgement in the portal venous system,
contribute to the perversion of the functions of the vast multitude
of absorbent and secretory glands along the course of the aliment-
ary canal, because of its accumulated quantity and altered quality
in the intestinal capillaries; while the augmented amount and
perverted quality of the biliary secretion is conveyed to the organ-
izing force of many of these glands; but this force is so diminish-
ed in intensity by the altered quality of the blood in these gland-
ular capillaries, that when the perverted biliary secretion ap-
proaches the glands its nascent formative condition is transmuted,
and the constituents of the food, which it was forming into ele-
Tuents of blood, are attracted, combined, and dejected with this
altered and perverted foecal compound. This constitutes what is
commonly called irritation of the mucous membrane of the bowels.

" When we see the vast number of absorbent and secretory
glands in the mucous membrane of the alimentary canal ; whea
we contemplate the important and multiplied functions they per-
form for the conservation of the organism, we can easily appreci-
ate the immense advantages of their constant and careful protec-
tion, and of their earliest possible relief when disturbed in func-
tional duty.

"In the treatment of this complication of fever I greatly prefer
cold water injections to all the much commended astringents, be-
cause they seldom favor the production of other and often more
dangerous complications, as some astringents frequently do ; and
they promote the establishment of a state of the organism favour-
able to the administration of quinine and other necessary remedi-
al agents.

^''Bathing is often a valuable therapeutic agent to harmonize the
relation between the nervous systems when no considerable de-
gree of diseased transformation of the tissue exists. It ma}^, there-
fore, be often advantageously employed in the forming state of
fever, or during the convalescence of a patient."

We are unwilling to conclude even our brief remarks on the
therapeutic application of cold water, without referring to the ex-

602 Meteorological and Nosological Report [October,

cellent articles of our valued contributor, John Stainback Wilson,
M. D., of Muscogee County, Ga., on " Hydro-therapeutics,"

As our readers are familiar with this series of Essays, we do not
think it necessary to reproduce them in this place, but would
earnestly ask that they be read again in connexion with Dr. Cas-
selberry's treatise, for in these four articles we find collected some
of the most thoroughly praciical and useful views and precepts to
be found anywhere upon this important subject.

We hope Dr. Wilson will continue his Essays, as we think he
could not do the profession a better service in the therapeutic de-
partment than by so doing. His former articles will be found in
the twelfth volume (for 1856) of this journal, the series running
throuojh the numbers for October, November and December.

Meteorological and Nosological Report for Mernpliis^ Tennessee ; dur-
ing the first six months of A. D. 1857. With an Appendix on
the Pathology of Zymotic Fevers. By Daniel F. Weight,
M.D., Secretary of Board of Health, and Proiessor of Physiolo-
gy and Pathology in the Memphis Medical College.

Scattered through this able report, w^e find, many important
views and many valuable facts, which have practical bearing upon
the phenomena of climate and disease in their mutual relations.
Facts, and tabular statements which can be used hereafter by others,
in forming important inductions for the investigation of these and
kindred subjects ; but it is more particularly to the appendix of
the report that we wish to call attention ; for here the author has
worked up the facts for himself, in that particular train of thought,
which make them subservient to a special set of conclusions
referring to the etiology and pathology of zj-motic fevers. This
appendix we beg leave to lay before our readers. The collocation
of facts will be found most apt, and the inductions from them of
the most striking character. It gives us extreme pleasure to see,
how now medicine and medical and pathological phenomena are
beginning to be investigated, not hastily and skimmingly and
slouchingly, and we might acid aimlessly, but deeply and mi-
nutely, and with a definite object in view, ever keeping every
relation of every fact, however remote in their general aspects they
may appear to be to each other. One sided views, narrow
reasoning, and special conclusions, seldom accomplish much in-
inductive reasoning. Wide and comprehensive must be the

1857.] Meteorological and Nosological Report. 603

generalization, and well balanced the intellect that can hope for
safe and durable results in the broad fields of inquiry every day
opening to the present generation of investigators; anatomy,
physiology, pathology, chemistry, meteorology, and physical laws,
and then the obscure, but at the same time important bearing
vital forces exercise upon all these, when brought in relatiou with
the animal economy, must be the familiar implements of the true
medical logician of the present day; nothing less than the whole
circle of the sciences will be tolerated, because, nothing less than
the whole circle of the sciences will complete the chain, and make
us feel safe in accepting the teaching from any source. If any
weak point remains, the whole is weak, for "in argument as in
architecture, no structure is stronger than the weakest part." A
chain which has a feeble link, though it may in other parts, be*
strong enough to moor a universe, is still no stronger than that
weak link.

Professor Wright's remarks present the novel recommendation
of looking closely into the minute relations of things, and devel-
oping their bearings in the aggregate, in great results. At the
cpnclusion of the Report, he remarks

"In the above report I have spoken of the exanthematous dis-
orders so prevalent last spring, in a manner which, if not altogether
novel, is yet sufficiently unusual to excite some discussion. I have
spoken of them as liable to originate in certain Thermometricand
Hygrometric conditions of the atmosphere. ^J'his idea in refer-
ence to diseases generally considered contagious, or. at least,
infectious in their character, will naturall}^ be deemed to demand
some explanation ; so, at least, even if I should fail, to make out
my point, I shall be expected to state precisely what is my posi-
tion in reference to these diseases. To commence, then, I think
it may be easily seen that, whatever may be people's views with,
regard to their contagious or infectious character, neither is incon-
sistent with the possibility of an atmospheric origin for their epi-
demic prevalence. I shall endeavor to show, in other words, that
an atmospheric cause may, without contradiction, be supposed to
prod.uce disease, which, when produced, ma}^ become communica-
ble, either by infection or contagion.

Is not, then, a dry, cold condition of the atmosphere at any
rate, calculated to predispose the skin to a morbid condition? The
commonest experience shows that under such circumstances the
iskin does suffer chapped hands and lips, chilblains, etc., are fa-
miliar evidences of this; but the question arises whether the pro-
Ipuged effect of these iaffaences on the skia may not produce

604 Meteorological and Nosological Report, [October,

morbid conditions affecting the system generally ? To estimate
this question aright, let us consider some of the functions of the
cutaneous surface. In treating of the skin as a secreting organ,
physiologists have, I think, too much limited their attention to its
secretion by" the sudoriferous and sebaceous glands. Important
as these may be, it seems to me that they are far subordinate to
that great system of excretion that depends upon its constant
epithelial desquamation : of all products in the human body the
solid substance excreted by the exfoliation of the epidermis
abounds most in nitrogen, and seems, according to the best
analyses, to contain ammonia ready formed in considerable quan-
tities. This being the case, is it not evident that where this pro-
cess is going on with activity a larger amount of azotised excretion
must be effected this way than by all other emunctories put toge-
ther the kidneys not excepted? Now there are many evidences
that in early spring and summer there is, under ordinary circum-
stances, an increased activity given to this process. Cutaneous
diseases are much more common at this season, the eruptive fevers
now under consideration are much more prevalent at this soason,
than any other, and the analogy of the whole animal creation
shows an increased activity in the cutaneous system of nutrition
and disintegration thus we have beasts throwing off their winter
coat, as it is called, and the newer and more perfect fur or hair
rapidly taking its place, birds moulting and serpents casting their
skin, &c. and can it be doubted that the result of this is the throw-
ing off of various materials which, during the suspension of this
function in winter, have accumulated, und would otherwise act as
a source of disease? Indeed, the very act of throwing it off seems
to constitute a sort of disease, for birds when they moult, horses
when they change their coat, are, as is well known, out of condi-
tion the serpent retires to his den to change his skin, and goes
through the process more dead than alive. May not these changes
be considered as a sort of normal exanthematous fever, from which
the animal comes forth with his winter constitution depurated and
invigorated for the procreative season ? Now, a well known phe-
nomenon in popular pathology is that of spring-sickness; it is
looked upon as a thing to be expected that a certain amount of
mild indisposition shall take place at this season indisposition
which is expected to yield to the mild medication of herb teas, etc.,
and probably does not need eventliis: these popular impressions,
however mixed up with error, always contain some truth at the
bottom, and the man of true science, though he may scrutinize
them strictly, is always too wise to pass them over. If these sea-
son sicknesses are less noticed at the present day than in old times,
I think that it would still be unphilosophical to reject them as ex-
ploded chimeras; they are probably less distinctly marked than
formerly, from the fact that advancing civilization, with its in-
creased means in the way of clothing, and firing, and well con- ,

1857.] Meteorological and Nosological Report. 605"

structed dwellings for moderating the extremes of temperature, has
really, to a groat extent, equalized the seasons and so partially
obliterated those periodic revolutions in the animal economy
which have given their pathological characteristics to the different
seasons. Still much remains to show that the spring especially is
'a period of considerable constitutional changes in man as well as
.the lower animals.

And may not the truth at the bottom of all these general facts
and general impressions be, that during the spring certain accu-
mulated materials have to be thrown ofi' which have been retained
in the blood, through the partial suspension of this epithelial ex-
cretion during the winter? To estimate the probability of this,
let us consider rather more in detail the effect of cold weather upon
this function. Take, for instance, the simple and common phe-
nomenon of chapped hands, already alluded to. Here, at first
sight, the phenomena would seem to suggest rather an increased
than a diminished epithelial action ; the corium becomes bare, the
epidermis roughening and becoming split into chinks. But a
slight consideration will serve to show that it is not so much the
more rapid disintegration of old tissue which is at work, as the
less active development of new. Thus familiar observation shows
that where the nutritive forces of the skin are unimpaired, any
cause which rapidly removes the disintegrated epidermis, (friction,
for instance,) tends, by stimulating the nutritive process, to increase
rather than diminish the substance and consistency of that mem-
brane when, therefore, cold effects an exposure of the corium or
cutis vera it is not by excess of what is removed from above, but
through defect of what is supplied from below in short, from a
defective nutrition of the skin ; and why this should result from
cold is plain. The contractile muscle cells, both in the substance
of the skin itself, and those entering into the structure of its arte-
rioles, are caused to contract, cold being their most energetic irri-
tant, and thus the supply of blood diminished, which alone is
sufficient to account for a diminution in both its nutritive and
excretive functions, growth, that is, and its exfoliation of waste
substance. But now, if the plastic material prepared in the sys-
tem for the nutrition of so large a portion of it as the cutaneous
expanse be for several months of the year, to a great extent pre-
vented from subserving that purpose, then, what becomes of this
unappropriated material ? Here the aphorism of Treviranus seems
to have much force, " that every organ and tissue of the body
in reference to its nutrition, serves as an excretive organ to the
rest of the system." In the rapid changes which the skin goes
through in its normal condition, it is difficult to say which is the
inore prominent, the function of nutrition or that of disintegration,
the Wo processes being so mutually dependent on each other;
and can any one suppose that when so rapid a medium of excre-
tion is from any cause retarded or suppressed, when so large an

608 Meteorological and Nosological Report. [October,

amount of material, whicli being adapted for skin-nutrition, is sa
far unadapted to the nutrition of any other tissue, is retained in
the system, that then no disturbance shall take place in the equili-
brium of the organic forces?

Let it even be supposed (which, doubtless, does take place to
some extent,) that the matter thus accumulating is disposed of by
some other medium of excretion, the secretive functions of the
kidney, for instance yet, even then, it can scarcely be supposed
that no pathological result ensues. If, even, we could suppose
that the excretion could be performed as perfectly when one organ
alone performs its own share of the work, and that of another too,
still the very fact of the additional calls upon the vicarious organ,
would lead us to anticipate, after awhile, derangements in its func-
tions from an excessive demand upon its exertions, and then of
course the evil would be redoubled.

And now we are in a position to appreciate the probable effects
of just such a spring as we have been passing through.

As a general thing, the bland and genial warmth of advancing
spring, gradual in its progress and tempered with a grateful moist-
ure, is exactly the condition calculated to encourage the resump-
tion of the cuta.neous functions, at a season when their suspension
could not be continued without evil resulting, the gradual eleva-
tion of temperature producing a gradual dilatation of the cutaneous
capillary system, and thereb}^ promoting a gradually increased
nutiition, while the moisture of the atmosphere prevents the exha-
lations of the sudorilic glands from being carried off too rapidly,
and allows them to settle on the cutaneous surface sufficiently to
keep it in that state of moisture which is most favorable to the
exuviation of the waste products of this nutrition. But instead
of tlie growing warmth and genial showers of our customary spring
weather, we have, as above shown, had everything reversed. A
few days of unseasonably warm weather in February were suc-
ceeded by a wintry coldness and arid drought throughout the
entire months of March and April. The results naturally to be
expected from these circumstances would be, first of all, that the
cii'culation in the skin would be resumed too suddenh', and in
such a manner as to favor inflammation rather than increased nu-
trition; and, secondly, that it would again be cut off entirely a
second winter, as it were, intervening before the effects of the first
were eliminated from the system. Thus, not only is there left in
the blood and the system at large, the accumulated material re-
sulting from the suppression of epithelial excretion, but a fresh
supply added on account of this second suppression, while the skin
itself is already in excited or irritated state, from the incipient
resumption of its functions early in February being suddenly ar-
rested by the ensuing cold. Can it be doubted that this abnormal
accumulation must be now attended by disease? Any accumula-
ted ajiimal matter ia the. blood, not normally belonging to its con-

1857.] Meteorological and Nosological Beport. 607

stitution, must eventuaHy, if not excreted, undergo decomposition
there, so as to constitute what the modern humoral })athology
delights in designating a blood poison. Moreover, as the materials
of this poison were originally elaborated for the skin, and failed
to be so appropriated through a defect of its nutribility, it is ob-
vious that the skin is their appropriate excreting organ, that their
special vital affinity is for that membrane. Here, then, we have a
morbitic poison seeking elimination through a definite organism,
that of the skin, while that structure is in a state of impaired func-
tional activity ; and is not the result, necessarily to be anticipated,
a morbid excitement of the epithelial process: in other words, a
cutaneous eruption accompanied by such constitutional or febrile
derangement as is to be expected fi'om the presence of an accumu-
mulated and imperfectly eliminated poiscm in the blood? In
other words, have we not shown that all the circumstances with
which our population has been surrounded this spring have been
favorable to the development of fevers, attended with cutaneous
eruptions the regular exanthematous fevers that is to say, such
as scarlet fever, sma.ll-pox and measles? And if we find that,
exactly those diseases have prevailed which the considerations we
have presented represent as due to the antecedents, then is there
not a strong probability that the alleged antecedents have really
stood to the results in the relation of cause and effect? I know
that the great obstacle to the reception of my conclusions will be
the spco'jic character of these diseases, as showm by their commu-
nicability by infection and contagion, and by their generally se-
curing persons once affected by them from a recurrence of the
same disease.

Fortunately it is not necessary for me to enter the intricate field
of controversy, to which the mention of these subjects generally
leads. My own hypothesis implies the existence of a blood poison,
consisting of organic matter undergoing decomposition as the re-
sult of atmospheric influences, which I suppose to be the original
morbific c^use ; and, whether it be the theory of infection or con-
tagion, or epidemic diathesis, which my readers may hold and
which I, at present, meddle not with, they are at liberty to suppose
that this poison in a solid or fluid or gaseous form, or the catalytic
process or decomposing force which it gives origin to is communi-
cable, or finally, that the same causes, acting upon different indi-
viduals, produce the same effects. M}^ hypothesis is altogether
independent of all these opinions and of the controversies to which
they have given rise.

Not that I am without my opinions on those subjects; and I
will here mention that the aspect which these diseases have assum-
ed in Memphis this spring is well calculated to modify extreme
opinions regarding their specific character. The blending of the
types of the several exanthemes, the successive development of
their characteristics in the same individual during the same attack,

60S Lecture on Frequent Micturition. [October,

the simultaneous occurrence of the different exanthemes in the

same family, seem to point significantly to a generic cause, pro-
ducing specific symptoms, varying in their character according
to the constitutional condition of the subject in which its effects
are developed. At any rate, whatever may be the difficulties of
the atmospheric hypothesis, (and I am not insensible of their co-
gency,) an insuperable difficulty exists, on the other hand, with
those who hold for specific infection as the only origin for these
exanthemes, the question, namely, how did the first case of scarla-
tina or small-pox or measles originate? I am aware, too, that this
mode of dealing with the subject is calculated to unsettle patholo-
gical views relating to other specific diseases, Syphilis for instance;
and I am prepared for the inference as not indefensible that this
scourge of humanity may also have arisen, and may still continue
to arise, from a specific and communicable poison indeed, but from
one which may be developed without specific infection from the
vitiated secretions which arise from abnormally continued irrita-
tion of the reproductive organs, accompanied with a want of per-
sonal cleanliness, and if this is contested, the question might again
be put, '' how did the first case of Syphilis arise ?" as was asked
before regarding the exanthemes; and to show what a difficulty
this question really is, in the way of candid believers in its exclu-
sive origin by specific infection, we have only to refer to the por-
tentous theories of its original commencement which some of them
have been led to adopt: let one be enough, the revival, namely,
of Yon Helmont's theory of its being derived from unnatural in-
tercourse with the lower animals. Yide Acton, p. 2^1, Am. ed.

But this is not a treatise on Syphilis. I have only mentioned
this disease to show that I am not at present unprepared for the
extension of my hypothesis to other diseases besides the exan-
themes of which I have here been taking especial cognizance."

!

Croonian Lectures^ delivered hefore the Boyal College of Physicians^
1857. By Gr. Owen Eees, M. D., F. R. S., Physician to, and
Lecturer on the Practice of Medicine at Guy's Hospital.

LECTURE 11.

OH FREQUENT MICTURITION.

Mr. President I now come to the consideration of hysteria as a
cause of frequent micturition. Much has been said of the practi*
ces adopted by the more juvenile of the opposite sex in order to
excite the compassion of those around them. While this pervert-
ed state of moral feeling prevails it may sometimes happen that
our patient complains of too frequent call to pass urine. This
may be true or it may be false. Again, if true, it may be attribu-
table to the hysterical condition, or it may be the result of other

1857.] Lecture on Frequent Micturition.

and more tangible disease. The task in cases such as these is na
easy one. Sometimes we may detect deceit by according com-
pletely with the patient, taking Ijer part, as it were, and leading
her to believe we are the dupes of her ingenuity. If she be de-
ceiving, her next step will be to encroach on our presumed credu-
lity, and she may describe some fresh symptom which may serve
to lead to her detection.

Thus such persons may be known to present pieces of brick to
the medical attendant, representing them to be stones passed from
the bladder. My friend, Mr. Lonsdale, lately met with such a
case. The irritability of the urinary organs will be spoken of as
most excessive daring the passage of these bodies, and the usual
symptoms of calculus will be very graphically given. They do
not describe the frequent micturition as being associated with an
increased discharge of urine. It is probable we sometimes see
only a part of that which is evacuated, but we may generally
judge that only a moderate quantity passes, inasmuch as the spe-
cific gravity of what we obtain is almost always sufiieiently high.
Whether these patients be hysterical or insane, or the subjects of
hysterical insanity, if that be the politer term, 'it matters little;
they are guilty of deliberate mendacity, in order to make others
miserable; and there we will leave them, with the remark that
these are pseudo cases of frequent micturition, which it is merely
necessar}'- to allude to, as part of the history of the subject. Fre-
quent micturition is, however, an occasional concomitant of hyste-
ria. It is not only young girls who may become the subjects of
the symptom ; it is to be observed in matured and married females,
and yields to the ordinary remedies for hysteria in their case as in
that of young and unmarried women. Now and then the fre-
quent micturition is caused by the secretion of a large quantity of
light urine^ that symptom so well known to practitioners. At
other times this may not persist. The urine may be nearly
natural, but with the hysterical symptoms the bladder becomes
irritable.

The true nature of these cases is chiefly to be determined by
excluding other causes as productive of frequent micturition, and
there is usually but little difficulty in doing this. The hysterical
symptoms may not be very prominently shown, but if attention
be directed to the point the truth appears plainly enough. A
knowledge of previous history is very necessary in these hysterical
cases. It happened to me to see a young lady about two years-
ago, in whom the symptoms of frequent micturition was supposed
to depend upon hysteria, but in reality was caused by the pre-,
sence of a mulberry calculus in the kidney. This may appear an
unaccountable error. It was only through the history that we
arrived at the truth, and significant as the indication was which
her story revealed, still the hysterical condition had so cojnpletely
distracted the mind from tlie point, and had been regarded by

610 Lecture on Frequent Micturition. [October,

those who had seen her as so sufficient in itself to explain all^ that
even the important symptom of hijcmataria was sliglited.

As this case is not an isolated one, I will briefly detail it. The
patient was a young lady of fully developed ^ignro. and of healthy
appearance. Her symptoms were principally those of hysteria.
She had loin pain to some extent, but not more than we continu-
ally meet with in women. The urine was passed often, but no-
thing remarkable could be detected in it. The persistence of
frequent micturition eventually led to close questioning as to the
previous history of this young lady, and it was clearly ascertained
that she had passed blood on several occasions some months be-
fore. I have since heard of a similar case, in which calculus
caused irritability of the bladder and slight hsematuria, h3^sterical
symptoms being present in a marked degree. I would not have
it supposed that 1 am inclined to connect all hysteria with the
presence of calculus in the kidney, but these two cases deserve
notice, and will serve to warn practitioners against classing fre-
quent micturition amongst purely hysterical symptoms without
careful inquiry.

What we, however, see in urinary pathology and its therapeu-
peutics is so suggestive that I trust I shall not be regarded as
trenching on the Held of those who keep the ladies so much to
themselves if I offer the results of experience, which is not easily
accessible to those who, as obstetric practitioners, may not have
made the chemistry of urine an especial study. The connexion
existing between the nephritic and uterine branches of the sym-
pathetic are most intimate, but while uterine irritation has been
spoken and written of in every possible phase, and while scarce
an organ or tissue of the body has escaped the criticism of uterine
pathologists, the kidney has by no means received the amount of
attention it deserves. I have already mentioned two cases in
which calculus existed concurrently with hysterical symptoms,
and many cases suggest themselves to my mind, which lam much
inclined to believe would have gone far towards establishing the
fact that the kidneys are often primarily involved in this affection.

My friend Dr. Lever lately gave me the notes of a case strongly
bearing on this point, in which the hysterical symptoms were very
severe. Death took place by coma, and post-mortem examination
showed the kidneys advanced in disease. The poor girl died with
all the symptoms of uraemia. Her blood, poisoned by admixture
with urinous materials, produced death precisely as it occurs in
morbus Brightii.

The next cause productive of the disease under consideration
often occurs in connexion with hysteria, but not necessarily so.
It consists in the presence of hardened fa?ces in the rectum. Sir
Benjamin Brodie directed attention to the point many years since,
and urged the propriety of examining the rectum in order to re-
move the indurated mass. Purgatives are unavailing, the fifices

1S5

1857.] Lecture on Frequent Micturition. 611

requiring removal by an instrument. 1 was consulted in a case
of this kind some three or four years ago, in which the cure was
effected by mechanical means. The relief was immediate. There
may be occasional diarrhoea, but the rectum contains hardened
fences notwithstanding, and the motions find their way by the
sides of the concrete mass.

Another cause for frequent micturition exists apparently in a
state of skin brought about by the application of cold to the sur-
face. I have seen this produced by an insufficiency of bed-cloth-
ing. The case puzzled me much at first. I have known the same
result to follow from a married man taking it into his head to
sleep alone, having previously slept in the same bed with his wife.
Again, I have observed the result in persons exposed to the influ-
ence of our colder climate after residence in the East. These cases
occur in irritable constitutions, and the skin is generally delicate
and thin, but otherwise the health may be perfect. It would ap-
pear here that the kidney takes on a vicarious action, owing to the
spasm of the cutaneous secreting surface, and irritability of the
bladder results as a consequence, in an increased quantity of pale
urine being passed.

Amongst causes for frequent micturition, we find diabetes enu-
merated, and it certainly may become a symptom of the disease.
The quantity passed on each occasion is, hoAvever, so large, com-
pared with that characterizing most of the other states I have
described, that the patient's attention is attracted by the large dis-
charge, as well as by the frequent call, and the former is related
as the more prominent symptom. This should lead at once to the
examination of the urine for sugar, and if that be not found, we
may perhaps determine the presence of insipid diabetes by the low
specific gravity, the increased flow, great thirst, and other charac-
teristic symptoms. It does, however, now and then happen in
diabetes, that frequent call to pass urine has been the symptom
most noticed by the patient, and then if due care be not taken, the
practitioner is a long time led astray. Cases such as these by no
means infrequently occur. They are sometimes treated as depend-
ent on the gouty diathesis, an uric acid deposit having attracted
:he attention of the medical attendant. Treatment is then perse-
vered in until all the more aggravated symptoms of diabetes ap-
oear. The early detection of this disease, which is so important
or its relief, is thus prevented.

I now have to speak of two forms of cancerous affection which

nay produce frequent micturition viz., malignant disease of the

xidney and of the bladder. These two states are characterized by

sematuria. It sometimes happens that the irritability of the bladder

so great when the kidney alone is involved, that this sympathetic

ection may be mistaken for the primary disease, and the nephritic

ischief entirely overlooked. What I would wish to enforce is, that

ese two symptoms, haematuria and frequent micturition, taken

N.s. ^voL. xin. NO. X. 89

612 Lecture on Frequent Micturition. [October,

together, should be regarded (the prostate being excluded) as indi-
cating calculus or malignant disease^ and that either the kidney
or the bladder may be in fault. The indications of cystitis^ shown
by the urine when calculus exists, have been already dwelt upon ;
but when malignant disease is present, there may be none of these.
The urine may be clear, or may only contain such a small quanti-
ty of blood that very careful examination is requisite in order to
detect it by the naked eye. Here the kidne}^ might be considered
in fault, and the diagnosis is not always to be made.

If w^e have a tumour of the abdomen over the region of the
kidney, then w^e may safely din gnose that organ involved; but
this indication is not always afforded us, and then we should ex-
amine the bladder very carefully. If, on sounding, haemorrhage
occur to an extent exceeding that usually produced by explora-
tion, there is most likely a growth on the mucous surface of the
bladder.

Before leaving this part of my subject, I must say a word or two
respecting the seat of tumour in these forms of disease. First, with
regard to the kidney. It is necessary to guard against being led
astray by the tumour appearing in a position somewhat removed ^
from that in which it ordinarily exists. Nephritic enlargement
sometimes occurs at the upper portion of a kidney, and in abscess
of the organ especially, there is often considerable bulging upwards.
This may occur to such an extent that the tumour eventually may*
be felt in that part of the abdomen usually occupied by the liver,
and in malignant affections also, if the right kidney be involved^
the tumour may exist over nearly the whole of the right hypo-
chondriac region. An able paper Avill be found in the "Guy's
Hospital Eeports," in which Dr. Bright has given sketches illus-
trative of this fact.

As regards the production of frequent micturition by malignant -
disease of the bladder, the tumour must be situated near the neck
of the organ in order to cause the symptom. I have had two cases
within the last few years especially illustrative of this point. In
the one, so little inconvenience was felt that had it not been for
the microscopical indications of the urine, I should have inevita-
bly mistaken the disease. There was no increased desire to pass-
nrine, and no pain ; and haematuria was only an occasional symp-
tom. Post-mortem examination showed the advantage to be de--
rived from microscopic research, the diagnosis being verified by
the presence of a large mass of villous growth on the fundus of
the bladder. The situation of the tumour, far removed from the
neck of the organ, explained the absence of the symptom of fre-
quent micturition. In the other case, a tumuor of the same kind
existed near the neck of the bladder, and the irritation was most
torturing. The symptoms otherwise exactly resembled those of
the former case. There was the same haemorrhage after sounding,
and hasmaturia was of very frequent occurrence. I have spoken

1857.] Lecture on Frequent Micturition. 613

of certain microscopical appearances which determined my diag*
nosis : these were merely such as I have detailed in former lectures,
consisting in the presence of those corpuscles or cells which are
found in the villous growths from mucous membranes, and which,
when they can be satisfactorily determined to exist in the urine,
are always most significant.

It has not yet fallen to my lot to demonstrate the presence of any
peculiar structures when the kidney alone has been affected; but
the subject is somewhat novel, and it is for too early to propose the
discover}^ of such cells as a positive proof that the bladder, and
not the kidney, must necessarily be the part involved in the dis-
ease.

Before leaving the analytical symptomatology of frequent mic-
iturition, I would speak of the influence of habit and of nervousness
in continuing the symptom, even after the obvious causes pro-
ducing it are removed. With regard to habit, it is in some cases
of the greatest importance to inform the patient of his position,
and instruct him to restrain himself as much as possible. If he
will do this, his malady becomes of necessity of shorter duration.
We often find the subjects of this symptom acquainted with every
corner suitable for the relief of their wants. They are reminded
of their malady on approaching their wonted haunts. An effort
is required to pass them, and it is well to instruct such patients to
make a point of doing so if they possibly can. The nervous feel-
ing which arises in sufferers from this infirmity when they find
themselves in company is very distressing. They are certain to
feel the inclination when there is the greatest difficulty in gratify-
ing it. They consequently refuse to go into society. They are,
perhaps, urged to do so ; they suffer great misery, and their com-
olaint becomes ao'sfravated. This should never be allowed. Let
:hem avoid company, and as their complaint improves they get
nore courage ; and there is no fear of a return of this nervousness,
except they again become the subjects of those physical ailments
jyhich originated the disease.

This closes the list of causes for frequent micturition which I
lave proposed to consider, and I shall next proceed to remark on
the treatment advisable in some of the more important diseases
^ving rise to the symptom.
First, with respect to the inflammatory conditions viz., cystitis,
used by calculus and by retained secretion, or arising after gon*
Trhoea. I would beg your indulgence while I proceed to premise
' e more practical part of my remarks by considering the ana-
mical conditions of the lining membrane of the bladder, and the
Peculiarity of its position when it becomes the subject of inflam-
lation. In connexion with this subject it is important to reflect
n the effects of disease as observed in the mucous membranes
ienerally.
The mucous membrane lining the mouth, fauces and cesophagus,

614: Lecture on Frequent Micturition. [October,

and extending to the auus, is known to secrete a mucus in disease,
varying in quantity and qualitv. Its physical and other charac-
ters are easily determined, for the reason that we have constant
opportunity of separating it from admixture with the solids excre-
ted from the canaL It is not necessarily macerated^ nor more or
less dissolved in the fieces, nor is the character of the latter changed
in such manner by the presence of mucus but that we can make
due allowance for its presence, and separate in our minds the in
dications afforded by each. The other part of the gastro-pul mo-
nary mucous membrane, descending into the respiratory canals,
secretes, under irritation, a mucus which we can collect nearly at
all times in a pure and unmixed state.

Now, neither of the above conditions apply to the urinary mu
cous membrane. The secretion from the mucous surface of the
bladder, and from the whole of the urinary tubes, mixes with and
alters the secretion of the kidney. The urine is acted upon and
changed by the various results of inflammation, which may be
poured out by the membrane, and it is the effect produced on the
urine by the fluids resulting from inflammation that it is import
ant for us to remember.

There has been great carelessness shown on this point. The
jmne has been regarded as not very materially changed by the
secretion of the mucous surfaces lining the passages, and the pos
sible modification effected in its constitution during its passage
from the kidney to the orifice of the urethra has received but lit-
tle consideration. An acid and an alkaline state of urine, as
evacuated from the urethra, have been too much regarded as iu
dicative of the states of those urines as secreted by the kidney.

Whole pages have been devoted to the explanation of the alka-
linity of urine and the cause sought for in presumed states of the
general system, v/hile there is little doubt that the kidney has been
all the while secreting a strongly acid fluid, which has subsequent-
ly become alkaline owing to admixture w^ith the secretion of the
inflamed mucous surface. For many years there has been a great
horror of alkaline urine, because it is so often connected with ad-
vanced disease of the urinary organs,* and this fear even extends
to the rejection of remedies capable of inducing alkalinity. We
hear it said, "We must take care not to make the urine alkaline; an
if we do we shall cause phosphatic disease." Now I defy any one of
to succeed in doing this. He may administer alkalies for months, Die
and he shall not necessarily cause a deposit of the earthy phosrtlii
phates. The urine may remain alkaline during all that time, butiH
the effect so described will not take place. All he will do will beiof
to cause the excretion of an urine depositing earthy phosphateauv
on boiling {sL necessary result of rendering urine even slightly alka-iid,
line), but the earthy salts remain dissolved unless a boiling tem- ;
perature be applied, and they will not be present in more thanier
natural proportion.

1857.] Lecture on Frequent Micturition, 615

Having taken the opportunity in former lectures of bringing
these views before the notice of the profession, I shall not now
make any extended notice of the subject further than to refer my
readers to the facts and arguments adduced in support of the pow-
er possessed by the mucous membrane of the bladder, when in-
flamed, to neutralize and render alkaline the urine which has been
secreted of its full degree of acidity.

The fact that by alkaline treatment we can often succeed in ob-
taining an acid urine from the urethra when it has previously
been of alkaline reaction, is in itself almost a positive proof that
the mucous membrane has produced the alkalinity of disease, the
fact being utterly inexplicable on any other theory. Alkalies
administered in small doses, so that the acidity of the urine, as
secreted by the kidney, is only partially destroyed, will, as the
mucous membrane becomes less inflamed, eventually cause a
faintl}^ acid urine to pass from the urethra; and when the remedy
is withdrawn, the urine may be observed of its natural acidity.
This, too, happens in cases where acid remedies have entirely fail-
ed to afford relief

After these observations, it will not be matter for surprise that I
should speak strongly in favour of alkaline remedies in all cases
of inflamed bladder. And, lirst, let ns consider what benefit we
may hope to obtain from their use when cystitis is dependent on
the presence of calculus. In this form of disease, the mucous
membrane being subjected to mechanical irritation, we cannot
hope to do much for our patient by medicines. The removal of
a calculus, however, may be performed at a favourable or at an
unfavourable time; and therapeutics are in this way of much ser-
vice. The bladder is so circumstanced that its inflamed mucous
membrane is constantly pouring out large quantities of secretion,
in order to protect it from injury. This" irritation once set up by
:he calculus, is aggravated by the presence of normally acid urine;
md so long as the secretion of the kidney possesses an acid reac-
tion, so long will the evil be aggravated. It might be imagined
:hat because the urine is naturally acid the mucous membrane
)ught to find acidity more genial than alkalinity. This is, doubt-
ess, true in health, but if inflammation occur, the case is different;
^nd I would mention, in illustration of this, the familiar instance
>f gonorrhoea a disease in which it is well known the mucous
nembrane being inflamed, great relief is obtained by rendering
he urine alkaline. The alkaline treatment is, then, advisable in
ill inflamed states of the urinary mucous surfaces; and the dread
>f inducing the phosphatic diathesis is a mere bugbear which, in
DY belief, by interfering with correct therapeutics, has cruelly
'.dded to the sufferings of humanity.

In my lectures of last year, I described the plan I adopt in or-
ier to render the urine alkaline, as secreted by the kidney viz.
;he administration of the neutral salts of vegetable acids. These

616 Lecture on Frequent Micturition. [October,

enter the urine very rapidly as supercarbonates, and according as
the bowels require to be acted on or not, I administer the more or
less purgative forms of such salts. The citrate of potash answers
remarkably well merely to produce an alkaline urine, and the
tartrate may be added in due proportion two or three times during
the day, should it be necessary to relieve constipation. This plan,
with the addition of anodynes at night, is all we can well do in
cases of calculus, and the bladder will sometimes be so relieved
by it, that patients may lose most of their symptoms, while those
remaining will be greatly mitigated.

There is a point connected with the administration of these
neutral salts well worthy of attention. The decomposition occur-
ring after they enter the stomach being productive of a supercar-
bonate of the alkaline base in the urine, we produce a fluid in the
bladder possessing peculiar chemical qualities. Thus while, on
the one hand, uric acid is soluble in such a menstruum, we also
know that the earthy phosphates will dissolve in it a double
property long sought for by those who would effect the solution
of calculi in the bladder.

I do not put this forward as the discovery of a means of effect-
ing the solution of vesical calculi; but it is impossible to shut one's
eyes to the fact, that an urine kept constantlj^ under such chemi-
cal conditions must inevitably be exercising a solvent action, both
on the uric and phosphatic ingredients of calculi, every minute of
the day. The plan, moreover, is one which renders the urine
soothing to the mucous membrane, and this is an important indi-
cation to answer. I would entreat my surgical brethren who are
so constantly treating calculous cases, to use the alkaline citrateSi
freely. It is to them we must look for results as to the efficacy of
the remedy in exerting this solvent action on urinary concretions.
Of the great value of the plan, after the operation of crushing, I
am perfectly satisfied.

I shall not enter on a consideration of the methods which have
been proposed at different times to disintegrate calculi while in
the bladder by electrical decomposition. These propositions have
for the most part originated with ph^-sicians. The late learned
President of this College was the first to make allusion to the pos-
sibility of this being affected. Since he wrote others have taken
up the subject. Thusw^e find in Dr. Pereira's "Materia Medica,",
3rd edition, p. 47, the following statement: "Bonnet suggested-
that the bladder should be injected with a solution of nitrate of
potash, and the calculus subjected to the action of electricity in
this liquid, in order that the nitrate may be decomposed into nitric
acid and potash ; the former of which, it was suggested, would
dissolve the phosphates, while the latter would dissolve the uric
acid and urate of ammonia."

The above view has since been taken by Dr. Bence Jones, and
will be found in a paper lately published in the "Royal Transac-

1857.] Lecture on Frequent Micturition, 617

part^ though it may seem presumptuous to
fix the limit beyond which human ingenuity is not to step, yet
there appears so much which is opposed to the possibiUty of suc-
cess when contempUiting such proposals, that I have no hope
whatever of their adoption leading to the desired result.

As regards the treatment of cystitis following gonorrhoea, I have
nothing more to say than that the alkaline plan exceeds all others
in efficacy. The combination of hyoscyamus with citrate of pot-
ash, in half-drachm or scruple doses, repeated every four hours,
will generally produce relief The dose of hyoscyamus must be
moderately small, as it is to be so frequently repeated, but twenty
minims of the tincture will not be found too much. If inflamma-
tion run high, this plan must be combined with the abstraction of
blood by leeches or cupping.

The treatment of cystitis, as produced by paralysis, depends
much upon surgical aid. The bladder should be emptied by the
catheter, and the ivJiole of the urine being thus drawn off, the opera-
tion may be in like manner again repeated after a few hours. The
viscus, thus freed from the presence of an irritating fluid, often re-
covers its natural condition; but while this is doing we always
improve the condition of the inflamed mucous membrane, by
keeping the secreted urine alkaline, and the citrate of potash may
be advantageously administered at intervals. Much has been said
of the benelit derived from strychnia and the various preparations
of nux vomica, in assisting the paralysed bladder to recover itself.
Inasmuch as strychnia is an excellent tonic, it may sometimes do
good in judicious hands; but I am not much inclined to believe
in its possessing that power over the bladder of which some have
spoken so highl)^

With respect to the second class of causes productive of frequent
micturition, many of them consist, as I have already shown, in the
presence of diseases bearing a very general relation to therapeu-
tics. Thus diabetes insipidus and mellitus, and albuminuria fre-
quently cause the symptom. Of these diseases I need only remark,
that the remedies best suited to their relief are those which will
most benefit the bladder, by lessening the discharge of urine, on
the one hand, and, on the other, decreasing the proportion of albu-
men contained in it. The other causes described, consisting in
the presence of hardened feeces in the rectum, and inertness of
skin from exposure to cold, need no remark, the treatment being
sufficiently obvious. I would say a few words, however, as to the
management of calculus in the kidney, when it is keeping up
sympathetic bladder irritation. When we have a patient in this
plight, w^e hope for the passage of the calculus as the most desira-
ble termination of the case, and our treatment should therefore
apply to the fulfilment of that end. How is this to be effected?
^Our object must be more especially to lessen spasm, and to pre-
vent the concretion increasing in size. Alkaline treatment is here

618 Lecture on Frequent Micturition. [October,

most valuable. The citrate and tartrate of potash or soda, exhib-
ited at intervals during the day, are not only theoretically indica-
ted as neutralisers of the urine, the acidity of which must irritate
the inflamed renal structure, but the action of these remedies, in
producing a supercarbonate of the alkali in the urine, is just what
we require in order to dissolve the uric acid or phosphatic earthy
deposit, and to prevent its increase. I have now been in the habit
of recommending this treatment for some few years, and, where it
has been carefully carried out, have been much gratified with the
result. In several cases it has appeared to facilitate the expulsion
of the concretion ; and in one or two instances, where the urine
has been carefully watched, there has been no retuim of the dis-
ease.

In inveterate uric diathesis, where calculi are constantly form-
ing, this plan of treatment may not always gain credit. The
calculi already formed may come down as before, and it may not
be easy to impress our patients with the soundness of our views
when they observe as many calculi as ever entering their urinary
canals. The benefit has, however, been to me sufficiently obvi-
ous, and I am convinced that it is the only true mode of combating
the calculous tendenc3^

When speaking of calculus in the bladder, I alluded to the
chemical effects produced by the alkaline supercarbonates, and I
may here relate the manner in which any one can assure himself,
without difl&culty, of the power they possess of effecting the solu-
tion of earthy phosphates. I need say nothing of their action on
uric acid.

If we take recentl}- precipitated earthy phosphate, and wash it,
and then pour upon it a solution of bicarbonate of soda, allowing
digestion to go on in the cold, with occasional shaking, we find
that the bicarbonate will dissolve a ver}^ notable quantity of the
phosphate. This may be shown by boiling the filtered solution,
when the earthy salt will fall as a precipitate.

I have next to notice the treatment of hysterical subjects com-
plaining of frequent micturition. Of the pseudo-cases described,
little need be said. They require moral management, and some
diversity of opinion may exist as to the best course to pursue.
Were 1 to advise, I should say, when you have satisfied yourself
that they are deceiving you, tell them privately that they are do-
ing so, and advise them to get out of the sci'ape by gradually
acknowledging themselves cured by remedies which you propose
to administer. In this way they are saved from exposure, and by
thus compounding with their mendacity, they may be induced to'
give up such practices for the future. Of course, when this plan-
is adopted, it is right some responsible member of the family should
be made privy to the scheme and the rationale of its action.

If hysteria be really complicated with irritable bladder, we have
the means of doing much good. When 'describing this state, I

^1

1857.] New Views on the Physiology of the Large Intestine. 629

alluded to the fact that it was not necessary a large flow of urine
should occur, in order to produce the symptom of frequent mictu-
rition. It would appear that in some cases the skin refuses to act
altogether, and nearly the whole of the water discharged from the
system has to find its way through the kidney. This may be
owing to the feeble and irregular state of the circulation observed
in hysteria, and here the irritability may be removed by tonics and
stimulants; and when the skin begins to act, as a result of the
restoration of action to the extreme vessels, the symptom ceases.

In other cases less aggravated, it would appear that though the
skin maintains the power of excreting water, it loses that amount
of energy necessary to render it an emunctory of the more solid
constituents of the blood. In this way, the excretion of extractive
and other matters is thrown more fully on the kidney, and the
urine is apt to become abnormallj^ acid. Here we have an im-
portant indication to fulfil, and it becomes necessary, while we
administer tonics, that we should render the urine of an uuirritatiug
character. The use of the citrate or tartrate of potash or soda will
here also do all we require, and they may be advantageously ad-
ministered in combination with antispasmodics. Of these, assafo^-
tida is perhaps the best. It is a disagreeable remedy, it is true,
but great benefit accrues from its administration. The cutaneous
surface, as we well know, is rendered active during its ingestion,
the perspiration possessing the odour of the drug in a marked de-
gree. The kidney, under this treatment, has less acid to excrete,
and the irritability of the mucous surfaces is thus lessened. The
best form for this unpalatable drug is in pill, and five grains may
be given three times a day with each dose of the saline remedy.

\_London Lancet.

New Views on the Physiology of the Large Lntestine. By M. F. Col-
by, M. A., M. D., etc., Stanstead, C. E.

It is now more than eighteen months since I discovered the
error in the received physiology of the function of the large intes-
tine, particularly in that part of it called descending Colon, Sigmoid
flexure and rectum. Every day's observation since has confirmed
me in the correctness of my views. Although I have not been
able to engage in general practice, I have had numerous opportu-
nities of testing them as to their bearing on pathology. The
knowledge of the true function of the descending bowel does away
with all the uncertainty complained of by medical men as to the
effect of cathartics, and more particularly of enemas, in many
cases. A discussion took place in the Westminster Medical So-
ciety in 1833, which is reported in the London Lancet. The dis-
cussion developed one fact, that there was a consciousness among
all present that there was something not satisfactory in the received

620 New Views on the Physiology of the Large Intestine. [October,

physiology; which led off the question to the anatomists present,
whether there was anything in the anatomical structure of the
descending bowel which could operate as a valve?

I can demonstrate the received physiology of the function of the
descending bowel to be untenable, and that it implies the charge
that the Creator has left a defect in the organization of a particular
part, which renders it inadequate to the performance of the func-
tion assigned it. My new physiological doctrine recognizes two
distinct apparatuses, each possessing peculiar and distinct functions
over and above what is recognized by the old system. These
functions were supposed to pertain to that apparatus called the
large intestine, and heretofore assigned to the function of organic
life, assisted by the voluntary co-operation of the abdominal mus-
cles.

As to the purport of my new physiological doctrine, I quote
from lectures which I am preparing illustrative of the subject, the
following recapitulation :

1st. I assume that the organic function of the colon ceases at its
left transverse extremity.

2nd. That the portion called descending colon and sigmoid
flexure has a separate and independent function.

8rd. That this portion of the bowels is anatomically inadequate
to the performance of the function heretofore assigned it.

4th. That this portion constitutes the link between the animal
and the organic life. That it is possessed of both animal sensibili-
ty and contractility to such an extent as to entitle its functions to
be considered those of animal life.

5th. That although it is to a certain extent subject to the will,
and can be brought into action at any moment by it, yet it has an
independent instinctive life which gives it an influence and a pow-
er which neither its organic or its animal life could give it.

6th. I assume the name of curator as proper to express its func-
tion ; and as it is a dualite acting under its instinctive life, at times
in a separate capacity, I give the name curator superior to that
portion above the superior spinous process of the ileum, and which
for the time is devoted to the functions of organic life; andc?/rt(tor
inferior to the portion below, usually called sigmoid flexure this
for the time being devoted to the functions of animal life.

7th. That the curator^ when acting as a unit, occupies the post
of observation between the two lives. That it takes cognizance of
the time when the digestion and the nutritive absorption is com-
pleted in the small intestine ; that it then opens the ileo-colic valve,
and at the same time by a suctive and expansive action it takes
the faecal matter from the transverse colon aiid conveys it to the
rectum, which it aids the levator ani muscles to raise, and by a
divergent action of its two longitudinal muscles it opens to receive
the same. The curator by its instinctive power, recognises the
fitness of the rectum to receive and expel the fascal matter simul-

1857.] New Views on Hie Physiology of the Large Intestine. 621

taneous to the opening of the ileo-colic valve; it also at the same
time brings into action the abdominal muscles, by which the con-
tents of the small intestine are pressed forward to supply the place
of the refuse matter removed from the colon. Its otiice is there-
fore not only prehensile in taking the faecal matter from the trans-
verse colon and conveying it to the rectum; but it exercises the
conservative function of keeping the ileo-colic valve closed till
such a time as the absorption of all nutritive matter from the
contents of the small intestine renders its closure no longer neces-
sary.

8th. That the rectum is part of an apparatus which I call rectal,
and which is wholly under the domain of the will; that it exer-
cises the function of defecation, and aids in that of urination and
parturition. In its anatomical structure it is analagous to that of
the upper part of the digestive tube with the difference of the re-
vei'sion of the sphincters. It consists of the strongest muscular
portion of the bowel; the rectum, with its muscles; the two
sphincter, the levator ani, the coccj-gei, etc. The same looseness
of the cellular tissue, which connects the muscular coat of the oeso-
phagus, is found between these coats of the rectum.

9tli. That the power of the will extends over that part of the
digestive tube which extends from the mouth to within two or
three inches of the cardiac orifice of the stomach ; so also the
power of the will extends from the external sphincter ani to
within two or three inches of the left transverse extremity of the
colon.

10th. That the rectum in that abnormal state which resultsfrom
phlogosis of its muscular coat, has its contractility exalted so as to
cause it to act antagonistically to the curator. This is the most
frequent cause of constipation and its consequence. When this
contractility becomes spasmodic this resistance leaves the curator
to mechanical forces hence results accumulations and distension
of its weakened side walls. It is this abnormal state of the most
sensitive part of the digestive tube w'hich fills the hospitals
with the insane. It is also in this state that the curator^ by its
instinctive life, acts as a dualite by a peculiar transposition
which gives it a great powder in overcoming the resistance of the
rectum.

11th. The ileo-colic valve may have its functions suspended by
local disease, as well as by peritoneal inflammation ; but the most
frequent cause is the suspension of the function of the curator^
which may arise from antagonism from the abnormal state of the
rectum, or from a phlogosed state of its own mucous membrane.
A sudden closure of the valve would cause tympanitis, ileus or
strangulated hernia. A weakened or too active state of the valve
would result in emaciation from the premature passing of the nu-
tritive matter. \_Montreal Medical Chronicle.

622 Use and Abuse of Pessaries in Prolapsus, [October,

On the Use and Abuse of Pessaries in Prolapsus. By Dr. GIBSO^'.

Of all the displacements of the uterus, prolapsus is unquestion-
abl}^ the most common. We may go further, and say, that of all
diseases of married women, prolapsus uteri is the most frequent.
Nevertheless, it is only where the displacement is great that much
inconvenience is felt, as a general rule; and usually the prolapsus
has been in existence a considerable period before the descending
uterus has advanced far. Prolapsus vaginae is not a common dis-
ease, without a greater or less amount of descent of the uterus,
and probabl}^ never occurs extensively without displacement of
the bladder, or rectum, or both. When the uterus has descended
from its position at the brim of the pelvis, the abdominal contents
press upon the organ as they did before its descent, and the pres-
sure of the abdommal muscles is rather increased than the contra-
ry. Yaginal cystocele and vaginal rectocele are almost invariably
associated with tumors, and as the vaginal prolapse increases, the
cul de sac (formed by the rectum or the bladder, as the case may
be) is also increased, and ultimately it becomes difficult to empty
the rectum or the bladder completely. Hence it is palpable that
the tendency of these displacements is from bad to worse. The
facility with which the early progress of prolapsus uteri may be
checked bj^ pessaries and the like, has undoubtedly exercised a
baneful influence upon the study and treatment of the disease,
whilst with many practitioners the unhappy results of the indis-
criminate employment of the pessary have had the effect of remov-
ing this instrument from their practice altogether; and I venture
to submit, that the indiscriminate use of the pessary is greatly
more injurious than its disuse altogether. One bad consequence
of the use of the pessary is the amount of irritation set up by its
persistent pressure irritation in the walls of the vagina, in the
bladder, and in the rectum. Another is the expansion of the va-
gina consequent upon its continued pressure; from hence results
excessive dilatation of the vaginal tube, relaxation of its coats,
excoriation, leucorrhoea, &;c., &c. Another effect, and often the
most serious of all, is the pressure of the pessary upon the os and
cervix uteri; hence the production here of inflammation, ulcera-
tion, hemorrhage, and a whole host of evils. Still it is undoubt-
edly true that, by careful management, the pessary is a most useful
instrument. I recommend a pessary, which, I think, will obviate
many of the objections urged against its use light, clean, com-
pressible, cheap the vulcanized india-rubber ball, used as a toy
by children, having a peg at the aperture and a loop for easy re-
moval. This, with a well-adapted bandage externally, will relieve
very many cases of prolapsus. An excellent pessary is made of
sponge, with a loop of tape passed through it for its easy with-
drawal. It should be somewhat excavated before and behind, and
may be (where large size is a great objection in introduction,)

1857.] Use and Abuse of Pessaries in Prolapsus. 623

dipped in a solution of gum,'and compressed by tape or twine, as
in the ordinary manuflicture of the sponge tent. When dry, and
the compressing tape or twine removed, and the surface smoothed
with a sharp knife or scissors, it is duly oiled, and passed into the
required position into the vagina. The medicated pessary is much
neglected, and may be made to fulfil very many indications ; in-
deed it is self-evident that the persistent application of any given
medicinal agent must be vastly more influential than the brief
application of such agent by way of injection, the ordinary form
of application. The sponge pessary may in this wise serve a dou-
ble purpose. I say nothing of recumbent posture, cold sponging,
or bathing, food, air, exercise, tonics, aperients, <Scc., my experience
in these matters differing little from that of almost all modern
writers upon the subjects under consideration. My experience of
the use of caustics chiefly nitrate of silver to the walls of the
vagina, is not satisfactory ; in mild cases they are, for the most
part, not indicated, and in the severe forms they appear to me un-
equal to the requirements of the cases. I have in a few cases ap-
plied solutions of iodine in chloroform, ether, &c., to the vaginal
sui'face, but here also I have not met with any commendable
success.

Everything considered then the progressive tendency of the
diseases from bad to worse the acknowledged difficulty in their
treatment, their frequency, kc. it becomes desirable to know
whether other means, beyond those ordinarily employed, are not
to be found, which shall relieve or cure those forms of disease
which have resisted ordinary treatment. The agency of the knife
has not had fair scope, and this principally from two causes. 1.
The repugnance of the patient and the practitioner to such active
treatment of these delicate organs. 2. The possible destruction of
these organs as agents in copulation and parturition. The first
objection need not be combated here by me; and the second is
more ideal than real. It is, indeed, true that the passages have
been extensively interfered w^ith, as in the case to which I shall,
in a moment, direct your particular attention. But it is also true,
that in many instances well fitted for operative interference, the
genital canal will admit of very extensive contraction without de-
triment, or with little detriment to copulation or parturition that
these objections yery often do not hold, as in the aged and in the
widowed and that the distress of the disease is often so great,
that copulation and parturition are entirely out of the question.

Operative interference may be, and has been, varied much by
the caprice of the operator, or the requirements of the patient ; but
it may be stated, generally, that the aim of operators, hitherto, has
been to produce contraction in some part of the genital canal.
Diefienbach removed an oval piece of mucous membrane from the
side of the vagina, and brought the edges of the wound together
by sutures. Baker Brown performed a somewhat similar opera-

624 Use and Abuse of Pessaries in Prolapsus. [October,

tion, but on a smaller scale and then, in addition, pares the
edges of the labial inferior) y, and brings the raw surfaces together.
The latter part of Baker Brown's operation has been alone per-
formed ; and all have been attended with a measure of success. I
have pejformed two operations with the knife and ligature, for
the relief of these affections. One, which has been pertormed by
many others, consists of removing strips of mucous membrane from
the sides and back of the vagina, and bringing and sustaining the
edges of the wounds in contact, by means of sutures. This oper-
ation has been successful with me, but I have only performed it
once.

The operation to which I desire particularly to direct attention,
has not been, so far as I am aware, performed by any person ex-
cept myself The patient had suffered for sixteen years from
prolapsus uteri, and for several years, from vaginal cystocele and
rectocele, and had undergone treatment of various kinds, from
time to time. Moreover, a fibrous-pediculated tumor, one inch
and a half in length, was found attached to the posterior lip of the
OS uteri ; this was easily removed by ligature and the bistoury.
The patient was afterwards confined to the recumbent posture for
a few days, and then the operation for the cure of the prolapsus
was performed. The patient being placed in the ordinary posi-
tion for lithotomy, and the genital canal fally exposed, an incision
was carried from the medium line posteriorly (about two inches
and a half above the posterior labial commissure) forward, be-
neath the arch of the pubis, to the margin of the labium anteriorly
on each side; from these points downwards the vagina and vulva
were completely denuded of mucous membrane by a careful dis-
section with the scalpel. This part of the operation being satis-
factorily completed, three interrupted sutures brought and retained
the lateral halves of the upper lines of incision together. Two
other interrupted sutures were inserted into the anterior margin
of the denuded surfaces, whilst three deeply-placed quill sutures
kept the lateral masses firmly in contact. The patient was then
removed to bed, and a mild opiate given.

The urine was regularly drawn off twice a day for the first ten
days, "i'he bowels were acted upon by enema on the third day.
Considerable inflammation resulted from the operation, but ablu-
tion with warm water, injection of the vagina by means of a
syringe and catheter with warm water, a rigid observance of the
horizontal position, and simple food, were found equal to the re-
quirements of the case. The first suture was removed on the se-
venth day, and on every second and third day from this date
another suture was removed. The patient rose from her bed on
or about the twenty -first day, and gradually, from this time, as-
sumed the active duties required of her by her household. At the
present hour she is quite well. [Xewcastle and Gateshead Path,
Transactions^ and Ranking^ s Abstract.

1857.] Suhcarhonaie of Bismuth. 625

On the Preparation and Therapeutical Employment of Suhcarhonaie
of Bismuth.

The following is the mode of preparation of the subcarbonate of
Bismuth described by M. Ilaonon, Professor at the University of
Brussels. The bismuth is lirst purilied by melting this metal in
powder with ten times its weight of powdered nitre. After cool-
ing, the metal is again powdered and mixed with ten times its
weight of nitre, and after a second fusion the bismuth may be con-
sidered as entirely free from the arseniurets and sulphurets which
it almost always contains. Then three parts of nitric acid are put
into a retort, and one part of pure bismuth is added. When the
reaction is complete, about a third of the liquid is evaporated, then
the solution is poured drop by drop into a solution of carbonate of
soda, and a white precipitate is obtained, which is subcarbonate
of bismuth. The precipitate, after having been washed five or
six times with distilled water, is throvrn upon a filter, and washed
again to remove the last traces of carbonate of soda. It should be
preserved in well-stopped bottles. The physiological properties
of the salts of bismuth are very little known, for the simple reason
that the subnitrate is the only salt which has been employed in
medicine. The operation even of this salt is not well understood,
as its insolubility offers an obstacle to the observation of the
physiological phenomena which might have been observed in the
other salts of bismuth, such as the citrate, the tartrate, or the car-
bonate. It isalso the insolubility of the subnitrate which renders
it inefiicient in the greater part of the cases in which it is indica-
ted; and it also occasionally produces a very inconvenient sensa-
tion of weight at the stomach. The subcarbonate is soluble in the
gastric j nice, its action is rapid, it produces no sensation of weight
at the stomach, it rarely constipates, colors the stools less than the
subnitrate, and may be employed for a long time without oppress-
ing the stomach. The action of the subcarbonate appears to be
sedative during the first days of its employment, and subsequently
to excite all the phenomena which result from the action of the
tonics.

As to its therapeutical action, it may be noted that all cases of
gastralgia consecutive upon phlegmasia of the digestive passages,
cases in which the tongue is red and pointed, and cases in which
the digestion is laborious and accompanied with putrid or acid
eructations, or in which there is a tendency to diarrhoea or spas-
modic vomiting, demand the employment of the subcarbonate of
bismuth. This salt is also required in the vomiting of children,
whether caused by dentition or succeeding to frequent fits of indi-
gestion, and in the diarrhoea of weak children, especially when
^ occurring at the time of weaning. One great advantage possessed
by the subcarbonate of bismuth is, that it neutralizes the acids in
excess which are found in the stomach. The subnitrate, as is well

626 Diabetes Treated by the Use of Rennet. [October,

known, fails always in this respect. In all the cases where the
sLibcarbonate has been taken, the pain in the digestive passages is
first found to disappear ; then the eructations cease, together with
the vomiting or diarrhoea; the digestion becomes less and less la-
borious, the tongue gradually receives its normal form and color;
and if the use of the subcarbonate is continued, the appetite in-
creases from day to day, the yellow tint of the countenance disap-
pears, and the face becomes colored at the same time as it ceases
to be shrivelled.

The subcarbonate of bismuth is perfectly insipid, and excites no
repugnance. It is given before meals. Adults take it in a little
water, and children in honey. It may also be made into lozenges.
The dose for adults is from one to three grammes, taken three times
a day in increasing doses. [Bulletin de Tlierapeutique^ and British
and Foreign Med. Chir. Rev.

On a Case of Diabetes treated by the Use of Rennet. By Dr. IVERSEN.

Dr. Iversen relates the case of a patient, in the lower class of
life, who had well marked diabetes, who was treated with rennet,
and the details of whose case were carefully recorded day by day.
As all the usual plans of treatment had been unsuccessful before
the patient's admission into the hospital under Dr. Iversen's care,
he made an experiment of the rennet treatment. In order to ob-
tain as accurate a result as possible, it was determined, in the
beginning of the treatment, not to alter the diet of the patient,
except to recommend the greatest possible abstinence from drink-
ing. By the table prepared by Dr. Iversen, the treatment seems
to have been successful in diminishing the quantity of sugar in the
urine ; but from some circumstances which are not explained, the
patient was seized suddenly during the progress of the case with
fainting, followed by spasms, ending in death. No post-mortem
examination was permitted, and the case is therefore imperfect.
Kotwithstanding the unfortunate result, Dr. Iversen considers that
the constant diminution of the urine, both in its actual quantity
and in its saccharine ingredient, was very remarkable. He shows
that in the first four days, during which the patient took no medi-
cine, the average quantity of urine voided, amounted to 10*108
cubic centimetres. In the following period of seven days, during
which she took the rennet, the quantity of urine reached only
7*927 cubic centimetres, with aquantity of sugar amounting to 324
grammes. In the next five days, during which she took the
rennet in combination with phosphate of soda, the average daily
quantity of urine sank to 6*988 centimetres, with 250*817 grammes
of sugar. The patient herself attributed to the rennet the power
of allaying in some measure the burning thirst which she experi-
enced. [Archiv. des Vereinsfiir Gemeinschaftliche Arheiten^ and lb.

1857.] Tubercle of the Cms Cerebelli. 627

In selecting the following short report, we call attention to the
fact that a lesion of a nervous centre here produces symptoms of
chorea. This case rather corroborates our remarks at the end of
Dr. W. C. Brandon's case in the original department of this num-
ber of our Journal, page 585. Since Dr. Brandon's case, with our
remarks, have been in print, we have had the opportunity of
witnessing a case resembling his in many points, and especially in
the Chronic symptoms.

Miss F., aged about 68 years, fell from her bed on the morning
of the 11th inst. Dr. K. Campbell visited her some hours after:
found her perfectly rational, and able to give an account of the
accident in intervals of spasms. Her head was bent forcibly for-
ward and rested upon her knees. She was convulsed almost unin-
termittingly in her arms and lower extremities, but more violently
in the left arm. There was a severe contusion on the left side of
her head and face.

By the use of sedatives and quinine with brandy, the general
spasmodic symptoms were arrested. She became apparently
much relieved, ate with appetite, and conversed rationally and
composedly, but the spasmodic action of the left arm never abated,
except during sleep, from the time of her fall till her death, which
occurred on Saturday, 19th inst., by gradual sinking, eight days
after her first attack. Her mind, from first to last, did not mani-
fest the least aberration whatever.

On Tubercle of the Cms Cerebelli^ with symptoms simulating Chorea.
By T. H. Shute, M. D., Physician to the Torbay Infirmary.

As any case tending to elucidate the physiology and pathology
of the brian is of importance, I send the following, thinking it
presents many points of interest to the readers of Ths Lancet:

Elizabeth S , aged twenty -six, married three years, no family,

was admitted under my care March 11th, reported to be suffering
from chorea. She presented the following appearance : Counten-
ance not sunken nor pallid, and not evidencing pain ; features not
distorted; muscular and adipose tissues sufficiently developed;
tongue furred, protruded with a jerk; head constantly moving to
the left side ; articulation very imperfect ; understands and an-
swers everything that is said to her ; constantly talking whilst
awake; left arm in perpetual movement, being jerked across the
chest (during sleep the convulsive movements cease, and she is
"quite tranquil) ; total inability to support herself on her legs ; but
>3he can move them up in the bed ; sensation not affected ; has a

628 Tubercle of the Cms CerebelU. [October,

constant short cough, as if caused by accumulation of mucus;
pulse 90; urine acid; no albumen. There was much difiicultyin
examining the chest. Left side appeared duller than right ; mucus
and subcrepitary rales, with respiratory sounds of the diffused
blowing type, on that side.

The history of the case w^as very obscure. We could not ascer-
tain that she had ever complained of headache ; had had occasional
cough for two years ; had never spat blood. Four months since,
whilst out walking, she suddenly fell against a wall, but without
loss of consciousness, since which time she has been in her present
condition.

Diagnosis. Organic disease at the base of the brain, probably
softening, near the pons Yarolii ; tubercular disease of the left
lung. She was ordered blisters to the calves of the legs ; compound
ipecacuanha powder, ten grains.

March 12th. The Dover's powder had been repeated, and at the
period of the visit she was in a profuse sweat, and in a quiet sleep ;
the movements of the arm had ceased.

13th. Still quiet; takes her food when roused.

14:th. Yery noisy ; movements of arm and head have recom-
menced. Ordered, acetate of morphia, potassio-tartrate of antimo-
ny, of each one grain ; Avater, one ounce; one drachm to be taken
every three hours till she was quiet.

16th. Only two doses of mixture had been taken, and she was
in such a state of prostration as to require brandy and ammonia
to rouse her.

16th. Recovered from the state of prostration ; movements of
arm had ceased, and did not return; right pupil dilated, contracts
under the influence of light, but dilates again immediately.

She died on the 6th of April.

Autopsy J forty-eight hours after death. Vessels on convexity of
brain congested ; arachnoid membrane adherent along the upper
and posterior edge of the longituninal fissure; no evidences of re-
cent inflammation of the membranes ; consistence of brain firm,
somewhat congested; no effusion into the ventricles; in slicing
downwards, no appreciable lesion discoverable. At the base (^
the brain the right crus cerebelli was softened to the depth of a
line on its anterior aspect, and in its substance were imbedded
three crude tubercles the size of a pea, one in the centre, and two
on each side, forming a triangle. The lungs were not taken from
the thorax, bat the posterior portion of the left was infiltrated with
crude and softened tubercles.

Bemarlcs. The diagnosis in this case was somewhat obscure.
On the one hand, we had all the symptoms of chorea, such as the
constant' agitation of the arm and head, the jerking protrusion of .
the tongue, difficulty of articulation, and perfect quietude during i
sleep. On the other hand, the age was not that at which chorea ,
commences in the great majority of cases, and the mode and sud- |

1857.] Hysterical Affections. 629

denness of the invasion of the malady was opposed to the idea of
its being a purely nervous affection , Therefore we came to the
conclusion that there was organic lesion, and that its scat was the
base of the brain, which was verified b}^ the autopsy. The depo-
sition of tubercle in the brain of the adult is very rare, though
common in children, "so much so that Louis only met with' one
case in 117 cases of phthisis ; and Ingol, in his extensive practice
at St. Lonis, has only met with eight cases, and in six of these no
syniptom existed during life." (Solly.) It will be remembered,
that in the experiments of Magendie, when he divided one of the
crura cerebelli, the animal immediately began to rotate to the same
side. Now here, although the patient in all probability fell side-
ways against a wall, the perpetual movement of the arm took place
on the opposite to the diseased crus, the fibres of which were all but
destroyed by disease ; but the case is confirmatory of the proposi-
tion, " that individual parts of the brain answer individual pur-
poses, as regards the power of regulating our movements."

[London Lancet

On the Age in which Hysterical Affections are most likely to he devel-
oped. By Dr. Briquet.

Dr. Briquet passes in review the doctrines tanght by various
writers on the subject of the occurrence of hysteria, and then
analyzes a series of 467 cases occurring in his own practice in the
course of ten years, in which the commencement of the affection
was carefully noted. Some of his inferences would probably not
be universally adopted, but his numbers are important, the more
so. as they are in the main corroborated by the analysis of numer-
ous cases collected by Dr. Landouzy, whose results are also given
in the following table :

Landouzy

Briquet.

3irth

to 10

years, . .

0 cases

. ... 61

cases.

10

" 15

.. 48

"

... 104

15

" 20

.. 105

... 162

20

" 25

.. 80

"

... 73

25

'* 30

. 40

"

... 28

30

" 35

.. 38

"

13

35

" 40

.. 15

"

... 12

40

" 45

7

"

3

45

" 50

8

"

1

50

" 65

4

"

2

55

" 60

4

"

1

Dr. Briquet attributes the differences that are manifest between
bis table and the numbers given by Dr. Landouzy to the circum-
stance of his having exercised great care in determining the exact
jommencement of the disease. The following are his chief con-
lusions :

1. A considerable number of cases of hysteria occur while the
i^xual organs are yet in a rudimentary state.

630 Fever Poisons. [October,

2. The development of hysteria does not bear a direct ratio to
the period of activity of the sexual organs, as this period com-
mences at eleven or twelve years, and does not cease till the fortieth
or forty-fifth year. On the other hand, hysteria progressively ad-
vances up to the age of twenty, and very rapidly diminishes from
the twentieth to the forty-fifth year. Consequently, of thirty -foui
years of sexual activity, there are only from nine to ten during
which hysteria prevails, while it becomes less frequent during the
remaining twenty -four ; and yet the sexual activity is greater from
twenty to forty -five years of age. [IJ Union Medicak, and Med.
Chir. Rev.

We find the following short article in the Eclectic Magazine, 2l
journal which we here take occasion to commend to our readers
as one of the best, if not the best literary journal in the world
We have several times transferred from its pages valuable matter,
which, though intended for popular reading, will be found to pos
sess much interest to the Profession. Such an one appears to ua
in the following extract from a pamphlet on Fever Poisons.

Fever Poisons.

[On the subject of Scarlet fever, vfhich has been lately making
extraordinary havoc among old and young, the following usefull!
observations occur in a small tract intended for popular dissemina-
tion by Mr. K. Pairman, surgeon, Biggar.]

After referring to the value of thorough ventilation, light, and
cleanliness, in order to disinfect clothes and apartments from thdf
invisible air-poison exhaled from the sick, the author proceeds:
It is important to know regarding infection, that when not destroy-
ed or dispersed in the sick room, it attaches itself and adheres with
great tenacity to all articles of furniture chairs, tables, drawers,;
&c., nestling in their innumerable pores ; and unless thes articles!
be scrubbed with a solution of chloride of lime, or exposed to a^ li
strong heat, or a free current of air for several hours, it may again (]
become evolved, more virulently than atfirst^ after the lapse of many \
weeks. But it chiefly adheres to cotton and woolen materialswij
The patient^s body-clothes and blankets become saturated with it,||
like a sponge with water. And in airing these materials, a mere
passing breeze is not always sufQcient to carry it away. A gen-
teel country family lately related to me that, a few years ago,, they
had occasion to reside some time in Edinburgh ; while there, one
of the domestics became affected with fever of a peculiar type,!
After her recovery, the bed-clothes as was thought were suffi-
ciently aired, packed up, and conveyed home along with the family.
Through some inadvertance, they remained for four months thus

1857.] Feuer Poisons, 631

folded up ; after wliich, being required for use, they were opened
iout and washed. Within a week, the person who washed them
'jbecame attacked with the same type of fever, though none was
iprevailing in the district at the time ; so that infection thus im-
jprisoned in a blanket, or anywhere else, and not exposed to any
current of air, seems not only quite indestructible, but, while thus
confined, probably grows in virulence every day. Thus the in-
fection of plague which is just a form of t3^phus fever has been
Dacked up in a bale of cotton, and after being conveyed many
lundred miles, struck with instant death the person who unloosed
t. The following curious and dreadful incident, related by Dr.
^arr, of Exeter, showing how plague was once disseminated in an
English town, we extract from Macauley's i>^c^^<97^ary of Medicine:
" The last plague which infested the town in which we now write,
[says Dr. Parr,) arose from a traveller remarking to his compan-
on, that in a former journey he had the plague in the room where
hey sat. ' In that corner,' said he, ' was a cupboard where the
Dandages were kept ; it is now plastered, but they are probably
:here still.' He took the poker, broke down the plastering, and
bund them. 21ie disease was soon disseminated, and extensively
'atair

The next point requiring notice is, that one man may convey
nfection to another, while he himself escapes the disease. Some
j^ears ago, I received a message from a much esteemed and worthy
ninister, requesting a visit to two of his children. On arriving, I
bund them ill with scarlatina ; and as they had both become sud-
enly affected at the very same hour the previous evening, it was
vident that both had simultaneously imbibed the poisonous dose.
3ut the question arose: Where could they possibly get infection?
or they had ever been carefully tended by their nurse, come in
contact with nobody but members of the family, and no fever of
ny description was prevailing for several miles around. At
ength the father remembered that about a week before he had
dsited a little girl under scarlatina in an adjoining parish; had,
n the act of engaging in religious conversation, sat by her bed,
aken her by the hand, rubbed his clothes on the bed-clothes of
le patient in a word, had quite unconsciously done everything
ikely to saturate his own clothes with infection ; after which, the
light being cold, he wrapped his great-coat firmly around him
lus idadvertently preventing its dispersion mounted his horse
nd trotted home at a rapid pace. On reaching home, he threw
(ff his great-coat, drew in his chair to a comfortable fire, and as
ny fond parent would be apt to do, forthwith got both of the
hildren perched upon his knee, little dreaming of the poisonous
present a father's love was unconsciously bestowing. That this
ras the mode of communicating the disease was evident by a pro-
ess of exact calculation ; for the infection of scarlatina lurks in
lie blood about five days before the fever shows itself; and on

,i Use of Chloroform in Retention of Urine. [October,

calculatiDg five days back from the onset of the fever, we were
brought exactl}^ to the time when the iacident occurred.

If two pieces of cloth of the same material, the one hlack^ and
the other white^ were, in equal circumstances, and for the same
length of time, exposed to infection, the black cloth would be far
sooner saturated with it than the other. We have here some-
thing analogous to the well-known law about the absorption of
heat. As dark objects absorb heat more powerfully than white
ones, so do they also more readily absorb infection, and all kinds
of smells. Hence the mere fumigation of closes and wynds in
epidemic seasons is not enough ; they are afterwards very proper-
ly whitewashed. Hence also the wholesomeness of light as well
as air in the dwellings of the poor, and of all those measures of
cleanliness and comfort which the whiting-brush is able to impart.
The haunts of infection realize those conditions with which child-
ish fancy clothes the haunts of spectres. Dark and cheerless are
its favorite dens. The "bleezmg ingle and the clean hearth-
stane," it seems to shun ; but lurks and lingers in the gloomy ho-
vel, fattens on its dirt, and in the crevices of its smoked and dingy
walls finds those most congenial nestling-places which it cannot
find in the plastered, whitewashed, smooth and shining walls of
cleanliness. Its fittest emblem is that mysterious plant, the dead-
ly nightshade, which loves the darkness rather than the light, and
luxuriates less abundantly in sunshine than in gloom.

Use of Chloroform in Retention of Urine.

An intemperate cabman, aged 52, was admitted into a medical
ward at Guy's a few days ago, on account of chest symptoms. It
appeared that he had had gonorrhoea twelve years before, and had
ever since had more or less difiiculty in passing his water. After
having been in the hospital nearly three weeks, he vvas seized with
retention of urine. The dresser and house surgeon made patient
and repeated attempts to pass a catheter, but without result. There
was little doubt that the stricture was a permanent one, which had
been closed by inflammation. In February the retention had be-
come complete for two days; the symptoms were becoming very
urgent, and Mr. Cooper Forster was accordingly called to see him.
Opium had been most freely given. Having failed in persevering
attempts to introduce a No. 2 catheter, Mr. Forster determined to
administer chloroform, and, if needful, to puncture the bladder by
the rectum. When completely insensible, another trial was made
with a No. 3, which now passed most readily. We cite this case
as important, because it proves beyond dispute the influence of the
anaesthetic state in relaxing an otherwise impermeable stricture.
An opiate treatment had been fairly tried before, and had failed,
and the catheter had also been found useless in the hands of sev-

1857.] Editorial. 633

eial well practised surgeons. The plan of administering chloro-
form in cases of obstinate stricture and retention, is one in wide
use, both in hospital and private practice; but, as it is not yet in
such general favor as it deserves to be, we have thought that so
pointed an example of it5 advantages might be worth bringing
before our readers. \_Med. Times and Gazette,

EDITORIAL AA^D MISCELLANEOUS.

Professor Eve's Report. In consequence of the severe illness of his
son-in-law, Dr. Walton, while away from home, Dr. Eve was compelled
to be absent in North-Carolina, just at the time when his Report was part-
ly in type, and thus its preparation for publication was interrupted ; which
we greatly regret, both on account of the cause our friend's illness and
the effect it has had, of depiiving us of the continuation of this paper.
We take pleasure in informing our readers, that Dr. Eve and Dr. Walton,
have both returned home the latter improving in health and that, we
hope, to furnish them with the remainder of that valuable document in
our next number.

Dr. J. F. E. Hardy. In the above connection, we esteem it a privilege
to be able to record an instance of professional courtesy and brotherly
love, which even in our courteous, liberal and loving profession, has met
with few parallels. Dr. J. F. E. Hardy, near Ashville, jS". C, was called to
see Dr. Walton, a perfect stranger and unconnected, save by the bands of
Medicine ; he removed him from his hotel to his home, with the tenderest
care, where he watched over him with paternal solicitude he and his
kind family anticipating every desire of the sufterer with lavish generosity,
and supplying the places of home and oi friends in the nearest significance
of those, to an invalid in a strange land, most endeaiing terms. We learn,
that this noble and philanthropic man, whom we are proud to call brother,
was prevented from even accompanying Dr. Walton, on his way home,
only by a press of business.

Professor Juriah Harriss. At the close of the last course of Lectures
in the Medical College of Georgia, Dr. Harriss, at that time Prosector to
the Professor of Surgery in this Institution, was elected io the Chair of
Physiology in the Savannah Medical College, vice Professor Martin, resign-
ed. The above chang-e occurred just about the time of our assuming
I editorial charge of this journal, and has thus, till now, passed unrecorded
= by us. Our friend, Dr. H., is well known to the readers of this journal by
I certain able Surgical and Physiological papers in its former volumes.

634 Miscellaneous. [OctxDber,

Physiology, we believe, was ever his favorite branch, and we congratulate
our friends, his colleagues, upon being able, so promptly and satisfactorily,
to fill the breach made by the resignation of Prof. Martin.

An Exposition of the Signs and Si/jnptoms of Pregnancy : with some other
Papers on subjects connected with Midwifery. By W. F. Montgomery,
A.M., M.D., M.R.LA., Ex-Scholar of Trinity College, Dublin; Professor
of Midwifery in the King and Queen's College of Physicians in Ireland,
&c., &c., from the second London edition. Philadelphia : Blanchard &
Lea. 185Y.

This is a new edition of Dr. Montgomery's well known work on the Signs
and Symptoms of Pregnancy, carefully revised and considerably enlarged ;
with a number of able essays on important subjects connected with ob-
stetrics.

We do not think it is claiming too much for this work to say it is the
very best in print on the signs and sjmptoms of pregnancy, and that it is
as perfect as a book well can be. It is only to be regretted that the Ameri-
can edition has not the beautiful colored plates, shewing the successive
changes in the areola caused by pregnancy from the third to the ninth
month, which are found in the original English work ; but a very good
reason is assigned by the American publisher.

The first eight chapters are devotod to the signs and symptoms of preg-
nancy.

The subjects of the other five chapters are:

*' Chapter IX. Examination of Substances expelled from the Uterus. An
early Ovum. Decidua. Moles. Hydatids. The Membrane formed in
Dysmenorrhoea, and in other Conditions of Uterine Derangement. Mem-
branous Formations from the Vagina.

" Chap. X. Accidental Circumstances. Idiosyncracies. Beccaria's Test.
State of the Blood, Urine, and Pulse. Kyestein. Vaginal Pulse.

" Chap. XL Pregnancy under unusual Circumstances. At a very early or
advanced Age. Complicated with Diseases affecting the Uterine Sys-
tem. With Extra-uterine Foetus. Without Consciousness of Inter-
course. Without Sexual Sensibility. After Imperfect Intercourse.
With a Secondary Ovum. With a Blighted Ovum.

"Chap. Xn. Spurious, or Simulated Pregnancy. Imitative Labor.
Phantom Tumor. Unnecessary Gastrotomy. Heim's Extraordinary
Case. Theories of Schmitt and Harvey.

" Chap. Xin. Investigation after Death. Examination of the Uterus and
its Appendages. The Ovaries. Corpora Lutea. Fallopian Tubes.
Antrum Tubse.

" On the Period of Human Gestation. The Natural Period. Premature
Births. Viability. Protracted Gestation. Tables.

" On the Signs of Delivery. Delivery during Natural Sleep. Examination
after Death. Fatty Degeneration, and Reconstruction of the Uterine
Substance. Uterine Contraction after Death. Posthumous Parturition.

1857.] Miscellaneous. 636

" On the Spontaneous Amputation of the Foetal Limbs in Utero, and some
other I'atholog-ical Lesions, to which the Child is liable before Birth.
Rudimentary Reproduction of Lost Parts. Fractures. Wounds. Ef-
fects of Coherent Placenta."

These are all very interesting subjects, treated in the most able and mas-
terly manner, by an elegant writer and an accomplished physician, who is
deservedly regarded among the highest authorities in every thing that ap-
pertains to obstetric science and practice. J. a. e.

On the Diseases of Women ; including those of Pregnancy and Childbed,
By Fleetwood Churchill, M.D., T.C.D., M.R.LA., Vice-President and
Fellow of the King and Queen's College of Physicians in Ireland ; one of
the Presidents of the Obstetrical Society ; Professor of Midwifery, with
Diseases of Women and Children, in the King and Queen's College of
Physicians in Ireland ; Associate Member of the College of Physicians of
Philadelphia, U. S., &c., &c. A new American edition, revised by the
author. W^ith Notes and additions, by D. Francis Condie, M.D., Fel-
low of the College of Physicians, Philadelphia, &c., &c. Philadelphia :
Blanchard & Lea. 1857.

Soon after the publication of Dr. Churchill's book, on Diseases of Females,
in America, we adopted it as a text-book, believing it to be, though not the
largest, the most comprehensive and systematic work on the subject in the
English language. For some years past, a revised edition has been needed
with the more recent improvements. We hail wnth mucb pleasure the
volume before us, thoroughly revised, corrected, and brought up to the
latest date, by Dr. Churchill himself, and rendered still more valuable by
notes, from the experienced and able pen of Dr. D. F. Condie, of Philadel-
pbia.

Dr. Churchill and his works are too well known to the Profession in the
United States to require any commendation : a simple announcement is
sufficient.

This is certainly as complete a resume of all the latest and best informa-
tion on all the diseases to w^hich w-omen are ever subject, as could be
desired by pupil or practitioner. W^e have requested our friends, Messrs.
T. Richards & Son, to have an ample supply on hand before the commence-
ment of our next course of lectures. j. a. e.

Death of Dr. Marshall Hall. In recording here, from the London
fjancety the melancholy intelligence of the death of Marshall Hall, we are
filled with feelings of deep regret. Science has indeed lost one of her most
ardent and successful cultivators Medical Philosophy her most able ex-
positor, and mankind a long-tried friend and benefactor.

Our recent interesting relation to Dr. Hall, and his fair and generous
relinquishment of his claims to a Physiological discovery, in our favor, had

636 Miscellaneous. [October,

endeared him to us, and heightened the regard which we had ever enter-
tained for him. It will henceforth be to us a most consoling reflection that
in the whole of this discussion above referred to, our sentiments and ex-
pressions towards this illustrious leader in Science, were ever characterized
by the high regard and reverential respect which he inspired.

Death, that most unsparing of tyrants, has exacted from the greatest
physiologist of the age the last debt of nature. Slowly, surely, and relent-
lessly, disease has been undermining the earthly tabernacle of a mind which,
for vast powers, high purposes, and indomitable energy, has found no supe-
rior in its native land in the present half-century. On Tuesday last, the
11th inst.. Dr. Marshall Hall died at Brighton, aged 67 years.

It is impossible to record this melancholy event without feelings of the
deepest sorrow. The loss is one which all must feel most keenly w^ho have
a reverence for high endeavors, for earnest devotion to science, and for all
the sterling qualities which can adorn a man. Science has lost the wor-
thiest of her sons, medicine has lost a great master, and philosophy a great
thinker. The clear and vivid intellect of this celebrated man has steadily
and successfully risen superior to the depressing influences of disease for the
last fifteen years. Even during the present year, when confined to one
room, his chamber has been a scene of intellectual activity. Physical de-
bility, which robs most men of their power of thinking and reasoning, had
not dimmed the brightness of his wonderful mind. Clear and penetrating,
and impelled by a wide philanthropy, the last contribution of Dr. Marshall
Hall to science has been a preeminently useful one to the cause of humani-
ty. It is thus that great men should die. There is a grandeur in such a
life-end, to which the mere external grace of a falling Caesar is not for one
moment comparable.

Dr. Marshall Hall w^as born at Bashford, in Nottinghamshire, in the year
1790. His father was a manufacturer, and a man of no small capacity
and information, and had the merit of being the first person to perceive
the value of chlorine as a decolorizing agent, and applying it on a large
scale. The gifts of intellect were bestowed with no sparing hand in this
family. The father and two sons fully vindicated their claims to high in-
tellectual endowments. But Dr. Marshall Hall has eclipsed his less brilliant
relations. What in them was acumen and sagacity, was developed in him
into genius. There was in him that rapid and far-searching intellectual
vision which travels into regions far beyond the common ken of man,
visible and appreciable only to the eagle glance of an almost prescient
inquirer.

The history of such a man cannot fail to present numerous points of in-
terest. The investigation of the rise and progress of a mind which has
ever been foremost in the ranks of science, must aflford many good and
useful lessons. No fitful glare can be recognized in this life no charlatanic
attempt to pluck a crown of laurels which was not deserved ; but a stern,
conscientious, and faithful continuance of patient scientific toil, and the
solid reward of a vast reputation.

The first step in Dr. Marshall Hall's education was taken at Nottingham
Acaderav, then conducted by the Rev. J. Blauchard. From this school he
went to Newark, where he acquired some elementary medical and chemi-
cal knowledge. But the fii'st salient point in the life of Dr. Marshall Hall

1857.] Miseellaneous. 637

was his matricuhition at Edinburo'li University, in the year 1809. For a
vigorous and apt mind, no better school coukl then have been chosen. In
the present day it is hardly possible to realize the enthusiasm which inspired
Edinburo-h at that time. There were o-iants in those davs. Enthusiasm,
indeed, is almost too tame a word. There was a furor, an excitement pro-
duced by the united intluence of a complete galaxy of talent. It was im-
possible but that such men as CuUen, Home, Rutherford, Gregory, Hamilton,
Bell, and Barclay should kindle in the ardent minds of a vast concourse of
students a flame which should burn with answering brightness to their
own. From the school of that time we know many gi-eat men have sprung.
It is unnecessary to particularize names which are "familiar in our mouths
as household words." In that genial atmosphere, then, did Marshall Hall
first imbibe that enthusiastic love of science which has been his most mark-
ed characteristic. With youthful impetuosity he plunged into the study
of chemistry. Not content with merely assimilating the accepted doc-
trines of the science, he boldly endeavored to push its boundaries farther.
With wonderful power of generalization for so young a man, and with such
small materials as then existed for the purpose. Dr. Marshall Hall pointed out
that there was a grand distinction between all chemical bodies, which ruled
their chemical affinities. He showed that this distinction was the presence
-or absence of oxygen. That oxygen compounds combined with oxygen
compounds, and compounds not containing oxygen with compounds simi-
larly devoid of that element ; and that the two classes of compounds did
not combine together. He believed that this general law would elucidate
other chemical doctrines, and might prove valuable in the prosecution of
still more recondite principles. But a mind of such soaring aspirations
was not likely to confine itself even to such a comparatively wide field as
chemistry. The vast domain of medicine was before our student, rich in
unexplored regions, abounding in all that could excite his eager spirit of
inquiry, and reward his love of definite results. It was exactly at this pe-
riod in the history of modern medicine that physicians were taking stock,
as it were, of their old principles. Morbid anatoni}^, pursued in close con-
nection with clinical medicine, was showing the defects of diagnosis. With
the sagacious eye of one w^ho was capable of seeing that the great necessity
of the day was a science of diagnosis. Dr. Marshall Hall threw himself into
the prosecution of this immensely important department of medicine at
once. Here again we find fresh evidence of his eminently progressive
spirit. Ko mere systematizing of wdiat other men had gathered, but an
original and comprehensive treatise resulted from the labors of his student
life and early years in the profession.
! In 1812 Marshall Hall took his degree of M. D., and shortly afterwards
was appointed to the much-coveted post of house-physician, under Drs.
Hamilton and Spens, at the Royal Infirmary of Edinburgh. In the follow-
ing year we find Dr. Hall lecturing on the Principles of Diagnosis to a class,
amongst whom w^ere Dr. Robert Lee and Professor Grant. It was from
this course of lectures that the treatise on Diagnosis, which was first pub-
lished in 1817, took its origin.

In 1814 Dr. Marshall Hall left Edinburgh, after a residence there of five
years. Great as was the individuality of this remarkable man, we cannot
but point out that he was reared in a great school, taught by great men,
and infected with an enthusiasm which pervaded, in some degree, all who
^ame within its magical circle. Before entering upon his career as a pri-

688 Miscellaneous, [October,

vate practitioner, Dr. Hall determined to visit some of the continental
schools. We find him, therefore, shortly after his departure, successively
at Paris, Berlin, and Gottingen. The journey was made partly on foot,
and armed. At Gottingen Dr. Hall became acquainted with Blumenbach.

In 1815, Dr. Marshall Hall settled at Nottingham as a pnysician, and he
speedily acquired no small reputation and practice. After a time, the ap-
pointment of physician to the General Hospital there was conferred upon
him, and in that sphere he labored until his removal to London, about ten
years after his first settlement at Nottingham. Of his work on Diagnosis
it is almost unnecessary for us now to speak in terms of praise. Compre-
hensive, lucid, exact, and reliable, this work has, in the main, stood the test
of forty years' trial. A better has not been produced. It was at this period
of his career, too, that Dr. Hall made his researches into the effects of the
loss of blood, the result of which was embodied in a paper read before the
Royal Medical and Chirurgical Society in 1824. This paper and another
in 1832, detailing Dr. Hall's "Experiments on the Loss of Blood," were
published in the " Transactions of the Royal Medical and Chirurgical So-
ciety." It is hardly possible to overrate the importance of these inquiries.
They revolutionized the whole practice of medicine. A new light broke
in upon the medical world. A distinction, not recognized before, was
drawn between inflammation and irritation. It was pointed out that de-
lirium and excitement were by no meansnecessarilydeclaratory of cerebral
or meningeal inflammation, or even congestion. Loss of blood was shown
to be at the root of much that had passed before for various grades of in-
flammation. Practical rules were educed both for treatment and diagnosis.
It was shown that active inflammation produced a tolerance of bleeding
from a free opening in the upright posture ; and the rare merit of supply-
ing at once a rule of treatment and a rule of diagnosis was Dr. Marshall
Hall's. Other works came forth from his pen about this time, for his mind
was teeming with ideas, and his activity as an observer was unparalleled.
It is hardly possible to enumerate all, but in 1827 came the "Commenta-
ries upon various Diseases peculiar to Females " a work which may still
be consulted with advantage.

It was in 1826 that Dr. Marshall Hall sought this great metropolis as
the umbilicus of the world. So active and earnest a mind could not find
enough to satisfy its eager cravings in a provincial town. It w^as here, in
this mighty city, that he determined to measure himself again with numer-
ous competitors, and to win, if possible, all the honor and all the rewards
that fortune can give to those who woo . her stoutly. The mind of this
great man was essentially metropolitan and liberal. A fair field and no
favor, and victory to the strongest, were the characteristics of his mind.

The next onward step in Dr. Marshall Hall's career was a series of re-
searches into the circulation of the blood in the minute vessels of the batra-
chia. A great step in physiology resulted from these. It was shown that
the capillary vessels, properly so-called, are distinct, absolutely, both in
structure and function, from the smallest arteries or veins ; that the capil-
laries, or methcemata, are the vessels in which the nutritive changes in the
economy ai:e carried on.

But the great source of Dr. Marshall Hall's honor, the basis upon which
his fame must rest in all time to come, was yet undeveloped ; his paramount
claims to the admiration of his cotemporaries and of posterity consists in
his discoveries concerning the nervous system. Like ail really important

1857.] Miscellaneous, 639

discoveries in natural science, those of Dr. Marsliall Hall have had great
practical effects. The soundest theory has been shown to be the best
foundation for practice. That stupid heres)'-, that there is a vital distinc-
tion between the practical and theoretical man, was never more completely
disproved than in the case of Marshall Hall. But we must endeavor to
trace the progress of his researches. While engaged on the ICssay on the
Circulation of the Blood, it happened that a triton was decapitated. The
headless body was divided into three portions : one consisted of the ante-
rior extremities, another of the posterior, and a tliird of the tail. On irri-
tating the last with a probe, it moved and coiled upwards ; and similar
phenomena occurred with the other segments of the body. Here, then,
was a great question. Whence came that motor power ? To set at rest
that question, to solve that problem, has been the great labor of Dr. Mar-
shall Hall's life.

The establishment of the reflex functions of this spinal cord ; in short,
the whole of the excito-motor physiology of the nervous wSy stem is the sole
work of Dr. Marshall Hall. And not only this, but he has shown that
there are in reality three great classes into which the various parts of the
nervous system resolve themselves; the cerebral, or sentient-voluntary;
the true spinal, or excito-motor ; and the ganglionic. This was the real
unravelling of that perplexed and tangled web which none had before been
able to accomplish. The true idea of a nervous centre could never be said
to have existed before the time of Marshall Hall. The ideas of centric and
eccentric action, of reflexion, &c., so necessary to the comprehension of
nerve-physiology, were unknown before the labors of this great discoverer.
But these physiological discoveries were not mere barren facts. How rich
a practical fund of therapeutical measures naturally follows the physiology
and pathology of the excito-motor system, every well informed physician
can testify. Two departments of medical practice have gained incalcula-
bly. The success of Dr. Marshall Hall in the treatment of nervous diseases
was almost entirely the result of a rigid application of his own physiologi-
cal discoveries to their pathology and therapeutics. Obstetricians have
found their art elevated more than any other branch of medicine. In the
place of uncertain and empirical rules, there are now definite and scientific
principles upon which to fall back, with the unhesitating assurance that
they will stand in good stead. The most complicated of all physiological
acts, viz : the act of parturition, has, by the aid of the excito-motor system,
been unravelled and reduced to beautiful harmony, if not simplicity. In
hke manner, many of the diseases of pregnancy are explained and illumina-
ted by the same physiological knowledge. Innumerable symptoms of
other diseases are rendered intelligible and rational, which before were
obscure and empirical. But to follow out the influence of Dr. Marshall
Hall's discoveries through their numerous and important ramifications
would be almost to write a volume on the principles of medicine. It is
impossible to say when we shall cease to find some new and important
application of his discoveries to the great art of healing.

We cannot pass by this period of Dr. Marshall Hall's life without re-
marking upon the disgraceful treatment he received from the Royal Society.
The days of persecution had happily passed by, but the day of dull obstruc-
tiveness still remained. The Royal Society thought Dr. Hall's memoir
" On the True Spinal Marrow^ and the Excito-Motor System of Nerves"
jmworthy of publication ! So much for the acumen of this Society. A

640 Miscellaneous, [October,

very different verdict has, however, been given since by the great body of
scientific men ; and the Society, Avhich formerly received this great man's
contribution coldly, now mourns the loss of its brightest and most illustri-
ous member.

Since the promulgation of his researches upon the nervous system. Dr.
Marshall Hall has been principally occupied with extending, applying, and
developing them in every possible direction. The admirable success with
which he indoctrinated the profession at large with his views must be at-
tributed as well to his native lucidity as to their inherent truth.

During the time of Palmer's trial, it occurred to Dr. Hall to institute a
physiological test for the recognition of strychnia. As if to show the abso-
lute correctness of his views, and ho\v unlimited were the number and
nature of the scrutinies they would bear, he found that a frog, immersed
in water containing the joVo P^^'^ ^^ ^ grain of strychnia, would, in process
of time, be thrown into tetanic convulsions. For the details of these expe-
riments we must refer to The Lancet of last year. The physiological test
was found to be far more delicate than the chemical. Here was an instance
of sagacity and precision of thought which would have done credit to any
man in the flower of his age.

The last and crowning effort of Dr. Marshall Hall in the cause of science
and humanity has been his discovery of what is now universally known as
the "Marshall Hall Method" of restoring asphyxiated persons. How
completely and irrefragably he has proved the inutility and danger of the
practices hitherto in vogue for the resuscitation of asphyxiated persons !
Space prevents us from going into the theoretical details of Dr. Marshall
HalFs method ; but our columns have, for any time these last six months,
contained overwhelming proofs of its tnith and adaptation to practice. It
is pleasing to find that this last labor of a great mind has been a labor of
love, something added to the stock of human happiness, something taken
away from the bitterness of life. It is singular enough that in the veiy
place where Marshall Hall has drawn his last breath, two cases have lately
occurred illustrating the superiority of the ''Marshall Hall Method" over
the empirical rules of the Royal Humane Society. In one case of drowning
the warm bath was administered ; in another, the " Marshall Hall Method."
was resorted to: in the first case death was the result; in the second, re-
storation to life. It is also remarkable that in this number of our journal
should be recorded three more examples, illustrative of the successful appli-
cation of the " Marshall Hall Method " of treatment. It is curious, too,
that one of them should have occurred at Xottingham.

In the practice of his profession, Dr. Marshall Hall was very successful.
He linked himself early and resolutely to a great subject, and rose into
fame upon his development of it. He realized an ample fortune as the
reward of a life of unremitting toil. We do not mean to imply that com-
petency was hardly earned under such conditions. Such a man would
have been less than*^happy in a different sphere. Labor was to his restless
and indomitable spirit a necessity. Even now, when we are recording the
death of this illustrious and lamented physician, there is a volume in the
pi-ess, a recent effort of his prolific mind ; and until within two months
before his dissolution, the mental energies of this extraordinary man were
engaged in preparing for publication, in " The Lancet^ a series of papers,
entitfed, "The Complete Physiology of the Nervous System."

It is somewhat remarkable that Dr. Marshall Hall never held the oflice

1857.] Miscellaneous, 641

of physician in a hospital in London. He was only physician to a dispen-
sary for a short time. He lectured at the Aldersgate-street and Webb-
street School of Medicine, and also at St. Thomas's Hospital Medical School.
He was a candidate for the Professorship of Medicine at University College
upon one occasion ; but owing, it is believed, to some improper influences,
matters assumed such an aspect as to induce Dr. Hall to retire from the
field.

We have thus far considered Dr. Hall as a man of science. In otlier
relations of life he was equally deserving of our highest respect. As a politi-
cian, he was liberal in the highest degree. He was a strictly moral man,
and was deeply imbued with a sense of the obligation of a practical culti-
vation of religion. That which he thought right to do, he did^ with un-
swerving honesty and courage. All subterfuge, tricker}-, quacker}^, and
guile, were utterly foreign to liis nature. So simple and childlike was he
in disposition, as hardly to be able to imagine in others the guile which
had no home in his own breast. He was a kind husband, a most indulgent
father, and a faithful friend. He married, in 1829, Charlotte, second
daughter of Valentine Green, Esq., of Normanton-le-Heath, Leicester-
shire. Mi's. Marshall Hall's maternal grandfatlier was M.P. for Shaftesbury,
and son of Dr. Cromwell Mortimer, physician to the Prince of Wales, father
of George HI. Throughout the protracted illness of Dr. Marshall Hall, the
assiduous, devoted, and unremitting attentions of an affectionate wife were
probably never surpassed. This testimony is due from personal observa-
tion of the fact. The deceased has left one sou, who has relinquished the
profession for the rural life of a country gentleman.

We must now close our notice of one over whose name we would fain
linger. Melancholy as it is to say he loas among-st us, our sorrow is staved
by the reflection that he did not live in vain. All that a grateful profession
has to give to his memory will be given. We shall still think of him with
affectionate respect as a Father in Medicine, but as a child in the purity
and simplicity of his mind. Though no title has adorned the name of the
great Marshall Hall, we who are left behind will esteem him as one who
would have graced rather than have been graced by honors however exalt-
ed. The title^ which he preferred beyond all others was that of the En2:lish
physiologist.

The mortal remains of this distinguished man w-ere, on Wednesday last,
removed from Brighton to Nottingham, where, we believe, a post-mortem
examination has been made by his brother-in-law, Mr. Higginbottora, his
nephew, Mr. Higginbottom, Jr., and Dr. Ransom, physician" to the Notting-
ham General Hospital. It is believed that the death of Dr. Marshall Hall
was caused by exhaustion produced by a stricture of the oesophagus of
many years' standing, accompanied latterly, it was considered bv many
eminent surgeons, with malignant ulceration of the part. Dr. Alfred Hall,
of the Old Steyne, Brighton, was one of the chief medical attendants of the
deceased in his last illness. Sir Benjamin Brodie had long since pro-
nounced tlie malady from which Dr. Marshall Hall was suffering to afford
no hope of the application of any permanent remedy.

Sulphate of Zinc and Nitrate of Silver in Chronic Ophthalmia. Dr.
Posta endeavors to lay down some rules, based on practical experience,
respecting the employment of these substances. In all ophthalmias, the
zinc should be employed as soon as the chronic stage commences, the pro-

642 Miscellaneous.

portion being at first 1 part to 75 of the vehicle, going on in case of resist-
ance of the disease to 2 to 100. When there is a slight degree of chronic
keratitis present, with cloudiness of the cornea, the nitrate (1-20 part to 30
parts) is the preferable means. He considers that all greater strength than
this is unjustifiable and mischievous. [^Bull. de Therap.^ and Peninsular
Journal of Medicine.

Gonorrhoea. Mr. Dallas, of Odessa, confirms the statements of Taddei,
Marchal and others, that copaiba injections afford the most efficacious
treatment of gonorrhoea. He reports sixteen cases cured, without internal
remedies, by repeated injections of the following mixture : Copaibse, dr. 5 ;
vitell. ovi unius ; ext. opii, gr. j ; aqu?e, oz. vij. Dr. Henry Hancox (Lan-
cet, Aug. 1856) pronounces buchu as eftectual as copaiba in the treatment
of gonorrhoea. [Med. Chir. Rev.

Climate in Consumption. Dr. Hays, by request, gave his views to the
Ohio State Medical Society in regard to the treatment of chilblains, frost-
bites, &c. In the course of his remarks, he said that in the expedition to
the Arctic regions with Dr. Kane, he had never seen a case of tubercular
disease among the natives, and heard of but one case of haemorrhage from
the lungs. "If he had a consumptive patient, he would send him to
Greenland, if possible, and put hira upon train oil diet, with a dog sledge
and a bear hunt for exercise." Boston Med. and Surg. Jour. ' "

Wholesome Bread. A large company has been formed in London for
the manufacture and sale of perfectly genuine flour and bread. A mill of
enormous capacity has been secured, and the dongh will be kneaded by
machinery, exposed to public view while in full operation. All the analyti-
cal arrangements will be under the immediate personal supervision of Dr.
Hassall. A capitalist, an experienced miller, is so confident of the com-
mercial success of the company, that he has engaged to embark in it no
less than fifty thousand dollars. \lh.

Lilac Leaves as a Febrifuge. M. Macario having been induced to try
these in intermittent fever, owing to a popular reputation they had acquired
in Flanders, found that of 20 cases, 13 Avere entirely successful, ai^d 7 failed.
In some of the former, quinine or arsenic had failed. A decoction of the
leaves was administered fasting, during five or six days in succession.

Bev. Med., and Peninsular Jour, of Med.

Sesquichloride of Iron in Hemorrhages. Dr. Herzfelder quite confirms
the good accounts of this given by the French practitioners, as a most
valuable agent in various kinds of internal hemorrhage, and far superior to
ice, alum, tannin, etc. He dissolves a scruple in 4 ounces of water, and
g'ives a spoonful every quarter or half hour. Dr. Raith confirming this
account, and especially as regards uterine hemorrhages, prefers the tinct.
ferri sesquichl., as the watery solution is very nauseous. \Buchner'8 Bepert
and Nashville Jour, of Med. and Surg.

SOUTHERN

MEDICAL AND SURGICAL JOUEIAL.

(NEW SERIES.)

Vol. nil.] AUGUSTA, GEORGIA, NOVEMBER, 1857. [No. 11.

ORIGINAL AND ECLECTIC,

AKTICLE XXXh

A Report on Diseases of the Cervix Uteri. By JoSE?H A Ev, M. B.^
Professor of Obstetrics and Diseases of Women and Children, in
the Medical College of Georgia. (Read before the Medical So"
ciety of the State of Georgia, at the Annual meeting in Augusta,
April, 1857, and ordered to be printed.)

[Concluded from p. 627, Sept. No.]

With respect to the third point the Treatment there is great
difference of opinion ; some consider no special local treatment
necessary, and look upon medical treatment alone as sufficient for
the cure of inflammation and ulceration of the cervix, whilst
others regard this as altogether inadequate, and believe local sur*
gical applications essentially requisite.

For many years my reliance was almost exclusively on medical
treatment, with the prescription of vaginal injections, blisters,
eupg, etc., to the sacrum and loins j my success was only partial
and very unsatisfactory such cases frequently relapsing, and re-
:juiring a repetition of the same remedies; whereas, since the
urgical, or what has been styled the medico-chirurgical treatment
)f simple inflammation and ulceration of the cervix has been
adopted, such cases are undertaken with more confidence andcer-
lainty of cure, than any other class of chronic diseases; their ra-

N.S. VOL. Xin. NO. XL 41

644 Eve, on Diseases of the Cervix Uteri. [November,

covery being only regarded as- a question of timey depending on
proper perseverance on tlae part of the patient.

I would hre ask permission to make a longer extract from Br.
West's- Croonian Lectures than I am ever wont or willing to make^
aot only oq account of the high rcwspect I entertain for his talents-
and candour^ but because his views are so plausible that they are
well calculated to mislead any mind not strongly fortified by pre-
vious experience, l^o one for a moment can doubt Dr, West's
sincerity ^he has an eye single for truth ; he desires nothing else ;
he is actuated by the purest and noblest motives; he has no- other
aim or object but to promote the cause of science and humanity p
but he is unfortunately biased by preconceived opinions: or our
experience and observation have,, at least,, led us to very different
conclusions.

Dr. West says, (page 81,) "It may,, however,, be asked',, how is
it that such successful results have followed a course of treatment
directed exclusively to the cure of the ulceration that the appli-
cation of caustics to the os uteri has been succeeded by the restora-
tion of the patient to health? Now, I think it should be borne
in mind that^ in connection with this mode of treatment, various
other measures are of necessity adopted, eminently calculated ta
relieve many of the slighter forms of uterine ailment. The marri-
ed woman is for a time taken from her husband^s bed; the severe-
exertion to which either a sense of duty urged,., or a Tove of pleas-
ure prompted her, is discontinued ; while rest in the recumbent
posture places the uterus and the pelvic viscera in just that posi-
tion,, in which the return of blood from them encounters the small-
est difficulties. The condition of the bowels,, probably before-
habitually neglected, is now carefully regulated,, and the patient's-
diet, bland,, nutritious, and unstimulating, often differs widely
from that with which, while all her functions were overtaxed, she
vainly strove to tempt her failing appetite. Add to this, that the
occurrence of the menstrual period is carefully watched fo-r; that
all precautions are then redoubled,, and each symptom of disorder^
such as on former occasions had been borne uncomplaininglyy
though often not Vtrithout much suffering,, is at once encountered
by its appropriate remedy ; while generally returning convales-
cence is met in the higher classes of society by a quiet visit to the*
country, o? to some watering-place, in pursuit not only of gayety,.-
but of health- and we have assembled just those conditions best,

1857.] Eve, on Diseases of the Cervix Uteri, 645

fitted to remove three out of four of the disorders to which the
sexual system of woman is subject. But the very simplicity of
these measures is a bar to their adoption ; for you will bear me
out in saying, that the rules which common sense cannot but ap'
prove, but which seem to require nothing more than common
sense to suggest them, are just those to which out patients least
readily submit. The case is altered, however, when these same
rules are laid down not as the means of cure themselves, but only
as conditions indispensable to the success of that cauterization
which, repeated once or oftener in the week, is the great remedy
for the ulceration that the doctor has discovered, and which he
assures his patient, and with the most perfect good faith^ produces
all the symptoms from which she suffers. The caustic used in
these milder cases is the nitrate of silver ; the surface to which it
is applied is covered by a thin layer of albuminous secretion^
which it is not easy to remove completely, and which serves
greatly to diminish the power of the agent, while the slightly
stimulating action that it nevertheless exerts seldom does harm,
sometimes, I believe, does real good, though no more than might
have been equally attained by vaginal injections, or other similar
remedies, which the patieiit might have employed without the
intervention of her medical attendant."

When my treatment of such diseases consisted of internal
remedies, external applications and vaginal injections, without
cauterization, all those measures, which Dr. West considers of
themselves so potent to cure, and on which he thinks success
mainly depends when caustics are used, were enjoined and en^
forced, as far as was at all practicable. However unpleasant an
allusion to the subject might be, I was very particular in reference
to the first measure } but since cauterization is employed it is
deemed unnecessary to interfere with " family affairs ;" it is pre-
sumed, if sensible, they will at least be temperate, and if otherwise,
injunctions would not avail: moderate indulgence does not ap-
pear to exercise an injurious influence, unless it excites pain or
causes hemorrhage, which would be apt to result soon after cau-
terization, and which thus itself becomes, to some extent, a barrier
to excess. Dr. Bennett says, in reference to inflammation and
ulceration of the neck of the uterus, "it is scarcely necessary to
add, that during the treatment of this form of disease, separation
of the husband and wife should be strictly enforced."* This is

* Bwmett on the Utems, p. 264.

646 Eve, on Diseases of the Cervix Uteri. [November,

doubtless requisite, when the stronger caustics are employed; but
it is certainly not absolutely necessary, when nitrate of silver only
is applied at weekly or even longer intervals.

In reference to the treatment of leucorrhoea, which is tantamount
to that of inflammation or ulceration of the cervix, inasmuch as in
most cases of lencorrheea the pathological condition is inflamma-
tion of that part, with or without ulceration,. Dr. Tykr Smith
remarks : " Absolute separation should never be advised except
for good and sufficient reasons. In leucorrhoea intercourse s-hould
only be forbidden in the worst cases. This is one objection to
the use of caustics in mild, cases of leucorrhcea, because it is
necessary to enjoin separation w^hile they are employed. When
intercourse causes considerable pain, excites bleeding, or where
the OS and cervix are secreting pus, it is out of the question, but
its moderate "use is quite compatible with the successful treatment
of profuse mu<x)us leBcorrheea. It may be questioned whether it
does not relieve the uterus of states of congestion, which occur in
the "unmarried, and are probablj a cause o^f leucorrhoea in single
women, or in tbe married who live in separation from their hus-
bands."

According to this truly scientiflc and talented author, the pre-
sence of the husband might even prove beneficial. Since caustics
have been employed no- difference is observed in the treatment of
those whose liusbands are present and in that of the unmarried, it
or those whose husbands are absent ; before their employment, the 't
latter certainly improved faster than the former.

At present, so far from enjoining "rest in the recumbent pos- i
ture," my patients are required to take exercise in the open air .\
legularly^ and systematically, as much as they can. without in- ,
ducing pain or much fatigue. One great advantage in the treat-- U
ment by cauterization is, that it allows exercise,"^ which is-essential ^
to restoration of the general health and strength p without atten-
tion to which,, local affections, generally, are not treated to be
advantage.

The condition of the bowels, the state of the stomachy and c
tbe general system^ the regulation of diet, &c., all received as mucb^
if not m^ore,, attention,, before, than since the adoption of cauter- .
ization.. The occurrence of the menstrual period was watched
with as much care, and every symptom of disorder met by its ap-
propriate remedy as promptly heretofore as at present.
* See Tyler Smith, p. 194-195.

1857.] Eve, on Diseases of the Cervix Uteri. 647

As great reliance was uecessarily placed on internal remedies,
nothing was neglected that might tend to improve the gen-
eral health, and with it, the local condition of the uterus; no
remedy was untried that might possibly, through the general sys-
tem, act locally or specifically on the uterus. Vaginal injections
were also as full}'- and faithfully administered then, as now; for
they were regarded of primary importance.

When the cervix is coated by a layer of albuminous secretion,
it is previously washed away by injections of cold \vater, or re-
moved by a piece of cotton or soft cloth applied to that part, by
the speculum forceps through the speculum, before applying the
caustic, which is generally done thoroughly^ especially when
ulceration is present: the lightness or severity with which the
application is made must be governed by the acuteness of the in-
flammation or the sensitiveness of the part: sometimes a very
slight touch would do much good, when a more active cauter-
ization would do harm-
No one would welcome with more pleasure than myself, any
plan of treatment which would dispense with ''the intervention
of the medical attendant:" this would indeed be a great desidera-
tum an attainment in practice of inestimable value. Consulted
by patients for supposed uterine disease, I am always happy when
able to declare their apprehensions groundless and an examina-
tion unnecessary, or when an examination is indicated, that the
the case does not demand remedies which require to be applied by
the physician himself. Nor would I ever have been w^ illing to
make applications of caustics directly to the neck of the uterus,
had not all the measures, considered so efficient by Dr. West,
very often proved most unsatisfactory in serious chronic cases
after the most faithful trial.

The treatment Dr. West proposes is, doubtless, well calculated
to remove a large portion of ''the disorders to which the sexual
system of woman is subject," and the most zealous advocates of
cauterization admit the same in theory and carry it out in prac-
tice: but in confirmed diseases of the cervix, although it may
often afford temporary alleviation, it will generally at least fail to
effect a permanent cure.

In corroboration of these views, I would here make the fol-
low^ing extract from Dr. Bennett's Keview of Uterine Pathology,
page 27:

648 Eye, on Diseases of the Cervix Uteri. [November,

^' That the local lesions and the break-down of health are coH'
nected is evident from their very general co-existence ; and that
the entire removal of the local mischief is necessary for the per'
manent recovery of health, .is a fact of which I QYtrj day become
more convinced. For many years I have been living amongst a
population of invalids, presenting the two conditions. Before
they apply to me they have generally exhausted, during years,
all the resources of medical science, and have enjoyed every ad*
vantage that social me^ans and the affection and kindness of rela-'
tives can. contribute ; but all in vain, because the local uterine
mischief has been overlooked. That once discovered and remedi-
ed, they gradually rally, and are eventually restored to health.
Such, also has been the experience of very many talented practi-
tioners whom I could name, were it desirable. Nor can it be said,
as Dr. West surmises (p. 81), that these patients recovered ow-
ing to the rest and the correct medical and hygienic management
which was combined with the local treatment, the latter being a
useless concomitant of such general treatment.- All these means
have generally been tried for years, in the cases to which I allude,
by the most skilful practitioners, but in vain."

Elsewhere, Dr. B. speaks of the failure of general treatment as
the test for the necessity of local, special or surgical treatment.

In the treatment of these cases, as of all other diseases, it is a
great error to rely on any exclusive plan of treatment. When the
inflammation is at all acute, scarrification of the cervix, externally
or internally, and the direct application of leeches, are of the very
first importance ; and general antiphlogistic treatment avails much ;
also, soothing and sedative lotions, and revellents to the sacrum
and the hypogastric and inguinal regions. But when the inflam-
mation is chronic, especially when there is ulceration, nothing, in
my opinion, can be so effectual as the application of the milder
caustics directly to the inflamed or ulcerated surface. I decidedly
prefer the milder caustics, and believe the more intense are seldom,
if ever necessary in simple inflammation or ulceration : of their em-
ployment in specific and malignant affections it is not my place to
speak: of their effects in the latter, I trust we will hear from one
who I know is able to do justice to the subject ^my friend, Dr.
J. M. Green of Macon, who has been appointed by this Society to
"Vvrite a report on that subject.

J prefer the solid iSTit. of Silver, No. 1, in larger sticks than

1857.] Eve, on Diseases of the Cervix Uteri. 649

tisually found in commerce, applied by means of the speculum-
forceps, through a speculum, to the cervix externally, and intro-
duced directly into the <;ervical canal The application should
.be repeated every six, seven or eight days, avoiding menstrual
periods, and two days before and after. M. Lisfrance says, " the
caustic is not to be applied within four or five days of the appear-
ance of the menses, and for three or four days afterward." This
is eertainl}^ not necessary in using the nitrate of silver; two days
before and after are amply sufficient : indeed I have known it
two or three times applied during menstruation, without any un-
pleasant consequences, but would not advise it except under very
peculiar circumstances.

For the application of the caustic a long slender pair of forceps
answers best; for by it the caustic may be held at any angle,
more -accurately and uniformly applied to the cervix, and intro-
duced with greater facility into the cervical canal. Ever since
1848, I have been in the habit of thus introducing the solid caus-
tic into the cervical canal, some years before I remember to have
seen it recommended by any one else.

On reference to an American edition of Dr. Bennett's work,
published in 1853, which, however, I had not previously read, I
find he says '" If the ulceration penetrates into the cervical cavi-
ty, the solid nitrate of silver may be pushed into it as far as it will
enter, or a camel-hair pencil, loaded with a saturated solution,
ihay be used in the same way. There is no fear, as we have seen,
of penetrating too far, as the cervical canal is only sufficiently
dilated to admit the brush, or the caustic cylinder, in the region to
which inflammatory action extends. Beyond the point where
inflammation ceases, the natural and healthy coarctation of the
cervical canal will prevent their passing. I prefer the brush when
the inflammation penetrates very far, lest the stick of caustic should
break. This has occurred to me more than once, but I have nev-
er had any difficulty in extracting the fragment, either by means
of the speculum forceps, the end of which I have had purposely
made small, or of the uterine sound. Thence the necessity of ex-
amining the piece of caustic that has been used, when it is with-
drawn, in order to see that it is entire."

In another edition, which was published in 1850, Dr. B. says :
^'The only caustic that can be used with advantage in inflamma-
tion of the cervix without ulceration or hypertrophy, is the nitrate

650 Eve, on Diseases of the Cervix Uteri. [November,

of silver, which acts, however, more as an astringent than as a
caustic. The solid nitrate of silver, or a strong solution, should
be applied everj three, four, or five days, to the inflamed mucous
membrane covering the cervix. This is also the mode of treat- .
ment to which I have principally recourse, in the first instance, in
inflammation of the cavity of the uterine neck, carrying the caus-
tic into the cervical cavity as far as it will pass."

The introduction of the solid nitrate into the cervical canal is
doubtless intended, but the mode is not expressed, In Dr. Ben-
nett's first treatise on Inflammation and Ulceration of the Cervix,
a very small work, republished in this country in 1847, 1 do not
think it is advised. I regret not having a copy for reference.

While in Philadelphia, in 1848, my friend, Professor Meigs, sug-
gested to me the use of an instrument for cauterizing the cervical
canal, very similar to Lallemand's sound for the male urethra ; but
finding it comparatively inefficient and unsatisfactory, I adopted
the method of inserting the solid nitrate by means of the specu
lum forceps."^

Dr. Bennett prefers the brush when the inflammation penetrates
very far, lest the stick might break ; but while the solid caustic is
more efficient, his apprehension is groundless, for such is the con-
tractile power of the cervical canal, that whenever the stick breaks
or becomes loose from the forceps, it is immediately extruded. In
proof of this power, Dr. Gardner of New York, in his excellent
work on Sterility, published last year, says, (page 26,) " I passed a
loose piece of nitrate of silver, about three-quarters of an inch in
length, into the cavity of the cervix, by means of a long pair of
forceps, and as fast as it was introduced and there left, it was im-
mediately pushed out by the contractions of the neck of the uterus,
and with so much force as to be thrown out of the vagina."

I have very frequently seen it thrown from the cervical canal
into the vagina or speculum: the caustic has not only the proper-
ty of exciting the contractility of the cervical canal momentarily,
but by repeated application it causes permanent contraction, when

* Note. Dr. Churchill, in a new edition of his work on Diseases of "Women,
published since this report was read, says, " after curing the external erosion or
ulceration, we must carefully examine, as far as we can, the state of the cervical
canal, and if the disease has extended therein, apply the iodine or other prepara-
tions to the part by means of long fine pencils of lint," thus ignoring, or at least not
directing, the more effectual method advanced above, when the nitrate of silver is
used.

I

1857.] Eve, on Diseases of the Cervix Uteri. 651

it has been previously rendered so patulous by inflammation as to
admit easily the introduction of a finger; in these cases it has been
restored to its natural size.

When the stronger caustics are employed, the canal sometimes
becomes so much contracted, almost obliterated, thata rtificial dila-
tation is rendered necessary. I have never known this result
from the use of nitrate of silver. Dr. Bennett, however, says arti-
ficial dilatation may be required after the use of the milder caustics,
but that it is then more easily accomplished, the contraction ex-
isting in a minor degree.*

I often insert a piece of caustic an inch long, sometimes an inch
and a half and even two inches into the cervical canal, in which
last instances it probably passes beyond the os internum, which
perhaps is only practicable when preternaturally patulous from
the extension of inflammation or ulceration through it, when also
its diminished contractility renders greater caution necessary in
its introduction, lest a piece might break off and slip into the cavi-
ty of the body of the uterus, which, however, I have never known
to happen: when it passes beyond the os internum, it generally
causes pain, sometimes requiring an opiate for its relief, but no
other unpleasant symptom has ever supervened.

Dr. Green, in his able treatise, already referred to, recommends
the application of caustics to the cervical canal, even during preg-
nancy (page 48.)

" *' Ulceration of the cervix uteri may be treated with more cer-
tainty and success during the pregnant state, from a disposition in
nature to cure the disease at this time and remove the inflamma-
tory hardening, thus preparing the way for delivery,

''During pregnancy, where abortion or miscarriage is threaten-
ed, we should not wait a moment for the commencement of treat-
ment, but apply our caustics immediately to the whole ulcerated
surface, clear up to the internal coarctation. Nitrate of silver is
the great sedative of chronic inflammation and irritations of the
mucous membrane, and prompt treatment the only thing to pre-
vent the irritation extending through the canal to the uterine
body, and provoking the premature expulsion of its contents,

" In pregnancy these cases will bear stronger applications, and
more decided treatment than in the non -pregnant state."

It may be excessive and needless caution, but I concur with

* See pages 242, 243, last edition.

652 E"S^, on Diseases of the Cervix UterL [November,

those who consider it safer to use no caustic stronger than nitrate
of silver during pregnancy.

The satisfaction and success I have had in treating cervical dis*
ease depend in a great degree on the adoption of this method
that is, on examining particularly into the state of the cervical
canal, and in promptly treating disease when it extends therein.
The external application alone will not always suffice; the exter-
nal inflammation may be cured, while inflammation of the canal,
perhaps an ulcer concealed within, may continue, with a muco-7
purulent or purulent discharge from the os. A case strongly
illustrative of this fact occurs to me. Dr. B., from South-western
Georgia, in returning from Virginia last summer, requested me to
visit his lady and make a specular examination, stating that an
eminent phj-sician had treated her for inflammation of the cervix
by caustic. Externally there was no inflammation, but it appear-
ed to extend into the canal. On enquiry, I was informed that
the caustic had not been applied internally. I advised him to
apply it internally and to give her tonics. In a few months in-
formation was received of her perfect recovery.

In another case, more recently, I was consulted by a lady from
Newton county, who had been treated for inflammation of the
cervix by cauterization externally. On specular examination,
there was not a trace of external inflammation, while ulceration
was observed to extend from the os into the cervical canal.

In some cases, on first examination, the speculum reveals in-
flammation or ulceration in the interior of the cervix, the external
surface being free from disease.

In the intervals between the applications, astringent vaginal
injections should be used two or three times daily, consisting of a
solution of alum alone, or with tannin, or in sage tea. Sulphate
of zinc is also an excellent astringent. Goulard's extract, diluted,
or a solution of morphine in flaxseed tea may be prescribed, when
there is much irritation.

These vaginal injections have a much better effect, when ad-
ministered to the patient on her knees and breast, in which posi-
tion the womb, if prolapsed, returns to its natural situation, as
soon as air is allowed to enter the vagina, which is in a cor-
responding degree lengthened and capacitated to hold a larger
quantity of the lotion, which may be retained as long as de-
sired, by the patient pressing a napkin firmly against the vulva

1857,] Eve, on Diseases of the Cervix Uteri. 653

previous to lying down : a napkin thus applied serves to retain
the injection as long as desired, and to absorb it when allowed to
pass away.

If too weak to assume or maintain this position, the patient's
pelvis may be elevated by a pillow; for when administered in the
usual way, the patient sitting or lying down, only a very small
quantity enters and passes directly out, doing comparatively very
little good.

Unless the vagina be permanently contracted by the long con-
tinuance of the prolapsus, whenever an injection is administered
in the position indicated, the womb is replaced and the vagina
submitted fully to the astringent and roborant influence of the lo-
tion : the patient is thus very thoroughly and generally effectu-
ally treated for the prolapsus, while undergoing treatment for the
cervical disease, and the subsequent necessity for artificial support
almost invariably obviated.

When the patient's general health is in all respects good, her
suffering altogether local local applications are found sufficient
alone, without general treatment ; but there are very few cases of
long standing without some complication, demanding medical
prescription.

The perfection of practice in these affections consists in the hap-
py blending of medical and surgical treatment. Our limits will
not allow us to say much on the subject of the medical treatment
it consists in the adoption of such measures as may be indicated
for the removal of sympathetic or concurrent diseases in other
organs and the improvement of the general health of the patient,
as through the blood, and in the administration of those remedial
agents which may through the system act locally on the uterus.
For the fulfilment of the first indication, may be called in requisi-
tion tonics of all kinds, especially the chalybeates and vegetable
bitters, mercurials, laxatives, antacids, nervine stimulants, the
regulation of diet, of exercise, and indeed whatever is calculated
to improve health and increase strength.

When dyspepsia and anasmi a are present, as they often are, re-
quiring prescription, next to properly regulated diet and exercise,
the following combination of medicines will often be found very
beneficial a pill, consisting of { gr. of the extract of nux vomica,
2 grs. of iron by hydrogen, and 10 grs. of the subnitrate of bis-
muth : one to be taken three times a day.

654 Eve, on Diseases of the Cervix Uteri. [November,

Nux vomica acts very beneficially as an excitant of the whole
nervous system, and in promoting the peristaltic action of the
intestinal canal : when prescribed merely for its effect upon the
bowels, it is better to give it in combination with blue mass,
rhubarb, comp. ext. of colocynth, or some other purgative, which
it renders efficient in comparatively very small doses.

Iron by hydrogen is decidedly one of the best chalybeate pre-
parations the dose is very small, it is not offensive to the taste or
to the stomach, and appears to enter with great facility into the
circulation. As a gastric tonic, the subnitrate of bismuth is equal,
if not superior to any article in the whole Materia Medica. It may
be given with impunity, and often with great benefit, in much larger
doses than stated above. When there is dyspepsia without anae-
mia, the same number of grains, or more, of the extract of hyoscy-
amus may be substituted for the iron; but the beneficial influence
of iron is not limited to anemic subjects. When a bitter tonic is
indicated, none answers better than Huxham's tincture of cincho-
na comp. tincture of gentian, or, what is perhaps better than
either, a formula suggested by Dr. Eobert Campbell of this city, a
tincture composed of equal parts of red bark, gentian and carda-
mom seed these may be prescribed alone or as vehicles for some
of the preparations of iron and iodine.

The medicines that act most beneficially on the general system,
and through it locally on the uterus or other organ that may be
in a morbid state, are the preparations of iodine, iron, arsenic, mer-
cury and silver : when administered in proper doses and under
proper circumstances, they influence vitality and modify nutrition
so favorably, that they may with great propriety be termed eu tro-
phies; but although very similar in some of their effects, they are
different in their mode of operation. Mercury is decidedly antiphlo-
gistic and depressing ; hence its great value in all acute inflamma-
tions, whilst at the same time its influence in modifying nutrition is
mostpalpably evinced in resolving indurations, and in causing the
removal of nodes, chronic enlargements, as seen in cases of enlarged
testicles, &c. Mercury, although perhaps one of the most reliable
agents in hypertrophy, induration or chronic engorgement of the
uterus, must be employed with great circumspection, unless the
patient has considerable stamina left. The proto-iodide is in such
cases decidedly the best preparation the combination with iodine
renders it more efficient in modifying nutrition, while it corrects to

1857. J Eve, on Diseases of the Cervix Uteri. 655

some extent its depressing influence: the only objection to its use
is that, hke other preparations, if not given with great care it will
sometimes cause salivation. Another most excellent formula for
the administration of mercury is Plummer's pill. Iron^ iodine,
arsenic and silver, in small doses and they ought never to be
prescribed in any other are all both tonic and eiitrophic. Of
these the best preparations are Quenesville^s metallic iron, syrup
of iodide of iron, iodide of arsenic, iodide and oxide of silver,
iodide of potassium, Lugol's solution, tartrate of iron and potash,
Yallet^s paste. It has been said, and I believe with truth, that
the best effects from iron and iodine can be obtained by the con-
joint prescription of tartrate of iron and potash and iodide of
potassium.

The following formulae have been frequently employed with the
most satisfactory results :

^. lodid. Potass. . . ^ , . , , Siij.

Tart, ferri and Potass.. , . . * 3vj.

Water or Comp. Tinct. Gentian, , Cj.
A tablespoonful to be taken three times a day,

^, Iodide of Silver,. , ^ 3i,
Ext, Hy osciami. . . 3 ij.
Iron by Hydrogen, , 3iij.
Make 60 puis. One pill to be taken three times daily.

^, Proto-iod'ide of Mercury, r . gr, ]&xiv.

Ext, Hyosciami. , . .- ^ , gr, ixxij.

Iron by Hydrogen^ . . ^ , 3isg,

Make B6 pills. One pill to be taken three times daily.

In ssome cases of leucorrhoea, supposed to depend on, or to be
connected with, cervical inflammation,, (it being always desirable
to try medical treatment,, before resarting to* surgical means,) the
patients have been directed to take one of the following pills three
times daily, and to use astringent vaginal injections,''^ which have

* Since this report was read, I often prescribe chlorate of potash according to
the suggestion of Dr. Brown of North Carolina. It was my intention to have add-
ed, as a supplement to this report, remarks on chlorate of potash and several other
ittbjecta, and a few illustrative cases ; they may be furnished for a future number.

666 Henley, on Hysterical Convulsions, [November^

caused the removal of the leucorrhcea at least, and an improve-
ment of their general health.

^. Sulph. Ferri,
" Zinci,
" Quinite, aa 3ij. Make 60 pills.

No particular restriction in diet appears to be necessary in gen'
eral, except that it be the most digestible and nutritions- and least
exciting.

The importance of exercise has been already stated.

In concluding this report, I cannot but regret not being able to
do justice to so important a subject. Although restricted to its
narrowest limits, the more closely it is- contemplated, the more
it grows in magnitude and importance, demanding for its- full ex--
amination and elucidation a far more thorough and extended
elaboration than this Society could possibly expect or d-esire on
the present occasion.

ARTICLE XXXII.-

I^marhalte Case of Hysterical Convulsions. Keported by Albert"
W. Henley, M.D., of Bushville^ Franklin County, Ga.

As it may be interesting to some of my junior brothers, I
propose relating a few of the principal characteristics connected
with the case above mentioned, which came under my notice last
year.

The patient was a robust, healthy gii^l, aet seventeen years, of
leuco-phlegmatic temperament; was taken in the evening of 25th
April, 1856, complaining with slight pain in the head, which was
soon followed by prostration, accompanied with spasmodic or con-
vulsive twitchings of the feet and hands.- A messenger was im-
mediately summoned to start fur me, but was called back, being
told that the patient was dead. She, however, gave signs of re-
turning vitality, and he was again dispatched. I reached her
about twelve o'clock at nio-ht. On hearins^ her moans and shrieks
as I alighted at the gate, I was instantly struck with the idea of
hysterics, When entering the house, I perceived her lying full
length on the floor, on her back, apparently dead, or in articulo

i

1857.] Henley, on Hysterical Convulsions. 657

mortis] the fingers being violently contracted, eyes fixed, and the
lower maxilla in a drooping condition. I addressed her several
times, but she returned no sign of attention. The inmates of the
house told me that she had ''' died away" several times in the same
manner before I reached her. I then examined the pulse, found
it perfectly natural, with no febrile excitement^ the body being of
an equal temperature; but not the least sign of respiration could
be detected. I then made an attempt to arouse her^ by raising
her in the recumbent posture^ frictions, cold applications to the
head, stimulants to tlie nostrils, but none availed anything ; how-
ever, she aroused herself voluntarily, when she screamed until she
again fell into a state of syncope or coma and so on. I was at
first somewhat uncertain as to forming a diagnosis. I made in-
quiry as to whether she had sustained any previous injury or not
as the case presented somewhat the appearance of a case of teta-
nus she had received no injury known to any one present, and
I therefore Jbelieved more strougly that it was a case of hysteria
or hysterical paralysis. 1 inquired into the condition of the cata-
menia, but could get no definite answer, as the patient was from
home and her mother not present, I then examined the spine
and could detect no tenderness, except about the third and fourth
lumbar vertebrae, and that was very slight. But in examining
other parts of the body, I found extreme tenderness over the epi-
gastric and mammary regions ; which could onlj^ be detected dur-
: ing the paroxysm. She did not appear sensitive to anything
during the intermission. After about the sixth paroxysm, a vio-
lent fit of laughter succeeded the comatose stage, the convulsions
again returning. I then inquired if she was laboring under any
mental emotions of any kind. Those present knew of none,
Knowing that a woman (her sister) had been in labour, primapa-
fa, on the premises, late the same evening, I inquired as to whe-
ther the patient witnessed the delivery or not? and what impres-
sion it made upon her? I was told that she loas present, and it
alarmed her very much, it being the first thing of that nature she
had ever witnessed. Some of the family having arrived, I again
inade inquiry as to the condition of the menses, and learned that
! she had been "unregular" for something like twelve months pre-
viouisly, and that she also suffered with leucorrhoea. I then based
my diagnosis^ as I considered, on the etiological facts, namely^
deranged menstrual secretion, and noental emotions froni witness-

658 Henley, on Hysterical Convulsicms. [November,

ing the delivery of lier sister ; both connected, brought on these
hysterical phenomena.

Nothwithstanding, a good old sister, one of the wary disciples
of the obstetrical art, thought different. She thought, and tried to
make me believe, " that her courses turned up and got into her head!
Scared hack !P^ I then proceeded to the treatment and consider-
ed that an emetic of ipecacuanha and tart, antimonii, from its re-
laxation, revulsion, and excitation, would be the best to begin
with ; I however first experimented with water to know whether
deglutition was suspended or not, and found that it was ; for dur-
ing the paroxysm the teeth were so violently approximated that I
could not separate them by compression, nor in any other man-
ner; and during the comatose stage there was a perfect dyspha-
gia, the fluid being introduced would immediately return. Des-
pairing of emesis at that time, I had her immersed in a warm
bath, applied a blister to the nucha, directed the spine to be rub-
bed with a strong liniment, and administered; with difficulty, 25
drops of laudanum. She then became quiet, fell into a comforta-
ble sleep and I took my departure, promising to return next day.

I would here mention that the spasms or paroxysms would, up
to this time^ return about every four and five minutes, sometimes
longer. They would be invariably followed by a profound state
of coma, ushered in at times by a laugh or a smile.

I returned next day, 26th, in the morning, was told that she
liad slept well J ^'had one fit about day," blister had drawn well,
patient looked more natural, but yet had not spoken but one or
two distinct words from the time she was taken ;. would give no
signs of being rational, only by laughing at persons about the
house when they would look toward her, I then administered
an active cathartic of calomel, rhubarb and aloes; directed, after
six hourSy to give oleum ricini if she could swallow ; if not, to give
enemas. It was with great difficulty that we got her to swallow
the medicine, as there appeared to be some obstacle in the organs
of deglutition globus hystericus.

Eeturned next morning, 27th : could not take oleum^ ricini ; had
given several enemas no operation. I directed more injections ;
after the second, she gave signs of wanting to go to stool, ^dis-
charged considerable quantities of bilious feculent matter, but no
urine. So extremely sensitive was she about the thoracic region,
that I was fearful of acute gastritis, which was also the opinion of

1857.] Henley, on Hysterical Convulsions, 659

a young medical brother, who called in to see her. But there
were no symptoms of tliat malady, only the extreme tenderness,
tvhich would not admit the weight of the bed clothing. I then
put her on the use of sulphuric ether, camphor, etc*

Eeturned next day with Dr. G. S. Martin, an old and ex*
perienced physician, who directly concurred with the diagnosis^
and approved of the treatment I had pursued, and thought, aS
well as myself, that cathartics,- anti-spasmodics, etc., were of no
avail; that an emetic would be the best, but after first trying with
Water we found that deglutiton was again imperfect. Directing a
strong stimulating liniment to the spine, we left about 10 o'clock
A.M.

The following night, about 6 o'clock, she spoke tolerably intel-
ligible for the first time, saying she wanted to see the Doctor, and
urging the attendants to send. The messenger was dispatched^
and I reached her about 9 o'clock, but found het again in ft
complete state of coma, and learned that she had had several par*
oxysmsv I succeeded, however, for the first time, in arousing her
from the comatose state. She spoke in an indistinct manner said
she was going to die-^I need give her no more medicine, &g., &c<
It being the first time I could derive any thing from her own
language I propounded to her several questions. She stated there
was ''something in her throat trying to choke her to death;" but
all her talk was very indistinct, the words spoken in a semi-articu*-
late manner. I prescribed tinct. assafoet. and spts. nitric ether,
left, and returned next morning. I found she had taken only one
dose,- but that deglutition was then practicable. I then proceeded
to administer the treatment first adopted, viz: An emetic of
ipecacuanha, 3ss. ; ant.- ext. potass, tart., gr. 2 dissolved in warm
water 6. Give 5I every ten minutes: after the fourth dose
copious vomiting ensued. Assisted by tepid diluents, she ejected
a great deal of bilious matter; after which she discharged an im-
mense quantity of limpid urine.

After emesis, no tenderness could be detected in the thoracic
region : the patient, getting up with an insatiable appetite, went
home the next day and resumed her usual avocations ; was trou--
bled for a few days with the choking sensation, with occasional
singultus, both of which yielded to the use of tinct.- assafoet.- in
'Combination with camphor.

But the great object of publishing this case has not yet been

N.S. VOL. XIII. NO. XI. 42

660 Henley, on Hysterical Convulsions, [November,

told. From the daj she was taken, to this, she has not been able
to articulate a word plainly. There appears to be a partial par-
alysis of the tongue, she not being able to raise it to the roof of
the mouth, nor can it be protruded more than half the usual dis-
tance. What can be the cause of this singular phenomenon,, unless
it be an injury received in some af the lingual or laryngeal mus-
cles or nerves during those violent fits of screaming? It must be
an injury to some of the organs of speech received during the
attack^ as speech was in no Avay impeded previously.. If any of the
older brethren of the profession can give a reason why this par-
tial aphonia or semi-articulation should occur. I would be pleased
to hear from them at any time.

The tonsils have been somewhat inflamed and enlarged: this I
subdued by external applications. The uvula appears natural^
with no elongation. The patient is yet under my care, I have
endeavored to regulate the catamenia, thinking she might be re-
lieved were she to menstruate regularly. I used ferruginous pre-
parations; also, aloes,, myrrh,, guiacum, tonics, balsam, with a
blister to the neck; stimulating plasters and embrocations to the
spine, bathing, &c., &c. ; none of which appeared to yield any de-'
eided benefit. I, however, believe she is gradually improving.
The leuconhoea has subsided, and for the last three or four men-
strual periods she has been much better, but not beings as the
mother informs me, " of the proper appearance."

She had another attack, similar to the first, in the month of
November. I was sent for ; could learn of no exciting cause, with
the exception that she had assisted in shrouding a little girl the
day previous,, immediately after which, the family thought, she
was taken with colic, and was "thrown in her old way." I
first used antispasmodics, but with no effect ; I then applied a
large sinapism to the epigastrium administered an emetic as be-
fore. She discharged large quantities of bilious fluid, which
relieved her immediately.

The attack was similar to the 'first regular spasmodic parox-
ysms, followed by a low moaning^ with no screaming ; and no-
doubt that this time mental excitement was a leading cause in
bringing back the spasms. She is now up, able to work, visit her
friends, &c. The family think they can understand her much
better ; I can make out but very little of what she says. Her
appetite is good, bodily strength as usual, mental faculties as good

I

I

1857.] Henley, on Hysterical Convulsions. 661

as ever, but not being able to speak plainly, makes her somewhat
bashful.

The irregular menstruation has, since the last attack, assumed
the form of dysmenorrhcea. I am treating it in the usual manner.
The patient being in limited circumstances, there is little regard
paid to dietetic regulations, besides directions are not strictly com-
pHed with. I shall hope, by the assistance of nature, eventually
to restore her to her wonted health. I am treating the case pretty
much on general principles, not being fully satisfied as to its pa-
thology. I advise her to avoid depressing passions, or mental
emotions of any kind. I have been thinking of using electricity.
My sole attention is now directed to the improvement of her gen-
eral health.

[We will venture to make but a single remark about the above
interesting case, and that in relation to the aphonia. This is most
probably due, not to any injury done the organs of the voice, by
the violent use of them, but results from injury sustained by the
nervous centres at the base of the brain, which give power of mo*
tion to the tongue, and muscles of the larynx. This portion of
brain was probably put in an apoplectic condition during the
violence of the convulsive paroxysm, either by congestion or by
a slight extravasation in this particular region.

The case reminds us strongly of a similar one which was some
time since under the care of Professor L. D. Ford of this city.
A negro girl, aged about 22 years, had been subject to repeated
violent attacks of hysterical convulsions, followed by hysterical
lethargy. These would return every two or three months. The
attacks were generally relieved with much difl&culty, emetics,
revulsives, and chloroform by inhalation, being the principal
remedies employed. The paroxysms, however, was not the Doc-
tor's principal care : to break up the disposition to return employed
most of his attention. Tonic and emmenagogue treatment proving
of but little avail, he introduced a seton in the back of the neck,
for in the cervical spine there was great tenderness on pressure.

In a conversation many months afterwards with Dr. Ford, he
informs us that his treatment had been perfectly successful in pre-
senting the return of the attacks, and he attributes this happy
result mainly to the seton.

The case, the subject of the present report, we think is one well

662 Reagas^s Case of Epilepsy. [Kovember,

suited for the application of the seton, both with the view of prevent- .
ing any return of paroxysms, and further, because such a form of
revulsive and such a permanent drain, would be likely to afford
much relief to the embarrassed nervous centres at the base of the
brain, which condition of embarrassment^ doubtless^ causes the
paralysis of the tongue J Edts,

ARTICLE XXXin.

Professor LawsorJs Theory of Epilepsy : A Case reported by Tho-
mas J. Eeagan, M.D., of Alma, Texas.

I notice in the Southern Medical and Surgical Journal, for April^
an article entitled " A few thoughts upon Epilepsy," selected from
the Western Lancet. In this paper,, the wTiter (Prof, Lawson)
proposes the theory that the disease is one of diminished nervous
action, and advances in support of his idea, that an intercurrent
excitement fever, &c., temporarily suspends epilepsy. This idea
of epilepsy being suspended by an intercurrent disease,, brings to
my mind a case of this malady with which I had to deal.

Miss W , about 21 years of age, residing in Coweta county,

Georgia, had been a subject of epilepsy for several years; the ex-
act time, or how often they recurred, I do not recollect, as I write
entirely from memory. She was attacked with remittent fever,
for which I prescribed, without any regard to h^r epilepsy, never
having been called to treat that specially. During the progress of
the case she became severely salivated. Three years after 1 1-earned,
that she had not had a return of the epilepsy since her sickness.
I at that time attributed its non-recurrence to the salivation,, but
was imable to explain the modus operandi by which a suspension
of the disease was brought about. But whether it was the saliva- \
tion or the fever that broke up the morbid chain, or not, I ami
unable to say. Since seeing Dr, Lawson's article I am led to re-
port the case

1S57.] On Scarlatina. 663

On Scarlatina. A Clinical Lecture, delivered in Paris, by M.
Trousseau. (Translated from the Gaz. Hepdoinadaire.)

Scarlatina is, of all the exanthematous and contagious pyrexias,
the most variable in its forms and characteristics. It is also the
most variable in relation to the danger the patient undergoes.
Variola, whether benignant, discrete, malignant, or confluent, is
still variola; you can always recognize it by its special character-
istics ; it always shows itself exteriorly by appearances which are
proper to it, whether modified or not, as it so often is by vaccina-
tion or by a preceding variola. Scarlatina, on the contrary, may
not appear, and frequentlj'' is not apparent upon the skin, yet is
none the less severe on this account. Rougeola almost always
preserves its characteristics, or very nearlj^ so. Its diagnosis is
ordinarily simple, almost always easy ; its complications generally
foreseen, take place at a certain time, upon a certain day which
the physician can foretell. Scarlatina, as we shall see, presents
compHcations most usually unsuspected, which the physician can-
not know beforehand, even at a period very near their appear-
ance.

This disease is sometimes so light, that one of the greatest ob-
servers of the past, Sydenham, said of it, in speaking of several
epidemics he had seen : Vix noinen morbi meretur^ it hardly deserves
the name of disease. But Sydenham has given in his writings
only the results of his personal experience, and as he had never
seen it in its severe form, he treated scarlatina with that sort of
disdain which he was far from having for rougeola or variola.
Now, those writers, whom it is proper for us to consult, tell us that
for many years the cases of scarlatina they saw were so mild in
character that they never saw any body die from it.

Graves, in his clinical lectures, states that in 1800, 1801, 1802,
1803 and 1804, scarlatina ran through Ireland and was very fatal;
that from 1801: to 1831, those physicians who had found it so
very destructive during the years we have already cited, no longer
witnessed a death from this affection, which had become singular-
ly mild. In 1831, a new epidemic of severe scarlatina appeared
in Dublin and vicinity, and in 183-1 this disease spread over Ire-
land a sadder gloom than did the typhus a few years later, or the
cholera two years before. When I commenced my medical stu-
dies at Tours, M. Bretonneau told us that scarlatina, which his
masters had always spoken of as a severe disease, had at first ap-
peared to him as a very mild disease. He said that from 1799 to
1822, at which time he made these remarks, he did not recollect
to have seen a single person die from scarlatina, and he had prac-
tised for a long time in the country before he became phj^sician -in-
chief of the hospital at Tours. Since then he had seen numerous
cases, both in hospital and private practice, and up to that time

66^ On Scarlatina. [November,

this exanthematous pyrexia was to him the mildest of all. But in
1824 an epidemic broke out in Tours and its vicinity. In less
than two months M. Bretonneau saw the sick die off with such a
startling rapidity, that, opposed as he was to the doctrines of
Broussais, then in high estimation, he accused the treatment pur-
sued by his confreres, who bled excessively (a I'outrance) in order
to moderate the angina and the inflammatory fever at the com-
mencement of the attack ; soon, coming himself in contact with
the disease, he learned that he could not always strive against it
with advantage, a considerable number of his patients succumb-
ing. Then, he who before 1824 had treated scarlatina so lightly,
learned to class it with the plague, with typhus and cholera.

For more than a quarter of a century, then, scarlatina reigned
epidemically without presenting any gravity. Suddenly its char-
acter changes ; it strikes those whom it attacks most cruelly. It
is not thus with rougeola, it is not thus with variola. Doubtless
the epidemics of rougeola and variola are sometimes very severe,
but they are never so generally light or severe as those of scarla-
tina. For scarlatina the epidemic type is more dominant than for
the others, and according to the nature of this type the disease is
extraordinarily simple or singularly severe.

What is the duration in scarlatina of ihe period of incubation?
In an exanthematous fever, nothing is more difficult to fix when
the virus is not directly inoculated, nor is there any thing more
variable than the manner in which this question has been decided.
For scarlatina, some say that the incubation continues four days ;
others eight, and others again fifteen, twenty, and thirty days. In
ft word, only hypothetical data have been given, because those
who made them would not see that no certainty was possible un-
less a precise date of the commencement of the incubation was
assigned. But one pyrexia only can furnish us this precise time,
variola, because it is inoculable, and since this inoculation has
been performed for a half a century and very extensively through-
out Europe, We have been able to ascertain positively the time
which intervenes between the moment when the virus is introdu-
ced under the skin and the manifestation of the disease. In this
manner the duration of the incubation of variola has been fixed.
It is not so with the other exanthemata, which have not been
inoculated, and which perhaps are not inoculable. For then, in
default of inoculation, the moment the individual was placed in
contact with another person affected, is taken as the point of de-
parture for the incubation ; but contact and incubation are two
different things, For example, five hundred sheep are placed
together in the same park, or in the same sheepfold, one of them
takes the rot, an eruptive disease in animals, analogous to variola in
man. Fifteen or twenty days later seven or eight more sheep are
taken, and each day successively a few fall sick ; four months
would have to pass before the last would be attacked. Yet all

I

1857.] On Scarlatina, 665

these animals, shut up in the same place, breathing a confined air,
pressed against each other and wet by pus from the sick, were
not taken at the same time; some were attacked sooner, others
later. Would you conclude from this that the duration of the
incubation was longer in some than in others? Not at all, for
inoculation performed the same day in all, the disease would also
show itself the same daj^ in all without exception. Contact and
inoculation, then, are essentially two dift'erent things. By inocu-
lation the virus is necessarily introduced into the economy ; by
mediate or immediate contact, the absorption of the virus does
not always take place. When this absorption once takes place,
the evolution of the disease takes place in a certain determined
time, the same, wdthin a few hours, or a few days, in all.

Well, that day when scarlatina shall be inoculated, the duration
of the period of incubation will be fixed for it, as has been done
for variola, until then it is impossible to determine it In a
family composed of ten persons, five weeks will sometimes elapse
before all will be taken. It will be the same with them as with
the sheep of which I have just spoken. It does not result from
th-e fact that they have not come in contact, but that they have
been in different conditions to be affected by it. It is the same
as with syphilis. The syphylitic virus methodically inoculated
produces after a certain number of days the evolution of a specific
vesicule, and this number of days is very nearly known. Several
persons may have connection with a diseased woman, some would
take the disease immediately, while others having relation with
her several days in succession, would become diseased only the
last day. This happens from the fact that the first were in phys-
iological or pathological conditions such that, from the first contact
the virus was inoculated, while the second were not in this condi-
tion till later.

Finally, gentlemen, the period of incubation in scarlatina, that
is to sa}^, that period comprised between the precise time of the
inoculation of the scarlatinous virus, and the precise period of the
first manifestations of the disease, that period in scarlatina, can-
not be rigorously determined. The same remarks are applicable
to rougeola, they also apply to variola when it is not directly
inoculated.

In scarlatina the period of invasion is also undetermined. You
know how it occurred in variola, and you can affirm that in regu-
lar cases of small pox, when you see the eruption appear forty-
eight hours after the commencement of the invasion, the variola
will be confluent, because it is at the end of the second day, or
at the commencement of the third that the pustules appear in this
form of the disease ; if the pustules appear about the fourth day,
you will diagnosticate a discrete small-pox. Seldom is the erup-
tion of the confluent variety put off till the fourth day ; seldom
does that of the discrete form appear as soon as the second day.

666 On Scarlatina, [November,

These characteristics of variola which are almost positive, give
you the ability of immediately saying whether the disease will be
jBevere or mild. Let me be well understood, I speak only of regu-
lar variola, and not of modified small-pox or varioloid, the char^
acteristics of which are not tbe same.

In scarlatina, the progress is different. In some patients the
eruption appears during the first four or five hours of the fever
of invasion, rarely later than the first day. It is still rarer, except
under complications, that it is deferred to the second day, and
for the same reason it is still rarer that it appears only until the
third day. Although a few physicians believe that they have
observed this appearance as late as the third day, I repeat it, that
this fact is extremely rare. I do not deny its possibility in an
9,bsolute manner, according to my belief, however, it is because
the attention of the patients was not called to it, or because it was
not sought for in a great number of cases. In general, it is upon,
the face that we first look for the febrile exanthemata, because it is
there that it first shows itself. It is so for rougeoja and variola,
but it is not so for scarlatina. In this disease it is more particu-
larly upon the body, upon the fore arm, upon the belly, or in the
folds of the thighs that the eruption first appears, so that it can
exist twenty-four to thirty-six hours before it makes its appear-
ance upon the face or jieck. We may think that it only com-
menced then, when in reality it had existed some time. But
when we are informed of the progress of the disease, this error is
easily avoided. In fact the period of invasion in scarlatina is ex^
tremely short.

T^he phejiomena which characterize it are ordinarily a high fever
with or w^ijthout a previous chill, most frequently this chill is ab-
sent. The frequency of the pulse is considerable, more so than
in the other febrile exanthemata. This fact is important, for in
studying scarlatina in its elements, in speaking of scarlatina
without eruption we shall see that under a good number of cir
cumstances we ghall ma^e out our diagnosis of this disease by the
single consideration of this extreme frequency of pulse, which is
not found in the other affections which may be confounded with.
scarlatina in part effaced^ if I can make use oi this expression. To ,
this fever is added cephalalgia, a general malaise, anorexia, vom-
itings, diarrhoea, oftentimes very abundant, Almost always
from the moment that the fever appears, the soreness of the throat
also appears, so that from the commencement of the affection,
before many hours have passed, the patient complains of pain in
that region, he speaks of it as the most prominent symptom of all
he feels, and it is to that he calls your attention. This phenome-
non is a very important one to be studied, because we may be
deceived by it, for this angina may be mistaken for a simple
^.ngina, and an improper treatment be adopted, or at least one in-
sufficient for a malignant scarlatinous angina. The tongue pre-

1

1857.] On Scarlatina, 667

sents the first day nothing particular, it is feverish that is to say,
covered with a fur a little slimy, slightly red at the point, and
upon the edges, but upon the palate a deeper red is observable
and in some cases already presenting a dotted a})pearanee. This
redness is very marked upon the tonsils, which are slightly swol-
len. This redness, this dotted appearance of the veil of the pal^
ate, of the tonsils without marked tumefaction, accompanied with
severe pain and intense fever, should put you on your guard,
especially when an epidemic of scarlatina prevails, and should
cause you to suspect a scarlatinous angina.

When scarlatina is malignant, the symptoms take another form.
The frequency of the pulse is still greater, reaching as high the
first day in the adult as 130, 140, 150, 160 pulsations, even be-
fore the eruption has appeared upon the skin. At the same time
I the nervous s}' stem becomes affected, showing itself by a great
; agitation, or by a sleeplessness which nothing can overcome,
\ almost always by a sub-de-lirium when the patient is left to him-
1 self These are symptoms very rare in simple sore throats, very
; rare also in the commencement of other febrile diseases. From
I the first day, from the first hours, malignant scarlatina announces
itself with all its malignancy, and this malignancy may be such
that the patient succumbs before twenty-four hours pass.

I wa3 called by my friend, Dr. Bigelow, to see a young American
girl in a school in Paris, She had been affected since morning by
an alarming delirium^ she had an intense fever, and incessant
vomitings ; the pulse was so frequent that it could not be counted,
the skin was remarkably doaj. These phenomena caused me to
say, when w^e reached the bedside of the patient, that it was scar-
latina, and in fact, although nothing else demonstrated its exist-
ence, my diagnosis was confirmed by the presence of the charac-
teristic eruption upon another 3^oung girl of the same school,
jvhere an epidemic of scarlatina prevailed. Our patient died
before the end of the day.

In 1824, at the commencement of that disastrous epidemic
which broke out in Tours, of which I have spoken, we saw, with
M. Bretonneau, a young woman die in less than eleven hours,
with terrible symptoms, delirium, excessive agitation, extraordi-
nary frequency of pulse, and nothing indicated scarlatina to us,
excepting that we were in the midst of an epidemic, and that
many persons in the family of this young woman had had it.

Beware then, when in the midst of an epidemic of scarlatina,
when especially persons around a patient to whom you have been
; called have already been attacked by it ; beware of those nervous
symptoms which show themselves thus at the commencement of
disease. Almost always they announce a malignant scarlatina,
and this almost alwaj's kills ^\ith an astonishing rapidity.

I dwell upon this point because it can give rise to the most
eerious errors in diagnosis ; because it can give rise to faults in

!

668 On Scarlatina, [ISTovember,

prognosis, most serious to the reputation of a physician. Do not
forget these precepts, and when you find yourself in presence of
the symptoms of which I speak, be reserved, for these symptoms
may terminate rapidly in death; they seldom show then:iselves
so severe in rougeola, and never m variola.

In scarlatina, then, there is an uncertain period of incubation,
a very short period of invasion, after which comes the eruption.
This new period has a duration not as clearly determined as it is
in rougeola, and especially as it is in variola, in which it is so easy
to calculate it. Commencing from the first day of the disease, the
eruption of scarlatina is sometimes apparent the twelfth and the
fourteenth day, although ordinarily it begins to disappear towards
the eighth. In the simplest cases it continues from five to eight
days. What are its characteristics ? When you consult your
books, it would seem from them that a physician should not hesi-
tate in making out his diagnosis. Kougeola, says one, consists in
an eruption of small, isolated spots, of irregular form, leaving be-
tween them intervals of white skin. Variola is recognized by its
small acuminated papula, becoming vesicular the second day,
pustular the third, pointing and becoming surrounded about the
eight day with an inflammatory areola. All these facts are very
simple, and these characteristics so well designated, that they
should not be mistaken. As to scarlatina, its characteristics are
still better marked ; a diffuse, wine-like coloration. The descrip-
tions are far from giving exactly that which exists in all cases.
You see, in fact, cases of rougeola, and I have shown you some
of them, which present an eruption, diffuse, uniform, without red
spots, isolated by intervals of white ones. In truth, this form of
the eruption is not the rule, but it does exist.

In contradiction to this you will' meet with cases of discrete
scarlatina, and even cases of confluent scarlatina, in which the
eruption will be in certain points, composed of red spots, and still
better, by small rounded, red points, perfectly isolated from each
other, not having the wine-like, the raspberry color which has been
attributed to it. It differs, however, from the eruption of rougeo-
la, yet may sometimes be confounded with it.

What also distinguishes scarlatina, is the presence of a miliary
eruption, which very often accompanies the redness of the skin,
and which is met almost invariably when the scarlatina is very
slightly confluent. It appears upon the sides of the neck, upon
the chest, upon the bowels. It is known without seeing it. By
passing the hand over these parts, small elevations are felt, which
give the same impression as goose flesh. Searching for them,
then, a multitude of small vesicules will be perceived, which, after
thirty-six or forty-eight hours, are filled with a lactescent fluid.

As to the eruption of scarlatina itself, it is not really of an
uniform tint, like erysipelas, but of an infinite series of httle eleva-
tions of the skin, resembling an extremely fine eczema. They

i

1857.] On Scarlatina. 669

are recognized by the touch, and by the magnifying glass this
disposition is very evident.

The redness exists, at its greatest intensity, upon the neck,
upon the chest, upon the bowels, and the internal surface of the
arms and thighs. It appears about the same time everywhere,
although it is most frequently seen upon the neck and chest,
before it shows itself upon the countenance. Upon the iiice it has
not the same characteristic as upon the body. Of a speckled ap-
pearance, of a deep red in some points, adjoining white spots, the
skin of the face seems as though it bore marks of the fingers, with
which it had been severely struck. At the same time it is swollen,
and this puffiness is also observable in the hands and feet. It takes
place the instant that the eruption appears, increases with it, and
is consequently more marked the second or third day. In the
hands it interferes with the movement of the fingers, which the
patient can fold only with difficulty, and it can easily be proved
to the sight. Progressing with the eruption, it usually disappears
with it, as well from the face as from the extremities. It remains
for a while at the angle of the jaws, upon the neck, and these
regions are painful to the touch.

Examine the throat of the patient, a deep color and tumefaction
of the veil of the palate, and of the tonsils, is seen ; very often
these present small whitish concretions, the first manifestation of
the membranous angina of scarlatina, upon which I shall have
to dwell.

The appearance of the tongue is such, so specific, that by it
alone the disease can be distinguished. Neither in rougeola nor
in variola, will you find that appearance which the tongue takes
in scarlatina, a characteristic as special in this exanthematous fever,
as is the variolous eruption of the mouth in variola. The first day
the tongue ofiers nothing special, other than the more or less thick
slimy fur, more or less white, of a yellow or greenish color when
the patient has vomited ; nothing more than the slight redness of
the point and edges, of which we have already spoken. The next
day the redness increases in intensity and extent; it increases the
third day even, and towards the fourth or fifth day the thick fur
has more or less completely disappeared ; the whole tongue is of
a bright red color, tumefied, presenting a considerable elevation
of the papillae, which gives to it an appearance analogous to that
of a strawberry. It is deprived of its epithelium, and in some
oases you can assist this work of desquamation, you can even
hasten it, by rubbing the tongue with a piece of cloth. This is
an invariable phenomenon in scarlatina, at least when the affec-
tion has not been marked by any febrile phenomenon. There is
nothing analogous to this in rougeola, nor in variola, even when
this is accompanied by stomatitis. Towards the seventh or eighth
day, still preserving its red color, the tongue becomes smoother,
and towards the eighth or ninth day the epithelium is renewed ia

670 On Scarlatina. [November,

a very apparent manner, at first excessively thin, but towards the
twelfth day it has nearly regained its natural thickness ; but the
mucous membrane remains a little redder than in the normal
condition.

The phenomena which attract our attention the most in scarla-
tina, are the nervous symptoms. It is proper to say that their in-
tensity in thi^ disease is so special, that they alone, in a great many
cases, will suffice to separate it from any other exanthematous
fever. Never, or very seldom at least, is rougeola announced by
any severe cerebral symptoms, with the exception of eclampsia ;
and as in fact it is only in this respect that any possible confusion
can be made between rougeola and scarlatina, the intensity of
these symptoms alone establishes a capital difference between
these two diseases.

They are present from the beginning ; from the first day they
exhibit themselves by delirium.. This is not the case in mild scar-
latina, but in its severe form it is seldom absent. When the dis-
ease is serious, it is as well marked as in the most severe typhoid
fevers; it appears with the eruption, persists until the period of
desquamation, or more correctly speaking, until the fever falls.

Delirium is not the only manifestation of nervous disorders;
they are also shown by carpliologia^ jactitation^ coma, and in some
cases by coma vigil ; in a word, all the forms of tj^phoid nervous
symptoms are met with.

In infants it is not uncommon to witness attacks of eclampsia in
the first two or three days of the disease. The convulsions have,
however, a very different character, as regards their seriousness,
than have the initial convulsions of rougeola and variola; for
while those of variola are considered by certain authors, Syden-
ham among others (whose opinion I do not partake), as being of
a favorable augury, while the initial eclampsia in rougeola is
generally regarded as a symptom of very slight value, the attacks
of eclampsia occurring the first or second day in scarlatina are,
upon the contrary, of great gravity. This gravity is still greater
if they arise in the third period of the disease, when there is gen-
eral oedema ; we shall have again to speak of its signification ; we
shall have to say that then the convulsions are often fatal symp- .
toms.

Even in adults examples are not wanting. Epileptiform symp-
toms appear the second or third day of the scarlatina, in those
persons particularly, who have been subject to attacks of epilepsy,
these initial convulsions are repeated, coma succeeds, and death
comes in the first twenty-four hours after their appearance.

There is still another marked nervous phenomenon of a very
bad prognostic. I speak of dyspnoea, which is, however, not at-
tributed to any material lesion of the lung, a dyspnoea which is
met with its mournful signification in a great number of septic
diseases, in puerperal typhus, the typhus of camps, in cholera, etc.,

1857.] On Scarlatina. 671

dyspnoea which you have been able to witness in that woman re-
cently delivered, who was so sudderxly carried off by scarlatina.

Independently of these disorders inherent to the disturbances of
cerebral and spinal innervation, there are others which are allied
to perturbations sustained by the g an glio nary system^ and which I
shall point out to you.

You^ doubtless, are acquainted with the wonderful works of M.
Claude Bernard, upon the section of the ganglionary nerves; you
know that this section produces in the parts to which the filaments
of nerves are distributed, not a paralysis, but, on the contrary, an
exaggeration of certain functions, particularly of calorification and
of secretion. The learned Professor of the College of France has
shown you how, by cutting the sympathetic filaments which go to
the ear and face of the rabbit, an elevation of temperature is pro-
duced in these parts, which may rise from 4 to 5 degrees higher
than the normal temperature; he has shown you that by cutting
the ganglionary nerves of the coronary plexus, considerable hy-
persecretion of the gastric mucous membrane results. From these
experiments you will draw the conclusion, that each time that
caloricity is increased in an animal, there will be reason to infer
some disturbance in the ganglionary nervous system, rather than
in the functions of the cerebro -spinal system. But there is certainly
BO disease which is accompanied by a general elevation of tempera-
ture as high as scarlatina. In those affected with scarlatina, in fact,
the thermometer introduced into the rectum, or placed in the arm-
pit, has marked 40 to 41 degrees centigrade. This elevation of
temperature can only be explained by the disturbances in the
ganglionary innen^ation, which are also shown in other functions,
under the subjection of the grand sympathetic, as the incessant
bilious vomitings which persist in some persons four, five, and six
' days, and the abundant intractable diarrhoeas. Graves had pointed
out this polycholie in scarlatina independent of any phlegmasia.

The non -inflammatory nature of these symptoms it is important
to note. If, in fact, impressed with the idea of inflammation,
which the heat of the skin seems to indicate, you endeavor to
combat the diarrhoea and the vpmitings by antiphlogistics, you
will adopt the worst medication, in fact the most perilous treat-
ment that can be adopted for scarlatina, for of all the eruptive fe-
vers, scarlatina is the last one which requires this kind of treatment,
seldom beneficial in rougeola or variola.

Besides the nervous symptoms which I have just indicated,
others arise, sometimes at the commencement,, rarely, it is true, at
this period ; these are haemorrhages hemorrhages from the mu-
cous membrane, subcutaneous haemorrhages, renal hemorrhages.
These haemorrhages belong, however, rather to the third period of
the disease, and we shall see that in its declination haematuria in
particular, coincides frequently with the anasarca of scarlatina, of
which I shall have to speak.

672 On HcBmaturia after Scarlet Fever. [November,

In studying the relation existing between the severity of the
disease and the intensity of the eruption, it will be seen that cer-
tain authors have committed a great fault in this respect, and the
greater because they may lead into error those physicians who
are not familiar with scarlatina. They say, in fact, that when the
eruption is well developed, very bright, or, to use a vulgar ex-
pression, ivell out, the patient runs fewer chances of having any
serious symptoms. Well, it should be said of scarlatina what is
said of variola, its severity is in direct ratio with the intensity of
the eruption. In a discrete scarlatina the danger is ordinarily less
than in confluent scarlatina, as in a discrete variola there is less to
fear than in a confluent variola. In both of these exanthemata,
the more intense the eruption, the more serious the symptoms and
the greater the danger. Such are the facts established by obser-
vation during the course of epidemics.

Scarlatina, I have insisted, does not even resemble itself j iden-
tical, be it understood, in its essence, it is not so in its forms. In
some cases, after ten or twelve hours of fever, an insignificant
eruption appears upon the neck and body, and two or three days
afterwards this eruption and the fever which attended it have dis-
appeared^ the patient has hardly felt sick, desquamation goes on,
it takes place by little bands, then after five to six days the dis-
ease is cured, and if the patient does not expose himself to cold,
or commit any imprudence, it passes entirely off. The disease has
been so simple, that in certain families it passes unnoticed.

Between this mild form and that more severe form, the outlines
of which I have already traced for you, there are intermediate
forms. Malignant scarlatina, I have told you, becomes a terrible
scourge, equal to the most fearful pestilential diseases.

I now come to speak of a few particular symptoms of scarlati-
na, which I have indicated en passant, and which it is necessary I
should dwell upon more in detail.

And first, of the angina of scarlatina. [Am. Med. Monthly.

[To be continued next month.]

On Rcematuria after Scarlet Fever. By Wm. R. Basham, M. D.,
Physician to the Westminster Hospital, and Lecturer on the
Practice of Medicine.

H^MATUEIA AFTER SCARLET FEVER; ANASARCA; PULMONARY
AND CEREBRAL COMPLICATIONS ; CONVULSIONS ; DEATH.

If further proof were necessary, to establish the doctrine that
the morbid sequelae of scarlet fever are to be traced to the imper-
feet elimination of the original virus, it might be found in cases in
which the morbid symptoms of this secondary stage are not limited-
to renal disturbance, but where serious complications, both of the;
cerebral as well as the respiratory functions, co-exist. In these:,

1857.] On Hcematuna after Scarlet Fever. 673

cases, where cerebral symptoms become developed during the pre-
sence of general dropsy, the urine being highly albuminous, with
abundant exudation of the renal epithelium, there can be no hesi-
tation in attributing the convulsions, coma, and death, to uriemic
poisoning. The symptoms are strictly analogous to one form of
cerebral disturbance frequentl}^ observed in cases of renal degen-
eration in adults, in whon^ the function of the kidneys is limited
to the excretion of the water and albuminous constituents of the
blood, and fails to eliminate the urea, the retention of which, act-
ing as a poison in the blood, manifests its virulent power by the
most fatal indications. It might therefore be assumed that these
symptoms are referrible rather to the renal incompetency than to
the febrile poison. Proximately, doubtless they are so ; but it has
been already shown in a previous lecture that the incipient stage
of the renal disorder, the congestion, the ha^maturia, are not acci-
dental conditions, but arise undeniably from the secondary effects
of the original febrile virus. There can be no dif&culty, then, in
tracing the convulsions and fatal termination as much to the im-
perfect elimination of the scarlatina poison as to the intensity with
which the system was in the first instance impregnated.

Case. Adolphus L , aged six, was admitted into Burdett

ward Feb. 10th. The child is reported to have had scarlet fever
about a month since, and he has been attending as an out-patient
for the last three days, but the gravity of the symptoms rendered
him a fit object for admission. There is a considerable degree of
constitutional disturbance, febrile heat of skin ; pulse rapid ;. the
tongue red, and inclined to become dry ; the whole surface of the
body is anasarcous ; the face is pallid, sodden, and puffy to a great
extent under the eye-lids; the scrotum is much distended and the
prepuc ecedematous ; no indication of ascites. There is a purulent
discharge from the left ear. The chest is moderately resonant
throughout, but there are coarse moist mucous murmurs all over
the left side, and with considerable bronchial wheezing on both
sides; the respirations are 24; the pulse 96 ; frequent cough and
&ts of dyspnoea ; heart sounds natural. The urine is moderate in
D[uantity, smoky in appearance, specific gravity 1-014:, abundantly
albuminous. The mother states that for several days in the pre-
vious week the urine was of a blood-red colour. The urine, ex-
amined b}^ the microscope, exhibited many free blood-corpuscles ;
pauch amorphous granular matter, stained with hsematin ; and
numerous fibrinous castes filled with blood-discs. Warm baths
were ordered; the compound jalap powder, as a purgative; and
saline medicine, with three drops of the tincture of digitalis to
ach dose. Two days afterwards the urine remained the same in
^uantit}^, but became much higher in specific gravity, 1*020. Free
Durging with the compound jalap powder was established on the
L5th, with great advantage to the symptoms, the skin becoming
jool, and the tongue less red and moist, the patient eagerly taking

674 On Hcematuna after Scarlet Fever. [November,

the farinaceous food prescribed. There was also considerable
diminution of the oedema of the prepuce and scrotum, although the
face still continued puffy.-

Ten days after admission the urine became more copious j the
smoky appearance had given place to a clear amber-coloured
tirine, of a specific gravity 1"007, and copiously albuminous. On
adding nitric acid to the heated urine,- the colour becmne first of
a bluish green, and subsequently greenish black. I shall hereafter
direct your attention to the nature of these pigmentary alterations
in albuminous urine. They are of occasional occurrence in the
progress of renal degeneration, and, so far as my experience teaches
me, are conditions of very unfavourable significance.- The pulse
continuing good, and the appetite improving, the bowels acting
freely with the cream- of- tartar purgative, the potassio-tartrate of
iron was ordered.

On the 8d of March, three weeks after admission, he wa& sitting
tip in bed, and is reported to have improved somewhat in appear-
ance ; the face being, however, still CBdematous, particularly in the
morning. The quantity of urine passed in the twenty-four hours
had notably increased, but without any corresponding diminution
in the anasarca of the surface, although, as compared with the
week previous, the dropsy had much decreased. The specific
gravity of the urine was very low, l*005-6, and the quantity of
albumen seemed increased, as its coagulation by heat rendered the
contents of the tube nearly solid. Examined under the micro-;
scope,- numerous castes of the tubes were visible, partly transpa--
rent,- containing, however, epithelial cells, highly granular in
appearance,- with many scattered fat granules; there was also
much free granular matter in the field. On this day, soon after
he had taken his dinner of beef-tea and rice-pudding, convulsions
suddenly came on; they were of the type of those intermitting'
movements so frequently seen produced by dentition or intestinal
irritation ; constant jactitation of the limbs, with rolling of the
head on the neck. These continued for several hours, with only
slight intermissions;- the pupils were dilated; the breathing was^
laboured and quick ; the pulse 110 to 120. Purgative enemata,
and mustard poultices to the lower extremities. The convulsions
returned in paroxysms during the nighty and in the intervals the
patient was quite comatose, with stertorous breathing; the urine
and fcBces passed involuntarily, and the child died at 2 P. M. on
the 5th,forty-eight hours after the first convulsion. Unfortunately
no post-mortem examination was permitted.

TVe have no information that can be considered satisfactory of--
the earlier stages of this child's illness, beyond the fact of its hav-
ing had Jscarlet fever. Whether the eruptive period was distin-
guished by any untoward symptom, or whether desquamation of
the cuticle followed, cannot be ascertained, as the mother seems to
have paid no attention to these points. That the secondary affec-

1857.] On ffcematuria after Scarlet Fever, 675

tion was characterized by symptoms of unusual severity, the state
of the child on admissioa very plainly testitied, and it is to these
symptoms I would specially direct your attention. First, the de-
gree and character of the febrile disturbance ; secondly, the renal
and pulmonary complication ; thirdly, the cerebral conditions and
sequel. The fever was less of the asthenic type than is usual in
these cases; it was more expressive of irritative action, such as
usually accompanies local or regional inflammation ; nevertheless,
the dropsy and pallid look forbade any general or topical deple-
tory measures. The state of the urine, the physical signs within
the chest, each told of congestive conditions formidable obstruc-
tions to the purification of the blood by respiration on the one
hand, and of its depuration by urinary excretion on the other.
What principle of treatment is to guide us in such complex states?
If I may sum up in a few words the broad fundamental, thera-
peutical principles in such cases, I would say, we must endeavour
to bring into activity and act upon those functions and emuncto-
ries which are not, or only in a moderate degree, implicated in
the morbid disturbance, and by their agency relieve, if possible,
the oppressed and impeded organs. Thus, though the surface of
the body is anasarcous, we must endeavour to promote its exhal-
ing power; and as the intestinal mucous surface gives no indica-
tion of sharing in the morbid state of the kidneys, we must bring
its secretions into activity to pur^e the system of the accumulated
fluid, and vicariously, for a time, relieve the kidneys of their office.
The intimate sympathy between the kidneys and skin, and be-
tween the latter and the bronchial mucous membrane, when the
latter is the seat of inflammation, would entitle us to expect the
most beneficial results by vigorously promoting the cutaneous
function ; but unhappily, in these cases, the dropsical state of the
surface of the skin precludes our obtaining much efficient aid in
this direction. Warm baths effect oftentimes great temporary
relief to the lungs; the breathing becomes less oppressed, and the
secretion from the bronchial tubes more free ; but the hot-air bath
appears to be the most efficacious; there is not that exhaustion
which is induced by a succession of warm baths, and, to my ob-
servation, the amount of relief felt by the patient is greater. To
wd these external appliances, ammoniacal sahnes may be given
internally with advantage. Active purging, however, yields the
fcest results. It is, however, of importance to select appropriate
means to obtain the greatest amount of relief, for it is not every
purgative of the pharmacopoeia which answers this purpose
Bqually well. That purgative which acts most directly as a hy-
drogogue is the best adapted, but which, at the same time, is not
followed by any disproportion ed exhaustion, or by any torpid
reaction. The combination of jalap and cream-of-tartar is most
admirably suited to these ends. It acts quickly, without depres-
sing the system, is not followed by inactivity, and induces copi-

K. S. VOL. XIII. NO. XL 43

676 On Hcemaiuna after Scarlet Fever. [November,

ous watery dejections. This patient was much benefited by these
purgative remedies: the febrile state was lessened, the tongue
became moist, and doubtless, from the amount of fluid drawn
away by the cathartic, may be explained the great increase in the
specific gravity of the urine. There was manifest abatement of
the dropsical condition, and the breathing was easier and expec-
toration more copious. Continuing this plan of treatment, the
improvement became sufficiently pronounced to justify the admin
istration of chalybeates. At the same time, the state of the urine
revealed by the microscope, together with the appearance of that
peculiar pigmentary condition observed in combination with the
albumen, suggested a very unfavorable prognosis, although I
was not without hope that the renal degeneration had not reached |
that stage at which ultimate, though remote, recovery might be
possible. The casts of the tubes were partly transparent, partly
granular. The few epithelial corpuscles visible within the tubes
were filled with fat granules, and the tubes contained many scat-
tered fat granules; highly refractive, and completely removed by
ether. These microscopic conditions indicate an advancing stage
of degeneration, and if spread through both kidneys, must be
quickly followed by an imperfect elimination of the chief uniary
constituents ; and this was evident by the singularly watery state
of the urine, its specific gravity not exceeding 1.005^ but contain-
ing abundanance of albumen, and this latter associated with a
peculiar pigmentary matter, rendered visible after boiling by the
addition of nitric acid.

It would be out of place here to enter into an investigation of
the nature of the pigments that are occasionally met with in the
urine, cyanurin, melanurin, &c. Experience tells me that the
developement of this pigmentary condition, in combination with
albumen in tne urine, is of the gravest import. It is -always asso- -j
ciated with, the most advanced stage of renal degeneration, and U
in every instance in which I have seen it, it has been quickly B
followed by fatal results. Lehman, in his " Physiological Chem- '
istry," (vol. ii., p. 428,) says, as far as his experience goes, it
only when uraemic symptoms have manifested themselves, tl;
this peculiarity of the urine is generally observable, and tL
entirely coincides with my own. We should not then be unpre-
pared for the developement of unfavorable symptoms whenever
this peculiarity of the urine is observed ; so that notwithstanding
the apparent improvement in the child's condition, even to the '
diminution of the dropsy of the surface, I expressed my fears at
the time that this hopeful state would be but temporary. And
surely nothing can exhibit the value and importance of frequent
examination of the urine in such cases more forcibly than the fact )
here obtained, and the unfavorable inference deduced. In all |
other respects there was an apparent amendment, and if we had |
based the prognosis only on the general aspect of the patient, we I

1857.] On the Therapeutic Use of Oxygen. 677

might fairly have inferred that all was going on well, It is not
of less importance in hospital practice than in private, nor is it
less necessary amongst the poor than amongst the rich, to be expli-
cit and candid in the expression of our fears or hopes to those
anxiously interested in the welfare of the patient. It is as much
the office of the physician to allay anxiety where that can be done
with prudence, as it is his more distressing, but not less impera-
tive duty to disclose his worst apprehensions, especially when he
sees expectations of amendment cherished, which experience
teaches him will be but temporary, and which must soon give
way to less equivocal signs of approaching clanger.

In the present instance, I believe the warning given to the
mother was unheeded ; the amendment was so palpable to her,
that she would not believe but that our unfavorable opinion was
mere conjecture. You may learn an important point here name-
ly, the suddenness and abruptness with which the symptoms of
uremic poisoning oftentimes commence. In some cases, particu-
'arly in adults, the indications are progressive; but here all other
things being promising, cQnvulsions suddenly supervene; they
intermit, but coma characterizes their remission, and the patient
dies forty hours after the first indication of the urinous poison
acting on the nervous centres. You may very probably ask, Can
piothing be done in this crisis ? Are there no remedies available
For such a state ? These cases of convulsion are not always fatal ;
sometimes in the intervals, conciousness returns. Such cases offer
i better prospect for remedial agents than where the patient re-
mains comatose. In either state, how^ever, an effort should be
uade to excite the bowels to active excretion. Enemata contain -
ng, according to the age of the patient, half a drop or a drop of
iroton oil, should be administered; and where the ability to swal-
ow is unimpared, you may expect some benefit from the chlorine
mixture, the agency of which, according to the hypothesis of
Frerichs, depends on its union with the carbonate of ammonia,
nto which the urea in the blood is converted, and which he
considers to be the poisonous agent in these cases of fatal
irjemia. I have in vain sought for proofs of this doctrine,
)ut whether the hypothesis be true or false, clinical experience
ells me that much benefit is often derived from chlorine ad-
inistered in the form constantly employed by me. [London
ncet

On the Tlierapeutlc Use of Oxygen. By S. B. BiRCH, M. D.

In venturing to call professional attention to the subject of this
laper, I may safely premise with the remark, that it is one respect-
Lig which there exists great diversity of opinion and very little
{jractical knowledge. The therapeutic use of oxygen gas, either
lone or as an adjunct, in various intractable cases, is a subject of

678 On the Therapeutic Use of Oxygen. [November

vast importance to my professional brethren, enhanced in valu(
as it is by an impartial reflection upon the still very uncertain
and very unsatisfactory state of our knowledge of medicinal mo
dus operandi. Thus far, excepting to a few individuals, and to i
very limited extent, this gas, although so well known in its physi
logical relations, has been practically little better than a "secret'
in its therapeutic bearings. Notwitlistanding that from the time
of Dr. Beddoes and Sir Humphry Davy several practitioners have
made successful trial of oxygen in private practice ^notwithstand-
ing that the researches of modern chemistry have made us mor(
scientifically cognizant than formerly of the relations of oxygcL
to the other elements of the vital organism, and the tran&forma
tions which determine the pathological conditions of that organ
ism notwithstanding that the daily observation of every man
who has disease to treat shows him that the patient needs plenty
of pure air^ more air (in other words more oxygen) than he can
possibly obtain under many circumstances and in many diseased
states from the atmosphere around him the idea seems merely to
float through the professional mind^ without any resalting gene-
ral endeavor to make a practical application of it.

It would not be dijB&cult to show cause why the use of this rem
edy has been neglected. It involves some trouble and loss oi
time to the practitioner^ and consequently the very want of prac-
tical knowledge still existing may be justly attributed to the ne-
glect to carry out fair trials on a sujBScient scale in practice. Thus
the profession has been led to overlook or ignore oxygen as a
medicine, even though chemical science tells us decidedly that it
ought to be a most valuable remedial agent. A single trial, or
several trials on several patients, are no evidence, if they fail,
against its value; they are only proof either that it was not suited
to the case, or that it was not properly exhibited. Drs. Beddoes,
Thornton, Hill, and others, who have tested this gas in a suffi-
ciently large number of cases, afford conclusive evidence that it is
a powerful therapeutic ; while occasional experiments in which it
has been unsuccessfully tried, can only be accepted as proof that,
were we to seek an " universal panacea,^ oxygen i& not that rem-
edy. True, medical science will learn to value it at its intrinsic
worth only when it is allowed to have a fair and sufficiently ex-
tensive trial.

That oxygen may be exhibited with the success which it merits,
much valuable time must necessarily be devoted by the physician ;
in consequence few practitioners have hitherto had the patience to
use it even in a limited number of cases. And here I may ven-
ture the truism, that confidence in any medicine can be acquired
by men of judgment only through the medium of ample experi;
ence. The limited amount of practical acquaintance with oxygen,
as a therapeutic, at present in the profession, has been forced on
my mind by the variety of opposite opinions that have been ex-

I

1857.] On the Therapeutic Use of Oxygen. 679

pressed. Some of my brethren express their firm belief that it
"must be an injurious excitant or stimulant;" others, taking a
precisely contrary view, somewhat contemptuously observe, " It
is, I suppose, just like taking a little more fresh air, it can do nei-
ther much good or much harm;'' others, again, join issue with me
on the presumed "too rapidly destructive metamorphosis of tissue"
in attenuated subjects. \gtj many have serious misgiving as to
the gas setting up pulmonary inflammation; while one eminent
physician told a patient of mine that the Almighty had given us
a certain per centage of oxygen regularly to breathe ergo^ there
could be no necessity, under any circumstances, to increase
that quantity. Other opinions I could name, but the above will
suffice. As a rule, I may say, that oi apjCroi ignore oxygen as a
worthless remedy, founding their opinions upon former failures;
oj itoXhjil with few exceptions, have never heard of its having
been tried and found wanting, but entertain a general belief, when
induced to reflect on the subject, that it ought to possess valuable
but, to their minds, undefined curative properties. Even Dr. Pe-
reira himself, in the last edition of his " Materia Medica," con-
cluded his remarks upon the therapeutic action of oxygen in these
words: "On the whole, then, I believe oxygen to be almost use-
ess as a remedy." Thus prestige and authority are decidedly
lostile to this powerful remedial agent.

In this paper it is not my intention to enter into the details re-
specting the chemical actions of oxygen upon the organism, and its
highly important relation to the vital dynamics. I hope shortly,
however, to throw out a few suggestions for the consideration of
my superiors in the scientific world.

Meanwhile I will content myself with asserting, as the result of
considerable experience and close clinical observation, that an in-
creased supply of oxygen to the S3^stem may become, under differ-
ent circumstances, exciting, depressing, sedative, tonic. Each
patient must be treated according to peculiar characterictics of
temperament, diseased conditions, long or short continuance of
disease, existing and changing symptoms ; and the effects of the
eatment must be carefully watched. No practitioner must ex-
ect full success aifirst^ if he be induced to make a trial of oxygen
n difficult and intractable cases. As obtained formerly with my-
elf, he may for some time meet with much disappointment; and
,e may probably discover the necessity of extended clinical expe-
ience with the gas, before he will feel himself able to administer
,it with justice to the patient, to himself, and to the remedy. Every
thing depends upon minute details; while not unfrequently much
Judgment and practical knowledge of I his therapeutic are requisite
for the due selection of medicinal and dietetic adjuncts.

Having for some time extensively employed oxygen in my own
ractice, and now feeling myself in a position to adduce some
Tactical evidence not without value, I hope to offer occasional

680 On the TJierapeutic Use of Oxygen. [November,

clinical facts and remarks, which may prove of some little service
in the highly-important, but imperfectly-explored, prairie of the-
rapeutics. Subjoined are two cases :

S. B , Esq., aged thirty -three, unmarried, of temperate

habits, of nervo-sanguineous temperament, with some hereditary
strumous tendency, had been the subject of secondary syphilis for
seven years, and had undergone a variety of fruitless treatment.
Amongst other measures, he had, under the best advice, been sub-
jected to several courses of mercury, iodide of potassium, sarsapa-
rilla, nitric acid, cinchona, and all the most approved means
usually employed in treating such cases. Finding himself rather
worse than better, and coming to the sad conclusion that his con-
stitution had become terribly shattered, quite as much from the
mercurial treatment as from the original disease, he resolved, by
the advice of a friend, to place himself at a hydropathic establish-
ment. Here he underwent such severe treatment that he was
compelled after some weeks to give it up, owing to increased
general weakness and exhaustion of his vital powers, with tenden-
cy to ulceration of the legs. He now consulted several eminent
practitioners; went through a repetition of iodide, cinchona, &c./'
and was recommended the most generous diet possible, with wine
and porter. This failing, he was advised, as the only hope of cure,
to take a long sea- voyage to a warmer climate. He had made up
his mind to follow this advice as a dernier resort, when one of his
legs became suddenly so seriously ulcerated and his whole s^'stem.
so debilitated, that he determined to place himself under my care
in consequence of hearing of the extraordinary agency of oxygen
in cases of ulcerated legs and general debility. Such was his
history.

June 29th, 1856. This unfortunate gentleman consulted me,
I found him extremely weak and anaemic, his powerful and mus-
cular frame completely relaxed and attenuated ; the skin through^
out the body was quite blanched, and so transparent as to show '
deeply beneath the surface general dirty-looking congestion, with '
occasional spots of complete purpura. Some caries of one superi- '
or maxillary bone was observed, extending from the alveolar i
processes of the molar teeth. He suffered much from cerebral '
irritation, the eyes being suffused, intolerant of light and almost
useless, with chronic iritis, and some effusion of lymph of low or-
ganization. Pulse from 100 to 112, very small, almost impercept-
ible; tongue white and relaxed ; and although the weather was
tolerably warm, his vital powers were so low as to render it almost '
impossible to generate sufficient animal heat to keep him alive, '
the extremities being cold and clammy. In fact, universal pros-
tration and torpidity of function prevailed; and I ought to add,
that he had a suspicious, short, hacking cough (which had existed
some months), with profuse nocturnal perspirations, but no well-
marked physical signs of tubercular deposit. Upon examinatioii

1857.] On the Therapeutic Use of Oxygen. 681

of his leojs, a very large ulcer was seen on one calf, and a little
ulcerated point, communicating with a small but deep cavity on
the other. The larger one, he informed me, had commenced in a
little spot about a fortnight previously, and had for some days
been spreading very rapidly, causing much severe pain and con-
stitutional irritation. It now presents the peculiar appearance of
a sloughing mercurio-syphilitic ulcer, exactly circular, about two
inches in deptli, oonsiJerably excavated ; the whole circumfer-
ence for the distance of an inch and a half or two inches from the
edges, is hard, red, and extremely sensitive; there is a discharge
of dirt3^-looking sloughy matter and acrid sanious fluid. In spite
of the vigorous and judicious measures advised by an eminent
London surgeon, who had been consulted a few days previously,
the sloughing ulceration is rapidly extending; and in the exces-
sive prostrated condition of the suflcrer the case appears by no
means hopeful.

Here an opportunity offered of severely testing the power of
oxygen; and knowing what this therapeutic agent could eflfect in
analogous non-syphilitic ulcers, and in most cases of extreme de-
bility and languid circulation, I at once determined energetically
to bring it into action. My patient was ordered to preserve the
horizontal position, and to foment, poultice, etc. The same after-
noon I administered a large dose of the gas, which had the effect
of making him feel more comfortable. The following morning,
the ulcer still alarmingly progressing, I carefully superintended
the administration of the largest quantity that could be borne, and
ordered a moderate inhalation in the evening. From that time it
spread no further, and by daily watching my patient during the
succeeding fortnight I had the satisfaction to witness the separa-
tion of the dead portions, the perfect cleansing of the whole sur-
face (the muscle being left exposed for some distance, and its
movements being seen at the bottom of the cavity), and the gra-
dual filling up of the depth with granulations; while at the same
time the appetite returned, and the capillary circulation, with the
entire nervous system, began to regain tone. Small doses of
iodide of potassium were now ordered three times a day, and nu-
tritious but moderate diet with porter; cod-liver oil was rubbed
into the chest twice a day, and tepid daily sponging of the whole
body was enjoined. In five weeks he was able to walk about, and
in seven weeks entire healing of the large and deep excavation,
resulting from the ulceration, had taken place, permitting him
with his increase in strength to walk without difficulty many
miles. He now left town, taking with him a supply of condensed
oxygen, with a strict direction to continue his moderate inh^a-
tions, the iodide of potassium and the cod-liver oil externally, and
to communicate with me by letter once a week. Three weeks
afterwards, having walked rather too much, and having otherwise
irritated and injured the place on the other leg, where the small

682 On the Therapeutic Use of Oxygen. [November,

la

point of ulceration had apparently healed under the influence of
the oxygen without sloughing^ he thought it advisable to return
to London. I found an ulcer of moderate size, much inflamed
from irritation, rubbing of his trousers against it, and neglect;
moreover, he had caught a severe cold, and his cough (which had
never left him), with profuse perspirations at night, caused much
disturbance. He was feeble and extremely sensitive to cold, al-
though the weather was warm, I gave him stringent directions h
as to quiet for his leg, largely increased his quantity of oxygen at
each inhalation night and morning, continued his other constitu-
tional treatment as above mentioned for the specific diseases, and
watched him closely by means of two long daily visits. He again
progressed most satisfactorily, and was soon enjoying his favorite
pedestrian exercise.

Steadily continuing his treatment, he, towards the middle of
September, had entirely lost his consumptive cough and nocturn-
al perspirations, had fully regained his nervous tone, and had re-
covered his flesh ; he suifered no longer from cold and languid
circulation ; the dirty congested appearance beneath the cuticle
had quite disappeared ; the jaw (from which there had been some
exfoliation) seemed quite sound, and the general cerebral irritation
with iritis nad for some weeks ceased to evidence itself, the efl used
lymph likewise having undergone complete absorption, and the
membranes and chambers of the eye being quite clear and free in
their movements.

About the end of October, this gentleman, an ardent disciple of
Nimrod wrote for permission to tbllow the hounds again. With
a caution, I acceded to his request; and I have since learned that
he rode very hard during the hunting season without any return
whatever of his former protracted disease. A few days ago, I
may add, I heard some further account of him, and he is now
stouter and stronger, and altogether in more robust health, than
(he thinks) he ever recollects.

It is especially worthy of remark, with this interesting case in
retrospect, that there exists probably no remedy at all comparable
with oxygen ai> (in common parlance) a "purifier of the blood,"
when judiciously administered. My own experience particularly
points to its well-marked and energetic action upon the general
capillary circulation and upon the skin ; in most cases it power-
fully promotes the healthy secretions of the latter, and enables it
to throw off an immense amount of morbid and poisonous matters ;
and, unlike all other medicines, while performing this duty, it
produces no weakness or other untoward effects, but, on the con-
trary, simultaneously acts as a general tonic to the entire constitu-
tion. It will be observed that I ordered, as an essejitial adjunct to
treatment, tepid sponging of the whole body daily, the poisonous
debris cast off with the aid of the gas, and accumulating on the
skin, obviously necessitating either such sponging or the use of

1857.] The History of Dr. Marshall IlalVs Case. 683

the tepid bath. It also merits a passing notice how quickly the
heroic doses of the gas, temporarily and carefully given, demon-
strated the power of this therapeutic in cutting short and arresting
the progress of rapidly-spreading ulceration.

I will give a second case very briefly, from memory, so as not
to lengthen my present paper too much.

A. B , a policeman, aged thirty-six, had been nearly three

< months under skilful medical treatment on account of inveterate
: boils and carbuncles, which, appearing in continuously successive
I crops, resisted every remedy. At length he was advised that me-
dicine could do no more for him, and that he must get immedi-
ately into the country, for the purpose of trying what that change
could effect. He was at this time covered with from twenty to
i thirty specimens of this very painful eruptive disease, and his
I health was necessarily much undermined from acute suffering and
\ constitutional irritation. Being accidentally met with, he was of-
fered gratuitous treatment under oxygen. Having a family to
provide for, he could ill afford to leave them, and therefore thank-
fully accepted the proffer. He at once commenced a daily inha-
lation, and so rapid was his progress that in from ten days to a
fortnight all the eruptions had entirely disappeared, and the un-
! healthy constitutional condition was so completely overcome as to
render the cure permanent. [Ibid,

Dr. Marshall Hall: The History of his Case^ and the Post-mortem
Appearances.

If the pages devoted to the science of Medicine in this country
may with advantage be illustrated with interesting and important
cases, on no occasion can a space be more usefully or more grace-
fully afforded than in the present instance. We have to record
the particulars of the case of one of the most distinguished, most
talented, and most industrious of her professors ; for such a man in
every sense, was the late Dr. Marshall Hall. To render the story
of his case complete, it is necessary to go back some years previ-
ous to the appearance of the last severe and fatal symptoms f for
some peculiar features connected with the earlier symptoms ren-
dered the case somewhat different to those generally met with in
practice, and made the sufferer himself, always patient, thoughtful
and suggestive, consider that it presented features worthy of no-
tice ; and also made him anxious that its investigation should be
completed by a post-mortem examination.

His own account of an early inconvenience or difficulty in swal-
lowing, best explains the symptoms as they occurred; "Some
fifteen years ago," he wrote to a friend, "I undertook to deliver
two long and distinct courses of Lectures on the Practice of Phy-
sic, during the same winter." His custom was to lecture from six

684 The History of Dr. Marshall HalVs Case. [November,

to seven, and then from eight to nine, in the same evening. He
felt inconvenience during this winter from hoarseness and cough
for the first time, and began to perceive that minute portions of
food were apt to remain m his pharynx, and that after meals he
occasionaly raised some small portions. This difficulty of swal
lowing very gradually appears to have increased; and he was in
duced, some years ago, to consult Sir Benjamin Brodie and Dr.
Chambers on account of the increasing symptoms of obstruction
but on Sir Benjamin Brodie passing a bougie, no evidence of ob
struction by contraction of the oesophageal tube could be detected
Mr. Guthrie, whom Dr. Marshall Hall also consulted, told him that
he was only suffering from what was called "clergyman's throat."
But the dysphagia continued, and during deglutition much care
was requisite in the act of swallowing, and food could not be hast-
ily taken, and while in the act of swallowing much regurgitation
could be heard by those sitting near him.

He considered this condition to be due to a defective reflex ac-
tion which prevented the muscles of the pharynx from acting with
sufficient power to propel all the food lodged in it; but the proba-
bility is, that there was some such dilatation of the pharynx at
this early period as is sometimes met with, and which in a meas-
ure acts upon the aperture of the oesophagus mechanically, and
thus interferes with the ready passage of food. Such were the
symptoms which continued slowly increasing, but which never
prevented a sufficient amount of food to be taken, both solid and
fluid, to keep up a projper nutrition, until about the end of 1855,
when Dr. Marshall Hall first perceived that in the expectoration
he usually had in the morning there was occasionally a slight tinge
of bloody and this especially after much speaking or exercise. The
dysphagia also commenced from this time to be troublesome and
serious.

Previous to this date. Dr. Marshall Hall had retired from active
practice in London, as he found his health was failing to a certain
extent, and some spots of purpura appearing on his legs. He wise-
ly determined at once to give up the anxieties of professional oc-
cupation, though it entailed the sacrifice of a large professional
income. He made a tour of the United States in 1854-55, and
spent the following winter and spring in Italy. He returned to
England much better in health, but not improved so far as the
throat affection was concerned. After a short stay in town, he
went to Hastings, and came to town again in October following.
It was now that the symptoms of permanent stricture of the oeso-
phagus were fully established. He had some time ceased to par-
take of solid food ; milk, cream, and cofi:ee, were the fluids he
chiefly preferred. With the evident obstruction there was con-
stant copious expectoration of purulent mucus, somewhat offen-
sive in character, and occasionally during each day tinged with
blood. He was seen in consultation by Dr. Williams, Mr. Caesar

1857.] The History of Dr. Marshall HalVs Case. 685

Hawkins, Mr. J. R. Martin, and Mr. Pollock, all of whom were
agreed as to the serious nature of the complaint. He was quite
prepared for the expression of their most unfavorable opinion, and
was even cheerful whilst under examination. In speaking to one of
his medical friends, who was constantly with him whilst in town,
he said, "I don't ask you what your positive opinion is as to \\)y
prospect of life, for no one can be certain of the result of a hidden
malady ; but I look upon my disease as a fatal one, and have long
done so. I have no hope of recovery. I don't wish you to men-
tion this to Mrs. Hall. I have no fear of death, and cannot be
alarmed by the truth. 'My only wish to live is for the sake of
otheis; but I am resigned to the alternative, if it be ordered that
I should not live much longer." The calm, resigned, and almost
cheerful manner in which he spoke, at once showed the prepara-
tion and the courage of a man who knew his end was not far dis-
tant, though still, as ever, unselfish, considerate, and afiectionate
for those dear and near to him.

Whilst in London, he had a wish to have the nitrate of silver
applied in solution to the supposed ulcerated part of the pharynx;
but when advised not to employ it, he readily acquiesced in the
opinion of those he had consulted. He had applied the solution to
the throat when in the country, but had been apparently much
distressed by it; and though he had expressed a wish for its ap-
plication a second time, he evidently had no desire to persist in its
use, from the distress it had occasioned.

After a short stay in London he removed to Brighton. He now
placed himself under the care of Mr. Wildbore, whose constant
care and attention to him he always spoke of with much gratitude,
and to w^hose note-book we are indebted for the remaining parti-
culars of his case.

After being settled in Brighton, he complained of, and suffered
much from cold. It always distressed his throat, and rendered
more difficult the efforts of swallowing. His room was obliged to
be kept at a temperature of from 70 to 75; his diet was entirely
milk, cream, and coffee. In January of this year he wrote to Mr.
Pollock: "I have been for two months at Brighton, and the
complaint has made no progress, but in cold, foggy weather my
dysphagia is always worse. I am intensely susceptible to cold.
1 have been many days lately without blood in the expectoration ;
and last night it came on, after going to bed, without any assign-
able cause. Everything I take is apt to leave particles in my
pharynx, even a light-boiled egg. Hence the cause of the irrita-
tion and consequent ulceration there. If so slight a thing will
irritate and produce exudation of blood, there is surtly ulceration
thtjre, and this, in fact, has all along been ni}^ opinion." We shall
hereafter see how tiue was the opinion he had foi-med of his own
case.

There was at all times, to a greater or less degree, " a stinging,

686 The History of Dr. Marshall HalVs Case. [November,

burning pain" behind the larynx ; sometimes for a day or two it
was absent During February the symptoms were variable, the
dysphagia increasing as the temperature became colder. Once or
twice there was slight regurgitation of fluid by nose and mouth.
Some considerable benefit was derived from sipping a solution of
chlorate of potash in water several times a day, with marked tem-
porary benefit to the swallowing, but the efiectwas not permanent.

In March he had a severe attack of the gout, when much uric
acid passed in the urine. This was relieved by small doses of
potash sipped in water, and also used in an enema. The dyspha-
gia slowly but gradually increasing, four pints of milk were now
only taken in the course of the day, and it occupied nearly half an
hour to get down half a pint.

On the 10th of March he walked out, after four months confine-
ment to the house. The sun was hot, but the wind very cold, and
the following day he was confined to bed, suffering from bronchi-
tis, and all his ordinary symptoms aggravated. During several
hours no fluid could be swallowed, and on attempting to pass a
tube for himself, an obstruction was met with opposite, as he said,
the first or second portion of the sternum. This attack left him
very weak. He complained much of thirst, and said his feelings
of hunger were dreadful. Still he was most patient, and even
cheerful in conversation, under all his sufferings.

In a few days the attack of bronchitis passed off, and he now
derived much comfort from supping iced milk and sucking small
pieces of ice ; but the exhaustion and emaciation were becoming
considerable, and the quantity of fluid taken by the mouth was
reduced to about two pints in the twenty-four hours. Mr. Wild-
bore therefore recommended him to allow the administration of
nutritious enemata, of which the following was the mixture : five
ounces of strong beef-tea, one ounce of port wine, and three grains
of quinine. This was given three times daily, and the whole
quantity always retained. The quinine was added on account of
his suffering from intermittent fever, which came on every night.
The enemata were evidently absorbed, for the bowels only acted
once in three or four days under the influence of a warm water
enema, with some salt dissolved in it, and this would be followed
by a healthy motion.

On the 10th of April, for twenty -four hours, there was complete
interruption to the passage of fluid through the throat ; but on the
following day he was again able to swallow milk and some wine
and water. Towards the end of the month the difiiculty of swal-
lowing was so great, that if more than three teaspoonfuls were
taken directly one after the other, the fourth would bring on
cough, and the greater portion would be returned by nose and
mouth, mixed with mucus, as if the fourth spoonful filled up the
tube to the aperture of the glottis, and thus excited cough.

During the month of May he suffered much from hunger ; but

1857.] The History of Br, Marshall IlalVs Case. 687

taking the enemata four and five times a day appeared to nourish
him to the extent that he was able to bear the erect posture, which
he could not a fortnight previously owing to vertigo. The aguish
attacks were also severe, and he took constantly about twenty
grains of quinine in the enemata, which had the effect of relieving
him, but produced deafness and singins^ in the ears.

In June the voice began to be aff.jcted; the expectoration,
which had become white and frothy, was again purulent and of-
fensive. The efforts to swallow were attended with much exhaus-
tion, and the struggles to get fluid down were very great. The
loss of voice at the end of June was unchanged; the "stinging,
burning pain" greater, and debility increasing; the expectoration
very copious. Notwithstanding his condition, about the middle
of the month he ate a fair dinner of lamb and asparagus for three
or four days consecutively, swallowing it all. Then came a cold
wind and increased dysphagia.

In July, early in the month, he applied himself a four-grain so-
lution of nitrate of silver to the pharynx five times. This increased
the "stinging, burning pain" greatly for two hours after each ap-
plication, but no beneficial result of any kind was obtained. Chills
and profuse sweats attacked him every evening, and the aphonia
continued. During July he gradually became weaker, and the
quantity of fluid taken by the mouth was about a pint to a pint
and a half of milk daily. It may be mentioned that nearly all
the time he was at Brighton, up to the last few days of his life, he
looked fresh and healthy a circumstance somewhat remarkable.

By his own desire, he went out in the early part of August in
an open carriage, but all his symptoms were becoming worse ; the
breathing short and asthmatic, and the air-passages clogged with
mucus. The rectum also became uncertain in its power of reten-
tion, and the enemata were sometimes returned. On August 11th,
at twenty minutes past eight, be died, maintaining his conscious-
ness to within a few minutes of his death.

His friend Mr. Wildbore wrote of him, but a few days before
his death, " It is wonderful to me how he bears up against his
disease. He is ever thoughtful of and kind and considerate to all
around him, and most grateful for the least kindness or attention
shown him ; always interested in professional questions, and ever
active in mind upon those subjects which have chiefly occupied
his attention. He is most patient, and perfectly resigned." All
who knew and watched him during the progress of his disease,
and witnessed the high courage and true resignation with which
he submitted to his sufferings and to the prospect of death, will
feel that Mr. Wildbore^s estimation and record of him was only
what was just to the character of the greatest of English physiol-
ogists.

The post-mortem examination of the body was made by Dr.
Ransom, of Nottingham, thirty-eight hours after death, in the pre-

688 The History of Dr. Marshall HaWs Case. [November,

sence of Dr. Hutchinson, Dr. Robertson, Dr. T. Wright, Mr. Hig-
gin bottom, Mr. Eddison, Mr. Wildbore, and Mr. M. H. Higgin-
bottom ; and for the record of which we are indebted to Mr.
Eansom.

The body was emaciated. No external marks of decomposition.

Thorax. The Inngs did not collapse on the cavities being
opened. The right one was universally adherent by old adhe-
sions; the substance of the lungs healthy; no pleuritic effusion.

The pericardium contained nearly two ounces of dirty red fluid.
The heart was flabby (perhaps from cadaveric changes) ; it con-
tained frothy blood in the right ventricle and auricle. The valves
were competent. There were some slight atheromatous deposits
on the inner surface of the aorta, which was stained a deep red.

The bronchial glands were larger than usual, soft and black.

On making examination of the parts higher up in the throat, it
became evident that some undue thickening and adhesions existed
behind the larynx. The latter was therefore removed, with the
pharynx, oesophagus, and trachea. In doing this, the intimacy of
the adhesions necessitated that the knife should be carried close to
the bodies of the corresponding vertebrae; with every care, how-
ever, button-holes were made in two or three places. On removal
it was seen that the walls of the pharynx were extremely thin, and
that its cavity was dilated. Through the openings made by the
knife there escaped a dirty-brown flaky fluid, of a creamy consist-
ence. The adhesions were to the bodies of the sixth and seventh
cervical, and first and second dorsal vertebrae.

The parts removed, when examined, showed a stricture of the
oesophagus, about the level of the eighth ring of the trachea, and
a dilatation, with ulceration and vasculation of the oesophagus and
pharynx above the stricture, to the extent of nearly tbree inches.
The stricture was attended with but moderate thickening of the
tube, and the aperture was not very small, but the membrane was
folded in, so as to present a conical eminence upwards, the apex
of which was opposite the narrowest part of the stricture, which
here was rather larger than a goose-quill. In this way the pas-
sage was almost valved, and food would have had the tendency
to pass down by the sides of the eminence into the pouches and
sacculi of the ulcerated portion. Indeed, the finger passed down
from above, previous to opening the oesophagus, could not enter
the passage, though a similar difiiculty did not exist if the finger
was passed from below the stricture. The upper border of the.
ulceration was on each side about level with the bases of the ary-
tenoid cartilages, but did not extend so high in the middle. The
dilatation was throughout irregularly ulcerated, soft, pulpy, ragged,
of a dirty grey or slate colour, and with a few loosely-adhering
flakes on its surface. Its base was not much thickened, though
here and there it was somewhat so, and felt firmer in such parts. '
The walls of the pharynx and oesophagus were perforated in sev-

1857.] The History of Dr. Marshall HalVs Case. 689

era! places, leading to pouches or sinuses amongst the muscles of
the neck, having very thin delicate walls of false membrane. Two
of these pouches were y^^ry large, and ran upwards on the outer
surface of the thyroid cartilage, one on each side as high as its up-
per border, the right pouch being the largest. A narrow slip of
mucous membrane remained at the bnck of the trachea, but this
at the lower extiemity was quite undermined.

At the lower part of the dilatation the ulceration had nearly
perforated the trachea through the posterior membranous wall, and
hud set free the right extremities of the fourth, fifth, and sixth
cartilages. The pharyngeal mucous membrane above the ulcera-
tion appeared neaily natural, except for two oi' three little i-ounded
elevations, as if there was a deposit in the mucous membrane, each
less than half ii pea in size. There was a small pendulous poly-
pus attached to the thyro-epiglottidean fold. The oesophagus be-
low the stricture was healthy.

In the mucous membrane of the trachea directly corresponding
to the deep ulceration which threatened to perforate it, was a small
deposit or growth semi-transparent, solid, and slightly elevated.
There was ' similar one higher up, inside the cricoid cartilage, but
it was more opaque and white.

The patch on the tracheal mucoxss membrane was cut across,
and from a section of it were obtained cells which possessed all the
characters of cancer-cells. They were delicate, large, irregularly
angular, with elongated processes ; some were, however, rounded,
had peculiar la)ge nuclei and nucleoli; often several of these in
one cell, and sometimes a cell-wall around one or more of the con-
tained nuclei. Some few of the nuclei presented a delicate, regular
radial striation, which Dr. Ransom observes he had not before
seen. These cells were contained amongst the meshes of the elas-
tic tissue. From the whiter patch on the inside of the cricoid
cartilage, similar ceils were obtained, but they were fattily degen-
erated, and t'lierefore were less characteristic. From the base of
the ulcerated surface, Dr. Ransom found in parts examined no sa-
tisfactory evidence of the nature of the pathological process which
had preceded; but amongst a mass of granular and fattily degen-
erated elements, several bodies were always seen resembling retro-
grade cancer-cells.

The fluids from the surface of the ulcer consisted mainly of
molecular detritus atid fiat, in drops and granules, with a great
number of epithelium scales, mostl}^ of the scaly variety ; but a
few were cylindrical and ciliated, probably separated from the
upper parts of the pharynx. In the little elevations on the mu-
cous membrane of the pharynx, nothing was found but globular
corpuscles and cells filled with fat granules, of various sizes, and
one beautiful hexagonal crystal-like cystin was observed.

A portion of the pharynx and oesophagus, examined by Mr.
Caesar Hawkins, Mr. Pollock, and Mr. Holmes, curator of St.
George's Hospital Museum, gave the following results :

690 Death of Charlotte Bronte. pTovember,

1. A portion of the disease was surrounding the great vessels in
the neck, and apparently making pressure on the upper part of
the pharynx. The interior appeared of a cellular character.
Sections showed fibrous tissue, with numerous nuclear bodies,
and much fat.

2. A small tubercle, beneath one of the rings of the trachea,
contained an immense number of nucleated cells, resembling those
of healty epithelium, but of more curious form and size, also a
good deal of fat.

3. Amass containing dark masses (of black pigment), other-
wise exactly resembling the portion first mentioned. [Ihid.

Death of Charlotte Bronte. By Walter ChaxnING.

The death of Charlotte Bronte is the saddest fact in a life whose
key-note was sorrow, and whose melancholy music filled the very
atmosphere in which she lived, and moved, and had her being.
She may almost be said to have been baptized in the dark waters
of death. Her mother died when she was about five years of age,
and, in quick succession, four sisters and her only brother.

It was not a common family, that of Charlotte Bronte. Two of
her sisters died young, but hved long enough to indicate that they
would have left their mark on their times. The two elder sisters
gave the same evidences of their power in written works. Her
brother had large intellectual endowment and culture, but worse
than wasted all that might have greatly distinguished him. We
do not design in this notice of one whose life has been so admira-
bly written by Mrs. Gaskill, and which all readers have read, to
review this work. And yet it may not be out of place to say that
it is a record of a remarkable person, who in the midst and pres-
sure of severe trial, never failed in duty to herself, and to all to
whose well-being she could in any way contribute. She was
small, delicate in person apparently incapable of effort. Yet she
meets, or makes occasion for intellectual, moral and physical ac-
tion, which in its detail astonishes us by its rarity, and still more
by its success. She writes with startling strength ^brings before
you men and women, her own creations, and reveals what is in
them, both in their word or work, in language and act which
leaves little ground for question. She goes to a foreign country,
of different language from her own goes alone, by the guidance
of the same instinct which always accompanies a true object, and
accomplishes all she attempts. She writes, and while her manu-
scripts are gathering dust on the publisher's shelves, she writes on,
nothing daunted, and at length comes forth as an author, and de-
clares anonymously, her gigantic power. "Who wrote Jane
Eyre ?" is the question. " Not a man," says one, " for a man
would not" "Not a woman," says another, "for a woman could
not."

1857.] Death of Charlotte Bronte, 691

Pardon us, for we have for a moment deviated from our pur-
pose to speak of the death of Charlotte Bronte. We could not
but say a word of a life so sad as was hers, and for the reason that
in an event which was to her an unmixed felicity, she found death.
Sadly, in deep sadness, do we ask, was it not a fitting coronation
of such a genius, and such a life?

Charlotte Bronte married late in life. Her father opposed her
marriage, and the daughter could not marry the man she so deeply
loved, as her marriage must separate her from her father, now more
than eighty years of age, and with no living creature of his house,
but her left. At last, her father's consent is given and she is mar-
ried. This was an event in Haworth. Every body came to the
wedding. Charlotte had been the friend of all the poor. She
would traverse, in snow and rain, the wild moors of her home, to
carry something for the sick child or parent, or to do something
for them. Every body knew her, and every body loved her.
Says Mrs. Gaskill, "many old and humble friends were there,
seeing her look like a snow-drop." Her bridal dress, after a few
months, became her shroud.

She became pregnant, and soon after experienced the ordinary
symptoms of that state, but which rapidly became morbidly severe.
Nausea, vomiting and faintness; and fainting, at first frequent,
became, at length, constant. The sight of food was sufficient to
produce them all in most distressing forms. Said one, " a wren
would have starved on what she ate during those last six weeks.*'
A physician was called. " He came, and assigned a natural cause
for her miseraole indisposition ; a little patience and all would be
right."

From the record, nothing more seems to have been said or done
in thi^case. We copy the following from Mrs. Gaskill, because
of its professional interest, and as showing something of the suf-
ferer's state in the last moments of her life.

"Long dfeys and longer nights went hy ; still the same relent-
less nausea and faintness, and still borne on in patient trust.
A-bout the third week in March (it was early in the new year,
.55, that the symptoms first appeared), there was a change; a
ow, wandering delirium came on ; and in it, she begged constantly
or food, and even for stimulants. She swallowed eagerly now ;
>ut it was too late. Wakening for instant from this stupor of in-
dligence, she saw her husband's woe- worn face, and caught the
ound of some murmured words of prayer that God would spare
ler. 'Ohl' she whispered forth, 'I am not going to die, am I?
le will not separate us, we have been so happy.' "

[She died Saturday morning, March 31st.
It is of the professional relations of our subject the treatment
f the signs of pregnancy when morbidly aggravated, that we
rould now speak. Was the cause the motive cause of those symp-
oms which produced death in Charlotte Bronte, removed ? The

N.5. VOL. XIII. NO. XI. 44

692 Death of Charlotte Bronte. [November,

question is of great interest. Nearly half a century ago, it was our
privilege to attend the midwifery lectures of Dr. John Haighton,
in London; and a better lecturer than Ilaighton, is not in our
memory. He discussed this question of removing the cause of
these symptoms, and showed conclusively that in cases in which
other means had failed, and the worst consequences were to be
looked for, it was the duty of the physicians to remove the cause,
viz., to remove the foetus from the wor)ih. Haighton related his ex-
perience, and dwelt on the opposition he had met with in consul-
tations, to such measures as he knew could alone save life. More
recently we have spoken with eminent men abroad, on this sub-
ject, and have met with objections to the practice; or, when it has
been allowed to be proper, it has been after so much evil has been
done that there has hardly been any reason to look for success
from it.

We have felt it our duty to resort to the measure under consid-
eration, and in every case recovery has been rapid and complete.
We have known death to happen when the measure has been re-
jected by patient or friends, and where all other means have been
faithfully used. In one case it was clear that death must occur, if
things remained as they were, but in which the mother of the pa-
tient would not consent to the measure ; unless the physicians who
advised it would in the first place guarantee its success. The at-
tending physician would not do this ; and soon after our consulta-
tion we heard of the patient's death.

In another instance, the lady lived in a distant State. She was'
a clergyman's wife, and of the Church of England. She was re-
duced by nausea and vomiting to excessive weakness, and abso-
lutely could keep nothing on her stomach. It was between the
second and fourth months of pregnancy. The foetus was removed^
and in twenty -four hours after, we found her heartily eating solid
food, and she was soon well. The operation was performed on
the same patient a second time under the same circumstances, and
with the same result. Let it be remembered that this practice was:
not attempted until full trial had been made of the most approved
methods of treatment, and after the best evidence that the disease
was rapidly increasing. In another lady it was not until convul-
sive movements had occurred in the universal exhaustion^ that
the measure was adopted. This patient recovered,, and this was a
second trial of it in the same patient.

We dwell on these cases, because a grave moral question is in-
volved in our subject ; and to say that it is only in those cases in
which life is clearly in jeopardy, that any physician who deserve*
the name, would for a moment entertain the question we are con-
sidering. It is then as a remedy^ and only to be used under what
we believe are really desperate circumstances.

Whether the cause was removed in Charlotte Bronte's case, or
whether she died of pregnancy, we know not* We know not

1 1857.] What are Internal Uemorrlioids. 698

i what was the limit of that "little patience, when all would go
I right." But as the disease continued unrelieved till death, may it
I not be asked if the cause of that disease did not remain undisturb-
! ed till it became the cause of death ? The question is put, because
' in no like case which has come under our care, however unprom-
j ising, has death occurred after the removal of the contents of the
womb.

The Rectory at Haworth is now desolate. Its venerable head,
in his extreme age, stands erect and alone, literally in the midst
of the graves of all his house ; and before him, in his church, i3
the simple tablet on which is recorded the names, the ages, and
the death, of his wife and all of his children. [Boston Med. and
Sitrg. Journal.

What are Internal Hemorrhoids'^

Preparatory to entering upon any question as to their treatment
we must a little clear the way by a few words as to the real nature
of internal hemorrhoids. That "internal piles," in their ordinary
form, are dilated or varicose veins of the anus, may now safely be
pronounced a relic of by-gone and very mistaken pathology. If
cut across they bleed most profusely ; but the hemorrhages is arte-
rial, not venous ; and if tied, there is little or no risk of phlebitis.
On dissection they show scattered, small, venous cysts, but these
are minute in proportion to the mass ; and should a large coagu-
lum be found, it has more the appearance of being the result of
extravasation than the contents of a varix. They are not at all
more liable to occur in those who suffer from varices in the legs,
etc., or varicocele, than in others. The dilatatio venarum theory
has, indeed, been specifically renounced by most of the recent
teachers and writers on the subject. Mr. Salmon is very positive
in his opinion on this point, and he is supported to the full by
"r. Ashton and Mr. Syme. And here the distinction between
ixternal and internal piles must be borne in mind; the former, a
re and comparatively unimportant form, are admitted by all to
venous. External piles have, when the skin is thin, the uni-
rm. bluish tint of a vein, which can not well be mistaken, while
he purple color of the internal one rather resembles that of the
ntense congestion of almost strangulated mucous membrane. Ex-
fernal piles may be snipped off, and there is no danger of bleeding
ifter the vein has once emptied itself; internal ones, if cut away,
fleed continuously and profusely, and their hemorrhage, as just
itated, is arterial, not venous.
We come, then, to the question "What are internal hemorrhoids?
,nd to this the answer must be, that they consist of prolapsed folds
if the mucous membrane lining the sphincter, extremely vascular
flid hypertrophied and thickened by long constriction. In chil-

694 Administration of Quinine. [November

dren, the parts about the rectum, the sphincter, etc., are lax, and
the mucous membrane is very loosely connected to the musculai
one; hence their liability to large prolapse, which in them always
comprises the whole circumference of the bowel. In adults, how-
ever, the sphincter is more firm, and the mucous and musculai
coats much more closely connected ; hence the great rarity of cir-
cular prolapse. From the necessity that the mucous membrane
lining the sphincter itself should be capable of wide dilation during
defecation, an arrangement has resulted, however, by which du-
ring the closed state of that muscle, it is thrown into longitudinal
folds, which are smoothed out when it opens. Between these
folds, which, first described by Morgagni, are known as Morgagni's
columns, the mucous and muscular coats are more closely united
to each other, whilst beneath them the intervening cellular tissue
is, of course, loose. These columns vary in number from three to
six. By reference to this arrangement, the reason why extruded
piles almost always present the appearance of being divided into
lobes is easy to be assigned. Mr. Salmon defines piles as prolapsed
Morgagnian columns, hypertrophied and rendered vascular by
constriction^ and states that their divisions into segments corres-
ponds in number with the number of the columns in the individu-
al. Thus, then, we have it clearly explained upon anatomical
grounds why children almost never have piles, and why adults so
very rarely have circular prolapse, and also why adults who have
circular prolapse never have "piles," as a complication ; the latter
fact being one, which, upon the old view of their being distinct
conditions, it would be very difficult to account for. We hava
already adverted to the importance, in respect to treatment^ of this
view of their nature, and how well it coincides with the results ctf
practice. ]^o one would fear ill consequences from tying up a.
mass of congested and thickened mucous membrane^ while every
surgeon would shrink from the risk attendant on putting ligatures
on bunches of inflamed veins. \_Med. Times and. Gaz,

Epidermic Administration of the Sulphate of Quinine. By Da:^IEI:j
F, Wright, M. D. :

i
I purposely substitute the term epidermic in this communication^ :
for the more common expression endermic, to mark a difference in
my mode of application in the case I am about to describe, from
that usually adopted.

My patient was a little girl, about four years old, daughter of
Mr. i3. Fox, of this city. A mild attack of scarlatina had been ^
succeeded by an obstinate consecutive fever, of a remittent type, I,
The attempt was made to treat this with moderate doses of the ,
sulphate of quinine, the administration of which was found utterly
impossible, from the resistance of the child ; indeed, the irritation

1857.] Administration of Quinine. 695

resulting from the attempt was so excessive as finally to compel
me to acquiesce in the mother's opinion that it aggravated the
fever. Still the periodic symptoms continued, and I was persuaded
that nothing but quinine would relieve them; the question was,
how was it to be admiuistered? The endcrmic method was, I
considered, contra indicated b}^ the conditioQ of the skin, which
had been desquamating freel}^, as is usual after scarlatina. Finally,
as the skin, from this recent desquamation, was in a state pecu-
liarly favorable for absorption, 1 determined to try whether this
could not be effected without the removal of the cuticle ; accord-
ingly I directed a sort of half-jacket to be made of coarse domes-
tics, capable of covering the thorax and upper part of the abdomen,
about two-thirds of the way round the body. This was saturated
in a strong solution of sulphate of quinine, made according to the
following formula:

^, Sulph. Quin 3i.

Acid Sulph. Arom. . . 3ij.

Aquas 5ij. 3vj.

M. Sol. ft.

And the mother was directed to saturate it again as soon as dry,
without regarding the quantity used. While applied to the body,
;he whole was covered with oiled silk, to prevent absorption by
the clothing.

The remissions had been occurring during the night and morn-
ng, commencing about midnight, and being most complete at
bout four or five in the morning; they then lasted till about eight
A M., and were succeeded by fever, which lasted till midnight.

To be sure of being soon enough, the ^^ quinine jacket^''^ as we
called it, was put on at nine o'clock P. M., and directed to be kept
on, saturated with the quinine solution, till I saw the patient ia
:he morning. I purposely delayed my visit till ten A. M., (two
Qours after the fever usually arose,) and found my patient entirely
ree from fever. Thus encouraged, I directed the treatment to be
Jon tinned till noon, and afterward commenced at nine P. M., and
jpntinued as before. The child never had a return of fever, and
apidly convalesced, without any unfavorable symptom.

I have presented this case primarily as affording a useful hint
br physicians who may be similarly situated ; but it was attended
3y a phenomenon highly interesting in a physiological point of
7iew. Not more than half an hour after the jacket was put on,
he child complained of a bitter taste in her mouth, and insisted,
vith great indignation, that quinine had been given her while she
^as asleep. This taste after a while went off, but was instantly
enewed on her eating any thing; even the idea of eating^ when
jxcited by offering her food, brought back her taste, so that she
experienced it before putting the food into her mouth.

Does it not seem that the blood of this child was saturated with
he quinine to a degree beyond what can be effected by its inter-

696 Lactic Acid a Remedy for Dyspepsia, [November,

nal administration ? I know of no other mode of reasoning by
which we can account for the taste, than that the blood circulating
in the gustatory papillae was sufficiently saturated with the drug
to effect the nerve filaments contained in them in the same way as
if it had been brought in contact with them ab externo.

The recurrence of the taste after it had subsided, upon the pre-
sentation of food, is still more interesting. It would seem as if a"
true ideo-'raotor influence was excited upon the minute muscular
structure at the base of the gustatory papillae, of such a nature as
to endow them with a function similar to that of the erectile or-
gans, namely, of receiving a largely increased amount of blood
when in a state of excited activity, so that when the quininization
of the blood has been too much diminished by excretion to give
the sensation of taste, the papillae being unexcited, yet when the
quantity circulating in them is increased by this exciting emotion,
a sufficient quantity of quinine is again brought in contact with
the gustatory nerve filaments to renew the sensation.

I have doubts whether this mode of quininization could be so
successfully applied in older persons, whose skin is both less deli-
cate and less vascular ; and even in children it might not be so
rapid where the skin was not as well prepared by desquamation,

[Memphis Medical Recorder,

Lactic Acid a Remedy for Dyspepsia,

A remedy which has for a long time been used by Dr. Nelson,
of Birmingham, and subsequently by many French physicians,
under the name of Pepsine, for the cure of dyspepsia, and other
functional derangements of the stomach, has within a short time
been prescribed freely by some physicians in London. It has been
very favorably noticed by Drs. Ballard and Sieveking. Dr.
O'Connor has also tested its value in those cases in which it has
been recommended, but not with the success attributed to its use.
He was led subsequently to have recourse to lactic acid, a remedy
which he believed likely to be more beneficial in those affections
of the stomach in which the so-called pepsine has been adminis-
tered. Before using the acid internally, Dr. O'Connor, we un-
derstand, in order to test its digestive powers as compared with
pepsine, placed an equal weight of animal fibre, in equal propor-
tions of pepsine and lactic acid, in separate vessels, in an equal
temperature, when he found that the fibre in the lactic acid was
reduced to a pulpy state in a very much smaller space of time
than that which was put into the pepsine. After this experiment,
which he thought sufficiently conclusive of the superiority of the
lactic acid as a promoter of digestion, he had recourse to its use as
a remedy in those affections of the stomach before alluded to.
The great number of patients with affections of the stomach pre-

1857.] Prevention of Bleeding after Operations, 697

senting themselves among the out-patients of the Royal Free Hos-
pital, afforded an extensive field to Dr. O'Connor for testing the
efficacy of lactic acid in dyspeptic conditions. After a trial in
over fifty cases, he considers that the good results following its use
fully justify him in recommending it as a valuable agent. It is
very necessary to be sure that the lactic acid prescribed should be
of chemical purit}^, and of uniform strength. The dose varies from
half a drachm to two drachms or more, in infusion of colomba, or
a little cinnamon water. It should be taken during a meal. The
lactic acid found in the shops is not generally pure ; that which
Dr. O'Connor has found to be most efficient, from its greater puri-
ty, is prepared by Mr. Bastick, of Brook-street, Grosvenor Square.

[Med, Times and Gazette,

Prevention of Bleeding after Operations upon the Eectum. By Mr.
Salmon, Surgeon to St. Mark's Hospital for Fistula, &c.

In the operation for fistula and fissure, Mr. Salmon is in the
I habit of making very free and deep incisions, and his rule in the
former disease, of cutting the base of the sinus as well as the sphinc-
ter, necessarily involves an extent of incision at least three times
; as great as that usually employed. Hence no unfrequent hemor-
rhage would result if certain precautions were not adopted. Of
these precautions the first is the use of cotton -wool instead of lint,
I as a dressing. Immediately after the incisions are completed, a
! large plug of the finest jeweller's wool is introduced into the gut,
and pressed gently into the whole length of the wound. There is
. some art in accomplishing this neatly and efficiently. A metal
probe, the thickness of a quill, should be used, and the forefinger
of the left hand having first been passed into the bowel, the latter
is held well open, away from the wound ; the tuft of wool is then
pushed high up into the gut, and lastly pressed down on the line
of incision. The wool must on no account be oiled, otherwise its
object, as a restrainer of hemorrhage, will be defeated, since it is
by its loose and absorbent texture that it forms so excellent a plug.
Its softness prevents it becoming a source of irritation to the rec-
j tum, as a fold of lint of any size generally does. Each patient on
being sent back to bed has a separate attendant allotted to him,
whose duty it is to wsit by him with a piece of sponge gently press-
ed against the anus, and to report any bleeding should it occur.
No styptics are ever used; and the actual cautery, which is deemed
the one resource, has been employed at the hospital but twice
during the last two years. Continued pressure is the means which
is almost invariably found efficient. [Ibid.

698 Editorial and Miscellaneous. [November,

EDITORIAL AND MISCELLANEOUS.

We cordially give place to the following Communication on an important
Ethical point. It is from the pen of one who reasons correctly and justly,
because he reasons from observation and experience :

MEDICAL ETHICS.

Messrs. Editors :

I was forcibly impressed with the correctness of the dews of the Boston
Medical and Surgical Journal upon a question of Medical Ethics, reproduced
in your valuable number for September last (p. 577). The article in ques*
lion was in reply to a correspondent who complains that he is " largely
afflicted" by the reception of letters, often very lengthy and badly written,
asking for professional advice, without the enclosure of the usual consulta.
tion fee, nor even of a postage stamp.

I do not recollect that the code of Ethics adopted by the American
Medical Association contains any clause touching this question and the
omission may be construed into an admission that there could be no differ-
ence of opinion with regard to a proposition so self-evident as that "the
laborer is worthy of his hire." If the professional opinion or advice of a
man of standing and reputation be sought, it is because it is deemed valu-
able ; and he is justly entitled to remuneration for his trouble. The gen-
erous and fraternal usage among physicians of all countries, of rendering
professional services to each other without fee, will, I trust, never be aban-
doned. But the case is very different in which one practitioner is requested
by another to give his written opinion for the benefit of a person not of the
profession and who is able to pay the consultation fee. If the parties re-
sided near each other a visit of consultation would be paid for by the patient^
whether made at the suggestion of the patient or of his professional attend-
ant. Upon what grounds then can it be expected that a written consulta-
tion, whether made at the suggestion of the patient or of his physician,
should be unrequited ? In most instances the former service would be less
troublesome than the latter and always more satisfactory, inasmuch as it
is difficult conscientiously to prescribe for a case without seeing it, however
clearly its peculiarities may be set forth.

If the attending physician honestly believes that his patient ought to
have the benefit of additional counsel, his duty requires that he state the
fact to the patient or to his friends, who will rarely hesitate to furnish the
means of remuneration. If the counsel of one at a distance be sought, the
letter should enclose the usual consultation fee, which is SlO in this section
of country. As to the little matter of postage, it is hardly to be presumed
that any gentleman acquainted with ordinary propriety would address

1857.] Editorial and Miscellaneous. 699

another upon business of his own. without sending a stamp for the letter
of reply.

There are, of course, exceptions to all rules, in Ethics as well as in gram-
mar. A pupil may write to his preceptor, or one friend to another, upon
professional as well as upon other topics, without the enclosure of a fee.
The rule above advocated is not intended to do away with the amenities
of friendship, but to regulate business transactions. A physician's know-
ledge and reputation constitute his business capital, and he ought not to
be expected to furnish it gratuitously when the party to be benefited is
able to pay for it. No physician, worthy of the name, ever hesitates to do
all he can for the indigent, as cheerfully as he does for the more fortunate.
He is, therefore, doubly entitled to remuneration at the hands of those who
have the means of contributing to his support ; and practitioners who write
for letters of advice ought not to allow their patients to forget this.

Justice.

Prfvate Libraries. The accumulation of a Library of Medical works
k a most important object to every practitioner. It should begin with the
commencement of his professional studies, and only terminate when his
eye-sight has failed from diligent reading, or w^hen he has lost all interest
in scientific subjects an event which cannot occur, if he uses the hbrary
he is accumulating. "We have seen some queer accounts of Libraries:
Professor Gibson, in his graphic sketch of the great Velpeau,* describes
him as having access in early life only to his father's library, which consisted
of but two books, a work on Farriery, " The Complete Drover," and a vol-
ume of Medical Receipts ; this, perhaps, is a little better than the " Libra-
ry" described by the inimitable author of "Handy Andy," where old
1 Squire O'Grady spent much of his leisure time ; this " library" was compre-
hended in, so far as we can recollect, (we have not the catalogue by us,)
" a pair of Spurs," " a Boot Jack," " a Fishing Tackle," " a pair of Antlers,"
and perhaps " a book on Stock-raising." Velpeau made the most of his
library ; from his book on Farriery and his book of Receipts, his ambition
was stimulated into active vitality, he left his native village, went to Paris,
became first the Scullion (this is too bad he had " the run of the kitchen")
in the family of the celebrated Dubois, then his oflSce boy, then his pupil,
finally his equal, and his, and almost every body else^s superior in scientific
lore, in the city of Paris indeed, in the world. Velpeau accumulated and
used a library. Dr. Gibson found him " in his study behind a pile of
books which he was pitching with great vivacity from right to left, in search
of authorities and quotations for a large work on Surgery, then in Press."
In the

* See Gibson's Rambles in Europe.

700 Editorial and Miscellaneous, [November,

Paris, it was at that time necessary for each contestant to present a treatise
on some subject, kindred to the department in which he was candidate for
a place ; M. Velpeau, with an abmidance of accurate knowledge in every
department, produced his treatise ; through improper influences was at
first defeated, but contested again and again, till finally he gained a posi-
tion where his contests were no longer with individuals, but with the
the world and in that contest he came oft' conqueror. We are not, how-
ever, preparing a sketch of M. Velpeau, but we are simply engaged in,
w^hat are only entitled to be called, " ruminations on the subject of private
libraries," and " the Blacksmith of Breches " came up naturally as a re-
markable illustration of the wonderful results of an ardent and devoted
attention to books.

Sir Thomas Carlyle,* in his own graphic style, thus portrays the relative
value of books and other modes of gaining knowledge : " Universities,"
says he, " are a notable, respectable product of the modern ages. Theii
existence, too, is modified, to the very basis of it, by the existence of Books.
Universities arose while there were yet no Books procurable ; while a man,
for a single Book, had to give an estate of land. That, in those circum-
stances, when a man had some knowledge to communicate, he should do
it by gathering the learners round him, face to face, was a necessity for
him. If you wanted to know what Abelard knew, you must go and listen
to Abelard. Thousands, as many as thirty thousand, went to hear Abelard
and that metaphysical theology of his. And now for any other teacher
who had also something of his own to teach, there was a great convenience
opened : so many thousands eager to learn were already assembled yonder;
of all places the best place for him was that. For any third teacher it was
better still ; and grew ever the better, the more teachers there came. It
only needed now that the King took notice of this new phenomenon ; com-
bined or agglomerated the various schools into one school ; gave it edifices,
pri\dleges, encouragements, and named it Universitas, or School of all Sci-
ences : the University of Paris, in its essential characters, was there ;
the model of all subsequent Universities ; which down even to these days,
for six centuries now, have gone on to found themselves. Such, I conceive,
was the origin of Universities.

" It is clear, however, that with this simple circumstance, facility of get-
ting Books, the whole conditions of the business from top to bottom were
changed. Once invent Printing, you metamorphosed all Universities, or
superseded them ! The Teacher needed not now to gather men personally
round him, that he might speak to them what he knew : print it in a Book,
and all learners, far and wide, for a trifle, had it each at his own fireside,
much more eflfectually to learn it ! Doubtless there is still peculiar virtue

* " Six Lectures on Heroes and Hero-Worship and the Heroic in History."

1857.] Editorial and Miscellaneous. 701

in Speech ; even writers of Books may still, in some circumstances, find it
convenient to speak also, witness our present meeting here ! Tliere is,
one would say, and must ever remain while man has a tongue, a distinct
province for Speech as well as for Writing and Printing. In regard to all
things this must remain ; to Universities among others. But the limits of
the two have nowhere yet been pointed out, ascertained ; much less put in
practice : the University which would completely take in that great uew
fact, of the existence of Printed Books, and stand on a clear footing for the
Nineteenth Century as the Paris one did for the Thirteenth, has not yet
come into existence. If we think of it, all that a University, or final high-
est School can do for us, is still but what the first School began doing,
teach us to read. We learn to read^ in various languages, in various sci-
ences; we learn the alphabet and letters of all manner of Books. But the
place where we are to get knowledge, even theoretic knowledge, is the
Books themselves ! It depends on what we read, after all manner of Pro-
fessors have done their best for us. The true University of these days is a
Collection of Books."

Thus speaks this original master mind of the importance of Books and
Beading. At the present time and in our glorious country, no single book,
nor a library of books, can " cost an estate of land," but they come to us,
are crowded upon us, at prices which it would seem, by their very cheap-
ness, arouse our suspicions of their value. Books on all subjects, translated
from all languages and the productions of the best minds of all countries,
are accessible to every one who has the taste and the diligence to read
them. Any one may have a library anyone may possess in his own
house, what this great Thinker calls " the true University of these days,
a Collection of Books " a domestic University, w^hose very atmosphere is
improving and refreshing, whose teachings give tone and dignity to our
bearing, and whose faithful cultivation establishes in our minds and hearts
associations, approaching to a tender affection^ for each one of its silent but
potent members ; for our part, w^e never read a book, good or bad, (none
are wholly bad,) but that we feel ourselves ever afterwards attracted to-
wards it, and that it has laid us under an everlasting obligation, by some
new idea we have gained, or some new train of thought it has put in pro-
gress. The time has come when the reading world is really the riding
world, for reading leads to effectual writing, and " the pen is mightier than
the sword." As in Government, so in Science.

On account of the unusual number of works sent us for renew the
present month, we have occupied most of our Editorial space with book-
notices, to the detiiment of our Miscellany. "We hope to make this depart-
ment fuller in our next number. Notices of several important works have

702 Editorial and Miscellaneous. [November,

been crowded out for want of space. They also will appear in our Decem-
ber number.

A Theoretical and Practical Treatise on Midwifery^ including the Diseases
of Pregnancy and Parturition^ and the attentions required hy the Child
from Birth to the period of Weaning. By P. Cazeaux, Member of the
Imperial Academy of Medicine ; Adjunct Professor in the Faculty of
Medicine of Paris ; &c., &c. Adopted by the Superior Council of Public
Instruction, and placed, by Ministerial decision, in the rank of the Clas-
sical works designed for the use of Midwife Students, in the Maternity
Hospital of Paris. Second American, translated from the fifth French
edition, by Wm. R. Bullock, M. D. With one hundred and forty Illus-
trations. 8vo., pp. 992. Philadelphia: Lindsay & Blakiston. 1857.
(For sale by T. Richards & Son.)

The first edition of this truly valuable work was published in 1840, in
Paris. It was my good fortune the same year to obtain a copy, which I
found of essential service in the preparation of my lectures. I desired very
much an English translation as a text-book for my class, and would gladly
have undertaken the task, had my engagements allowed. The first trans-
lation into our language, in the United States at least, was made by Dr.
R. P. Thomas, of Philadelphia, in 1850, from the second French ; which I
have since recommended as one of our best text-books on Obstetrics.

Professor Cazeaux has recently published the fifth edition, which he has
carefully revised and enlarged to double the size of the first : of this fifth
edition the work before us is a translation.

The adoption of this work by the Royal Council of Public Instruction in
Paris is sufficient evidence of its high reputation, while its great popularity
is as satisfactorily proved by the fact that it has passed through five edi-
tions in French, besides those in the English and other languages.

While we believe this treatise is the most correct and comprehensive
but concise exposition of the present state of obstetric science and practice,
we would not subscribe, without reserve, to all the opinions and views of
the author : for to cite one instance

Professor Cazeaux is certainly mistaken in restricting the use of opium
in puerperal convulsions to anemic cases, and in rejecting anesthetics alto-
gether from their treatment; for these are unquestionably most invaluable
agents, by the proper administration of which the mortality of this truly
terrific affection has been very much diminished.

It would be unwise indeed to take ofi'ence at a few small defects, where
there is so much to approve and admire : there are few books of the same
size in favor of which so much, and against which so little, can be said.

This work was principally designed and is admirably calculated as a
text-book for students ; but the practitioner will find it very useful and
interesting as a book of reference. j. a. e.

1857.] Editorial and Miscellaneous. 703

A Collection of Remarkable Cases in Surgery, By Paul F. Eve, M. D.,
Professor of Surgery in the Medical Department of the University of
Nashville. Philade'lphia : J. B. Lippincott & Co. 1857. pp. 858, 8vo.
(For sale by T. Ricliards & Son, Augusta.)

We have several times made mention of the expected appearance of the
above work and promised in it a highly interesting- and useful Book. We
are happy to inform our readers that, on a careful examination of it, we are
far from being disappointed. It is the cream and the Romance of all that
is interesting and startling in Surgical Literature, and as such is a most
engaging and attractive book; in this light, it may be called "Half hours
in Surgery," or "Surgical Recreations," for none of the cases reported are
tedious, and all of deep interest ; but in another light, it sustains a most
important relation to the Reader. From the perfect system observed by
its distinguished author, and for which he is so remarkable in every thing
he attempts, we find in it, what may be considered " a complete Diction-
ary of remarkable and rare cases of Surgery," which every writer or record-
er of surgical facts must ever hereafter turn to and consult, before he records
any case, however remarkable it may appear to him, as unprecedented or
unique.

The w^ork is embodied in Ten comprehensive Chapters, respectively de-
tailing the striking points in cases, of Injury and of Diseases of the nine
different regions into which the body has been divided thus, the Head,
the Spinal Column, the Face, the Neck, the CJtest, the Abdomen, the
Pelvis, the Genito- Urinary Organs, and the Extremities. " Chapter X." is
added for the record of remarkable miscellaneous cases, which is by far the .
largest division of the work.

The above arrangement we very much approve of, especially looking
upon it as a work of reference; for now, should any one desire to consult
the work with the view of finding some case analagous or identical with one
of his own, it will only be necessary to turn to the particular chapter de-
tailino; the cases of the region which refers to his owm case.

The work shows much erudition and great research and labor : Cases
are there collected from the surgical records of every land and every
tongue, and presented to the reader in a compact but comprehensive
form many of the author''s own cases being distributed throughout the
volume.

As the author bas complained of '-^Tembarras des richesscs,^ and frankly
confesses that much matter which he had prepared was excluded for want
of space, we hope the apology will be suflacient for those who may feel neg-
lected, and we further hope that a second volume will be the result of this
" superabundant wealth." We can truly say of this work " that it should
be found in every medical library."

704 Editorial and Miscellaneous. [November,

A Treatise on Diseases of the Skin. By Erasmus Wilson, F. R. S. Fourth
American, from the fourtli and enlarged London edition. 8vo., pp. 649.
Philadelphia: Lea and Blanchard. 1857. (For sale by T. Richards &
Son.)

Every practitioner should possess some treatise on Diseases of the Skin.
There is, perhaps, no class of aifections which so often bring mortification
and disgrace upon the regular members of the Profession as the class of
" Cutaneous Diseases " there is no class in which the Diagnosis is so un-
certain, the Treatment so empirical and the Prognosis so entirely beyond
all prediction, as in this particular class ; and yet, when we consider closely
the subject, we feel confident that " this ought not so to be." Cutaneous
diseases are, of course, all exlernal, open to the examination of the diagnosti-
cian. Even the microscope can be brought to bear in the examination, and
in all their varions stages and phases, they are patent to the eye and to
the touch, while remedies of every kind can be more conveniently applied
to the locale of these affections than in any other class.

Notwithstanding all these great advantages, the generality of practitioners
dread such cases show great reluctance to undertaking their treatment
treat them, almost invariably, unsuccessfully^ and finally neglecting them,
they find their way into the hands of quacks and empirics, who, by some
lucky chance, cwrethem, and heap well-merited disgrace upon the Profess-
ion. It is the general opinion we mean, of course, the popular opinion
in manv communities,^ that physicians do not understand these diseases;
and the popular opinion is most shamefully correct they do not under-
stand them for the very reason that they do not study them with one tithe
of the care they devote to every other class of affections. This stat of
things does not arise from the want of an advanced state of the science, in
regard to skin diseases, or from any deficiency of excellent treatises upon
this department; for there is no class of diseases in which the science has
become more thoroughly, or has been for a longer time better established,
than in this. The want of knowledge on the part of the practitioner, is
from the want of reading ; for certainly, the descriptions of no class of affec-
tions, can be more graphic, than those given in our systematic works of
Diseases of the Skin. We were about to say, that few physicians possess
a treatise on Diseases of the Skin ; this, perhaps, may not be true, for
Wilson's treatise has been through four editions in this country, proving
that somebody must buy it, even though few may have studied the work
carefully.

The present edition of this work is much enlarged, and presents to the
reader the whole science of the subject. It is the best treatise on Diseases
of the Skin and in our opinion, one of the best and most complete medical
works in the English language.

Accompanying the Text, Messrs. Blanchard & Lea advertise an Atlas of

1857.J Editorial and Miscellaneous. 705

Plates, exquisitely colored ; we have not seen these, tlioiigh doubtless, they
will add much to the clearness of the descriptions in the Text.

We would, unhesitatingly, advise our readers to procure the work, and
the plates too, and devote about two months to acquiring some definite and
reliable knowledge of this class of diseases, so that hereafter they may ap-
proach them with some degree of confidence. "The next thing to know-
ledge," says the great Samuel Johnson, " is to know where you can find it."
We will assure our readers that if they wish to come near to knowing all
about Diseases of the Skin, they cannot do better than to possess Wilson.

A Manual of Examinations U'pon Anatomy^ Physiology^ Surgery^ Practice
of Medicine, Chemistry, Obstetrics, Materia Medica, Pharmacy and
Therapeutics especially designed for Students of Medicine', to which is
added, a Medical Formulary. By J. L. Ludlow, A. M., M. D., Fellow of
the College of Physicians, Member of the American Medical Association,
and one of the Consulting Physicians to the Philadelphia Hospital, etc.,
etc. A new edition, thoroughly revised and much enlarged. With three
hundred and seventy Illustrations. 12mo., pp. 816. Philadelphia:
Blanchard & Lea. 1 857. (For sale by T. Richards & Son.)

The above title fully explains the character of the work under notice.
As the author has stated in the preface: "This Manual of Examinations "
has for its object " to give at a glance the piincipal points necessaiy to guide
the student in the prosecution of his studies, and to revive his recollection
of subjects treated upon in more voluminous works."

Time was, when even this explanation would not save " a Manual of Ex-
aminations," where the whole Science of Medicine is crammed into a nut-
shell to be " crammed" into the heads of students from condemnation.
That time has past ; students are now rushed through in such hot haste,
that he who is able to cram the most deserves the most credit, for the whole
course is a cramming operation. Seriously, though, we would recommend
this book as one of the best of its kind, and to eveiy right-minded student
a most valuable aid in acquiring the Facts of Medical Science.

Principles of Medicine. An Elementary Vieio of the Causes, Nature.^
Treatment, Diagnosis and Prognosis of Disease: with brief remarks on
Hygienics, or the Preservation of Health. By Charles J. B. Williams,
M.D., F.R.S. A new American from the third and revised London edi-
tion. 8vo., pp.486. Philadelphia: Blanchard & Lea. 185*7. (For
sale by T. Richards & Son.)

This is one of those standard, well established works which has run
through editions enough to prove the good opinion of the Profession. It
needs no commendation from us. We would, however, make one remark
here, for the benefit of students and younger members of the Profession
(we take it for granted the older members have all read the book) , the
remark is this: that no works are so improving and so important, in the

7C6 Editorial and Miscellaneous,

beginning of a physician's career, as works on the general principles o
Medicine. " General Principles" is the common sense of every science, ani
without some quantum of this philosophy special facts must ever remaii
in the mind of the gatherer, unlinked and undigested and, indeed, unavaila
ble. The present treatise is one of the best, and is every way worthy tin
good opinion it has ever commanded from the Profession.

The Hand-Booh of Practical Eeccipts, of Ever7j-Day Use : A Manual fo:
the Chemist, Druggist, Medical Practitioner, Manufacturer, and Heads o
Families; comprising the Officinal Medicines, their uses and modes o
preparation; and Formulse for Trade Preparations, Mineral Waters
Powders, Beverages, Dietetic Articles, Perfumery, Cosmetics, etc. A
Glossary of the terms used in Chemistry and Medicine, including olc
names, contractions, vulgar and scientific denominations ; with a copious
Index to all the Preparations. By Thomas F. Braxston. First Ameri
can, from the second London edition. 12mo., pp. 307. Philadelphia.
Lindsay & Blakiston. 1857.

The present edition is the iirst appearance of this useful little work, ir:
this country, though it has passed through two editions in England. From
a careful examination of our copy, we feel warranted in giving the opinion,
that it is a most convenient, comprehensive and useful book, either as a
manual or as a book of reference. We do not hesitate to commend it to all
for whose use the work has been prepared.

Manual of Physiology. By William Senhouse Kirkes, M. D., Fellow of

the Royal College of Physicians ; Assistant Physician to, and Lecturer:
on Botany and Vegetable Physiology, at St. Bartholomew's Hospital.
A new and revised American, from the last London edition with two
hundred Ilkistrations. 12mo., pp. 584. Philadelphia: Blanchard ki
Lea. 1857. (For sale by T. Richards tfe Sou.)

The present new edition of the above work brings it up to the latest
period of the science. It has been the Text book of many Colleges
throughout the Union for years; and this last edition, with its two hun-
dred illustrations, is well calculated to sustain its deservedly high character.'.

Treatment of Sore Nipples. A friend, whose judgment and experience j
entitles his opinion to much consideration, assures us that equal parts (by j
weight) of glycerine and tannin is the best application for sore nipples}
which he has used. It is also an excellent remedy for chaps and excoria-
tions of other parts. Tlie tannin dissolves readily in the glycerine. We !
hope this formula will be as widely known as the celebrated tincture of
benzoin cure, which has, we believe, been quoted in every medical journal
in this country. [^Boston Med. and Surg. Journal.

SOUTHERN

MEDICAL AID SURGICAL JOURNAL.

(NEW SERIES.)

Tol. XIII.] AUGUSTA, GEORGIA, DECEMBER, 187. [No. 11

OMGIML Am ECLECTia

ARTICLE XXXIV.

Dysentery^ Its Nature and Pathology. A Clinical Lecture, deliv-'
ered at Jackson-street Hospital. By Egbert Campbell, A.M.,
M.D., Demonstrator of Anatomy in the Medical College of
Greorgia.

" As all the normal phenomena of the living organism are known to occur under
he superintending influence of the Nervous System, and are dominated by it, so
t is but rational to regard all morhid actions as being more or less influenced in
heiv manifestations by aberrated nervous action."

[Transactions of the American Medical Association, toL X/ j

Gentlemen, We have deemed it not inappropriate to select
[)ysentery for the subject of a few remarks to-day, as an im-
Dortant, and latterly, a common field of investigation one, which
nust necessarily some time lie in your pathway and therefore,
IS a theme well deserving your attention. Moreover, we were
particularly desirous of bringing to your notice, on some occasion,-
lertain considerations, hereinafter to be discussed, concerning the
lature and treatment of this disease, which have been derived
rom the observation and study of many interesting cases, hoping
I'ou may find them some day of practical benefit to you.

In an article transmitted us for publication, in the Southern
ledical and Surgical Journal, (October No.,) entitled ^^ Creosote in

N.S. VOL. XIII. NO. XII. 45

708 Campbell's Lecture on Dysentery. [December,

Dysentery^^"^ which records the author's happy, experience with
this agent, occurs the truthful sentence " As regards the treat-
ment, there is less unanimity of sentiment than in any other dis-
ease that we have to contend with." And this is doubtless the
result of the diverse and indefinite ideas entertained generally as
to its pathology. Hence, we ever and anon see mustered intc
columns of varying length, a diversified array of evidences con-
cerning different and antipodal remedial measures ; which cause
has had the effect of greatly mystifying the understanding of the
profession at large, as regards the true nature of this disease, what-
ever that may be. Besides, the increased and epidemic prevalence
of this alarming and often fatal malady in our Southern and the
Western States of late years, has compelled a more peculiaj
interest in, and a more energetic inquiry into, its character and
its treatment, upon those whose lines have fallen unto them
in these z^/i-pleasant places, and whose duty as well as prerogative
it has been, to deal with the destroyer. And they have disclosee'
to us the result of their ratiocinations, upon whatever basis theh
interpretation of the nature of this disease, may have presented tC|
them. Some practitioners are found still clinging to the Opiate
and Astringent routine, as the sheet-anchor of their hopes, in or
der "to stop the bowels;" and whatever maybe the unavoidable]
though salutary interludes displayed upon the case, their Opiunci
and their Tannin, with its host of representatives, and their Acetate:
of Lead, are sure to bear the palm. Anon, we hear one proclaim]
ing the infallible potency of the Cold-Water Enemata another;
lauding Mercury, the indispensable back-bone of his medicatioB i
And again, the saline or purgative treatment has h^^Ti mucl
vaunted, and not without some array of substantiating testimony
These may be said to be the leading, though antagonistic, doG
trines before us, presented for our guidance, with respect to thii
very important matter of consideration. If " in a multitude o
counsellors there is safety " always, we certainly should conside:
ourselves enlightened and feel at ease upon these premises ; j^et
may it not make confusion more confounded, when the experieno
of another is entered upon the record. But before commencin|
the detail of proceedings, it would be fair to premise briefly, th<
impressions derived, concerning the nature of that condition

* By Dr. Win. K McMath.

1857.] Campbell's Lecture on Dysentery. 709

wliich constitutes Dysentery, from our interpretation of its symp-
toms, and which have prompted our course, not of entire innovation
but rather of selection and amendment.

Dysenteby, as it is known, from oug- and v75pov, signifying
difficulty in tJie intestine the large intestine is a term whose ap-
propriateness and peculiar etymological adaptedness to the idea it
embodies, furnishes at once, when considered strictly, a summary
of the nature of the disease, which it is meant to designate, and
at the same time, well nigh indicates the basis of the operations
to be pursued, in answer to the symptoms, which come to us as
complaints, wrung from this organ, in the distress, occasioned by
its inability or difficulty in performing its normal function. For,
Grentlemen, this is the plaint the cot??.- plaint of the bowels par
exccllajice, the ^^ bowel-complaint^^ of which you have so often heard
in common parlance. As in contra-distinction to this, it is also
well known, that we have handed down to us, from a far-back
Deriod in the progress of Medlcir^c, the compound word *' Diar-
hcea pertaining to the small intes^'jie signifying the opposite
5tate an easy flowing through.

If any apology should be required, for this descent into the
onstruction or definition of the nosological nomenclature, we will
')ut cite the almost universal blending and confusion of ideas, con-
erning these two diseases as is especially manifested in the simil-
rity of their treatment. Forsooth, there .appear to be some
vho require to be reminded of what, in this connection, they never
znew, upon Pope's cute principle, that

" Men should be taught, as if you taught tliem not,
And things before imknown, proposed as things forgot,"

That condition which is implied and comprehended in the term
)ysentery, is recognized principally by its two characteristic
ymptoms, viz. Tormina, recurring more or less frequently ; and
le almost immediate, subsequent and repeated dejection from the bow-
of a jelly-like mucus, or muco-sanguinolent discharge, of inconsid-
able amount, often, with long continued straining.

The appearance of the discharges presents much variety, the
nount of blood is subject to great variation, the passages being
)metimes found without a trace, at others, consisting principally

the vital fluid, constituting hemorrhage; which may occur in
ss or greater degree, occasionally, even to an alarming extent.
^ the disease has continued for a length of time, the dejections

710 Campbell's Lecture on Dysentery. [December,

may have a curdled or granular aspect, presenting the appearance
of whitish grains of coagulated Ij-mph, suspended in a thin, serous
fluid, or they may consist of bloody serum, or contain pus. Not-
withstanding all this agonizing effort on the part of the large in-
testine, there generally appears to be a total suspension of the
ordinary and natural evacuations, except, occasionally there may
be voided, after extraordinary effort, attended with excruciating
pains, a small scybalous mass; or, as is sometimes the case, the
ordinary alvine discharges may continue to recur, with their
wonted regularity, if not interrupted by the action of opiates.

The Fever of Dysentery appears to vary in type or character,
with the degree of intensity in the local inflammation. Whatever
may be their relative positions as regards cause and effect, or
whichever phenomenon is prior to the other, is a matter not very
well defined in all cases ; yet, there is a correspondence between
the intensity of the local symptoms and the degree or the type of
the pyrexia, as is generally noticeable in th5 other phlegmasise.
In reference to types of fevers, it is well known, that in our cli-
mate and it is presumable, that in every climate, if it were but
recognized, in obedience to the known laws governing the nerv-
ous system, peo'iodicity is a stamp impressed^ with greater or less
force, upon many forms of disease. Hence it is, that we see Dys-
entery accompanied with the intermittent or remittent fever, of
greater or less distinctness ; and as the fever intermits or remits,
so will there be found a corresponding, temporary abatement of
the accompanying phenomena. It is not uncommon to see casea
set in with a violent chill, followed by high fever, which will
continue to recur, unless prevented by Quinine.

This description does not comprise those cases of simple irrita-.
tion in the large intestine^ attended with dysenteric passages, with-^
out fever, which require for their relief, but a dose of Oil, to wasl^
away all irritating substances, and a placebo, in the form of a dc
cided opiate, to obtund the nervous sensibility of the irritated
part. And, Gentlemen, it may be here added, that this is about(>
the only place, where Opium as a curative measure or to chech the
frequency of the passages in Dysentery^ is admissible, in accordanc
with its known qualities and a proper understanding of the
indications to be met^ in the treatment of the fully established
disease.

The term " Typhoid Dysentery" has been much handled of lat:

1357.] Campbell's Zec^wre on Dysentery. 711

until tlie sound thereof has become ns familiar to' the ear as house-
hold words; while we must say, that cither our experience has
been too limited to have furnished us with a case. to spit this, io
us, contradictory phrase, or that, our apprehension of the ultimate
nature and the characteristic and distinguishing properties of these
two pathological conditions, so incompatibly associated in the
above incongruous misnoma, is at fault, or at variance with their
appreciation by others, though pei'haps of more extensive experi-
ence. Diseases are dubbed typlioid^ from some real or fancied
resemblance to that pathological state called TrrnoiD Fever,
whicli is sui generis a unique condition of the whole organism,
and found only in alliance with such complications, sib its own
peculiar disorganizing inlluence, acting through its own appropri-
ate channels, may determine; and within the limits of our com-
prehension of them, we cannot accord to D^^sentcry a place among
them. Typhoid Fever is essentially an a-sthenic disease, of long
continuance and self-limited in duration, depending, we believe,
as is in accordance with the rational interpretation recently set
forth by our brother, Dr. Henry F. Campbell, upon a peculiar ab-
normal condition of the whole, ganglionic, sympathetic or secretory
sj'stem of nerves; and whose symptoms are but manifestations of
this condition of this system of nerves, vrherever they may be
found whether in the state of the blood, the secretory apparatus-
es and surfaces, the integrity of the tissues, and in fact, in what-
ever sphere of organization, or in whatever property of function,
over which, its influence may have control. Here, are no sthenic
developments, no active inflammations, no agonizing pangs the
senso-motory apparatus of nerves, seeming to be obtunded and
enfeebled, probably from depraved nutrition the nervous super-
intendent of the blood-making process, being out of order; but
the passiveness, quiescence and uniformity, which characterize the
operations of this system in health, are developed into the obtuse-
ness, sluggishness and continuousness, which mark its actions in
this state of disease. The amount of congeniality between the two
morbid conditions, denominated Dysentery and Typhoid Fever,
may be estimated, when it is considered, that out of the vast num-
ber of Typhoid Fever cases, recorded by those assiduous statistical
reporters, Louis of France, and Austin Flint of America, Dysen-
tery has not appeared as a symptom or as a complication, in even
single exceptional instance.

712 Campbell's Lecture on Dysentery. [December*

The error of considering this a typhoid disease and naming it
such, no doubt arises from the fact, that the influences at work
here, if not soon successfully combated, are peculiarly favorable
for inducing, in a marked degree, that state of enervation and en-
feeblement of the system, which may supervene upon any active
disease, when allowed from any cause, to rage unrestrained upon
the powers of life, for a length of time. The spurious typhoid
fever, succeeding other diseases of long continuance, then, is all
that we can recognize in this application.

The ZiVer whatever be the character of the manifestations ;
whichever be the organ unmistakably deranged, and however
distantly located and unassociated it may be the Liver, Gentle-
men, is made by many, the scape-goat of all the offences commit-
ted against good order and soundness, within the sphere of the
human organism ; and dearly has it been made to atone, for being
placed, an organ, among the organs of humanity. There is no
doubt, but that a deranged state of so important a recrementitioua
secerner and emunctory, may give rise to much damage, seconda-
rily, to some of the other members of the S3'stem ; and likewise,
there are many primary conditions of the general system, fever for
instance, which maj^ injure and vitiate the action of this organ
go that it is as much sinned against as sinning. Notwithstanding,
whatever be the history of such derangement, whether it exists as
cause or effect, judicious aid is never out of place, should it occur
in Dysentery, as it often does, or in any other disease. But the
philosophy of saddling the Liver, with the charge oi producing an
inflammation of the mucous membrane of a portion of the large
intestine, of variable localitj^, while all the remaining portions of
the primce vice are intact, which inflammation is accompanied with
paroxysmal fever and that assemblage of symptoms, constituting
Pysentery and which is also, often, epidemic, is so obscure, aS'
not to be appreciable by our naked eye. And yet, there are
many, who in the absence of a better pathology, have certified this
accusation.

As regards the Pathology of Dysentery, Gentlemen, there is
little necessity for dismissing it among the mysterious and inex-
plicable problems of our science, or reaching far after its explan-^
ation, in assumed connexions, which have no substantial basis -
when a glance at its anatomical and physiological implements, re-
veals a more simple theory of its nature. There is an inflamma-

1857.] Ca^ipbell's Lecture on Dysentery. 713

tion of some portion of the mucous membrane, lining the large
intestine, which may occur from irritation continuously exerted

- upon that surfoce, whether that irritation be direct or reflected.
It may be, that the fiecal mass, through some ulterior cause, be-
comes detained in its transit along a portion of the canal, until it
becomes inspissated and concrete, from the absorption of its fluid

' particles, the accumulation continuing and the amount o^ difftcidty

increasing, the longer this constipation lasts, until finally, the irri-
tation, thus induced, is sufficient to call for relief, and incite an

, endeavor on the part of this violated organ, to rid itself of its
hurtful incumbrance and thus, an excito-motory and an excito-
secretor}^ process is instituted, which results in, or rsithev constitutes,
the local element in this disease. The ulterior or more remote
cause here referred to, would seem to be satisfactorily explained,
by attributing it to an obtuseness, or we may say, a imralysis of
the nervous supply of the part ; which, if we take into view the
fact, that the state of the bowels is in a great measure influenced
by the condition of the great spinal centre as is manifested by
the effect of a counter-irritant, a mustard plaster, for instance, ap-
plied to the spine, being capable of enhancing greatl}^ the action
of a small dose of any laxative medicine we may with propriety,
venture to trace this effect, of the stagnation in this portion of the
alimentary canal, to a condition of the spinal cord^ as its remote
cause. And if we still farther proceed to inquire after the ultim-
ate/o^5 et origo of causation, we must interrogate those influences
in man's relation to the external world, which, acting upon the
susceptibilities of his physical organization, are capable of thus
determining, in an important part of the nervous system which
system enacts and controls all his vital phenomena, whether nor-
mal or ab-normal that condition, w^hich may give rise to the
manifestations of this disease, apparent to our perception.

Probably, no fact is better established in pathology than the
spinal origin of paroxysmal fevers which, not always but often,
are accompanied with an inflammation, attacking one or another
organ of the body. And it is well understood, that the more se-
rious the inflammatory action, the graver is the type of the fever,
and vice versa. ISTow, Gentlemen, with such analogous traits be-
fore us, what is to forbid our classifying Dysentery amono; those
affections only differing, as it does in the peculiarity of office,
and, therefore, in the singularity of construction, properties and

714 Campbell's Lecture on Dysentery. ^December,

relationships of the organ diseased and which but yields its owu
characteristic evidences of its suffering condition ? As in accord'
ance with the generally received opinion, relative to the exercise
of those organs and those functions, which are under the superin-
tending influence of the spinal system of nerves that their oper-
ations are characterized by stages of action, alternating with peri-
ods of rest, or intermittingly the intermittent character of the
pains, as well as the other symptoms in Dysentery, may be also
regarded as indicative of its spinal nature.

It has been said, that the initiatory stage of this condition was
one of constipation of the bowels, (though this is by no means al-
ways the case,) where the effete mass was detained in its recepta-
cle, the large intestine, probably, by the effect of obtunded sensi-
bility or paralj'sis of its nerves. Now, this idea of paralysis would
but illy comport with the known effects of spinal irritation, until
it is recollected, that prior to that action being established in the
Bpinal cord, which is denominated "spinal irritation," there must
be a stage of congestion or something akin to it, the effect of
which condition in a nervous centre, the brain for instance, ig
known to be that of obtunded sensibility and loss of motion, or
paralysis. Thus we see, and it is satisfactorily presumable, that
whilst the initiatory stage of the intestinal affection is in progress,
the inceptional condition in the nervous centre which probably
determines it, is co-temporary with it ; and in like manner, when
the active process begins in the bowel, there is to be found a cor-
responding, simultaneous activity existing in the spinal cord, con-
stituting spinal irritation as evidenced by the paroxysmal fever,
as well as those enhanced, spinal, excito-motory phenomena which
pertain to this disease.

The only mode of incursion of this disease, heretofore noticed,
and which has been used as the example, from being the most
common, is that with constipation ; although, as it has been re-
marked, this is by no means the invariable rule, as it is sometimes
preceded by diarrhoea, as well as being also, occasionally, accom-
panied with that affection.

That these are excito^secretory phenomena, is an opinion origin-
ating with Dr. Henry F. Campbell.

If, in our conjectures concerning the implication of spinal dis-
ease in the constitution of Dj^sentery, we are correct, it would be
au interesting process of inquiry to seek an interpretation of the

1857.] Campbell's Lecture on Djsentein/. 715

rationale of this latter condition, tbrough the aid of this newly
discovered function of the nervous P3'stem. Then, we assume the
position, Gentlemen, that the diarrJtcea preceding and accompany-
ing Dysentery is an excito secretory result] whWa Dysentery iIsqM^
unaccompanied thus, is, for the most part an exclto-motory jjUeno-
menon.

That condition in the nervous centre, which, when from its lo-
cality and anatomical connections, is favorable for exerting its
influence upon the large intestine, is accompanied with Dysentery;
when those relations obtain in reference to the small intestine, it
is attended with diarrhcea simply from the fact of the peculiar
anatomical construction and functional endowments of this portion,
of the canal which, w^hen under the operation of a like influence,
yields its different and characteristic manifestations. Let us be
understood that in Dysentery there are two co-existing and co-
extensive conditions, as manifested by their co-equal symptomatic
results, viz : Spinal irritation^ and an inflammation in the mucous
membrane of the large intestine.

It must be recollected, that the spinal marrow is in intimate
connexion with a long chain of ganglia, belonging to the sympa-
thetic or secretory system of nerves; w^hich ganglia are again as-
^sociated with others, among the abdominal viscera, &c. Now,
any source of irritation, whether cold applied to the surface of the
body," or any which might have its origin in the mucous mem-
brane of the large intestine itself, if conveyed to, and then reflect-
ed back from, this grand mixed nervous centre, the spinal centre
the nervous circle being complete and adapted to this direction
of its force, might spend its excitation upon the muscular coat of
the large intestine, if that be its terminus giving rise to their in-

* "In the relation of the visceral nerves to the external nerves of the body, there
is a sympathy established between the walls of the cavities of the body and the or-
gans contained in them. It exists not mereh' between the skin of the cranium and
the brain, between the skin of the neck and the larynx. where a vascular connex-
ion might be conjectured but also between the thoracic walls and the lungs, the
abdominal walls and the abdominal viscera. Cold or warmth, or any other irrita-
tion of those external regions, operates immediately, either injuriously or health-
ily, upon the viscera situated beneath. ... On the other hand, according to Rade-
macher, in painful diseases of the liver, the abdominal muscular fibres of the right

":' are in continual spasmodic tension." [Henle's General Pathology.
-ilso, " A partial keen current of air falling on any portion of the skin may in.

luce inflammation in any susceptible internal organ. An extensive burn or scald 18

apt to induce pneumonia." [Marshall Hall.

716 Campbell's Lecture on Dysentery. [December,

creased, exaggerated contraction ;* and also upon the abdominal
muscles, if its centripetal energy be sufficient to reach the spinal
marrow, the origin of the nerves of voluntary motion occasion-
ing the incontrolable straining,f and producing Dysentery, the
excito-motory phenomenon. Or the same force arising in the
mucous membrane of the large intestine or elsewhere, and reach-
ing in its course the secretory ganglia, and being reflected back
upon the mucous surface of the small intestine, would give rise to
diarrhoea, the excito-secretory result brought about, it may be,
by an irritation radiating from an inflamed point in the large in-
testine.:}:

In substantiation of this position we would but adduce the fact,
familiar to every one, presented in the effects of stimulating ene-
mata the first simply evacuates the large intestine, but if perse-
vered in assiduously, so great an irritation may be wrought up in
the large intestine as to be reflected upon the upper bowels, and
they are acted upon. Monthly-nurses seem to be aware of this
result, for in the application of the soap suppository in infants, if
decided action upon the bowels is desirable, they but persist in its
introduction, beyond the number of times requisite to empty, the
rectum.

The spinal marrow beiug in a state of irritation, excitement or
*' polarity" would greatlj^ fortif}^ or enhance the reflected influence,
and from its propinquity to, and intimate connexion with, the
sj'mpathetic ganglia, it is reasonable to suppose that they might
participate in its excitement. So that, it would not be so great a.j
stretch of imagination to suppose, the spinal ganglia of the sym-
pathetic nerve as well as the spinal cord, to be in a state of irrita-
tion in these special cases.

* " Reflex motions aud reflex sensations, from sympathies of the splanchnic nerves
among each other, are principally apparent in pathological and physiological
events. To reflex sensations ve may attribute the pains which accompany spasm
of the large intestines (colic), and contractions of the uterus. Rejiex motions, as in
external parts, appear immed'tatehj under the irritated membranous regions, as -well
from irritation of serous as of mucous membranes Still, single regions of the mu-
cous membranes also stand in relation -with very remote muscles." [^Henle.

f " The apparently involuntary contractions of the abdominal muscles in spasms
of the bowels, parturition, tenesmus, and other affections, may be reflex motions
proceeding from nerves of sensation." {^Ilenle 's General Pathology.

\ " There is scarcely a part from which internal inflammation an excito-secre-
tory effect may not be excited." [Marshall Hall.

1857.] Campbell's, Lecture on Dysentery. 717

To resume : Then, in Dysentery, there are apparent two distinct
elements constituting tlie disease viz., spinal irritation, and an
inflammation of the mucous coat of some portion of the large in-
testine. The former, is manifested by the paro>iysmal fever, the
tormina from spasmodic contraction of the muscular coat of the
intestine, and by the straining or forced voluntary contraction of
the abdominal muscles. The latter, by the character of the dis-
charges, the great irritability of the surface of the organ at the
point inflamed, as is indicated by the evidences yielded upon con-
tact of the contents of the bowel the more solid they be, the
greater being the amount of irritation, as shown in the exaggera-
tion of all the reflex phenomena on the passage of scybala; also,
by the evidences derived from an examination by pressure of the
hand, should the point of inflammation be above the pelvic cavity,
it being always discoverable by tenderness on pressure, along the
ascending, tranverse or descending colon ; or if located in the rec-
tum, where it is out of reach of manual examination, by the in-
creased amount and frequent occurrence of tenesmus, and when
used, by the great intolerance of all enemata.

These are the two conditions: That they have a connexion is
sufficiently proven in their co-existence, and the sympathetic asso-
ciation in the degree of their manifestations: though the problem
of priority of birth, or of w^hat one has to do, w4th the origin of
the other whichever is the parent and which the oflspring, is wrap-
ped in more obscurity. But from the evidences already adduced,
as well as from the testimony furnished in the application of the
laws governing the operations of the various elements of the ner-
vous system, herein implicated, we deem it more philosophical to
suppose irritation in the central organ of the nervous system in
question, to be more capable of determining such actions at the
peripheral extremities of its motor and sentient nerves, under the
circumstances, than that an irritation impressed upon the sentient
mucous surface, could impart to the nervous centre, that species of
persistent and intense excitement as is here manifested. And be-
sides, we have the testimony implied in the fact, that the more
decided evidences of spinal disease, chill and fever, &c., are often
the first to make their appearance in Dj^sentery. Furthermore,
in corroboration of these views, we will quote the words of a cel-
ebrated German neuro-pathologist of the present day"^ viz., ''In

' * Henlc. ~ "

718 Campbell's Lecture on Dysentery. [December,

proof of the dependence of tlie vascular nerves upon the brain and
spinal marrow, we may farther adduce, the excretions of persons
hanged, and of paraplegic persons, the cedematous swellings in the
epidermis, and particularly in the serous and mucous membranes
of parts which are paralyzed by injury of the spinal marrow, or
lie within the affected parts, the inflammations and ulcerations in
the kidneys and the mucous membrane of the bladder after inju-
ries of the medulla spinalis, perhaps also the extensive abdominal
inflammations which Scliiff observed after section of the thalamus
nervi optici. I will also here mention the inflammation of the
uvula connected with inflammation of the cervical portion of the
spinal marrow, the peritonitis and nephritis connected with in-
flammation of the medulla spinalis, the gasiro-enieritis^ in hemor-
rhage^ inflammation and ramolUssement of the brain and spinal mar-
roiv^^ the softening of the stomach in meningitis of the base of the
brain," &c.

The patient in Dysentery is, as it were, between two fires each
having the power, through nervous communication, of lending
force to the other with increasing energy and perilous reciprocity.
"Whenever an irritation is impressed upon the sentient and irrita-
ble mucous surface, and is conveyed to the irritable nervous cen-
tre, it is reflected back with redoubled force upon the muscular
coat and abdominal muscles, causing their spasmodic action, com-
pressing the tender mucous lining and straining or wringing out the
fluids^ which furnish the discharges in this disease : each spasm of the
muscular coat of the intestine increasing the irritability of the mu-
cous coat, the impression of which is again received by the nerv-
ous centre, and again retorted back with increasing vehemence
and so on, in fatal repetition of the round the fever all the while,
when it exists, lending its influence to this work of destruction.
It will be seen, that the coats of the organ are disadvantageously
arranged with respect to one another in this disease the muscular
coat surrounding the mucous lining, subjects the latter to pressure
upon every contraction ; especially, as its calibre is a canal through
which must pass contents, having more or less solidity and resist^'
ance. And thus, may the effect of contact with a hardened faecal
mass, be imagined, but cannot adequate! 3^ be described.

The continuance of these perturbating and enervating causes
upon the general nervous system which have in themselves the

* These italics are ours.

1857.] Campbell's Lecture on Dysentery. 719

. elements of increase and multiplication ad infinitum^ in a geome-

trical progression, the longer they continue unallayed are suffi-

cient, verj soon,^ with the aid of the accompanying fever, to
exhaust the energies of the constitution, by the excessive excita-

tion and taxation of its powers--;-and not, surely, by diminishing
the strength, as many appear to believe, through the draft upon
the circulatory mass, in consequence of the frequent discharges.
, For, it should be distinctly understood, that these are not passages.
In fact, there is generally very little loss of fluid, and that little is
as nothing, in debilitating the patient, compared with the fatal
torture and fatigue, with fever and loss. of rest and sleep, by which

" We see liim day by day,
Wither d on the stalk aAvay,"

Thus, sooner or later, is ushered in that state of abasement of the
vital energies the pseudo-typhoid fever, or the Typhoid Dysen-

.' tery, as many are pleased to term it ; vv^hen the impressibility,
power of conduction and reflection, of that portion of the nervous
system first engaged and over-taxed, have failed leaving it de-
void of tone and paralyzed ; for, by degrees, we may observe the
tormina becoming of shorter and shorter duration, then consisting

. of a sudden jerking pang, at the time of a discharge, and finally,
ceasing altogether a bloody, purulent discharge taking place,
from time to time, involuntarily. In support of this view of the
subject, we find in the valuable work to which we have had occa-
sion so often to refer, the following cursory expression of a coin-
cident opinion, which although not given in reference to Dysente-
ry, (as this book treats of no particular disease, but of the attrib-
utes of the nervous system generally^ under the influence of disease,)
yet may serve to furnish authority to the reasonableness of oar
ideas, concerning the pathology of this disease viz., "Irritation
and inflammation of the mucous membranes were for a long time
described only in connexion with spasm of the corresponding
muscular layers. Abercrombie first gave value to another opin-
ion in reference to the intestinal canal, by demonstrating that not
spasm, but a paralysis of the intestinal canal, was the cause of
tIqm^ {iliaca passio)^ which sometimes appears alone, sometimes in
connexion with inflammation of the mucous membrane ; in the
latter case, the inflammation may be either present from the be-
ginning, or only added to it subsequently. Stokes refers to these
[ facts in order to explain how a dilatation of the bronchia may oc-

720 Campbell's Lecture on Dysentery. [December,

cur, in and after broncliitis. Now, if we look at tliese phenomena
alone, there is an antagonism, of the mucous and muscular mem-
branes, iiTitation of the former ivith paralysis of the latter. But an-
other question arises, whether the internal connexion here is that
of antagonism ; whether the paralysis is occasioned through the
interposition of nerves from the mucous membrane ? Abercrom-
bie expresses no conjecture concerning the relation of these two
affections to each other. Stokes considers the paralysis as second-
ary, the result of an exhaustion of the muscular power after its activity
has first been sympathetically increused.*^^

Of this condition, there appear to be TWO distinct varieties^ the
difference depending absolutely upon the state in which the bow-
el is found upon the supervention of these latter symptoms. 1st.
In one, the constipation still persists, or has not been overcome,
in the upper portion of the canal. And it is surprising how long
this state of affairs may exist, without being detected, or even sus-
pected in the least, when all the while, there, at that point, remains
the inexorable barrier to relief This must be remedied, or the
patient must finally succumb to an inevitable continuance of this
consuming process. We would say, in passing, that the physician
will always do well to see the dejections, to ascertain how many
contain faecal matter, how much they contain, or if any at all ^for
if no foecal matter has passed, there has been no passage.

The diseased section of the intestine is unable to rid itself of its
contents; being entirely paratyzed, it yields to the intrusion of an
increasing incumbrance becomes, it may be, stretched to the ex-
treme of distension, forming a pouch, out of which the solidified
accumulation cannot pass into the lesser calibre of the uninjured
portion of the canal and often pours out blood in a frightful
manner, (nearly all the discharges consisting of pure blood,) which
may pass in fluid form or in clots; or perhaps, being retained
through the action of opiates, may undergo change and become
disorganized and give a putrescent and most "unbearable odor.

2d. In the other form of this low condition, the irritation hav-
ing been reflected for so long a time upon the upper portion of
the primce vice, we see, in addition to the purulent or bloody evacu-
ations, a continuous and wasting diarrhoea. Higher up, the stom-
ach becomes involved in some instances, and there are loss of
appetite, nausea and vomiting, even of the blandest fluids to-

* The italics are ours.

1857.] On Scarlatma. 721

gether with a red, dry tongue, quick and feeble pulse, entire pros-
tration of strength, cold extremities and dullness of tbe mental
faculties and thus, the vital spark grows dim, flickers and goes
out, unless again rekindled by its appro {jriate stimuli. It will be
perceived, that the characters of the disease, in this form, have
undergone a change where there was Dysentery, there is diar-
rhoea with prostration. The nervous system having been over-
wrought, loses its excitability 'becomes paralyzed. The mucous
membrane of the large intestine having been racked and bruised,
remains a passive, purulent, secretory surface, sometimes retaining
the marks of its sore conflict for years afterwards, as is apparent
from the evidences of chronic ulceration continuing for that length
of time.

In this entire metamorphosis, the chanicters of the original dis-
ease have disappeared. It is not Dysentery, and requires a change
of management. It is not Typhoid Fever, as shown in its history,
and as is manifested, often by the sudden and almost miraculous
recovery of cases, upon the application of its appropriate treat-
ment.

And now". Gentlemen, from the foregoing considerations, so sa-
tisfactory to our mind, appears the interpretation wdiich w^e have
ventured to suggest, of the phenomena concerned in Dysentery,
that we would risk the prediction, that ere long, in the progress of
our science, by the light of the now dawning nervous pathology,
such an elucidation of the nature of this important disease, will be
more authoritatively and more clearly defined.

The Treatment of Dysentery will be made the subject of a sepa-
rate Lecture.

On Scarlatina. A Clinical Lecture delivered in Paris, by M.

Trousseau. (Translated from the Gaz. Hehdoniadaire) Con- ^
tinned from page 672.

The angina of scarlatina is one of the most difficult diseases to
describe properjy or to recognize readily. To point out its simple
or severe forms is, in general terms, easy ; but it is not so with one
of the varieties of the latter, which we shall study in its turn, in
which diphtheritis arises as a complication, disconcerting the pre-
visions of the physician, and giving to the angina of scarlatina a
character of fearful seriousness.

Scarlatina is essentially an anginous disease, if you will permit

72.2 > Oil Scarlatina. [December,

me this expression. However benign it may be, it is seldom that
it is unaccompanied by pain in the throat, as it is seldom that ru-
beola, however light it may be, is unaccompanied by pain in the
larynx. This pain in the throat is also met with in variola, and the
presence of three or four pustules upon the pharynx explains it ; but
the angina of variola differs essentially from the angina of scarla-
tina.

From the first day of the disease, the veil of the palate is red, of
a tint analogous to the skin, deeper however; the tonsils, slightly
swollen, are of a violet color. As the disease progresses, after two,
three, or four days, there appears upon one of the tonsils, sometimes
upon both, small, whitish concretions, ordinarily of a milky white,
at least when they are not di:colored by any substance ejected from
the stomach in vomiting. Examining them more nearly, by re-
moving them with the handle of a spoon, you will perceive that
they differ from diphtheritic false membranes ; these of a yellowish
white are adherent, and when they are seized, by means of forceps,
they come off in shreds; the concretions of scarlatina, pulpy, but
not adherent, have not the characteristics of false membrane, re-
sembling rather those concretions which arise, for example, upon
the surface of bad ulcers.

The disease progressing, the intensity of the angina may become
so great as to interfere with respiration, and especially with deglu-
tition ; fluids taken, return by the nose ; the voice becomes nasal,
and the ganglions of the neck, principally those of the angles of the.
jaw, are engorged. When not interfered with by medication, or
when a mild course of medication is adopted, this angina retrocedes
with the disappearance of the eruption upon the kin of scarlatina.
The tonsils throw off their concretions, remaining red, and some-
times excoriated: the disease is cured. The throat and tongue,,
however, still remain sensitive, and this excess of sensitiveness per-
sists longer upon the first of these parts than upon the second. It
ends by a kind of desquamation analogous to that which we have
noted as taking place upon the tongue. Such is the ordinary form,
the simplest form of scarlatinous angina. There are other more
severe forms : there is one, in particular, to which I have already
alluded, and which I have almost invariably seen to terminate fa-
tally. I shall now speak of this form.

Some individuals are attacked with scarlatina of moderate severi-
ty : they are slightly delirious at night, restless, pick their bed-
clothes ; the pulse is quite frequent, and the soreness in the throat
moderate. The disease passes to the eighth or ninth day ; recovery
seems certain ; the fever abates, the eruption disappears, and the
family feel secure. Suddenly a considerable engorgement is ob-
served at the angle of the jaws, occupying not only this region, but
the neck also, and sometimes a part of the face. A sanious liquid,
fetid, and very abundant, flows from the nares. The tonsils are
very voluminous, the breath is very offensive ; the pulse suddenly

1857.] On Scarlatina. 723

becomes very frequent and small ; the delirium re-appears, and other
nervous symptoms re-arise; the delirium continues ; coma succeeds,
and, at the same time, the skin becomes cold, the pulse more and
more feeble, and the individuals succumb, after three or four
days, in a slow, painful manner, or die suddenly, as though from
syncope.

How can this be explained ? It may be asked, if it be not diph-
theritis which complicates the scarlatina? for these phenomena
resemble so much the terrible forms of diphtheritis, those forms
which destroy adults, as well as infants, before the croupal affection
has had time to reach the larynx, the false membranes being con-
fined to the nasal passages, the ears and fauces ; these phenomena
resemble so much those terrible forms of malignant diphtheritis,
that we are tempted to believe that it is not scarlatina, but this last
woful disease, that has destroyed the patient.

I am the more inclined to believe this because, in some cases, the
larynx is invaded. Graves cites some observations of persons who
died of croup following scarlatina, or recovered from this exanthe-
matous fever, after having throv/n off tubular false membraties,
moulded upon the trachea. Graves, in citing these facts, has re-
proached me with having mistaken this forai of the disease. I had,
in fact, heretofore mistaken it. I said : scarlatina does not love the
larynx ; but during my service at the Children's Hospital, I found so
extraordinary an identy between malignant scarlatinous angina and
malignant diphtheritic angina, that I w^avered in my opinion.
Now I cannot help believing although I dare not affirm it, my
convictions not being sufficiently established, that these phenome-
na of which I have just spoken, are none other than the symptoms
of diphtheritis appearing at the close of an attack of scarlatina, as a
most serious complication. Patients die, in fact, with all the symp-
toms of diphtheritic poisoning: general coldness, small pulse, fetidi-
ty of the breath, both by the mouth and nose, universal paleness of
the skin, a frightful dissolution of the tissues symptoms which are
not found in any other kind of severe disease. It is possible that
persons being subjected to particular conditions in the midst of an
epidemic atmosphere which is especially witnessed in hospitals for
children, where diphtheritis is almost always present it may be
that the angina of scarlatina becomes the point of attraction for a
diphtheritic exudation, absolutely in the same way as a little exco-
riation behind the ear, as an ulceration of the vulva, of the folds of
the skin, as any other w^ound may, in persons placed in the same
epidemic conditions, become the point of departure for the mani-
festations of diphtheritis. What tends to strengthen me in this
opinion, is the fact that of all the anginas arising suddenly at the
ninth or tenth day of scarlatina, I do not recollect to have seen a
single case get well; w^hile for the angina scarlatina, even very
severe, but commencing with the scarlatina itself, and reaching its
height towards the sixth, seventh, or eighth day of the disease, for

K. g. VOL. XIIL KG. XII. 46

724 On Scarlatina. [December,

this angina recovery is the rule, which often takes place without
the aid of art.

When we take up the subject of the treatment of scarlatina, I
shall speak to you of the treatment of the angina of scarlatina.
Now I will simply say to you, that the croupal angina of scarlatina
(I do not speak of that severe form to which 1 have drawn your
attention, but the simple form which we have said is almost always
accompanied with pultaceous croupal concretions), this simple
croupal angina of scarlatina acts very differently from the severe
angina, from diphtheritic angina; for while this is very mobile, and
tends towards the nose and larynx, the other on the contrary re-
mains generally limited to the pharynx, and for it I maintain the
proposition which Graves has condemned ; Laryngem amat evitare.
The angina of scarlatina is then pharyngeal, very different from the
angina rubeola which is laryngeal, and from the angina of variola,
which is both pharyngeal and laryngeal. The voice of those affect-
ed with the angina of scarlatina is nasal, but it is sonorous ; it does
not undergo any other modification than that it meets with in pass-
ing into the mouth. In rubeola the timbre of the voice is, on the
contrary, very often altered from its formation in the lar}^nx ; it is
not modified in passing the throat.

In some cases towards the close of the disease, towards the decline
of the eruption, other symptoms appear upon the neck, or elsewhere:
these are the huhos of scarlatina.

All pestilential diseases are accompanied with bubos. Putrid fe-
ver has its mesenteric bubos, for you know that towards the ninth or
tenth day of that disease the mesenteric ganglions can acquire the
size of a pigeon's egg, and even more. Scarlatina, which is also a
pestilential disease, has then its bubos. They occupy the cervical
region ; the lesions which determine their evolution are seated in
the throat. From the commencement of the disease you will per-
ceive the ganglionary engorgements upon the sides of the neck and
at the angles of the jaw. Sometimes, towards the tenth or twelfth
day, independently of the disorders produced by that severe form of
angina of which I have just spoken, there will arise a sudden in-
flammation of these cervical ganglions ; the skin reddens, becomes
tense, and in four, five, or six days, a large phlegmon is formed. If
it is opened pus will be found, and sometimes the cellular tissue
which envelopes the ganglions is sphacelated. I recollect a young
lad fourteen years old, in whom this gangrene was so extensive that
the neck was dissected out as though by a diffused phlegmon, and
the carotids were seen to beat at the bottom of this frightful wound;
he got well, but retained a sad deformity. Graves reports an iden-
tical case.

These lesions can arise in other parts of the body, where gangli-
ons d<d^ not exist, where at least they do not appear to have been
the cause of the symptoms. In the young lad of whom I have just
spoken, independently of the phlegmon of the neck, another diffused

1857.] On Scarlatina, 725

phlegmon appeared the tenth day of the disease upon the leg, which
produced a considerable shortening of the tendons and left the pa-
tient lame, to such a degree that he was excused from serving, when
six or seven years afterwards he was drawn in the conscription.

Besides these acute ganglionary engorgements, besides these dif-
fused phlegmons of the cellular tissue, scarlatina can also give
rise to chronic ganglionary engorgement.

In infants which are not at all scrofulous, you can see as the conse-
quence of scarlatina, chronic engorgements which commenced with
the disease, and which persist two, three, or four months after re-
covery. In scrofulous infants, these engorgements often terminate
in scrofulous ulcerations.

The urine during the period of the eruption in this disease, ig
sometimes bloody, and often albuminous. It has been estimated^
that in this period of serious cases of scarlatina, albuminuria is pre-
sent one time in three. You know that this alteration of the urine
is also frequently observed in typhoid fever, in erysipelas, in variola,
and in other affections. Although frequent in the acute periods of
scarlatina, albuminuria does not constitute a symptom very differ-
ent from the albuminuria which is observed, more rarely it is true,
in Other affections which we have designated.

There is another symptom which is also seen in the acute period
of scarlatina, rheumatism. The rheumatism of scarlatina is a very
common symptom, but as it does not exhibit itself by the symptoms
general to ordinary rheumatism, as it is limited in most cases to
three or four articulations, and principally to that of the wrist, it is
often mistaken. However, by carefully questioning the patients,
by examining carefully their articulations, by pressing carefully
upon them, articular pains will be discovered in perhaps a third of
the cases. This is important, for in the course of the disease, you
will often see acute symptoms arise in the joints, general arthritis^
and also frequently pericarditis, endocarditis affections upon which
M. Thore (of Sceaux)has recently published some excellent works-
affections indicated by Graves, which I have observed myself, and
which appear to me to be of a rheumatismal nature. These rheuma-
tic symptoms often have as a result another disease, chorea, which
is witnessed in young children.

Desquamation commences the 10th or 15th day; it may last till
the 16th or 17th day, as we have at present an example in No. 7, in
the women's ward. It is apparent first upon the neck and chest, then
upon the limbs, upon the back of the hands, upon the palm of the
hands, and finally, upon the bottoms of the feet.

Upon the body this desquamation has peculiar features, but which
are still more characteristic upon the hands and feet. Upon the
body it takes place in scales, which are often no larger than 2 or 3
millimetres, and which acjain are one, one-and a-half, and two cen-
timetres in size. Upon the arms, upon the legs, where the epidermis
is a little thicker, they may be four to five centimetres in size, the

726 On Scarlatina. [December

epidermis may be raised in large bands, as after erysipelas anc
phlegmons, but this desquamation has never the furfuraceous an
pearance of the desquamation of measles. In rubeola, these sea;
are so small that they have to be attentively examined to see theijj
and often they can only be seen by brushing, so to say, the skin o
the patients with the sleeve of your coat, in order to collect the fine
powder which this eruption produces. Upon the hands and feet
the desquamation of scarlatina is so distinctly marked that it is im-
possible to mistake it. There the epidermis is elevated in gre-.
patches, resembling pieces of a glove. The desquamation of t
feet is the slowest; in some cases the nails, which are, as youkno
an epidermic production, fall. This is rare, but it has been obsei
ed, and Graves cites^ a case.

We have still to study scarlatina in the symptoms which arise
during its period of dechne, and again in its elementary forms^. that
is to say, in the forms which it assumes when it ceases to present its
habitual characteristics, when it is so altered, that unless it be ex-
amined attentively^ in many cases it would be impossible to recog-
nize it. This part of the history of scarlatina is certainly the most
important to study, less on account of its nosological relations than
its practical relations.

Of these sj^mptoms, some may be considered as immediate, others
as mediate, arriving much later.

The first are the nervous symptoms. A person is cured of scarla-
tina he is convalescing, you have no longer any anxiety on his
account, when suddenly vomitings take place similar to those of the
commencement of the disease ; with the vomitings come delirium, a
terrible agitation, a great frequency of pulse, and the patient dies in
eoma or with convulsive symptoms. Still there is no anasarca, no
albuminuria, no hematuria, nothing which can explain these phe-
nomena. These symptoms are not only seen in children but in
adults also. These symptoms arising in the course of the disease
have, you see, a much more terrible signification than they have in
the first period, and yet they are then very serious. I could not
then tell you too emphatically that in scarlatirta, you cannot regard
your patient as cured until along time after the cessation of the last
morbid phenomena. There is no disease which shames the physi-
cian more, there is none in which one is more subject to errors of
prognosis, and these errors are inevitable. The fever has subsided,
only a very few slight symptoms remain, you announce a cure, and
yet the disease is still formidable, it wall kill the patient with great
rapidity, and this cannot be foreseen.

Among the immediate phenomena of this period of decfine, which
takes place during desquamation, anasarca is one that deserves your
particular attention.

This symptom appears not in the most severe form, but rather in
the moderate form of scarlatina. It afflicts the convalescents not
only when they are exposed to cold, when they have committed

1857.] On Scarlatina. 727

some imprudence, some dereliction in diet, but when surrounded
hwith the very best care, and attended to with the most constant
^IsoHcitude.

"' Anasarca often appears in the most sudden manner. It invades

^'|the face, the v^'hole body, in some cases it is so great, that an infant,

for example, which the evening before you had left thin and pitiful,

seems to you the next day fat, on account of the enormous pufRness

which he presents.

This swelling reaches its maximum in twenty-four hours ; it is
'^j universal, and to a degree which you will rarely find in anasarca,
M consecutive to organic disease of the heart, or Bright's disease. In
other cases, on the contrary, the anasarca is very slight, and is lim-
ited to the face, and to the extremities ; but it is accompanied by
a remarkable paleness of the skin, and it is almost always preceded
or accompanied by hematuria.

Hematuria is a symptom in fact very common in scarlatina,
although frequently it is not recognized. If the blood be pure, if it
be only slightly altered by mingling with the acids of the urine,
which is then of a black color, this hematuria is discovered and
pointed out b}^ the parents, but it is not noticed when the bloody
secretion is slight, the urine remaining of a rose color. The color
of bloody urine can also be greenish like whey, a color essentially
difTerent from that of the urine of Bright's disease, and from all
other kinds of urine. The first few days the micturition of blood
may be so great, that the urine can deposit at the bottom of the
vessel used in experimenting, blood globules forming a precipitation
one or two centimetres in depth. The urine then looks like a strong
solution of rhatany. According as the disease progresses, the urine
is colored as we have said, but blood can still be recognized by the
altered globules which are found adhering to the sides of the glass,
or by the enormous quantity of albumen contained in the urine.
When this is heated or treated by nitric acid, you do not get a
white albumen like that which is obtained in Bright's disease, but a
brownish albumen, or a dark colored albumen analogous to that of
acute albuminuria.

Ordinarily children recover under a hygienic treatment easy to
give them ; but in other cases, notwithstanding this treatment, the
anasarca, when it is great, and when it has come on rapidly, carries
off the patients by producing various symptoms of which I shall
now speak.

At times some complain suddenly of a violent pain in the head,
attended with difficulty in the sight : convulsions are then to be
feared. It is well to know this fact, for upon the one hand it is
important to announce to the families what is to be expected, and
on the other hand, in some cases you can ward oflf these attacks.
To hold the head elevated, to place the legs hanging over the side of
the bed, and to administer an active purgative, are the means effica-
ciously employed under these circumstances. But most generally

728 On Scarlatina, [December,

the convulsive attacks come on, whatever may be done, and some-
times immediately destroy the patient. In other cases they are
repeated rapidly with intervals of an horn' and a half, an hour, or of'
an half hour; they are almost continuous, one hardly terminating
before another commences, and the patient succumbs in a stupor
and coma unless prevented by active treatment.

At other times the anasarca reaches to the more profound parts.
I have seen it attack the veil of the palate, the uvula, the epiglottis,
the aryteno-epiglottic ligaments, and in the infant in whom these
lesions were present, the symptoms of oedema of the glottis arose ; he
owed his life to an active cauterization of the superior part of the
larynx. Cases of persons carried off by an oedema of the glottis,
during the anasarca of scarlatina, are not rare. Death takes place
the more readily, because the throat having been attacked by in-
flammation, that inflammation has extended to the aryteno-epiglottic
ligaments, and the tumefaction produced by the oedema, is added to
the swelling consecutive to the antecedent phlegmasia.

There are other symptoms which arise during the decline of
scarlatina, which are much less known, although they are more so
than formerly ; I speak of malignant pleurisies, of pericarditis, and
of rheumatism.

When we speak of eruptive diseases, we sa}^ that rubeola invites
the thoracic diseases. This is true, for rubeola first attacks the
bronchial tubes, it declares itself there before it manifests itself
upon the skin, as scarlatina manifests itself by a pharyngeal angina
before any eruption of the skin. The first symptom of rubeola is
pulmonary catarrh, and from this it can be easily understood how
that, when this catarrh is more severe than usual, inflammations of
the lungs are frequently produced. Thus when on the seventh or
eighth day of a rubeola the patient is still feverish, you can be al-
most certain that he has either an acute catarrh or a pneumonia, or
even a pleurisy,

Authors agree on this point, that, on the contrary, in scarlatina
the thoracic organs are respected. They are, it is true, in the acute
period of the disease, but they are not so in its decline. It is quite
common, in fact, to see in some aftected with anasarca, and even
in others who are exempt from it, symptoms of disease of the chest
suddenly supervene. The lungs in this case are not attacked as
in rugeola, bnt the serous membranes, the pleura, and the peri-
cardium.

These pleurisies of scarlatina are ordinarily malignant, not only
on account of the rapidity with which the effusion takes place, but
also on account of the quality of the liquid effused. At the eighth
or tenth day of the pleurisy, the liquid is often purulent like that of
a puerperal pleurisy. The cause of this production of pus is a gen-
eral infection. On which account the eruption, the inflammations
of scarlatina, have an extensive tendency to suppuration.

At the Children's Hospital, I operated for paracentesis of the

1857.] On Scarlatina, 729

chest upon a child sick with scarlatina, who at the 12th day ah'eady
}| had pus in the chest. In a little patient of whom I shall soon speak,
f| and who had anasarca without havini]^ had any eruption of antece-
dent scarlatina (this however prevailed in his family), I also punc-
tured the chest for a pleurisy at the twelfth day, and drew off 750
grammes of perfectly formed pus.

You will never observe anything similar to this except in those
who are under the influence of a diathesis of suppuration, as are, for
example, women in tlie puerperal state. There is, then, in these
symptoms of scarlatina the influence of the malignity which you
will find again further on.

This cause of suppuration, so active in pleurisy, is less so in peri-
carditis. In truth, this is more seldom and comes on more tardily.
This phlegmasia of the pericardium, pointed out by Graves, has
been particularly investigated by M. Thore, of Sceaux, to whom
we owe the fact of having established the relation, existing between
this affection and scarlatina. M. Thore has demonstrated that a
certain number of individuals, during the convalescence of scarlati-
na, take pericarditis, mortal for some, curable for others.

We have said that articular rheumatism was one of the most
common symptoms of scarlatina, more so than is generally supposed.
Graves intimated this fact. "In a great number of cases," he writes
in his Clinical Lectures, "I have seen articular rheumatism follow
scarlatina." Yet it has been overlooked, and for many years I
insisted upon this remarkable coincidence. Generally, and what is
singular, rheumatism in this malignant disease is not very severe;
it usually gets well of itself without any intervention of therapeutics.
Still this existence of the rheumatismal diathesis explains to a cer-
tain degree, the appearance of pleurisy and pericarditis ; it enables
us to understand why these affections are so common, and how
endocarditis can arise, for it also follows scarlatina. The rheuma-
tism of scarlatina at first usually attacks the articulations, then the
serous membranes of the heart, and the pleura. In some cases,
from the very first, it invades the thoracic organs w-ithout touching
the articulations, like ordinary rheumatism. Sometimes it takes
that terrible form, the suppuration form, which kills w^ithout mercy.
It is as the sequel of scarlatina or of puerperal fever that we most
usually observe suppurative rheumatism. At first it seems simple
for a few days, the articulations become more painful, a more in-
tense fever comes on, delirium supervenes, ataxo-adynamic symp-
toms appear, and the autopsy reveals the presence of pus in the
articulations and in the sheaths of the tendons.

Such are the immediate symptoms of the decline of scarlatina.
Other mediate symptoms coming on later, are allied to the first, and
among others is St. Vitus' Dance.

In children you will see this disease follows very soon after scar-
latina, supervening six weeks, two months or three months after.
The remarkable works of M. See have thrown much light upon the

730 Adulterations Detected in Food and Medicine, [December,

relations existing between rheumatism and St. Vitus' Dance. It is
very seldom that children escape the last affection when they have
suffered from the first, as it is also rare (but this proposition is less
absolute than the preceding) to find a child who has had St. Vitus'
Dance who does not afterwards have the symptoms of rheumatism.
In chorea consecutive to scarlatina, the bellows murmur indicating
the pericarditis which had preexisted, sometimes the friction sound
of the pericardium, manifestations of the rheumatism of scarlatina,
show that it is through this rheumatism that St. Vitus' Dance is
allied to scarlatina, constituting one of its mediate symptoms.

I shall pass rapidly in review other symptoms, such as the chronic
suppuraiion of the eyelids ; the chroidc suiypuratlon of the nose^ which
may result in necrosis, tumors, lacrymal listulae; suppuration of the
mrs, resulting m i^^Tforaiion of the tympanum^ partial deafness^ caries
of the petrous portion of the teirporalhone, and consecutively /aaa?
paralysis. We also merely cite the chronic inftamrnation of the
lymphatic ganglions^ principally the ganglions of the neck, producing
scrofulous swellings in those of a tuberculous diathesis. These
gymptoms are also quite com.mon. [American Med, Monthly,
[To be concluded in the Jaji. Ko.]

[We seldom copy Reviews into our "monthly journal, but tbe
following from the pen of Professor J. C. Dalton contains such a
comprehensive condensation of two most valuable and interesting
works, that we venture to present it to our readers, trusting that
they will not begrudge the space thus occupied.]

Adulterations Detected ; or Plain Instructions given for the Discovery
of Frauds in Food and Medicine. By Arthur Hill BL^SSALL,
M. D. London, 1857,

On the Composition of Food^ and how it is Adidterated ; witli Prac^
tical Directions for its Analysis, By W. Marcet, M.D., F.C.S.
London, 1856.

The subject of the adulteration of drugs was first brought before
the notice of the American Medical Association at its annual
meeting at Baltimore in 1848. A communication was then read
by Dr. T. 0. Edwards, at that time member of Congress from Ohio,
in which an exposure was made of the great prevalence of adub
teration in imported drugs, and the evils necessarily resulting from
it. The Association at that time presented to Congress a memori-
al on the subject, recommending prompt legislation ; and a bill
was accordingly passed, the same year, providing for the appoint*
ment of drug inspectors in all the principal ports of entry, whose
duty it should be to examine critically all medicinal articles im.
ported into the country, and refuse admission to such as wer^

1

1857.] Adulterations Detected in Food and Medicine. 731

adulterated or in any way deficient in cpality. These inspector-
ships have been continued from that thne to the present.
I The exposures which were made, at the period referred to, of
the worthless character of many imported drugs, attracted imme-
diately the attention of the profession, and will no doubt be fresh
in the minds of many of our readers. 1'he discovery that they
had been for some years employing in practice opium from wliich
the morphia had been wholly or in part extracted, or scammony
which consisted of scammon}', flour, gamboge, and chalk, equal
parts, was naturally calculated to excite a lively interest in the
minds of practical physicians. It was very evident that some
check to this wholesale and injurious adulteration was absolutely
necessary ; and the appointment of the government inspectors,
mentioned above, offered the most direct and efficient means of
arresting the evil.

It appears that this measure Ikis been productive of considera-
ble benefit. Six months after the law went into operation, Dr,
Edwards made a report to the Secretary of the Treasury, in which
he designated the following as the beneficial effects which had re-
sulted from its operation :

1. An elevation in the quality and purity of the medicinal
agents imported.

2. An entire prevention of adulterated and deteriorated drugs
from entry and use.

3. No embarrassment to the honest importer and dealer,

4. An increased revenue.

5. Protection to the medical profession and community, an in-
creasing confidence, and an earnest desire on the part of the people
for the continuance of the law and its faithful application.

The effect of the law w^as soon felt, it was said, by the Europe-
an exporters, so that they ceased to send worthless medicinal arti-
cles to this countrv, as formerly ; and consequently a much small-
er proportion of the imported drugs were condemned during the
second than during the first year after the establishment of the law.
Indeed, a committee of the Association were informed by Dr.
Bailey, drug inspector for the port of ISTew York, in 1849, that
not one-tenth of the spuiious and adulterated articles arrived at
that time that there did before the passage of the law. The un-
easiness of the profession, which had been excited by the unpleas-
ant discovery of the extensive existence of adulteration, was,
therefore, somewhat quieted by the assurance that the evil was
effectually arrested, or at least in a fair way to become so.

At the same time, however, a certain degree of suspicion re-
mained behind, that the remedy which had been adopted was not,
after all, completely effectual. Dr. Edwards was yqvj possibly
right when he claimed, as one consequence of the operation of the
law, an entire prevention of adulterated and deteriorated drugs
^ from entry ; but it is by no means certain that it would as effectu*

732 Adulterations Detected in Food and Medicine. [December,

ally prevent their use. If the foreign dealer and manufacturer
found it a profitable business to adulterate before importation,
there is no reason whj our own should not find it equally profit-
able to adulterate them afterward. The foreign adept in this kind
of manufacture need not even allow the business to be taken out
of his hands. It would only be requisite for him to establish a
^'New York Branch" of the original London or Brussels estab-
ment, and he might then continue his operations with the same
facility as before. These considerations, accordingly, still weighed
with the minds of some of the profession, and prevented their be-
ing entirely satisfied with the establishment of the drug inspector-
ships.

The American Medical Association, furthermore, at their meet-
ing, in 1848, appointed a committee of five to report at the next
meeting -first^ the nature and extent of the sophistication and
adulteration of drugs, as practised, by the wholesale dealers and re-
tail druggists ; and, second^ the best means for the prevention of
the evil in its various forms.

Such a report was accordingly made in 1849. The committee
state that they have made inquiries of wholesale and retail dealers
respecting home frauds, " without obtaining much exact informa-
tion," the dealers being found '' unwilling," from some cause or
other, " to give any statements except of a general character;" ex-
citing, in this way, a natural suspicion that home adulterations
had already, to a certain extent, taken the place of the foreign.
The committee appear to have ascertained, the existence of adul-
teration in many articles of domestic preparation, as well as in
some of foreign manufacture which had passed the custom-house
in a pure state; and they come finally to the conclusion that "there
are enough" in our country "ready to engage in such dishonest
work on a large scale, and so great is the temptation, now that
foreign adulterations are excluded from our ports of entry, and
the prices of medicines consequently enhanced, that it will require
the utmost vigilance of this Association and of the public to pre-
vent their carrying it on."

Notwithstanding this, the committee for 1850, to whom the
continued consideration of the subject was intrusted, reported, in
general terms, that domestic adulteration seemed at that time not
to have increased, but even rather to have diminished ; and that
adulterated medicines were " not commonly vended in our large
cities" (unless by those engaged in the sale of nostrums), except
under certain particular circumstances. What these particular
circumstances were, did not very clearly appear from the report
of the committee. In fact, the special instances mentioned in the
report showed so much impurity in the drugs actually in the mar-
ket, as rather to contradict the conclusions just cited; as, for in-
stance, where samples of rhubarb and cinchona obtained in Boston,
were respectively only one-half and one-eighth the proper strength; -

1857.] Adulterations Detected in Food and Medicine. 733

and where, of fifteen samples of blue mass, obtained in St. Louis,
only one-third gave an approximation to the ofiicinal proportion
of mercury. Cod-liver oil, again, was found to be so extensively
adulterated that "hardly a tenth," it was believed, of what was
sold under that name was genuine, being either refined whale or
sea-elephant oil. It seems rather difficult to reconcile such facts
as those with the belief that adulterated medicines were " not com-
monly vended in our large cities."

Still, the report of this committee was, in its general conclusions,
rather calculated to quiet the agitation of the subject of adultera-
tion, and to convey the idea that it was, on the whole, not a very
gross evil, at least in the Atlantic cities. The committee suggest-
ed as remedial measures the following :

1. That the various State and local medical societies be request-
ed to annually appoint boards of examiners, whose duty it shall
be to procure specimens of drugs from the stores within their lim-
its, for examination, and report upon the same to their respective
societies at least once in every year.

2. That the respectable druggists and apothecaries throughout
the United States be requested to take active measures for sup-
pressing the fabrication and sale of inferior and adulterated drugs;
and that it be respectfully suggested to them, wherever practica-
ble, to form themselves into societies or colleges for the promotion
of pharmaceutical knowledge and general improvement in their
profession.

8. That a committee be appointed, consisting of one member
from each State here represented, whose duty it shall be to collect
information in regard to spurious and adulterated drugs, and re-
port the same at the next meeting of the Association.

These suggestions were adopted by the Association, and a com-
mittee appointed accordingly ; but nothing has since been done,
so far as we know, in regard to the matter. . Practically, the whole
work of protecting the community against the use of adulterated
medicines has been left, since 1850, to the custom-house inspectors
appointed by the law of 1848.

Now, we believe that the almost universal verdict of medical
men, even in the large Atlantic cities, at the present time, will be
that this law has been practically ineffectual in preventing the exten-
sive sale and employment of spurious and adulterated drugs. The
complaints of constant disappointment in the operation of simple
and important drugs, which ought to be reliable, and of their ex-
tremely variable efficacy, were never more frequent than at the
present moment. There can be little doubt that the general skep-
ticism as to the efficacy of therapeutical agents, now so prevalent
among physicians, and which has been almost constantly on the
increase, is at least partly owing to the deteriorated quality of the
drugs themselves. The inefficiency of the custom-house examin-
ation depends probably upon two causes. First, the inspectorships

734 Adulterations Detected in Food and Medicine. [December,

are liable, we regret to say, like almost all other government offi-
ces in our country, to be regarded as purely political appointments,
and to be conferred on purely political grounds, with but little if
any regard to the professional qualifications of the appointees. It
is to be feared that this mode of conferring appointments has be-
come so interwoven with our political sj'-stem as to leave but little
prospect of modification for the better, and little security for the
capacity, or even the integrity, of the inspectors. Even if this
were not the case, however, and if we could be assured that none
but genuine drugs were ever allowed to enter our ports, there
would still remain a second and much greater difficulty, and one
entirely beyond the reach of any custom-hoQse supervision : that
is, that drugs, as we have already intimated, are just as liable to
be adulterated after as before importation. The same inducements
for it are held out to the unprincipled dealer and manufacturer,
and the same injurious results to the community follow from its
practice.

Dr. Hassall, whose book on the adulteration of food and medi-
cine has more recently called attention to the subject, indicates
the only effectual mode of detecting these impositions. Adultera-
tions must be detected in the samples sold or kept for sale by the
retail dealer. All other inspections, whether of the crude import-
ed or domestic material, or of the recently manufactured or whole-
sale article, though useful to a certain extent, must necessarily be
incomplete ; since adulteration may be, and certainly is, practised,
according to the observations of Dr. H., at any point between the
custom-house and the counter of the retail druggist. In England
an excise law exists, similar in its operation to the inspectorships
of the United States ; and 3^et the amount of adulteration practised
in the former country, in articles of both food and medicine, is so
extensive and scandalous as to excite the indignation of any who
will take the trouble to read over the details which this book pre-
sents. Scammony made up of " guiacum and jalap, with woody
fibre, cellular tissue, and other insoluble vcidXieT ]^^ powdered jalap^
consisting, for one-third of its bulk, of rasped wood; ipecac.^ con-
taining " large quantities of carbonate of lime or chalk;" quinine^
containing gum, starch, chalk, stearine, carbonate of magnesia,
&c., &;c,; such are the drugs which are actually in the English
market, and in daily use by practising physicians in that country.

Now it is a very essential question for us whether we are any
better off, in this respect, than the English. We seem to have
settled down, since 1850, into a somewhat quiescent state about
this matter, trusting to the existing laws for protection. It has al-
ready been shown that these laws do not and cannot protect us.
Supposing the custom-house requirements to be thoroughly and
fairly carried out, the nine years which have elapsed since 1848,
have certainly afforded time enough for a tolerably active and
quick-witted people to learn all the tricks that were formerly done

1857.] Adulterations Detected in Food and Medicine, 7S5

by foreigners, and to gain sufficient experience for successfully
practising them at home. Some further precautions, therefore,
must be adopted, unless we are willing to continue in the use of
such medicines as are to be found in the market at present. A
few reflections, suggested for the most part by Dr. Hassall's book,
will show that the subject is fully deserving of all the considera-
tion we may bestow u})on it.

Adulteration consists in mixing with the genuine article other
substances of inferior value, which increase its bulk and enhance
accordingly the pi-ofits of the vendoi'. The foreign substances
which are selected for this purpose are usually such as may be
readily incorporated with the original article, so as not to be easily
detected by ocular inspection. They are, in many cases, simply
negative in their properties ; and so far, the effect of the adultera-
tion is merely to diminish the efficacy of the medicine ; as, for
example, where opium is adulterated with clay, or alcohol with
water. This adulteration may be carried to such an extent that
the properties of the original article are, for all practical purposes,
entirely destroyed ; and it then amounts to a complete substitution
of other materials for those of which it should properly be com-
posed. Hassall states for instance, that samples are occasionally
to be met with, professing to be scammony, which *'do not con-
tain a particle of that drug, or small proportions only," and are
made up of a variety of ingredients, including even wood and
ivory-black.

In most cases, however, the simple adulteration of a drug with
an indifferent substance, or its dilution, as it might be called, is
not the only or the most important alteration which it is made to
suffer. The admixture of large quantities of foreign material ne-
cessarily impairs the sensible properties of the drug; and these
must be restored or imitated as well as possible, by a further adul-
teration. Thus Cayenne, according to Dr. Hassall, is extensively
adulterated with ground rice, and its colour afterward restored by
the addition of red lead, or even the red sulphuret of mercury^
Mustard is adulterated first with wheat flour or clay to increase its
bulk, then with red pepper to give pungency to the mixture, and
lastly with turmeric or chromate of lead to restore its colour. The
purchaser is, therefore, not only defrauded of the article which he
wishes to procure, but is supplied at the same time with other ma-
terials which are absolutely injurious.

It would seem almost superfluous to point out the injurious
effects of such practices, and their disreputable character ; and yet
there is a tendency in the minds of some, resulting principally
from a too hasty consideration of the subject, to overlook some-
kinds of adulteration as unimportant, or to palliate them as excus'
able. This has sometimes led to a distinction between injurious
and harmless adulterations ; the former class including those cases
in which deleterious substances, such as red lead or arsenite of

736 Adulterations Detected in Food and Medicine, [December,

copper are fraudulently introduced into the mixture ; the latter
including those in which the bulk of the article is simply increas-
ed with some indifferent substance^ as where milk is adulterated
with water, or calomel with chalt. The slightest consideration
will show, however, that all adulterations, especially in medicinal
articles, are injurious and dangerous, as well as fraudulent. If we
prescribe six grains of calomel to a patient who requires the oper-
ation of the drug, and three grains of the powder which he takes
under that name consist of chalk, it is not merely' a pecuniary loss
which he suffers, but an actual bodily injury. Even should the
adulteration be detected the next day, its effects cannot be coun-
teracted by giving another similar dose of pure calomel ; for the
time for the most favourable operation of the drug has passed, and
the patient's illness is, at the very least, prolonged for twenty-four
hours. It is easy to see that much more striking cases than this,
and cases quite as likely to happen, might readily be cited. But
it is not necessary. There is plainly no proper distinction, except
in degree, as to the danger of adulterations in medicine. They
are all injurious ; and those which are ordinarily the least so, may
at any time become extremely dangerous, owing to the accidental
circumstances of the case.

But there is another excuse which we frequently hear from those
engaged in the trade, and which is too often allowed to pass cur-
rent, to a certain extent, even among professional men. It is the
following : There are, it is said, in all articles of merchandize dif-
ferent grades of quality, corresponding to the means and taste of
the purchasers. Articles of the first quality, which necessarily
bear a high price, are within the reach only of the wealthy , infe-
rior goods, at a cheaper rate must be supplied to the poorer class-
es, for they would otherwise be obliged to go without altogether.
Accordingly, there are always to be found in the market goods of
these different qualities with corresponding prices. It must ne-
cessarily be so ; and in the drug trade as well as in others. There
is no fraud in this, it is said. On the contrary, it is perfectly well
understood that the higher priced articles are always the best, and
the cheaper of an inferior quality. If the customer is willing to
pay for the best article, he can have it. If he prefers to purchase
at a cheap rate, he can be accommodated with an article, corres-
ponding in quality and in price.

iSTow, it will be observed that the aboTC excuse or explanation,
plausible as it seems, rests entirely for its justification on the pre-
sumption that the varying quality of the article, corresponding
with its price, \s perfectly ivell known to all parties^ purchaser as well
as dealer. So long as this is the case, the variation in quality is
not a fraud upon the public, but rather an accommodation. When
a man buys a fine broadcloth coat for thirty dollars and a rough
pea-jacket for five, he understands perfectly well the reason for
this difference in price. It is evident on mere inspection of the

1857.] Adult&i'ations Detected in Food and Medicine, 737

articles ; and so long as the articles are good of their kind, and
actually are what they profess to be, no harm is done, and the
transaction is strictly honorable.

But the case is very different when the inferior article is fraud-
ulently made to resemble the better one, and sold as actually being
Buch. There is a certain class of dealers in clothings who make a
business of getting up, in his way, garments of sham quality;
smooth and lustrous externally, but put together of such inferior
materials, and in such an inferior manner, that they are ready to
fall to pieces after a few week's wear. They are sold at a less
price than similar garments of the best quality, but they are sold
^as really being such ; and the unsuspecting purchaser is led to be-
lieve that he is really obtaining a good article at a lower price
than he could get it for elsewhere. This kind of trade is proper-
ly regarded everywhere as dishonest; and those carrying it on
are not considered as belonging to the class of respectable trades-
men.

Now, the adulteration of drugs, for the purpose of supplying a
cheap and more saleable article^ is the same kind of transaction
with that just described. There is^ and can be, in the nature of
the case, no difference in the quality of the real drug, Scammony
is scammony, and sulphate of quinine is sulphate of quinine ; and
always of the same composition. But when scammony is mixed
with guiacum and the mixture sold as scammony, or when sul-
phate of quinine is adulterated with chalk, and the mixture sold
as sulphate of quinine, such a transaction is nothing less than the
sale of one article in place of another, and is therefore fraudulent
and disreputable. It is useless to say that the cheap article cannot
be supposed to be as good as the high-priced one, and that the fact
of its adulteration is well known to the trade. The consumer does
not knoiv it. The consumer buys the article, supposing it to be
scammony or quinine, and not a mixture of worthless or deleteri-
ous substances. In this fact lies the fraud. The truth is, the
dealer in adulterated medicines is not guided by any desire to ac-
commodate the public, but simply to enhance his own profits : for
though the spurious mixture is sold at a less price than the pure
article, it brings a higher price in proportion than it is really worth.
Thus coffee is adulterated with an equal bulk of chiccory, and
the mixture sold at a price intermediate between its real value
and that of pure coffee. Opium, from which the morphine has
been extracted,, is sold as a low-priced opium, when it is in reality
altogether without value.

The matter,, therefore, becomes perfectly simple, as soon as sub-
jected to a moment's examination. The keeping and vending of
adulterated drugs are fraudulent, no matte? what may be the
mode or manner of its performance. It is to be regretted, there-
fore, that in the report of the Committee on Adulteration, made to
the American Medical Association in 1850^ some expressions oc-

738 Adulterations Detected in Food and Medicine. [December,

cur, which might be regarded as palliating its practice to a certa*
extent among the trade.

"Extensive inqiiiiies among physicians, manufacturing chemists and
druggists,'' say the committee, " have led to the following conclusions :
Firtit, that the -wholesale druggists in the large cities, equally in the South
and West as in the Eastern States, who are not specially engaged in sell-
ing nostrums, either as proprietors or agents, conduct their business on
fair and honourable principles. As a general rule, they buy their choice
chemicals fi-om those who manufacture them, and either import other arti-
cles, or get them directly from those who do ; and are always disposed to
supply good articles to customers who are willing to pay a remunerating
price. At the same time, many of this class keep inferior articles which,
they dispose of for a corresponding price to physicians and storekeepers
who insist on buying at reduced rates."

Now, it is difficult to reconcile this trade in "inferior,'^ that is
adulterated, drugs with " fair and honorable principles" of busi-
ness. These adulterated drugs are purchased by the retail dealers
in order to be sold as genuine. It is not true that the public are
ever parties to the transaction ; or that they prefer a cheap article
knowing it to be adulterated. No man, suffering with intermit-
tent fever, would buy a cheap quinine in preference to a high-
priced one, if he knew that he would be obliged to take a teaspoon-
ful of the former for every grain of the latter. The retail sale,
which is the end and object of all previous trade-sales, is always a
fraud. The w^holesale dealer knows this perfectly well, and is,
therefore, a party to the transaction, when he deals in articles
which he knows to be destiued for that purpose. Keeping and
selling medicinal substances, therefore, knowing them to be adul-
terated, under the pretence of supplying customers who wish a
cheap article, is but little, if any, less injurious and disreputable
than actually making the adulteration or retailing the spurious
drugs.

We have been led to make the foregoing remarks because it
seemed to us that the profession in this country had been lulled
into a kind of false security with regard to this subject, and to the
amount of protection afforded them by the existing laws.

Dr. HassalFs book possesses a still more general interest from
the fact that it treats extensively of the adulterations in food as
well as those in medicine. Indeed, the greater part of the book is
occupied by the former topic. The author shows that in England
at the present day the most important articles of food and drink
are hardly less adulterated than medicines. Some of these adult-
erations are practised abroad, some of them at home ; some on
foreign and some on domestic articles. In some cases the genuine
and spurious materials are both imported from abroad, and mixed
after being brought into the country. Dr. H's statements have
the greater value since they are not merely the result of general

1857.] Adulterations Detected in Food and Medicine, 739

inquiries among manufacturers and dealers, but of direct ex-
amination of samples purchased at retail, and consequently
in the same condition as they are ordinarily obtained by the con-
I sumer.

An extremely important feature of the work is the extensive
application of the microscope to the detection of foreign matters in
alimentary or medicinal substances. Many adulterations have
heretofore escaped detection in consequence of the inability of the
chemist to recognize them by any means at his command. Some
adulterations are so coarse that they may be recognized, by any
one familiar with the appearance of the genuine article, by a care-
fui ocular inspection; as where foreign leaves are mixed with
those of a tea or senna. In other instances, where inspection
would fail, a chemical examination is sufficient; as where calomel
is adulterated with substances which are not volatilized by heat,
or which are soluble in water. There are other cases, however,
principally those of powdered vegetable or animal substances, in
whicli ocular inspection and chemistry are equally at fault; a&
ground coffee, for instance, adulterated with chiccory or exhatlst-
ed tan, or mustard adulterated with wheat flour and turmeric^
Here, however, the microscope steps in and accomplishes all that
could be desired; for no amount of grinding and powdering can
destroy the shape of the vegetable cells and libres, or the optical
characters of starch-granules peculiar to different kinds of vegeta-
ble substances. Thus the minute anatomical structure of all the
different kinds of flour is readily recognized when these are min-
gled together. Chiccory is detected in coffee, potato flour in arrow-
root, and the fibres of rasped wood in powdered opium. We
know of no application of the microscope, ' yet made, whicli has
been more directly and practically serviceable than this.

Tea is adulterated, according to Dr. H.'s investigations, with
various foreign leaves, such as those of the beech, elm, horsechest'
nut, plane, willow, poplar, hawthorn, and sloe. Two or three
kinds of foreign leaves are mixed with the tea by the Chinese
themselves, previous to exportation. The Chinese manufacture
also a spurious article for the purpose of admixture with genuine
Varieties, which they designate by the expressive name of "lie tea."
It consists of the dust of tea-leaves, sometimes of foreign leaves,
and sand, made up by means of starch or gum into little masses,
which are afterwards painted and colored so as to resemble either
black ot green gunpowder. "This article," says Hassall, "al-
though the chests containing it are branded with the words ' lie
tea,' was at a recent period extensively imported into this country,
and of course found purchasers."

But it is in the coloring and dressing of the real tea-leaves that
the most important, because the most extensive and deleterious,
adulteration is practised. Tea drinkers will probably be surpri&ed
to learn that with every cup of green tea they swallow so muck

N. S. VOL. XIII. NO. XII. 47

740 Adulterations Detected in Food and Medicine, [December,

mineral painty artificially put on in order to increase the brilliancy
and lustre of the leaves.

'-' It is with green tea," says Dr. H., " that the practice of artificially co-
louring the leaves is carried to the greatest extent. The varieties of green
tea imported into this country from China are Twankav, Hyson-skin, Young
Hyson, Hyson, Imperial, and Gunpowder. Now the colour of the whole of
these teas, without a single exception, is artificial, and caused by the adhe-
sion to the leaves of various colouring matters.

" The usual colouring matters enaployed are ferrocyanide of iron or Prus-
sian blue, turmeric, and China clay. These are mixed in various propor-
tions, so as to produce difi'erent shades of blue and green ; the surface of
the leaves being moistened, they are then agitated with the mixtures until
they become faced or glazed, as it is termed. Occasionally other substan-
ces are employed by the Chinese, as indigo and sulphate of lime, or gypsum.
In proof that it has long been the practice fi'equently to colour green tea
artificially, we have the evidence of various travellers; but the most con-
clusive and complete evidence, both as to the extent of the practice and
the nature of the ingredients used, has been supplied by the microscc^e."

In these cases, then, the consumer gets green tea, and various
colouring matters in addition. But in other instances he gets the
colouring matters alone. One branch of the adulterating business
in England consists in buying up tea-leaves which have been alrea-
dy zised and exhausted^ drying them, colouring them artificially,
adding sulphate of iron or catechu to restore the astringency^ and
re-selling them as black or green tea. The colouring matters em-
ployed for this purpose Dr. H. found to be frequently more injuri-
ous than those used by the Chinese; viz., rose pink, Dutch pink,
chromate of lead, Yenetian red, soapstone or French chalky carbo-
nate of lime, carbonate of magnesia, carbonate of copper, arsenite
of copper^ Prussian blue, and indigo.

Coffee is adulterated with chiccory, roasted flour, scorched peas
and beans, roasted carrots, mangel-wurzel, acorns, mahogany saw-
dust, burnt sugar, Venetian red, and baked, livers. This last article
is one so little likely to be suspected beforehand, that we give a
short description of the process, quoted by our author from a work
on coffee, published four or f^YQ years since.

" In various parts of the metropolis, but more especially in the east, are
to be found liver bakers. These men take the livers of oxen and horses,
bake them, and grind them into a powder, which they sell to the low-priced
coffee shop-keepers, at from 4(f. to Qd. a pound, horse's liver coffee bearing
the highest price. It may be known by allowing the coffee to stand until
cold, when a thick pellicle of skin will be found upon the top. It goes
further than cc^ee, and is generally mixed with coffee, and other vegetable
imitations of coffee."

Why baked livers should be especially selected for this purpose
does not at first sight appear. It is evident enough, however, as-
soon as we have become a little familiar with the "fundamental

I

1857.] Adulterations Detected in Food and Medicine, 741

principles" of adulteration. Horses' and bullocks' livers are, in
the first place, cheap. Secondly, the biliary matters with which
they are imbibed serve to imitate tolerably well the colour and
bitterness of real coffee. They are therefore much better adapted
for this purpose than other internal organs, such as the spleen,
kidneys, or brains. Coffee, again, which has been largely adulter-
ated with scorched flour or beans, has its colour and bitterness
partly restored by the addition of burnt sugar.

We subjoin, as a curiosity in its way, the following, from page

Results of the microscopic examination of thirty-four different Coffees, of all
qualities and 2yrices, and sold under the following attractive titles:

COFFEES OF HIGH PRICE,

1. Finest Mocha Coffee. No adulteration,

2. Noted Old Mocha. No adulteration.

3. Finest Jamaica Coffee. No adulteration,

4. jRich Old Mocha. Of cliiccory, a good deal,
6. Best Old Mocha. A little chiccory,

6. Fine Old Turkey Coffee. Much chiccory,

7. Very Fine Mocha. Much chiccory.

8. Genuine Old Mocha. A little chiccory,

9. Finest Turkey Coffee. Contains chiccory.

10. Celebrated Old Mocha. A good deal of chiccory,

COFFEES OF MEDIUM PRICE.

11. Costa Hica Coffee. Nearly one-half chiccory.

12. Fine Jamaica Coffee. Contains a considerable quantity of roasted
com.

13. Delicious Coffee. Roasted beans and chiccory, forming about one-
third of the article.

14. Plantation Coffee. Of roasted corn much, with some chiccory, both
not less than one-third.

15. Finest Turkey Coffee. Much chiccory, and some roasted corn; ve-
ry Httle coffee.

16. Celebrated Jamaica. Very little coffee; principally chiccory.

. 17. Finest Berbice Coffee, About one-half coffee, much chiccory, and
some wheat.

18. Splendid Turkey Coffee, About one-half coffee, the rest chiccoty.

19. Fine Plantation Coffee* One-third coffee, the rest chiccory, with a
little roasted corn.

20. Beautiful Jamaica Coffee, Two-thirds coffee, the rest chiccory,
with a little corn.

21. Finest Java Coffee. Half coffee, much roasted corn, with a little
chiccory.

22. Superior Plantation Coffee. Three-fourths coffee, the remaining
cliiccory.

COFFEES OF LOW PRICE,

' 23. Fine Mountain Coffee. Four.fifths coffee, one-fifth chiccory,
24. Parisian Coffee, Principally chiccory and corn ; very little coffee;.

742 Adulterations Detected in Food and Medicine. p3ecember,

25. Sujperh Coffee. The principal part corn and cliiccory ; very little
coffee.

26. Rich Drinking Coffee. One-tliird coffee, the rest cliiccory, with
some roasted corn.

27. Very Excellent Coffee. One-half coffee, the other mostly chiccory.

28. Delicious Fctmily Coffee. One-fourth coffee, three-fourths chiccory.

29. Fine Ceylon Coffee. Very little coffee, a great deal of chiccory,
some roasted corn.

30. Fine Java Coffee. Much chiccory and some roasted potato; very
little coffee.

31. Coffee as in France. Principally chiccory.

32. Very Excellent Coffee. Principally chiccory.

33. Fine Plantation Coffee. Nearly all chiccory; very little coffee.

34. Delicious Drinking Coffee. A large quantity of chiccory, and much
roasted corn.

Cocoa, sugar, Loney, milk, flour, butter, lard, arrowroot, and
their adulterations, are all described in a similar manner. With
many new and unsuspected adulterations, discovered by Dr. Has-
sall, there are some, popularly supposed to be very common,
which he shows to be either quite rare, or even not to have an ex-
istence. Thus sugar is generally thought to be extensively adult-
erated with sand; but Dr. H. found no sand in over one hundred
samples of sugar which he subjected to examination. The impu-
rities vhich he met with were starch, treacle, glucose^ fragments
of sugar-cane, fungous sporules, and specimens of the acarus sac-
ehari. Milk, again, very seldom contains chalk, contrary to the
general belief Dr. H. did not meet with it in a single instance.
The most prevalent and important adulteration of milk is with
water; after which the operator adds molasses or syrup to sweeten
it, salt to give it a flavor, and anatto to color it. Starch and
sheep's brains are sometimes added, in order to restore the opacity
to diluted milk ; but these adulterations are rare, the dealers not
usually taking the trouble to practise them. These impurities
would furthermore, like chalk, be at once detected, on allowing
the milk to stand, by subsiding to the bottom of the vessel as a
visible deposit.

A very amusing chapter is that on what the author calls ^'pro-
prietar}^ alimentary preparations ; that is, various mixtures which
are prepared of cheap ingredients, patented, and then sold at a
dear rate under some high sounding title; such as Kevelenta Ara-
bica, Nutritious Farina, Semola, Semolina, and the like. These
substances consist mostly of baked flour, or even of cheaper ingre-
dients, sometimes scented and coloured, and sold at prices varying
fram twenty-five to sixty-eight cents per pound ; their real value
according to their composition, not exceeding in any case five
or six cents per pound. Thus the author gives analj^ses and
microscopic drawings of the following of these articles among
others :

1857.] Adulterations Detected in Food and Medicine, 743

Duharnjs Revalenta Arahica ; consisting of starch-granules of
the Arabian lentil, barley flour, sugar, and salt.

Wharton^ s Ervalenta; consisting of a mixture of the French or
German lentil with a substance resembling maize or Indian corn
meal.

Gardiner^ s Alimentary Preparation; consisting of very finely
ground rice.

Leaih^s Alimentary Farina^ or Horaoipathic Farinaceous Food;
consisting principally of wheat flour, slightly baked, sweetened
with sugar, together with potato starch, Indian corn meal, and
tapioca.

Bullock^ s Semola ; consisting of the gluten of wheat, with a pro-
portion of wheat starch.

Maidman^s Nutritious Farina; consisting entirely of potato flour,
artificially coloured of a pink or rosy hue.

Plumbers Traproved Farinaceous Food ; composed, of bean or pea
flour, some potato flour and a little arrowroot.

Palmer's Vitarohorant ; consisting of a mixture, sweetened with
sugar, of wheat flour with the red or Arabian lentil.

The flour, sugar, &c., were introduced, in many of these prepa-
rations, merely to diminish the strong flavor of the lentils, which
is sometimes disagreeable.

" Extremes meet," says the author ; " lentils, being somewhat cheaper
than peas, are supplied to many of our workhouses, to be used in the pre-
paration of soup, kc. Thus they are not only consumed by paupers, but
by the rich, the chief difierence being that the latter frequently pay 2s. Qd.
per pound for them."

Dr. H. suggests' also one or two receipts for preparing similar
mixtures, which shall have all the advantages of the patented ar-
ticles, if any such there be, without their exorbitant price.

" As the cost of most of the prepared lentil powders sold as ervalenta,
revalenta, &c. viz., 25. 9c?. per pound forms a very serious obstacle to
their use, supjxjsing that it is in any respect desirable that they should be
more generally consumed, we have framed the two following receipts,
whereby a considerable saving of expense may be effected :

\st Reeeipt,
Red or Arabian lentil flour, - - 2 lbs.

Barley flour, - - - - - 1 lb.

Salt, - 3 oz.

Mix into a uniform powder.

" The red lentil may be obtained of almost every corn chandler at about
4c?. per quart ; the cost oi our ervalenta would be about 2(i. per pound ;
and it is perfectly clear from the analyses which we have given above, that
whatever may be the advantages possessed by the much vaunted ervalen-
tas, revalentas, (fee, that our article must contain them all."

744 Adulterations Detected in Food and Medicine. [December,

2nd Receipt,

Pea flour, - 2 lbs.

Indian corn flour, - - - - 1 lb.

Salt, 3 oz.

Mix as before.

Increase of bulk is not the only object for which adulterations
are practised. We have already seen that, in the case of teas,
foreign and sometimes poisonous substances are added merely for
the sake of improving the colour and external appearance of the
article. This is still more remarkable in the case oi. pickles. These
articles of food are almost universally more or less artificially co-
loured, and generally with some preparation of copper. This
adulteration is sometimes so excessive as to be readily detected,
even by the eye. Every one must have noticed samples of pickles
kept for sale by the grocer, in which the green colour was unna-
turally strong ; the preserved pickles being often, in fact, greener
than the same vegetables when in a fresh condition. This green
colour has even sometimes a distinct and altogether unnatural
shade of blue. Now, in all these instances, the colour depends
upon the presence of some salt of copper ; either the sulphate (blue
stone) artificially added, or the acetate produced by the action of
the vinegar on metallic copper. When metallic copper is used,
the sulphate is frequently formed as well as the acetate, owing to
the previous adulteration of the vinegar with sulphuric acid.

The examination of twenty -three samples of pickled vegetables
led Dr. H. to the following conclusions :

1. That the vinegar used for pickling is of a very weak descrip-
tion, the percentage of acetic acid ranging between 1.48 and 2.91.
It will be remembered that vinegar of good quality ought to con-
tain from four to five per cent, of pure acetic acid.

2. That nineteen out of twenty of the vinegars submitted to
analyses, poor as they were, yet owed a portion of their acidity to
sulphuric acid, the amount of which varied in the different sam-
ples from .38 to 2.52 in the 1000 grains ; the largest quantity of
this acid being detected in the vinegars in which the red cabbages
were pickled.

3. That in the whole of the sixteen different pickles analyzed
for copper, that poisonous metal was discovered in various
amounts ; two of the samples contained a small quantity ; eight,
rather much ; one, a considerable quantity ; three, a very consid-
erable quantity ; in one, copper was present, in highly deleterious
amount; and in two, in poisonous amounts.

4. That the pickles which contained the largest quantity of
copper were those which consisted entirely of green vegetables, as
ghirkins and beans.

The author presents a most repulsive picture of the composition
oi potted meats and^ fish, as subjected to his examination. These
articles are but little used in this country, but in England they

1857.] Adulterations Detected in Food and Medicine. 745

are extensively employed and are generally regarded as a delicacy.
The form of a homogeneous paste is, however, that which presents
the greatest facility for adulteration ; and these preparations are
accordingly found to contain not only such ingredients as flour
and starch, and to be partly made up of inferior qualities of meat
xmd fish, but to be artiticiall}^ coloured also, in most instances, with
Venetian red or Armenian bole. These earthy substances are
added, according to Dr. H., not only for the purpose of heighten-
ing the colour of the mixture, but also to conceal the dirt contain-
ed in the brine, in which the fish is imported.

The artificial colouring of sugar confectionary is much worse
than the above. These articles are sometimes coloured all over
with the same tint ; and are sometimes parti -coloured, two or three
different tints being applied, for the sake of ornament, to diff'erent
parts of the same piece. From the examination of 141 samples,
Dr. Hassall arrived at the following result:

Fifty-nine w^ere coloured with Chk03IATe of Lead.

Fleven with GrAMBOGE.

Twelve with Eed Oxide of Lead.

Six with BisuLPHURET OF Mercury (vermilion).

Eight with Brow^^ Ferruginous Earths, Vandyke brown,
umber, or Sienna.

One with IxDiGO.

Tvjentyfour with Prussian Blue.

Ten with a mixture of Chro:mate of Lead and Prussian
Blue, making several varieties of green.

One with Carbonate of Copper.

Nine with Arsenite of Copper.

Four with Carbonate of Lead.

Enough has been said to show the great extent of the above
adulterations, and the abominable consequences that are liable to
result from them. It must be recollected that many of these sub-
stances, fraudulently introduced into food, are actually poisonous;
and, furthermore, that some of them belong to the class known as
cumulative poisons. The small quantities in which these substanc-
es are introduced, day by day, is therefore no protection against
their finally producing poisonous effects. Whoever takes Cay-
enne pepper every day upon his salad, is liable to be dosing him-
self at the same time with red oxide of lead ; and the lover of
green tea may after a time find his eyelids swelling and his legs
aching from the arsenite of copper with which the leaves were co-
loured. Lest it should be supposed that such dangers as these are
altogether imaginary, we subjoin the following account of a case in
which lead palsy was produced by taking snuff: an article which
is not unfrequently coloured with chromate of lead, or the red ox-
ide of the same metal. The case is given on no less authority
than that of Mr. Erichsen ; and it is of so remarkable and interest-

746 Adulterations Detected in Food and Medicine. [December,

ing a character, that we extract it entire. It is from page 617, of
Pr, Hassall's book ,

*^ Case of slow fjoisoning by Snuff containing Lead. By Mr. Erichsen,
Whilst ou a profes.sioiial visit in the country, Last March, I was requested
to see a gentlemau who had been invited down to a friend's country-seat, in
the hopes that change of scene and air would inlluence favourably an at^
tack of paralysis, which was said to bo of a rheumatic character, by which
he bad been disabled from work for many months past, and of which he
despaired of recovering, having relinquished all treatment.

''I found the patient in bed, and somewhat exhausted by the jouiney
down, a distance of nearly a hundred miles from his usual residence. He
was peculiarly sallow, the complexion having almost an icteric tinge ; but
the countenance was lively and expressive, and the intellect as bright as
usual.

" Mr. A. B. could stand, and, if supported, could walk, though feebly and
with much difficulty. He complained much of pain about the shoulders
and the fleshy parts of the thighs and legs, and especially of burning sen-
sations in the soles of his feet. The articulations all appeared healthy ; no
swelling or looseiiess was perceptible about any of them!

^'I was, however, particularly struck with the appearance of the hands
and arms, which were lying powerless on the coverlid of the bed. There
was marked ' wrist-drop' of both arms, the hands hanging flaccid and at
right angles with the forearms, without the patient being able to extend or
raise them in the slightest degree, There was, however, some slight pow-
er of extension left in the fingers, especially in those of the left hand.
Though unable to extend iliQ fingers, raise the hand, and scarcely having
power to elevate the arm, Mr. B. could Jiex the fingers pretty firmly, so as
to give a tolerably good grasp to whatever was put into his hand. The
index finger of the right hand seemed to be the most aff"ected, and was
permanently flexed.

"There was a very marked degree of wasting of the whole mass of the
extensor muscles of the forearm, so that a longitudinal hollow correspond-
ing to the interosseous space was perceptible down the whole length of the
forearm, and a very deep and marked depression in the interspace between
the first and second metacarpal bones. The hands were quite powerless,
and the patient was unable to render himself the slightest assistance.

" The tongue was pale and flabby ; and on examining the gums, I found
a deep blue-black or leaden-coloured line around the teeth, more marked
about the molars. Digestion was much impaired. Appetite capricious,
with much flatulence, and occasional attacks of constipation, with colicky
pains.

" On inquiring into the historj^ of the case, I learnt that Mr. A. B., who
is much devoted to literary pursuits, and habitually led a sedentary life,
had for some years previously suffered from pains of a rheuinatic or gouty
character; that in May, 1853, he had been attacked by constipation and
colic while lodging for a short time in a newly-painted house. In August
of the same year he had first begun to lose power in extending his arms,
finding a difficulty in raising them to put on his coat ; and from this time
the paralytic symptoms gradually increased, until they had assumed the
4egi"ee in which 1 found them, when he had become reduced to a state of

1857.] Adulterations Detected in Food and Medicine. 747

coiirplete physical helplessness; tliough, as I have already observed, his
powertul and clear intellect was as perfect as ever.

" On exauiining- Mr. A. B., I was at once struck by tlie very marked
"wrist-drop,' more complete than I had ever seen before; the limitation of
the paralysis to the extensors, which were greatly wasted ; the existence of
a bine line around the teeth ; and the occurrence of occasional attacks of
constipatioji and colic, together with flying pains in the fleshy parts of the
body, with absence of all articular inflammation. These symptoms led me
to the conclusion that Mr. A. B. was suft'ering from saturnine paralysis,
and that he had been slowly poisoned b}^ lead.

" The difficulty was, however, to ascertain how poisoning by lead could
have been ettected. With this view, I made diligent inquiry into the pa-
tient's habits, the water he drank, the utensils he used, &c., but could not
detect any source to which the presence of the mineral in the system could
be traced, except that the first attack of colic and constipation had occur-
red whilst temporariK- lodging in a house which smelt of fresh paint ; but
as he soon left this, I thought it very insufficient to explain his continued
and increasing sufferings. In the course of my inquiries, however, I found
that he took snuff' in considerable quantities ; 1 accordingly emptied his
box of its contents, and took them up to town with me with a view to fur-
ther examination. The snuff" was analyzed by Professor Williamson, who
detected in it a considerable quantity of lead ; and another supply having
been procured from the shop at which Mr. A.B. was in the habit of pur-
chasing it, was subjected to analysis by Dr. Garrod, who readily detected
large quantities of the metal in it.

" Mr. A. B. was now put under treatment for saturnine paralysis. The
snuff" was left off"; the bowels were kept open with the acidulated sulphate
of magnesia; iodide of potassium was freely given in conjunction with
strychnia, wdiich was applied topically to blistered surfaces as well as ad-
ministered by the hands ; and galvanism was assiduously employed. Un-
der this plan of treatment he gradually improved in all respects ; the
colicky symptoms rapidly disappeared, the muscular pains subsided, and
the paralytic condition of the extensors was gradually removed, until at
the end of July he was able to resume and to discharge public duties of a
very onerous character with his usual ability and energy.

" With the above sketch we received from Mr. Erichsen a sample of the
snuff" which was the occasion of all the mischief. On analysis it was found
to contain 1.2 per cent, of red oxide of lead ; that is very much less than
some of the other samples, the analyses of which have already been given."

The author goes through, in a similar manner, with the descrip-
tion of vinegar, spices, cheese, ale, porter, spirits, wines, &c., and
their adulterations. We will not, however, dwell further on the
very interesting details which he presents, but refer the reader for
them to the book itself

In conclusion, we would offer some remarks on the adulteration
of food and medicine in our own countrv, and the means of pro-
tecting ourselves from it, for which we believe the reader is already-
prepared. It is plain that the adulteration of food is a serious in-
jury^, not to the purse only, but to the health of the consumer.
That of medicine is certainly not less deleterious. It is always

748 Adulterations Detectedin Food and Medicine. [December,

fraudulent and may at any time become even homicidal in its con-
sequences. By its operation all the devotion, skill, and judgment
of the practical physician are set at naught. A patient has per-
haps swallowed, intentionally or by accident, an overdose of laud-
anum. The physician who is called finds him already half coma-
tose ; and he knows that ipecac and tartarized antimony are too
slow in their operation to be trusted as emetics. Sulphate of zinc
is not at hand; and if it were, half of it would, perhaps, consist
of Epsom salts. But there is mustard ; nearly always to be found
ready in every family, the most active, prompt, and local in its
operation of all emetics, and the most stimulating to a semi-narco-
tized stomach. He mixes a liberal dose, succeeds by dint of per-
severance in compelling the patient to swallow it, and awaits the
result. But, unfortunately, the mustard was partly clay, partly
plaster of Paris, and partly turmeric, with a little mustard and red
pepper to give it pungency. No vomiting follows. Another
dose is forced down, with greater difficulty than before, with a
similar ineffectual result ; and by the time the assistant arrives with
a stomach-pump, the patient's blood is loaded with the narcotic,
and he is fairly beyond the reach of help from either medicine or
surgery.

Take another instance. A physician wishes to give an emetic
to a slender and delicate child, who has eaten the wrong thing at
dinner and is sick in consequence. Sulphate of zinc or copper
would be evidently unnecessary and inappropriate. Tatarized
antimony especially is to be avoided, on account of its depressing
effects and the persistence of its operation. Ipecac, mild and ef-
fectual as an emetic, without any violent depressing constitutional
effects is the drug which he judiciously selects. But his judg-
ment is without avail ; for the ten grains of ipecac administered to
the little patient contain eight grains of liquorice and one of tar-
tarized antimony.

Now, let it be remembered that such cases as these are liable to
occur at any moment in the practice of any physician. Similar
instances, where the immediate effects are not quite so disastrous,
evidently do occur daily, and do not require to be especially de-
signated. In view, therefore, of the moral character, the intention
and the consequences of these adulterations, there can be but one
conviction as to the necessity of legislative interference, and the
manner in which it should be exercised. The adulteration of food
or medicine should he made a felony ; and sliould he placed upon the
same level with the coining of false money ^ and the counterfeiting of
lank notes. The dealer who vends a spurious article, knowing its
character, would then be placed in the position of one who passes
a counterfeit bill, knowing it to be counterfeit. The consumer
would then have every reasonable protection. The honest trader
would not be compelled, in self-deience, to adopt the practices of
the unscrupulous, or at least to wink at their existence, as he does

1857.] Mercury in Tyj^hoid Fever. 749

at present; and, finally, the practical operation of medicines
would no longer disappoint the physician and discourage the pa-
tient, as they too often do at the present da3\ It is to be hoped
that both tne National Association and the local societies will
continue to agitate the question, until they succeed in bringing it
properly under the notice of the State legislature. J. C. Dalton.

\_Ain. Jour, of Med. Sciences.

On Mercury in Typlioid Fever. By Dr. Ware. (A Paper read
before the Abbeville District Medical Society.)

There is probably no question more interesting to the medical
practitioner of our district, or more practically important, than
that which relates to the propriety of using mercury in the treat-
ment of typhoid fever. We are every year becoming more pain-
fully familiar with the ravages of this mysterious, this obstinate
form of disease, and yet the opinions entertained as to its pathology
are almost as unsettled as ever, and the treatment of it as empirical
as when it first visited our latitude. True, we have witnessed,
time and again, all the symptoms that manifest themselves during
the progress of the disease, in all the various forms that it assumes,
and we can unhesitatingly trace these symptoms to the different
tissues, of the disordered states of which they are significant. We
are fully acquainted, too, with all the morbid appearances, all the
appreciable lesions revealed by post-mortera dissections, and still
we are forced to admit, that our positive knowledge stops short at
secondary links in the chain of causes ; that we are yet ignorant
of the real nature of the primary impression or lesion, from which
results the pathological conditions manifested by the phenomena
developed during the progress of the disease, and which causes these
pathological conditions to resist the influence of remedies usually
found eflicient to overcome diseased states occurring in other forms
of fever, but affecting the same organs and tissues, and giving rise
to the same, or apparently the same train of symptoms. Often
are we forced to watch a case, week after week, unable to check
its progress, trying first one plan of treatment and then another,
without seeing any decidedly beneficial effect from any ; and in
the end we are totally unprepared to say, if the case terminates
fatally, whether death was the result of the disease or of the means
used to subdue it ; or, if the patient recover, whether or not any
thing we did, contributed to his cure. Such is the uncertain state
of our knowledge, such the humiliating admissions which honesty
forces us to make ; and it becomes us to examine rigidly and can-
didly every plan of treatment proposed, and to submit every
remedy to the test of a most scrutinizing investigation, before ad-
mitting its claims.

750 Mercury in Typhoid Fever. [December,

Typhoid fever is, according to the best evidences of its true
pathology, essentially a disease of irritation, and this irritation,
whatever part, tissue or organ, may be its primary seat, results in
general irritability of the system, or in some local inflammation, or
both ; and all are agreed as to the grand, leading indication, viz.,
to subdue irritation, and support the system under its wasting in-
fluence. It is our object to prove, that this, the most important
indication, and the one to which all others are but secondary, can
not be met by the use of mercury, and that such use is not only
unphilosophical, but hazardous : unphilosophical, because it consti-
tutes an attempt to remove a cause by relieving an effect; and
hazardous, because it involves an expenditure of vital energy un-
der which the patient may sink, and which can, under no circum-
stances, contribute to his cure.

Settled opinions, it has been well said, are difiGicult outposts to
carry, though nature herself be battering at the walls; and the
tenacity with which many cling to the mercurial treatment, fully
exemplifies the truth of the assertion. Accustomed to see all
evidences of the disordered states of the digestive organs, as occur-
ring in fevers of miasmatic origin, yield to the influence of
mercury, it was not at all surprising to find physicians slow to
acknowledge the utter ine6.cacy of this drug, when used in the
treatment of a disease having so many symptoms in common with
that one, in which it is wont to exhibit the most beautiful display
of its powers. We may have, during the progress of a case of
remittent miasmatic fever, a congestion or inflammation of the
liver, a torpor or an excessive action of this organ, and any or all
of these conditions may be relieved by the judicious administra-
tion of calomel. In typhoid fever, the liver becomes congested
and inactive, and mercury fails to remove the disorder. Remittent
fever, it is admitted on all hands, has its proximate cause in a
nervous centre, and with equal unanimity it is agreed that typhoid
fever has its primary seat in some portion of the nervous system.
Then, why these different results from the same course of treat-
ment, when instituted in two diseases having their proximate
causes in the same system of organs, and whose more remote con-
sequences, as displayed in their effects upon the liver and its
functions, are apparently the same? May we not, upon true
inductive principles, answer, that the two diseases are, in their
nature, essentially different, that they are generated by circum-
stances and agencies totally dissimilar, and that they commence
their attacks by making impressions having no real analogy?
And may we not, with equal propriety, contend, that, in reference
to the liver, in the one case, the disorder is the result of causes
overpowering the existing energies of that organ ; in the other, of
such as diminish the native force of those energies? That in the
one case, functional derangement is the result of increased action;
in the other, of diminished vitality. In remittent fever, the action

1857.] Mercury in Typhoid Fever. 751

of the liver is disordered or suspended, because the channels
through which it acts arc obstructed, its machinery clogged \ in
typhoid fever, this viscus exhibits evidences of imperfect or disor-
dered action, as a result of the diminution of its motor power; and
this diminution is caused, not by continued resistance to the exer-
cise of that power, but by the failure of its source. Hence it is
that mercurial purgation, in remittent fever, increases the strength
of the patient, and contributes to his comfort, by reheving the
surcharged vessels of the portal system, and thus allowing the liv-
er the free exercise of its powers, which had been held in check,
not obstructed ; whilst the same agency, in typhoid fever, increases
debility and aggravates existing symptoms, by worrying an organ
rendered incapable of being aroused to healthful action, in conse-
quence of its diminished supply of nervous influence.

Again, diarrhoea frequently occurs as a complication of remit-
tent fever, and no symptom is more frequently present in typhoid.
And yet, how different the diseased states upon which depend the
symptom, as they occur in these two forms of fever, and how
strikingly different the means required for the relief of each. The
same organs are affected in both instances, but, if I may be allowed
the expression, from different directions. In remittent fever, the
diarrhoea occurs in consequence of engorgement of the liver, in-
ducing a congestion in the vessels ramifying upon the mucous
lining of the intestines, or from the presence of acrid secretions, or
of indigestible substances, or from all these causes combined; and
we have, accompanying the profuse alvine discharges, a furred
tongue with red edges, (probabl}' dry,) and a tumefied condition
of the abdomen, with great tenderness on pressure. The tumefac-
tion of the abdomen is removed, and its tenderness relieved, by
blistering its surface, and under the continued use of calomel and
opiates, the diarrhoea is checked, and the discharges gradually as-
sume a healthy appearance. Here, too, the cause of deranged
action is distant from the source of power, and coming within the
reach of calomel, the organs are restored to the proper exercise of
their functions. But in typhoid fever, the diarrhoea is the result
of a diseased condition of the mucous follicles of the intestines ;
which diseased condition is induced by the failure of healthful
innervation, entirely independent of the portal engorgement, viti-
ated secretions, or indigestible matter; and though we have, as
before, a tympanitic condition of the abdomen, yet there is very
little tenderness upon pressure, a blister fails to relieve, and the
administration of calomel is not followed by a change in the char-
acter of the discharges, approaching more and more nearly to the
healthy standard, because the seat of the difficulty is beyond the
Teach of this medicine, and located in a system of organs over
which it exerts no direct controlling influence. True, if opium
be combined w^ith calomel in such quantities as to prevent its act-
ing upon the bowels at all, the first discharges that occur may be

752 Mercury in Typhoid Fever. [December,

consistent, and they will probably, exhibit some trace of biliary
secretion ; but, if allowed to continue, they invariably become
watery- again, and the scanty admixture of bile gives to them a
dirty, dingy, brick- dust color, strikingly different from that ap-
pearance so characteristic of stools induced by the specific action of
mercury. Nor is the patient at all benefitted by this purgation,
but on the contrary, he is invariably left in a more debilitated
condition, and frequently with all his symptoms manifestly aggra-
vated. Another consideration, too, renders this practice eminent-
ly unsafe ; for the calomel, if used at all, must necessarily be given
in small and repeated portions, and combined with an opiate:
thus ptyalism may be induced, and if this occur, cancrum oris will
be likely to supervene, in consequence of the putrescent condition
of the fluids, always present in typhoid fever. If this be true,
(and a painful experience convinces me that it is,) is not the use
of mercury, as a means of relieving the disordered condition of the
bowels generally incident to this disease, both unphilosophical and
hazardous ? And if the views that we have expressed as to the
difference in the pathological conditions, upon which depend the
symptom^s that we have investigated, and which occur both in
miasmatic and typhoid fevers, be correct, there is, certainly, no
analogy between the two forms of disease, and any plan of treat-
ment predicated upon the supposed existence of such analogy, is
in violation of the plainest principles of medical philosophy.

But the impropriety of the use of mercurials is not only proved
positively, by the fact, that the pathology of the disease under
consideration is essentially different from that of the disease in
w^hich mercurials manifest their happiest effects, but also, by im-
plication, from the ef&cacy of remedies of a totally different nature,
viz., stimulants and anodynes. These allay irritation, check diar-
rhoea, subdue delirium, overcome watchfulness, promote sleep,
equalize temperature, support the powers of life, prevent the dis-
ease from expending its force upon any one vital organ, and, in
a vast majority of cases when judiciously administered, conduct it
to a favorable termination. And if in the assemblage of symp-
toms, constituting typhoid fever, these desirable results can be
accomplished by the use of mercury, its properties are much more
varied than we have been accustomed to regard them, and after all
the time and study that have been devoted to the investigation of
its physiological effects and uses, we are still unprepared to assign
it its proper place in the classification of the materia medica.

[Transactiojis South Carolina Med. Association,

1857.] Inflammation and Abscess, 753

On the Nature and Treatment of Inflammation and Abscess^ and the
Modern Doctrines on that sid)jcct. By F. C, Skey, F.K.S., F.K,
C.S., Surgeon to St. Bartholomew's Hospital^ etc., etc.

Gentlemen, It was my intention to day (July 13, 1857,) to
lecture on "Abscess," acute and chronic, a most practical subject.
One cannot occupy the mind with the consideration of the nature
of abscess without reverting to its origin or cause, and this leads
me to the wide study of ''Inflammation." Now, you will find the
subject of inflammation so misinterpreted and misunderstood in
books, and in the wards, that I cannot give you any reason for the
" faith that is in me" as to the nature and treatment of abscess,
without first saying that I entertain some yqtj peculiar opinions,
more especially as to the results of inflammation in surgical cases,
and the general treatment to be adopted. Microscopic inquirers
on inflammation are too theoretic for my taste. When a young
man is asked in his university examination, what is inflammation ?
he answers something out of books that he scarcely understands,
though it may be the most recent and orthodox idea on the sub-
ject. Perverted nutrition ! Inflammation is perverted nutrition,
A student says that's an answer, and he understands it ; but to
my mind, there is really no clear idea attachable to it. How will
the cabalistic words ''perverted nutrition" help you in an obscure
case, say of abscess in the pelvis, or in the inner ear, or the skull ?
I advise you to go more practically to work. Did not Galen tell
us inflammation is a state of vessels attended with pain, heat,
swelling, and redness ? Depend upon it, that in clinical practice,
it is better to adhere to Galen, for believe me, though " perverted
nutrition" may be more scientific and less old fashioned, it is also
less intelligible. I hold that, wherever you have inflammation
you have a condition of the vascular system attended with pain,
swelling, heat, and redness; and, I hold also, that where you have
not pain, swelling, heat or redness, that there you have something
else, other than inflammation. There is a great number of mod-
ern books on this subject, but I am inclined to pass them over at
present. Half a century ago, Dr. Thompson published an admir-
able book on inflammation, but even this work has carried away
the mind of the profession rather too much from the good common
sense of Galen. What is the crisis of inflammation? Why it is
that point where inflammation stops, Mr. Joseph Henry Green
has gone over this very well ; read what he says. Thompson says
the tendencies of inflammation are towards effusion, suppuration,
ulcer, gangrene, cicatrization, resolution, adhesion. There are
seven of them, according to Dr. Thompson, but crisis and resolu-
tion are one, and I hold very firmly that these seven may be re-
duced, perhaps, to two, gangrene and deliquescence.

Well, what is chronic inflammation ? A word in the mouth of

764 Inflammation and Abscess. [December,

every doctor. There is no such condition at all. What is suppu-
ration ? What is abscess ? Local inflammation, the surface soft-
ens, matter forms, and you have in an eminent degree pain, heat,
redness, and swelling. Now, chronic inflammation and local in-
flammation are entirely different things. What is ulceration?
Here the theorists meet you again ; disintegration of molecules !
That's fine, is it not? But what of pain, heat, redness, swelling?
Certainly if they are essential to inflammation you can have ul-
cers without them ; so that ulcer is not a result of inflammation,
or rather inflammation is not a sine qua non of ulcer ; you will
have ulcers from starvation. I hold that the two essential results
of inflammation are, gangrene or deliquesence. Take this idea
with you through the wards, and see if I am not right.

Adhesion of opposite sides of pleura, how is that effected ? Is
there heat, redness, pain, and swelling ? Certainly not. If I do
a rhinoplastic operation, is that attended by local inflammation ?
I think not. I know very well that this is the way all such pro-
cesses are explained; but it is an explanation which explains
nothing. Then effusion, a condition as in hydrocele, attended
by a pouring out of water. Surely there you have no pain, heat,
redness, swelling. To my mind it is simple nonsense to call this
inflammation, or the effusion of fluid in the pleura or pericardium,
in debilitated subjects.

Cicatrization, the last of the lot, is the same ; it is not inflamma-
tion, there is no w^ord so prostituted in fact as this convenient
term of inflammation. These views of Dr. Thompson are unprac-
tical, and it is absurd to apply local depletion to vessels already
weakened and showing want of tone. I say to you go back to
Galen, and adhere to his definition, imprint it on your memory.
Heat, pain, redness, swelling, where you find these you find in-
flammation. Chronic abscess ! What a large subject that is ; and
psoas abscess in half-starved scrofulous children ! But if you re-
member what I am saying, it is easily explicable. I often think
if the term "inflammation" were restricted to one-tenth of the
cases that it is, we should go nearer to the truth of nature, and I
am sure w^e should gain more credit with our patients. Inflam-
mation to us surgically, is sometimes an unhealthy state originated
for a healthy object. If you had a thorn in the skin, inflamma-
tion is set up to get rid of the thorn. But can you apply that
process to the repair of a broken bone? I say you cannot;
they are quite different processes. Now as to treatments I be-
lieve in seven cases o-ut of ten depletion does harm. There is no-
thing more common than to apply leeches to arrest or check in-
flammation or abscess, I will take an impending mammary
abscess in a poor woman suckling. There is nothing, in fact, like
leeches or bleeding, for increasing the inflammation. Your leech
is your trae destructive to hasten suppuration.

Mammary abscess occurs in weak women during lactation, weak

1857.] Inflammation and Abscess. 755

women with what we know as *' bad" confinements, that is, a
tedious labour with much subsequent hiv.Mnorrhage, &;c. Does not
nature herself open your eyes to the fact that there is impaired
vital power? Is it not common sense that bark, wine, tonics,
meat, and such like, are the proper plan of cure ; not purging,
leeches, antimony, &c.? I never saw a case of abscess that was
not improved by the former plan. It is to me quite deplorable to
witness the mischief committed by the depleting system. The
whole testimony of the best men in the profession is to give up
the lancet. Tlie times of the lancet are gone by ; you might as
well set up cat-o'-nine-taHs and chains in lunatic hospitals, I have
the highest regard for the opinion of Sir Benjamin Brodie, and I
asked him the other day Does he not use the lancet less than
formerly ? What about bleeding ad deliquium animi the vener-
able old formula when I was a student? The reply of Sir Benja-
min Brodie was curious " I never see a lancet now, I haven't
one in my possession." Bleeding is almost unknown amongst
oiir best practitioners. Every abscess you see in hospital is the
result of debility, rather than of the phlogistic diathesis. I believe
that pus itself is an indication of a condition below par blood
altered into pus. The term congestion is often a better word than
inflammation ; but we induce the congestion if we weaken the
heart as to fever ? Do not be misled about that either ; many
things which we do, selon les regies^, only keep up fever, inasmuch
as they keep up irritation in the system. Bleeding in Typhus
fever, starvation, blisters to the head, these are all wrong, and
perhaps only as wrong as the miserable attempt to stop mammary
or other abscess by local depletion. I say increase the heart's
action, but do not weaken it.

I have great confidence in the old Jesuit's bark and wine ; in
the out-patient^s department you will see it " work wonders," es-
pecially when the patient is brought subsequently into hospital.
Take those thick deposits of lympli round a bubo ; those slow te-
dious things that come day after day to hospital, you will never
cure them by weakening the patient ; but first change your hand
and try bark and ammonia ; or in erysipelas, try bark, and am-
monia, and wine, and you'll cure your patient. Let us now re-
capitulate, and you will then discover the bearing of all this on
the cases of abscess we have in the hospital. 1. I object to the
doctrine of " perverted nutrition," and wish you to adhere to the
more practical definition of Galen, viz., pain, swelling, heat, and
redness. 2. As a rule, venesection does harm rather than good
in the cases of so-called inflammation, in hospitals. 3. Chronic
inflammation is a term that signifies very little, if it be not, in the
majority of cases, a term without any significance. 4. Eesolution
or gangrene are the only results of pain, swelling, heat, redness.
Ulceration is the result from congestion. All the others are acci-
dental in their natures, or mere concomitants. [i/ed ^Circular.

N. s. VOL. xni. ^'o. XII. 48

756 Artificial Rupture of the Ar^miotic Sac, &c. [December,

Artificial Rupture of the Amniotic Sac during labor. Objections to
the practice. By B. F. Richardson, M.D., Adjunct Professor
of Obstetrics and Diseases of Women, in the Medical College of
Ohio.

Is it desirable to maintain the integrity of the Amniotic Sac during
labor 1 According to some authors, its only purpose during labor
is to dilate the os uteri. Others in conjunction with this,, consider
it capable of protecting the foetus from injurious pressure during
uterine contractions. All writers that have been consulted, with
the exception of Dewees, suppose it to be the only proper and ef-
ficient agent in the accomplishment of dilatation of the os uteri ;
and that having secured this end (complete dilatation) its further
maintenance becomes, at least, a matter of indifference; and those
who allude to its protective power over the foetus, seem to have
reference alone to those cases wherein the liquor amnii is evacuat-
ed prior to a dilated or dilatable condition of the os; for their in-
structions clearly show, that after complete dilatation, they have
no such apprehensions in regard to the child.

Is the Amniotic Sac the only proper and efficient agent in the pro-
duction of dilatation of the os uteri f Prof Murphy of London has
endeavored by a laboured and ingenious argument to sustain the
afiGirmative of this question. The defect of his argument lies in his
having assumed that as fact, which remains to be proven. He
asserts that the amniotic sac is a better dilator of the os, than the
smooth, round, and comparatively unyielding vertex. His argu-
ment is by no means conclusive on this point; for the reason, that
to sustain the assertion would require a total disregard of well
known hydrostatic and mechanical laws. Again, he assumes as
a postulate that until a certain degree of dilatation has occurred,
if the vertex, uncovered by the membranes, presses upon the os
uteri, it will irritate it and render it rigid and unjnelding. This
idea is reiterated several times. Terms are sometimes more con-
venient than convincing. On page 85, London Edit. 1852,) he
says : " If, when the liquor amnii escapes, the dilatation be slight-
ly advanced, and the orifice of the uterus increased only an inch
or two in diameter, you may expect more or less delay in the com-
pletion of this stage,, (the first,) unless the cervix of the uterus be
extremely thin. If it be at all thick, the irritation of the head,
generally^ renders it rigid^ no matter how dilatable it may have been .
previousl3^" The italics are our own.

NoAY, it may be pertinently asked, what is the character of that
pathological condition imparted to the structure of the cervix by ,
the pressure of the smooth and usually well lubricated vertex^
whereby it becomes rigid and loses its former dilatability ? On'
the other hand, the pressure on the os uteri,. no matter how
violent, ^by the amniotic sac, however tense, firm and unyielding
it may be ; is presumed to be incapable of producing a like patho- "

1857.] Artificial Rupture of the Amniotic Sac^ (S:c. 757

logical condition. Prof. Murphy stands not alone in the enter-
tainment of these views; and we shall therefore endeavor hereaf-
ter to point out the true causes of this actual delay in delivery and
apparent change in the condition of the os uteri, where the waters
are evacuated early in the first stage of labor.

Are there any important objections to rupturing the membranes after
comj^late dilatation of the os uteri has taken 2^l<fce f The opinion of
writers as to the uses of the amniotic sac during labor, may be
clearly derived from their answer to this question. Chailly says,
page 229, ^^ After having ascertained that the dilatation is complete^
that tJie presentation is favorable^ and that there is no other mechanical
obstruction than the resistance of the membranes^ it becomes the duty of
the accoucheur to rupture them." He is here speaking of resistance
of the membranes without regard to the efficiency or non-efficiency
of the uterine contractions. Again, on same page he saj^s : "I
have stated, as a principle, that the membranes should not be rup-
tured until the dilatation is complete," &c. In regard to the con-
duct of an ordinary labor Dewees saj's: ''Should the pains be
efficient, and the os uteri well dilated, or even easily dilatable, and
the membranes entire, let them be ruptured by the pressure of the
finger against them, or by cutting them with the nail of the intro-
duced finger." The imputation of Prof Ramsbotham against
Burns, could have been applied to Dewees more justly. Again,
in the same paragraph he says : " And this should be done for
the follow^ing reasons: first, because when the mouth of the uterus
is dilated, or even easily dilatable, the membranes have performed
every duty they can perform^'' &c. Denman sa_ys : " We will there-
fore agree in establishing it as a general rule for our conduct, that
the membranes should never be ruptured artificially, at least be-
fore the OS uteri is fully dilated," &c. Burns says, when speaking
of the conduct of natural labor : "Even if the membranes be not
considerably protruded, if the os uteri be completely dilated, no
injurj^ can arise from rupturing them, for they ought, in the natu-
ral course of labor, to give way at this time." Grooch says :
*' Never rupture the membranes until the os uteri is almost or en-
tirely dilated," &c. Lee says: " If the perineum and os uteri are
rigid, and the head is high up, and it is the first child, it is seldom
necessary to have recourse to rupturing the membranes before the
first stage of labor is nearly or fully completed." Churchill re-
marks, when treating of natural labor: "When we are quite sa-
tisfied that the head has passed through the os uteri, we may rup-
ture the membranes, by pressing the finger against them during a
pain, as their integrity is an impediment to the advance of the
child after this time ; but it should not be done hastily, nor until we
are certain that their usefulness is at an end." F. H. Ramsbotham
says: "It is desirable in practice to preserve the membranous bag
entire as long as possible ; or, at least, until it has performed the
whole office assigned to it by nature, viz., the dilatation of the os

758 Method of Improving the Digestibility of Milk, [December,

uteri, the vagina, and somewhat of the external parts." Velpeau
remarks that "where the point of the ovum is too slow in giving
way, it must be ruptured. To be done without inconvenience^ this
little operation requires the combination of the following condi-
tions : first, that the dilatation shall be, at least, very much ad-
vanced, etc." Cazeaux gives similar advice ; Blundell likewise.
Several of the foregoing authors allude to the advantage derived
from the persistance of the amniotic sac where it may become ne-
cessary to introduce the hand into the uterine cavity. It will be
perceived upon a careful review of these quotations, that their
authors believed that in all ordinary labors, when the os uteri is
fulty dilated, the office of the amniotic sac is entirely fulfilled. In
the next number of this journal we shall endeavor to show, that
one of its most important uses remains unfulfilled until the pre-
senting part has passed through the superior strait \ and that in all
natural, uncomplicated labors, especially premipera, the mem-
branes should not be ruptured at any time. [ Western Lancet.

An Easy Method of Improving the Digestibility of Milk. By Dr.
GuMPRECHT, of Hamburg.

It is well known that cow's milk, which is commonly employed
for the diet of newly -weaned children,, and also for those who are
older, is frequently not w^ell borne, and gives rise to indigestion,
acidity, flatulence, colic, diarrhoea, etc.. Hence it has been pro-
posed to improve its properties by the addition of water, and sugar
of milk. Experience shows that this fulfils but imperfectly the
object in view.

Eeflecting that food for adults is never prepared without com-
mon salt, which not only renders it more palatable but also more
digestible, because (as Moleshott has well remarked in his Physiol-
ogie der Kahrungsmittel) salt not only acts as a stimulant to all the
glands of the digestive apparatus, increasing their activity, but
also renders the albumen (and consequently the casein of the milk)
as well as the fat, more soluble in the digestive fluids, I was natu-
rally led to the idea of rendering the milk intended for recently
weaned and older children more easily digestible, by the addition
of a little salt; and I found that I could in this way prevent the
indigestion so often following the drinking of cow's milk,, and
even remove it when already present.

So far as I know, no author who has treated of the diet of new-
ly-weaned children, has mentioned this useful addition to milk,
and it is in lact remarkable that so natural an idea should not
have occurred long ago, as to season the milk intended for the
nourishment of weaned children with a little salt, to make it more
digestible, since milk is often given them mixed with flour, groats,
pounded biscuit, etc., which require this wholesome condiment in

1857.] MeQwd of Improving the DigestiUlity of Milk. 759

order tx) become more easily digested and assimilated. It gave
me, therefore, much pleasure to hear a Dutch phj'sician, whose
acquaintance I made a few weeks since, and with whom I convers-
ed on the above subject, say, that in his practice in Holland he had
frequently directed the addition of a little salt to the milk for
newly-weaned children, with a very happy result.

On my inquiry how the idea occurred to him, he said that he
had observed that the peasants of Holland, in order to preserve
the swine and cattle from a diarrhoea which frequently occurred
in consequence of indigestion, mix salt with the fodder, and he
reasoned from analogy that perhaps also children after weaning
might in a similar manner, namely by the addition of a little salt
to their milk, be protected from the diarrhoea which is so common
under the circumstances; and the result had justified his expecta-
tions.

The proportion of salt to a given quantity of milk, must be de-
termined by the age of the child ; as much as can be taken on the
point of a knife, or two or three times this quantity, may be added
to a cup full of milk. In order to make the resemblance between
cow's milk and woman's milk more perfect, I direct it to be boiled
and skimmed, then a little sugar of miilk is added, and lastly the
salt. Fresh milk to which salt has been added should not be al-
lowed to stand long, as acids will be set free, and coagulation pro-
moted.

In a theoretical point of view, as I think, there is less objection
to the addition of salt to the milk for young children, from the
fact that this condiment not only benefits the stomachic digestion,
by rendering the casein more soluble, but favors the formation of
the blood, and renders the latter more fluid while circulating.
Thus Moleschott in the Physiologie der Xahrungsriiiitel., says : "Of
the inorganic elements of the blood, the chloride of sodium is the
most abundant ; its quantity is so great that it is not difficult to
cause it to crystalize from an aqueous solution of the ashes of the
blood. The chloride of sodium is also found abundantly in the
tissues, especially in the cartillage, and also in the secretions and
excretions."

Although milk, as Prout has very justly remarked, is to be re-
garded as the tj^pe of all food, since it contains all the elements
which are necessary for the growth and nourishment of the human
organism, as albumen, sugar, fat and the salts, and is particularly
adapted, by its bland nature, for the organism of the child, yet it
is often unfit for adults, who are accustomed to a more stimulating
diet, on account of its insipid quality, and frequently gives rise to
^oppression and acidity of the stomach, and sometimes even to di-
arrhoea. Hence some persons have a strong objection to it, on
account of its want of flavor. This objectionable quality is, how-
ever, easily removed; it is only necessary to infuse powdered
cinnamon into the boiling milk, then dissolve in it a sufficient

760 Treatment of Gonorrhoea. [December,

qiiantity of salt, until the milk acquires an agreeable piquant taste,
and add powdered sugar, in order to give it a decided and agreea-
ble flavor. I liave found that milk prepared in this way is very
palatable to adults, and is readily taken and well borne by them.
Those persons who are accustomed to take spirituous liquors may
add to the milk, in order to improve its quality, rum or brandy
(a small wineglassful to an alc-glass of milk). In this way milk
is often taken in England and hi Holstein, particularly in summer,

"When the physician orders a regimen consisting wholly of milk
(niilk-cure), he should not forget to recommend salt and sugar to
be added to the milk, according to the above method, both to ren-
der it more digestible, and also more acceptable to the taste ; since
the success of the " cure" depends in a great measure on the per-
fect digestion and assimilation of the milk, which are much assist-
ed by these additions.

Morning milk, ^fresh from the cow, is frequently directed for
women who are suffering from the effects of general morbid irrit-
ability, and often with good results. It sometimes happens, how-
ever, that the fresh milk is not well borne, or that the patients
have a strong repugnance to its insipid taste. In such cases I ad-
vise a little salt, with one or two teaspoonfuls of powdered white
sugar, to be dissolved in a small quantity of milk placed in an ale-
glass ; then fill up the glass with milk fresh from the cow, and
drink it quickly. I have found that new morning milk prepared
in this way is very easily borne. The remarkable effect of fresh
milk in removing the above-mentioned morbid condition seems
partly to be attributed to its being saturated with an animal vapor,
a peculiar evanescent odorous principle, which cannot be isolated,
and which speedily disappears after the milk has been drawn from
the cow .^[Boston Med. and Surg. Journal.

On the Tretitment of Gonorrhoea ivithout Specific Medicines.
Having stated the necessity which existed for basing all decis- i
ions as to the value of remedies on written cases only, and for
examining carefully the properties of one remedy at a time, till its
true value had been ascertained, the author proceeded to give the
result of his inquiries as to the action of certain curative measures
in uncomplicated cases. All cases having been rejected which
were not traced to their termination, it was found on careful ana-
lysis that the antiphlogistic plan of treatment did not appear to
exert any material influence over the course of the disease ; that
waiting as manj^ days with the same amount of rest and low dietj
was equally serviceable. Local bleeding, to whatever extent it was
carried, was not found to produce any real abatement of the symp- ^
toms, it only made the patient more languid and indifferent; ape-
rients and purgatives, with zinc injections, were about equal to

1857.J The Plantago Major in Spider Bite. 761

specifics, as were also iujections of nitrate of silver used without
medicines. A combination of these formed a useful but not a
certain plan of treatment. The result of the inquiries was, that
chloride of zinc, in whatever way used, was not superior to the
nitrate of silver ; that injections of either could not be relied on ;
but he denied that any proof of their producing stricture or orchi-
tis, except in a very small number of cases, had been brought for-
ward. The author then recommended the preparations of potass
as the most certain remedies yet introduced. Mr. Langston Pai--
ker, Mr. Henry Thomson, and many other surgeons had tried
them with complete success. \_Med. limes and Gazette.

The Plantago Major in Spider Bite. By D. W. Maull, M.D., of
Georgetown, Del

The Plantago Major, commonly designated Yard Plantain, so
far as our researches extend, has never laid much claim in the
books to the properties that we are about to ascribe to it. It is
true that mention is made of it in this connection in some of the
old journals, but its claims to the title of Alexipharmic, probably,
were not sufficiently urged, or there were not enough cases ad-
vanced upon which to base its reputation. This plant is described
as being refrigerant, diuretic, and deobstruent in its nature, but
no reference is made to its possession of properties more valuable
than any or all of these, in its power to counteract the effects
arising from the bite inflicted by the venomous spider. "With
many of the profession and laity of this country a locality where
the plant and spider are both very common the herb has attain-
ed to not a little repute in consequence of these virtues ; and, in-
deed, deservedly, we opine, for from our own observation and that
of others, we are led to regard it almost in the light of a specific,
if such a term is admissible. My father has had frequent opjDor-
tunities of testing its efficaciousness in this respect, and it is upon
these cases coming under our notice, that we chiefly base our re-
marks and our confidence in its powers.

As to the habitat of this spider, it is found in cellars, along old
fences, in lofts, and in dark and damp places generally. It is
black, with a red spot upon its back. The wound inflicted by it
partakes more of the characteristics of a bite than of a sting.
With regard to the results of the admission of this septic poison
into the system, it may be stated that the bite is quite dangerous
in its consequences, and is regarded by some as virulent as that
.produced by the rattlesnake. We have seen ode case where par-
tial paralysis ensued upon it. The symptoms became somewhat
alarming. If it is one of the extremities wounded, the limb soon
becomes nearly rigid ; swelling is not a prominent feature ; the
pain extends along tke limb and becomes excruciatingly severe;

762 Ahortion for Relief of Sickness. [December,

the peculiar poison soon diffuses itself; tlie system soon intimately
sympathizes with the primary local disorder, as evidenced by the
gastric irritability, and, if the poison is not counteracted, fatal re-
sults are apt to follow. With such alarming manifestations as
these, it is very fortunate, we conceive, that we almost always
have a remedy at hand to counteract its virulence.

This perennial plant the plantago is too familiar to all to
require description ; it is quite general in its growth, and conse-
quently is easily obtained. The mode of preparing and adminis-
tering, is to express the juice from the fresh leaves, and give three
or four fluid ounces at a time. Cold water, with the view of facil-
itating the expression, may be poured over the leaves after they
are bruised. This expressed juice may be given with every assur-
ance of almost immediate relief The intense pain consequent
upon the bite soon ceases ; the limb loses its rigidity, and assumes
its natural use and motion. The irritability of the stomach is al-
layed, and all the parts soon acquire their normal appearance and
functions. We may here embrace the opportunity to say that the
toad, it is affirmed, in its combat with the spider, has been observ-
ed to resort to this plant every time that a bite has been inflicted.

The modus medendi of this potent mediciue we shall not attempt
to explain. Xo appreciable change is experienced in any of the
evacuations. Under iis employment, sleep is sometimes induced,
but this is owing rather to the sudden freedom from pain which
the patient begins to enjoy, than to any soporific tendencies inhe-
rent in the plant.

These observations have for their basis facts and cases sufficient
to force upon the mind convictions as to the potency of this indi-
genous article in the relief of the spider bite. JSTo hypotheses are
indulged in, and no reasoning from analogies brought forward in
support of a statement founded upon facts, and dependent upon
no adventitious doctrines for its maintenance. This remedy un-
questionably possesses merits sufficient to recommend it to the fa-
vorable consideration of the profession. [2Ied, and Surg. Rep.

Abortion for Relief of Sickness.

Mrs. , aged 38, a tall, pale, exsanguined, and emaciated

woman, had been attended by me in previous confinements. She
was the wife of a tradesmau, and mother of a large family, and had
alwa3's suffered exceedingly from sickness during the latter period
of pregnancy, so much so as to necessitate confinement to her bed
for the last month or two. She consulted me in April, 1854, when
she was six'months advanced, imploriug me to do something for
%er sickness, or she should inevitably die. On former occasions I
\d exhausted remedies, and was therefore little hopeful of doing
jood. It is true, the treatment might have been deemed em-

1857.] Abortion for Relief of Sickness. 763

pirical, but this was of necessity. Doing battle with a symptom in
no way advances the removal of its cause ; and, indeed, it is diffi-
cult to conceive how vomiting, sj'mpathetic with an allection of a
remote organ (whether it be an uterus occupied with its ovum, a
gall-duct impacted with calculi, or an ureter distended with lithic
acid concretions), can be controlled otherwise than by remedies
especially directed to the primarily affected organ. Of these, so
far as the womb is concerned, we iiinj be said to possess none, save,
of course, such as would produce contraction and expulsion of its
contents.

The poor woman's state was truty pitiable; not a particle, of
food nor a drop of fluid would remain on the stomach, even for
five minutes. So long as total abstinence was maintained, there
was peace; but the smallest quantit}^ of the blandest material was
immediately rejected ; and, what seemed astonishing to her friends,
for every spoonful she swallowed, two were thrown up. I went
through the form of administering purgatives by the mouth and
rectum ; sedatives, as carbonic acid, preparations of opium, hydro-
cyanic acid, calomel, and morphia; compound tincture of senna,
in drachm doses (a remedy in which some old practitioners appear
to put faith ; but which seems to me of as doubtful efficacy as the
rest) ; blisters over the pit of the stomach, the vesicated surfaces
being dressed with morphia ointment ; croton liniment over the
spine. All was to no purpose; the vomiting persisted ; the de-
bility increased; the emaciation became extreme; the pulse re-
mained permanently at 110, and a mere wave ; and my poor
patient insisted that she must die. The seventh month was now
complete ; and although, on previous occasions, I had alwaj^s seen
Mrs. accomplish her full term, notwithstanding the exhaust-
ive drain to which she had been subjected, I now felt it could be
so no more. To exist two months, or even two weeks longer,
seemed clearly impossible. Death or delivery was the only alter-
native. I had been daily expecting that Nature herself, ere the
woman's life was really imperilled, would have emptied the uterus
of its contents ; but nature not seeming disposed to have anything
to do with it, I determined, after consultation with my partner,
upon immediately inducing premature labour. There was no
reason to doubt that the foetus was alive ; but the case was too
urgent for the question of its viability to be entertained. Exam-
ination per vaginam revealed the os uteri low down, patent to the
finger, soft and dilatable, and the head presenting. Puncturing
the membranes appeared the most facile and expeditious mode of
inducing uterine contractions. Sir C. Clarke's trocar and canula
were used ; the liquor amnii drawn offi Ko pain immediately
followed ; but in twelve hours one forcible uterine effort expelled
the child, which, small and feeble, survived but an hour or two.
From this moment the sickness ceased, but my patient for some
weeks appeared to be in a dying state, so great was her debility,

76i Editorial. [December,

and so little of any kind of nutriment was she able to take, on ac-
count of the extreme pain which this induced in the stomach.
However, by slow degrees she rallied ; and, after three or four
months, was enabled to be carried down stairs, and I gradually
withdrew my attendance.

In the spring of 1855, 1 was again sent for to Mrs. . It

appeared that she had never gained suflQ.cient strength to walk un-
aided across the room ; yet little more than a year after her last
accouchement she was again advanced upwards of six months in
the family way. All her old symptoms had returned, if possible,
in a more aggravated form ; she had incessant sickness night and
day, inability to take any kind of food or obtain sleep ; great ema-
ciation ; pulse 120 ; and debility so extreme, that the poor creature
could not turn in her bed without assistance. Again we punctur-
ed the membranes, and again a living child was expelled in about
the same time. It breathed an hour or two, and expired. Mrs.
T. now gradually ceased to vomit; but eating caused so much
pain that she took but little food ; the debility and emaciation in-
creased, and ten days after delivery she sank. No post-mortem
examination was permitted. [^Mr. Gurraway of Faversham in Brit-
ish Med. Jour.

EDITORIAL AND MISCELLANEOUS.

The American Medical Association its Power and its Influ-
ence. An examination of the minutes of the last meeting of the American
Medical Association will develope a most active vitality in the association,
and an earnest endeavor on the part of its members to promote the ad-
vancement of American Medicine in all its interests, whether Scientific^
Ethical^ or Educational. These three great interests, according to the
present constitution of the body, represent the grand triplicate object of its
jealous care. The guarding of these interests are the three great functions
of the Association. The first of these functions, every class of the Profess-
ion yields most cheerfully to the Association, as its high prerogative and
just privilege, at the second, only transgressors of the laws of Ethics are
inclined to demur, while in regard to the third, which relates to the reform
in Medical Education, there is a class who loudly exclaim against its daring
to interfere with the private affairs of institutions, in ivhatever way they
may be conducted.

The American Medical Association is not indeed a legislative body this,
its most ardent advocates and firmest defenders will readily admit : It does
not pretend to force its dicta as laws upon the Profession with the sanctions
of ordinary penal codes ; but though not a legislative court, it is far from
being a body without its legitimate influence, and still farther from being

1857.] Editorial 765

devoid of laws, the violation of which are ever atoned lor by pcnaJties
of the severest kind and most inevitable sequence. In its first establish-
ment, a number of the best, the wisest and most honorable of the Profess-
ion, earnestly sought to lay down principles of right, for the direction and
guidance of their bretliren throughout the country ; they met the aj)proba-
tion of the wise and the good wherever these principles were read. The
principles of right were thus established, and a standard formed by them,
which the Profession at large looked to as the criterion, ou all questions
of propriety pertaining to their conduct.

A standard and a criterion having thus been enunciated, and approved
by every one, the power of the Association henceforth rests not so
much in themselves as in the hearts and consciences of the Profession
at large. It is for the Association only to declare that such and such
a measure is not in accordance with the standard of Right, established and
acknowledged by thera, and by all, in and out of it, and this judgment be-
ing pronounced, public opinion applies the castigation which, in time, must
inevitably bring reform or confusion to the offenders.

We are aware that there are many who affect to despise the opinions
and rail at ethical rules and admonitions of the American Medical Associa-
tion, as arrogant, offensive, and based on a power, only ideal. Berkeley
asserted, and believed, that life was alia dream, and that external objects and
the powers of nature were but the ideal representations of things yet
Berkeley carefully avoided gettino^ into the fire, for fear of being burned, and
as carefully shunned the sea, for fear of being drowned. So these pretended
despisers of the Association, affecting to contemn its opinions and its judg-
ments, yet are ever anxious to prove that they transgress none of its rules,
but have squared with the last letter of its counsels.

The American Medical Association then is potent, it has a moral pow-
er rooted deeply in the hearts and consciences of men, and ramifying
throughout the length and breadth of this wide extended land, it is the true
exponent, the highest tribunal of right in the Profession. It has only to be
true to itself and to its own great principles keeping these ever before the
Tvorld as the standard of Medical Uthics^Jiever swerving from them in one
jot or tittle, but on the other hand, avoiding all petty and meddling tyranny
towards particular individuals or particular institutions and thus, however
much some may affect to despise its admonitions and to beard its powder,
still Reform will follow in its train, for as the fire ivill burn and the sea iviil
drown, so will the violation of its ethical laws wither and overwhelm all
who may be hardy enough to continue in transgression.

En'd of the Thirteenth Volume. With the present number closes
the thirteenth volume of the Southern Medical and Surgical Journal. In
reviewing our labors for the past year, no one thing has yielded us more

766 Editorial, [December,

satisfaction than the fact that we have been able to adhere to the spirit of
the sentiment expressed in our second number, which sentiment was at the
time intended by us as our Platform, in the Editorial conduct of the work.
We here reiterate it, and hope that we may be able to adhere to it through-
out the whole of our next volume.

" Our sixty-four pages, we find barely sufficient to elaborate the monthly
accumulation of valuable matter, which the daily progress of the science is
crowding upon us, and which duty impels us to lay before our readers.
We have held it an object very near to our hearts, to keep the Southern
Medical and Surgical Journal, as it has ever been, the conservative expo-
nent of sound Medical Doctrine, steering clear, if possible, of any involve-
ment in the many vexatious jarrings which too often destroy the symmetry
and dim the glory of periodical literature, both Scientific and Polite ; render-
ing the life of the Editor truly, but a " vanity and vexation of spirit ;" a
vanity, because it fritters away, in small things and personalities, time and
labor which should be earnestly devoted to the high and important objects
of his calling ; and a vexation, because " grievous words ever stir up an-
ger," and " an angry man stirreth up strife.' "

These were then our words, and whether we present sixty-four pages or
a hundred and sixty-four, we must thank the courtesy and good fellowship
of our confreres that we have never yet had occasion to depart from either
kindly impulse, or kindly sentiment.

By a reference to the Prospectus for the Fourteenth Volume, it will be
seen that our Publisher, with a liberality fully commensurate with the re-
quirements of the advanced state of Medical Science, proposes to add eight
pages to each number of the work, without any advancement in the price
of subscription. We hope that his generosity will be rewarded by an in-
creased list and punctual payments.

In the original department of the now closing volume, we are aware
that we have had too often, though reluctantly, to supply the defaults of
contributors by the introduction of papers from our own pens ; this was not
our fault, but indeed our misfortune. We have a corps of contributors
able to supply the most valuable matter, and what has been withheld
during the present year we earnestly hope will only serve to enrich the
coming volume.

The Transactions of the American Medical Association^ Vol. X. Printed
for the Association. Collins, Printer, Philadelphia. 8vo. pp. Q>1Q.

The above interesting volume has come to hand too late for us to present
to our readers, anything like an extended review, of any of the papers, in
our present number. Its size, and the character of its contents will, this
time, certainly vindicate the Association from the Trans-atlantic charge of
making " a big book with nothing in it."

1857.] Editorial 767

8

Besides the addressee* of the Presidents, the minutes of the last meeting
the reports of business committees, the plan of organization, code of ethics,
and list of officers and permanent members, the volume contains thirteen
papers, which may be said to be the Scientific Records of the Association
for the present year. Some of these reports show much ability, and confer
credit upon those who presented them, but at pref<ent we can do no more
than present a sim})le list to our readers.

They are the following ;

Report on the Medical Topography and Epidemics of Ireland.

Report on Infant Mortality in Large Cities : the Sources of its Increase,
and Means for its Diminution. By D. Meredith Reese, M.D., LL.D., (fee,
of New York.

Report on the Metlico-Legal Duties of Coroners. By Alexander J.
Semmes, M.D.

Report upon the Topography and Epidemic Diseases of the State of
Georgia. By John F. Posey, M.D., of Savannah.

Report on the Use of Cinchona in Malarious Diseases. By F. Hinkle, M.D.

Report on the Blending and Conversion of Types in Fever. By C. G.
Pease, M.D., of Janesville, AVis.

Report on a New Principle of Diagnosis in Dislocations of the Shoulder
Joint. By L. A. Dugas, M.D., of Georgia,

Report on the Fauna and Medical Typographv of Washington Territory.
By Geo. Suckle}^M.D., U.S.A.

Report on the Medical Flora of Washington Territory. By J. G. Coo-
per, M.D.

Report on Deformities after Fractures. By Frank Hastings Hamilton,
M.D.

Partial Report on the Nervous System in Febrile Diseases. By Heniy
F. Campbell, M.D., of Georgia.

Prize Essays. The Excito-Secretory System of Nerves, its Relations to
Physiology and Pathology. By Henry Eraser Campbell, M.D.
Experimental Researches Relative to the Nutritive Value and Physi-
ological Effects of Albumen, Starch, and Gum, when singly and ex-
clusively used as Food. By William A. Hammond, M.D., U.S.A.

Some of the abm^e papers we will hereafter notice fully in this Journal.

Binding of the Present Volume, It has been said that nothing
strikes the human mind with greater horror than the idea of annihilation
the thought of passing entirely out of existence ; hence every nation, from
the most savage to the most enlightened, in its Theology, necessarily con-
templates some place for departed spirits some aftei'-Wie^ whether in form
of a spiritual or a material Heaven or Hell they all revel in the idea of
continued existence, and are filled with horror at the blank or we would
rather say, the black idea of annihilation. This horror, we had almost said,
is ours, at the present moment. When we reflect, that our twelve months'
labors are Ipng disjecta membra in twelve perishable pamphlets, of sixty-

768 Editorial. [December,

four pages each, liable to be torn, soiled, mutilated annihilated^ the wish
(selfish perhaps) obtrudes itself upon us, that these twelve, to us, costly
members could be collected and hound together, and thus protected in the
more durable and convenient form of a single volume.

For the information of our subscribers who may reside conveniently to
this place, we will state that in zVugusta, there are two Book-binding estab-
lishments one connected with the office of the Chronicle and Sentinel,
and the other wi^h the Bookstore of Messrs. T. Richards k Son ; at either
of these establishments the work will be done neatly, expeditiously and
cheaply.

The Dissector^ fi Manual of Practical and Surgical Anatomy. By Erasmus
WiLsox, F.R.S., Author of "A System of Human Anatomy," "etc. The
third American from tiie last revised London edition. Illustrated with
one hundred and fifty-four wood engravings. Edited by William Hunt,
M.D., Demonstrator of Anatomy in the University of Pennsylvania.
Philadelphia: Blanchard & Lea. 1856. 12rao. pp.583.

This valuable work was transmitted to us, throusrh the kindness of its
American publish ei's, some time ago. Since its reception, it has been
our intention to call attention to it, at such a time as might be most ser-
viceable to those requiring its indispensable aid in the prosecution of this
arduous study, by giving notice of it just when they were about beginning
their dissections. As this is the season for Anatomizing, we would earn-
estl}^ advise every student, for his own benefit, to supply himself with a
copy of this manual, before commencing operations, as Anatomy will be
an up-hill business without it, and loith it dissecting is made an easy, inter-
esting and improving exercise. Not only is this System of Anatomy
suitable as a guide to the dissector, but to the practitioner it is, perhaps,
the most convenient and best arranged book of reference, in relation to the
topography of any part, he may have to penetrate. r. c.

Elements of Pathological Anatomy. By Samuel Gross, M.D., Professor
of Surgery in the Jefterson Medical College of Philadelphia ; and form-
erly Professor of Pathological Anatomy in the Medical Department of
the Cincinnati College. Third edition, modified and thoroughly revised.
Illustrated hj three hundred and forty two engravings on wood. Phila-
delphia r Blanchard & Lea. 1857. 8vo. pp.'T'Zl.

Nearly eighteen years ago, in the earliest days of our student-life, we
read a work by the above author, on General x\natomy ; both that and
Pathological Anatomy were even then comparatively in an unsettled state.
It is pleasant now to note the long advances which they both have made
since then, and it is but common justice to Dr. Gross, to say, that to his

1857.] Miscellaneous. 769

labors in this department, tlie profession in this country owe much of tlie
attention wliich is now priid to the study of the tissues, both in a state of
healtli and disease.

His, if we are corret:;tly informed, ^vas the first systematic work of any
importance, which appeared on this side of tlic Athmtic, devoted to Path-
ological Anatomy. It has firmly maintained its position of favor with the
profession, by the side of Vogel, Hasse, Kolliker, Cruveilhier, and a host of
others, and through the author's indefatigable watchfulness is kept posted
up to last hour of the Science at the issue of its several editions.

Dr. Gross has displayed much good jjudgment in keeping his work with-
in the bounds of a single volume, and that one of convenient size. To the
student of medicine we would say, that we know of no work which we can
more heartily commend, than Gross' Pathological Anatomy^

Treatment of Chorea. Dr. Barlow still continues the employment of the
iodine of zinc in the treatment of chorea when complicated with struma
a remedy which he introduced into use, and to which we then adverted
about two years ago. In cases in which there is no peculiarity of diathesis
he employs the sulphate, but in those in which any indications of struma
exist he prefers the iodide. Besides its influence over the scrofulous ca-
chexia, it is quite possible that the iodic element may be useful against the
rheumatic diathesis to which the choreic is so close a congener. Good
authorities are not wanting who would account for the frequency of heart
complications with chorea by supposing that the latter is a condition very
closely connected with rheumatism, depending upon similar causes, and
occurring more frequently in those liable to it than others. A little girl
was discharged the other day from under Dr. Barlow's care in Guy's, in
whom, under a cwirse of the iodide for zinc in chorea, a loud cardiac bruit
had very much diminished in intensity. [A^. 0. Med. I^ews and Jlos2ntal
' Gazette,

titrate of Potash in Dysentery. Dr. Tiedeman, of Philadelphia, has
issued a pamphlet on Dysentery, and its Treatment. He says : " The
internal remedy which I have almost exclusively prescribed, and frequent-
ly with surprising success, is nitrate of j)otassium^ \kal. nitr.) I have given
it in large doses, which agreed perfectly well wnth the patients. Locally,
I have ordered, immediately after each evacuation, no matter how often
they occurred, injections of pure cold ivater. In very severe cases, particu-
larly in hot weather, he has ordered injections of ice w^ater with the best
effects. As diet, I ordered milk, gruel, barley, rice-w^ater, toast and w'ater,
pure water, and butter-milk, as much as the patient liked to take." [JVash-
ville Journal.

Inflammation and Ulceration of the Sound Skin, produced by the appli-
cation of a strong Arsenical Solution. Dr. W. N. Brown, of Melrose, has
recorded the case of a farm servant who was aftected with inflammation of
the skin of the lower part of the abdomen, the penis, scrotum, and upper
part of the thighs, running on in some places to ulceration, consequent on
exposure foi two hours to the action of a solution of white arsenic. He

770 Miscellaneous.

d

had been enga2:ed in washing sheep in a bath composed of white arsenic
dissolved in boiling water, and his trousers had become saturated with the
diip})ings from the sheep. The skin was nowhere broken. He was en-
gaged in the work for nearly two hours, and on going liorae, had immedi-
ately changed his clothes. In the evening he complained of pain and
smarting, and the following morning the skin was red and inflamed. He
had severe burning pain, and considerable constitutional derangement. It
was a fortnight before he could return to work. The solution consisted of
two pounds of ai-senic, and a considerable quantity of soft soap to about
fifty gallons of boiling water. [^Edinburyh Med. Jour4

Dr. Ch. Robin, of Paris. We find in a letter of the Parisian correspond-
ent of the New York Times, a glowing but just tribute to Robin. Of the
medical luminaries of Paris, he is a " bright particular star.*' To listen to
his instructions; to see and know him and kindle one's own zeal by wit*
nessing his enthusiasm and self-sacrificing industry, are objects of them-
selves, sufficient to repay fox crossing the Atlantic. The labors of Robin
are not known in this country so much as their importance claims. His
great work incorrectly styled anatomical and physiolog-ical chemistry, pre-
pared in conjunction with M. Verdeil, is yet to be translated. He has been
for some yeai's past engaged on a still larger work general anatomy, heal-
thy and morbid whicli we trust will soon be completed. It is safe to pre-
dict that the publication of this work will form an important epoch in the
history of these branches of medical science. By his admirers, Robin is
often styled the Bichat of the present day. The following is the passage
in the letter referred to : *

"There is a young physician at Paris, whose example is well worthy a
notice here. His is a name which is heard hundreds of times daily from one
end of Europe to the other in the mouths of the most distinguished men of
science of all countries. And yet he is a poor man, who dines at a cheap
restaurant in the Latin quarter with students, and who lives upon a patri-
mony that would scarcely pay the servant hire of many of his colleagues
in science. This is Robin the microscopist. He is a deathly pale, thin,
serious-looking man, of about thirty-four years of age. His whole life is
devoted, by means of the microscope, to the study, the demonstration and
classification of morbid tissues. There is scarcely a cancer excised at Paris,
nor a ([owhiivxX post-mortem examination made, that Robin and his microscope
are not consulted, and his word is authority. His whole life is spent in the
exploration of the dead body in oi'der to benefit the living. x\nd all this
he does modestly, in poverty, and to the sacrifice of his health, for the pro-
motion of pure science and correct opinions. He has, it is true, the gratifi-
cation of being adored by his colleagues, old and young, of never having
his name pronounced but with veneration ; but it is such men as these that
are neglected by the public." [Buffalo Medical Journal.

" The Retired Physician!''' The readers of the newspapers for the last
few months, must have noticed an announcement of the existence of a " re-
tired physician whose sands of life have nearly run out," hailing from Jersey
city. This aged advertiser of a quack nostrum is said to be a young man
about twenty-five years old, in good health, and engaged most of the time
in writing for the New York Sunday papers. Such is the inexhaustible
credulity of a portion of mankind on the subject of remedies, that we pre-
sume this " new dodge" has proved remunerative to the inventor." [lb.

INDEX TO VOLUME XIII.

PAGE.

Abscess of Tibia 63

Abortion for relief of sickness V62

Acid, phosphoric in typhus fever. 193

Acetic Acid in scarlatina 466

Address of Prof. Lindsley, notice of. . 189

Adulterations in food and medicine. . 730

Air Poison 61

Alcohol, some of the effects of on the

constitution, <tc 451

Alkaloids, detection of 64

Ammonia, valerianate of in neuralgia, 46

do. do do 671

Amenorrhoea, electricity in 192

American iled. Association 241

do. do. do. notice of 381

do. do. do 433

r. do. do. do. minutes of . . 484

do. do. do. its power, <fcc. 764

do. do. do. transactions of 766

American Journal of Med. Sciences. . 508

Amputation, new instrument for. .... . 89

Amylene, history, discovery, cfcc. of. . 552

Amniotic Sac, artificial rupture of . . . 756

Anaesthetic, carbonic acid as an 41

Aneurism, contraction of pupil in. ; . 64

Ancient Medicine 67

Anomalous nervous disease 585

Antidotes and chemical poisons 127

Appendix, vermitbrmis, ulceration of 93

do. do. perforation of. 95

Apoplectic Ophthalmia 450

Arnold, on relation of yellow and bil-
ious fever 3

Arsenic as a caustic 369

Arsenical solution producing ulcera-
tion, <fcc 769!

Asphyxia, Hall's method in 227

do. warm bath in, fatal 281

Asphyxiated new-born children.treat-

ment of 284

Atrophy of skin, circumscribed 551

Barking Mania 184

Bartlett's fevers of U. States, novice of 191
Belladonna in arresting secretion of

milk ^,j^_^ 26

Belladonna in diseases of the eye 308

do. in incontinence of urine. . 432
Bilious and Yellow fever, relation of 3

Binding of the px'escnt volume 767

Books for vevie-.v 449

PAGE.

Bones, human, phosphate of iron in. . 69
Brandon, on an Anomalous Nervous

Disease 585

Branston's Hand-book of Receipts. . . 706

" Break a Leg," 573

Bronte, Charlotte, death of 690

Brown, on Chloroform iu Puerperal

Convulsions 464

Button Suture vesico-vaginal fistula 34
Butyric Acid, secretion of 65

Campbell, H. F., on strangulated ven-
tral hernia during pregnancy 8

Campbell, H. F., Effects of Dentition

in nursing children, remarks by. . . 20
Campbell, H. F., Uncontrolable vom-
iting in pregnancy, remarks by . .. . 30
Campbell, H. F., Traumatic Tetanus
clinical lecture at Jackson-street

hospital 75

Campbell, H. F., on strangulated ven-
tral hernia, recovery after opera-
tion in 131

Campbell, H. F., Letter to Dr. Mar-
shall Hall 243

Campbell,. H. F., Valerianate of Am-
monia in neuralgia 571

Campbell, Robert, Inverted Toe Nail,

treatment ol , 72

Campbell, Robert, Gun-shot Wound

of Hand 401

Campbell, Robert, Dysentery : its na-
ture and pathology a clinical lec-
ture at Jackson-street hospital 707

Cammann's Stethoscope 128

Camphor and Epilepsy 494

Caustic, preparation of with gutta

percha 60

Calescimus 188

Carpenter, Dr. W. B., retirement of. . 194
Carious Teeth, some of the eifects of. . 492

Cancer, chloride of zinc in 431

Carbonic Acid, an anaesthetic 41

Cazeaux's Treatise on Midwifery 702

Cervix Uteri, report on diseases of . . 515
do. do. do. do. 643

Change of Editors 56

Chloroform, poisoning from 61

do. death from 65

do, in traumatic tetanus. . . 77

Chemists and Druggists, statistics of. . 64

772

INDEX.

PAGE.

Chemical poisons and antidotes 127

Chlorate of Potash in atfectious of the

mouth. , 322

Chlorate of Potash, therapeutic appli-
cation of 497

Chlorate of Potash in leucorrhcea and

ulceration of the os uteri 500

Chorea, treatment of 769

Choreic Convulsions, case of 627

Churchill, on Diseases of Women. . . . 635
Circumcision, influence of on syphilis, 298

Clavicle, fracture of 573

Clinical Lecture on Urine 299

do. do. Dysentery, &c 707

do. do. Traumatic Tetanus. . 75

do. do. Scarlatina 663,721

Continued fevers, their discrimination 1 2

do. do. do. treatment. ... 100

Contraction of pupil sign of aneurism, 6-4

Collection of indigenous drugs 66

Cod-liver oil, a substitute for 128

Convulsions, puerperal 145

do. in children, aetiology of. .. 173

do. etherization in. .. . 312

do. case of hysterical 656

Constipation, nux vpmica in 175

do. treatment of 289

do. ext. nux vomica in 386

Coffee a powerful antidote 357

Coleman, Dr. J no. S., of Augusta. ... 510

Contagious Furunculoid 546

Consumption, climate in 642

Croton oil, poisoning with 65

Croup, diminished frequency of 64

do. early tracheotomy in 162

do. alum a remedy in 386

Cutaneous diseases, their principles

and treatment 139

Currv's Geology of Tennessee 510

Cynanche Tonsillaris, guaiacumin.. 561

Deafness, congenital, marriage of rel-
atives considered a cause of Ill

Death from sunmier dissections 11)2

do. of an aged horse 576

Degeneration of cutaneous warty ex-
crescences 576

Diabetes treated with rennet 626

Digitalis, effects on generative organs 60

do. in bowel atiVctions 386

Discrimination of continued fevers, 12, 100

Disk)cated elboAv, simple m<pde of re-
ducing 495

Doughty, on a case resembling hydro-
phobia 207

Dropsy, hepatic 178

do. nitrate of potash in 496

Dugas, Prof. L. A., valedictory 56

do. on Fractures of the scapula. . 328

Dyspepsia, lactid acid a remedy for. 696

Dysentery, cathartics in 167

do. its nature and pathology 707

PAGE.

Dysentery, chronic treatment of . . . . 109

do. observation on 484

do. bismuth & astringents in, 495

do. creosote in 580

do. nitrate of potash in 769

Early Catamenia, cases of 543

Ecraseurs, death after operation by. 185

do. new 194

Editors, change of 56

Effects of dentition in nursing chil-
dren 20

Electricity in Amenorrhoea 192

Embalming, historj'^ of the art of . . . . 361

Enemata, medicated 316

Epilepsy, a few thoughts on.|. 217

do. treatment of 221

do. cure by cauterization 303

do. theory of. 662

Erectile tumours, treatment of 379

Ergotine in epidemic diarrhcea 570

Erysipelas, lobelia in 130

Eve, J, A., report on diseases of cer-
vix uteri 515, 643

Eve's surgical cases 574, 703

Extra uterine pregnancy 28

Excito-secretory system of nerves. . . 243
do. do. claim admitted in

London 448

do. do. admission 503

Exploration by commotion 385

Eye diseases, sul}>hate of atrophia in 669

Fecundity, renuirkable ,

Fecundation not prevented by hypos-
padia '. . . . 63

Fever, typhus, phosphoric acid in. . . 193

do. water in the treatment of. 592

do. Poisons 630

do. ])eriodic vs. typhus 404

do. continued, discrimination of 12, 100

Fissure of anus, cure without bloody
operation 313

Flesh worm 462

Ford, Prof. L. D., address, notice of.. 57

do. do, Litroductory address

appendix.

Fractures, phosphate of lime in treat-
ment of 129

Frequent micturition, lectures on 531, 608

Galactorrhoea, its treatment 235

Gardner, on Pneumonia 259

Gastrotomy, a case of 238

Generative organs, effects of digitalis

on 60

Glycerine and Tannin in vaginitis. . . 55
do. for preservation of organic

bodies 65

do. and borax in crack'd tongue, 385

do. as a topical agent 428

Gonorrhoea 642

193 ',

INDEX.

773

PAGE,

GonorrliCEa, treatment without speci-
fic medicines 760

Granulations, ergotin to promote. ... 60

Grant, on Ancient Medicines 67

do. on Cutaneous Diseases, <fec. . . 139

Gross' Elements of Pathological Anat 768

Gun-shot wound of hand 401

Gutta Percha, preparation of with
caustic 60

Haematuria after scarlet fever 672

Hall, Dr. Marshall 448

do. do. reply to our letter. . . 501
do. do. claim of Henry Fraser

Campbell, M.'^D 503

do. do. death of 635

do. do. hi^^torv of his case, (fee. 683

Hardy, Dr. J. F. E. ,\ 633

Ilarriss, Prof Juriah 633

Heart, physiology and pathology of.. 48

Hemorrliage, utVrine, ice in 170

Henly's remarkable case of hysterical

convulsions 656

Hemorrhoids, internal 693

HiU'ti treatment of Neuralgia 147

Hip-joint, amputation of 384

Holt, S. D., letters on general path-
ology 195, 387

Holt, Dr. W. J., foreign honors con-
ferred on 575

Homoeopathy 578

do. death of 578

Homoeopathic Hospital, London.... 578
Hooping Cough, treatment by assa-

fcetida \ 382

do. treatment of 493

Hypospadia failing to prevefit fecun-
dation 63

Hydrophobia, a case resembling. . . . 207

do. following bite of dog. . 285

Hysterical affections, age liable to . . 629

Ice in uterine hemorrhage 170

Inflammation and abscess 753

Infant mortality, special reports. . . . 433

Indigenous drugs, collection of 66

Instrument, new. for amputation.. . . 89
Introduction to thirteenth volume. . . 56
Intestinal obstruction, treatment of. . 528

Insanity, uiedical treatment of 562

Intermittent fever, salt in 574

Inverted toe nail, treatment of 45

do. do. treated without op-
eration. . '. 72

Iodide, a new, in secondary syphilis.. 44
Iodoform ."' 130

Kirke's Manual of Physiology 706

Kollock, on vesico-vHginal fistula, 268, 342

Large Intestine, pathology- of 619

Lawson's Theory of Epilepsy 662

PAGE.

Laj'cock's Medical Observation 381

Lectures, clinical, on scarlatina. . 663, 721
do. do. on traumatic tetanus 75

do. do. on dysentery 707

Leeches, application of 62

Letter to Dr. Marshall Hall 243

Ligation of arteries 181

Lilac leaves as a febrifuge 642

Lindsley's Address 189

List of payments 191

Ligature of external iliac 386

Lobelia in erysipelas 130

Ludlow's Manual of Examinations. . . 705

Marriage between relations Ill

Medical Society of Ga., notice of 124, 187

do. do. do 254

do. do. do. minutes of . . . . 317
do. notes & reflections, notice of 190
do. Ethics, letter of advice, (fee. . 677

do. do 698

do. Independent 676>

do. College of Georgia 239 "

do. do. do 575

do. do do. meeting of

board of trustees 380 '

Medicine, a costly 577

Means, A. New instrument 89

do. Thos. A. Paris correspondence, 398

do. do. do. do 399

Measly Pork, its wholesomeness. . . . 412

Memphis Medical Kecorder 576

Meningitis, cerebro-spinal 311

McMath on creosote in dysentery. . . 680

Mellituria, pathology of 660

Milk, easy method of improving di-
gestibility of 758

do. belladonna in arresting secre-
tions of 26

do. diff"erence in composition 192

do. sickness, pathology of 488

Monthly Journals 126

Montgomery's signs, <kc. of pregnancy 634
Morphia suppositories, Simpson's. ... 379
Muscular rigidity in palsied limbs. . . 194

Nfevus, .treatment of 388

New iodide in secondary syphilis. . . 44
Neuralgia, valerianate ammonia in 46, 671

do. treatment of 147

do. facial and dental .... 460, 570

Newton, Professor 380

Nervous fever j)oetry 188

Nitrate of silver in small-pox 37

Nitric acid, remedy in pertussis 122

Nipple, cracked, treatment of 193

Night sweats 450

North Amer. Med. Chir. Review 125

Nux Vomica in constipation 175

do. do. sick headache 386

Obstruction of bowels, various forms 62

774

IKDEX,

PAGE.

Ohio State Medical Society 614

Opthalmia, sulph. of zinc and nitrate

of silver in chronic 641

Operation for strangulated ventral

hernia dm-ing pregnancy 8, 131

Orchitis, lectures on chronic 423

Otto's manual. on detection of poisons 449

Ovariotomy 385

Oxygen, therapeutic use of 677

Pathology,, letters on general. . .195, 387

Paper for, the profession 321

Paris correspondence 398, 399

Pertussis, nitric acid a remedy in 122

Pendleton, on spina bifida 215

Perohloride of iron 22

do. do. as a haemostatic. . . 225

Pessaries, use and abuse of 622

Phytolacca decandra in granular con-

junctivse SS3

Phymosis, new operation for 62

Physician's prescription book, notice ISO
Phosphoric acid in typhus fever. ... 193
Pigment ceils, phenomena iu life of. . 47

Piles, external and internal 384

Platform of So. Med. & Surg. Journal 126
Pneumonia, nature and treatment of 259

Poison, Air 61

Poisons and antidotes 127

Poisoning from chloi-ofcrm 61, 65

do. do. wafers 321

Powell's pocket Formulary, notice of 126

Pork, rav/, as an aliment 230

Prizes for Mass. Med. Society 578

Private libraries 699

Pregnancy, extra uterine 28

do. uncoutrolable vomiting in SO
do. extensive injuries during. 63

do. cause of vomiting in 186

dp. vomiting in, iodine a re-
medy... 193

Prevention of pitting in small-pox. ... 3b

Prof Eve's report 633

Pupil, contraction of, sign of aneur-
ism. 64

Puerperal Convulsions 145

do. do. . chloroform in 464, 490
do. fever, preventive treatment. 315
Pyro-phosphate of iron, therapeutic
employment of 568

Quinine,, epidermic administration of 694

Rea.san's case of spasmodic affection.. 11
do. Lawson's tlieory of epilepsy, 662

Reportof K. Y. Pathological Society, 93
do, of hospitals, dc. in Austria.. 418
do. of D. F. "Wright 602

Retention of urine, chloroform in. . . . 632

Rectum, prevention of bleeding after
operation on 697

Retired Physician 770

PAGE.

Bigidity in palsied limbs, rationale. . 194
Rigby, on treatm't of female diseases, 381

Robin, Dr. Ch. of Paris 770

RossignoL Valedictory 66

Saccharine Diabetes, new mode of
treatment ...

Sea-sickness, chloroform in

Sesqui-chloride of iron in hem.orrhage
Scarlatina, clinical lectures 663,

do. treatment by acetic acid..

Sciatica . .

Scapula, fractures of

Secretion of milk

Small-pox, prevent pilling in

do. nitrate of silver in

do, contagion prolonged

Sore Nipples, treatment of

Southern Jour. Med &Phys. Sciences
Southern Med. and Surgical Journal,

its platform

Spasmodic atfsction

Spiritualism in Eosion

I SpiderBitej plantago major in

j Spina Bifida and Kydri;cepahlus

j do. do :

I Strangulated ventral hernia during
pregnancy .. '.

Strangulated ventral hernia, opera-
tion, recovery

Strictures in urethra, &c

State Med. Society, meeting of.. 240,
do, do. do. proceedings of ...

Stevens, on the effects of alcohol on
the physical constitution

Strychnine, uses and abuses

Supra renal capsules and bronze dis-
ease

Sugar, nutriment in

Summer dis.sections, death from

Suppurating wounds, ligature of arte-
ries in

Sub-carbonate of bismuth ..

Syphiiization S*2l,

Syphilis, secondary, new iodide in . . .

Tannin and glycerine in vaginiiis. ..

Tapping, remarkable case of.

Tape-wor in, treatment of

Tate on the gaseous treatment of in-
testinal obstruction

Tetanus, traumatic

do. do. clinical lecture. ..

iio.

cases of,

Teeth, absorption of roots c:

Thirteenth volume, introduction

do. do. end ol

Toe n-ail, inverted 46

Tongue, wounds of

Tonsil, f.neccion ol

Todd & Bowman's phys. anatomy, &c,

Todd's diseases ol nervous system. . .

do, urinary orgfans and dropsies . .

Treatmenl of continued fevers

561

450

642

721

466

239

323

2o

36

37

62

706

57

125
II

514

761
3?

215

131
150
317

317

451

365

97
129
192

449

625

47G

85
296

528
511

75

!18
377

oG

7t5

5jJ
l'9
f' '9
i -0

INDEX.

776

PAGE.

Trousseau on effects ol dentition 20

do. scarlatina CG3, 721

do. supra-renal capsules, tc. 97

Tracheotomy in croup ; 1(52

Tumours, phantom, of abdomen 291

do. removal ol 577

Tubercular phthisis 371

Tubercle of crus cercbelli 627

Typhus lever, phosplioric acid in 193

Typhoid lever, mercury in 749

University of Louisville, burnt 127

Urticaria 314

Uterine hemorrhage, ice in 170

Uterus, irregular contractions of 183

do. child crying in 194

Vaccination 194

do. secondary eruptions of.. . 367

Vaccine virus, circular 321

Valerianate of ammonia in neuralgia 46

do. do. remedy lor do. 571

do. do. its preparation. . 223

Valedictory of Dugas & Rossignol ... 56

Vaginitis, glycerine and tannin in . . . 55

PAGE.

Varicose veins 382

Veratrum viridc, defence ol 589

Vesico vaginal listnla . . . 34,2C8, 342, 566

Vomiting in pregnancy 30

do. do do. iodine in... . 193

Voluntary contributions 434

Von Itlland, Dr., honors to 65

Walton, on puerperal convulsions. . . 145

Walker, N. S. Flesh worm 462

do. U. G. M. Veratrum viride. . 589

Williams' Principles of Medicine. . . 705

Wilson's Diseases ol the Skin 704

do. Dissector's Manual 768

Whooping cough, path, anatomy of

lungs in 58

do. do. seat and nature. ., . 175

Wholesome bread 642

Womb, displacement of 180

do. singular contractions oi" 183

Wythe's Physician's Dose Book 510

Yellow fever, its relatiou with bilious 3
do do. artificial refrigeration.. 62

I

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i>-i.

Date Due

LIBRARY BUREAU FORM 1137.3

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Southern Medical and Surgical Journal
If.- '5. 13 - 1857