Digitized by the Internet Archive in 2012 with funding from LYRASIS IVIembers and Sloan Foundation http://archive.org/details/southern1857medi SOUTHERN s~4 f?i- 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. ^tSSH^i AUGUSTA, GA: McClFFERTY'S OEFICE-J. MORRIS, PRINTER. 1857. Ct**'^ ^^ ^^ "f^^ < o u >- 111 a z >- < < z O < Z u Z I- >- OQ o Z D O CQ ENLAROED EDITION OF THE SOUTHERN MEDICAL AID SORGICAL JOURNAL VOLUME XIA^.XEW SERIES. FOR 1848. Each Number will contain SEVENTY-TWO Large Octavo Pages, issued regularly every month. TEEMS^THEEE DOLLARS PER AMNUM, IK ADVANCE. THE undersigned, having purchased the Printing Establishment from the estate of his halt-brother, James McCafkerty. deceased, (the late Publisher.) will still continue the Publication of the SOUTHERN MEDICAL AND SURGICAL JOUR- NAL, confidently trusting that its former patrons, and the Physicians of the South, generally, will continue to support it as heretofore. As regards the merits of the Journal, the former Volumes will speak for them- selves. The Editorial Department will still be conducted by Professor HENRY F. CAMPBELL and ROBERT CAMPBELL, M. D., assisted by Contributions from the Medical Facidty, and other eminent Physicians in this and the adjoining States. The Mechanical Depai-tment shall compare favorably with the preceding volumes. The Journal will be regularly published on the first day of every month. It has heretofore contained Sixty-Four Pages, but the undersigned, in order to increase the already respectable list of subscribers, and to answer the demands of the present advanced state of Medical Science, has been induced to enlarge the Journal Eight Pages each month consequently each number will contAin SEVENTY-TWO LARGE OCTAVO IWGES, making a Volume, when bound, of EIGHT HUNDRED AND SIXTY-FOUR PAGES OF CLOSELY PRINTED READING MATTER. In making this exptrusive eidargement of the work, he still retains the old price of subscription Three Dollars j)er annum. To meet the heavy expenses incurred b}^ the undersigned, in the purchase of the office and preparations for the new volume, he would respectfully request subscri- bers to comply with the tei'ins oi payment in advance. The most of the subscribers to the Journal do pay, and those are the persons who have sustained it; their names are registered on the cover every montli. Those who are unwilling to comply with the above reasonable regulations, will please signify it at once. Postmasters are especially requested to return the numbers refused, marked with . the name of the post-office and the person rejecting it. All payments for subscription will be duly acknowledged on the cover. Communications for insertion in the ,k)urnal must be addressed to the Editors. Letters containing remittances for sul^cription, or on business, must be addressed to "J. Morris, Publisher, Augusta, Ga." The names of subscribers and post-offices should be plaiidy written. Advertisements will be inserted at the usual rates of Journals, but must first pass through the hands of the Editors. Reference. The undersigned has been a citizen of Augusta for nearly forty years, and for the last thirteen years engaged on the Mec-hanical part of the above work; yet he is a stranger to I'nost of its patrons, and would refer them to the Faculty of the Medical College of Georsria, at Auijusta. ^ JEREMIAH MORRIS, Publisher. Augusta, Ga., Doc. 1st, 18: I :%im 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 : '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 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\\ 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 evar. 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^ 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 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 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^ . IVL * The ItaUcs are all ours. ^Edts. S. M. 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, 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 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, '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, 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 \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 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- 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 anarietes, 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.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\?> chefl, 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 tamperint 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 " 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. 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. 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 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, 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 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 any 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^ 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, 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 (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 d1Q. 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 prefhate 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, 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, -i. Date Due LIBRARY BUREAU FORM 1137.3 4^ I39e /^ Southern Medical and Surgical Journal If.- '5. 13 - 1857