SOUTHERN

MEDICAL AND SURGICAL JOURNAL.

EDITED BY

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

PROKES-OR OK BPECIAL AND COMPARATIVE ANATOMY IN TBI MEDICAL COLLEGK OF GEORGIA

ROBERT CAMPBELL, A.M..M.D.,

DBMOSrtTRATOB OF ANATOMY IN THE MEDICAL COLLEGE

MEPICAL COLLEGE OF GEORGIA.

YOL. XIV. 1858. NEW SERIES.

AUGUSTA, G A:

J. MORRIS, PRINTER AND PUBLISHER.

1858.

;.*ff

SOUTHERN

MEDICAL AND SURGICAL JOURNAL.

(SEW SERIES.)

Vol. XIV.] AUGUSTA, GEORGIA, JANUARY, 1558. [No. 1.

ORIGINAL AXD ECLECTIC.

AKTICLE I.

A Clinical Lecture upon some of the Effects of Intemperance; de-
livered at the Augusta City Hospital, by L. A. Dugas, M. D.,
aud written out by special request

Gextlemex,

The case of the woman we have just left in a moribund condi-
tion, is well calculated to arrest our attention. This woman,
who now seems to be about 40 years of age, and who presents to
us so lamentable a picture of the effects of vice, is one of the
frail sisterhood, who, having in her youth forfeited her social
position, fled from the parental roof to a den of infamy, and has
been ever since endeavoring to drown her remorse in alcoholic
and other narcotic potations. She was a short time since taken
from a miserable negro hovel and brought here to die and to
be buried at the expense of the city. You may have observe :1
when we first saw her, a few days ago, that she was still able to
speak, although her articulation was slow and somewhat diffi-
cult that she lay upon her back without the power to move
either her limbs or her trunk, but still retaining her sensibility
as well as her mental faculties comparatively unimpaired that
she was not laboring under paralysis, properly so called, but
that she was suffering from a real exhaustion of nervous power
throughout the whole system, which had been gradually pro-
s. VOL. xiv. no. i. 1

4 DuGAS^on Effects of Intemperance. [January,

gressive, and without any indication whatever of local organic
disease. She now appears to be asleep with her eyes half open,
but breathes quietly, and presents none of the phenomena of
apoplexy. She has passed into this state gradually since you
last saw her, and her small and rapid pulse indicates an early
termination of this process of resolution. The energies of life,
long undermined by dissolute habits, have gradually yielded,
and she now dies evidently from mere nervous exhaustion.

It is in the presence of cases like these that the physician re-
alizes in its fullest force one of the evils perhaps, alas, a neces-
sary evil of the social system of refined civilization ; I mean
that which condemns to perpetual infamy the unfortunate female,
who, in a moment of infatuation yields to the designs of an
artful and heartless deceiver ! She soon realizes her dreadful
error, and yet dares not, as she had always done before, appeal
to the parents who would affectionately overlook any other
guilt and endeavor to palliate it for sh* knows that this is an
unpardonable sin, even in the sight of those who gave her birth !
Oh, if she could only be allowed to throw herself upon her
knees, implore their forgiveness, and receive from them even a
look of kindness, she would do so, continue to dwell with them,
and probably lead a virtuous life the remainder of her days.
But, no ; she must fly, or be driven from the midst of those she
loves, and be an outcast among the vilest refuse of society,
where, with a broken heart and lacerated conscience, she natur-
ally seeks relief in the obtunding use of narcotics of one kind or
another! The effects of these are before us we here behold,
however, only one of the sad consequences of intemperance, and,
if you will pardon me for dwelling upon a topic, perhaps trite,
I will take this opportunity to make a few comments upon some
of the evils of intemperance to the individual who indulges in
this vice, to his offspring, and to his race.

I beg leave, Gentlemen, at once to say that I am not one of
those who think that a good cause is ever benefitted by exag-
geration and by positions unsustained by truth. I would not
therefore have you to give credence to the ridiculous stories
about alcohol being found in the ventricles of the brain,
about the spontaneous combustion of drunkards, &c. nor would
I tell you that a moderate and well regulated use of intoxicating

1858.] Dugas, on Effects of Intemperance. 5

beverages is always injurious, when the most casual observation
might falsify the assertion. It is of intemperance I wish to speak,
and not of temperance, and yet, I am free to say, that if a man
cannot drink without drinking too much, he ought not to drink
at all.

There are two forms of intemperance the one periodical and
the other continued. Those addicted to the former will drink
profusely for days or weeks, until the stomach rebels and rejects
the potations, and they cannot take any more. They will then
suffer greatly, mentally and physically, a few da}^s, and gradual-
ly get over their "spree," to resume it again after the lapse of
weeks, months, or even years. This is the most inveterate, the
most incurable form of intemperance. Indeed, I may say that
I look upon such cases as utterly hopeless, for I have never
known a single instance of permanent reformation, in those ad-
dicted to periodical intemperance. The victims of this form are
more violent and uncontrolable, more disagreeable and danger-
ous to society, more subject to delirium tremens, and more
liable to permanent insanity, than habitual inebriates.

The continued form of intemperance is that in which the
individual habitually takes too much ; some will attend to their
business during the day more or less efficiently, and yet be sur-
feited every night others are sober enough to attend to
business only in the forenoon and, finally, there are many
who can scarcely ever be found entirely sober. I recollect a
case in court in which a will was set aside upon the testimony
of the neighbors that the maker had not been sober enough in
ten years to know what he was about ! The will had been
executed six or seven years before his death. And yet this
man lived seventy-five years, and had been intemperate all his
life! I believe it to be a general rule, that the habitually intem-
perate live longer than those who are only periodically so. But
the habitual inebriate is more liable to liver disease, to dropsy
and to rheumatism neither of which affections have I ever
known cured under such circumstances. The periodical drunk-
ard is more apt to be carried off by an attack of mania-a-potu,
or of some other acute disease. "While, with most persons in-
temperance induces more or less of plethora and corpulency,
there are some in whom it produces an opposite effect, and we

6 Du 'GAS, on Effects of Intemperance. [January,

find these pale or sallow, and thin. When it terminates in
dropsy, this seems to be in consequence of hypertrophy of the
cellular tissue of the liver, by which the portal veins are com-
pressed to such a degree as to impede the free passage of blood,
and to cause its undue accumulation in the intestinal canal and
its investing membrane. In such cases the vessels may relieve
themselves by an abundant secretion from the mucous surface,
constituting diarrhoea, or by an exhalation into the peritoneal
cavity, so as to produce dropsy. Either of these symptoms may
be, in general, regarded as the precursor of early dissolution.

Intemperance deeply affects the nervous system of animal
life, as is evinced by the uncertain gait, the tremulous hand,
convulsions, and various painful diseases. But the brain, this
great seat of intellect and of the moral perceptions, reveals its
baneful influence under the forms of mania-a-potu, perverted
reason, and moral depravity. Who has not seen instances in
which the noblest intellect and the most refined sense of pro-
priety have been thus changed into stupid vagaries and knavish *
as well as brutal propensities ? With reason dethroned and the
moral perceptions blunted, the victim drags a miserable exist-
ence himself, and embitters that of all who loved and esteemed
him!

Let us now look at some of the effects of Intemperance upon
the offspring and upon the race. I think it susceptible of easy
demonstration, that the children of an habitual inebriate will
have but little stamina that is to say, that their powers of re-
resistance to morbid influences will be more or less impaired,
and that they will therefore be more liable to disease than they
would otherwise have been ; that they will often be scrofulous,
and occasionally insane, or idiotic. These effects will, moreo-
ver, become more and more apparent the longer the parent has
been a drunkard so that if he have a large family during his
intemperance, the deterioration of his children will be progress-
ive, and the last may be so puny as never to reach maturity,
although the first may be comparatively healthy. Nay, there
are some drunkards, whose own constitution being poor, will
rear a few children, and then lose in infancy or childhood all
those they may subsequently have. Just reflect a little upon
the condition of the families in your respective neighbourhoods

1 858.] Dugas, on Effects of Intemperance. 7

and I think that each one of you will recall to mind some illus-
tration of the correctness of these propositions.

Well, Gentlemen, what is true with regard to the influence of
intemperance upon the oflspring of the first drunken parent,
becomes most painfully so if the offspring himself follow the
example of his father and become also a drunken parent. The
issue of this second generation of drunkards will, in all proba-
bility, be few in number, and their stamina will be so much
impaired that it will be with the utmost difficulty that any of
them can reach maturity. Let us follow this third generation,
and if it perchance also take to the bottle, it will be the last of
that family for I do not hesitate to proclaim it as a law of
almost universal applicability, that three successive gene-rations of
drunkards will leave no issue ! The third generation may have
children, but not one of these will be reared to manhood !
This may appear to you a startling announcement; but I believe
that you will find it based upon truth. As I have long since
entertained these views of the effects of intemperance upon fami-
lies, I would like to adduce some of the evidence I have collect-
ed from personal observation, were it not manifestly improper
to lift the veil from the private history of families who have
passed away. But we can, without the least impropriety, study
the history of families, in connection with that of the race to
which they belong, and if you will bear with me a few moments
more, I will endeavor to illustrate my proposition by a reference
to the sad history of our aboriginal savages.

I need not repeat what you all know that tribe after tribe of
the children of the forest have vanished from before the sun
and still continue to do so with awful rapidity. Why is this
so ? Is there anything in their physical organization that inca-
pacitates them for the perpetuation of their species, or race, if
you prefer the term ? Certainly not. Then, I again ask the
question, why is it so? In order to answer this, let us examine
the influences that have been brought to bear upon this race in
the different portions of our continent, and let us see if they
have suffered equally in these several regions.

America has been colonized by two classes of people : in the
one we find the Spaniards, the Portuguese, and the French ; in
the other the British and their American descendants. Now

8 Dug -as, on Effects of Intemperance. [January,

how have the Indians fared under the dominion of these two
classes ? Under the former they have increased and multiplied
whereas, under the latter they have been annihilated! The
Spanish, the Portuguese, and the French, are temperate people,
and the British and Anglo-Americans intemperate and while
the former have propitiated the good- will of the savages, have
fraternized with them, have civilized and christianized them,
probably as far as their nature will permit; the latter have done
neither, but have, on the contrary, introduced among them their
own vices and intemperance, and driven them from their hunt-
ing grounds to perish like outcasts. Contrast the history of the
Indian in Mexico, with that of the same race in the United
States or even in Georgia. Towards the close of the last cen-
tury the population of Mexico was about four millions, of which
the pure Indian element constituted about two millions. The
population of that Eepublic is now about seven millions, of
whom at least four millions are pure Indians, two millions mix-
ed races, and one million pure castillians. Sixty years ago, one
half of the State of Georgia was peopled with savages and
where are they now? With the exception of a small remnant
of Cherokees and Creeks, who have been driven across the Mis-
sissippi, these mighty tribes have ceased to exist! In South
America, it is highly probable that the Indian population is
fully as great as it ever was, if not greater. Under the French
dominion, the Canada Indians prospered as they do in South
America ; but they have been deteriorating and dwindling away
rapidly ever since the British have acquired those provinces.
Look at the influence of the boasted civilization introduced
by the drinking races among the Sandwich islanders! The
third generation of drunkards is now living there, and it is esti-
mated that in fifteen or twenty years more there will not be left
a solitary representative of that people. The sailor with his
bottle has doubtless had more followers than the missionary
with his Bible in that unhappy land. Look at the dissolute and
drunken habits of our frontier Indians, and you cannot be long
in discovering the true reason of their extinction. The same
baneful influence operates upon the free blacks who seek refuge
in the large cities at the North. The climate, may, it is true,
account in some degree, for the great mortality among them ;

1858.] DtJGAS, on Effects of Intemperance. 9

but intemperance is unquestionably their greatest enemy. The
philanthropist will look in vain for a solution of these stubborn
facts, unless he attribute them to intemperance, the most potent
destroyer of mankind.

I hope, gentlemen, that you will pardon the length of the di-
gression into which I have been insensibly led from the case
under our special consideration, I did not intend to make you
a temperance address but I never see a victim of this awful
propensity, without feeling that something ought to be done to
put a stop to it. I have therefore endeavoured to direct jour
attention in as forcible a manner as I could under the inspira-
tion of the moment, to some of its pernicious effects. You are
destined, I trust, to exert some influence upon the communities
in which you may fix your abode. No member of society has
it more in his power to do good, than the intelligent and moral
physician. The subject before us affords a noble field for the
exercise of enlightened benevolence. Unite your efforts to ex-
tirpate this, as you will do to stay the ravages of other diseases.
Let us look upon intemperance as a disease and treat it as such.
Must it not indeed be a veritable mental derangement, that
would lead a man irresistibly, as it were, to the destruction of
self, of family and of race ? Let us but call it a species of in-
sanity^ and the remedy will suggest itself immediately.

That intemperance is a disease, will, I think, be very general-
ly conceded by enlightened physieians. Like other morbid/
conditions, it may be inherited, or acquired. When derived by
inheritance, the patient may not be so much to blame as when
it is acquired by improper indulgence. It nevertheless, in all
cases, reveals a morbid condition of the brain, not unlike that
which constitutes other forms of monomania. The patient is as
irresistibly impelled to drink, as some monomaniacs are to thieve,
notwithstanding all the influences of education and of other in-
centives to good conduct. Some will say that it is only a
depraved appetite, or a want of proper self control but this does
not change the matter. This depraved appetite, or this inability
to control one's propensities, is a morbid state often as much
deplored by the patient himself, as by his friends. I have fre-
quently heard these patients in their lucid intervals, declare
most solemnly that they would cheerfully give all they possess-

10 DuGAS, on Effects of Intemperance. [January,

ed to gat rid of this dreadful propensity. And I believe that
they were sincere.

But how shall we treat such cases ? Place them in an asy-
lum as you do those affected with other forms of insanity ; and
let them undergo such treatment as may be deemed best adapted
to the restoration of the brain and nervous system to their pro-
per and normal functions.

I am aware that, under existing circumstances, this cannot be
done. We- need legislation upon the subject, before we can
carry out our views; and I can see no good reason why some
men should be sent to the lunatic asylum, and their property be
placed in the hands of trustees, until they be relieved of certain
forms of insanity, while others equally injurious to society, and
unable to manage their affairs, in consequence of intemperance
another species of insanity are allowed to run at large, squand-
ering their estate, embittering the lives of their family, annoying
whole communities, and committing every variety of crime. I
verily believe that a majority of the inmates of lunatic asylums
would be found less dangerous and less annoying to the commu-
nities from which they were sent than any equal number of
drunkards.

I think that the legislature of New York has taken the initia-
tive in chartering a voluntary Asylum for Inebriates. This is
a step in the right direction, and may of itself be productive of
much good. But inebriates ought to be put upon the same
footing as other lunatics. Let a writ of lunacy bring them be-
fore a jury and upon conviction, let them be ordered to the
asylum, and their estate be placed in the custody of trustees un-
til their recovery and I firmly believe that permanent cures
may in very many instances be the result.

The sufferers from intemperance are entitled to our sympathy,
and we should come to their relief, however loathsome they may
be in the sight of the non-professional members of society. Let
us not apply to them degrading epithets and treat them like
brutes ; but on the contrary, extend to them the hand of kind-
ness and the offices of christian charity. It is thus alone that
we may obtain their confidence and become useful to them.

The fact being once established by the legislation of the coun-
try, that intemperance is a disease, and that it can only be treated

1858.] Battey, on Sub- Carbonate of Bismuth. 11

successfully in an institution humanely and properly devised for
this special purpose, much of the odium that now attaches to
this condition, and which might otherwise result from the con-
finement, will be removed. I believe that such a system would
do more good than all our temperance societies. The combined
influence of both, however, would in all probability erase from
our national escutcheon one of its foulest blots. If you agree
with me, let us unite our endeavors to bring about in our re-
spective communities such a state of public opinion as may result
in the legal establishment, in every state, of Asylums for the
Inebriate.

AETICLE H.

Sub- Carbonate of Bismuth. New Mode of Preparation. By Rob-
ert Battey, M. D., of Rome, Ga.

The attention of the Profession having been called to the sub-
carbonate of bismuth in connection with the operose process of
Prof. Hannon, of Brussels, for obtaining it it would seem de-
sirable that a simple and easy mode of manipulation should be
more generally known.

The repeated fusion of the impure bismuth with nitrate of
potassa, to free it from arseniurets and sulphurets, with which it
is usually contaminated, may well be replaced by the simple
solution in nitric acid, and precipitation (as sub-nitrate) by dis-
tilled water. This precipitate, if not absolutely pure, is suffi-
ciently so for all medical purposes it should be well washed
with distilled water. By this process the impurities are oxidized,
and rendered soluble in water, or left behind undissolved by
the acid ; in both cases they are gotten rid of very satisfacto-
rily.

To prepare the sub-carbonate, dissolve the sub-nitrate in a
sufficiency of nitric acid to effect the solution when warmed
decant the clear liquid, and add it slowly to a filtered solution
of carbonate of soda collect the precipitate upon a filter wash
well with distilled water, wrap in filtering paper, and dry by a
gentle heat.

12 Battey, on Subcarbonate of Bismuth. [January,

For the physician, it will be convenient to use the sub-nitrate
which he has upon his shelf. If it be entirely soluble in nitric
acid, without effervescence, and is not clouded on the addition
of a few drops sulphuric acid, it may be esteemed pure ; other-
wise, decant the clear solution and precipitate with distilled
water to render it so.

Eain-water, boiled and filtered, may be used in place of the
distilled water.

A sample of the sub-carbonate, made by the above process, was
subjected to Marsh's test, and found entirely free of arsenic.

[By reference to the October number of the 13th volume of
this Journal, page 625, Mr. Hannon's mode of preparation will
be found. Compared with the above, it is difficult and incon-
venient, only practicable to the regular chemist while that
proposed and effected by our contributor is easily adopted by
the ordinary practitioner, and is therefore, in our opinion, pre-
ferable.

This sub-carbonate of bismuth, if it answers the expectations
which we have every right to entertain from a soluble salt of
this metal, is destined to become a most valuable therapeutic
agent. The insoluble salt, the sub-nitrate, is every day become
ing more extensively and variously applied, and the results of
its action, in a variety of cases, are often very surprising even
startling to the practitioner. Its action, however, is generally
slow, and it is inefficient in many cases on account of its insolu-
bility. "The sub-carbonate is soluble in the gastric juice, its
action is rapid, it produces no sensation of weight at the stomach,
it rarely constipates, colors the stools less than the sub-nitrate,
and may be employed for a long time without oppressing the
stomach. The action of the sub-carbonate appears to be seda-
tive during the first days of its employment, and subsequently
to excite all the phenomena which result from the action of
tonics."

We quote farther, from the article above mentioned, in order
that our readers may have before them, in connection with this
new mode of preparation proposed by Dr. Battey, the whole
amount of facts at present known in relation to the therapeuti-
cal action of the sub-carbonate of bismuth.

1858.] Campbell's Classification of Febrile Diseases, &c. 13

"As to its therapeutical action, it may be noted that all cases
of gastralgia consecutive upon phlegmasia of the digestive pas-
sages, cases in which the tongue is red and pointed, and cases in
which the digestion is laborious and accompanied with putrid
or acid eructations, or in which there is a tendency to diarrhoea
or spasmodic vomiting, demand the employment of the sub-
carbonate of bismuth. This salt is also required in the vomiting
of children, whether caused by dentition or succeeding to fre-
quent fits of indigestion, and in the diarrhoea of weak children,
especially when occurring at the time of weaning. One great
advantage possessed by the sub-carbonate of bismuth is, that it
neutralizes the acids in excess which are found in the stomach.
The sub-nitrate, as is well known, fails always in this respect
In all the cases where the subcarbonate has been taken, the
pain in the digestive passages is first found to disappear ; then
the eructations cease, together with the vomiting or diarrhoea;
the digestion becomes less and less laborious, the tongue gradu-
ally receives its normal form and color ; and if the use of the
subcarbonate is continued, the appetite increases from day to day,
the yellow tint of the countenance disappears, and the face be-
comes colored at the same time as it ceases to be shrivelled.

The subcarbonate of bismuth is perfectly insipid, and excites
no repugnance. It is given before meals. Adults take it in a
little water, and children in honey. It may also be made into
lozenges. The dose for adults is from one to three grammes,
taken three times a day in increasing doses."]

ARTICLE III.

Classification of Febrile Diseases by their Relation to the Nervous
System* By Henry F. Campbell, M. D., Professor of Anat-
omy in the Medical College of Gerogia and Chairman of
Committee on Nervous System in Febrile Diseases.

During the examination of our subject since the time of our
appointment as a special committee, by this Association, we
have been, at each step, more and more impressed with its
importance, and at the same time with the extreme difficulty
attending its full, clear, and thorough elaboration. "A man,"
says Lord Bacon, " must collect facts, in order to know the law

* A partial Report read before the American Medical Association, Nashville,
May, 1857.

14 Campbell's Classification of Febrile Diseases, &c. [January,

of facts ;" diligently and earnestly engaged for the year past, in
collecting and interrogating the facts which have a bearing on
the important subject of Febrile Diseases, in the relation assign-
ed us for examination, we have scarcely had time to do more
than note, here and there, the gleam of truth which has been
evolved during a bare hasty collocation of data ; much less to
determine satisfactorily any fixed law in relation to the vast
subjects involved in the investigation. That such laws will be
recognized, and that the careful generalization of the facts will
be productive of important, fruitful results, we have already
seen enough fully to persuade us. Pleading then the magnitude,
as well as the embarrassments of the subject, we ask of this As-
sociation the previlege of having our special committee contin-
ued for another year, allowing us at present to lay before this
body a few conclusions arrived at, as the result of the investiga-
tion in its present state of progress.

I. As all the normal phenomena of the living organism are
known to occur under the superintending influence of the ner-
vous system, and are dominated by it, so it is but rational to
regard all morbid actions as being more or less influenced in
their manifestations by aberrated nervous action. In that class
of diseases ordinarily designated fevers, our researches and ob-
servations have led us to the confident belief that the above law
applies with sufficient prominence to constitute the basis of their
classification, and we would here respectfully claim for it, that
it is the only reliable basis of their clasification, and further, that
in its more extended application, it will hereafter be found to
constitute what may be called par excellence, the Law of Febrile
Diseases. Simply to assert the recognition of this law, and to
suggest a new and more comprehensive classification of Fevers
based upon it, is the sole object of the present brief exposition.

II. As in the Nervous System, we recognize two grand de-
partments, viz : 1st. The Cerebro-spinal System, all the normal
actions of which are subject to cessations and interruptions ; and
2dly. The Ganglionic System, all the normal actions of which
are of a continuous and ^interrupted character, so in the mani-
festations of febrile diseases, do we distinctly recognize two grand
distinguishing characteristics respectively typifying the normal
actions of these two systems of nerves : thus a character of par-

1858.] Campbell's Classification of Febrile Diseases, &c. 15

oxysm obtains in certain cases, while a character of continuous-
ness as plainly marks the others.

III. Again : as in the Cerebro-spinal System, we find that
its normal action pertains almost exclusively to sensation and
to motion, with only a secondary and comparatively somewhat
remote influence (which we have termed Excito-Secretory) upon
nutrition and secretion, while in the normal action of the Gan-
glionic System the entire function is known to be, to preside
over nutrition and the secretions ; so in paroxysmal fevers do we
find intense pain, modified sensation, and symptoms allying
them to neuralgic and convulsive diseases very prominent,
while in continued fevers, modified nutrition and altered secre-
tion, are the marked and most prominent characteristics. We
would, therefore, announce as our classification of febrile diseases,
two grand divisions of fevers corresponding with the two grand
divisions of the nervous system, thus :

I. Cerebrospinal Fevers.
All Paroxysmal. The secretions und nutrition only seconda-
rily affected.

IT. Ganglionic Fevers.
All Continued. The secretions and nutrition primarily affec-
ted.

I. Under the head of Cerebrospinal Fevers, we would
place the whole family of Paroxysmal Fevers, whatever type
they, may assume,* and also the various forms of neuralgia,
which are nearly always intermittent, as well as the sthenic forms
of Traumatic Fever, together with the Fever accompanying
simple Pharyngitis, Pneumonitis, Dysentery, and many other
diseases of malarial districts.

II. Under the head of Ganglionic Fevers, or Fevers of
the Secretory System of Nerves, we think that we find
ample ground for bringing together many diseases heretofore
widely estranged from each other. Thus, as the archetypal

* The primitive location of these fevers, in the cerebro-spinal system, vras de-
veloped by Prof. L. D. Ford, of the Medical College of Georgia, in the Soulhcm
- rgical Journal, in 1836, and called by Maillot, "Cerebro-spinal
Intermittent Irritations,"

16 Campbell's Classification of 1 diseases, <tc [January,

forms of ganglionic fevers, we place at the head of the list.
phus and typhoid fever,* then, allied to these in various de-
grees of affinity, but all equally, in the one essential element,
that they present themselves as manifestations of disease through the
Gan ^sierra, are variola, scarlatina, rubeola, varicella, and

many other forms of eruptive fevers, heretofore not classified by
nomologists. All of these last diseases are marked by fever of a
nued or non paroxymal character, all present marked aber*
rations of nutrition and secretion, and each has its own peculiar
eruptive character; and, further, each one is definitely self
ted in its duration, as yet, no remedical interference having
been found competent to arrest or shorten their progre-

TTe will here make the remark, that we do not wish to be
mistaken as classifying these diseases in relation to their eruptive
feature, but only as signifying a recognition of the common
influence of the secretory system of nerves in all of them by the
eruption. In typhoid fever itself, it must be recollected that
the eruption is not a prominent feature, and yet, we consider the
secretory system of nerves primarily deeply affected, and place
this at the head of the list, notwithstanding the fact, that the
ganglionic implication manifests itself but little upon, the skin and
mainly in the intestinal canal.f

It may be asked, if all of these fevers are due to aberration in
the innervation of the ganglionic or secretory system of nerves,
why should they present such marked specific differences ? A
satisfactory answer may be given thus : that specificity of mor-
bific cause must rationally be expected to secure a specificity of
morbid manifestation ; thus the virus of variola, when taken
into the system, gives rise to the morbid manifestations peculiar
to smallpox, while the morbific influence (of whatever nature
it may be) of typhoid fever, produces a specific form of disease
entirely different, but not the les3 for that reason, locatable in

* As first developed in an essay entitled: "An Inquiry into the Nature of Ty-
phoidal Fevers, based tepoa a Consideration of their History and Pathology? pre-
sented to the American Medical Association at its Session of May, IS 5.3, by Henry
npbeU, Chairman of Committee on Typhoid Fever. The implication of the
ganglionic system of nerves, in typhus and typhoid fever, has been, in the above
essay, argued at length.

.uiry, <fcc, pp. 53 and 54.

1858.] Campbell's Classification of Febrile Diseases, &e. 17

parts of the organism entirely controlled by the secretory ner-
vous system.

Blending of Types of Fever. Much interest has been
taken by this Association, for the last five years, in the subject
of the Blending of the Types of Fever. We would claim for
the present Pathology and Classification of Fevers, that it is the
only one which admits of any plausible explanation of the mys-
terious phenomena comprehended under the term, "Blending
of Types ;" thus, a cerebro- spinal or paroxysmal fever may as-
sume, under certain circumstances, some of the characteristics
of some one or other of the forms of continued fever. This we
hold can be explained by attributing it to a propagation of the
irritation, originally located in the spinal marrow, to the gan-
glia of the secretory system. Then, again, the reverse may
obtain ; we may find, and do often find, in continued fevers,
especially in malarious districts (whether the case be typhoid
fever, rubeola, or scarlatina.) intermittent paroxysms, interrupt-
ing the even course of the continued, form, sometimes obscuring
the diagnosis, and making it necessary to modify the treatment.
The use of quinine, it is well known, will generally break up
these paroxysms, but not in the least modify the course of the
continued fever. In the first of these cases, the morbific influ-
ence has been "centripetal" and in the second "centrifugal,"
and thus the "blending of types" may be rationally and phil-
osophically explained.

We are aware that, in presenting thus a condensed exposition
on the obsoure subject of " The Nervous System in Febrile
Diseases," without more argument and fuller elaboration, we
are running the risk of being charged with "bare assertion,"
but we will honestly avow that each proposition has been earn-
estly and carefully considered, keeping constantly in view all
the phenomena of febrile diseases comparing them faithfully
with the normal actions of the two grand departments of the
nervous system.

It will be remarked, that we have not attempted to define
what is the exact morbid condition of the nervous centres, or
of the nerves, which gives rise to the phenomena in the two
classes of fever. Such a process of reasoning we have careful-
ly abstained from, because such a discussion would be conver-

18 Indigenous Races. [January,

sant about subjects which cannot as yet be said to have been
brought within the legitimate domain of science. We can only
as yet trace the effects to their causes ; it is a different thing to
discuss the nature of the causes themselves ; and as Professor
Whewell has made a distinction between the Laws of Phenom-
ena and the Causes of Phenomena, so we only here claim to
have recognized a Law, leaving the more recondite inquisition
into the Causes, for a more advanced and enlightened age of
science. In conclusion, we will say, we may have been, in the
above exposition, unfortunately obscure in presenting to others
what has become a clear and well defined conviction to us ; but
in the pertinent language of another,* whose deep philosophy
has charmed us, while it has been of unspeakable service to us
in many of our investigations, we will say, that " to our mind
this doctrine stands firm and impregnable assailable by no
known fact consistent with every established truth."

ARTICLE IV.

Indigenous Races of the Earth ; or a few Chapters of Ethnological
Inquiry ; including Monographs on special departments of
Philology, Iconography, Cranioscopy, Paleontology, Patholo-
gy, Archeology, Comparative Geography, and Natural Histo-
ry : contributed by Alfred Maury, Francis Pulszky, and
J. Aitken Meigs, M. D., presenting fresh investigations,
documents and materials ; by J. C. Nott, M. D., and Geo. K.
Gliddon, authors of "Types of Mankind. Philadelphia:
J. B. Lippincott & Co. 1857. Large 8vo., pp. 655.

Although we have had this volume upon our table for some
length of time, circumstances have prevented an earlier notice
of it. As indicated by the title page, it is made up of contribu-
tions from several writers and we may add, from men of well
established erudition. The first paper is by A. Maury, " on the
distribution and classification of Tongues, their relation to the
geographical distribution of Paces ; and on the inductions which
may be drawn from these relations." The second by T. Pulszky,
being " Iconographic researches on Human Paces and their Art."

* Dr. M'Cosh, on the Method of the Divine Government.

1858.] Indigenous Races. 19

The third by J. A. Meigs, on the " Cranial characteristics of the
Kaces of Men." The fourth by Dr. J. C. Nott, on " Acclimation ;
or the comparative influence of Climate, Endemic and Epidemic
diseases, on the Kaces of Men." The fifth by G. K. Gliddon,
entitled, " The Monogenists and the Polygenists ; being an ex-
position of the doctrines of schools professing to sustain dogmati-
cally the unity or the diversity of the human races ; with an
inquiry into the antiquity of mankind upon Earth, viewed
chronologically, historically and palseontologically." And, final-
ly, the sixth, also by Mr. Gliddon, is a " Commentary upon the
principal distinctions observed among the various groups of
Humanity and on the Geographical distribution of the Simiae
in relation to that of some inferior types of Men." It will thus
be seen that however much these disquisitions may interest the
Naturalist, the contribution by Dr. Nott is the only one which
strictly comes within the domain of medical studies, and should
alone, therefore, occupy our attention as conductors of a period-
ical devoted exclusively to medicine. We may, nevertheless, be
permitted to express our appreciation of the learning displayed
by the other contributors, and although we cannot admit the cor-
rectness of all their views, we derived especial pleasure from the
perusal of Mr. Pulszky's interesting sketch of the history of the
fine arts, as illustrative of national instincts or proclivities.

The following extract will indicate the object of Dr. Nott's
paper : "In the preceding chapters, man has been viewed from
opposite stand-points; and each new group of facts would seem
to lead more and more directly to the conclusion, that certain
distinct types of the human family are as ancient and as perma-
nent as the Faunas and Floras that surround them.

" We propose in the present chapter, to investigate of Accli-
mation ; that is to say, of Eaces in their relations to Climate,
Endemic and Epidemic Diseases ; and if it should be made to
appear that each type of mankind, like a species of animals or
plants, has its appropriate climate or station, and that it cannot
by any process, however gradual, or in any number of genera-
tions, become fully habituated to those of opposite character,
another strong confirmation will be added to the conclusion
above alluded to."

While admitting that man, in common with certain of the

20 Indigenous Races. [January,

lower animals and plants possesses a sufficient degree of " consti-
tutional pliability" to enable him to bear great changes of clim-
ate, the author objects to the opinion entertained by many, that
he (man) is a cosmopolite in the strict sense of the word. The
Jews, who originally inhabited a region in which they were
exposed to cold winters and warm summers, are well adapted
to the dispersion to which they have been subjected, but "the
Eskimau on the one extreme, and the Negro, Hindoo, and Malay
on the other, have no power to withstand the vicissitudes of
climate encountered in traversing the 70 deg. of latitude between
Greenland and the equator. Each race has its prescribed salu-
brious limits. The fair races of northern Europe, below the
arctic zone, of which the Anglo-Saxon are impure descendants,
will serve as another illustration. These races are now scattered
over most parts of the habitable globe; and in many instances,
they have undergone far greater physical changes than the Jews.
The climates, for instance, of Jamaica, Louisiana, and India, are
to them much more extreme than to the Jewish race. The
Israelite may be recognized anywhere; but not so with the
Scandinavian and his descendants in the tropics. The latter
becomes tanned, emaciated, debilitated ; his countenance, energy,
everything undergoes a change : and were we not familiar, from
daily observation, with these effects of climate upon northern
races, we should not suspect the original ancestry of many of
the present inhabitants of hot climates. In these cases we be-
hold, not simply a healthful modification of the physical and
intellectual man, but a positively morhid degradation. The pure
white man carried into the tropic, deteriotes both in mind and
body; the average duration of his life is lessened ; and, without
fresh importations, his race would in time become extinct.
When, however, his descendants are taken back to their native
climes, they revert to the healthful standard of their original
types : the latter may have been distorted, but can never be
lost, except in death", (p. 356.)

The author then refers to the deteriorating effects of climate
upon the English in Hindostan, the Indian Archipelago, Africa,
the West Indies, and South America ; upon the Dutch in Bata-
via and other Indian Islands ; upon the French in Algeria, &c;
in neither of which colonies can the European cultivate the soil

1858.] Indigenous Faces. 21

nor engage in other laborious pursuits with impunity. " The
negro, too, obeys the law of climate. Unlike the white man,
his complexion undergoes no change by climate. While the
white man is darkened by the tropical sun, the negro is never
blanched in the slightest degree by a residence in northern lati-
tudes. Like the quadrumana of the tropics, he is inevitably
killed by cold ; but it never changes his hair, complexion, skel-
eton, nor size and shape of brain."

With regard to the effects of the climate of our Southern
States upon Europeans, we find the following language : " Let
us suppose that a thousand inhabitants of Great Britain or
Germany should be landed at Mobile about the month of May,
and one-third placed on the hills, one-third in the town, and
the remainder in the fenny lands around the latter, and ask
what would be the result at the end of six months. The first
third would complain much of heat, would perspire enormous-
ly, become enervated ; but no one would perhaps be seriously
sick, and probably none would die from the effects of the clim-
ate. The second third, or those in the city, if it happened to be
a year of epidemic yellow fever, would, to say the least, be deci-
mated, or even one-half might die, while the resident acclimated
population were enjoying perfect health. The remaining por-
tion, or those in the fenny district, would escape yellow fever,
but would, most of them, be attacked with intermittent and
remittent fevers, bowel affections, and all forms of malarial or
marsh diseases ; fewer would die than of those in the city, but a
large proportion would come out with broken down constitu-
tions." " In our cotton -growing States, the malarial climate

is by no means confined to the low and marshy districts; on the
contrary, in the high, undulating lands throughout this exten-
sive region, wherever there is fertility of soil, the population is
subjected more or less to malarial diseases. These remarks ap-
ply, as will be seen further on, more particularly to the white
population, the negroes being comparatively exempt from all
the endemic diseases of the South."* (p. 363.)

* A medical friend (Dr. Gordon) who has had much experience in the diseases
of the interior of Alabama, South Carolina, and Louisiana, has been so kind as to
look over these sheets for me, and assures me that I have used language much
too strong with regard to the exemption of negroes. He says they are quite as
liable as the whites, according to his observations, to intermittents and d}'sen-
tery."

22 Indigenous Races. [January,

We must differ with the learned author when he affirms that
negroes are comparatively exempt from all the endemic diseases
of the South. Such is certainly not the case in this section of
Georgia, and in the adjacent portions of South-Carolina, and
Alabama, where every planter knows that his negroes suffer
equally with the whites, annual attacks of intermittent and re- .
mittent fevers, dysentery, malarial pneumonia, &c. We had
occasion a number of years ago, to point out the same error in
the work of a distinguished Southern medical writer, and have
since found these views to be pretty generally entertained by the
physicians on our seaboard. The error seems to have originated
in the fact that negroes are comparatively exempt from fever
upon the rice and cotton plantations of the low-country, the field
of their professional observation ; and this fact had led us long
since to the inference that the low-country fever, is essentially
different from that of the up-country. In the low country ne-
groes become acclimated and comparatively exempt from fevers,
but in the up-country no length of residence, nor even nativity,
affords the least immunity either to the white or to the black
man ; on the contrary, we may safely affirm that the liability to
our fevers are in a direct ratio with the length of time the indi-
vidual has resided in the malarial district, and that natives are
the most susceptible. With yellow fever and perhaps low-coun-
try fever, one attack usually secures immunity from a second :
but with up-country fever, 'an attack one year is almost invari-
ably followed by similar ones the subsequent autumns, and the
oftener it is repeated, the more susceptible does the individual
become. The negroes born and reared upon the plantations of
the middle portions of Georgia and South- Carolina, are fully as
liable to fever as new comers, and, we think, much more so.
We know, from long observation, that in this city (Augusta),
while we frequently see fevers among natives (white and black),
it is exceedingly rare that we meet a case among our Northern
people, who constitute a large portion of the permanent mercan-
tile population. These views are sustained by the mortuary
statistics of this city through a long series of years, published in
the Southern Medical and Surgical Journal (volume for 1836).
The low-country fever, like yellow fever, must then be essen-
tially different from any form of fever in the upper sections of

1858.] Indigenous Races. 23

the Southern States. What constitutes the pathological differ-
ence is yet to be determined, and should be studied by those
who have the opportunity. It is an interesting subject of re-
search, worthy of the attention of some of the eminent patholo-
gists of the sea-board.

When penning the remarks just made, we did not expect to
find the author advocating pretty much the same views a little
farther on. In order, therefore, to do him justice, we shall quote
his own language :

" The fact is so glaring, and so universally admitted, that I
am really at a loss to select evidence to show that there is no
acclimation against the endemic fevers of our rural districts. Is
it not the constant theme of the population of the South, how
they can preserve health ? and do not all prudent persons, who
can afford to do so, remove in the summer to some salubrious
locality, in the pine-lands or the mountains? Those of the
tenth generation are just as solicitous on the subject as those of
the first. Books written at the North talk much about acclima-
tion at the South ; but we here never hear it alluded to out of
the yellow-fever cities. On the contrary, we know that those who
live from generation to generation in malarial districts become
thoroughly poisoned, and exhibit the thousand Protean forms
of disease which spring from this insidious poison.

" I have been the examining physician to several life-insur-
ance companies for many years, and one of the questions now
asked in many of the policies is, lIs the party acclimated?1 If
the subject lives in one of our southern seaports, where yellow
fever prevails, and has been born and reared there, or has had
an attack of yellow fever, I answer, ' Yes.' If, on the other
hand, he lives in the country, I answer, ' No ;' because there is
no acclimation against intermittent and bilious fevers, and 'other
marsh diseases. Now, I ask if there is an experienced and observ-
ing physician at the South who will answer differently ? An
attack of yellow fever does not protect against marsh fevers, nor
vice versa.

" The acclimation of negroes, even, according to my observa-
tion, has been put in too strong a light. Being originally
natives of hot climates, they require no acclimation to tempera-
ture, are less liable to the more inflammatory forms of malarial
fevers, and suffer infinitely less than whites from yellow fever:
they never, however, as far as my observation extends, become
proof against intermittents and their sequelae. The cotton
planters throughout the South will bear witness, that, wherever
the whites are attacked with intermittents, the blacks are also

24 Indigenous Races. [January,

susceptible, though not in so great a degree. My observations
apply to the region of country removed from the rice country.
We shall see, further on, that the negroes of the rice-field region
do undergo a higher degree of acclimation than those of the
hilly lands of the interior. I know many plantations in the
interior of Alabama, South Carolina, Georgia, Mississippi, and
Louisiana, on which negroes of the second and third generation
continue to suffer from these malarial diseases, and where gangs
of negroes do not increase." (p. 376.)

And again : "Certainly, negroes do suffer greatly on many
cotton plantations in the middle belt of the Southern States ;
and I have seen no evidence to prove that negroes can, in this
region, become accustomed to the marsh poison ; and my observ-
ation has been extensive in four States. A question here arises:
Is there any difference in types of those malarial fevers which
originate in the flat tide-water rice-lands, and those of the clay-
hills, or marsh fevers of the interior? I am inclined to think
there is." (p. 381.)

Having already extended this notice of Dr. Nott's able and
interesting paper, beyond the limits we had intended, we must
bring it to a close, by adding the author's conclusions.

" 1. That the earth is naturally divided into zoological realms
each possessing a climate, Fauna, and Flora, exclusively its
own.

" 2. That the Fauna of each realm originated in that realm,
and that it has no consanguinity with other Faunas.

" 3. That each realm possesses a group of human races, which,
though not identical in physical and intellectual characters, are
closely allied with one another, and are disconnected from all
other races. We may cite, as examples, the white races of Eu-
rope, the Mongols of Asia, the blacks of Africa, and the aborig-
ines of America.

" 4. That the types of man, belonging to these realms, ante-
date all human records, by thousands of years ; and are as
ancient as the Faunas of which each forms an orginal element.

" 5. That the types of man are separated by specific charac-
ters, as well marked and as permanent as those which designate
the species of other genera.

" 6. That the climates of the earth may be divided into phys-
ical and medical; and that each species of man, having its own'
physiological and pathological laws, is peculiarly affected by
both climates.

" 7. That no race of man can be regarded as cosmopolite ; but
that those races which are indigenous to latitudes intermediate

1858.] On Scarlatina. 25

between the equator and poles, approach nearer to cosmopolit-
ism than those of the Arctic or the Torrid Zone.

" 8. That the assertion, that any one race ever has, or ever
can be, assimilated to all physical or all medical climates, is a
hypothesis unsustained by a siDgle historical fact, and opposed
to the teachings of natural history." (p. 401.) D.

On Scarlatina. A Clinical Lecture delivered in Paris, by M.
Trousseau. (Translated from the Gaz. Hebdomadaire.) Con-
cluded from page 730, vol. xiii.

We have now come to a more difficult part of the question
to the consideration of that which I have called latent (fruste)
scarlatina.

You know what is meant in archaeology by a latent (fruste) in-
scription; that a greater or less part of it is wanting, a line, a
letter, a point even only remaining. In speaking of pneumonia,
we have seen that that disease could be latent, that often there
was only a word in the symptomatological phrase, and that from
this word alone the physician should find out the whole phrase. It
is with the physician as with the numismatist and archaeologist.
At the commencement of their studies these have to read from
well preserved medals, from stones intact, while the student of
medicine requires that all the symptoms which usually character-
ize a disease should be found in a case which falls under his ob-
servation. After a while, however, the archaeologist only requires
a word, a letter, to be enabled to decipher the effaced inscription.
So it is with the more experienced physician ; he divines from a
single symptom of a disease the whole disease. Of all the latent
diseases, scarlatina presents these desiderata the oftenest.

In 1829, one of my friends told me that scarlatina prevailed in
a little village near Mennecy, in the department of Seine-et-Oise,
and principally in the communes of the Chateau de Villeroy.
Wishing to study this epidemic, I could do it more easily from
the fact that as the chateau was perfectly isolated, the evolutions
of the disease could be easily followed.

I saw individuals of the same family affected with sore throat,
without eruption, and although they remained in the midst of
those who were afterwards attacked with scarlatina, these persons
escaped. Their sore throat was violent, accompanied with high
fever, redness, and desquamation of the tongue. Others, who
were attacked lightly, being slightly unwell for eight or ten days,
sudenly became swollen, and passed blood. Albuminuria was
not known at that period. These facts struck me, and caused

26 On Scarlatina. [January,

me to think these persons having, some of them the eruption and
consecutive anasarca, others the anasarca of sore throat only,
were differently attacked, but that all had the symptoms of scar-
latina.

Three years since at Meaux, an analogous fact came under
my observation, occurring in the same house. A young girl,
fourteen years old, was taken with a violent scarlatina, character-
ized by croupal angina, the eruption, and an intense fever. A
few days afterwards, her sister was also taken sick with the same
symptom ; almost at the same time a chambermaid fell sick ; two
or three days after, a man-servant, who staid in the room the
whole day, was affected with a severe sore throat, with croupal
exudations on the tonsils, redness and exfoliation of the tongue,
high fever, but without cutaneous eruptions. It was clear to me,
as the physician of the family, M. Saint Armand, also thought,
that all these patients had scarlatina, and in fact the man-servant,
although remaining in the midst of the epidemic locality, did not
take the disease with which he had been inoculated in the same
degree as the rest of the family ; while the scarlatinous phase was
complete in the others, in him the inscription was latent (fruste).
There still remained a young boy, six years old. Suddenly, with-
out having been sick a single instant, he became swollen. M.
Blache and myself were called in consultation, and we recog-
nized the anasarca of scarlatina presenting itself at the outset; it
was considerable, and accompanied with haematuria. The father
and mother, who were very attentive to the health of their son,
declared that in the morning he had breakfasted as usual. This
child had neither fever nor eruption, and the disease manifested
itself in time, by the single symptom which we have indicated.
Eight days afterwards he had a double pleurisy, and came near
dying. Called again in consultation, M. Blache and I recognized
this affection ; four days after, we found one of the sides of the
chest cured, while the other had taken on an enormous develop-
ment. We performed paracentesis of the chest, and drew off one
pound and a half of pus. During two to three months, Dr. Saint
Armand made iodine injections into the pleura; notwithstanding
a pulmonary perforation, the child recovered, and is now in good
health.

I have not myself had any cases like these. Graves cited sev-
eral, a few of which I shall translate for you.

"Young F was taken home from school when scarlatina

prevailed. He complained of sore throat upon swallowing, head-
ache, nausea. The next day the tonsils were swollen, and he
experienced a greater difficulty in swallowing. His pulse was
quick,' skin hot, but no traces of eruption. These symptoms
continued three days without increasing in severity, and then dis-
appeared. Before he entirely recovered his two sisters and his

1858.] On Scarlatina. 27

father were attacked. The eruption appeared upon the skin in
his two sisters, and ended in desquamation, while in his father
there were only a few red points upon his skin, without ulterior
desquamation."

"Master O also returned from school with scarlatina.

During his sickness his two sisters and his brother were taken
with the same disease. In all these it manifested itself under the
form of small eruptions, or maculae, upon the skin. At the same
time the man-servant and maid-servant suffered from violent an-
gina, with high fever, which lasted several days."

These facts are identical with those I have myself seen. In
the following, which occurred in the family of a physician, you
will observe that the disease developed itself by anasarca :

" The following case," says Graves, u was communicated to me
by a very eminent practitioner of Dublin. A few years since
scarlatina broke out in the family of this physician, and attacked
all the children, with the exception of a young lady who, although
taking care of her sisters during their sickness, had no symptom
of it. When they were convalescing, the family was sent into
the country for the sake of the change of air, ihe sister who had
not been sick accompanying them. There, to their great aston-
ishment, she was suddenly taken with that peculiar anasarca
which is observed in those who have had scarlatina. Her father,
who took care of her during this sickness, was struck with this
singular fact : he paid particular attention to it, and became con-
vinced that it was a latent scarlatina."

" These cases, and those of which I have already spoken," con-
tinues Graves, "are very interesting in a pathological point of
view ; they tend to prove this fact, that, in many circumstances,
diseases produced by contagion do not present the same series of
symptoms which ordinarily characterize them."

These extracts from the English author prove that the same
things occur in Dublin as in Paris. It is very certain that you
will see these latent scarlatinas ; you cannot, therefore, become
too familiarly acquainted with them. Graves insists upon these
facts as a means of demonstration, and he positively indicates
that these are cases of scarlatina ; for, says he, the disease being
essentially contagious, it would be impossible that those who only
had the sore throat or the anasarca should be alone exempt in the
midst of their family sick with scarlatina, which had attacked all
the rest.

Treatment. The eruptive diseases, whether the eruption
takes place on the skin or upon the internal viscera, as is the case
in putrid or typhoid fever, which is an eruptive disease of the di-
gestive tube, the eruptive diseases have a fatal course ; that is to
say, they have determined phenomena against which we cannot
n.s. vol. xrv. no. i. 2

28 On Scarlatina. [January,

cope with success. In the treatment of these diseases, the physi-
cian should not forget this grand fundamental fact ; that whatever
may be said, he cannot prevent the progress of a putrid fever, nor
can he cut short a case of variola or rubeola. Doubtless, unskil-
ful attention can retard or modify, in a certain manner, the ap-
pearance of the eruptions ; but whatever means may be employed,
art is powerless against the evolution of an exanthematous fever,
whatever it may be. In these diseases, more than any other, the
physician should be minister natural et interpres ; for in these dis-
eases, more than any other, quicquid meditetur etfaciat,. si natural
non obteinperat natural non imperat; his duty, when everything
progresses regularly, should be essentially passive, otiosus crisium
spectator, as Fizer said ; if no severe symptom arises, he has only
to fold his arms; in a few days the disease will have accomplish-
ed its evolution naturally.

When the eruptive fevers become in some particulars men-
acing, our intervention, let us avow it, is generally of little avail.
In some circumstances, however, we can be useful. These for-
tunate circumstances in which art interferes efficaciously, are
more frequently met with in scarlatina and rubeola than in vario-
la and putrid fever.

I shall show you what the physician can do in the first of these
diseases. Above all, it is well to recollect that scarlatina varies
greatly in its form and severity ; that sometimes it is of an extra-
ordinary mildness, sometimes, on the contrary, its malignancy
renders it a terrible disease, the equal of the plague and typhus.
This should be taken into account, for success should not be
attributed to the medication which he may have used, the honor
of which belongs entirely to the benignity of the epidemic itself;
nor should his failures be laid to the treatment wThich could not
prevail against the essentially malignant nature of the disease.

Epidemics can be generally severe for a whole population ;
they can also be severe for a single family. The malignancy can
be circumscribed, so to say, within a small compass ; but in these
cases, it is malignant for almost all those it attacks within the cir-
cle to which it is confined. In this connection I will recall to
your recollection the sad fact, published lately in the English
journals, of scarlatina carrying off, in one week, six or seven
children of a clergyman of York.

It seems that the poison with which those attacked with scar-
latina are infected, has a particular activity, or that the constitu-
tion of each of the patients is disposed in a special manner for
receiving it. Whether the malignancy depends upon the nature
of the disease, upon its epidemic character, as Sydenham and
others say, whether it depends upon the particular constitution
of the individuals, according to the opinion of Stoll, this grand
fact always remains, namely : that when scarlatina breaks out in

1858.] On Scarlatina. 29

a family, with its terrible phenomena, destroying the first it at-
tacks, it is well to mistrust and fear it, for it will probably take
off other victims ; and also when its first severity has moderated,
when it appears from the start benign, it is well to hope, for gen-
erally it will remain benign.

This should be said before entering upon the study of the treat'
ment, in order to put you upon your guard against yourselves. I
cannot repeat it too often that, if the disease is in itself severe,
the best medication will most frequently fail ; if it is in itself be-
nign, recovery will most usually result, and the most inappropriate
medication will not be injurious.

There is a point upon which all epidemiographists agree ; it is,
that the antiphlogistic treatment, bleeding, too energetic purgatives,
and rigorous diet, are pernicious. There is not, perhaps, an au-
thor, I speak of those who have followed, studied, and described
many successive epidemics, who has not established the danger
of this treatment in severe scarlatina, and even when, in the pnv
gress of this disease, acute inflammatory phenomena arise, such
as phlegmons of the tonsils, of the lymphatic ganglions, of the
cellular tissue, that bleeding and leeches do not generally succeed,
probably because they are directed to symptoms of a septic dis-
ease, of a disease of a bad character, mali maris, one of those
malignant diseases in which the antiphlogistic treatment is always
invariably injurious.

Still these epidemiographists, in giving the sad results of their
experience, in condemning the antiphlogistic means of which
they have observed the bad results, these epidemiographists' teach
you that, if the energetic purgatives are hurtful, the milder mer-
curials, the neutral salts, given in a proper proportion, are of real
utility. They say that, under the influence of laxatives which
produce two or three passages a day, the febrile movement will
be most usually moderated. However, they are far from pretend-
ing that the disease is always cured by these means.

We have seen that, in Scarlatina, and particularly when at its'
height, patients seem to succumb to a nervous exaltation, at least
to nervous disturbances, arising either in the centres of organic
life, characterized by an extra ordinary elevation of the tempera-
ture, vomiting, obstinate diarrhoea, or in the centres of animal
life, manifested by delirium, coma vigil, subsultus tendinum, and
convulsions. For these nervous symptoms there is a treatment, the
value of which has been proved by experience, a treatment
which the physician adopts, however, with great caution. I speak
of the cold affusions extolled by Currie.

Currie was the first to recommend their use. He treated a
large number of patients afflicted with the severe form of scarla-
tina, and had considerable success from the use of cold affusions.
Emboldened by his fortunate results, he insisted upon this mod

30 On Scarlatina. [January,

of treatment, and established its application as a general rule in
scarlatina accompanied with severe nervous symptoms, such as
delirium, convulsions, diarrhoea, excessive vomiting, and a high
temperature of the skin.

How should this treatment be applied? The patient placed
naked in an empty bath-tub, three or four pails of water, at a
temperature of 20 centigrade (68 Fahrenheit) are thrown over
his body. This affusion lasts from a quarter of a minute to a
minute, at the longest. The patient is immediately enveloped in
blankets, placed in bed without being wTiped off, and properly
covered ; reaction generally follows in fifteen or twenty minutes.
The allusions are repeated once or twice in the twenty-four
hours, according to the severity of the symptoms. They should
be administered at that moment when the nervous phenomena
assume such an intensity as to excite our fears of imminent dan-
ger; they are to be repeated until these symptoms cease, relieving
the mind of the physician from further cause of alarm.

To suggest in private practice a treatment apparently so bold,
one would have to have grown old in practice, to be beyond the
necessity of being sustained by public opinion. He should be
fortified by a deep sense of duty by a consciousness of doing
well, in order to strive successfully against the popular prejudice,
of all prejudices perhaps the most unfortunate, which demands
that, in eruptive fevers, patients should have warm drinks and be
wrapped in more coverings than they are accustomed to in health.
There is no prejudice, we say, which is more unfortunate than
this ; there is none which more frequently occasions the death of
the patient. Yet the voice of Sydenham, which has spoken for
two hundred years, the authority of the most distinguished phy-
sicians who still object to it, resist in vain.

You understand, then, the difficulties which the young physi-
cian will have to encounter who believes he should have recourse
to these cold affusions. These difficulties are the greater because
it is in the severe cases, where the scarlatina threatens to be fatal,
that the indications of this treatment are found. In adopting this
treatment, you know that the disease gives one chance of recove-
ry to two of death, and you can foresee, if you are not successful,
what will be the opinion of the family afflicted with the loss they
have sustained.

I have employed these affusions for a long time. I tried them
in private practice before adopting them in hospital practice, for
I have never made use of anything there which I had not previ-
ously tried in my private practice. As to these cold affusions, I
can assure you that I have never used them without gaining
some beneficial effect from them. I do not pretend to say that
all my patients were cured. Far from it. I have lost a great
many, but they died notwithstanding the treatment. The affu-

1858.] On Scarlatina. 31

sions, instead of being injurious, seemed to moderate the symp-
toms and retard the fatal termination. By acting in this way in
private practice, my reputation ran great risks, and I have been
often badly recompensed for doing what my profound conviction
dictated; but I remained firm in my course which duty marked
out for me, and I persist in it up to this hour, for a stronger rea-
son than formerly ; for now, my position being established, my
responsibility does not influence me as much. I understand your
fears not that you doubt the advantages of the treatment which
you dare not adopt, but because, while consulting before all the
interest of the sick entrusted to your care, you yet have to watch
over your own reputation, which is so easily affected at the com-
mencement of your career as practitioners. Still, when the voice
of duty speaks to you, when your conscience tells you that this
treatment you dare not adopt because it is contrary to the preju-
dices of the world, is a useful treatment, it is still necessary to try
it, it is right that you should do it. But then, instead of resisting
this prejudice face to face, instead of taking the bull by the
horns if you will pardon me this vulgar expression avoid the
difficulty, by administering these useful cold affusions, leaving the
patient, and especially the attendants, in the belief that the affu-
sions are warm.

Scarlatina, as I have already said, especially in its malignant
form, has, of all diseases, the highest elevation of the temperature
of the body. In some cases. I have also told you. it is as high as
106 Fahrenheit, consequently about six degrees above the normal
temperature. Now, do not make use of the affusion, but of sim-
ple lotions, and with water at seventy-seven degrees Fahrenheit,
that is, 29 less than the temperature of the skin of the patient;
relatively it is cold. Put the patient upon a cot-bedstead and
sponge the body with this water, first in front and then behind, and
then replace him in his bed, wrapped in blankets, as I have already
indicated. Although less efficacious than cold affusions, this kind
of affusion has a positive effect, and following its application, you
will perceive that the skin, which was before very dry and ex-
tremely hot, will become in half an hour cooler and moist. What
is still more remarkable, is the diminution in the frequency of the
pulse. Instead of beating in the infant 160, 170, 180 ; in the
adult 140, 150 ; it falls to 130, 135, 140, in the former; to 120,
115, in the latter; consequently, 30, 35, 40, pulsations less. At
the same time the cerebro-spinal phenomena diminish in intensi-
ty, the vomiting and excessive diarrha?a, symptoms depending
upon disturbances of ganglionary innervation, also diminish.
Thanks to these lotions, then, you obtain, for a short time I grant,
a remarkable sedation. I say for a short time, for in two or "three
hours the symptoms sometimes return, when the lotions, or affusions,
should also be repeated two, three, or four times in the twenty-four
hours, and sometimes five or six days in succession.

32 On Scarlatina. [January,

What becomes of the eruption ? You will observe this fact,
which will surprise the assistants and reconcile the family to the
'lotions, the affusions which they mistrusted; that, almost invaria-
bly, from the beginning of the affusion, the skin, which was pale,
or of a faint red color, becomes more developed. These affusions,
therefore, not only do not decrease the eruption, but bring it out,
so that the parents themselves notice it, and as long as danger
continues, they are often the first to solicit its employment,
unable to refuse to recognize the amelioration which this
method of treatment has produced, particulary struck with the
fact that the eruption reappeared more distinct. Yet, in verity,
if the result of this amelioration is not favorable, if death takes
place, they forget the encouragement they gave you, they accuse
you of the misfortune which can only be attributed to the char-
arter of the disease.

To meet these terrible symptoms of scarlatina, other internal
remedies can be administered with advantage. And first, the am-
moniacals, the carbonate of ammonia, spirits of mindereri, which
is an acetate ammonia, mixed with some empyreumatic products ;
these two medicaments in the dose of \ a drachm to 1 drachm,
ammonia itself in the dose of 10 to 20 drops, can be very
useful. I shall say as much of musk, of which 3, 4J, 6 grains,
and even 15 grains, is given in the course of twenty-four hours.
These means should be used with prudence; they constitute an
accessory treatment in those cases where the cold affusions are
employed ; when they are not employed, they comprise the prin-
cipal therapeutical means.

The angina of scarlatina, which is accompanied with croupy
exudations, when they are not very abundant, is not very dan-
gerous. But in malignant scarlatina the disease attacks the
throat, and generally the physician cannot prevent it.

I have tried cauterizations with nitrate of silver, with chlorohy-
dric acid; I have tried borax in collutories; I have given
chlorate of potassa within, and I must say that all these remedies
have very often failed in my hands. However, of all these thera-
peutic agents, the most to be depended upon, chlorohydric acid,
applied twice a day, has seemed to be of some use. This caustic
is to be used with great prudence and precaution. In children,
during the stuggle to overcome their resistance, you may burn .
the tongue, the teeth, the internal walls of the mouth, and thus
increase the evil without cauterizing as it should be done. By
holding the child properly, and opening his mouth by means of a
spatula, you can sometimes obtain good results from these cauter-
izations, touching the diseased parts twice a day, for five or six
days, with a camel's hair pencil saturated in the acid. Insuffla-
tions of alum and tannin, used alternately, are also very useful.
As to that form of angina which is not observed during the height

1858.] On Scarlatina. 33

of the disease, but comes on suddenly about the ninth or tenth
day, with an abundant exudation from the nose, with deafness,
or severe pain in the ears, foetid breath, frequent pulse, and great
depression, as to that angina which is probably only a diphtheri-
tic complication of scarlatina, it resists all our efforts. All kinds
of treatment which I have tried have failed nasal injection with
styptics, with the solutions of sulphate of copper, of sulphate of
zinc, nitrate of silver, with the decoction of rhatany, with tannin,
the cauterizations of the throat all have failed ; patients almost
invariably succumbing, whatever you do. In these cases you must
Tely upon generous treatment, upon sulphate of quinine, coffee,
and especially upon a strengthening alimentation.

And now of the anasarca of scarlatina and the symptoms
which complicate it. I have already stated that it follows less
frequently the severe forms than the benign eruptions. Often it
constitutes a complication of the greatest importance, in other
cases this complication is not serious. When it is slight, I have
also said that hygienic means, rest in bed, lukewarm drinks, a
moderate diet, is all that is necessary. When, however, the urine
contains blood, acid drinks, lemonade, the decoction of uva ursi,
sweetened with the syrup of turpentine, small quantities of digita-
lis, mild laxatives, will meet these symptoms. But when the
haemorrhage is quite large from the commencement, when the
anasarea increases with great rapidity, it will be necessary to
resort to other means to prevent the threatning symptoms.

Sulphuric acid given internally either pure or in alcohol (eau
de rabel), in the dose of \ a drachm to \\ drachms a day, in a
draught sweetened with syrup of rhatany, will be found useful
when the haemorrhage is abundant.

The anasarca which comes on rapidly and in a great degree,
is ordinarily accompanied with convulsions, which sometimes
destroy the patient with the first attack. Energetic purgatives
are, in these cases, useful, by causing a part of the serum effused
into the celular tissue to be thrown out upon the surface of the
intestine. It is also important to place the lower limbs of the
patient hanging over the side of the bed, and the head raised by
pillows. By this means imminent convulsions may be prevented.
But in some cases these convulsions are present from the begin-
ning, coming on without giving warning of their approach. The
patient complains of a severe headache, difficulty in the sight,
upon one side alone or both together, sometimes ringing in the
ears and deafness. In these cases, scarifications of the inferior
extremities may be of advantage. What is sometimes better, in
attaining the same result, is the application of very large blisters
upon the legs, and not upon the thighs. After seven or eight
hours, phlyctenne will be formed, and when they are opened
serum will flow abundantly from them, relieving the patient, and
enabling him to pass the crisis of his anasarea.

31 On Scarlatina. [January,

If the convulsion takes place, give, during the attack, mush in
connection with small doses of belladonna. For a child eight or
ten years old, musk, in the dose of from 3, 4, or 6 grains ; bella-
donna in that of one-tenth of a grain for a single dose. At the
same time you should make use of a means I have employed
for more than twenty years, and from which I, as well as other
physicians, have experienced great service : I speak of the com-
pression of the carotids. This compression requires to be carefully
made, and in a certain manner. When the epileptiform convul-
sion predominates upon one side, the compression should be
exercised upon the opposite side. If, then, the convulsion be
predominant upon the right side, it is the left carotid which should
be compressed, and reciprocally if the convulsion be predominant
upon the left side the right carotid should be compressed. If the
convulsion be equilateral the compression should be alternately
produced upon the two carotids, I speak, be it well understood
of the primitive carotids and even simultaneously upon both,
if it is possible to do so without interfering too much with the
respiration of the child.

This compression is easier to perform than you would suppose.
Place yourself so that the right hand can compress the left
carotid, and the left hand the right carotid ; push aside the sterno-
cleidomastoid muscle, while with the back of the ungual phalanx
you push aside the trachea, and you will feel the beatings of the
carotids. Seizing it, then, from within with the ends of the
fingers, carry it backwards a little and press it against the verte-
bral column. You will instantly perceive that it is compressed,
by the absence of pulsation in the corresponding temporal artery,
by the paleness which sometimes suddenly succeeds to the previ-
ous redness of the child's face, and again by the fact that in some
fortunate cases the compression is no sooner established than the
eclamptic convulsion ceases. Continue this compression upon
one of the arteries for fifteen to twenty minutes, then compress
the other. If you have an aid that can assist you, his assistance
will be useful to you in this operation; the mother, whose solicitude
renders her so intelligent, can replace you. By this means, having
patience, the convulsions accompanying the anasarea of scarlatina
can be arrested, in a certain number of cases, in a few hours.

There still remains that form of anasarea which if it becomes
chronic, can be relieved. When the convulsions, which are so
often mortal, have ceased ; when the hematuria, which precedes
or accompanies the anasarca has passed, give the patients diure-
tics, nitrate of potassa principally, in connection with small doses
of digitalis, give also a remedy prescribed by Graves, the iodide
of potassium in large doses.

In some cases the anasarca and the albuminuria, which are
ordinarily cured in fifteen days, three weeks or a month, can be-

ISoS.] Artificial Rupture of the Amniotic Sac. 35

come the commencement of Bright's disease. The acute symp-
toms disappear, the albuminuria persists ; if it persists a month
or six weeks after scarlatina, beware of this symptom: it indi-
cates the commencement of Bright's disease ; the kidney is infil-
trated with fibroplastic tissue, after six weeks the fatty element
predominates, and a few months later the patient succumbs to
this new afFection.

Finally, there are a few more serious symptoms which are
developed in this last period of scarlatina about the same time as
anasarca. They are the serous effusions of the pleura and peri-
cardium.

For these the repeated applications of fly-blisters, and if the
hydrothorax or the hydro-pericarditis is very great, puncture
may be useful.

In large pleural effusions, thoracentesis sometimes becomes
necessary after a very few days. But often, as I have already
observed, with the first puncture, even when the effusion has not
existed more than ten. fifteen, or twenty days, you will find a lactes-
cent serum, sometimes pus, already formed. Then you have
empyema, a formidable complication, which you can frequently
cure in young persons by puncture, and repeated iodine injec-
tions ; but which, in adults, notwithstanding these means, you
will rarely cure. [American Med. Monthly.

Artificial Rupture of the Amniotic Sac during Labor. Objections
to the Practice. By B. F. Richardson, M. D., Adjunct Pro-
fessor of Obstetrics and Diseases of Women and Children, in
the Medical College of Ohio.

[The above being a subject of much interest, we present to our
readers Dr. Richardson's second paper, from the Western Lancet^

In the last number of this Journal, quotations were made from
numerous standard obstetrical authorities, which, directiy and
by fair implication embody the doctrine, that the amniotic sac is
the only proper and efficient agent in the production of dilatation
of the os uteri ; that after it is well dilated, or dilatable, there
remain no important objections to rupturing the membranes ;
and that, therefore, it is undesirable to maintain the integrity of
the amniotic sac beyond that period. At the conclusion of that
article we promised to show, " that one of its most important
- remains unfulfilled until the presenting part has passed
through the superior strait ; and that in all natural, uncomplica-
ted labors, especially primipera, the membranes should not be
ruptured at any time."

If this proposition can be sustained by argument and numer-

36 Artificial Rupture of the Amniotic Sac. [January,

ous facts, the inference is patent, that the views entertained and
inculcated by obstetrical writers generally, in regard to the office
and treatment of the amniotic sac, are well calculated to serious-
ly mislead those who exercise their memory more than their
reason. He who conceives of no objection to the rupturing of
the membranes after the os uteri is well dilated, will, almost
certainly, rupture them, in expectation of exciting more vigor-
ous uterine contractions.

Perhaps, on no other point connected with obstetrics has there
been so much misinterpretation of facts, assumptive reasoning,
and erroneous conclusions, on the part of writers, as in regard to
the mechanism and phenomena of the first stage of labor. As
the views entertained by Professor Murphy on this point are in
accordance with those of most writers, and as he has elaborated
the argument through which these views have generally been
derived, a review of his positions will be appropriate, in the
course of my remarks.

Is the amniotic sac the only proper and efficient agent in the pro-
duction of dilatation of the os uteri ?

Are there any important objections to rupturing the membranes
after complete dilatation of the os uteri has taken place f

The discussion of these questions will embody the answer to
the first : Is it desirable to maintain the integrity of the amniotic sac
during labor?

Prof. DeweeSj by an ingenious argument, attempts to show
that, ordinarily, the amniotic sac has nothing to do in the pro-
duction of dilatation ; but unfortunately he admits, in part, that
which he undertakes to disprove ; and moreover is guilty of
palpable inconsistency. At the conclusion of paragraph 515, he
writes: " but in this admission, let it be recollected that I con-
sider the waters as useful by their equal pressure upon the lower
part of the uterus, and by distending, and at the same time, by
the same agency, weakening, the circular fibres of the part, and
thus indirectly favoring the dilatation of the mouth of the ute-
rus." Now turn to paragraph 518. " When the os uteri does
dilate, it is not by its edges being stretched mechanically ; it is
an absolute inability in the circular fibres to maintain a state of
contraction, and, for the time being, may be considered as par-
alyzed; or excessively fatigued; or, perhaps, more properly
speaking, it is the relaxation of a sphincter not subject to the
control of the will." Where a proposition is faulty, the reason-
ing is apt to be illogical. This gifted and lamented author was
endowed with a spirit of controversy to an extent that some-
times led him into the adoption and support of views, which his
acknowledged powers of argumentation were insufficient to
sustain. However, in attempting to exclude entirely, the amni-
otic sac as a usual participant in the dilatation of the os uteri,

1858.] Artificial Rupture of the Amniotic Sac. 37

he assumed a task perhaps not more difficult than that of Prof.
Murphy, who undertakes to demonstrate that it is the only pro-
per and efficient dilating agent.

We have heretofore stated that the argument and assumptions
of Prof. Murphy involve "a total disregard of well known hy-
drostatic and mechanical laws ; and that he takes the position
" that the amniotic sac is a better dilator of the os, than the
smooth, round, and comparatively unyielding vertex." At page
55, commenting upon the argument of Dewees, he remarks :
" It would make the membranes not only useless as a means of
dilatation, but rather a difficulty in its accomplishment. The
head of the child, directly applied to the cervix, would over-
come the resistance of the circular fibres much more efficiently
than the liquor amnii, so that the most favorable kind of dilata-
tion would be that which occurs when the membranes are rup-
tured at the commencement of labor. It is very well known
that this does not happen ;" and after giving Dewees' explana-
tion of the difficulty, proceeds : " But in place of the waters, there
is the large, round, and unyielding head of the child forced down
upon the lower part of the uterus, which one would suppose
more efficient for the purposes of mechanical distension." Ac-
cording to the opinion of Dewees, and not his own, as we may
fairly infer. Again, at page 50, "If the uterus exerted its fuU
power upon the un dilated os uteri, and if the unyielding head
of the child were driven forcibly against it, the almost certain
consequence would be, that the irritation would excite increased
resistance, and ultimately terminate in inflammation of the
mouth of the uterus. To obviate such an effect, nature interpo-
ses a fluid medium between the power and the resistance. The
liquor amnii contained within the membranes, occupies the
cavity of the uterus, and when its parietes contract upon it, the
force exerted is (as we have explained) by this means, accurate-
ly conveyed to the os uteri. When the latter dilates in the
slightest degree, the fluid insinuates itself within the smallest
opening, and expands it by a direct lateral pressure against its
edges. The power of the uterus is thus made to act in the most
favorable manner for distending its mouth."

On same page, he says: " Further, so long as the tissue of the
uterus intervenes, it is necessary to moderate the great power
which the uterus is capable of exericising to dilate it : this is
effected by the liquor amnii." Again, on page 108 : " The gra-
dual escape of the liguor amnii also gives rise to tediousness. If
this take place when the os uteri is slightly dilated, in other
words, when the latter is so long exposed to the pressure of the
head of the child as to become irritated by it, the result is rigidi-
ty of the os uteri, etc." On page 55 we also read: " If they are
ruptured when the dilatation is very slight, the suddenly in-

38 Artificial Rupture of the Amniotic Sac. [January,

creased power of the fundus, forcing the head of the child against
the os tineas, soon excites irritation, prevents its expansion, and
sometimes causes inflammation. But if they are broken when
the uterus is sufficiently open to allow the membranes to protrude
into the vagina, and the contractions of the fundus to increase,
it is probable that the dilatation will be advanced more rapidly,
etc." This last quotation contains its own refutation. I have
been thus copious in my citations, for the reason, that they em-
body the views of all authors within my knowledge, Dewees
excepted.

Now, what inferences are fairly deducible from the foregoing
quotations ? I shall state and answer them as I proceed : First-
ly, the amniotic sac is the essential agent in the production of dila-
tation of the os uteri, producing it uby a direct lateral pressure
against its edges." The fact, that in a fair proportion of multi-
paras labors, the uterine orifice opens readily and to some con-
siderable extent, before either the head or membranes have
engaged within it, is fatal to this theory. Further, it is a well
known fact to those who have made careful observation, that
occasionally in multiparas labors, where, from fragility of the
membranes, the liquor amnii has been evacuated early, and be-
fore the head has descended sufficiently to press upon the os ;
enlargement of the orifice proceeds without interruption.

There are three agencies concerned in the production of dila-
tation. Firstly: and essentially, contraction of the cervico-
fundal fibres acting upon the circle of the os uteri through their
free extremities. Secondly, a body (the amniotic sac or presen-
ting part) over which to retract the border of the os ; and, Third-
ly : pressure by descent of the amniotic sac, or presenting portion
of the foetus.

Secondly : The amniotic sac is a more efficient dilating agent
than the vertex, for the reason, that the force exerted by the uterine
contractions is " accurately conveyed to the os uteri'" tuhereas the
same force transmitted through the vertex, would " soon irritate" the
os, and " prevent its expansion." Here we have groundless as-
sumption, misinterpretation of facts, and erroneous conclusions.
By what law of mechanics does a yielding body like the am-
niotic sac, become a more efficient mechanical dilator than a
solid body like the vertex ? If the force of the contractions is
(as is asserted) accurately conveyed to the edges of the os uteri,
the membranes being non-distensible, and therefore unable to
absorb any of the force why is the amniotic sac incapable of
irritating and inflaming the os and arresting its dilatation, no
matter how great the power exerted by the uterine walls ? Can
the vertex do more than transmit this force to the edges of the
os uteri ?

Again, it is assumed that the whole force of the uterine con-

1858.] Artificial Rupture of the Amniotic Sac. 39

tractions is accurately conveyed by the amniotic liquor to the
edges of the os uteri, as soon as the latter is opened in the
" slightest degree." Now, the exact measure of force which the
liquor amnii is capable of conveying to the edges of the os uteri,
is determined by the force which the "unsupported membranes at
the orifice are capable of sustaining. Who can suppose for a
moment, that these frail membranes can support the whole
power generated by vigorous uterine contraction ? Let us take
even Prof. Murphy's own statement, when combatting the argu-
ment of Dewees, in regard to the antagonism of the circular and
longitudinal fibres : " but how the membranes could resist the
effect of this struggle it would be difficult to understand, when
we know that change of position, walking across the room, or
other such trifling causes, are sometimes sufficient to rupture
them, from the gravitation of the fluid alone, and therefore the
greater force arises from the action of the fibres of the uterus
against each other, must break them more frequently than what
we know to be the case." Prof. Murphy therefore supposes, that
antagonism between the vertical and transverse fibres, imparts
to the liquor arnnii, greater force, than when they contract con-
jointly. Such a view evinces a defective knowledge of hydros-
tatic laws. The simultaneous contraction of all the uterine
fibres, will distend the membranes at the orifice more forcibly
than any partial contraction possibly can.

Further, it is assumed, that when the amniotic sac is prema-
turely ruptured, it is replaced by the vertex, which transmits
the power of the uterine contractions to the os uteri, thereby
irritating, and rendering it rigid and unyielding ; and the con-
clusion is, that the tediousness of delivery, and apparent change
in the condition of the os uteri, which usually attend this acci-
dent, are attributable to the alleged fact, that the vertex is in-
capable of dilating the os as efficiently as the amniotic sac. I
have dwelt at length on this point, as the most important con-
nected with our discussion ; and an exposition of the mechan-
ism and phenomena of the first stage of a primiperoa labor, will,
I think, show wherein obstetrical writers have been led into
fallacious reasoning, and false conclusions, by the oversight and
misinterpretation of facts. At the commencement of labor, and
before the os uteri begins to open ; we find the child occupying
the uterine cavity, with its pelvic extremity in contact with the
fundus, and its head resting upon the pelvic brim, presenting
the occipitofrontal diameter more or less modified, the liquor
amnii filling up the inequalities. As the contractions continue,
the liquor amnii is displaced in that direction in which there is
least resistance the inferior segment ; for it is a well known
fact, that the muscular tissue diminishes in quantity, and there-
fore, in power, from the fundus towards the orifice. Whilst the

40 Artificial Rupture of the Amniotic Sac. [January,

inferior segment is undergoing distension by the downward pro-
jection of the liquor amnii, the superior portion of the cavity is
lessened, and the walls of the body and fundus permitted there-
by to apply themselves more closely upon the child. Then,
as the cervix continues to dilate, and the os begins to open,
further descent of the liquor amnii is allowed; so that the pro-
portion of the uterine force transmitted to the pelvic brim,
through the body and head of the child, increases step by step:
As the os continues to open, and the membranes are more and
more exposed to rupture from diminishing support inferiorly,
the increasing contractile power of the uterus would certainly
rupture them, were it not that, as the labor progresses, the pro-
portion of force transmitted to, and extended upon the pelvic
brim, through the child, is gradually increased. This is a wise
provision of nature, for if the undivided power of the uterus
should be exerted upon the unsupported membranes at the
orifice as alleged by Prof. Murphy and others, rupture of them,
unless preter naturally strong, would be inevitable at an early
period of dilatation, in a large majority of first labors. As the
labor progresses, the uterine walls are applying themselves more
firmly upon the child, during each contraction, and the head is
being flexed, so as to bring its smallest circumference in relation
to the superior strait. Now suppose that at an early period of
dilatation, and before flexion of the head has proceeded to any
considerable extent, the amniotic sac is ruptured, either from fra-
gility of the membranes, or interference on the part of the medi-
cal attendant; what results? Usually, abnormal protraction of
delivery, and injury to the child and mother proportionate to its
duration. The cervical segment being relieved from distension,
by the evacuation of the liquor amnii, retracts by its elasticity,
and applies itself closely upon the presenting part, and does not
come to be pressed upon until the head is completely flexed, and
its sub-occipito-pregmatic circumference is passing through the
superior strait. When the head is of due relative size, this step
in the mechanism is never attained in the early period of dilata-
tion, unless the cervical tissue is preternaturaily unyielding. I
therefore venture to assert that the statement of obstetrical wri-
ters, Prof. Murphy included that the ruptured amniotic sac
is replaced by the vertex, which, by pressing upon the os uteri,
irritates and renders it unyielding, thereby causing the tedious-
ness which usually results where the liquor amnii is early evacu-
ated ; is entirely and radically erroneous. Further, it is a mere
assumption to assert, that when the vertex, (covered by the soft,
well lubricated scalp,) does come to press upon the os, it will
irritate, inflame, and render it unyielding ; for when in the pro-
gress of labor, the occiput descends, it will dilate the orifice as
favorably and as rapidly as the other unfavorable conditions

1858.] Artificial Rupture of the Amniotic Sac. 41

will admit. Again, the theory implies that the delay will termi-
nate with the full dilatation of the os, whereas it is a fact, that
the delivery is delayed at evey step throughout, by the two early
evacuation of the liquor amnii. We have heretofore stated, that
at an early period of dilatation, the head is but imperfectly
flexed, and is not yet so adapted to the pelvic orifice as to pre-
vent the outflow of liquor amnii, produced by the recurring
"uterine contractions. Complete flexion, and adaption of the
sub-occipito-pregmatic circumference of the head to the pelvic
brim, is by far the most tedious step in the mechanism of a
primiperae labor ; usually requiring many hours for its accom-
plishment. The liquor amnii being thus gradually and com-
pletely expelled, the uterine parietes are permitted to close upon
the unequal surface of the child. The circular fibres of the body,
meeting with the least resistance, contract upon and constrict
the abdominal region of the foetus. Each succeeding contrac
tion increases the constriction, until the compressed part be-
comes as resisting as the other portions. The child can only
be expelled from the uterus by being made to glide upon its inner
surface, and anything that militates against this process, will
retard delivery proportionately. Now, as the resistance of the
presenting part, conjoined with the resistance of this constriction,
must be overcome by the contraction of the cervico-fundal fibres ;
the true cause of tediousness is at once made manifest ; for the
amount of power absolutely lost, is exactly equal to that which this
constricted portion of Hie uterus is capable of exerting. And this
relation of the uterine parietes will, at least, be partially main-
tained at every subsequent step of the labor, until the head is
delivered ; thereby causing abnormal delay throughout.

Through the foregoing explanations, it will be perceived,- that
protraction and injury are liable to result, whenever the liquor
amnii is evacuated before the head is properly adapted to the pelvic
orifice, no matter what degree of dilatation may have taken place.

We have thus undertaken to show, " that one of its most
important uses (the amniotic sac) remains unfulfilled until the
presenting part has passed through the superior strait ; and that
in all nutural, uncomplicated labors, especially primiperae, the
membranes should not be ruptured at any time."

In case of actual inertia, the practitioner must exercise his
judgment, in view of the conditions present; but rigidity of the
membranes can in no way impede the descent of the presenting
part through the pelvic brim. Therefore it is my deliberate
opinion, derived from careful and extended observation, that
rupture of the amniotic sac, especially in primiperae cases, before
the head is properly adapted to the pelvic orifice; is injudicious,
and generally injurious, and sometimes fatal, especially to the
child, in its results. For, the altered condition of the uterine

42 Cathartics in Dysentery. [January,

sinuses and the placenta, consequent upon prolonged and undue
retraction of the uterine parietes, in conjunction with the violent
pressure to which the infant is subjected; are well calculated
seriously to impair the child's viability, even though it may be
born alive.

There are other and important objections to rupturing the
membranes, even when the os uteri is well dilated. Who knows
at what period of a labor eclampsia may occur? Version may
be desirable, but difficult and dangerous if the waters have been
long evacuated. The same may be said in regard to rupture of
the uterus. So also, of haemorrhage ; the first expedient being
rupture of the membranes, the next, version.

In conclusion : as it is difficult to estimate in a given case of
labor, to what extent its bad results may be fairly attributable
to improper management, we may feel disposed to rest satisfied
with our preconceived ideas and modes of practice. Let us,
however, be reminded of the statistical fact, established by the
observations of Burns, Collins, JNTagaele, Simpson and others ;
that the liability to injury and death, upon the part of the mother
and child, increases proportionately with the duration of labor.

Cathartics in Dysentery. By 0. C. Gibes, M. D., Frewsbury,
New York.

At the meeting of the Buffalo Medical Association, Sept. 2d,
1856, as per report of proceedings in the October number of
the Buffalo Medical Journal, a discussion took place in regard
to the propriety of using cathartics in dysentery ; also the kind
of cathartics best calculated to fulfill the indications in that dis-
ease. As this question is fairly before the readers of the Jour-
nal above mentioned, we suppose it is open for the expression
of opinion or experience, by any of its many readers. Hence
we give expression to a few thoughts, based partially upon our
individual experience, and partially upon the generally received
opinions in regard to the nature of the affection under consider-
ation. A knowledge of the nature or pathology of any disease,
is, perhaps, the surest guide to the appropriate indications of
treatment. The public generally, are apt to look upon all
diseases accompanied with frequent evacuations from the bow-
els, as similar at least, if not identical in character. Physicians
themselves are not always free from this vagueness of nomen-
clature. In muco- enteritis, as well as milder forms of mucou9
irritation, each case is accompanied with a diarrhoea or frequent
alvine evacuations, and the public generally do not discriminate
between such cases and dysentery, and we have seen physicians
not unfrequently, if not guilty of the same error in diagnosis,

1858.] Cathartics in Dysentery. 43

at least of the same vagueness of nomenclature. Dysentery con-
sists in an inflammation of the mucous membrane of the colon
and rectum, and, though the evacuations may be over in ten
minutes, yet, except it may be in the incipiency of the disease,
they are not fcecal, but consist almost wholly of mucous and
blood. Hence, though the griping pains in the abdomen and
the tenesmus may be never so great, though the characteristic
muco-sanguineous evacuations may be never so frequent, or the
straining at stool never so persistent, the case may be accompa-
nied with obstinate constipation. The public generally look
upon the frequent bloody evacuations as constituting the whole
of the disease, and, consequently, urge the importance of power-
ful astringents, which, if unadvised by the attending physician,
they sometimes clandestinly and injuriously bring to bear upon
the disease. But the physician who resorts to them, to the ex-
clusion of evacuants, will certainly have no reason to boast of
his success.

Permit us to say, that we do not propose to discuss the nature,
cause, or symptoms of dysentery, nor to enter into full details
of treatment. We propose only to make a brief expression of
our opinion, upon the question under discussion, viz : the pro-
priety of cathartics in dysentery.

Some authorities have condemned the use of evacuants in
dysentery, on the ground of their supposed irritating influence
upon the inflamed mucous membrane. But we feel confident
that, when the evacuant is judiciously selected, and repeated
with due discrimination, and with proper adjuncts, its irritating
influence is more fancied than real. The object of the cathartic
seems, at first, to be to free the bowels from irritating secretions,
and the object of their repetition is, conjoined with the above,
to prevent constipation, which is the inevitable sequence of the
inflammation and consequent fever. A second, and not less
important object to be secured by the evacuant, is to unload the
portal veins, thus diminishing congestion in that important
circulatory system, and to stimulate the capillary circulation in
the liver, which is often sluggish, resulting in a deficient biliary
secretion.

In regard to the choice of a cathartic there has been and is a
great discrepancy of opinion. Some have advised calomel at
first, to be succeeded by castor oil ; others have advised castor
oil from the first. Ehubarb, compound powder of jalap, cream
tartar, epsom salts, rochelle salts, &c., have all had their advo-
cates.

We were formerly in the habit of giving, at first calomel in-
timately commingled with rhubarb and a little pulverized opium,
and afterwards, whenever an evacuant seemed demanded,
gave castor oil with a few drops of laudanum. But recently
2*

44 Cathartics in Dysentery. [January,

we have made choice of a different evacuant, and, so far, have
been much pleased with the change. In the June number of
the Western Lancet, for 1855, Dr. D. B. Dorsey communicated
the result of twenty years' experience with a cathartic mixture,
first proposed to him by Dr. Lemoyne, of Washington, Pa.
Summing up his result he said " in a practice, not very limited,
in the cities of Wheeling, Ya., and Steubenville, 0., in the lat-
ter of which dysentery prevailed as an epidemic twice or thrice
during my residence there, I had the high gratification of seeing
all recover who were treated with this remedy from the com-
mencement of the attack." With this high encomium before us,
we made trial of the combination in the next case that came
under our observation, and with such happy results that, except
in young children, we have used it in all dysenteric cases since,
with success in all cases.

We quote Dr. Dorsey's formula and directions from the paper
above referred to. " Take of saturated solution sulph. magnesia,
seven fluid ounces ; aromatic sulphuric acid, one fluid ounce mix.

" The saturated solution is prepared by dissolving epsom salts
in an equal quantity of water, by weight, at 60 deg. Fahrenheit.
It will be ready for use in eight or ten hours. During that
time it should be shaken occasionally.

''The medium dose of this medicine for an adult, is one table-
spoonful, delivered with two or three ounces of water, every
four to six hours, until it gently moves the bowels. It should
be given regularly, and perseveringly, until the bowels are man-
ifestly under its influence, which will be evinced by feculant
discharges, abatement of tenesmus, and general feeling of relief.
The size of the dose and time of repeating it, must be varied by
the practitioner's judgment, according to many circumstances
of age, violence and stage of disease, &o. Sometimes it will re-
quire two tablespoonfuls of the medicine, every three or four
hours ; at others a teaspoonful every six or eight hours will be
sufficient.

" Accompanying each dose, when the pain and tenesmus are
great, one sixth of a grain of sulph. morph. may be given. But
this remedy, also must be varied, both in quantity and frequen-
cy of repetition, according to circumstances."

We have seldom or never exceeded tablespoonful doses, and'
oftener fallen below that. But instead of giving once in four
or six hours throughout the twenty-four, we have usually com-
menced with it in the morning, to be repeated every three hours
until it operates, always combined with a small quantity of
morphine. This course we repeat every day so long as the in-
dications demand. During the remainder of the twenty-four
hours, we give ipecacuanha with morphine, or such other rem-
edies as the circumstances of the case seem to require. It may

1858.] Puerperal Vomiting. 45

not be amiss to say here that mercurials are incompatible with
the mixture.

The acid doubtless stimulates the capilliary circulation in the
liver, promoting bilious secretion, while the sulphate of magne-
sia relieves the portal congestion and frees the bowels from ir-
ritating secretions. From the relief which speedily follows its
action, to the tormina and tenesmus, greater than that following
any other evacuant, we cannot help thinking the acid has a
direct sanitary influence upon the inflamed mucous membrane.

With young children, where smallness of dose and pleasant-
ness of taste are always considerations of much importance, the
above mixture is decidedly objectionable. The taste is rather
disagreeable, and the necessity for diluting the mixture, renders
the bulk such as no child will readily take. In such cases we
have been in the habit of scorching rhubarb, adding boiling
water and extract of hyosciamus, the dose of such proportion to
the age and condition of the patient, sweetening the mixture
and flavoring with nitre.

This is to be given in repeated doses in the morning, sufficient
to produce a laxative effect, and during the balance of the day
we give hydrargyrum cum creta, in small doses, with Dover's
powders, or such other medicines as the circumstances of the
case may indicate. [Buffalo Med. Journal.

Puerperal Vomiting cured by the Induction of Labor. By Fran-
cis W. Sheriff, M. D., L.K.C.S.E.

Having recently read your article on Professor Cazeau's late
work on the Diseases of Pregnancy, &c, I thought it might be
interesting to some of your readers to relate a case of severe
Puerperal Yomiting which lately came under my care. My
patient, Mrs. Moore, first consulted me four years ago, being in
the eighth month of her fifth pregnancy. She complained of
almost constant vomiting, and had been reduced to great debil-
ity by absolute inanition. A few doses of hydrarg. cum creta
and opium checked the vomiting, and she was delivered of a
healthy child at the proper time. The placenta was retained,
and she had considerable hemorrhage before I reached her resi-
dence, which was about nine miles distant. She became anae-
mic and was confined to bed for nearly three months. She
eventually was quite restored to health, and has not been preg-
nant since until this time. On the 26th of July last I was
requested to visit her. I found her aparently healthy, and robust
looking, pulse natural. She stated that she was in her seventh
month of pregnancy and that since its commencement she had
vomited a great deal, but that lately it had become much more

46 Puerperal Vomiting. [January,

troublesome, and that she was afraid of relapsing into her for-
mer condition, as her bowels were rather costive. I prescribed
the pills and a mixture of chloroform and tinct. lavand. comp.
and at the same time paid great attention to the state of her
bowels. On the 10th of August I was again called to visit her.
She stated that since the 7th, the vomiting had been almost con-
stant, that she retained nothing on her stomach and that she
vomited a great deal more than she swallowed. She complain-
ed of great thirst, pain in the epigrastrium, great anxiety and
restlessness, and was urgently calling for relief. Pulse 120 of
good strength, breath foetid, having the odour of chloroform. I
bled her to the amount of ! viii. without causing fainting, and
prescribed at different times calomel and opium, senna, enemas,
warm applications to the epigrastrium, creosote mixture, &c, but
all of no avail, the vomiting continued as bad as ever. The
swallowing of a little fluid of any kind was almost immediately
followed by great retching and vomiting. The fluids vomited
were colourless and inodorous, and largely exceeded what had
been swallowed. In addition to the medicines prescribed, I
ordered nourishing enemas to be frequently administered.

11th. Symptoms rather more favorable, vomiting not so severe,
and has slept a little, complains more of debility, >skin rather
cool. Has retained a little opium, which she thinks has relieved
her.

12th, 8 a. m. Is much worse, vomiting as bad as ever, ex-
tremities cold, skin wrinkled and withered like a person in col-
lapse of cholera. Has very great anxiety, and calling urgently
for fresh air. Had to get her bed elevated to the height of the
window so that she might have her head in the open air. Pulse
130, weak and variable. As it was evident that death must soon
ensue if relief was not obtained, I determined to bring on labor;
but before doing so, I requested that Dr. Anderson, a neighbor-
ing practitioner, might be sent for. He arrived at 3 p. m., and
agreed with me on the propriety of immediately inducing labor.
I introduced a flexible catheter into the uterus, ruptured the
membranes, and drew off about 8 oz. of liquor amnii. My pa-
tient was relieved almost immediately, and the vomiting ceased.
I prescribed 1 drachm of tincture of Ergot every two or three
hours, supporting her strength at the same time with stimulants
and nourishing enemas. She remained easy and comfortable
all night, and next morning, about twelve hours after the rup-
ture of the membranes, labour pains came on, and continued
regarly all day, but at long intervals. About 8 p. m., I admin-
istered an enema of infusion of ergot, which soon had a most
powerful effect, and within an hour afterwards she was safely
delivered of a living child which cried lustily. It, however,
lived only about eight hours. My patient rapidly recovered,

1858.] Physiology of the Ear. 47

and in two or three weeks was entirely restored to her usual
health. In this case so urgent were the symptoms and so rapid
had been the approach of sinking and colapse, that I had no
doubt that the delay of the operation for a few hours more would
have proved fatal. From the immediate relief experienced after
drawing off the liquor amnii, it would appear as if the cause of
the vomiting had been the pressure of the gravid uterus.

[Medical Chronicler

On the Physiology of the Human Ear. By "W. Kramer of Berlin.

Our knowledge of the physiology of the auditory apparatus
is still very incomplete, partly on account of the difficulty of
experimenting on the organs of hearing, and partly on account
of the imperfection of the science of acoustics. We are happy,
therefore, to record the results of the investigations of Dr. Kra-
mer, (Deutsche Klinik, 1855.) whose vast experience in the
treatment of aural affections is universally known. In review-
ing the researches of his predecessors, this author points out the
impossibility of determining what takes place in the living ear
from experiments on inert matter. His own experiments have
been made upon the ear itself, in the healthy and diseased states.
It would be out of the question for us to reproduce the details
of these experiments ; we must be satisfied with the author's
conclusions :

1. The cartilage of the ear conducts more than a third of the
sonorous waves which reach the membrana tympani.

2. The concha is the most important part of the auricula
cartilage.

3. The cartilage of the ear, in its natural position, simply re-
ceives and conducts the sonorous vibrations to the auditory pas-
sage.

4. The cavity of the auditory passage transmits about 500
times as many undulations as the solid parts enclosing it.

5. The curvatures of the meatus and the cerumen have no
influence on the sonorous vibrations.

6. These arrangements serve to protect the canal and the
membrana tympani from external agents.

7. The membrana tympani transmits the sonorous undula-
tions in due quantity and quality, only while its structure is
normal.

8. The membrana tympani also serves as a protection to the
drum.

9. The ossicula have but little agency in transmitting the
vibrations of members of the membrana tympani to the laby-

48 On Rheumatism, &c. [January,

rinth. Their office is rather to support the membrane between
two strata of air.

10. The membrane of the fenestra rotunda is designed espe-
cially to transmit to the labyrinth the vibrations of the tympa-
nal cavity.

11. The mastoid cells are of trifling acoustic importance.

12. The Eustachian canal is an open tube. (Dr. Toynbee
had announced a contrary opinion.)

13. Through this tube the air of the tympanum is renewed,
and the sero-mucous secretion of that cavity eliminated.

14. Hearing is not entirely destroyed by the absence of the
fenestra rotunda and the loss of the liquor cotunnii. [lb.

On Rheumatism oftlie Epithelial and ISl on- Epithelial Fibrous Tis-
sues : Its Sequence to Scarlatina and other Exanthemata. On
Rheumatic Grout, Chorea, &c. &c* By H. P. DeWees, M. D.
New York.

The term "Kheumatism" is derived from a Greek word sig-
nifying " a fluxion, or catarrh." It is divided into acute and
chronic, although a third form may be correctly added, viz : the
flying, or fugitive." The tissues affected are chiefly of the fibrous
or sero-fibrous class. But muscular structure itself may become
the seat of the affection, from its component elementary fibrous
structure.

The true disorder consists in a certain more or less altered
condition of the blood, from its normal composition. This con-
dition may arise from causes apparently most opposite, but which
resolve themselves into one and the same action, namely : their
power to change the constitution of the blood from its healthful
state.

The bedside statements confirm this view. By some, the ex-
citing cause of the attack is attributed to cold, or to "check of
perspiration." By others, to waste of nervous force by long-
continued watching, to strains, or over-exertion, to being "out
of order" for a long time, though not conscious of having been
exposed to damp or cold, to the sudden suppression of a skin
eruption, to indigestion after a debauch, and so on, till one would
be led to believe that any imprudence might be followed by an
attack of rheumatism.

In some families it is, apparently, as hereditary as the gout ;
whilst in the gouty it is not unfrequently a conjoined affection.

_ * Some of the views announced in this paper are so like those given in the ar-
ticle on Scarlatina, published in our pages, that our readers may suppose they
were suggested by it. It is due to the author to state, that the present paper
has been ready for publication three years. [Eds. Monthly.

1858.] On Rheumatism, &c. 4&

But the gouty, from their mode of life, are more apt to superin-
duce rheumatism, than are the rheumatic to earn gout. Where
the parents of the patient have been subject, one to gout and
the other to rheumatism, a sort of hybrid attack may sometimes
result, rendering diagnosis difficult, whilst relief can only be
obtained by conjoining the remedial measures of each. This
coalescence, however, is not always the case, as I have seen
gout and rheumatism run their distinct course in separate attacks
in the same person. Eheumatism may safely be termed a blood
disease. This blood condition may arise from causes apparent-
ly very different, but which resolve themselves, in their final
result, by producing alike morbid changes not only in the cir-
culating fluids, but in the nutritive action of the tissues them-
selves. Xor does time, or any specific interval, form a necessa-
ry element in the anormal production. It may result suddenly,
or may be the sequence of the gradual want of integrity in the
healthful assimilative functions. The sudden cutaneous sup-
pression (so prolific a cause generally,) by which certain excre-
tory elements are forced to remain in the blood, loading it with
a specific poison, and resulting in the phenomena of rheumatism,
may be represented in a like manner by the errors of an organ
or organs, by which a similar toxic condition of tlte blood may be
induced. Kor is it necessary, that the superficial excretory
actions, or the internal assimilative organs themselves be impair-
ed both may work in their perfect normal role, yet from the
supply, by diet, being improper or in excess, a state of blood
similar in its impurities may be produced, with the exhibition of
rheumatism or gout as its index. It is only thus that the various
accounts as to the origin of the attack can be reconciled.

The acute rheumatism of children, in almost all cases, can be
readily traced to improper exposure or to damp. The recession
of so much highly animalized excretion as is constantly being
thrown from their surfaces, loads the blood with excrementitious
products, whilst the proper actions of the kidney, liver, &c, are
interfered with ; or congestions may be superinduced, which
cannot but serve to usher in the disorder. The young are more
liable to general rheumatism than are the more advanced ; and
heart disorder is more prone to ensue in them than in the latter.
This, most probably, is owing to the higher condition of irrita-
bility of the cardiac tissues from the altered blood, and from the
fact of the exanthematous diseases, as scarlet fever, measles, &c, being
of later occurrence ; leaving the great excretory organs in a more
or less damaged state. The determination of the disease, both
in the young and the more advanced, to become local or general,
apart from the considerations just mentioned, is in strict accor-
dance to the blood condition, and the resisting power of the part
exposed. For example: two individuals of the same age may

50 On Rheumatism^ &c. [January,

be subjected to similar atmospheric causes, yet the result may be,
and generally is, different : one being attacked with rheumatism
of a single part, whilst the other may be taken down not only
with the local selection, as in the first, but with every joint in
the body affected. Or he may escape the like local manifesta-
tion, and be attacked in the knee or feet, although these parts
were not only well protected, but not exposed at the time to the
impinging draught ; thereby clearly showing the relation of the
blood condition to the disorder. In many cases, the selection
for the rheumatic outbreak is in some part previously weakened,
as by strain or fracture, or by local nervous loss. These cases,
however, require great discernment, as local phlebitis or puru-
lent deposit in or near a joint may, and has been frequently mis-
taken for true articular rheumatism, giving rise to the opinion of
its terminating in suppuration, more often than it does. To
these and other points I shall again refer in their proper order.

Although for the most part the attack of the acute rheumatism
is sudden, yet in some, distinct warnings occasionally take
place before a " first instalment" is paid in. These premonitions
vary in different persons according to the attack dating from
exposure, or from its being kindled spontaneously by previous
disorder of the blood, without any outward exciting cause of a
recognizable kind. Disturbance of the digestive organs, attended
by flitting pains through the joints or in the muscles the sud-
den eruption on the skin of some herpetic or other disorder,
attended with burning, itching, or aching, and its rapid evanes-
cence or, the drying up of any chronic discharge, the appear-
ance of a singular sour-smelling perspiration whilst in bed during
sleep these, with other premonitions, serve as sufficient data of
the impending evil, to those who have already suffered, or are
remembered with dread at their subsequent appearance, by those
who did not translate their bearing correctly. In others, no
such unpleasant " avant-couriers" announce the attack; but a
peculiar nervous excitability, attended with moist skin, and a
sensation of feeling better than usual, is recorded by the patient
the attack being generally attributed to check of perspiration
on going into cold air from a warm room, although others who
were in the same atmosphere did not feel over-heated.

Here the disease early manifests itself by the usual sweating,
but in advance of the pain. This, however, soon invades the
insteps, ankles, knees, or wrists, attended with more or less
chilliness, hot flashes, and increased perspiration. The arteries
throb quickly through the now swollen, mottled, hot, and shin-
ing parts, whilst the superficial veins leave their dark-blue
traces through the sensitive skin. As the location is variable,
so is the duration of the intolerable agony uncertain. One or
both corresponding articulations may be attacked, alternately or

1858.] On Rheumatism, &o 61

simultaneously ; or, shifting from ankle to knee, a running fire
from joint to joint may be kept up, till apparently reinforce-
ments of the disease arrive, and every joint be tensely invested
by the relentless enemy. Voluntary motion now becomes im-
possible, or is effected under the greatest torture. Change of
position by any aid is rendered agonizing, whilst the desire to
move increases hourly ; and the patient is worn out between the
increasing sweats, which bring no relief to the severity of the
pains, and the sleepless restlessness for change of posture, which
adds no comfort. The pulse hammers on, increasing in rapidity
and pain-bearing force through the disabled parts. Fever seems
firmly established in every essential form, save the dripping
skin, whose sour sweatings fail to moderate the heart's over-
action ; and that the after effects are unlike those which would
be dreaded in other fevers, attended by so much apparent in-
flammation, and with local disorder of nutrition of such threat-
ening aspect.

A respite is generally gained during the sun hours, but the
night comes loaded with terror. Sleep is now broken from the
startled slumberer, by spasmodic jerkings of the limbs; and the
dread of their re-occurrence, robs the pain-snatched hours of
their balmy gift. And thus passes night into day, pain into ex-
haustion, and labored conversation into incoherent wanderings,
or delirium, more or less persistent during the weary night
hours. The appetite is gone, whilst the thirst is unquenchable.
The countenance, for a time flushed with dark purple blood,
bearing evidence of the riot of the heart, and its over-loaded
condition from the wasting tissues, becomes at length heavy and
pale-sodden, whilst the forehead drips with outstanding perspi-
ration, and the sclerotic tissues of the eyes become finely pen-
cilled, and the mucous tears drain from the sticky and often shut
lids. '

From the seventh to the ninth day such is the course of acute
rheumatism, when relief may come permanently, or by shifting
the scene of action to other parts, with moderation in degree and
duration of the pain ; whilst the limb previously affected be-
comes less unpliant,- although aching with an almost paralytic
stiffness, as regards progression or action. The patient is a child
once more, every motion is uncertain ; he totters with his weight,-
and has, as it were, to learn to grasp again. In some, at this
period, gloomy inaction, or heart-desponding forebodings har-
ass the tedious convalescence. In others, although the recovery
seems certain, the hopes are found delusive, and they again be--
come victims to a re-attack. Pain renews its seat, the clothes
become drenched in the sour sweats, and the morrows are mort-
gaged in nights of agony. Nor is this relapse always to be'
dated from imprudence of motion, or of exposure, or of diet,

N.S. VOL. XIV. NO. I. 3

On Rheumatism, &c. [January

which, from the improving appetite, or greater constitutional
demand of the patient, had been more generous. It may and
frequently does result from many causes unconnected with mo-
tion, atmospheric change, or regimen. Amongst these may be
mentioned in this place, renewed blood disorder, encroaching
purulent disturbance, the impairment of an organ by a more or
less rapid hindrance of action from effusion, or by partial degen-
eracy of normal structure, etc., etc. It is here that the skilful
physician is required ; not only to guard against present impend-
ing difficulties, but to restrain, if possible, the disposition to
organic damage in the various organs; which, if allowed to
proceed in their stealthy progress, may suddenly shorten life
before its prime, or leave it as a dreary tenure to the joyless
sufferer.

The prognosis, in many cases of rheumatism, depends upon
the previous condition of the patient. Whether he has*been
more given to vegetable or animal diet, or to alcoholic drinks;
also, as regards the state of the primary and secondary diges-
tion, if he has had syphilis, or been lately subjected to gonor-
rhoea, whether the kidneys have been for a long time diseased
or disordered, the origin dating from the exanthemata or not,
or if the heart has been affected. In females especially it is im-
portant to know whether they have been subject to hysteria,
with or without convulsion, or if chorea has at any period of
life been present, or if the patient has at any time been affected
by Marsh malaria or intermittent, whether extensive suppura-
tion had been present, or chronic eruptions been repelled. These,
and many other conditions, in connection with the habits, occu-
pation, and the history of the parents, have to be fully entered
into, before a just opinion can be formed as regards the progno-
sis and rational treatment.

For no disease does there exist in general a more unsatisfact-
ory selection, or a more discrepant account, as regards effective
remedial measures, and this amongst medical as well as non-
medical observers. The indisposition amongst many to regard
rheumatism as a blood disorder, the real difficulty at times in
making a satisfactory determination as regards the tissues affect-
ed, and the, lithic or lactic acid excesses in the circulation, with
an apparent natural skin excretion, or their non -elimination from
the blood, with deficient cutaneous action, these, and many
other causes, together with the inaccuracy that will attend the
diagnosis of even the most skilful, render at times, the treatment
vague, unsteady, and in most cases purely empirical. For every
one you meet has a remedy with a list of cures.

The remedial selection, therefore, often requires much acumen
in distinguishing simple acute or true fibrous inflammatory
rheumatism, from the affection upon which the various organs

1858.] On Rheumatism, &c. 53

have engrafted their assisting vices ; as witnessed in some dis-
guised states of Bright's disease, or after scarlet fever, or spinal
derangement, local phlebitis, insidious tumor, long continued
and unrecognized constipation, etc., etc.

As acute rheumatism does not necessarily resolve itself into
chronic, so may it be said that the latter, as a general thing,
starts its onward course of injury and disfigurement in a stealthy
and insidious manner, without much painful inconvenience in
the early steps. There is, as is well known, what may be
termed chronic acute rheumatism ; that is, where the patient,
after an acute attack, is never entirely free from aching pain or
slowly-increasing disablement of the joints, till seized with an-
other attack, But, as above remarked, chronic rheumatism, in
most cases, begins stealthily. Antecedent impairment of health,
at first scarcely noticeable ; fitful pains shooting here and there,
stiffness of the back or in the joints, on rising suddenly from
the sitting or lying posture ; skin-aching more intolerable whilst
warm in bed ; deep, heavy, and weakening pains in the larger'
muscles, rendering sleep uncertain and uncomfortable ; frequent
desire to urinate, sometimes attended with more or less scalding,
and even with muco-purulent urethral or vaginal discharge^ ren-
dering a suspicion of, and at times mistaken for, gonorrhoea!
disorder, the slow but increasing enlargements of the joints,
unaccompanied with desquamation or irregular disfigurement, as
in gout ; the general stiff-hinge movements, these, and many
others, being the intelligence to the afflicted that the record of
their assimilative imperfections, or their imprudence of all hygi-
enic rules, is most ineffaceably written in their persons. The
symmetrical disposition to disfigurement is peculiarly noticeable
in chronic rheumatism, the distortion of one joint, or of its
burse, being apt to be daguerreotyped in the corresponding part
of the other side,

But chronic rheumatism may exist unwritten in joint or mus-
cle, and even unsuspected by the practitioner and patient, the
brunt of the disorder falling upon organs hidden to view during"
life, and whose altered organic condition, with the cause, is only
revealed by the knife. For what is true in the diffused form of
gout, is also true in chronic rheumatism. The patient may be
tortured under the belief of an existing and incurable organic
disease of an organ important to life ; whilst, in reality, it is only
laboring under the insidious functional poisoning of unrecog-
nized rheumatic infection. It has been my frequent opportunity
to see both the young and the old treated for organic cardiac
disease, attended with disturbance of action, and all the bruits
that play their JEolian strains over the strings of the heart,
when, by addressing the treatment to the rheumatic condition
of the blood, relief has been gained in a satisfactory, and i

54 On Rheumatism, &c. [January,

many instances, in an almost magical manner. And the same
may be said of the apparent heart-disease in the gouty, colchi-
cum and hydriodate of potash being their best friends.

In what may be properly termed chronic acute rheumatism
that is, in persons subject to frequent attacks of the acute form
with slow recuperation the heart is liable to become affected in
about thirty in one hundred cases, and this, especially in chil-
dren, from seven to fifteen years of age. In the plurality of
these cases, the previous exanthemata, as scarlatina or measles,
"most likely laid the foundation, or were associated in the rheuma-
tic attack. For the valvular lesions so frequently attending
rheumatism, are not uncommonly preceded by kidney derange-
ments, which date their origin from causes as above mentioned.
It therefore becomes needful, whilst seeking into the existence
and date of an hypertrophied ventricle, (which, of itself, is so
frequently conjoined with disease of the aortic valves, or if di-
latation exist, with adhesion to the pericardium,) to enquire if
the exanthemata had at any time been suffered from. For it is
undeniable that kidney disease, from whatever cause, frequently
exists with altered muscular structure of the heart and a high
irritability in its serous lining membrane. This state is more
frequently found in females than in males, and thus in part,
may account for the greater prevalence of choreic disease in
them.

As regards selection, the left side of the heart, from its greater
tendinous structure, is more subject to rheumatic inflammation
than the right. From the considerations above-mentioned of the
liability of the heart to previous damage from kidney derange-
ment, the fact of rheumatic pericarditis being less frequent than
valvular inflammation, may be accounted for. In many cases
of rheumatic pericarditis, the lining membrane of the heart is
found more or less involved, and pleurisy by extension may
result. Where extensive kidney disorder has existed previous-
ly, suppurative or purulent inflammation may, and frequently
does ensue, whilst the ursemic symptoms are prominent ; and
this, especially, if the patient has been lately subjected to the scarlati-
nal poison.

Indeed, pleurisy unconnected with pericarditis, is rare in
rheumatism, and in some cases, apparently, will be proportioned
to the amount of urea, remaining uneliminated from the blood.
The pleuritic effusions sometimes are so great as to displace the
lower organs, and especially the liver ; leading, on hasty exam-
ination of the abdomen, to the belief of enlargement of that
organ, or of tumor, as has been witnessed by me on post-mortem
inspection, where the serous or sero-purulent collection in the
left side was so extensive, as to cause a large bag to descend low
down towards the crista of the ileum ; rendering, during life, all

1858.] On Rheumatism, &c. 55

diagnosis unsatisfactory and obscure. Where the effusion is on
the right side in excessive quantity, and accompanied with
ascites, the liver may be floated, as it were, and pushed far over
into the left side, giving rise, also, to the supposition of a tumor
existing there.

Hypertrophy of the left ventricle is a most common sequence
or associate, of disease of the kidneys; and in these cases is fre-
quently independent of valvular disorder, whilst apoplexy
forms one of the modes of death. Where rheumatism attacks
an individual, who previously may have been laboring under
hypertrophy of the heart, the prognosis is of course more unfa-
vorable as regards the ultimate result ; as the vessels of the brain
are apt to become diseased or degenerated in this condition of
the heart. If disorganization of the kidney co-exist, the danger
to the patient is also increased ; as the hypertrophic state of the
heart has a double association. What exact proportion in these
cases have been affected by scarlatina, I do not know, but it
appears to me that the number is in greater ratio.

The peculiar irritable manner and appearance in the patient
at first, but changing to a dull yet anxious expression, in rheu-
matism with previously disorganized or impaired kidney, is to
be accounted for, by the gradual poisoning of the brain and
great organic centres, from the retention of urea and other ex-
crementitious matter in the blood. This condition may be par-
tially relieved by the occurrence of effusions ; but only for a
time, as resorption, fresh accumulation, and functional impedi-
ment by dropsical extent, ensue, whilst convulsion, or coma,
ends the scene.

The absorption of urea is by no means to be measured by the
drowsiness of the patient ; in some it acts as an excitant, produc-
ing sleeplessness or vivid fancies, as is not unfrequently witness-
ed after opiates. Indeed, I have seen the utmost watchfulness
persist ; sleep or coma, only ensuing just before death. It is the
object of this paper to more than call the attention of the pro-
fession, to the fact of the frequency of rheumatism after scarlati-
na, or other exanthemata, and to extreme liability of the epithe-
lial serous linings of the various parts of the body, to become the
seat of the disorder, after the kidneys have been disturbed, or
diseased in their epithelial structure. Hence, the frequency of
sero-fibrous rheumatism after scarlatina ; and where no kidney
disorder exists, the preference of this rheumatic affection to the pure
fibrous structures. In the former, purulent effusions are apt to
take place, whilst in the latter they are very rarely witnessed,
though the swelling, etc., is greater.

The student should carefully divest himself of the too preva-
lent idea of the metastasis in rheumatism, gout, and other dis-
eases not strictly confined in certain regional bounds. ; The

56 On Rheumatism, &c. [January,

endeavor should be to classify anatomically, the tissues endowed
with the same organic elements, and having alike functions. By
bo doing, identity of structure with their liability to functional
error will usurp the vague idea of the so-called metastasis ; and
the disturbances of other organs, will resolve themselves into
their own legitimate actions and re-actions. It is also important
to weigh the mechanical association, or situation of parts involv*
ed, and their disturbing influences. For instance, pericarditis
with adhesion, although highly interfering, still will allow the
function of the heart to be carried on better than in endo-cardi?
tis with valvular narrowing of the orifices, or where the natural
elasticity of the inner mechanism is hampered by thickening, or
by restraining adhesions ; or, by roughening vegetations oppos^
jug an obstacle to the uniform current of the blood, etc., etc.

The various compounds remaining in the blood from deranged
elective balance, may act as other poisons do when introduced
from without. These toxical influences may become directly
injurious, by completely paralysing the functions of an single
organ, highly essential to life; or they may, by inducing a grad-
ual degeneracy of all the nutritive centres, so leaven the whole
circulating mass, as to render every structure more or less attaint-
ed in their vital uses. Nor are these effects subjected to any
regularity, as regards their exhibition. In one, paralysis of mo-
tion may ensue, whilst in another, disorder of any special sense
may result; and blindness, deafness, or insanity, be the product,
leading, too generally, to the belief of structural degeneration,
rather than of functional derangement. This subject is full of
the highest importance, and must ultimately form the platform
of future improvement in the treatment of disease, before medi-
cine can be safely called a science.

These blood poisons act by excess or deficiency of the normal
ingredients or by new combinations, not existing in the health-
ful state or from the introduction of a specific poison, such as
the syphilitic, cadaveric, etc., which have the power either to
arrest the natural blood formations, or to impress upon them a
new formative growth and self-like, not consonant with the
normal organic constitution. Cancers seem to be an illustration
of this. Each of these specific entities, or poisons, have a given
type -life in some, without the power of reproduction in the
same individual (as witnessed in small-pox, measles, scarlatina,
etc.), running through their periods of incubation, growth, and
decline, in a regular manifestation of events. In other blood
poisons no such self-limitation of developement, nor after-inocu-
lative exemption exists. A disposition to increase without limit,
and to perpetuate their destructive changes in every tissue, forms
a prominent feature in them ; as seen in syphilis and cancer.
J3ut these latter kinds are more amenable to early treatment, or

1858.] On Rheumatism, dx. 57

to death by remedy ; or, in other words, to cure, than the form-
er. It is, however, a curious fact, as regards the development
of syphilis amongst the Northern Esquimaux, that even this
poison, so frightful in its ravages amongst civilized and warmer-
climed people, runs in them from the primary stage to complete
eradication, in six months, without treatment of any hind. For
this fact I am indebted to my distinguished friend Dr. Kane.*

A slight outline of some of the disorderly associates of rheu-
matism, and of those affections attended with pain apparently
rheumatic, but dating their origin from other morbid conditions,
may be proper here. Rheumatism is not only frequently con-
joined with scarlet fever, but is exceedingly prone to afflict
persons who have been subjected to this disease, or to other of
the exanthemata. From the views early mentioned, this might
be suspected, since the kidney is also liable to suffer greatly in
this fever. "Where the renal derangement is early manifested,
the pains in the joints is apt to make a corresponding appear-
ance, and will frequently mask the attending scarlatinal affection,
or cause it to be entirely overlooked if feebly developed ; the
delirium, convulsions, or increasing coma that may attend, giv-
ing rise to the surmise of translation of the rheumatic action to
the brain, or its coverings. In these cases of apparent rheumatic
origin, it therefore becomes important to investigate closely into
the exact condition of the child, as to its exposure to scarlatinal
infection, or to the epidemic influence at the time prevailing.

The subsequent difficulty about restoration to general good
health the desquamations the sudden chest difficulties, or
dropsical effusions, ensuing shortly after, and even without in-
cautious exposure, on the subsidence of arthritic pains these
many times serve to point out what has been overlooked. In
none of the exanthemata is untimely exposure more severely
witnessed than after scarlatina. Another fact is well worthy of
consideration, viz : the albuminal persistence in the urine, to-
gether with tubular casts, epithelial deposits, etc If this condi-
tion is found to exist in a case of sudden but ill-defined rheuma-
tism and more especially in children who have never been
known to have had scarlatina, attention should at once be di-
rected to the probability of the incurrence of this affection, and
to the fact of the engagement of the kiclnej'S.

The rheumatic symptoms generally do not exhibit themselves
in the commencement. The scarlatinal disease may have been
declared some time, even to the period of desquamation, before
the joints are complained of. But whenever this may happen,
and the kidneys are becoming more or less deranged, the danger

* This paper, it will be remembered, was written before the death of this
noble man.

58 On Rheumatism, &c. [January,

is great, not only for the present but for the future ; since the
effusions into the joints are at times amongst the lesser evils, the
heart and brain being the special organs for anxiety. The effu-
sions within the joint, although they may not be great, may
eventuate in suppuration (as in purulent synovitis), producing
more or less permanent alteration of structure and model, from
mere thickening to articular caries.

In all cases of diseased joints in children, the strictest inquiry .
into the preceding disorders, and especially as to scarlatina, then
becomes of vital importance. As is found in the destruction of
the aural bony-chain and surfaces, being confined mostly to one
side, so, in the articular, is one joint, especially the knee, more
frequently injured. Where the history of the case is imperfect
or obscure, still, by the careful examination of the urine, even
at a late date, much information can be gained ; as by it, we
can often obtain a satisfactory diagnosis between the affection
being the result of true fibrous rheumatism, to which it may
have been attributed, or of the involvement of the articular fibro-
serous membrane, with kidney derangement. This portion of
the pathology of joint affections is worthy of serious considera-
tion, and the prognosis must ever be uncertain without it. Most
medical and surgical men can recall cases where the history of
the affection, or the successful result of treatment, will prove the
truth of these views. It is nothing new to attribute the abscess-
ular conditions of the ear, or the ossicular caries, with sloughing
of the tympanum, to the after effects of scarlatina. But the in*
juries to the joints, and other parts, have not met as ready
observation, owing probably to the descriptive statements given
of the pain, leading to the idea of simple rhematism of the non-
epithelial fibrous tissue,

Both old and young have been, and will be time and again,
treated for apparent rheumatism, where the affection owed its
origin to sub-fascial abscess, or impinging deposits of pus, either
of local origin or from purulent absorptions. Scarlatina, typhus
fever, local injuries, etc., may all produce this condition, and
the errors of treatment may at times be pardonable, but in gen-
eral are dependent upon ignorance or carelessness. In children,
rheumatism more frequently terminates with suppuration than
in adults ; and their more recent exposure to scarlatina readily
accounts for this. But in the older, a diseased condition of the
kidney, with epithelial-disintegration, frequently takes place.
In these, rheumatism of the internal sero-flbrous membranes of
the joints is prone to ensue, and pus may be generated. The
results, then, are nearly the same, the difference being marked
chiefly in the higher nutritive changes which take place in the
young. In scarlatinal-rheumatism, the joints are not the only
sufferers when the kidney has been damaged. Any parts hav-

1858.] On Rheumatism, d-c.

ing the fibro-serous element, may become the seat of derange-
ment. Hence heart disease, pleurisy, arachnitis, with intra-
cranial effusions, may result ; and the time of their demonstra-
tion will be variable. It may be shortly after the attack, or
proceed so stealthily or slowly, that even adult age may be
reached. For disease is not a running horse, to be timed exactl}*.

The modes of death in the child and in the adult are some-
what different. In the child, the hypertrophic condition of the
heart is less frequently attended with valvular disorder ; and the
changes in the vessels of the brain, by which apoplexy, from
rupture, is so often accomplished in the adult, rarely proceed to
very great disorganization. But a fatal issue may speedily
attend with convulsion and coma, from the higher impressibility
of their nervous system. The arachnitis of the convexity of the
brain is rapidly ushered in with alarming symptoms. The pain
is intense, and the sleepless irritability attending from the first,
alternates with delirium more or less marked, till convulsion or
coma may close the scene. But the symptoms, when the base
of the brain is affected, though less prominent, are more on that
account, to be dreaded, from their insidious character. Pain is
not much complained of, and the delirium, if any, is less pro-
found ; but the coma is more sudden and quickly fatal.

In the adult, the hypertrophy of the left ventricle, (sometimes
of the heart, independent of any valvular disorder,) accompanied
by kidney disease, gives rise to, or at least is often associated
with, alteration of the vessels of the brain, extending to more or
less profound degeneration of their coats. Hence, apoplexy
sometimes sudden and fatal, as from the stroke of a hammer
is not an unfrequent consequence ; or softening of the brain
may come on with rapid strides or stealthy step, rendering life
uncertain, or held at expense of motion, or intelligence, accord-
ing to the extent and its seat.

In the child, the pale, pasty skin, the fretful restlessness, or
the listless inactivity, varying according to the greater or less
power in the surface and kidney to depurate the blood the
errors of motion, or perception, or of any special sense ; these,
and many other indications, should always attract to the threat-
ening condition. That much permanent benefit can be obtained
by any treatment, where organic changes have proceeded so far,
is not always to be expected ; but it will be satisfactory to know
that the state of the patient had been noticed, and that death did
not claim its victim before any rational measures for the pro-
mulgation of life, or mitigation of suffering had been entered
into.

The choreic disturbances in children (and especially if they
have been subjected to scarlatinal infection) dating their origin
more or less closely after an attack of rheumatism, are well wor-

60 On Rheumatism, Sec. [January,

thy of notice. In many cases the chorea is the first symptom
attracting notice to the condition of the heart. When rheumatic
inflammation has been seated in the lining membrane, St. Vitus's
dance has been so frequently a sequence, that it is, by many
viewed in the relation of cause and effect. And this opinion,
in many cases, seems verified. As above observed, the muscu-
lar irregularities sometimes cause the detection of the heart's
injury for the first time. The interval between the occurrence
of the rheumatic disturbance and the chorea is irregular ; whilst
the prognosis as to the subsidence of the choreic motions from
heart complications, depends on the power of arresting the
damage, and the capability of improving the general nutritive
system. If the latter can be accomplished, the remodeling as it
were, of the heart, keeps pace with the progress of growth in
the patient. At times, however, the heart is so slightly disturb-
ed as not to indicate any appreciable organic difficulty, although
sufficient irritability is established to reflect upon the spinal
nerves the disturbances of relation. It is in these latter cases
that the metallic tonics, such as arsenic, zinc, oxide of silver, act
so rapidly in cure. But in the graver cases, where the heart is
more seriously affected, time forms one of the chief elements, by
allowing the reproductive changes to ensue with the growth.
In these cases is witnessed the reason of the insignificance of
remedies which had proved so beneficial in others. Independ-
ent of any heart or kidney disease, the errors in the composition
of the blood after rheumatism, or any other blood disorder, may
act as frequent causes of disturbances of innervation. Hence,
stimulant tonic, or sedative treatment, may be called for : in
one the reproductive actions being below par ; whilst in the
other, a want of relation between the blood and the assimilative
power of the tissues themselves may be at fault. A third cause, ap-
parently, may be independent of any blood relation, and exist
in the nervous centres, or the nerves themselves. In this way
the proneness of chorea to be a one-sided disease may be ac-
counted for.

The tendency to rheumatic complaints in a family where
scarlatina has been irregularly developed, sometimes affords a clue
both as to the nature of the attack and its relief. For it is not
uncommon to find one child subject to rheumatism, and another
having chorea without any apparent rheumatic affection. In
these, fright, which in general is a highly productive agent, acts
readily and violently. After twelve or fourteen years of age,
private abuse, through the reflex actions of the spermatic
branches over the heart and the nervous masses at the. base of
the brain, may produce alike disturbances. The bellows sound
of the heart and in the great arteries in tjiese cases resemble, in
a measure, the bruits from more serious organic difficulty.

1858.] On Rheumatism, <Cr. 61

Fright is more commonly an excitor in the rheumatic or debili-
tated, than in sound and robust children. The development of
the attack is also more immediate after fright, than after rheu-
matic disorder. "Where the urine is of high specific gravity,
depositing lithates or oxalates, and overcharged with urea, and
the patient does not become correspondingly weak and emaciat-
ed, the error lies chief!}' in the diet being in excess to the assim-
ilative powers. The blood here represents the conditions favor-
able to acute rheumatism ; and if previous kidney derangements
had been engrafted from exanthematous disease or other cause,
an attack is apt to follow. But if the individval be free from
any renal difficulty, the rheumatic attack may not be fully gen-
erated, but disturbances of nutrition or in the assimilative bal-
ances may ensue, with chorea as a result.

Stammering in children, may sometimes be traced to the same
causes and yield to proper treatment. As in chorea, fright, or
other emotional excitement, has also been a prolific agent in this
affection. Indeed, stammering might be called a chorea of the
tongue^nd larynx. Almost every practioner, and layman, can
recall cases of early impediment, which subsided gradually with
the increasing growth and strength of the person.

Excepting in those cases of sudden and continued violent
chorea, where the nervous exhaustion is so great as to defy
timely repair, the prognosis, for the most part, is favorable ; and
even in choreic paralysis, a happy termination may be safely
anticipated, if the kidneys regain their normal actions.

It is not difficult to understand, when the conditions of the
blood or of the heart and kidneys in rheumatism are known,
that dropsy may be a sequence its severity dating from its de-
gree, time, and place. Nor would it be, as it often is, a matter
of surprise to the relatives of the patient, who have wondered at
the apparent over-attention of the skilled practitioner, were his
anxieties as to the issue of the case known, as long as the purr-
ing sounds of the heart and the cellular puffiness about the eyes,
and the epithelial and albuminous deposite continue.

Diffused gout is sometimes mistaken for rheumatism; the lia-
bility to cardiac pains, palpitation, etc., adds to the belief. But
the history of the patient, his mode of living and appearance,
the family diathesis, and the success that may have attended the
previous administration of remedies, serves to clear away any
difficulty in the diagnosis.

As instances of rheumatic origin may be mentioned, the sud-
den attack of lumbago, pleurodynia, crick, stitch in the inter-
costals, the muscular achings whilst at rest or after getting warm
in bed, or the dull and heavy pains, attended with a sense of
coldness in the part, etc Yet it may be well to mention that
all these may be the result of long-continued constipation, and
will frequently take their flight after a brisk purge,

62 On Rheumatism, &c. [January,

There is a painful affection of the skin, termed dermalgia, that
I will refer to. This affection, so afflicting to the patient at
times, is by no means unfrequent. It is a somewhat common
companion of hysteria; and from this fact, I have been led to
regard some of the forms of this protean malady, as offshoots of
rheumatism, or at least as indicating a rheumatic tendency in
the blood. In many cases I have detected epithelial deposits,
tubular casts, etc. From much opportunity in witnessing ute-
rine disease, the frequent connection of hysteria with painful
menstruation, has satisfied me that rheumatism plays an import-
ant part in it, and it also does in many cases of dysmenorrhcea
unattended with hysteric phenomena. In apparent spinal dis-
order, this painful tenderness in the skin is a common attendant,
and sometimes exists to such an extent over the processes, as to
lead the unwary examiner into the belief of severe local injury.
By pinching up the skin, and then making the same amount of
downward pressure, this suspicion can be frequently dispelled,
as the pain will be found much lessened, or at least not increas-
ed. The same condition exists also in certain gouty individuals,
the increasing tenderness in the skin being many times a fore-
runner of an acute attack.

I cannot refrain from attracting attention, in this place, to a
painful condition of the surface in children, the slightest touch
being complained of. It is frequently the forerunner of severe,
if not fatal convulsions, and evidences great functional or organic
derangement of the nervous centres. When noticed, no time
should be lost in making such applications to the spine, and
base of the brain as may be demanded. If fortunate enough to
be attracted early to this symptom of superficial pain, the con-
vulsions may be rendered lighter, and of less duration. But
unfortunately this condition sometimes remains unnoticed, or
has made such progress when noticed, that the exhaustion from
the convulsions is so profound, that organic repair and nervous
recuperation do not ensue ; and the child dies, either after a
succession of rapid convulsive efforts, or becomes comatose, and
sinks without a sign into its last sleep. These cases I have seen,
especially after scarlatinal kidney disorder in some an interval
of comparative health had supervened, but after a time an icte-
rode hue assumed the place of the natural complexion, with a
certain puffy appearance, leading the parents or a common ob-
server to think indicative of increasing flesh. If the kidney had
been damaged, the violence of the convulsions by their contin-
ued succession, acts in a doubly dangerous manner in the first,
by the exhaustion, and in the second by the extra amount of
animalized matter that is thrown into the circulation, and which
cannot be voided by the natural emulgent channel of the kid-
neys. As in chorea, where the muscular movements are exces-

1858.] Catamenial Gonorrhoea and Syphilis. 63

sive, the sulphates as well as urea will be found in excess in the
uriner evidencing the rapid waste of muscular structure, by the
inordinate movements during convulsions. \_Am, Med. Monthly,

(To be continued.)

Lecture. Catamenial Gonorrhoea and Syphilis.

Mr. Frederick C. Skey, Surgeon to St. Bartholomew's Hos-
pital, has recently lectured on Gonorrheeal Rheumatism. The
London Medical Circular gives us the lecture, from which we
make the following extract, bearing upon a point of great inter-
est:

I saw some time ago another most remarkable case of this
kind the splitting in pieces of a family might have occurred
from the raillery and ignorance of the hospital surgeon, but he
could not see it. A respectable-looking married man came with
this catamenial gonorrhoea ; he was very much puzzled about
it, but the surgeon laughed at him. "So ho, my find friend," he
said, "you've simply gone and done it; you've been with the
girls." The man said not that from the nature of his business
it was impossible. " Then some onehas been with the girls or
with your wife, for you have the bad disorder that's the short
and long of it." The man protested, till at last he swore an
enormously large oath at the ignorance of us all. " Why, I have
committed as many crimes as many men, and why should I be
such a fool, if I wished to be cured, as to say, if I had, that I
had not had intercourse with a woman." I don't believe he had,
but that it was one of the dozens of cases where the irregulari-
ties of married life had given rise to a gonorrhoea, or blenhorr-
hcea, that I defy you to distinguish from common gonorrhoea,
I say there is a "tertium quid engendered during the period
of ovulation or menstruation in the female, that may give rise
to gonorrhoea, but I do not believe in syphilitic inoculation. If
you know how to treat rheumatism, you know a great deal also
of this disease. Mr. Abernethy, as I said, already went to the
threshold on the subject, as regards "rheumatic gonorrhoea," or
what you will see copied in the books and manuals as gonorrheeal
rheumatism. Evans and Rose and Hennen, away from the
coteries of London, settle the thing forever. You are probably
aware, the prostitutes in France are all examined at stated times,,
and are furnished with clean bills of health ? Well, Evans saw
several hundreds of these women examined, and only three
were diseased ; but he had one hundred and fifty-three soldiers
under his care at that moment with syphilis ! I say, how did
these 153 soldiers become diseased from three women ? How
did they get it ? Where was it to come from ? To my mind,-
now, it is as clear as that chloroform will produce insensibility,

64: Catamenial Gonorrhoea and Syphilis. [January,

or any other fact in surgery ; they got it from the clean women,
and not from the diseased. I told you of Torres Yedras. This
army was inaccessible for a long time, and dozens of officers had
intercourse with the couple of girls dancing at the theatre.
These girls, mind you, in good health, yet shoals of these officers
came to England with bad phagedenic sores. Do you think
they got phagedene directly, as Mr. Hunter would think, from
these girls ? I don't.

Well, I'll tell you another case, and within a very short
period of the present not to go back to Torres Vedras or Wa-
terloo, or tire you with what you will find decked out in the books
of the schools the case of a lawyer. [I am glad it's a lawyer, if
it must be somebody (laughter ;) lawyers are so wedded to do
nothing, if erroneous, to the decision of their judges.] It was,
in a word, the counterpart of the first case seduction, love (the
old story) seduction, gonorrhoea and a crop of sores. I exam-
ined the lady with the utmost minuteness. I sifted this case
carefully. I believe there was no disease whatever in the lady
nor in the gentleman previous to the occurrence ; yet all the
what shall I call it legal evidence was the other way. Legal
proof on medical subjects at present is the greatest absurdity
Under Heaven, because Well bound books on surgery say one
thing to a man with a wig and gown on, and because a sur-
geon's opinion which is not only viva voce and original, but fair-
ly worked out after thirty or forty years' analysis of facts and
cases in hospitals, must be thrown to the winds, in favor of the'
dictum of some old book, or some new book copying the old.

I say, this material syphilitic infection is all a fallacy, I don't
believe either in all that black letter lore of syphilis coming from
St. Domingo with Columbus in the fifteenth century. Gonor-
rhoea is detailed in our oldest and most sacred of books.

Mr. Skey next stated the particulars of a very interesting case
a case of most frightful phagedenic sores in a gentleman, like
those of the officers sent from Lisbon, but where the disease was
clearly the result of scrofula, or some such constitutional taint in
the gentleman's system aggravated by those injudicious courses
of mercury, ordered for a very simple affection at first. The case
was one, also, where the nymen was ruptured for the first time,
but not a trace of disease existed in the lady.

"This old mercurial school, however, still holds out," Mr.
Skey continued to say ; "I am sorry that even men like Sir B.
Brodie still belong to it. It is not true that a woman who will
allow one man to her embraces, will allow any other ; and if the
disease be checked by mercury -post hoc, &c. that we should go
on giving it ! In this last patient it made all this difference, that
whereas Eose, or Evans, or Carmichael would have cured this
gentleman without mercury, in following the plan of the older

1858.J Treatment of Primary Syphilis. 65

schools he was at the point of death, owing to the mercury,
under the first advice in London, affecting the membranes of
his brain. We shall not speak of the hideous mutilations of
face and nose, the time sacrificed away from business on the sick
list, and the marks which rupia too often leaves on the forehead
and face, I am satisfied, and you will be so too, when you see
some practice, that all this old-fashioned dosing system with
mercury is bad. I would almost go so far as to say, that the
very worst cases of syphilis, so called in men that I have seen,
have been the result of something wrong with the man rather
than the woman, and where the "tertium quid" was aggravated
by this system of giving mercury, as a piece of murderous old
routine in all cases alike.

Well, a few words now as to gonorrhoea and rheumatism. Is
there such a thing as spontaneous gleet? Yes; it is a catarrh
of the parts. I know a gentleman who has had gleet ; but he
has been several months, aye years, in bed for another disease,
and he had no possible manner of getting gleet.

You will find gonorrhoea! rheumatism in excentric gonorrhoea,
mostly in oldish people, the disease mild or the opposite, fond of
fits and starts or aberrations ; it is gonorrhoea in a rheumatic sys-
tem, but not rheumatism connected as a secondary symptom or
as cause and effect with gonorrhoea. I am satisfied, gonorrhoea!
rheumatism and gonorrhoea are children of one parent, and not
related as rheumatism the child of gonorrhoea, the parent,

I will now tell you more: I have seen every form of syphilitic
disease as obtained from healthy women. These cases occur in
the better ranks of society, with men who are above suspicion.
"What is sometimes shocking in a moral point of view, is of the
utmost value to us pathologically. But I must not dwell on
these cases. The gentlemen come to me expressing their un-
bounded astonishment, yet if you make the most careful search,
even with the speculum, there is no disease in the lady ; it would
be almost a relief to one's mind to find something, but there is
no disease whatever. No, it is all fallacious. [Ohio Medical and
Surgical Journal.

Treatment of Primary Syphilis hy Preparations of Iron. Xtfcord sug-
gested the employment of potassio-laetate of iron in phagenic chancre,
and Mr. Acton recommends it very highly. Mr. Behrend (Lancet), be-
lieving in the essential identity of the virus of every form of chancre, and
attributing the apparent differences to special circumstances, was led to
employ this preparation of iron in the treatment of the common chancre.
He reports the details of a number of cases thus treated, with the most
satisfactory results. His method of administering the iron, is to make a
mixture of one ounce to six, of which two teaspoonfuls are to be taken
three times a day. The local applications are simple. [Med. Independent

66 Editorial [January,

EDITORIAL AND MISCELLANEOUS.

The Fourteenth Volume, of the New Series, of the Southern
Medical and Surgical Journal. In presenting the first number of the'
fourteenth volume of this Journal to our readers, we would call their
attention to the enlargement of the work, which, by the liberality of the
pulisher, presents to the subscriber as large an amount of valuable read-
ing matter, as any similar work, at the same price, in the country.

Having its circulation principally in the Southern and Western States,-
we have endeavored to embody in each number of the journal, such
original and selected matter, as our own judgment and the advice of our
more experienced colleagues have indicated to be most valuable for the
exigencies of the Southern Practitioner. No new principle in medicine,
no new view of pathology, or rational mode of treatment, has met our
eye, throughout the whole range of our fifty or sixty exchanges, Domes-
tic or Foreign, but what we have endeavored, so far as we had space, to
treasure up in our pages for the benefit of our readers. This we
shall still do, so long as our connection with the work shall con-
tinue. Having been in long and intimate relations with a large number
of Physicians throughout the country, we have, we hope, acquired a
sufficient knowledge of the wants of the Soul hern Practitioner, to pre-
pare for him a useful and efficient journal. We are aware that the
thirteenth volume of the Southern Medical and Surgical Journal, will be
found deficient in some of the departments of Medical Literature ; thus
in the department of Reviews, our estimation of the true intent and ob-
ject of a monthly journal has induced us not to occupy our space with
extended analyses of works, unless in so doing we could embody views
and suggestions, of a practical nature, for the benefit of the reader. We
have given each work, sent us by authors and publishers, a diligent and
careful examination, and, when found worthy of recommendation, have
given it our approval, or we have carefully pointed out its defects. We
look upon the department of Reviews as belonging more particularly to
the Quarterly and Bi-monthly journals, one of which, each member of
the Profession should subscribe for, but in no case, to the exclusion of the
monthly journals ; for in these last he finds the supply for his daily, and,
indeed, his hourly necessities. " Knowledge (says a distinguished writer)
evaporates like water ; and as the ocean itself, unless replenished, would
become empty, so the brain, unless its avenues to improvement are kept
open and well trodden, becomes but a barren waste, haunted by the
ghosts of worn-out and obsolete thoughts :" a fatuous and somnolent
demain, a " Sleepy Hollow" and its occupant a veritable Rip Van Win-

1858.] Editorial 67

tie dozing while the whole world has been advancing his mental
status being the index to its condition just twenty years gone by !

In making these remarks, of course, we have no fear of giving offence,
for none from this sleepy region will ever be offended by these distaste-
ful animadversions, for what is written, is for them, u as though it never
had been writ."

The volume of our journal, just now commencing, will, we hope, be-
sides the liberal enlargement by the publisher, present an increased
interest to its readers, in the many valuable original papers now in prepa-
tion for its pages. We have also on hand, lignographic illustrations of
several interesting articles, which are intended to embellish the work
and add to its value.

We continue to invite contributions from our brethren, and with their
countenance and support, we enter upon the labors of this fourteenth
volume with that hope and confidence, which, a determination to do our
duty, alone can inspire. Henry F. Campbell.

Robert Campbell.

Materia Medica and Therapeutics : with ample illustrations of Practice
in all the departments of Medical Science, and very copious Notes of
Toxicology, suited to the wants of Medical Students, Practitioners, and
Teachers. A new edition, revised and enlarged. By Thomas D.
Mitchell, A. M., M. D., Professor of Materia Medica and General The-
rapeutics in Jefferson Medical College, and formerly Professor of
Chemistry, Materia Medica, and Theory and Practice in the Medical
College of Ohio, Transylvania University, and the Kentucky School of
Medicine ; Author of u Elements of Chemical Philosophy," &c, &c.
Philadelphia: J. B. Lippincott & Co. 1857. 8vo., pp.*820. (For
sale by T. Pachards & Son.)

This last edition of Professor Mitchell's work has been brought up to
the very last hour of the Science of Therapeutics. Every thing new per-
taining to the subjects under discussion has been collected from journals
and books to enrich this volume ; and yet it is neither cumbrous, un-
wieldy or expensive. We regard it as perhaps the most practical of all
the treatises on its special subject. This work perhaps would not answer
as the sole treatise of Therapeutics possessed by the Practitioner, nor do
we know any work that would ; but the neglect of the practical good
sense and honest labor stored away in its pages will deprive the Physi-
cian of some most valuable suggestions and expedients.

In the miscellany of the present number of our journal will be found a
simple test for Quinine and morphine. We select it for its practical va-
lue and convenience, and also as a specimen of the many treasures gar-
nered up in Dr. Mitchell's book. The style of the work does much credit
to its publishers, Messrs. J. B. Lippincott <fe Co.

68 Editorial. . [January,

A Dictionary of Medical Science ; containing a concise explanation of
the various subjects and terms of Anatomy, Physiology, Pathology,
Hygiene, Therapeutics, Pharmacology, Pharmacy, Surgery, Obstetrics,
Medical Jurisprudence, Dentistry, etc. ; Notices of Climate, and of
Mineral Waters ; Formulae for Officinal, Empirical, and Dietetic Pre-
parations, etc. ; with French and other Synonymes. By Robley Dun-
glison, M. D., LL. D., Professor of the Institutes of Medicine, etc., in
the Jefferson Medical College of Philadelphia. Revised and very great-
ly enlarged. Philadelphia : Blanchard & Lea. 1857. 8vo., pp. 992.
(For sale by T. Richards & Son.)

Professor Dunglison the Samuel Johnson of Medical nomenclature
lias brought forth the Fifteenth Edition of his great work, " The Medical
Dictionary."

The above announcement speaks volumes ; a good reliable dictionary
is a necessity which admits of no choice; we may neglect other depart-
ments of Medical literature, but the words, " the vesture of our thought,"
must be at our command, or we must be dumb. The number of editions
through which this work has passed indicates its appreciation by the
Profession. The labor bestowed on this last edition is immense, and
speaks well for the industry and power of research of its distinguished
author. In its style and typographical excellence Messrs. Blanchard &
Lea fully sustain their well established reputation as publishers of medi-
cal works.

Lectures on Diseases of Women. By Charles West, M. D., Fellow of the
Royal College of Physicians ; Examiner in Midwifery at the Royal Col-
lege of Surgeons of England ; Physician Accoucheur to St. Bartholo-
mew's Hospital, and Physician to the Hospital for Sick Children.
Part I. Diseases of the Uterus. Philadelphia : Blanchard & Lea.
1857. 8vo., pp. 316. (For sale by T. Richards & Son.)

We have given the above work a careful examination. We are familiar
(as who is not?) with the previous writings of Dr. West, and all we
know of them speak much in favor of the present treatise. A fairer,
more honest, more earnest, and more reliable investigator of the many
diseases of women and children is not to be found in any country. His
own Preface will give a better idea of the intents and objects and uses of
the book, than any exposition of ours. We therefore quote briefly :

" These Lectures are a first instalment towards the discharge of that
debt which the opportunities of a hospital, and the responsibilities of a
teacher, impose upon me. A second volume, which will treat of all the
remaining diseases of the female system, will appear, if health and strength
are spared me, within three years from this time. I have published this
part separately, because I believe that students and junior practitioners
stand in much need of that help which, with reference to an important
class of these ailments, it may perhaps afford them."

For the Student and junior Practitioner the work has been particularly
prepared, and to this class we would earnestly commend it.

1858.] Editorial. 69

A Case of Excision of the Hip Joint for Morbus Coxarius, with remarks
upon the pi'opriety of such an operation, and a summary account of the
recorded cases up to the present time. By R. A. Kinloch, M. D., Sur-
geon to the Roper Hospital, and Lecturer on Surgery in the Charleston
Summer Medical Institute.

This valuable paper, sent to us by our friend, the author, has been
upon our table for some time, but by some mischance overlooked. It
details an operation by the reporter, which, though unfortunate in its
result, constitutes a valuable record in this department of operative sur-
gery. The value of the paper consists in the research made by the author
and the bringing together of a number of cases, with their peculiarities
and their results. This he has done in a tabular form, so that the main
points of each case are conveniently presented to the reader. "We com-
mend the article to all those who are interested in cases of Morbus
Coxarius, and to all who wish to become familiar with the statistics of
the operation of Excision of the Hip Joint.

Books received for Review. Besides the works noticed in our
present number, we have received from Messrs. Blanehard & Lea the
following :

" Dunglison's General Therapeutics and Materia Medica. Sixth edition,
revised and improved."

M Peasley's Human Histology :" a new and valuable work, to be noticed
in our next number.

From Messrs. Lindsay & Blakiston

" MendenhalPs Students Vade Mecum. Fifth edition, enlarged and
improved."

" A Practical Treatise on Diseases of Women and Children. By J.
Forsyth Meigs. Third edition, carefully revised."

From Messrs. J. B. Lippincott & Co.

"Essays on the Secretory and the Excito-Secretory System. By
Henry F. Campbell, M.D."

The above works came to hand too late for a careful notice ; they
shall meet with full attention in our February number.

Atlanta Medical College Resignations and Appointments.
Professors Boring and Means have resigned their respective Chairs of
Obstetrics and Chemistry in the above Institution.

To fill the vacancy caused by the retirement of Professor Boring, Dr.
T. S. Powell, of Sparta, has been appointed by the Trustees ; we hope
that the Institution will be able to secure as able a successor to Professor
Means.

Dr. Means retains his connection as Professor of Chemistry with the
Medical College of Georgia.

70 Editorial and Miscellaneous. [January,

Binding of Thirteenth Volume. We would suggest to our readers
the binding of their volumes of the Journal, thus adding a book to their
libraries, instead of having their tables cumbered with twelve perishable
pamphlets, which must soon disappear from their possession.

Discriminating Test for Quinine and Morphia. Although the
following is in a book, which all our readers should possess, on account
of its simplicity and importance, we record it prominently in our ex-
tracts :

" As mistakes have been made, and may be again committed, in con-
founding sulphate of morphia with sulphate of quinine, it is important to
distinguish accurately. The labels may have been rubbed from the bot-
tles, and it would not do to rely on taste or smell. Both salts are bitter,
but one is decidedly poisonous. If we add a drop or two of strong nitric
acid to small portions from each bottle, placed on a watch-crystal, the
quinine salt will be made yellow, while the salt of morphia will be
changed to a bright red. The experiment is performed with ease, and
is sufficiently accurate for practical purposes, and every physician should
keep the test in his mind." [MitchelVs Materia Medica, last ed.y p. 324.

Sympathetic Inflammation of the Eyeball. Mr. "Walton remarks
(British Med. Journal), that the horse doctor is in advance of the accom-
plished ophthalmologist in their knowledge of some diseases of the eye.
It has been a practice among farriers, in certain ophthalmic diseases of
the horse, to destroy the eye by suppuration, knowing well that the
other eye, which is in great peril, could be saved by this means. Mr.
Wardrop, taking advantage of this hint many years since, practiced
evacuating the humor of the affected eye, and thereby relieved the sound
organ from the dangers of a sympathetic inflammation.

[This has been the uniform practice of Professor L. A. Dugas, of this
College, for years, and we believe it is a measure now very generally
adopted by surgeons in such cases.] Eds. S. M. & S. Jour.

Oil of Tansy. Dr. Chapin, of Winchester, introduced (to the notice
of the Middlesex East District Medical Society, Nov. 4th, 1857) the sub-
ject of oil of tansy in its ecbolic and toxicological relations, and related a
case in which he was summoned at midnight to visit a married female,
" in a fit." The patient was found in bed, partly conscious, and in par-
oxysms. A distinct smell of the oil pervaded the apartment. Vomiting
had occurred. He immediately exhibited ipecacuanha and sulphate of
zinc, which was followed by free emesis. In an hour the mind became
clear and she got along very well. The woman was four months advan-
ced in pregnancy, and took the oil for abortion. The quantity taken
was half a fluid ounce. Dr. C. stated that some cases have been fatal.

Drs. B. Cutter and Drew, of Woburn, adduced similar cases, and Dr.
Underwood, of West Cambridge, spoke of a young woman in a hotel

1858.] Miscellaneous. 71

who took the oil to procure abortion. The immediate effect was violent
convulsions. At full term a child was born, not larger than a rat. The
child lived three weeks. This case was mentioned to show that the oil
sometimes arrests growth. Dr. Toothaker, of Wilmington, spoke of a
middle-aged married woman who took two fluid ounces of oil of tansy
in divided doses without effect. She then resorted to the woods, al-
though it was midwinter, and the snow knee-deep, and gathered a quan-
tity of savin leaves, an infusion of which was freely taken without success.
At term, she bore a medium-sized child, which for some time was esteem-
ed non compos. Now, however, at the age of ten, the child is a bright
boy.

Oil of Cedar. Dr. Ingalls, of Winchester, spoke of the exhibition of
half a fluid ounce of oil of cedar, which was followed by nausea and
fright. The girl took it for an emmenagogue. Dr. Hodgedon, of West
Cambridge, said he attended a woman who had been in convulsions
three or four hours on taking cedar oil. After an emetic she recovered,
with no ill effects. The patient was chlorotic, and dosed for amenor-
rhcea. Dr. Underwood asked if the use, by midwives, of an infusion of
raspberry leaves, in place of ergot, was known to the Society. Drs. B.
Cutter and Drew had found draughts of cold water useful to increase
pains, and allowed their patients a free use of the article during labor,
Dr. Toothaker inquired if the uva ursi wonld act as ergot. In one case
he used the infusion very freely, with no effects. On exhibiting a moder-
ate dose of ergot, contractions immediately ensued. [Boston Med. and
Surg. Journal.

Colica Pictonum produced by the White-lead Treatment of a Severe
Scald. Dr. G. A. Kunkler relates the case of an Irish servant girl, who
severely scalded the fore-arm and hand. Extensive vesication followed.
The blisters were punctured, and common white paint, of the consistence
of cream, was freely applied with a camel-hair brush, the part was covered
with cotton and a roller applied over the whole. This dressing was re-
peated on the following day. On the third day she exhibited unmistaka-
ble signs of colica saturnina acute abdominal pain, retraction of the
umbilicus, constipation, and slight discoloration of the gums. The symp-
toms yielded to opium and purgatives, and the linseed-oil and lime-water
dressing was substituted for the lead, under which treatment the burn got
well. Dr. Kunkler states that he has freely used the white paint in a num-
ber of other cases, some of them of great severity, without meeting with
a bad result. The editor believes this to be the only well-authenticated
case of colic resulting from the application of white lead to burns or
scalds. [Medico- Chirurgical Review.

On the Physiological and Toxicological Properties of Woorara. M.
Pelikan has communicated to the Academy of Sciences the results of his
experiments on woorara poison. With regard to its physiological effects,
the author arrives at the same results as M. CI. Bernard. As to its toxico-
logical action, M. Pelikan finds that an aqueous solution introduced into
the stomach by an elastic tube produces poisonous effects, but more slowly
and less energetically. This cannot be explained on the supposition that
woorara contains a certain quantity of serpent-poison, for it is characteristic

72 Miscellaneous. [January,

of nearly all the narcotic poisons which are easily absorbable. Curarine
possesses all the active properties of woorara. Five centigrammes of the
alkaloid introduced under the skin of a rabbit caused death, with all the
symptoms of poisoning by woorara. When woorara is absorbed in a suffi-
cient dose to produce death, there can be no question as to the antidote.
Strychnia can provoke its peculiar symptoms only in the case where the
dose of woorara has been insufficient, and vice versa. Solution of woorara
precipitated by tannin loses its effect in an ordinary dose, but in powder
mixed with powdered tannin, and introduced into a wound, it preserves its
poisonous action. The action of the poison is not destroyed by iodine dis-
solved in iodide of potassium, neither in the case of the two solutions mix-
ed, evaporated, and the residue introduced into the subcutaneous tissue.
[Archives Generates, and Brit. < For. Med. Rev.

Pulmonary Epithelium. In the July number of the British and For-
eign Medico-Chirurgical Review, we notice an article by Dr. C. Radclyffe
Hall, on the epithelium of the air vesicles of the human lung.

Some of our readers may recollect a paper by Dr. Hall in the last Oc-
tober number of the Review, in which he states that in chronic pulmonary
consumption, " fatty atrophy of the epithelium of the air vesicles is ante-
cedent to the formation of tubercle ; in the same number we have a paper
by Mr. Rainey, against the existence of epithelium in the air vesicles.
This paper by Dr. Hall assumes to demonstrate these epithelial cells, and
is illustrated by wood cuts of their microscopic appearance as seen by
Dr. Hall and Dr. Brittan. Assuming that these illustrations are correct,
and we have no reason to doubt it, there seems no doubt but that epithe-
lial cells can be demonstrated in the human lungs, and the lungs of the
mammalia. We cannot but agree with Dr. Hall, that on a question of
relative authority, " the positive evidences of one trustworthy observer is
usually allowed to overrule the negative evidence of many." An exam-
ination of this article by Dr. Hall, with the drawing of the microscopic
appearances by Dr. Brittan, will not fail to convince any one of the exist-
ence of epithelium in this situation. If this were not the fact, the state-
ment of Dr. Hall that fatty degeneration of the epithelium of the air cells
preceded the deposition of tubercle, (an observation which we conceive
to be of value, and which we hope may be further elaborated,) would of
course be entirely without foundation. [Buffalo Med. Jour. f.

Treatment of Anatomical Wounds with Lotions of Chlorine Water.
M. Nonat, Physician to the Hospital of La Charite, recommends the use
of lotions, with solution of chlorine, in cases of anatomical wounds, which
unfortunately are far from being always exempt from danger. Be the
wound large or small, be its surface united or unfractuous, the solution of
chlorine destroys the putrid matter, which acts like a virus, and which
causes so bad an influence on the system when absorbed. This agent
may perhaps be absorbed, mix itself with the blood, and thereby prevent
the mischief arising from them, or destroy those bad symptoms which
have already appeared.

The way to use it is very simple. The wound is first well washed with
water, then with the solution of chlorine. If the wound is one of some
days' standing, if it is inflamed, if the lymphatic vessels and glands are

1858.] Miscellaneous. 73

obstructed, if the general appearance is favorable, and provided there are
no symptoms of putrid infection, the lotions of chlorine may arrest
these accidents. It is useful in these cases, to use at the same time inha-
lations of chlorine.

M. Xonat has often had opportunities of testing these means, and in
very serious cases. He thinks chlorine ought to be put at the disposal of
the students, in the dissecting halls, and would have the following in-
scription upon the walls of the amphitheatre "Wash, as soon as possi-
ble your anatomical wounds with solution of chlorine." [ Union Medicalc,
and Medical Circular.

Cod-Liver Oil Solidified with Gelatine, Take of pure gelatine, half
an ounce ; water, simple syrup, of each four ounces ; cod-liver oil, eight
ounces ; aromatic essence, as much as may be sufficient. Dissolve the
gelatine in the boiling water, and add successively the syrup, the oil, and
the aromatic essence ; place the vessel containing the entire in a bath
of cold water ; whip the jelly for five minutes at most, and then pour it,
while still fluid, into a wide-mouthed glass bottle, furnished with a cork,
or with a pewter cap, or if a bottle be not at hand, into a porcelain or
earthenware pot, which should be carefully closed- [Bel. Gen. de Therap.
and American Med. Monthly.

Lichen and Cod-Liver Oil Take of Iceland moss jelly, four ounces;
gelatine, four scruples ; hydrocyanated cod-liver oil (to which two drops
of essence of bitter almonds have been added,) six drachms. Prepare
the Iceland moss jelly in the usual manner ; melt the gelatine and pass
it into the vessel which is to hold it ; then add the cod-liver oil ; stir the
entire with a spatula, until the mixture be homogeneous and the jelly
begins to congeal. Dose two or three spoonsfuls daily. [Bulletin
General de Therapeutique and Dublin Hospital Gazette

Lnteresting Case of Transfusion of Blood. This operation was success-
fully performed on the 16th of September, by Mr. "Wheatcroft, surgeon,
of Cannock, Staffordshire, England, on the person of a woman named
Wood, residing there. Immediately after her accouchment fearful hae-
morrhage set in, draining the woman of blood. She felt herself dying,
and summoned her husband to her bedside, bid him "good bye," and
earnestly requested him to take care of the children when she was no
more. She then became pulseless and gasping, occasional breathing
being the only indication of life. A vein was opened in her arm, and
one in the arm of her husband, and as the blood flowed from the latter,
it was transmitted, by suitable apparatus, into the veins of the wife. After
seventeen ounces had been thus injected, the pulse became perceptible,
the colorless lips reddened, the glassy eyes brightened, and she thank-
fully said, " I am better. The case has progressed very favorably, and
the woman is recovering. [Medical Circular.

Chloroform Liniment in Burns. M. Bargiacchi states that he has
found the extreme suffering produced in bad burns completely relieved
by means of a liniment composed of chloroform and cod liver oil. [Bull,
de Therap., and Med. Times and Gaz.

74 Miscellaneous.

Glycerine is found to be a solvent for almost all substances, and as a
pharmaceutic agent and vehicle, has an extensive range of applicability.
One is as a vehicle for the external application of Iodine, particularly
where it is desirable to have the article absorbed by the skin. Used in
the proportion of one part of Iodine to five of Glycerine, it produces some
smarting, but can be well borne. After painting it upon a part, it may
be covered with gutta perch a paper to prevent evaporation ; and in this
way, fifteen grains of Iodine may be absorbed into, and eliminated from
the system per day, for several weeks together without any injury to the
general health. This at least is the testimony of Dr. Szukits, a German
physician, who has tried it in 24 cases. [Peninsular Jour, of Med.

Glycogenic Function of the Liver. Dr. Louis Figuier read on the 27th
July, before the Academy of Sciences, a paper in which he aims to dis-
prove the glycogenic function of the liver, on which so much stress has
been laid by M. Bernard. He maintains that this function belongs to all
of the parenchymatous organs that receive blood, such as the heart,
lungs, spleen, <fec, and also in the blood of the general circulation.

[ Western Lancet.

Tetanus. The last number of Guy's Hospital Reports contains a
paper by Mr. Poland, on Tetanus. He gives an analysis of all the cases
treated in Guy's Hospital, since 1825. The whole number of cases
treated was seventy-two. The great majority were fatal, and in those
that recovered, it was impossible to assign the cure to any particular
remedy. Mr. Poland is of the opinion, that the best plan of treatment
is to strengthen the patient, and thus enable him to pass through the
disease [lb.

The Daguerrean Art in Medicine and Surgery. For some time the
daguerreotype has conferred much benefit upon the profession, by en-
abling practitioners to secure representations of disease externally mani-
fested, and also copies of internal lesions observed post mortem. In
surgical cases, especially, much advantage has been derived from thus
taking views of the diseased part at different times, and also in exhibiting
the final result.

A few days since, Dr. John B. Brown, of this city, showed" to us certain
daguerreotype views of individuals residing at a distance some of them
in Canada who were affected with distortion of the feet, of different
degrees of intensity. The representations thus sent enabled him to de-
cide what procedure should be adopted, and whether it would be neces-
sary for the patient to be under daily inspection or not. The results of
operations done to remedy club-foot have often of late thus been sent to
Dr. B. The same plan has been effectively adopted in cases of spinal
distortion. The many advantages secured both to patients and their ad-
visers by this method, must be evident, and the daguerreotype apparatus
may be fairly considered one of the articles of the surgeon's armamenta-
rium. The Talbotype process is even better suited than that of Da-
guerre for sending these views to a distance paper being used to receive
them instead of a heavy plate. [Boston Med. and Surg. Jour.

SOUTHERN

MEDICAL AID SURGICAL JOUMAL.

(NEW SERIES.)

-i'

Vol. XIV.] AUGUSTA, GEORGIA, FEBRUARY, 1858. [No. I

ORIGINAL AND ECLECTIC,

ARTICLE V.

The Treatment of Dysentery A Clinical Lecture delivered at
Jackson- Street Hospital. By EGBERT Campbell, A.M., M.D.,-
Demonstrator of Anatomy in the Medical College of Georgia/

" Pathology is only valuable when it has a tendency to the prevention, ameli-
oration, or cure of disease, and the results of our most successful labors in this
department are but nugatory, unless in them can be found, a clue to a more'
rational and, perfect management of the affections to which they refer."

[ Transactions of American Medical Association, vol. vi

Gentlemen :

In our recent consideration of the " Pathology of Dysentery, ,y
we attempted to present to you a brief analysis of the nature of
that disease. We now propose to inquire as briefly, into the"
character of the remedial means and measures which are to be"
employed for the relief of that condition, and which must neces-
sarily be derived from, and depend upon as in the treatment
of all diseases a full appreciation of the ends to be attained,-
and a proper understanding of the qualities of the agents appro-
priate for their accomplishment.

Now, from the very naming of this disease, as well as from
the foregoing pathological deductions, if they be just, you might
almost sufficiently anticipate us in the reeital of the measures to'
be adopted, as necessarily depending upon the application of the
indications therein set forth, and which are to be fulfilled in the
treatment ; so much so as well nigh to render a farther discus-
sion of the subject but a work of supererogation were rt not,-
that experience, the impartial teacher, is a better verifier of theo^-

N. 8. VOL. XIV. NO. II. 4

76 Campbell's Lecture on Dysentery. [February,

ry, than is conjecture; and hence, by the aid of the former, may
we endeavor to show, that Pathology must ever find its proof in
Therapeutics.

It will be perceived, that there are four important elementary
conditions presented for our consideration in the study of this
disease, which must be observed throughout, and also reconciled
to each other's demands and from these four conditions arise the
four indications of Treatment : they are

First. The existence of Fever, dependent upon spinal disease,
which confirms and enhances, at each return or exacerbation, all
the other evils of the case. Hence prevent this fever.

Second. There is inflammation of a mucous membrane, re-
quiring ITS OWN PECULIAR TREATMENT.

Third. This mucous membrane lines the interior of an excretory
canal the seat of the inflammation WHICH MUST BE KEPT OPEN
it will not do to obstruct it; for besides the ordinary and necessary
demands of health, that this prima via should be unencumbered,
and which also has a tendency (notwithstanding all interposed
efforts) to convey its contents onward to their exit if, from
any cause, the detritus of the process of digestion is detained
within its calibre, it would become concrete and consolidated,
and would act as an irritating body to the inflamed mucous
lining especially as every excited contraction of the muscular
coat of this canal, would compress its inflamed lining, firmly
against this resisting substance,, where it would probably be held
for some time, on account of the loss of normal tone in the mu-
cous and muscular coats at this point, and would greatly enhance
the difficulty therefore prevent constipation.

Fourth. There is a state of Exhaustion or, more properly,
Fatigue Kegular rest and resuscitation of strength are
TO BE secured TO the patient by whatever means attainable,
provided they can be reconciled to the three other obligations to be
fulfilled in order to indemnify his vital energies for the effect
of the harassing influences preying upon them.

In answer to the First, it is of the last importance, during an
intermission or remission, to stave off a return, or an exacerba-
tion, of fever, with the well known specific, Quinine that
magnificent boon of Heaven to Earth. Quinine should be given
unconditionally, and irrespectively of the other elements of treat-
ment, at such time and in such quantity as will accord with the

1858.] Campbell's Lecture on Dysentery. 77

typal arrangement and suit the degree of the fever. As some
of you may not be acquainted with the mode of administering
this medicine, we would say that, if the period of accession or
increase of fever is distinct, 20 grs. of quinine should be given, to
an adultj in four doses 5 grs. every two hours, commencing eight
hours before the expected paroxysm, that the last dose may be
taken at least two hours before its effect is required to be dis-
played, that each dose may be fully absorbed, and place the
system decidedly in that condition which supplants or resists the
invasion of fever. But should the paroxysmal character of the
fever be more indistinct, or even so as not to be recognisable,
commence at any stage of the case and give quinine, until its'
effect upon the patient is heralded in by the ringing of bells, so
fortunately characteristic of its adequate exhibition ; after which,
continue to give it at longer intervals, just so as to keep up its
influence; as indicated by the tinnitus aurium or "ringing in
the ears," for several days if need be, that you may be sure of
falling in with the paroxysmal period -though at some point in
the mean time, your perseverance will be amply rewarded by a
decided abatement, or an entire absence of fever, and the conse-
quent diminution or discontinuance, even, of every other symp-
tom. Many cases occur wherein, during the first paroxysm of
fever, the dysenteric symptoms are very intense, but on the
timely administration of quinine, a return of fever is prevented
and there is no further trouble from the Dysentery.

As to the modus operandi of this agent, there are many who
advocate the opinion of its sedative properties, ascribing all its
powers to its quieting effect the quality of inducing sedation \
while as many, perhaps, are as confident in the opposite belief
viz., of its stimulating influence, (among whom are the Homoeo-
paths,) attributing its virtues to the stimulation which they ima-
gine it produces. Now, Gentlemen, while we may see excuses
for the entertainment of either opinion, we think we have better
grounds for deciding that neither is correct, Although, in ex-
planation of our tolerance for the retainers of these opposite
views, we will cite the evidences of two cases, which very re-
cently came under our observation : One, a case of Typhoid
fever; the subject, a little boy, aged 5 years, wherein, always,
when under the influence of quinine, the frequency of the pulse
was twenty beats lower, than it was uniformly,- when he had

75 CAMPBELL'S Lecture on Dysentery. [February,

taken none. 7

during his attack, which lasted about th: a. The other,

a little girl, about the same age, affected with Intermittent :
with croupy symptoms, wherein, quinine, given during an in-
termission, induced a quick pulse, hot and dry : nderness
in the epigastric region, pain in the stomach, nausea and pe:
ent vomiting t, the whole jfcsemblage of symptoms simu-
lating g; hich condition generally foil. introduc-
tion of quinine into her stomach. The mother of this child has
been affected with the most violent urticaria, accompanied with
the semblance of inte: variably, during the past three
or four years, (but not before,) upon the ingestion of
qninine. Thus, it will be perceived that these phenomena re-
sulted from the action of an irritant (in upon the
stomach the three cases cited, in our opinion, being instances
of idiosyncrasy of constitution, or were dependent upon a then
r condition of the organism, giving rise to these

.^ordinary manil^ as neither class of these results

uniformly or commonly follows its exhibition, and yet it n
foil> in either case to prevent the recurrence of a parox;

"We would rather adopt the opinion, which attributes its em-
to its power of disseminating or equalizing the nervous
influence. And if we take into account the known effect of
this agent upon enlarged spleen and such like engorgem
we might venture tc s a disseminator or equal-

izer of the circulation, and acts by dispersing, wherever found,
all vascular accumulations, possibly r by giving tone to the vascular
tissue, and that it has control over the nerve m, under

. drcumstances, by dispersing such engorgements in its
centres. Hence, in cong: rr affecting the brain, remark-

able results have been often witnessed, from large doses of quinine,
Hitroduced into the rectum, during the existence of the coma.

jod here we would remark, that it is difficult to convince
or even argue with those who shrink from the admin :-
tion of quinine in all cases of fever, where there are any " head
symptoms" present thu3 denying the patient often, the only
means of escape from :_ce and progression into

and far more serious and fatal results. Xot to give quinine
when there is ion or inflammation of the brain, or its

membranes, as well as in acute inflammation of any organ, ac-

1858.] ,3PBKLLrs Lecture on Dysentery. W

companied with paroxysmal fever and it is always paroxysmal,
if it were but detected is a prejudice, or an error, which is un-
pardonable, because of murderous consequence. When did
quinine ever produce an inflammation, or increase it? For
instance, in traumatic fever, which, in its sthenic form, belongs
t: :~e :--:.ii :=: t: ::.r;z~5z:il :':T::;/ ": =::. --rinr :lr tit-: z~=:i^
:i:.- v,-:-.;-_.I ;:: :::::::_ ill ::: ~~i~:::c> : : in ::~ .'^d in :nirii To-
ry action, but on the use of quinine, the paroxysm is prevented
and the increased action is found to subside. We will say to
5';::::s::-::::r:.;, --;::, lisrlzriiiiird tt.'.-.t. in T^:innr ::
some mooted point "get first into the sphere of thought by
which it is so much as possible to judge of this thing, otherwise
than distractedly ; we may then begin arguing with you?"

T_^:7 ii ::.:: I'l^rv ;::::_ L::\l ~e :iii.Lk. :.: ie;,i~, ^T^^7 S:iii-
ern practitioner will bear us out in affirming. It is, in the 1st
r/n:r. :"_;.: ;.;-. -..;:: n. ^linine ~le~ riTen ririni" in ii'friiifii:-
or a remission of fever, prevents the return of the paroxysm ;
2d, that in ordinary doses it wiE not reduce the fever after the
rir:z"5n i-ii "::-.-t ".:::: :ci i:L :"_.:.: ii riTrn in '.:"-. ";: Tf i;.=e=
during the paroxysm, it will often abate the fever, apparently
by overwhelming it Of course we refer to paroxysmal fever
alone.

It hence does appear, that quinine, in any disease depending
on spinal irritation, probably acts by dispersing the cause of that
irritation, whether active or passive hyperemia in the spinal
c-:r:I ini :lerel~ rriiiTrS :he ^eirril r-fsil:az: :: :: lirion. Tie
explanation which we would offer for these phenomena is the
following :

When quinine is given only during a paroxysm of fever, no
opportunity is allowed for the display of its power over the
distended, congested or excited vessels; for the universal vascu-
lar excitement which pervades the organism, with the heart's
i-:Tz.ml :.i-;. m::- ::r:i:le a::::- rnniiing iLe :i:-:-i in ~r:n
these, already surcharged local vessels, and maintaining or
increasing their derangement, the display of its powers is pre-
vented, its effects are canceled. Hence, it is only during the
absence of fever, unle^ extraordinary doses are employed, when

'. issi&taiioa of Febrile Diseases,9 by their Eelasion to the >~erroa
m, in Introdoetion to xoiiame oa "The Secretory mad EmJUhSeerete:
tern." By Henry F. CampbdO^lL D.rju5t pohtished.

80 Campbell's Lecture on Dysentery. [February,

it has not these opposing influences to contend with, that it
readily overcomes the local condition, and thus suspends its
symptomatic results,

So, may it be perceived, that in the treatment of Dysentery,
quinine forms necessarily an essential element we had almost
said, without the single exception of a case for in those instances
unaccompanied with fever, if they do not yield promptly to
that management, of which this does not consitute a part, we
believe, that by acting upon the idea of its spinal basis, in ac-
cordance with our previous pathological suggestions, its addition
to the course would be acknowledged the desideratum in almost
every case,

We are aware that, as regards the employment of this agent
unorthodoxly, or otherwise than for "chills and fevers" there is
Borne opposition on the part of the community, who, consulting
their own prejudices will, through intentional and covert neglect
of the strictest injunctions, cause the failure of its object, to the
serious detriment of the patient's safety and the physician's re-
putation. We know also and the knowledge is humiliating
in our climate, where almost all acute diseases appear to be im-
pressed with the type of periodicity more or less decidedly
that there are members of our own profession, (charged as it is
with so awful a responsibility the arbitership of human life,)
whose minds being impregnated with the spawn of that popular
medical doctrine, above alluded to, or from some ill-begotten
prejudice, or some ill-fated notion, legitimately inherited, per-
haps, from some outlandish Alma Mater, some we say, who
look upon this invaluable and indispensable remedy, as "danger-
ous," something not far short of a poison, and therefore fail to
see its applicability to disease, or use it so daintily, as not to
allow themselves the opportunity of witnessing its efficacy;
whilst the devoted patient, deluded and lulled by the semblance
of a systematic course of attack being made upon the disease, is
cheated by periodical gradations into irrevocable ruin the
malady still raging with increasing fury against him, with every
reinforcement of its morbific armament the returns of fever
with the accompanying increase of all the other ills derived
from its cerebro -spinal ally until life " is sunk amid its foes."
Such is an unfortunate prejudice, and melancholy have been its
results for which the lives of many patients have doubtless
been made to atone.

1858.] Campbell's Lecture on Dysentery. 81

But what argument shall we employ against that stubborn
stupidity which, in this late day, still questions the right of this
agent to hold the rank it does in the Materia Medica ; or what
logic can avail to assure that doubting pusillanimity which yet
does not dare, or affects to fear, to use this remedy in efficient
quantity, after the mammoth, though innocuous doses, of Mail-
lot, of Dundas, and of others. Let such seek the first opportunity
by experiment upon his fittest subject, to divest himself of so
dangerous and criminal a delusion. Yes, let him take 40 grains
of this poison at one dose, (as we had occasion to administer to
a forlorn case of congestive fever, which actually recovered,) and
if he does not die, he will be convinced of its harmlessness, but
if he does well then, his patients in this region will stand the
better chance for living. We would not have you, Gentlemen,
to understand us to recommend such doses in ordinary practice,
as they are unnecessary ; for remember, that the two cases, (both
that of the doctor and that of the more pitiable patient,) here
coupled, are of a desperate type. But what we say is ; give
Quixine in Dysentery !

The most important and efficient adjuvant in the treatment
of that element of the disease, embraced in the condition of the
great nervous centre, is manifestly to be found in the applica-
tion of revulsives along the spinal column ; dry cupping and
sinapisms, or if any portion of the cord is discovered to be de-
cidedly irritable, by acute sensitiveness on pressure upon the
corresponding spinous processes, it may be necessary to resort to
vesication or to cupping with the abstraction of blood. TVe
have known the whole aspect of affairs in a case, wherein un-
controlable tenesmus was a very threatening accompaniment, to
be most astonishingly improved by the application of a blister
to the lower part of the spine.

So much for the consideration of the remedial means, which
are necessary for the relief of the cerebrospinal ingredient of this
disease ; let us examine now into the demands of the other ex-
isting condition that of the large intestine. These are com-
prised in the 2nd and 3rd indications, which may be treated of
in connection the latter being in this instance, involved in,
and forming a necessary condition to, the former that is,
whilst the mucous membrane, here, requires the treatment
appropriate to mucous membranes elsewhere, here, it is besides

82 Campbell's Lecture on Dysentery. [February,

the lining of an excretory canal, which conveys a material of
more or less solid consistence ; therefore, it is also necessary to
combine with that specific treatment, some peculiar method of
procedure to prevent the irritation of the contained solid excre-
ment, in its transit through the inflamed canal since it must
pass through; and this is best accomplished by reducing its
consistency from a solid to a fluid state, preventing its accumu-
lation and solidification, and also, by shielding the sore surface,
if possible, with some emollient or soothing application. These
two indications, then, together with derivative measures, com-
prise the treatment of the local or intestinal element of this dis*
ease.

Now, let us examine briefly into the rationality of a few of
the most prominent among the various measures which have
been proposed and are much practiced, for the relief of Pysen^
tery, the accomplishment of which can alone be attained, we
conceive, in accordance with the specifications just laid down,
whatever be the means put into requisition, for their fulfillment

The procedure which we have designated the M Opiate and
Astringent routine," or the system of giving, indiscriminately, a
specified quantity of some opiate and astringent compound, a
ter each discharge, mistaking them for passages, in order more
fully to clog up the bowels, cannot be too severely reprehended,
as it is indicative of pure ignorance or an entire misapprehend
$ion of the nature of things, and is in this instance attended
with no ordinary amount of pernicious result. For the adminis-
tration of astringents, there can be found no shadow of excuse .
their avowed attribute, being their capability of inducing, just
that condition which already exists as the chief difficulty in Dys
entery, and which should be one of the prime objects of the
physician, speedily to overcome. But the demand for opiates,
in view of their anodyne effect, is rather more plausible, as this
disease is attended with much suffering, and the unwary and
irresolute might perhaps be decoyed, through so urgent a plea,
into disregarding the admonitions of his better judgment, for
the sake of temporary respite, at the expense of radically in-
creasing the difficulty, even to fatality, or delaying in so much,
the fortunate termination of the case. This, Gentlemen, has re-
ference to the error of giving opium systematically, as a part of
the radical treatment of Dysentery, in the same manner that

1858.] Campbell's Lecture on Dysentery. 83

diarrhoea is treated by it and here let it be well understood,
that with this object, opium is never indicated in this disease;
because there is constipation already existing as an element of,
and a very serious aggravation to it and also as, very unfortu-
nately, one of the most prominent effects of this agent, is to
induce or increase that very same^condition, But, although
opiates are not admissible, as part and parcel of the regular treat-
ment, yet there are frequent circumstances under which their
pro re nata employment is demanded for another purpose that
of procuring rest and sleep, notwithstanding their very incon-
venient and pernicious quality, here obtaining, of suspending the
peristaltic action of the intestine, and thus increasing constipa-
tion ; which effect has to be guarded against and overcome, by
the unremitting pursuance of some procedure which will prevent
or neutralize this deleterious influence, by keeping the bowels
in a relaxed condition that procedure, fortunately, being the
proper and only appropriate treatment, under this head, for Dys*
entery, as has been indicated and will be further shown.

The secondary position assigned to this agent then, will be
found to be in the fulfillment of another and far different indi-
cation ; not in the treatment of the disease itself, but for the relief
of some of the untoward evils consequent upon the disease, and
will be noticed in its proper place. And it is to be esteemed a
great misfortune, in reference to this class of remedies in this
disease, that their valuable anodyne effects cannot be put in
requisition, except at the expense of enhancing the diseased
condition, through the consequent evil of their constipating ef-
fect. Hence, you perceive, that the M opiate and astringent"
treatment is worse than no treatment in the end that in fact,
the disease demands the reverse interpretation, to what is here
evident, as the basis of an opposite treatment.

The practice with Cold-water or other soothing enemata, cannot
take the place of treatment in Dysentery, but is valuable as an
adjuvant in some cases, to allay irritation. This subject has been
treated of at length, by Dr. Brown of Alabama, who in regard to
it, employs the following extravagant language, viz., u I will
now briefly consider the superior advantages of the Cold Water
Treatment, as pursued in the foregoing cases, and particularly
its topical application by enemata. The immediate effect of its
introduction is remarkable the patient generally expressing

84 Campbell's Lecture on Dysentery. [February,

entire relief from the pain and burning sensation, which suspen-
sion of suffering lasts for a considerable time. Thus, in its
anodyne effect, surpassing, by promptness and completeness, all
the ordinary means. The nervous irritability which is excited
in these cases, with nausea and intense thirst, especially in fe-
males, and the high febrile excitement, yield equally to its
sedative and cooling effects. The evacuant and cleansing proper-
ties of the measure, are unsurpassed by purgatives, and without
the danger of reducing the patient by hypercatharsis or inter-
ference with nutrition. While hydragogue cathartics may re-
duce the inflamed condition, by a draught upon the turgid
vessels of the part the cold application, by a more economical
process, would suppress the inflammatory action, by contracting
these distended vessels, driving out their superabundant blood,
and fortifying them against a continuance of the phlogosis."

Dr. B. recommends two modes of applying cold water in Dys-
entery : 1st. By towels, wrung out of the coldest water, kept
constantly to the abdomen, and renewed as often as they assume
the temperature of the body ; and, 2ndly, by the introduction
into the bowel, with a syringe, of a pint of cold water, after each
dejection. The suggestion is certainly a rational one, having
afforded much comfort to the patient, under our own observa-
tion ; and it is worthy of being borne in mind, to be brought
into requisition, to quiet the excessive irritation in the bowel,
inducing frequent tenesmus, as an accessory to the treatment of
some cases, where there is present no contra-indication.

The Mercurial practice has been recommended according to
two different modes of application, for the accomplishment of
two distinct objects viz: 1st. By the repetition of large doses
of calomel or blue mass, for the purpose of effecting continuous
mercurial purgation. 2nd. By the administration of small doses,
combined perhaps with some opiate, Dover's powder most fre-
quently, with the view of inducing ptyalism on account of the
supposed virtues of that condition, in controlling inflammation.
Now, we conceive the wholesale administration of mercury, in
any disease, to be an unnecessary and unwarrantable procedure
as also is the indiscriminate and unscrupulous subjection of the
patient to its poisonous effects, in the employment of complete
salivation, upon all occasions, as is common with some practi-
tioners^ small doses of calomel and Dover's powder seeming to

1858.] Campbell's Lecture on Dysentery. 85

be their panacea for every diseased state, supplying with, this
convenient compound, the place, often, of diagnosis; and whe-
ther the patient suffers through the intentional design of his
physician or his want of judgment as regards the danger of in-
ducing that state, with this medicine, the injury is the same it
is mercurial salivation notwithstanding.

We would suggest to those who habitually give mercury, as
a routine or mechanically, because they cannot interpret the
manifestations of disease, that they might disguise their ignor-
ance in some less hurtful manner by giving bread-pills, for
instance. And for those who wish to purge the patient in Dys-
entery, we would remind them, that they might employ some
agent of equal or superior activity, which would not be obnox-
ious to the same objections, from untoward consequences, owing
to the peculiar therapeutic properties of this article. Hear what
Mr. Annesley says upon this subject in his Sketches of the Diseases
of India (He performed many experiments with the express ob-
ject of testing the true operation of calomel) he says, "These
experiments presented uniform results, viz., that while the stom-
ach and duodenum of dogs that had taken large doses of this
preparation were much paler and less vascular than in ordinary
circumstances, the colon and rectum, from the caecum to the verge
of the anus, were most acutely inflamed, thereby explaining the re-
sults of clinical observation, namely, that although large doses of
calomel calm those symptoms usually caused by increased vascu-
lar action, or inflammation of the mucous surface of the stomach
and duodenum, they lower the vital energy of these important or-
gans, and occasion tenesmus, griping pains in the course of the colon,
mucous or bloody stools, hemorrhoids ; and if persisted in, many
more of the symptoms of Dysentery, or even structural change of the
colon or rectum. I am confident that Dysentery becomes chronic ;
that an occasional indigestion lapses into a constant dyspepsia ;
and that habitual constipation often passes into strictures of the
rectum, and hemorrhoids into fistulas, from the frequent exhibition
of large doses of this medicine* Ingenuity cannot devise a more
successful method of converting a healthy person into a confirm-
ed invalid, of destroying many of the comforts of existence, and
of occasioning hypochondriasis and melancholy than the prac-
tice of prescribing large doses of calomel on every trifling occa-

* These italics are ours.

86 Campbeli/s Lecture on Dysentery. [February,

sion, or when the bowels require gentle assistance; or because
the patient erroneously supposes himself to be bilious, or is told
so by those who should know better. The unfortunate word
'bilious,'' is the scape-goat of the ignorant"

As to the indispensableness of mercurialization for the cure of
acute diseases, generally, the dogma has long since been explod-
ed by the introduction of quinine into general use. And with
special reference to this disease, it is satisfactorily evidenced that
no additional benefit accrues to its employment Dr. Bell re-
marks, that " As regards the use of mercury in Dysentery, it is
mere empiricism to look to salivation, either as a necessary proof
that enough of mercury has been administered, or as an indis-
pensable means of curing the disease. Salivation is an occasional
result to be deprecated and avoided rather than sought for."

Now, gentlemen, we would not be understood to wish to de-
tract from this agent, a whit of its value and importance as a
remedial means ; but would claim for it, as such, an appropriate
place, and for its use, a specific object, with due regard to its
potency and its peculiar properties and would have you recol-
lect, that we only caution you against its abuse, the deplorable
effects of which, there is much recorded testimony to establish.

Moreover, after all that has been said, should you ask us if
we give mercury in Dysentery we would answer, that we do
give it ; not in all cases, but in many though, expressly, with-
out either of the objects which we have been hitherto discussing.
We use it but as an aid to the treatment yet not as & purgative,
for our doses would be insufficient for that purpose : not to sali-
vate, for it is given under such circumstances as would render
such a result next to impossible. Formerly ptyalism was attri-
buted to the patient's taking cold, or drinking cold water after
taking calomel; and doubtless many a poor victim has been
goaded on his way and been initiated prematurely into the in-
conveniences of a warmer climate, by this merciless notion
" without one drop of water to cool his parched tongue." For-
tunately, for the sake of humanity, this error has subsided, and
it has now become an acknowledged fact, that mercury will not
affect the system thus, except it be retained from want of ac-
tion unless this peculiar property should be determined by
idiosyncrasy of constitution. We remember the case of a lady,
of our acquaintance, who cannot take the slightest dose of any

1858.] Campbell's Lecture on Dysentery. 87

of the preparations of mercury, although it be followed immedi-
ately by an active purgative, without suffering all the horrible
realities of a complete salivation.

As was premised in our lecture upon the " Pathology of Dys-
entery," that, either as a co-incident event, or in consequence
of the pyrexic condition which constitutes a part and parcel of
this disease the Liver, in some eases, is found to be in a state
of disorder or inaction, as is manifested by the yellow, furred
tongue, tenderness on pressure over the right hypochondriac re-
gion, and by the persistent stubbornness with which the bowels
remain in a state of constipation the retained scybala resisting
their disintegration and dislodgment.

Now, it is well understood in Therapeutics, that the different
elements of the Materia Medica are classified from the fact, that
they are found to exert their specific agency upon different and
particular organs. It is also well known, that among the effects
of mercury, is its peculiar property of u stimulating the torpid
liver into action ;" and it is as well recognized in Physiology,
that the product of this secerning organ,- the bile, is the natural
solvent of the heterogeneous residuum of digestion, the faeces, as
well as the ordinary excitant of peristaltic action, and thus it has
been styled "the natural laxative of the system."

Well, in such cases as are here indicated, and only in such,
have we found it necessary to resort to the use of this agent.
And we use it, not as constituting the basis of the treatment, as
others do, but to counteract an embarrassment in the manage-
ment of the disease, i. e., the co-incident or consequent derange-
ment of an important organ, whose suspension in function
materially interferes with the natural processes, which are ordin-
arily contributive to relief. With this view, we administer the
mildest preparation, in small doses, and repeat them as seldom
as the demands of the hepatic disorder will warrant. And we
probably anticipate when we say, that in the appropriate treat-
ment of the intestinal element of this disease, no opportunity is
allowed for its retention in the system and the consequent effect
of ptyalism.

The preparation which we prefer is the following :
ty. Blue mass, . . 3j.

Prepared chalk, 3iij. Triturate well together.
It forms a blue powder, very similar in physical properties to

88 CAMPBtfLl/s Lecture on Dysentery. [February,

the officinal hydragyrum cum creta, to which, we scarcely know
why, (as they are almost identical in constitution) ; but, be it
fancy or fact, the former seems much superior and more satisfac-
tory, in many respects. And this is probably somewhat owing
to the fact, that this preparation does not have the effect of sick-
ening the stomach, so common to the officinal article. At any
rate, the impression has weighed sufficiently with us, to have the
effect, for many years past, of substituting the one for the other
preparation, with children, as well as in all other cases, wherein
its use was formerly indicated. Of this compound, we prescribe
10 grs. morning and night, or 20 grs. at night, as long as neces-
sary, irrespective of the other means employed, for the purposes
of acting upon the liver, and thereby operating upon the faecal
mass contained in the intestinal canal, to effect its evacuation,
and we give it with no other design, than thus to assist in the
accomplishment of the third indication of the treatment that we
have already distinctly laid down, the requirements of whichy
being now under our consideration.

The Saline or purgative treatment, so strenuously advocated
by MM. Bretonneau and Trousseau, is entitled to our consider-
ation, as a practice now much in vogue, and which, it cannot be
denied, is not without favorable evidence in the result of its
operation in many cases.

This treatment originally consisted of one or two drachms of
the sulphate of soda, dissolved in any vehicle and given in di-
vided doses ; and has been said " usually to arrest Dysentery in
twelve, twenty -four, or forty-eight hours f and that " any acute,
Dysentery which is not suppressed in this time by it, demands
the closer attention of the physician, as presenting complica-
tions or being of extreme gravity." But this article has been
replaced pretty generally, in our country, where there has been
ample opportunity for testing the relative value of all the vari-
ous practices ever recommended and where, we must say, all
the suggestions ever made, have had a full and thorough trial
with various results we say that this treatment has been super-
seded by the substitution of the sulphate of magnesia, used
pretty much in the same way, as less liable to irritate the sto-
mach and bowels. A tablespoonful of its saturated aqueous
solution is given at various intervals to suit the exigencies of
the case. The acidulated solution is sometimes used, prepared

1858.J Campbell's Lecture cm Dysentery. 89

according to the formula, and given as recommended by Dr.
Henry of Dublin, viz. " To seven ounces of a saturated aque-
ous solution of the salt, add an ounce of the diluted sulphuric
acid of the Pharmacopoeias, and give a tablespoonful of the mix-
ture for a dose, in a wineglassful of water."

Now, the action of these salts is similar, and their modus
operandi and effect in Dysentery, precisely the same. That is,
they deplete by producing watery stools, or by exciting from the
mucous membrane of the small intestines, the exhalation or
secretion of large quantities of serum, the fluid element of the
blood probably, through the agency of a species of irritation
there determined, as the specific therapeutic property of this
class of agents.

It presents itself to our mind in considering the applicability
of this class of remedies to Dysentery, that they must act without
any special reference to suitableness, or correspondence of their
peculiar therapeutic properties, to this particular diseased state,
as well as the ordinary and characteristic requirements of the
organ and tissue affected, when used under the operation of this
disease; and that the good they accomplish, whenever it is man-
ifest, must be by virtue of their depleting properties, as well as
that of revulsion or derivation, through the species of irritation
which is engendered in one portion of the canal, deriving from
that previously existing in another. They also have the effect,
during their exhibition, of keeping the canal clear of solid ma-
terial, thus, as long as their use is continued, placing out of the
question the danger of irritation thereby, to the sore mucous
lining of the faecal receptacle, the large intestine, which is the
seat of the disease. But it is an observation which has probably
presented itself to every practitioner, that as soon as the use of
this class of purgatives is suspended, there is a proneness to
constipation more determined than ever. Now, let us consider
these effects, in relation to the case in question, and with refer-
ence to the physiological attributes of the organs involved, with
their dependencies, as well as with reference to the natural* pro-
clivities of these organs under this condition of disease, which,
you recollect, we endeavored to develop to you on a former
occasion, when considering the Pathology of Dysentery. And
reasoning upon these premises, it is evident, that those cases1
which are relieved (and there are many, when they are treated

90 Campbell's Lecture on Dysentery. [February,

thus, in the inception of the attack) are relieved by virtue of
dejiletion, as would blood-letting relieve them, and often does.
And here let us remark, as we may not recur to this subject,
that there are cases which not only admit of depletion by hydra-
gogue cathartics, but demand the use of the lancet although
these cases are rare. But when the symptoms are extremely
violent in the onset of the attack, or where there is enteric he^
inorrhage threatening danger ; or when, after the appropriate
management of the two elements of this disease, the symptoms
do not relax in violence, in a reasonable time then may re-
course be had to blood-letting for their abatement, as under the
same circumstances in any other one of the phlegmasia. And
we would prefer depletion from the arm, in these rare cases of
Dysentery, to depletion to any great extent, from the mucous
lining of the small intestine a surface continuous with,- and
connected to, the diseased membrane by nervous, reflex associ-
tion, as we have endeavored to show for the following reasons,
which we may say are borne out by experience. In the first
place, after a case has been relieved by the depletion of the sa-
line treatment and the medicine is discontinued, the bowels
become constipated, as is usual after the exhibition of these
purgatives the contained solid excrement passing over the re-
cently sore surface, has a tendency to re-establish irritation from
that point, restore the difficulty and "tear agape the healing
Wound afresh." And we believe that this is the explanation of
the frequent relapses occurring in cases treated thus. And
again, we have the phenomenon referred to,- in the pathology of
this disease, viz : that it has a tendency to run into diarrhoea,
in the latter stages the interpretation of which, you recollect,
was by attributing it to reflected irritation, producing an excito-
secretory result. Now, if this treatment which operates by
exciting irritation at this point, which point is also liable to re-
flected irritation -should be carried too far, or be continued too
long, it must have the effect of predisposing or determining to
a metastasis of excitement, or so derange the organization of
the tissue, that when it does occur, as to render it incapable of
recuperation, and the patient's strength and vitality must speed-
ily be exhausted in the diarrhoea which supervenes. We have
had the unenviable opportunity of witnessing two cases, which
followed this course ad finem, through the patients' or their at-

1858.] Campbeli/s Lecture on Dysentery. 91

tendants' disobeying or mistaking instructions, and continuing
the purgation too far. And since then, we must say, that as for
ourselves, we have abandoned in toto the saline treatment of
Dysentery, without the entertainment of a single regret for its
banishment, for another one by which the patients or their
attendants can effect no serious injury by mistakes or disobedi-
ence of injunctions and more especially without regret, as we
have felt that its loss was more than recompensed in the adoption
and amendment of a treatment of general applicability, and one
more rationally satisfactory to our mind, inasmuch as it supplies
fully, what we conceive to be, every demand for the relief of
that condition of the organism, which we have endeavored to
interpret to you a remedy having none of its disadvantages,
but more than its every advantage.

Although we have thus spoken of the Saline treatment, and
of its rejection by us, for a better plan yet in justice to the re-
sult of its action in many cases, and to the somewhat appropri-
ateness of the rationale of its operation in which, after all,
there is more of the semblance of reason, than in the application
of the various other practices, to which we have heretofore re-
ferred we deem it but fair, before quitting the subject, to assign
to this mode its proper place, in strict accordance with the con-
sideration it deserves. *

Then, we would say that it is next in importance, and next
in reason to that treatment, which it now remains for us to in-
vestigate, as supplying fully the requirements of the two indica-
tions under consideration : and well deserves to be borne in
mind, as second to none other than the latter, in the earlier sta-
ges of the disease, when from any cause its practicability is
impossible yet its use should be always in subjection to the
proper restrictions, that its dangers may not lurk, too long con-
cealed, in its more deceptive advantages.

The appropriate Treatment of Dysentery will form the sub-
ject of another Lecture.

4*

92 Eve's Notes on Diseases of the Cervix Uteri. [February,

ARTICLE VI.

Notes to a Report on Diseases of the Cervix Uteri. By Joseph A.
Eve, M. D., Professor of Obstetrics and Diseases of Women
and Children, in the Medical College of Georgia.

Note 1st. Chlorate of Potash,

In the July number of the American Journal of the Medical
Sciences, Br. Bedford Brown of Caswell county, N. C, proposes
chlorate of potash as an efficacious and certain remedy in the
treatment of inflammation of the cervix and cervical canal. Dr.
Brown says:

"The discovery of some simple aud efficient means as a sub-
stitute for the uncertain astringent injections in common use,
and the tedious and often unsuccessful caustic and speculum,
would relieve the physician of an extremely disagreeable duty,
and the patient of an almost intolerable necessity.

" In those cases of leucorrhoea attended with ulceration of the
os uteri or cervical canal, and enlargement of the muciparous
glands of the vagina, or simple ulceration without leucorrhoea,
I believe the injections of the cKrorate far more certain and effi-
cient than the ordinary astringent injections, or the local appli-
cation of caustic. In these cases I have not thought proper to
give detailed reports of their symptoms and progress."

Since reading Dr. B.'s communication, I have several times
prescribed the chlorate of potash, and intend to give it a fair
trial ; for if nearly as efficacious as he asserts, it would be a
valuable addition to our resources in the management of those
affections. But when Dr. B. speaks of " the tedious and often un-
successful caustic and speculum ;" he shows that he has not a tho-
rough practical acquaintance with cauterization, or at least that
he has not been sufficiently persevering in his employment of it:
for if there be certainty in medicine, it is seen in the treatment
of simple inflammation and ulceration of the cervix by caustics,
when properly and perseveringly used ; and although oftentimes
tedious, it is less so than any plan hitherto devised. Chlorate
of potash will probably succeed well in many of the lighter and
more recent cases of inflammation of the cervix without or with

1858.] Eve's Notes on Diseases of the Cervix Uteri. 93

superficial abrasion, and it will I trust prove at least a more
valuable adjuvant to caustics than other vaginal injections; but
I would rejoice to find it prove as efficacious as nitrate of silver
in the more inveterate and serious cases. It would indeed be a
great benefaction both to patient and practitioner; and Dr.
Brown should be justly regarded as a friend, not only to the
ladies, but to his professional brethren.

My friend, Prof. Campbell, used chlorate of potash with bis-
muth with perfect success in a case of inflammation of the cervix
and vagina, in the City Hospital. This patient had an extensive
vesico- vaginal fistula, before operating for which, it was neces-
sary to remove the inflammation. Dr. Campbell prescribed vag-
inal injections of this salt and subnitrate of bismuth, three times
per day ; at the end of a few weeks, he examined and found the
inflammation had entirely disappeared. This patient, it is true,
was favorably circumstanced for the success of any plan of treat-
ment, but none could possibly have succeeded better.

Patients generally speak of it as pleasant in its effect ; one
patient, however, complained of its causing great pain. This
was an elderly lady who had for some time complained of symp-
toms of prolapsus, for which astringent vaginal injections were
prescribed ; as she was not relieved, a digital examination was
made, which detected moderate prolapsus, but nothing abnor-
mal in the cervix except that the os was somewhat more patulous
than usual. A globular pessary was inserted, which caused
considerable pain and which she succeeded in removing herself:
after which the chlorate of potash was prescribed and its admin-
istration followed by much pain, which is only explicable upon
the supposition that in consequence of the patulousness of the
os, it passed into the cavity of the body of the uterus. "When
this patient had used vaginal injections of cold water a few
days, a specular examination was made ; the cervix externally
was perfectly healthy, but intense inflammation was observed
extending from the os deep into the cervical canal. There was
in this case a very unusual occurrence, a remarkable exemption
from leucorrhcea, which induced me to suppose there could be
very little, if any, inflammation, and therefore to defer so long
the use of the speculum. In cases wherein there is much prolapsus
with relaxation of the vagina, it is very doubtful whether injec-
tions of chlorate of potash will succeed as well as alum and

94 Eve's Notes on Diseases of the Cervix Uteri. [February,

tannin in promoting the restoration of the uterus to its normal
position.

Note 2nd. Dr. Tyler Smith and Dr. Eigby.

In the first part of this Keport the testimony of these gentle-
men was said to be strongly in favor of the frequency of ulcera-
tion of the cervix : a little explanation may be proper. Dr.
Tyler Smith certainly recognizes the frequent' occurrence of
ulceration, especially of the lighter grades " epithelial abrasion
and superficial ulceration " but he considers it to depend on
leucorrhoea and not to be a consequence of inflammation. He
observes (page 92) : " The loss of portions of epithelium, the first
step towards ulceration, is so common in cases of confirmed leu-
corrhoea, that there must be some very frequent and simple cause
which produces it, and it appears to me that it is far more rea-
sonably accounted for by looking to the irritant discharges than
in any other way." But for full confirmation, we would refer
to . the whole of the fifth chapter in his able treatise on leucor-
rhoea.

Dr. Eigby, employing the term in its most restricted sense,
excluding all except deep ulcers, does say, (page 105,) "Ulcera-
tion of the os and cervix uteri, not connected with malignant
disease of the uterus, is, in fact, a rare affection." But from the
following paragraphs (page 94), and other passages in his work
on Diseases of Women, he plainly admits the frequency of in-
flammation of the cervix, and what Dr. Bennet and others con-
sider, and very properly, lighter degrees of ulceration.

" The female generative organs, situated at the lower part of
the trunk, supporting the chief weight and pressure of the intes-
tines, and subject to such great periodic alterations of vasculari-
ty, not to mention the wonderful changes they undergo during
pregnancy and parturition, are rendered peculiarly disposed to
be affected by any morbid action which may occur, especially in
the great machinery of the chylopoietic system, and liable to be
fixed upon in the various blood diseases, on which to localize
their energy and expend their virulence.

" It will therefore be seen that there are few affections of the
general health in a female, in which the generative system is not
more or less involved ; and although these local affections, which
in the first instance are mostly effects of deranged health, react

1858.] Eve's Xotes on Diseases of the Cervix Uteri. 95

and produce in their turn considerable sympathetic derange-
ment, yet it must be borne in mind that, unless a distinct local
cause be present, they must be looked upon as "the local
manifestations of a general derangement, in order that we may
form correct and rational ideas respecting their nature and treat-
ment.

"Inflammation of the os and cervix uteri seldom occurs as an
acute affection, but, in far the majority of cases, in a subacute or
chronic form."

It is true, he regards them as most frequently secondary or
sympathetic affections, depending on the state of the general
system, disappearing and reappearing as the patient's health im-
proves or declines, for he says, (page 103) :

" Allowing for the difference of position, &c, I would say that
the os uteri presents as great a variety and frequent change of
appearance as the tongue and throat do ; and I, moreover, feel
convinced, that if these parts could be as readily inspected, ex-
perience would soon enable us to recognize the appearances
which they present as indications of the state of the patient's
health much as we are accustomed to do in examining those
presented by the tongue."

How this may be when these affectious are recent and slight,
I do not know ; nor can I conceive how Dr. Rigby has arrived
at this conclusion ; for when sufficiently intense to indicate and
justify a specular examination, they have been found remarka-
bly persistent, varying very little, until they have been properly
treated ; after which I have never known a case relapse. My
experience cannot recall a single instance in which a patient,
after having been cured, has had a return of the disease ; although
suffering once does not afford any immunity for the future.

Dr. Bennet says, (page 277,) "Since I have made it a rule
minutely to investigate the state of the cavity of the cervix, and
never to dismiss a patient so long as there is the slightest vestige
of disease remaining, I am much longer in curing my patients,
but when they are once cured, I never have any relapse of the
ulcerative disease. The relapses which I formerly used continu-
ally to witness in the practice of the French surgeons, were
clearly owing to the disease not being followed into the interior
of the cervical canal, and thus not being entirely eradicated."

From the very first, in employing caustic, I have adopted this

96 Eve's Notes on Diseases of (lie Cervix Uteri. [February,

rule with respect to the cervical canal, and therefore I do not
remember ever to have had a relapse.

Dr. Kigby says, " Inflammation of the os and cervix seldom
occurs as an acute affection, but in far the majority of cases, in
a subacute or chronic form." Is it usual for chronic affections to
present great variety and frequent change of appearance ?

Note 3rd. Repetition of Caustics.

It is very important not to repeat caustic applications too
often once weekly is often enough : every sixth day is the short-
est interval admissible. The eschar does not always fall off in
a week. After several applications have been made, from four
to six, it is advisable to allow a period of two or three weeks to
intervene, that the effect of the caustic passing entirely off, the
real amount of improvement may appear. If the cauterizations
be kept up without intermission, it would be impossible to de-
termine when the patient was cured. A physician expressed
his surprise, that although he had cauterized the cervix every
other day for a considerable time, he had not succeeded in curing
his patient he was advised to stop and give her an opportunity
to get well. In another, cauterization was repeated weekly for
a year : if curable, she ought to have been cured in less time,
and with fewer applications.

Cauterizatian ought not to be too often repeated, or too long
continued. Few cases require more than from five to ten ap-
plications. I have known four to suffice, and two, even one, to do
much good ; though sometimes from fifteen to twenty have been
required.

Note 4th. " Dishonest Use of Caustics."
Among the causes of inflammation of the cervix, Dr. Rigby
mentions what he terms the " dishonest use of caustics," a favor-
ite phrase which he uses several times, and which savours more
of sensoriousness than of sense. That the injudicious use of caus-
tics may keep up inflammation, or may cause it, when through
error unnecessarily applied, is highly probable all are liable to
make mistakes, especially the young and inexperienced; but I
cannot comprehend what he means by "dishonest:" certainly
an unscrupulous money -loving physician can charge what he
pleases for his advice and visits, without resorting to means so

1858.] Eve's Notes on Diseases of the Cervix Uteri. 97

unpleasant to practitioner as well as patient ; most assuredly
physicians of the great metropolis, Dr. Rigby's confreres, must
have much less repugnance to making such examinations and
manipulations, unnecessarily, than physicians in this latitude,
who are much more apt to neglect them when proper.

According to my experience, patients are much more profita-
ble, when treated without caustics ; for if relieved at all, they are
constantly relapsing and requiring professional assistance. But
it is to be hoped no one would, for an instant, be so uncharitable
as to suppose that those gentlemen, who adopt such practice, are
actuated by a love of lucre. However erroneous their views, it
is presumed they do what they conscientiously believe best for
their patients.

Xote 5th. Effects of Nitrate of Silver in overcoming

Sterility.
Dr. Tyler Smith says, in reference to his 35th case, (page 164.)
"In this case, as in several others, I attributed the result of
pregnancy to the application of the nitrate of silver. On both
occasions the patient became pregnant after a free use of this ap-
plication immediately before the catamenial period. It appears
as though the application of the solid nitrate of silver is either
followed in a few days by a healthy secretion from the surface
to which it is applied, or the irritating discharges are neutralized
by its use. Of its influence in removing sterility in leucorrhcea
I have had many examples. Some cases of this kind which I
have seen in consultation with Mr. Guthrie, and Mr. "Walter
Bryant in particular, leave no doubt upon my mind of the effects
of this remedy, in cases where the disordered condition of the
secretions of the os and cervix is the cause of sterility." This
accords with my own observation, for in a review of cases treat-
ed by nitrate of silver, as very frequent consequences, are ob-
served conception in patients previously sterile, and fortunate
gestation in those previously subject to repeated abortions. Its
influence in removing sterility probably depends on its curing
the leucorrhcea, which usually attends and which in many in-
stances is doubtless the principal obstacle to conception. It pre-
vents abortion, by removing the inflammation and restoring the
natural condition and healthy action of the cervix in which
resides the retentive power of the uterus in gestation.

98 Eve's Notes on Diseases of the Cervix Uteri. [February,

Many cases might be adduced in illustration : very few may
suffice.

Mrs. , from Carolina, had been married 3 or 4 years, and

was in wretched health as long. She had been under the care of a
number of eminent physicians and had undergone a variety of
treatment for various diseases, but as the true pathology of the case
was overlooked no relief was experienced. This lady suffered
so many severe local and constitutional symptoms that life had
almost become a burden, and she had very little hope of ever
being restored to health. Upon careful investigation, she was
found to have prolapsus, with inflammation of the cervix and
cervical canal, to which I thought all her sufferings were fairly
referrible, that this was probably the primary affection and the
others secondary and sympathetic. The local affection was
treated by cauterization with nitrate of silver and astringent
vaginal injections. The principal constitutional remedies em-
ployed were preparations of iodine and iron and other tonics.
Very many intercurrent symptoms and sympathetic affections
were met by such medicines, as were severally indicated for
them ; these were indeed so numerous that it would be tiresome
to attempt to particularize. The treatment of this case, local and
general, extended over more than two years. The first cauter-
ization was on the3rd of March, 1853, and the last on the 24th
November of the same year sixteen in all, through a space of
nine months; few cases have ever required as many; but after
all traces of uterine inflammation had disappeared, she was
under prescription for the secondary affections during the whole
of the following year.

It often happens, when cases have been of long standing, that
the secondary affections do not subside for a long time, and not
unfrequently demand considerable treatment.

Fewer cauterizations, perhaps, might have sufficed, if they
could have been made with more regularity, but as this lady
lived at a distance, they were frequently unavoidably deferred
too long.

After all traces of inflammation had been removed and leu-
corrhcea had entirely ceased, this patient was subject to menor-
rhagia at nearly every menstrual period until June, 1855, when
she became pregnant, and in the following April gave birth to a
fine little daughter, since which Mrs. has generally enjoyed

1858.] Eve's Notes on Diseases of the Cervix Uteri. 99

very good health. And thus a most amiable and excellent
couple were rendered as happy as they well could be, who before
were perhaps equally miserable the husband from sympathy
with his wife in her sufferings, and she, perhaps, less from her
own sufferings than from the distress they caused him. Last
October this lady was in Augusta, looking as young, and more
blooming and happy than previous to her marriage, five years
before.

This case exemplifies the happy effects of the most patient
perseverance under the most adverse and discouraging circum--
stances. It required a longer course of treatment than any I
have ever attended, Had this lady not possessed and exercised
the most indomitable patience, she would have given up in utter
hopelessness,- long before a cure was accomplished.

Some two years past, a Scotch lady about 30 years of age*
some years married, consulted me occasionally for leucorrhoea^
for which I prescribed medical treatment and vaginal injections.-
In 1855 she had an alarming hemorrhage from the womb, which
might probably have depended upon an early abortion, but no
embryo or ovum was discovered. She had another excessive
hemorrhage Nov. 12th, 1856 no embryo or ovum being seem
Vaginal examination detected very considerable enlargement
and congestion of the uterus, but no evidence of pregnancy .-

She was informed that she probably had inflammation or ul-
ceration of the neck of her womb, and that as soon as she had
recovered sufficiently from the effects of the hemorrhage, she
ought to submit to specular examination, by which alone it
could with certainty be determined. On the 29th of the same
month, the speculum revealed a deep pus-secreting ulcer, extend-
ing from the anterior lip into the cervical canal, which was
freely cauterized by nitrate of silver* Chalybeate tonics and
astringent vaginal injections were also prescribed. Caustic Was
applied again on the 12th and 27th of December and on the 10th
and 27th of the following February in all, five times. At the
last examination, in February j there was great improvement.
Having called two or three times afterwards, without finding
her at home, and for a long time not having heard from her, I
lost sight of the case, supposing that, tired of this treatment, she
had sought assistance elsewhere.

But, to my surprise, in August she called to inform me that
n.s. vol. xrv. NO. II. 5

100 Eve's Notes on Diseases of the Cervix Uteri. [February,

since I saw her last, not only the whites, but "the reds," too, had
ceased, that she had no discharge at all for some months re-
marking, with perfect artlessness, what alarmed her most was a
large lump in the lower part of her stomach, and that her prin-
cipal distress was being very sick to her stomach, especially of
mornings. Her gloomy apprehensions were very easily and
pleasantly dispelled by assuring her that the tumor was perfect-
ly natural, and that she was just " as ladies wish to be who love
their lords,"

This worthy lady and her kind husband were made perfectly
happy in December by the birth of a little daughter.

This case is remarkable for such happy results, from so com-
paratively small an amount of treatment affording great en-
couragement to patients whose circumstances may not admit of
regular systematic treatment.

A lady, twenty-two years of age, who had been married about
two years, during which time she had one premature birth, came
from Muscogee county, and remained in Augusta five weeks,
She had been suffering since her labor, some nine months before
with the usual functional symptoms of prolapsus and inflamma
tion of the cervix, which were verified by digital and instru
mental examination. Nitrate of silver was applied four times
first, on the 28th day of January, 1854 on the 8th and 22nd
of February, and on the 4th of March ; in a few days after which
she returned home, with a silver-gilt globular pessary.

Some six months after her return, I heard from her friends
that she was enjoying good health, with good prospects ahead,
which were in due process of time happily realized.

This patient also used astringent vaginal injections. As she
was very feeble, thin and pale, chalybeate and other tonics were
prescribed. She suffered exceedingly from vesical irritation, for
the relief of which she took a comp. syrup of buchu, uva ursi, &c,
with very good effect.

The medical treatment was continued some time after her re-
turn home.

This case is remarkable for the promptness of its recovery
from such a distressing state.

Many more cases might be adduced, but it would be unneces-
sary and tiresome ; for to me nothing appears more dull and
uninteresting than a narration of many cases substantially the

1858.] Eve's Notes on Diseases of the Cervix Uteri. 101

same. The general rale has been, that married ladies, during
the reproductive age, have borne children after having under-
gone treatment by nitrate of silver for inflammation or ulceration
of the cervix : there are, however, some exceptions ; many of
these, we believe, are due to displacements, such as retroflex-
ion, retroversion, &c, which sometimes persist after recovery,
and are not easily corrected.

Note 6th. The Speculum.

"Whilst it must be acceded that the speculum, like every other
valuable medical or surgical means, has been abused by being
employed in cases to which it is not applicable in which it
could neither throw light on the pathology, nor prove of any
benefit in the treatment. But attemps have been made to throw
unjust and undeserved obloquy upon its use, by some from
whom better things might have been expected : As an instance
in point ; Dr. Eobert Lee makes the following illiberal and ill-
natured remark: " The speculum emanates from the syphilitic
wards of the hospitals at Paris, and it would have been better for
the women of England, had its use been confined to those insti*
tutions."

It is true, that all of the most important discoveries in patholo*
gy, and valuable improvements in practice, have not resulted
from experiments and investigations made in the Parisian hos*
pitals ; but if physicians, from pride or prejudice, were to ignore
or repudiate all that has emanated from that same source, who
could calculate the immense loss to science and to humanity ?

Admitting, for argument, that the speculum emanates from
the venereal wards of Parisian hospitals does not Providence
often bring good out of evil ? And on whom could it be more
justifiable to make investigations and experiments, that might
redound to the benefit of the good and virtuous, than on the
vicious and profligate of the same sex ?

There is no doubt but that the speculum has often been mis-
usedthat is, applied in cases wherein no knowledge could be
obtained or benefit secured, as, for example, in some cases of
large polypi and other tumors, and of cancer, especially when
far advanced, and in the various displacements and malpositions
of the uterus.

But the speculum frequently reveals much important informa~

102 Eve's Notes on Diseases of the Cervix Uteri. [February,

tion, which cannot be obtained by the finger alone. Many-
morbid changes which are not palpable to the touch are easily
detected by the eye.

Dr. Churchill (page 29, Dr. Con die's edition) makes the fol-
lowing very sensible remarks in reference to the employment of
the speculum :

"It enables us to ascertain accurately the length and thickness
of the cervix uteri, to detect variations from the natural color of
the mucous membranes, slight erosions which might be passed
over by the finger, elevations on the cervix uteri or walls of the
vagina, too little raised to impress the sense of touch ; small
vesicular polypi within the os uteri, eruptions upon the cervix,
and we are enabled to discover the color of the surface of an
ulcer. It will also confirm many characters recognized by the
touch. On the other hand, we must be careful that we do not
mistake for morbid changes those appearances which are caused
by the instrument itself. For instance, pressure en the outer end
of the instrument may change the elevation and position of the
uterus, and produce swelling and pufrmess of the cervix. There
can be no doubt of the great value of the speculum! both for the
detection of disease, and the application of remedies ; but it is pos-
sible that injury, beyond the violation of delicacy, may be occa-
sioned by it. It should never be used, if it be possible to avoid
it, in virgins ; or when there is any alteration of tissue, involv-
ing its greater liability to laceration, and as rarely as possible
with nervous women."

Dr. Churchill has omitted inflammation and ulceration ex-
tending into the cervical canal, which are of very frequent occur-
rence, and, generally at least, are not at all discoverable by the
finger.

His caution against mistaking "for morbid changes appear-
ances caused by the instrument," is very well timed and
judicious, especially in using Kicord's four-branch speculum,
which he recommends very highly and which formerly I em-
ployed much oftener than any other. This speculum pos-
sesses the advantages of being very easily introduced when
the blades are closed, and of giving a good view by the sepa-
ration of the blades in the vagina, but it is perhaps more
liable than any other, in expanding, to give pain, and by
irritating the vagina and cervix to cause temporary discolora-

1858.] Eve's Notes on Diseases of the Cervix Uteri. 103

tions, which might deceive the unpractised eye and possibly
mislead the more experienced. Another great objection is that
if necessary to change its position at all, it must be withdrawn
and re-introduced, for otherwise the expanded blades could not
fail to irritate and cause pain : it is also very apt to give pain in
being withdrawn ; unless closed with great care, the extremities
of the blades will almost certainly irritate, and if not withdrawn
gradually and cautiously while closing, the mucous membrane
of the vagina will be pinched.

Having tried and rejected a large number of complicated and
expensive specula, I now decidedly prefer the glass mirror spec-
ulum, in general at least, to all others. Although it has no
obturator, by introducing the projecting lip first carefully, and
pressing it gently backward against the perineum, it may be in-
troduced almost if not quite as easily as the bivalve or quadri-
valve with the obturator ; and then it may be moved freely in
any direction after its introduction so as to bring the os and
cervix in view, if needs be to hook them up and bring them for-
ward, when, as often found, inclined too far back to be readily
seen.

Much has been said against the speculum on the score of deli-
cacy ; but I cannot perceive that it is any more indelicate to
make a specular than a digital examination ; it is the necessity
of the case that renders either proper, and I do believe a truly
sensible and delicate lady would submit to the one as readily as
the other indeed, were it not that a digital examination almost
necessarily precedes the introduction of the speculum, the spec-
ular would involve less indelicacy than the other; for example
were it practicable for the speculum to be introduced without
the intervention of the physician, as I have known, in a few
instances, by the patient herself, or a female friend, and the
physician only required to look through it and, if necessary,
make an application, would it not wound her delicacy less than
a digital examination ? It is said that it involves more expo-
sure, but this is not necessary ; for it certainly can, by proper
care, and ought always to be avoided.

"When the speculum gives much pain, its use ought to be de-
ferred, until the patient is better prepared for it, by soothinc
and sedative vaginal injections. I cannot conceive that any in-
jury can result from the speculum, when used with proper care

104 Eve's Notes on Diseases of the Cervix Uteri. [February,

and caution, and under circumstances to indicate and warrant
its application.

Dr. Churchill says, il it should never be used, in virgins, if it
be possible to avoid it," that is, if at all compatible with the
proper treatment of their diseases, and the same may be said in
reference to all ; but besides the greater physical difficulty and
liability to inflict pain and injury, it is proper, on other consid-
erations, to defer it longer in the former, and wait until the
necessity is great indeed.

But when there is truly a necessity for a specular examination
in virgins, the physical obstacle is generally not so great as the
objection we naturally feel to subject them to any such investi-
gations ; for the long continuance of uterine disease has the effect
of so relaxing and dilating the vagina, that an examination is
attended with comparatively little difficulty. A respectable
young lady had, at 13 years of age, about the time of the first
eruption of the menses, been thrown from a horse with great vio-
lence, alighting on her pelvis, ever since which, she had been
subject to symptoms of prolapsus, "When examined at 17, her
womb was very much hypertrophied, and at the orifice of the
vagina which was so relaxed, that almost any speculum could
be introduced with ease.

On a distant visit, in 1856, I was requested to see a married
lady, about 20 years of age, who had a decided procidentia, the
uterus projecting about two inches beyond the vulva: she and
her mother told me, she had had this affection five years before
her marriage, which had taken place a few months before I saw
her. She was of very respectable family, and of unimpeachable
character.

These are indeed extreme cases, but more or less relaxation
always results from uterine disease of long standing. In any
case wherein it may be at all proper to make a specular ex-
amination, Whitehead's bivalve speculum may be used with
safety.

As respects the position ; in many cases, it answers very well
to have the patient on her back, or on her side, with the pelvis
near the edge of the bed ; but very frequently there is a great
advantage in having the patient on her knees and elbows, as
recently advised by Dr. Churchill, and many years ago by Pro-
fessor Antony. In this position, with the thorax lower than the

1858.] Eve's Notes on Diseases of the Cervix Uteri. 105

pelvis, gravity causes the womb to pass from the floor of the
pelvis toward the abdominal strait, elongating the vagina to its
full extent, so that, if not shortened by the long existence of
prolapsus, the os will be about the centre of the pelvis, and there
will be ample room to inspect the whole sub vaginal portion, and
to make a satisfactory application to any part of it ; whereas,
when the patient is on her back or side, situated, as the womb
often is, low down and in the axis of the superior strait, the
speculum passing in the direction of the axis of the inferior
strait, they necessarily meet at such an angle that it is often im-
possible to obtain a good view of the os, or to insert a piece of
caustic into the cervical canal. When the uterus has approach-
ed so near the vulva, as to have necessarily changed its direc-
tion from the axis of the brim to that of the outlet, it is of
course most easily inspected while the patient is on her back
or side.

The position of the uterus in the pelvis and the condition of
the vagina, must determine what position of the patient will be
most eligible in each particular case.

It is utterly futile to declaim against the speculum in cases de-
manding its use, when, in Europe and the United States, so many
hundreds and thousands of the most interesting and valuable of
the sex, whose health was wrecked, and whose lives were ren-
dered miserable, with an untimely grave in view, have, by
treatment involving its use, been restored to health and to happi-
ness, and have become again blessings to their families and to
society, without the slightest diminution of purity, or even of
delicacy, and in the highest possession of every moral and reli-
gious excellence that can beautify and adorn the female char-
acter.

With such witnesses in its favor, the opponents of the specu-
lum will exhaust their disapproval in vain declamation.

106 Report upon the Topography and [February,

Dr. Posey's Eeport.

[The following very able Eeport was presented to the Ameri'
can Medical Association by Professor K. D. Arnold, of Savannah,
at its last meeting, in Nashville, J)r, Posey, the reporter, not
being able to attend the meeting. Appreciating its deep inter-
est to the Southern Physician, and especially those of our own
State, in a statistical point of view, we begin its publication in
our present number. The balance of the paper, relating to Epi-
demic Diseases, will find a place in our March number.

Georgia certainly has no reason to complain she has record*
ed herself pretty fully in the last volume of our National Trans*
actions,

Report upon the Topography and Epidemic Diseases of the State of
Georgia. By Jo#N F. Posey, M, P., of Savannah, Ga,

The State of Georgia must, for purposes of medical topogra*
phy, be divided into three unequal parts.

The largest occupying more than half the area of the State,
extends from the sea-coast and Florida line on the south to the
head of navigation of the larger rivers.

The second division is separated from the first by a line be*
ginning at Augusta, at the head of navigation in the Savannah
Eiver, and running nearly west-southwest, by Milledgeville and
J^acon, to Columbus, at the head of navigation in the Chatta*
hoochee ; and is bounded on the northwest by a line drawn
from the northeastern corner of the State, and running nearly
southwest till it reaches the western boundary line of the State,
about half way between Columbus and Nicajack, on the Ten*
nessee Eiver.

The third occupies all the space, within the State, lying north-
west of the last mentioned line, and is much smaller than the
second.

The first division is, geologically, of tertiary formation, vary*
ing in height and quality of alluvium according to the distance
from the sea-coast.

Dr. P. M. Kollock describes the part nearest to the sea thus :

u The topographical features of this district may be distin*
guished into three separate orders, marked by strips or sections
extending lengthwise from northeast to southwest.

*' Commencing with the Sea Islands on the east, we remark a
series of sand-knolls or hillocks, apparently washed up by the
gea from its bottom, varying in elevation, intersected by salt-
marshes and creeks, and inclosing frequently brackish ponds
and lagoons.

1858.] Epidemic Diseases of the State of Georgia. 107

M The growth of these islands is live-oak, water-oak, bay, gum,
and pine. The live-oak predominates on the southern parts of
the islands, almost to the exclusion of the pine ; while this last
is found at the northern end,

" The soil is a grayish and yellowish-brown sand, mixed with
shells and vegetable mould, without any mixture or substra-
tum of clay. This soil, for the most part, is thin, extending only
a few inches in depth.

" These islands are separated from the mainland by extensive
salt-marshes, which are intersected by numerous creeks, and
overflowed by every high tide.

" The islands are also separated from each other by sounds,
or arms of the sea, which are the outlets of the rivers to the
ocean.

"Leaving the islands, and crossing over to the main, we enter
upon another section or strip of country, varying in its topo*
graphical features from the islands ; a low pine-barren, intersect-
ed with the rivers and swamps before mentioned.

"The growth of these barrens is the short-leaved pine, mim
gled with scrub-oaks and gums. The soil is sandy, with here
and there a sprinkling of red clay.

" In wet seasons, while the swamps are full of water, this

Eine-barren soil is kept in a sobbed state, the drainage being bad
y reason of its flatness.

"Passing across this section, inland, twenty or thirty miles
in width, we strike a somewhat more elevated and rolling region
of sand-ridges and hills, intersected with bay -galls and branches,
and sometimes ponds,

" The soil is sandy, with a substratum of clay at varying
depths. The long- leaved pine takes the place of the short, and
predominates, to the exclusion of almost every other tree."

The mainland adjoining the salt-marshes, which divide it
from the Sea Islands between the Savannah and Altamaha
Rivers, usually commences with a line of bluffs, which rises
twenty or thirty feet above the level of high water, separated
by arms of salt-marsh and small streams of fresh water, carrying
the water springing from a line of sand-hills twenty or thirty
miles further inland.

These streams have a tide flowing a distance of ten or fifteen
miles above the bluflfe, and for about the same distance further
they are margined by a fresh- water marsh and swamp, from half
a mile to a mile in width, with strips of higher land between
them, which are of an older formation than the alluvium of the
swamps, this last being yet in the process of deposit.

Some of these strips of higher ground are remarkable for the
growth of plants not usually found growing so near the sea-
coast.

108 Report upon the Topography and [February,

Between the line of bluffs and the line of sand-hills the great-
est part of the rice which is grown in Georgia is produced, and
also much of the long-stapled cotton.

The line of sand-hills is an abrupt rise from a comparatively
level plain, of about sixty feet, which height is very gradually
increased as the distance from the beginning line is increased,
with a succession of undulations of no great altitude, except
near the river swamps. These swamps are like wide, shallow
valleys cutting through the undulations, in which the streams
meander from one side to the other, without any apparent cause
for keeping any particular course.

These valleys are filled to their present surface-level with the
most recent alluvium, the vegetable mould now forming on the
spot, sometimes covered with water and a growth of cypress, and
in other places dry, with a heavy growth of such trees and bush-
es as delight in a damp, rich soil.

Into these swamps and lowlands the above-mentioned undu-
lations project more or less, producing an irregular line of river
hills, having the valleys between them gradually rising from the
level of the river swamps to that of the innumerable ponds that
are scattered all over the face of this part of the country. These
valleys, which carry off the surface water after rains, wind
about among hills of but little height above them, until ap-
proaching the river swamps, where they seem to have been
washed deeper, but are accompanied in their whole course by
that kind of water-drain called by the inhabitants " bay-galls,"
which are from thirty to sixty yards or more in width ; these
are like the river swamps, on a smaller scale, and often resem-
ble vast hedges dividing fields of open pine-barren, or dense
thickets of low whortleberry-bushes, or species of Andromeda
called by the people " tie-tie."

When these bay-galls, in their course to the river, meet to-
gether, they make considerable streams, which seldom run dry,
and in some places have cut for themselves channels with fall
sufficient to drain the swamps on their sides for some distance ;
these channels are commonly filled more or less thickly with
silicious stones, often being casts of some bivalve.

What is here called "rotten limestone," probably underlies
this whole region, and is found in digging wells, where they
have to be sunk deeply ; and where this is the case, the water
is commonly impregnated with what seems to be putrid animal
matter, which renders it exceedingly disagreeable, and, in the
general opinion, unhealthy.

At the distance of about one hundred and twenty miles from
the sea, the rotten limestone ceases, and mica-schist begins to be
found in the beds of rivers and other deep excavations ; here,
also, the hills are higher and steeper, and oak and hickory

1858.] Epidemic Diseases of the State of Georgia. 109

are mixed with the pines ; cypresses are no longer found, and
the small water-courses have high, steep banks, without swamps;
here, also, the long-leaved pines cease, and soon the primitive
formation crops out.

South of the Altamaha Kiver, after leaving the tide- way, the
face of the country is described by Dr. Kollock thus:

u The soil varies in its equalities and appearance, " being
either a dark-gray or a black mould, and is superficial, with an
argillaceous substratum to the depth of five or six feet, and in a
dry time becomes so hard that it is almost impervious to the
plough or hoe, and cracks in every direction, forming exten-
sive fissures of considerable depth." In such localities it is rare
to find good water. According to Dr. T. S. Hopkins, of Wayne
County, white clothing, washed in this water for a time, will
assume a yellowish hue, analogous to that which would be pro-
duced by a very weak solution of sulphate of iron.

" This section of country, says the same gentleman, is known
as the " lowlands," and is invariably abandoned by the plan-
ters in the early part of June.

"In a very dry or very wet season, the negroes on the plan-
tations seem to enjoy almost an entire immunity from the severe
grades of bilious remittent and congestive fevers which are
common at other seasons,

" Immediately above the lowlands, in Glynn County and the
great Buffalo Swamp, the land rises at least eighteen feet, the
soil is sandy and poor, the growth chiefly pine and blackjack,
intersected occasionally by spring branches, which afford at
almost all seasons of the year an abundant supply of fine water.
The well-water throughout this section cannot be surpassed in
purity and coolness even by our mountain springs."

On the south, in Ware County, is the great Okefonokee
Swamp, of which it is not necessary to say more than that it is
but little known as yet ; but a survey, by order of the legislature
of the State, is now in progress.

On the west, and further inland, "the face of the country,"
says Dr. H. Briggs, of Troupville, " is level, rolling somewhat
in the southern half, interspersed throughout with shallow ponds
and bays, some of which are timbered, others destitute of trees ;
filled to overflowing with water during the rainy seasons of
winter and spring, but usually nearly or quite dry during the
latter part of summer and autumn.

"There are some ponds of a different kind in the southern
part. They appear to have been formed by portions of land
settling down, and the water rising to a considerable height
above the depressed portions.

" These were formed a long time since, as the banks are now
very evenly sloped, and covered with trees of mature growth.

110 Report upon the Topography and [February,

They are usually round or elliptical, varying in depth from
three to fifteen or twenty feet, not very sensibly affected by rain
or drought.

" There are in almost all sections some evidences of lime un-
derneath the clay, such as lime-sinks and sundry subterranean
passages, into which the creeks pour a part of their waters ; also
some lime-water springs.

aThe country lies upon the Mexican Gulf slope, the declivity
being from fifteen to eighteen inches to the mile. The water-
courses have a general southern course, and are all tributaries
of the Suwanne or Ocklockonnee Eivers. The creeks and bran-
ches spread far and wide after a rainy season ; and after a long
dry summer they are either dry, or nearly destitute of running
water. The largest are mere drains for the surface water.

" The soil is a sandy loam, underlaid with clay at various
depths, from six inches to several feet.

" The well water is soft and generally free from lime, except
after protracted drought.

" The country is generally covered with pine forests, and the
wild grasses and flowering plants indigenous to all this region.

"There are some isolated portions of country covered with a
heavy growth of oak, hickory, magnolia, &c. The bays and
margins of the creeks and branches are wooded with cypress,
bay, gum, water-oak, live-oak, and a dense undergrowth of
evergreen shrubs.

" The pine lands are moderately productive, yielding corn,
cotton, potatoes, rice, sugar-cane, wheat and oats.

" The hammock lands are more productive, but probably not
more durable. Very little has been done, as yet, in the way of
reclaiming bay or swamp lands.

" Oyster and other marine shells abound in the beds of all the
larger streams ; they have undergone silicious petrifaction.

" In the southern part, along the banks of the streams, speci-
mens of chalcedony, large masses of yellow limestone, and orbi-
tulite are frequent.

" About midway between the Atlantic and Gulf coasts, the
temperature in summer, during the day, is often as high as
ninety or an hundred degrees ; I have not known it to exceed
one hundred and two degrees at any time. The nights are sel-
dom oppressively warm after nine P. M. The gales that so fre-
quently prove disastrous upon the Atlantic coast, are scarcely
observed here, Those of the Gulf coast are sometimes severely
felt, particularly in the western part of the district,"

The second division of the State begins on a line running
from Augusta by Milledgeville and Macon, to Columbus, being
the head of navigation in the principal rivers of the State, and
differs entirely from the first in geological formation, being

1858.] Epidemic Diseases of the State of Georgia.- Ill

primitive ; and the face of the country, which is more hilly, and
the streams being mostly confined between high banks, and
without any marginal swamps, with rocky beds, over which the
current is generaDy very rapid.

The hills, near the larger water-courses,- are commonly very
steep, often with large masses of coarse-grained granite piled up
like houses, and rapidly disintegrating, from the effects of the
weather. These hills are composed of clay of various colors, red
predominating on the higher parts, while in the deep cuts made
by the streams, a white, extremly tough plastic clay is found,
mixed with a very fine white sand, with white flint stones, often
in oblique cubes, with unpolished surfaces.

In some places dikes of silex, or of coarse mica, cut into the
hills like veins of a mine, as if immense masses of granite had
been decomposed into clay, leaving veins of silex or mica in
place.

The red clay always contains grains of silex, and sometimes
mica in very considerable quantities. Transparent crystals of
qnartz abound, sometimes single, but mostly covering a mass of
agate, or lining a cavity in the same. Small masses of felspar
are found on the surface, and geodes, an ineh or less in diame-
ter, containing a quantity of red ochre.

There are places in the central parts of this division, where the
granite lies bare, like an old field of some acres, having banks
around it like those of a tranquil water-course, green with moss-
es and constantly damp.

The soil is a light gray, and strong, and very productive
while new, but very quickly destroyed by careless cultivation,
such as has been practiced ever since the first settlement of the
country, leaving bare the clay, upon which scarcely any vege-
table can grow.

The most productive lands, and those which are longest in
being exhausted by the slovenly cultivation aforesaid, are those
called here " river low grounds," where the surface to a varying
depth, sometimes more than ten feet, is composed of vegetable
matter intimately mixed with the washings from the hills. This
land is always highest immediately at the edge of the stream,
and gradually becomes lower, until it reaches the foot of the
hills, where there is often standing water.

A large portion of the cultivated land in this part of the Stater
is in what is called "the Flat-woods," being table land on a
small scale, at a distance from the largest streams, having a stiff
clayey soil, not very pervious to water, and therefore, in a wet
season liable to be soaked, and sometimes overflowed, the water-
shed not always being very obvious.

The forest growth is oaks of several species, hickory, chestnut,
black walnut, pine, beach, maple, dogwood, buttonwood, here

112 Report upon the Topography and [February,

called sycamore, crab-apple, &c., in the order of frequency here
indicated.

The northern part of this division contains most of the rich
mines of gold, copper, &c, with mineral springs in various
places; but the springs and wells in general furnish very pure
' 'freestone" water.

The temperature varies much in the different parts of this
division ; along the southern boundary line the summer days,
in dry weather, are oppresively hot, with little wind, while the
nights are cool and pleasant Thunder squalls are frequent,
stirring up the atmosphere, bringing down the cold air from
above, while the rain washes the dust from the vegetation, re-
freshing everything.

In the winter the thermometer, seldom below zero, is very
variable ; light snows are common, sometimes lying in the
woods two or three weeks.

Approaching the mountain region, the summer heat is miti-
gated and the cold of winter is increased, and the temperature
is more governed by the course of the winds, snow lying on the
mountains till late in the spring.

The third division comprehends the limestone region of Upper
Georgia.

For information from this region, I am indebted to Dr. Kobert
C. Word, formerly of Cassville, now of Borne. "There is no
material difference," says Dr. Word, " in the geological features
of the several counties. There is in each the same succession
of broad valleys of rich fertile land, separated by intervening
ridges, from one to several miles across, of various degrees of
elevation, rising, in some instances, to the magnitude of moun-
tains, originally covered by a dense forest, now rapidly disap-
pearing. These valleys are well watered by streams fed by
large springs, which gush up from beneath the substratum of
limestone underlying the surface at various debths, through-
out their whole extent.

" The rains of winter and spring fill the stratum of earth
above the limestone with moisture, and give rise to innumera-
ble temporary fountains (called wet weather springs) at the base
and on the sides of the hills, and all over the valleys. These
all flow into the permanent streams, and occasion a great dis-
proportion in the height of their waters between wet and dry
seasons.

" The stratum of limestone, and in many places one of alumina
above it, presents a great obstacle to the absorption or ready
penetration of the superabundant water deeply into the earth,
and consequently there is excessive humidity of the surface, and
in many places large pools of water, or shallow lakes of consid-
erable extent, during the months of January, February, and

1858.] Epidemic Diseases of the State of Georgia. 113

March. The three succeeding months are generally delightful
in temperature. The genial warmth of the vernal sun quickly
evaporates the excess of moisture the dreariness of winter is
dispelled, and its fathomless abyss of cohesive mud forgotten in
the contemplation of the gorgeous scene displayed with magical
celerity by the luxuriant vegetation.

" The summers are by no means so depressing as upon the
seaboard, or in the middle portion of the State. The thermom*
eter occasionally, in the hottest part of the day, rises as high as
90 or 92 of Fahrenheit, but the nights are cool and refreshing,

"The same geological formation which favors the accumula-
tion of water near the surface of the earth in winter explains
also the remarkable absence of it during the months of August,
September, and October, when in dry seasons, the ground is
parched and cracked in many places, the atmosphere filled with
dust, vegetation languishing, and where the stratum of earth is
thin, totally destroyed ; the temporary springs, branches, and
lakes all dried up, many of the wells exhausted, and the water
in the permanent streams, reduced to its minimum, creeps slug-
gishly through the accumulated piles of drift-wood, which par-
tially block up the channels through which it flows.

" The highest heat of summer is of short duration, and the
temperature of the entire autumn is delightful,

" The two principal streams in this section of Georgia are the
Oostenaula and the Etowah, which, meeting at Eome, in Floyd
County, form the Coosa, a stream navigable for steamboats
many miles into the State of Alabama.

" These rivers drain nearly the whole of the fifth congression-
al district, and are of great size, but not different in their cir-
cumstances from their smaller tributaries, though much of the
alluvial land upon their banks, subject to inundation, is still
covered with primeval forest

"Throughout all the limestone region numerous sinks and
depressions are observable on the earth's surface. Many con-
tain water during the winter, but become dry on the approach
of warm weather. Others are permanently filled with clear pure
water. Subterranean caves are also numerous, especially in
the counties of Cass, Waker, and Dade.

"The great alternations of moisture and temperature, so com-
mon to our winters, are probably due to the character of the
prevailing winds, which are exceedingly variable, not unfre-
quently shifting their position to all the points of the compass-
in a period of less than twenty-four hours, each change in direc-
tion being attended with a corresponding change of tempera-
ture. The southeast winds, blowing from the Atlantic coast
during the greater part of fall and winter, are attended with
frequent rains, cold and penetrating in their effects upon the'

114 On Rheumatism. [February,

system. East winds are attended with cold drifting rains, and
frequently with sleet ; south winds with copious showers, not
quite so cold ; southwest winds with frequent showers, rather
warm. As the wind approaches the west, the rain ceases,
though the clouds continue until it reaches a point north of west,
when the weather becomes fair and cool. Due north winds are
very cold, though not usually of long continuance. Northeast
winds are not common,- and when they do occur, are apt to
bring with them snow. In the spring, we have rains and pas-
sing showers from the west and southwest. In summer we have
showers mostly from the west and northwest.

11 Situated and forming the dividing line between the grains
growing sections of Tennessee and the cotton region of Georgia,
the limestone counties of Cherokee Georgia, are not wholly un-
suited to the production of either. Though best adapted to the
growth of grain, grasses, and stock, the more southern counties
have been found to produce abundant crops of cotton. The
soil on the creek and river bottoms is rich with alluvial deposit.
In many places, both in the valleys and more elevated country,
the soil is strongly impregnated with iron, constituting the "red"
or " chocolate" land, exceedingly fertile, but u thirsty."

[To be concluded in March No.]

On Rheumatism of the Epithelial and Non- Epithelial Fibrous Tis-
sues : Its Sequence to Scarlatina and other Exanthemata. On
Rheumatic Gout, Chorea, &c. &c. By H. P. DeWees, M. D.
New York.

(Concluded from January No. p. 63.)

The secondary abscesses following rheumatism, result in most
cases, from local phlebitis, or from the detention of minute fibrin-
ous plugs arresting the circulation in the small vessels. Some-
times, the breaking down of larger plugs with interior pus, causes
irritation to be established, with more or less serous infiltration
into the adjacent cellular tissue, the abscess varying according to
the local arrest. The limits of this paper, however, will not allow
more than mention of these conditions. I will merely refer to1
the pathological facts of the vessels becoming inflamed, and sub-
sequently thickened or plugged up, so that more or less perfect
closure ensues, with resolution into abscess, or into mortification,
either local, or at a distal point, if the large vessels are arrested in
their circulation. The nature of the gangrene, whether moist or
dry, will in great measure depend on the perfection of the closure.
Sometimes, however, the surrounding parts become so agglutina-
ted by the adhesive action of repair, as to render the neighboring
tissues anatomically unrecognizable, and totally unfit for their pur-
poses of secretion or of motion. If such deposit take place in the

1858.] On Rheumatism. 115

lungs, the damage is the same, and in this way vomicae may arise
perfectly independent of tubercular origin, a plug of fibrin not
as large as the head of a pin arresting the local circulation, with
consecutive destructive changes; so that rheumatism, by its re-
sults, may become the parent of evils, equal, in their destructive
tendencies over life, to tubercle in its highest state of develop-
ment and disintegration. If the vessels of the brain become the
seat of arrest, its nutrition will be more or less interfered with,
and local atrophy or softening may ensue, with lesions of motion,
or of intelligence, as resultants. And thus paralysis and imbecil-
ity may follow in the train of that so-called " simple rheumatism/'
* The cases of paralysis after rheumatism of the spinal invest-
ments are not unfrequent. On dissection, this apparently high
inflammatory action, so complete in its functional arrest as even
to eventuate in death, cannot at times be recognized by the eye,
as regards structural change. And the same can be said of it
when seated in the serous membranes of the brain; the so-called
inflammation being a specific poisoning of the very centres of life,
leaving neither trace nor residue,

In the gouty the blood poison is not always exhibited by the
'; big toe" attack, with increasing demand for flannel. The skin
may become the beacon of its approach. Lichenous, herpetic,
or other eruptions, painful to bear and obstinate to treat, may not
only mask the attack, but for a long time keep it in " masterly
inactivity." And the same, at times, may be said of the poison
of rheumatism.

It would appear, from reasoning on the facts adduced in the
study of rheumatism and gout, that if the lactic acid formations
are in excess, either by over-generation or by non-elimination,
that an attack of acute rheumatism is apt to follow, and especially
after the sudden drying up of these eruptions. If this does not
take place, but the skin disorder recedes slowly, and there is ap-
parently but a small excess of lactic acid retained, the rheumatic
pains are irregular, flying from spot to spot, or the joints become
more or less stiff, not from any difficulty in their opposing surfa-
ces, but from muscular inability to apply the necessary force to-
wards movement. If, on the other hand, the uric acid is not ex-
pelled, or is generated in excess, gout is the frequent successor.
At this moment I have two cases that would apparently verify
these views.

The white fibrous tissue is the chief texture affected in simple
acute or true fibrous rheumatism, either as it occurs in the for-
mation of the ligaments connected with joints, or in the mem-
branous form covering tendons, or in the aponeurotic expansions
of the large muscles, as the fascia lata of the thigh, with its deep
prolongations, or in the cranial dura mater, sclerotica, &c.

It will be necessary to bear in mind that the sheathes of ten-

116 On Rheumatism. [February,

d0Ils the bursae (sometimes called the bursal synovial mem-
branes) between the tendons of muscles, between tendons and
bones, and between the projecting parts of bones and skin, as the
olecranon, &c, have no epithelium, although in function they
resemble the true synovial membranes, yet they differ from them
anatomically and in exact analysis. But this is not the case in
the bursa? communicating with the synovial capsules ; these as well
as the articular cartilages, have an epithelial layer. These ana-
tomical peculiarities are to be remembered, as they form the dis-
tinctive features in the pathology, diagnosis, and treatment.

Although the synovial membranes are not so prone to the effu-
sion of plastic lymph, as are the serous, yet the bursae are at times
found not only traversed by adhesive bands, but even completely
obliterated. The movements in such conditions are greatly im-
peded, but not so completely, as when the sheaths of the tendons
are in a like manner affected, the free play of the attached mus-
cles being rendered more or less impossible.

The fact is not to be lost sight of, that a large proportion of the
urea is derived from the disintegration of the body tissues, espe-
cially of the gelatinous and albuminous orders, independently of
the introduction of nitrogenized food into the system. It is chiefly
or at least frequently, in rheumatic disorders which are the off-
spring of deranged secondary assimilation, that urea forms so fatal
an agency, although nervous depressions and coma arise in non-
rheumatic diseases ; as those of the kidney, or from puerperal
causes, &c. Indeed, in many diseases involving the serous mem-
branes with kidney difficulty, urea forms a dread element, whilst,
by its non-elimination, or selective error, it lies at the secret cause
of disturbance, not only in the sclerotic membranes, but also in
many of the diseases of the aqueous and vitreous humors of the
eye. This is now only alluded to, and may form the subject of
another paper, or will serve to call notice from other medical ob-
servers. Not less important would be a series of observations as
regards the action of oxygenated remedies in a high lithic condi-
tion of the system, as the uric acid might thus be converted into
urea. In the gouty this change of uric acid into urea might take
place by the action of oxygenated remedies, and suppuration of
the synovial capsules and serous membranes ensue, as in rheuma-
tism, whilst arachnitis and coma form the modes of death, espe-
cially if kidney disorder exist at the same time. In other cases
those in which death is sudden, and the organic lesions are inap-
preciable or insufficient to account for the fatal termination the
urea, by a re- arrangement of its elements, may be converted into
cyanate of ammonia, thus poisoning the centres essential to life.

It is not always that in rheumatism there is a deficiency of sur-
face excretion, nor in gout that the kidneys are chiefly in fault.
The materies morbi may be generated by the imperfect compos*-

1858.] On Rheumatism. 117

tion and quantity of the blood itself, so that the tissues of selection
cannot be properly nourished, their structural assimilation being
more or less destroyed.

The excretion of soda in tophaceous deposits or articular incrus-
tations, does not take place in rheumatism as in gout ; it is, how-
ever, partially witnessed in the hybrid affection, viz : rheumatic
gout. This in part, may be accounted for ; as in the gouty the
primary digestion is disturbed, whilst in the rheumatic the secon-
dary assimilations are more at fault. Hence, the first are apt to
use soda as a corrective of acidity, or " to bring the wind off the
stomach ;" whilst, probably, from the inactivity of the liver, the
alkali from the salt used at table is not called on in the forma-
tion of bile, and thus collects in the blood. In rheumatism, how-
ever, we have at times such fusion of the immediate tissues about
the joints, rendering anatomical division almost impossible, that it
would seem by the excessive attraction of lactic acid to the parts,
it possessed the power to act as a solvent of the elementary fibres,
as I have found it for many years useful for that purpose in dys-
pepsia of animal substances.

It is well known that rheumatism more frequently attacks the
weakly, the intemperate, the irregular in diet (and especially if of
unwholesome nature,) those who may be exposed to vicissitudes
of temperature, or who long labor mentally or physically with in-
sufficient food, or under anxiety and mental depression. But the
strong, well-fed and able-bodied, young or old, are liable to its suf-
ferings ; in these, if the exanthemata, or accident, have not engraft-
ed a kidney vice, and the blood is not overloaded with nitrogen-
ized products, the attack will be of the simple inflammatory type,
affecting the nonepithelial fibrous structures or surfaces ; whilst
heart disease, and especially of the mitral valve, will be infrequent.
On the other hand, if kidney disease, accidental or exanthematous,
be present, then structures more important in their uses and ana-
tomical arrangements, viz : the interior capsular parts, the heart
and the arachnoid serous membrane, &c, are liable to become af-
fected, whilst the prognosis is against the patient, either immediately
or remotely. Delirium or coma, more or less profound, is the dis-
tinguishing feature in these cases. In the others, where the ex-
terior cranial fibrous dura mater is attacked, although the suffer-
ings are intense and the venous suffusion alarming, yet the chan-
ces to the patient are more favorable, and delirium and coma do
not follow in so fatal a train if present, unless the effusion be great ;
and even here, the disturbances are more of position than of nu-
tritive function.

The rich or the pampered are not, however, the sole proprie-
tors of the gout ; the poor, the half-starved have also their gout ;
it is the offspring of their very poverty. Dives, introduces into
his blood from without the sreat sources of his evil ; whilst Laz-

118 On Rheumatism. [February

arus produces a condition almost similar, by the rapid disintegra-
tion of his own tissues, loading his ill-fed blood with uric acid and
other compounds, from the wear and tear of his system. There
is no compensation by proper supply of food ; and the kidneys and
other emunctory organs are too enfeebled, though, perhaps, not
diseased, to extract the uric acid or urea from the blood. These
cases, though rare, yet take place it is the gout of the impover-
ished. They are, in general, inebriate from necessity and from
physiological instinct; their systems cry aloud for carbon, for
liquor, that the oxygen of the air they breathe shall not burn up
their pittance-saved bodies, but attack the free carbon and hy-
drogen of the alcohol, and leave in respite their meagre frames.
It is the gout of demand and not of supply. And here we find a
vivid example of the fact above stated, that the tissues suffer dis-
integration, or death, not only from deficiency of nutritive supply,
but from defective quality of the blood. In the gout of the impo-
verished, nitrogenized food the bane of the rich man and those
remedies having the power to retard the decomposition of tissue,
as tea, coffee, hop, &c, must be trusted in ; and thus the waste
of the system being restrained, the blood will not be surcharged
from the structures themselves, and the local disintegration will
be arrested, and the organs return to their uses ; but mostly with
deformity as an index of their past trials.

The urinary deposits, both in gout and rheumatism, sometimes
mask the condition of urine as secreted by the kidney the uric
acid formations being disguised by the alkaline, or earthy phos-
pates. This is chiefly owing to chronic vesical irritation or in-
flammation, the muco-pus acting on the urea, and converting it
into carbonate of ammonia, which precipitates the alkaline salts.
It is thus that the condition of the urine may be masked by the
presence of pus, or of a mucoid body, in its rout from the kidneys.
Indeed the highly acid state of the secretion may be the very
cause by which the bladder may be irritated. The prognosis in
these cases depends on the nature of the bladder or kidney irrita-
tion, the possibility of calculous formation, the recent or long
previous existence of the affection, &c.

The space allotted me is nearly exhausted, and will necessarily
oblige me to condense the chief features of treatment, with a run-
ning statement on some other points. From the preceeding views
the treatment almost explains itself. In the acute rheumatism
of the robust, at whatever age, the seat of attack is in the white
fibrous tissues, the fever high, attended generally with great sweat-
ing, the pain and swelling intense, but greater than when the epi-
thelial jibro-serous tissues are affected. Venesection is rarely called
for, though by some regarded as not only a mitigator of pain, but
as instituting a better condition for subsequent remedial action.
As a lessener of fibrin it is useless its chief value, if used, being

1858.] On Rheumatism. 119

the relief to the vascular tension, and the rather more rapid ab-
sorption of neutralizing remedies. In my own practice I have
not used it for many years. The local applications of leeches is
warrantable, but more troublesome in general than the affection.
A light antimonial emetic, however, answers more fully the desir-
ed end, followed, on the subsidence of its action, by an active pur-
gative of Hyd. chlor. mit., with Ext. Colocynth Comp. The
advantage of early emptying the bowels is realized, when the in-
creasing disablement of the joints renders the efforts to rise not
only agonizing but injurious. The affected parts should be bathed
with a warm mixture of Potassa-bi-Carb. and laudanum, and af-
terwards wrapped up in cloths saturated with the solution, and
covered with oil-silk or rubber, which can be gradually removed
if the heat is complained of. Potato water, as left after boiling
the vegetable or its parings, has proved a most soothing applica-
tion, when freely sponged quite warm over the swollen and pain-
ful joints, which can afterwards be wrapped up in it, as directed
for the alkaline wash. The Tinct. Actea Racemosa, in 6 to 12
drop doses, can be given in or followed by a solution of Nitrate,
Bi-Carbonate, or Acetate of Potash ; or the Tart, of Potash and
Soda, if preferred, can be substituted. Frequently, in children,
the Actea alone serves to cut short the attack after a few doses,
in conjunction with alkaline fomentations. The necessity for pur-
ging generally ceases after the bowels have been well moved in
the beginning. At all events, intestinal irritation is to be avoided.
It is well to remember that the expectant treatment of acute
rheumatism is nearly as favorable in its results as the active.
Colchicum, in the acute attack of the strong, who have deranged
hepatic action, combined with opium, after due operation from
the bowels, also forms a valuable remedy. Its purging and emetic
effect is unnecessary and to be avoided. It is more as a chola-
gogue and an excretor of lithic acid, than as a specific in rheu-
matism. Where the liver is already acting freely, it does not
form an agent of trust, and when frequently employed serves to
injure the system. Hence the discrepancy as to its value. In
alkaline combination it is frequently useful. The Nitrate of
Potash, so much lauded of late, will be found beneficial where a
high condition of fibrin exists in the blood, its solvent action over
that element being called for. Otherwise it is no more, and many
times not so valuable a remedy as the other alkaline salts. It is,
therefore, not from any specific eliminating power of the rheuma-
tic poison that is called for, but from its defibrinating action, and
its value as a diuretic, and its probably converting the lithic acid
into a more soluble compound, urea. After proper evacuation,
the Pulv-Doveri, in full doses, will generally, though not always
produce refreshing sleep and quiet the pain. If found stimulant
to the brain, watchfulness or flightiness taking place, it either

120 On Rheumatism, [February,

must be increased or left off. Opium acts, in many cases, as an
expeller of the lithic acid in chronic cases, conjoined with tur-
pentine, it sometimes causes immense quantities to be evacuated.

All things considered, time, forms as valuable an element in
the treatment as the remedies selected. A certain amount of ma-
teries morbi, and the disposition to its reproduction, has to be bro-
ken up, and time, sweating, and sometimes urination are at work
in the process of elimination. Remedies may assist, but if injudi-
ciously employed they will retard, the patient suffering from both
disease and doctor. The diet should be unstimulating, meat,
soups, and jellies avoided, toast and water, with light gruels, being
the best regulators. As the attack subsides, vegetable diet should
be adhered to, the local applications and internal remedies can
be moderated. Clam soup, and raw salt oysters may, after a time,
be allowed ; and now, if the blood shows decrease of its red cor-
puscles, the mild preparations of iron may be cautiously com-
menced on. If loss of flesh be increasing, coffee and tea will
prove beneficial as preventers of tissue waste. In the anasarca
of the debilitated, squill with quinine will be found most servicea-
ble.

By these means the immediate re-attack may be warded off, but
mental quiet and bodily rest are imperative. The supply being
small, the demand should be lessened. But the low diet system is
not to be carried too far ; it is well to remember that the fibrin is
increased in the blood by starvation, as well as by high feeding.
Rest, however, is absolutely necessary. No blood is to be thrown
into the parts in and about the joints, by the invitation of exer-
cise. Even in the very robust, acute rheumatism sometimes at-
tacks the joints after long-continued and violent exercise. But
where the parts have been "affected, with the system lowered by
diet, remedies, and wear and tear from pain and loss of rest, great
caution as to exercise is requisite ; as other structures, and of
higher importance, may become involved, and simple acute fibrous
rheumatism, be merged into an attack of the epithelial bursal and
synovial membranes of the interior of the joint, besides endan-
gering the heart, pleura, and other organs, when their liability to
become engaged was not at first probable.

It is this small point which makes the utmost watchfulness ne-
cessary, as regards keeping the system in good general working
order, and which has made the pathological statements so variable,
as respects the engagement of the heart in acute rheumatism.
Every practitioner has observed that, when in the first attack in
sound persons, the swelling, heat, redness, and pain have been
very great, the heart is not so liable to become affected, as when
all the symptoms are more moderate. In some cases, however,
both the tissues in and without the joint are attacked, and then
the diagnosis is to be carefully viewed, as the renal disturbance

1858.] On Rheumatism. 121

is mostly present, though perhaps later to observation, at the
time.

The friction with liniments, whilst the thickning, &c, remains,
after the subsidence of the acute pain, will be found beneficial.
The following recipe I am Jn the habit of using ;

$ 01. Origon, |i

OL Lavend. Spicat., . . Iss

Tinct. Aconite Sat., . . 3 i

01. Amyg. dulc, ... 3 Hi

Aq. Ammon. fort., ... 3ii

YeL, 5ss

M.
A light covering, with cotton batting and oil-silk, should be
applied, unless the heat is complained of. The gradual reduction
of the envelopes should take place after a time, so that chilliness
be avoided, which would attend its speedy withdrawal.

The treatment in chronic fibrous rheumatism has the same
features, differing more in degree than method, excepting in the
employment of iodide of potassium in small doses. The system
is to be carefully watched, exercise is to be judiciously and regu-
larly taken, the surface made to excrete properly, the bowels to
be kept soluble but unirritated, sleep should be rather longer than
in health, as a promoter of insensible transpiration and nervous
recuperation, whilst stimulant embrocations, oil-silk sweatings,
and light galvanic applications should be employed to the part.
The color, quantity, and specific gravity of the urine should be
watched, as giving evidences of approaching danger, or of increas-
ing constitutional vigor.

In the heart complications in rheumatism, the treatment re-
quires great circumspection. The difficulty of breathing, the
precordial pain, the out-of-breath manner of speech, the desire to
be propped up, the increasing effusions into the legs, scrotum,
chest, or abdomen, with diminished urine and rapid pulse these
point out the imminent peril of the sufferer, from which nothing
but a strong constitution and skillful treatment can save him.
The drain on the pent-up fluids is to be made through the bowels,
as the kidneys are generally too occluded, or broken down in
functional power, to be of any use. The Pulv. Jalapae Comp.
with Elaterium, or other hydragogues, with digitalis over the
heart, or internally 3 to 6 drops of the Tinct. Veratrum Yiride
must be administered, and watched during their operation. Sup-
port by brandy or champagne must be proportioned to the exhaus-
tion or nervons necessity, but no more. The stimulous, and not
the carbon, is wanted now neither lung nor liver can dispose of
it. If alcoholic drinks disagree, coffee and camphor can be sub-
stituted, sometimes with most excellent results. During purlins:..
the position of the patient is to he kept unchanged^ or even with iht

122 On Rheumatism. [February,

head lower if possible at all events, he is not to be raised sudden-
ly whilst stimulants should be snuffed through the nostrils, &c.
If these means are successful in reducing the effusions, the kid-
neys can now be gently invited into action. The palpitation
sometimes yields, most gratefully to the patient, after the adminis-
tration of champagne, the carbonic acid serving to allay the irri-
tability of the heart's action. By conjoining the infusion of the
wild-cherry bark or, where its bitter tonic property seems to
disagree with the stomach, a few drops of the dilute Hydrocyanic
Acid, a most happy effect may sometimes be obtained when
the irritability is excessive. But great caution is requisite in the
administration of organic sedatives, as will be mentioned further
on.

In the convalescence, if the liver still should continue at fault,
the preparations of iron are to be avoided, as they will serve to
induce congestion, and lock up the proper secretions of the organ.
At this period, however, the kidneys will sometimes resume their
functions, and labor not only for themselves, but, by taking off
the purpurates and other highly carbonaceous compounds, so re-
lieve the liver, that the system daily rises refreshed from their
effects. The urine becomes more and more abundant, and loaded
with the urates of ammonia and soda. It is here I would parti-
cularly caution the young practitioner, in his testing the urine
with nitric, or nitro-muriatic acid, lest he should mistake the
very copious deposits of the white crystals of lithic acid, for albu-
men. This I have seen done more than once. The deposit of
the phosphates by heat, is corrected from wrong interpretation
on the addition of the acid, which re-dissolves them. This dense
condition of the urine by the urates of ammonia and soda, is the
very salvation of the patient. Beware then of administering any
acid, either alone or in combination with a vegetable or mineral
tonic, as it will serve to neutralize just so much ammonia and
soda, and thus prevent the elimination by the kidneys of the very
lithic acid so poisonous in its action to the general system, but
especially to the serous membrane of the chest, and of the heart,
which will be again tortured by the acrid blood into renewal of
its exhausting efforts, whilst convulsion and coma stand threaten-
ingly near.

In the early part of this tumult of the system, when the organic
force is consuming by the overtask of the functions, I would
strenuously caution against the abuse of opium, or of any narco-
tic, to produce sleep or relieve from pain. And I will only reiter-
ate a maxim which I have before published, and often repeated,
viz : that in all organic diseases attended with pain and excretory
impediment, opium and other organic sedatives are to be avoided,
as, by paralyzing the organic centres, dropsies may collect in the
cavities.

1858.] On Rheumatism. 128

Lemon-juice, in some cases of acute and chronic rheumatism,,
is at times beneficial, though rarely to be trusted to alone. Yet
I have seen cases where it seemed to act as a perfect specific. It
will prove chiefly beneficial in uncomplicated cases, where the
urea fails in its urinary quantity, and where an excess of ammonid
exists in the blood. Benzoic acid, in these conditions of chronic
rheumatism, acts at times most favorably.

The children of gouty, rheumatic, and dyspeptic parents, are
prone to a lithic condition of the blood, or at least to its elimina-
tion by the kidney. It is early marked in them by incontinence of
urine, or " wetting the bed." Although the heart does not evidences
organic disease in them, yet its motions are violent and frequent
whilst crystalline lithic acid is formed in the Urine ; or they are
variable in their diet and irritable in their dispositions, the urine
being pale, abundant, but free from lithk? acid deposit 07,'in solu-
tion. The acid condition of the blood is irritating to the internal
membrane of the heart, and the contractions are sharp and fre-
quent. There is a loss of true tone in the system, and rheumatism
is apt to set in spontaneously, or after violent anger or any undue
exhaustion, exercise, or exposure. Here, opium forms a most
valuable remedy from its sedative influence and its power to dis-
engage the lithic acid from the blood.

Children given to masturbation, but whose urine alternates
from lithic to the phosphatic, the intermediate depositions of the
urates of soda and ammonia taking place, with increase of urea,-
are also subject to rheumatic attack or pains. Substantial diet,
with opium at night, is the chief remedy. The furtive look, the
desire for solitude, the uncalled-for sighing, the vesical irritability,-
the irregular languor, and the blowing sound in the heart and large
vessels, with more or less palpitation, will serve to direct suspicion
to the solitary acts of the patient, which careful watching may
verify. Organic changes may, and frequently do, establish them-
selves from these long continued functional disturbances. But it
is always well to remember, in the disorders of nutrition of the
heart, that the young are reproducers their organic desire to re-
model is ever at work ; that the hypertrophy, if it exist, is mostly
from interstitial deposit, and not a true fibrillar increase of the
heart itself. Restraint from the abuse, chemical changes afforded
to the blood, and the supply of fresh material by proper food, with
attention to moderation of exercise, and sometimes to complete
bodily rest, will form not only the treatment, but, in many a new
organ. Of this I have seen several most excellent examples. In
later life, an individual ceases to be an active remodeler ; he is
on the waste account ; his capital has no interest accruing, and
he is forced to use it up for the common necessities of his sys-
tem. These are distinctions as well as differences. Had these
views been more common, so many heart-disturbed children would

n. s. vol. xrv. no. n. 6

124 On Rheumatism. [February,

not have filled an early grave, or been moored to the stake of life,
to waste away an aimless existence in later years.

In scarlatinal rheumatism, all treatment at times is rendered
impossible by the condition of the patient ; as in scarlatina, the
do nothing system is frequently the best. Good nursing, attention
to the skin by sponging or moist wrappings, are better than the
" nimia diligentia medici." During the fever, the pain is mostly
in the wrists, or in one or two joints. The scarlatina and the
rheumatic complication are offspring of the same poison. There
is pain, as in true fibrous rheumatism, but it is seated in different
structures, and attended with different implications as regards the
head, the heart, and the chest. In the robust, the diet, or rather
the absence of it, forms the treatment. All animal food is to be
avoided the blood is yet too overloaded with nitrogenized pro-
ducts. If too early indulged in, the articular pains recommence
or' increase, chest or heart difficulties are renewed, and convul-
sions endanger the life of the patient. Farinaceous and vegeta-
ble diet must be continued a while longer. The debility is de-
ceptive ; it is more the result of the oppressive action of urea over
the great nervous centres, than loss of power from nutritive want.
The return, then, to animal food, must be cautiously watched.

But in the weakly, these fears have to be in a measure given
rap. At the first ingress of the rheumatism, a little abstinence
may be enjoined ; but after that, the position is different. Death
by debility would ensue more rapidly than by the disease. It is
the rheumatism of demand. Food and stimulus must be given.
Ulcerations pus makings, about and in the joints, are to be check-
ed; food and drink must do it; for specific medicines are useless,
unless quinine, iron and other tonics can be so called. Under a
lowering plan the coffin is sure to close over the wretched victims ;
and life to most of us, is better with a stiff leg or disabled joint,
than the kind attention of an undertaker.

In the convulsions attending both cases as above stated, the
directions should be : for the robust, feet and legs in hot water,
with head up, or at an easy reclining angle ; for the debilitated,
the horizontal posture, and no warm bath, but cold water sprinkled
n the face and chest, in the order of natural respiration. Here,
the brain must have blood, though diseased blood it be. From
the neglect of this simple precaution, I have seen a child killed as
though struck on the head, the feet, and not the brain, being
supplied with blood !

In syphilitic, and also in chronic rheumatism, iodide of potas-
sium acts more than well ; in the former it is almost specific. Its
combination with colchicum and with opium, may at times be
required. It is not only diuretic, but possesses the property to
re-establish assimilative vigor. Small doses, in repetition, act
more favorably than large doses at longer intervals.

1858.] On Rheumatism. 125

In rheumatic gout, especially where the fibrous sheaths of
nerves are attacked, the combination of Hyd. Pot. with Colchi-
cum acts most favorably, the Tinct. Aconite Sat., with Acid Hy-
drocyan. being painted freely over the route of the affected nerves
and kept from evaporating by strips of oil-silk or rubber. In the
cranial effusions, the Hyd. Potass, is the most reliable remedy.

Calomel is chiefly useful as a defibrinator, as a promoter of in-
terstitial absorption, and as a specific stimulant to the liver, by
which the decarbonation of the blood shall be promoted through
the secretion of bile. In the debilitated it is positively harmful,
if continued; although the balance at times, even in them, may
be in favor of its use, where the brain is oppressed by black blood.-

Guaiacum has long enjoyed a reputation in chronic rheuma-
tism, and with apparent good right. It seems to possess the power
of increasing the excretion of both lithic and lactic acid, by the
kidney and skin. In rheumatic dysmenorrhea, in leucorrhoeal
discharges attending this disorder in the dermalgia, so painful
on pressure or warmth in hysteria and hysteric knee-joint com-
plaints, mostly of a rheumatic nature, &c, this remedy, in con-
junction with others, or in the form of the Vol. Tincture, will be
found serviceable. The cases, however, are to be selected pro-
perly, whilst time forms an element in its action. I have known
it not only cure, but eradicate some of these disorders.

Rheumatic chorea has already been adverted to, with partial
mention of remedies. The irritability of the heart, or the ner-
vous propagation is, in many cases, to be quelled before any per-
manent success can be attained. Arsenic, as in Fowler's solution,
in six drop doses, with the endermic application of morphine, and
quinine (if after malarial influence) over the cervical spine, is at
times very valuable. In the rheumatic form, colchicum and
aetea racemosa, in small doses, have been found useful. The
same rheumatic condition of the system haVe been attended,
in both male and female, with globus hystericus. Stammering,
as before remarked, is sometimes the result of rheumatism, in
children whose systems have been Weakened, and who are thus
more liable to mental emotions, as fright, &c. The heart palpi-
tates readily, and the muscular nervous branches to the larynx,
and more rarely the hypo-glossal, or motor of the tongue, become
the channels of the disordered reflex action. I have many times
noticed the sudden hesitancy of speech, from sudden emotion, in
the rheumatic, differing from the arrest of power in the organs
from emotional acts in the unaffected.

In conclusion, I shall only refer to acupuncture in sciatica with
effusion into the sheath, and in muscular pains, having been at
times serviceable. Chloroform, blisters, the hot button, the ender-
mic applications of veratrine, morphine, delphine, aconitine,
strychnine, and other alkaloids, have had reputation for a time,

126 Exsection of Second Branch of Fifth Pair of Nerves. [February,

but chiefly in neuralgic affections. In the gouty and rheumatic,
local applications may relieve temporarily, but it is only by the
patient study of the blood changes, with the appropriate antago-
nistic remedies, and food, that any permanent benefit can be real-
ized, or security against attack be obtained. [American Med.
Monthly.

Exsection of the Trunk of the Second Branch of the Fifth Pair of
Nerves, beyond the Ganglion of Meckel, for Severe Neuralgia of
the Face: with Three Cases-. By J. M. Carnochan, Professor
of Surgery in the New York Medical College, Surgeon -in-
chief to the State Hospital (New York), etc.

The accounts heretofore given by authors of neuralgia, or tic
douloureux of the face, are of a very vague and indefinite char-
acter. Numerous essays and monographs have been written on
this subject, since the time of Fothergillr who published,, in 1776,
an elaborate description of the disease, which attracted consider-
able attention. In all these efforts,, the pathology of tic doulour-
eux is described with ambiguity. In practice the treatment
has been as empirical as it has proved to be unsuccessful. The
seat of the disease has been referred to distant irritations, espe-
cially in the splanchnic cavities to- a foreign body acting upon
the nerve to the pressure of bone upon some portion of the
nervous trunks. By some authorities, it is referred to increased
vascularity and thickening of the nerves; while Astley Cooper,
on the contrary, states, that the nerves present their natural co-
lour, and are rather diminished in size than enlarged. It can
scarcely be supposed that beneficial results should follow from
treatmant based upon theories so different in character.

Tic douloureux of the face, proper, or of the second branch of
the fifth pair of nerves, is by far the most common form of facial
neuralgia. This may be explained by the more numerous
branches, which are given off by this trunk, and by the position
which these branches occupy in some places pent up in osse-
ous canals, and in others subjected to exposure, to changes in
temperature, as well as to the agency of morbific influences, from
which the other two trunks of the fifth pair are exempt.

The same laws which govern neuralgic disease of one of the
branches of the fifth pair, must be applicable to the disease in
the other trunks. I believe that the phenomena of neuralgia
can be explained with as much precision as in any other disease,
when well understood. In cases similar to those described be-
low, whatever may have been the original exciting cause, I have
no doubt that the real seat of the disease is in the trunk of the
nerve, in front of the foramen rotundum in some parts of it, or

1858.] Exsection of Second Branch of Fifth Pair of Nerves. 127

in the whole of it. The causes of the disturbed and changed
condition of the trunks of the nerve may be numerous prolong-
ed irritation upon the periphery exposure injuries tumours;
diseases of the teeth pressure resulting from periosteal or osteal
thickening of the osseous foramina or canals sudden suppres-
sion of any of the important secretions, as of the catamenial dis-
charge. From one or more of these causes, the trunk itself may
be primarily affected, or acting upon its ramifications, the irrita-
tion may be propagated to it. Prolonged irritation induces in-
flammation, and this generally remains passive or chronic. Some
of the terminations of inflammation such as the effusion of
lymph among the interstices of the neurilemma or the nervous
tissue itself may become developed ; leading to a vascular, en-
gorged, thickened and enlarged condition of the nerve, or to a
softening of it, at one or more points. In fact, vascular engorge-
ment, or inflammation, with some of its consequences, of the
neurilemma alone, or of it and the nerve together, by whatever
cause produced, is the condition which constitutes the patholo-
gical changes in the trunk.

The three cases related below afford proof of what has just
been stated. In each instance, the exsected nerve was found to
be red, vascular, engorged and considerably enlarged.

The diffused character of the pain can be easily understood, if
we take into consideration the numerous ramifications of the
second branch of the fifth pair, and the extensive surface over
which their ultimate filaments are distributed. The periphery
of the nerve occupies not only the superficial parts of the face,
but extends deep among the bones of the upper jaw, to the nasal
fossae, to the septum nasi, to the hard and soft palate, to the phar-
ynx, to the inner ear, to the orbit, and to the temporal and
malar regions.

It is well established, that if the trunk of a nerve be irritated
along its course, the painful sensation will be referred to its pe-
riphery. If the ulnar nerve, for example, be struck where it
passes behind the internal condyle, a sensation of pain is excit-
ed, which is referred to the little finger and to the ulnar border
of the ring finger; and if a prolonged irritation be kept up at
this point, the skin of these fingers becomes tender to the touch,
the sensibility being very much increased.

It is by this principle which governs the action of the stim-
uli upon the nerves of sensation in connection with the ana-
tomical distribution of the nervous ramifications, that the various
phenomena of neuralgia can be explained. The disease being
seated in the trunk of the nerve, we can readily understand that
the pain must be referred to the peripheric extremities of the
nerves, and will there be felt, as long as the branches are in
communication with the encephalon.

128 Exsection of Second Branch of Fifth Pair of Nerves. [February,

From these views, we can perceive how futile the operation of
division of the nerve at the foramen infra-orbitale must bef
Where the trunk of the nerve is extensively diseased, no opera-
tion can rationally lead to a successful result, unless all the
branches emanating from the trunk are cut off from communis
cation with the brain.

I believe that, in such aggravated cases of neuralgia, the key
of the operation is the removal of the ganglion of Meckel, or its in^
sulationfrom the encephalon.^-Wheie even a large portion of the
trunk of the second branch of the fifth pair has been simply ex-
sected from the infra-orbital canal, the ganglion of Meckel con-
tinues to provide to a great extent the nervous ramifications,
which will still maintain and keep up the diversified neuralgic
pains. Besides, the ganglion of Meckel, being composed of
gray matter, must play an important part as a generator of nervous
power, of which, like a galvanic battery, it affords a continual
supply ; while the branches of the ganglion, under the influence
of the diseased trunk, serve as conductors of the accumulated
morbid nervous sensibility.

Case I. Henry Rousset, a French physician, residing in
Greenesborough, Caroline County, Maryland, consulted me in
the early part of October, 1856, for severe neuralgia, which had
for several years rendered him incapable of following his profes-
sion. He was of nervous temperament, good constitution, and
sixty -nine years of age.

The disease first made its appearance in September, 1851,
commencing with severe and lancinating pains about the region
of the left cheek and orbit. These pains continued for five or
six days, and then disappeared, leaving him almost free from
them for about four months. At the expiration of that time,
the neuralgic pains again returned with more violence, extend*
ing over the region of the left cheek, and continuing almost
without intermission, for more than a week. After this exacer?
bation, the patient again became comparatively free from pain
for a short interval ; after which, the attacks returned with in-r
creased severity, and were renewed with greater frequency, more
especially in the cold season, and in damp weather. As the
disease progressed, the pain was not confined alone to the eye
and cheek, but would also attack the lip and nose ; each paroxr
ysm being of longer duration than the preceding. "With but
slight variation, the disease went on this way to harass and dis*
tress the patient for four years. About the commencement of
March, 1856, the neuralgic exacerbation assumed a more violent
form, marked by excruciating and almost unremitting suffering.
He was at this time unable to eat, drink, converse, or laugh,
without having a most violent paroxysm, causing him to shriek

1858.] Exsection of Second Branch of Fifth Pair of Nerves. 129

in anguish. The paroxysms were more severe during the night
than day: sleep left him; his constitution began to give way,
and his mind became much enfeebled. The slightest touch upon
the surface of the face, a current of air or a mouthful of water
acting upon the palate, would throw the patient into a violent
paroxysm of agony. During this long period of suffering, all
the known remedies which have at times been extolled for neu-
ralgia of the face had been tried narcotics, tonics, antispasmo-
dics, with counter-irritants, and galvanism, without producing
any appreciable result. In this distressed condition, the patient,
wearied of existence and unable any longer to endure a life so
made up of excrutiating torture, presented himself to me for my
advice, at the beginning of October, 1856. He expressed him-
self willing to undergo any operation, however severe, which
held out the prospect of relief Having no internal remedy to
propose which had not already been administered, and having no
faith in the^mere division of the nerve upon the face, I proposed
to him the exsection of the trunk of the second branch of the
fifth pair of nerves to a point beyond the ganglion of Meckel.
Being a physician himself, I explained at length my views (as
expressed above) in regard to this malady. He immediately
consented to have the operation performed, and desired that the
earliest time should be appointed. I consequently agreed to
perform the operation the following day, the 16th of October.

Operation. The principal instruments necessary for this oper-
ation are a trephine, the crown of which is three-quarters of an
inch in diameter, an elevator, chisels of different shapes and
sizes, a leaden or iron mallet, the bone forceps of Luer, small
pieces of sponge tied to a stick or a piece of whalebone, and a
small fixed trephine of half an inch in diameter, which may be
used to perforate the posterior wall of the antrum. The assist-
ants being properly arranged, the patient was seated upon a
solid chair, opposite a good light, and was put under the influ-
ence of chloroform. The head was rested upon the breast of an
assistant, who maintained it in this position. An incision was
now made on the cheek, commencing near the internal angle of
the eye, on the inferior edge of the orbit, opposite the anterior
lip of the lachrymal groove. This incision was carried down-
wards and slightly outwards, for about an inch, to a point oppo-
site to the furrow on the lower portion of the ala of the nose;
another incision, which also terminated at this point, was made,
commencing about half an inch below the external angle of the
eye, opposite the edge of the orbit, thus forming a V incision, in
the area of which is situated the foramen infra-orbitale. The
flap thus resulting was thrown upwards, and the branches of
the second branch of the fifth sought for ; some of these being
found, they served as a ready guide to the trunk of the nerve.

130 Exsection of Second Branch of Fifth Pair of Nerves. [February,

This was now isolated from the surrounding tissues up to the
point of exit upon the face from the foramen. The lip was now
everted, and the mucous membrane detached from the superior
maxilla along the line of junction between the cheek and the
gum. A sharp-pointed bistoury was now inserted at the apex
of the Y incision, into the mouth, and carried downwards, so as
to divide entirely the tissues of the cheek and upper lip, along a
line passing midway between the ala of the nose and the com'
missure of the lips, The two flaps thus formed were now dis-
sected from the osseous tissue beneath, one being reflected out*
wards, towards the ear, the other internally, towards the nose,
The whole front wall of the antrum maxillare, with the nerve
passing through the foramen infra-orbitale, was thus exposed,
The crown o? the trephine was now applied on the anterior
wall of the antrum, immediately below the foramen infra-orbitale,
?md an irregular disk of bone removed, so as to expose freely
the cavity of the antrum. The circumference of the foramen,
the hardest portion of the canalis infra-orbitalis, was now des*
troyed by Iter's forceps, and a small chisel, The trunk of the
nerve was now traced along the osseous canal in the floor of the
orbit, which was broken down with care, so as not to encroach
upon the tissues in the cavity of the orbit, Arriving at the
back of the antrum, the posterior wall of this cavity was broken
down with a small chisel, and the portions of bone removed.
The trunk of the nerve was now still further isolated from the
other tissues in the spheno-maxillary fossa. The posterior dental
nerves being divided, and the dissection being carried still fur-
ther, the branches given off to form the ganglion of Meckel were
reached, These were divided, and also the branch given off to
run up towards the orbit, Lastly, by the use of blunt-pointed
scissors, curved on the flat side, the trunk of the nerve was di-
vided from below upwards, close up to the foramen rotundum.
The hemorrhage was not very profuse, the labial arteries being
easily controlled by pressure of the fingers, and the branches of
the internal maxillary artery, in the sphenomaxillary fossa, by
dry lint, or what is better, the compressed sponge. The lips of
the wound were brought together and maintained in place by
thirteen points of twisted suture, the German or Carlsbad pins
being used.

This severe and trying operation is perfectly justified by the
fearful nature of the disease for which it was projected. It is
one of those operations which could not be supported by the
patient without the influence of chloroform, The handling of
so large a nervous trunk with the forceps, and the necessary
contact with the hard instruments, while separating it from its
surrounding connections^ would, I suppose, be beyond human
endurance, without the aid of the anaesthetic influence of chloro

1858.] Exsection of Second Branch of Fifth Pair of Nerves. 131

form or ether, For the rest, the effects of the cicatrices upon
the countenance can scarcely be called disfiguring, and the pa-
tient speedily recovers without suffering from much constitu-
tional disturbance.

In this operation, and in those connected with the two suc-
ceeding cases, I was assisted by my colleague Prof. Cox, by Drs.
Proudfoot, Abrahams, Selden, Guleke, and Casseday ; and by
my pupils, Messrs, Dougherty, Henry, Scudder, and others.

Condition of the Nerve. The trunk of the nerve in this case
was much larger than natural in nearly its whole extent. The
neurilemma was very vascular, and the nervous tissue proper
was also engorged and red ; the trunk, after its removal, was so
red as to have somewhat the appearance of muscular tissue. The
length of the nerve removed was a little more than an inch and
three-quarters. The lining membrane of the antrum was sound,
as well also as the bones of the antrum and the osseous wall of
the canalis infra-orbitalis.

Progress of Union and After-treatment. Oct. lGth. Six hours
after the operation, the patient was visited. His pulse was 100;
there was a slight fever ; he complained of thirst, and lemonade
was ordered. t He spoke of a desire he had to vomit, which he
ascribed to the chloroform. He stated that he felt slight twitch-
ings on the nose, and at the corner of the lip,

17th (Friday). The patient was remarkably well under the
circumstances; sitting up; pulse 90; tongue lightly covered
with a white fur ; complained of pain in the wound, also of
shooting pains in the left eye ; he remarked that he could stick
a pin into the upper lip and cheek without causing pain, there
being no sensation in that region. Ordered chicken broth, and
wine and water.

ISth (Saturday), Patient improving ; wound healing ; pulse
natural; no fever; spoke of the numbed sensation in his face.

19th (Sunday). Pulse full and natural ; good appetite ; par-
took of a beefsteak; in the afternoon four suture pins were
removed ; slight pain in the wound ; no return whatever of the
neuralgia.

20th (Monday). Cure progressing; healthy suppuration from
wound ; appetite excellent ; general health much improved.

(Tuesday, Wednesday, Thursday.) During these days the
rest of the pins were removed ; patient felt no pain whatever
either in the wound or cheek; wound in the antrum syringed
with tepid water,

25th (Sunday,) Patient attended church ; feels no pain what-
ever ; incision of the upper lip and cheek entirely healed.

28th. Patient entirely well.

30th. Eeturned home to Maryland in high spirits, and deligh-
ted at the result of the operation.

132 Exsection of Second Branch of Fifth Pair of Nerves. [February,

December 7th, 1857. Fourteen months after the operation he
writes to me that he is enjoying excellent health, and has been
entirely free from neuralgic pain.

Case II. Florence Cordello, a native of Italy, aged 54 years,
of lymphatic temperament, chocolate maker by trade, was ad-
mitted to the State Hospital on the 14th of September, 1857,
suffering from severe lic-douloureux of the left side of the face.
The following is the account handed to me by the Assistant
Surgeon, Dr. Guleke. In the year 1828, the patient contracted
a very severe cold from exposure, and about this time he was
seized with the pain for the first time. According to his own
description, the pain started from the foramen infra-orbitale, ex-
tending upwards to the forehead, and downwards into the teeth ;
the paroxysm lasting about ten minutes. He supposed it to be
toothache, and had one or two teeth extracted. An interval of
eight years took place, when he was again attacked with neu-
ralgic paroxysms, lasting from five to ten minutes. Again, after
the lapse of a year, the paroxysms reappeared in a more severe
form, and at snorter intervals.

The patient, still believing his teeth to be the source of the
disease, had all of them extracted on the left side of the upper
jaw, but without any benefit. During these attacks he had been
subjected to many kinds of treatment, both internally and ex-
ternally ; he also repaired to some of the mineral springs on the
Bhine, but still to no purpose. He continued thus to suffer
more or less intensely from the neuralgic paroxysms, for a period
of time extending from 1837 to 1846, and with detriment to his
general health. In 1846, while passing through the city of
Heidelberg, in Germany, he consulted the celebrated Chelius
with the hope of obtaining some beneficial result from his ad-
vice. That professor divided the nerve as it emanated from the
infra-orbital foramen, by incisions from the mouth, and six weeks
after, again performed the same operation, without any favora-
ble result. During the next six years the patient continued to
suffer from the neuralgic paroxysms of more or less intensity.

Oppressed by extreme suffering, he again sought relief from
an operation, and in 1852 the nerve was again divided from the
mouth by forcing up the lip ; the actual cautery being at the
same time applied, by pushing the instrument from the mouth
upward into the wound as far as the foramen infra-orbitale. This
operation appeared to give some relief, and during the two suc-
ceeding years, the patient's sufferings were somewhat alleviated.
About two years ago, the paroxysms returned in the most aggra-
vated form, progressed, and continued without much abatement.
He, on the 1st of September last, being in New York, again
submitted to an operation for division of the nerve. This time,

1858,] Exsection of Second Branch of Fifth Pair ofXerves. 133

the branches of the nerve were divided by cutting through the
integuments directly upon the infra-orbital foramen ; this oper^
ation caused no other effect than insensibility to the touch in the
soft tissues near the infra-orbital foramen. Two weeks after
this, he entered the State Hospital The condition of the pa-
tient was then as follows; Notwithstanding the repeated divis-
ion of the nerve, there was sensibility to the touch over the
whole region of the cheek; the inner side of the lip alone ap-
pearing to be insensible. The patient describes the pain as
starting from the foramen infra-orhitale and extending up as far
as the lig amentum palpebral internum, and also to the external
corner of the eye; from the latter point, the pains shot dowrn in
nearly a straight line to a point about one inch to the outside of
the left corner of the mouth, and a little below a line drawn hor-
izontally on a level with the commissure of the lips. The pains
also extended backwards, through the more deeply seated por-
tions of the face, shooting from the inner corner of the eye, along
the base of the nose, and striking backwards towards the spheno-
maxillary fossa. The pain was of the true neuralgic character,
and so intense as to drive the patient into a condition verging
on delirium. A slight touch on the cheek, the inside of the
mouth, or on the hard or soft palate, swallowing, or speaking,
excited almost instantaneously the paroxysms in their severest
form.

The operation. -The operation in this case was performed after
the same manner as the preceding, and was modified only by
the greater depth of the antrum and face. There was also
more hemorrhage from the spheno-maxillary fossa; this was
controlled by compressed sponge pressed into the fossa. Sup^
posing that hemorrhage might return, the lips of the wound
were brought together by adhesive plaster, one suture only
being used. The other sutures were inserted the following day.
The nerve wras cut from above downwards. The ganglion of
Meckel was drawn out, hanging to the trunk of the nerve.

Progress of Union and After-treatment. Compressed sponge
was applied in the deeper portion of the wound; the external
surface was closed with one suture; an anodyne was ordered for
the night.

Oct. 11 (Sunday.) Patient slept well during the night; pulse
76 ; no bleeding ; five suture-pins applied ; ordered an anodyne.

12th. Patient slept well ; no pain whatever ; pulse 84 ; com-
plained of thirst ; but little appetite ; speaks and swallows with-
out pain.

12>ih. Slept badly; had an attack of dysentery; pulse 96;
felt a slight pulsating pain in the wound, which, however, was
doing well ; states that there is no feeling over the surface of the
left cheek from the inner angle of the eye, descending along the

134 Exsection of Second Branch of Fifth Pair of Nerves. [February,

nose to the lip, and upwards to the outer angle of the eye, includ-
ing the lower lid; ordered opium and quinine. (Afternoon,)
dysentery subdued ; pulse 96 ; more cheerful.

L&th. Patient improving ; pulse 92 ; a portion of the pins
removed.

15th. Kemaining pins removed; wound presents a healthy
appearance ; pulse natural ; slight pain felt in the course of the
wound.

16^. Eemoved the piece of compressed sponge, which had
been placed at the back of the antrum during the operation, to
restrain the bleeding from the spheno-maxillary fossa.

18^, Patient doing well ; eats well, and sleeps naturally.

26th. Still entirely free from neuralgic pain ; the whole ex-
pression of the face changed from that of suffering and anxiety,
to cheerfulness and serenity.

28th. Discharged from the hospital entirely cured, and in good
health and spirits.

Dec. 8. Visited the hospital ; still free from pain and in good
condition.

Condition of the Nerve. The nerve in this case, as in the pre-
vious one, exhibited a similar appearance. It was thickened,
vascular, and engorged. The neurilemma and proper tissue of
the nerve were both affected. The length of the trunk removed
was two inches.

Case III. Mrs. Mary Gr. Stevenson, a native of Portsmouth,
England, and who had borne children, 55 years of age, of full
habit and sanguineous temperament, consulted me in the month
of September, 1857, for severe neuralgia of the left side of the
face. She had been a resident of the Northern States for thirty
years, and had enjoyed generally, remarkably good health.

On the 12th of August, 1851, while eating a plum in her gar-
den, she was suddenly seized with a vivid shock of pain, com-
mencing on her cheek, and passing through her jaw, as if caused
by a sharp-pointed instrument, suddenly driven through her
face ; shooting pains of this character, with intermissions of en-
tire abatement, continued for several days. A dentist was con-
sulted, who attributing the symptoms to the teeth, extracted
several of them, but without the slightest benefit to the patient.
The paroxysms continued with more or less severity for two
months.

At the end of this time, they suddenly abated in their severity,
and the respite lasted for about six weeks. Upon hearing of
the sudden death of a friend to whom she was much attached,
the paroxysms were again renewed; they became more frequent ;
the intervals were shorter, and the intensity of pain was increas-
ed more and more with each succeeding attack. During the

1858.] Exsection of Second Branch of Fifth Pair of Nerves. 135

year 1852, the pain and paroxysms still continued with unyield-
ing severity. The tic would now last for two and three months,
with scarcely any of the intervals which had heretofore occur-
red. Cold air, the drinking of fluids, the slightest touch upon
the cheek, or any sudden mental emotion, would invariably
excite the most fearful paroxysms, Daring the year 1854, her
condition was not in any way ameliorated ; the pain, if possible,
was more severe, and her general health suffered from the
want of rest. During the year 1855, the disease progressed with
the same severity, In the early part of the year 1856, the par'
oxysms became still more aggravated J the patient, at times,
becoming almost delirious starting up, running about her room,
and screaming like a maniac. In the latter part of September,
she sought relief from a surgeon in this city, who divided by
subcutaneous incision the branches of the infra-orbital nerve,
as it issues from the infra-orbital foramen.

About this time, she also took large quantities of various nar-
cotics, and of the carbonate of iron. After the operation, she
experienced some relief. The amelioration continued from Octo-
ber, 1856, until May, 1857, when the paroxysms were again
renewed in their severest form.

The pain now became almost continual, depriving her nearly
entirely of sleep ; she was unable to eat without torture, the act
of swallowing invariably bringing on a paroxysm. During
these exacerbations, the pain was diffused in different directions,
extending from a point a little below the infra-orbital foramen,
or from the ridge of the gums, and striking through the superior
maxillary bone towards the deeper portions of the face, and
towards the orbit, and sometimes extending towards the region
in front of the ear. She described the pain as of a beating
character at times; each shock succeeding another in rapid suc-
cession, as if keeping time with the ticking of a clock. During
this long period of suffering, she had been under the alternate
care of several physicians ; the various remedies moet approved
of in this kind of disease had all been faithfully and sedulously
tried -, stramonium, aconite, belladonna, hemlock, opium, mor-
phia, chloroform, carbonate of iron, valerianate of ammonia, and
other medicaments had been administered internally ; while ex-
ternally, in addition to the division of the nerve, blisters, sinap^
isms, hydrocyanic acid liniment, tincture of aconite, and chloro'
form had beeai resorted to- also electricity and galvanism. At
the time I was consulted, she was suffering night and day from
repeated and excruciating attacks, and, as she herself stated, she
had visited the city to have an operation performed at all haz-
ards, however desperate it might be, if I could only hold out any
prospect whatever of its affording relief. Her general health
was tolerably good, and she did not complain of loss of appetite.-

136 Exsectionof Second Branch of Fifth Pair of Nerves. [February,

I explained to her the nature of the operation which I believe
to be the only one suited to her case. She immediately assent-
ed to submit to it as early as possible.

The operation was performed after the same procedure. The
face Was in this instance,- also,* very deep. The hemorrhage from
the spheno-maxillary fossa was considerable, and was stopped
by a piece of compressed sponge to which a strong ligature was
attached, by which it could be removed.

Progress of Union and After-treatment. Nov. 5. (Thursday
evening.) As soon as the operation was completed,, the patient
retired to her bed. Yomiting came on a few hours after, owing,,
probably, to the quantity of chloroform which had been used.

6th, Had slept tolerably Well during the night ; felt very little
pain ; pulse 80 ; no fever ; complained of some pain in the
Wound, but had no neuralgic pain.

7th. Left side of the face slightly swollen ; puffiness about the
eyelids ; has no pain ; has slept well without any anodyne ;
states that she feels better than she has for months; pulse 80;-
skin natural ; slight thirst ; five of the suture pins removed ;
line of incision looks as though union by first intention was
going on favorably. Still kept on fluids for nurishment gruel,-
rice-water,- ice-water, toast-water, and chicken tea. Ordered a
gentle aperient.

8th. Had slept well} tumefaction of face subsiding; com-
plains of headache ; cloth wetted with cold water applied on
forehead ; same diet continued ; pulse natural ; removed the
sponge which was used to stop the bleeding from the spheno-
maxillary fossa ; this came away without any difficulty by slight
traction,- a little blood following.- Complains of slight pain in
the orbit. Eemoved six suture pins, leaving one only that
Uniting the free border of the lip.- Fluid diet as before.-

9th. Patient slept well ; headache less ; pulse 78 ; no neural^
gic pain ; a Weak solution of the tincture of arnica ordered, to
bathe the cheek with ; removed the last pin ; union by first in-
tention, along the line of incision, complete.-

From the 9th Until the 16th all has progressed favorably. No
neuralgic pain whatever ; sleeps well ; swelling on cheek dimin-
ishing; pain has entirely left the orbit ; secretion into the mouth
from the wound in the antrum diminished. Ordered a gargle
of the tinture of myrrh. Appetite has also returned. Had
been sitting up, and walking about her room without any incon-
venience. Has taken a little sulphate of magnesia ; has not re-
quired any anodyne.

Bee. 3. The patient has been progressing favorably up to this
time. The wound has healed entirely, the line of cicatrix is
becoming effaced ; not the slightest trace of tic douloureux re-
maining. There is no paralysis of the muscles of the face upon
the side operated on.

1858.] Insanity connected with alleged Criminal Acts. 1#7

In the case of this patient, the nerve was enlarged, very vas-
cular, thickened and red. Two inches of the nerve were remc
ved.[ American Jour, of Med. Sciences.

The Lancet, (Dec. 19th,) is rather severe upon Lawyers, oil
account of their ignorance concerning insanity. Hear what the
editor says : [American Med Monthly.

"On Monday evening, Dr. Forbes Winslow read his paper
before the Juridical Society,. " On the Legal Doctrines of Kes--
possibility in Cases of Insanity connected with alleged Criminal
Acts.'* There was a much larger attendance at the meeting than
usual,- the Vice-Chancellor Sir John Stuart being in the chair,
and amongst the members present was Mr. Bramwell, as well
as many of the most distinguished members of the bar. This is
the first time that the attention of lawyers has been directed to
this important subject by means of a paper written by a medical
man,- and communicated to a legal society in which free discus*
sion is permitted;- and we cannot but rejoice that a Way has at
last been opened whereby the views entertained by the medical
profession upon what ought to be the legal responsibilities of
the insane can be distinctly enunciated and tested by that "touch'
stone of truth," oral discussion. We look upon the proceed-
ings of Monday night as constituting an era in the history of
criminal jurisprudence, and we venture to predict that when a
few more such papers shall have been read and discussed at the
Juridical Society, it will be impossible for that body to listen
with common patience to views to which Mr. Baron Bramwell
gave utterance in the course of the debate on Monday. We
have always believed that the great differences existing between
the doctrines of lawyers and medical men on these subjects de-
pended chiefly on the want of practical acquaintance with insan-
ity under which the former labor ; but we confess we were
unprepared for the appalling ignorance of the first principles of
moral and mental philosophy which was displayed by a lawyer
who has within the last two years been deemed worthy of ele-
vation to the bench. In reference to Dr. Winslow's remarks on
the distinction between the intellectual and moral feelings, Mr.
Baron Bramwell positively declared that, "for his pari, he doubt-
ed the existence of moral faculties, or a moral sense /" We are
acquainted with another learned judge who, on being asked to
read a well-known medical work on Criminal Insanity, abso-
lutely declined to do so, stating that he never read anything of
the sort, and in fact rejoiced in his ignorance. With such mate-
rials to work upon, progress must necessarily be slow, but it
will be sure; and the time is not far distant when the judges

138 Editorial. [February,

will shrink with as much horror from hanging a lunatic as they
would now do from burning a witch. Dr. Winslow's paper was,
as might have been expected, an extremely well-written and
philosophical essay, and was listened to with a degree of atten*
tion which, at any rate, argued a desire on the part of the mem*
bers of the Juridical Society to learn what they could.- It was
painfully evident, however, from the discussion which followed,
that the minds of the audience were unprepared to grasp the
great truths laid before them,- and we therefore hope that the
author will follow up this paper with another, in which, by
giving copious details of cases, he may furnish the legal mind
with a species of food which it can assimilate more readily than
the recondite truths of psychological philosophy."

Researches on Arsenic. Dr. Blofidlot, of Nancy, has just observed a
fact which explains the contradictions encountered by inexperienced
chemists in attempts to detect arsenic in connection with organic mat-
ters.- It is this: that when substances poisoned have been left to
putrefy, some sulphuret of arsenic is formed at the expense of the sulph-
uretted hydrogen, and this, as is well known, escapes detection "by Marsh's
apparatus. Sulphuret of arsenic also forms when the suspected matters
are carbonized by the action of sulphuric acid after the process of Flan-
din and Danger. The sulphuret of arsenic may be extracted by washing
the carbonized mass with ammonia ; this dissolves the sulphuret ; then
convert the arsenic into arsenic acid (AsO5)' by means of boiling nitric
acid, so as to obtain a second solution ; this, added to the first, may then
be tested in March's apparatus. [Amer. Jour, of Sci. and Arts.

EDITORIAL AND MISCELLANEOUS.

Meckel's Ganglion. In the January number of the Amer. Journal
of Medical Sciences, we find a paper from the pen of Professor J. M.
Carnochan, of New York, on the Exsection of the Second Branch (Su-
perior Maxillary) of the Fifth Pair of ^serves, for the cure of facial
Neuralgia. On account of the originality of the operation, its uniform
success, and the heretofore almost hopeless character of this disease in
certain forms, we have deemed it proper to transfer from that valuable
quarterly, the entire article to our own pages. The operation proposed,
and thrice successfully performed, by the distinguished reporter, meets
with our unreserved approval. If it is objected by any one, that the
operation is horrible, he can be answered, that it is to eradicate a worse
than horrible disease, a living and unending agony, to which even death
itself is preferable, and that the use of chloroform, insisted on by the

1858.] Editorial 139

surgeon, removes in a great degree, the strongest objection any one can
advance against it.

It is not, however, simply to signify our approbation, that we have
begun the present notice. Dr. C, in his remarks previous to detailing
his cases, in endeavoring to account for the success of his operation
when other modes of procedure had failed inadvertently, we are con-
vinced makes the statement of an opinion in regard to certain points
in the physiology of the nervous system, which to our mind, with the
experimental facts before him, should have been given with at least, a
certain degree of hesitancy, for it involves, either the correctness or the
incorrectness of news loner held as among the established truths of the
science.

After presenting a rapid, but a sufficiently lucid sketch of the many
forms of facial neuralgia and of the various operations proposed for their
relief and after reasoning, we think very justly, on the several causes
operating to produce a continuance or a recurrence of the affection after
measures taken for its relief, he says : " from these views we can perceive
how futile the operation of division of the nerve at the foramen infra-
orbital e must be. When the trunk of the nerve is extensively diseased,
no operation can rationally lead to a successful result unless all the
branches emanating from the trunk are cut off from communication with
the brain. I believe that in such aggravated cases of neuralgia, the key
to the operation is the removal of the ganglion of Meckel or its insulation,
from the encephalon. Where even a large portion of the trunk of the
second branch of the fifth pair has been simply exsected from the infra-
orbital canal, the ganglion of Meckel continues to provide to a great
extent, the nervous ramifications which will still maintain and keep up
the diversified neuralgic pains. Besides, the ganglion of Meckel, being
composed of gray matter, must play an important part as a generator of
nervous power, of which, like a galvanized battery, it affords a continued
supply, while the branches of the ganglion under the influence of the dis-
eased trunk, serve as conductors of the accumulated morbid nervous
sensibility."

Now, the objections which might be urged against the confident state-
ment of the above theory, are many and various ; some of which we will
here venture to suggest. In the first place, it is at least questionable,
whether or not the centres of the Ganglionic System can be productive
of sensitive phenomena. Secondly : The nervous ramifications, provided
by the Ganglion of Meckel, are not distributed upon parts where the
"diversified neuralgic pains are kept up," and especially is this certain,
after the trunk of the superior maxillary has been removed ; but they
are distributed to surfaces and parts located internally, as the fauces and
6*

140

Editorial.

[February,

the roof of the mouth, to the Schneiderian membrane lining the nasal
fossse, and probably, conjunctiva cornea, &c. at least, so anatomical
investigation and experimental physiology have uniformly determined
their distribution.

[We here introduce a cut, from Wilson's Anatomy, which illustrates
the position and some of the branches and connections of this nervous
centre.]

The Cranial Ganglia of the Sympathetic Nerve. 1. The ganglion of Kibes. 2. The filament
by which it communicates with the carotid plexus (3). 4. The ciliary or lenticular ganglion, giv-
ing off ciliary branches for the supply of the globe of the eye. 5. Part of the inferior division of
the third nerve, receiving a short thick branch from the ganglion. 6. Part of the nasal nerve,
receiving a longer branch from the ganglion. 7. A slender filament sent directly backwards from
the ganglion to the sympathetic branches in the cavernous sinus. 8. Part of the sixth nerve in
the cavernous sinus, receiving two branches from the carotid plexus. 9. Meckel's Ganglion
(spheno-palatine). 10. Its ascending branches, communicating with the superior maxillary nerve.
11. Its descending branches, the posterior palatine. 12. Its anterior branches, spheno-palatine
or nasal. 13. The naso-palatine branch, one of the nasal branches * The point where Cloquet
imagined the naso-palatine ganglion to be situated. 14. The posterior branch of the ganglion,
the Vidian nerve. 15. Its carotid branch, communicating with the carotid plexus. 16. Its petro-
sal branch, joining the angular bend of the facial nerve. IT. The facial nerve. 18. The chorda
tympani nerve, which descends to join the gustatory nerve. 19. The gustatory nerve. 20. The
submaxillary ganglion, receiving the chorda tympani nerve from the gustatory. 21. The superi-
or cervical ganglion of the sympathetic.

But in the third and last place, the most important objection which
now presents itself, in our mind, to Dr. Carnochan's ingenious theory is,
that the results of both experiment and observation are diametrically
opposed to his deductions.

The trunks and ganglia and branches, of the ganglionic system, have
been the subjects of physiological experiment for a period, now extend-
ing over more than a hundred years; since the year 1*732, when Petit
made a division of the trunk of the sympathetic in the dog, down to the
present day, we find ranged along the whole interval, a number of illus-
trious names, whose multiplied and varied experiments have only con-
firmed his results, and go to prove that this ganglionic system, has but
little agency in either sensation or motion, but has mainly confided to itr

1858.] Editorial 141

the important and more silent processes of secretion and nutrition.
Whenever a nervous trunk in any part of this system has been divided,
in experiment, or a ganglionic centre disturbed or removed, either by the
knife of the physiologist or in the progress of diseased action, there have
ever been found, signs of modified nutrition or altered secretion; the only
modification of sensation, we are aware of, is that observed by M. Ber-
nard and others, where exaltation of temperature takes place in the parts
answering to the branches of distribution of the divided nerve, or of the
ganglion which has undergone evulsion. (See Archives Generates.) So
much for observations and experiments upon the ganglionic system in
general. Now let us examine if any experiments can be referred to, as
illustrating the effect of the disturbance of Meckel's Ganglion in parti-
cular. There may have been others, but recent research has made us
more familiar with those of Dr. Alcock, of Dublin, reported in Todd's
Cyclopedia of Anatomy and Physiology. "We will premise that Dr. Al-
cock did not draw the same conclusions from the results of his experi-
ments which we have considered, taking them in connection with analo-
gous experiments on other portions of the ganglionic system, as unavoid-
able deductions. He instituted the series to determine, as he says, the
function of the nerves of Taste ; and yet he more plainly established, than
any one had done before him, the function of Meckel's Ganglion. In
order to determine the nerves of taste, he undertook the removal of
Meckel's ganglion from the dog : he attempted it several times and fail-
ed at different stages of the operation ; but in almost every case, the eye
of the same side became bleared within the next two days, a whitish pu-
riform matter exuded from it, in quantity proportioned to the case ; and
in one instance in which the ganglion was removed, it actually produced
opacity of the cornea and ulceration in that structure.

It will be seen, in the above account, that the effect of the injury or
removal of Meckel's ganglion was always well marked, and of an entirely
different character from that which results from injury or section of any
sensitive nerve.

Returning now to Dr. Carnochan's Explanation in his history of the
cases reported ; we find in none of the incidents there related, anything
which indicates the occurrence of any of those results which uniformly have
followed upon the evulsion of Meckel's ganglion. We can account for the
absence of these sequences on three different principles of reasoning:

1st. That these results may possibly have obtained in a certain de-
gree, but Dr. Carnochan regarding them as only the effect of the injury
(traumatic results) inflicted on the adjacent parts, did not deem them
worthy of record. Yet, still, the removal of the ganglion should, accord-
ing to all antecedents, have produced such an amount of perturbation in

142 Editorial. [February,

the nutrition and circulation of the eye, as to have compelled his atten-
tion, and if they were present, he certainly would have reported them.

2ndly. We might reason that this removal of Meckel's Ganglion in the
human subject, (not previously performed, so far as we know, by any
one,) is, perhaps not followed by the same results as when it is experi-
mentally done in the case of the lower animals, as the dog, <fcc. This, it
would be difficult, without farther repetition, to admit ; for the admission
would strike at the very root of the whole principle of, and destroy the
confidence on which, Experimental Physiology is based viz : the identity
of function in the various parts and organs in man and the lower animals.

Then, 3rdly, another explanation suggests itself to us, in this dilemma,
which is, that Dr. Carnochan might possibly have been mistaken in his
belief, that he had removed the ganglion of Meckel, in the operations
reported by him. This last, with all the lights before us, would appear
to us the most probable supposition, were it not, that Dr. C.'s high reputa-
tion and acknowledged familiarity with the parts in question, which,
while they have given the subject importance in our eyes, have also ren-
dered us averse to adopting this remaining supposition as our final
conclusion. We therefore respectfully leave the conciliation of the ad-
verse facts, to himself.

Our object, in the foregoing remarks, has been neither to deny, nor
captiously to question any conclusions which Dr. C. may have hastily put
forth in his report of his remarkable operation. These conclusions of
his are but incidental to the main object of his report, and perhaps no
considerable amount of importance was attached to them by him, and
no great thought or trouble expended upon them. They do not, in any
way, lessen the merit of his operations for the relief of neuralgia. We
were struck with the remarkable difference in the results reported by
him, and in those results which have been so long accumulating in the
records of Experimental Physiology. Perhaps ere this, the discrepancy
may have occurred to himself, but his manner of referring to this ques-
tion, so important in a physiological point of view, was such as to leave
it open for discussion. We have endeavored to do this fairly, and we
know, in a kindly spirit, carefully avoiding every expression which might
bear any semblance to disrespectful or uncourteous criticism.

Physicians and Lawyers. Technicalities before Juries. We have
transferred to our pages, an article from The London Lancet, commenting
upon a paper read by Dr. Forbes Winslow before the Juridical Society,
" On the Legal Doctrines of Responsibility in cases of Insanity connected
with alleged Criminal Acts." These comments bear rather heavily upon
the Legal gentlemen on account of their ignorance concerning Insanity

1858.] Editorial 143

in its forensic and other aspects. It is, doubtless, true, that the subject
of Insanity has received too little attention both from that Profession and
our own, and we would commend to the attention of all interested in
such subjects, a work which has recently delighted us, viz., "Mind and
Matter," from the able pen of Sir Benjamin Brodie. In this work the
subject of " Moral Insanity," soon to be discussed before the American
Medical Association, is pertinently touched upon, while many other ab-
struse points are handled with that philosophic clearness and happy fa-
culty of illustration, for which this great man is so remarkable.

We would here remark, with due respect to gentlemen of that learned
Profession, that we think, upon the whole, Lawyers estimate too lightly,
the important and intimate relations subsisting between the Science of
Medicine and their own calling. Medical Jurisprudence, though ably
taught at the present day in most of our Schools of Medicine, and we
suppose of Law also, is still a branch, in which much greater excellence
might most advantageously be sought by both Physicians and Lawyers.
Nothing so intimidates the young practitioner of medicine, as the appre-
hension of having to undergo a medico-legal examination ; and yet at
the same time, nothing can be less pertinent and more irrelevant than
the questions projected at him on such occasions, by the gentlemen of
the Bar. They both proceed with great caution. It is delicate ground
for both; the one is afraid of developing ignorance before the intelligent
audience usually assembled on such occasions, while the other is afraid
of developing something which may damage his interest in the case be-
fore the intelligent Jury. We know from personal experience, that the
Physician is afraid of the examining Lawyer, and we take comfort by
strongly opining that the Lawyer is sometimes a little afraid of the de-
posing Physician. The latter, however, has decidedly the advantage
he need only break such ground as he has had the opportunity and the
precaution to prepare for, previous to the opening of Court. A careful
study of some work on Forensic Medicine would place them both on a
level in this latter regard, for then the Physician would soon learn to
appreciate, as well as the Lawyer, what points in the case, were liable to
have an important bearing in the evidence about to be elicited, and he
too, could prepare and brighten up for the approaching ordeal.

These, however, are -not our only comments; but we deem it prudent to
premise our remaining remarks by a quotation from that most useful and
most treasured of all j uvenile journals, " Peter Parley's Magazine." Here,
many will remember, that in each number, there was a department
headed " To our Youngest Readers ;" so in all our remarks on this
subject, both foregone and to follow, do we address ourselves to our
" youngest readers." We would ask, then : Are there not faults which

144 Editorial. [February,

attach exclusively to our own Profession in its relations to the Courts of
Justice ? Do we always maintain our dignity and that of our Profession,
and are our depositions such as will serve most fully in answering the
ends of justice, by clearing the (so to speak) medical obscurities invest-
ing it ? The Lawyers may indeed be deficient in certain attainments
necessary for the proper administration of Justice in particular cases,
but we are, also, certainly often greatly at fault, both in the method
and in the wording of our depositions. We sometimes appear to forget
entirely that we are not deposing before a body of highly enlightened
Physicians, but before a Jury, composed of men utterly unfamiliar with
medical nomenclature and the technicalities of Science. We couch our
answers in such terms as to render them worse than " meaningless jargon "
to the Jury, whereas the plainest and most familiar synonyms should, in
our opinion, be selected to indicate, the organs, their conditions, the re-
sults of injuiries or of diseases, and, indeed, everything pertaining to the
point in question. What Jury on Earth, except a jury of scientific men,
could form any definite idea of the course of a Pistol-ball, for instance,
which, " after penetrating the integument above the superciliary ridge,
passed through the external table, diploic structure and vitreous layer
of the os frontis, then rupturing the three meninges ; dura mater,
pia mater and arachnoid, traversed the entire anteroposterior diameter
of the cerebrum, and in the post-mortem examination, was finally dis-
covered resting upon the tentorium, in close relation with the torcula
Herophili ? Yet pistol-balls, penetrating exactly these structures and
pursuing precisely the above course, have been known to produce death,
in cases which afterwards became the subject of medico-legal testimony.
It would have been more comprehensible to the Jury, and sufficiently
definite, to have deposed, that; the ball entered the front part of the
head and passed through the brain, and was found, after death, lodged
against the back of the head, on the inner side. Technical terms an-
swer very well for the records of Science they give a definiteness and
an accuracy to our reports, which no other expression can secure; they
are the language in which the scientific man thinks, and these words
thus become " the current counters of the mind ;" but in our humble
opinion, they have no place whatever, unless we intend to mystify, in our
communications with the uninitiated, and especially have they no place,
in medical depositions before any ordinary Jury. Simplicity, laborious
simplicity of language, alone is applicable before the Court. Should we
inadvertently, or through embarrassment, (for these examinations are
sometimes very embarrassing,) use a term which is too professional,
we should hasten to render it into one which can be readily appre-
hended ; and by pursuing this plan on all such occasions, we have

1858.] Editorial 145

little doubt but that, we will secure more confidence and respect for our-
selves, and maintain a position of greater dignity for our Profession,
before Judges, Lawyers, Jurymen and lookers-on, than we could gain by
all the technicalities furnished in all the copies of the whole fifteen edi-
tions of u Dunglison's Medical Dictionary."

We may be as " wise as serpents," but we had as well be, as dumb
41 as serpents." unless we speak in language simple enough to be com-
prehended by those we address. We may be like Moses, " learned in
all the wisdom of the Egyptians," but if we unfortunately employ the
Egyptian dialect, in which to communicate our thoughts to others, the
generality of mankind, at the present day, will never be " a whit the
wiser" for it. Simplicity of language is indicative of meekness, and
meekness we are told, on the authority of Holy "Writ, qualifies wisdom
itself; for there it is urged, that, we "show, out of a good conversation,
our works, with meekness of wisdom"

Honors conferred on American Physicians. We collect from va-
rious sources, the recountal of Foreign honors bestowed on American
physicians. We regard such evidences of appreciation as highly import-
ant, as they not only indicate the favor in which Americans are held
abroad, but their recountal must have the effect of encouraging our
younger brethren, and stimulating them to deserve honors even though
they may never receive them ;

" Tis not in mortals to command snccess:
TVe can do more deserve it."

Among the number of those honored with the Emperor of Russia's
marks of favor, we are gratified to find the name of a graduate of the
Medical College of Georgia, our friend and fellow-citizen, Dr. W. J. Holt,
now of Alabama, who has received still another mark of the Czar's distin-
guished and distinguishing consideration, since the one reported below.

uDr. E. B. Turnipseed, now of Xew-York. a native of South-Carolina,
has recently received from the Emperor, through Baron Stceckel, Puissian
Minister at Washington, the decoration of the Russian order of St. Anne,
of the third class, accompanied by two medals attached to the ribbons
of the orders of St. George and St. Andrew, in acknowledgment of his
services during the war. The Emperor has also conferred the orders of
St. George and St. Andrew upon Drs. Harris, Holt. Smith, Eldridge,
Johnson, and Matthews, all American physicians, who were associated
with Dr. Turnipseed.

" The cross of the order of St. Anne is a neat piece of workmanship,
set in gold and enamel. The decoration of St. George is the highest
military insignia in the empire, permitted only to those whose live? have
been risked in the service of the Emperor. The St. Andrew ribbon is
the highest civil honor. The above facts we gather from the Xew- York
Daily Times'' [Surg. Reporter.

106 Editorial and Miscellaneous.

Honors for Dr. Jackson. " We are gratified to record this morn-
ing, that another honor has been bestowed upon Dr. Charles T. Jackson
of this city, in token of appreciation of the services which he has con-
ferred upon humanity as well as science, by his discovery of anaesthesia
by ether. The King of Prussia has bestowed upon him the cross of
Chevalier of the Red Eagle, making the fourth order of merit which he
has received for the same cause, besides one gold' medal. The cross of
Chevalier of the Red Eagle, sent to Dr. Jackson, is of solid silver, and is
of the Maltese form. It bears in the centre, on obverse, the figure of the
red eagle, with shield on breast and a wreath of laurel in his talons, this
being executed in fine colored enamel. On the reverse, the crown of
Prussia, over the initials of Frederic William, the King. The cross is
suspended on a white ribbon, bordered with a broad stripe of cinnamon
color.

" We subjoin the letter of the Prussian Minister, notifying Dr. Jackson
of the new honor conferred upon him :

"New York, 30th November, 1857.

" Sir: With reference to my letter to you of the 5th of May last, I
have the pleasure of informing you that his Majesty the King of Prussia
has been pleased, agreeably to the wish expressed to me in your letter
of the 18th April last, to confer upon you the order of Chevalier of the
Red Eagle, as an acknowledgment of your merits in the discovery and
the application of Anaesthesia.

" The said decoration I enclose hereby, with the printed ' Thema/
marked No. 19,396, which I beg you to fill up by your hand writing,
and to send it back to me to Washington.

" I have the honor to be, with high consideration,
" Your obedient servant,

"Ferd. Gerolt,

" Prussian Minister.
u Chevalier Charles T. Jackson, Doct. of Med. at Boston."

[Boston Advertiser, Dec. 2.

Dr. Jackson has recently also had conferred upon him, by the King
of Sardinia, " the orders of Saints Maurice and Lazarus," in recognition
of his eminent services to humanity, and the patent and decoration of
the order have been sent to him.

" We have certainly every reason to be proud (says the Buffalo Med.
Journal,) of the appreciation which the services of our countrymen met
with, during the last war, from Russia and the French. The restless
spirit of a true American is so powerful that it cannot be subdued even
by the studies and experiences of medical life, and the opportunities
open to the medical man for gratifying this propensity, are so few, that
a war such as the last, is a perfect Godsend. We see this exemplified
in the numberless applications for appointments in the army and navy,
where, on this account, the examinations have been made so rigid, and
the standard of merit has been placed so high, that a comparatively
small proportion are accepted. Wherever our countrymen go, however,
they leave the impress of characteristic energy and zeal in doing what
they have to do, as is exemplified by the gratifying testimonials which
have been presented to them by the Russian Emperor."

SOUTHERN

MEDICAL AID SURGICAL JOUMAL.

(NEW SERIES.)

Fol. XIV,] AUGUSTA, GEORGIA, MARCH, 1858. [No. S.

' , ;

ORIGINAL AND ECLECTIC.

ARTICLE VII.

The Appropriate Treatment of Dysentery. A Clinical Lecture,
delivered at Jackson-street Hospital. By Kobert Campbell,
A.M., M.D., Demonstrator of Anatomy in the Medical Col-
lege of Georgia.

" All practical medicine depends upon a knowledge of three things to wit :
1st. Pathology; 2nd, The articles or agents of the materia medica; and, 3rd. The
relations between these two elements" [Baktlett's Philosophy of Med. Science.

Gentlemen :

In our discussion of the "Treatment of Dysentery," so varied,
inappropriate and often irrational and incompatible were the
measures, found to have dominion over this most important and
common field of interest that it became necessary for us to
inquire into their value, as well as the appropriateness of their
application to the existing state of this disease, and also into the
probabilities which were derived therefrom, in favor or against
accomplishing, by them, the relief of that condition.

And thus, were we obliged to lead you back to "first princi-
ples," in giving you a common-sense view of these different
systems, that you might apply the gauge of reason to whatever
of error or assumption might have obtained sanction in these
premises, and so be enabled to select from the varied and an-
tagonistic doctrines in vogue, whatever of good they might
contain, to the rejection of that which might operate in direct
opposition to the attainment of the ultimate object in view. In
n. s. VOL. XIV. no. in. 1

108 Campbell's Lecture on Dysentery. [March,

short, we have thus dwelt, to some extent upon this subject, for
the express purpose of co-ordinating and systematising the treat-
ment of this disease. And we have been able to gather, in our
survey of this field, some facts which were good and fit to garner
up, but so scatteringly have they been strewn, and so commingled
have they been with the greater amount of worse than useless
and pernicious chaff so much have these principles been found
to operate to the effect of " blowing hot and cold together" as
to call for the exercise of much discrimination and the adoption
of a system of stern and uncompromising selection.

Some of the plans of treatment in use and by far the most
valuable we have yet to notice.

There have been proposed, from time to time, many valuable
remedies for the relief of this disease and would it not have
been remarkable, at this stage of the world's history, if accident
or experiment had not pointed out the fact, that the exhibition
of certain medicinals was followed by good results in this dis-
ease ; and this knowledge had not come in reference to those
agents, under these circumstances , empirically ; especially, when
we consider, that thus, is first derived almost all of our know-
ledge concerning the action of remedies in general ?

But in this case, whether from the conflict between a false
conception of the pathology of this disease and the manifest re-
sults of these agents; or from the stubbornness of preconceived
notions in perverting the interpretation of these manifest results,
it appears always to have happened that although there has
been long in use, some appeopei ate teeatment for this disease,
yet it has existed in such fragmentary parcels, and has been so
mixed up and incongruously yoked with so much of counter-
vailing force, as steadily to have maintained, here, an unsettled
state of our science, or an entire stasis in this particular.

And this brings us to notice a certain class of remedial
agents, which constitute what we may call the "appropriate
treatment" of this, the intestinal element of Dysentery, on ac-
count of the applicability and the correspondence of their thera-
peutic action their specific agency, in supplying the demands
incident to this diseased state, as determined by the characteris-
tic qualities of the organ and tissue involved, as well as the
circumstances in which they are found, and whose abnormal

1858.] Campbell's Lecture on Dysentery. 109

condition constitutes this disease ; and especially, as experience
has taught us, that all or most of this group of remedial agents
have been found invaluable for the cure of this very disease.

Let us now return and see, what are the indications, which
are involved in this local condition, and what are these reme-
dies, whose specific properties of action, experience has taught
us to be of that character, which would be best adapted to meet-
ing the exigencies of this case. We have seen, that there were
two indications derived from our consideration of the state and
circumstances of the intestinal element of Dysentery. We will
now consider them separately.

First There is Inflammation of a Mucous Membrane requir-
ing ITS OWN PECULIAR TREATMENT.

Now, the Science of Therapeutics may be said to have been
based upon the fact, that certain agents, derived from the three
great kingdoms of Nature, are found to exert a decided influ-
ence upon the living organism when brought in relation with
it; and farther, that "they have particular tendencies towards cer-
tain parts of the body, over which parts they exert a peculiar and
special influence"* The arrangement of medicines, or their
classification, is made according to the knowledge of what these
tendencies are. And, says Headland, (in his recent and very
valuable "Essay on the Action of Medicines,") "This classi-
fication is certainly more scientific than a mere empirical ar-
rangement ; and it will be so far of use, that it will enable us
when we wish to make an impression on a certain organ or set
of organs, to select those medicines which especially influence it

or them There is no doubt whatever," says he, "of the

existence of these local tendencies or partialities, their proof,"
he continues, "depending in part upon the fact, that medicinal
agents are actually detected, in many cases, in the very organs
over which they exert a special influence."

It is maintained, on the high authority above quoted " that
medicines must (as a general rule) obtain entry into the fluids of
the body pass, that is, from the intestinal canal into the system
at large before their action can begin" unless we would
suggest the part to be affected by them be external or superfi-
cial and their immediate application is thus rendered practicable.

* Headland.

110 Campbell's Lecture on Dysentery. [March,

And just here, we would object to the proposition, as a general
rule, which requires in all cases, that every particle of all kinds
of medicines must be absorbed into the circulating mass, before
they can manifest their peculiar action in the direction of their
appropriate organ or tissue. For instance, in the case of the
mucous tissue of the alimentary canal the very surface upon
which, as a general thing, all medicines are thrown why may
not these agents be applied in sufficient quantity, as not to ad-
mit of an entire absorption of every particle, to travel the round
of the circulation and be directed to the same surface by which
they were taken up, before they can manifest their peculiar
agency when their application is primarily and immediately
made to that superficial surface ?

The advantage here is, that whilst such a surface is acted upon
in the usual way, that is according to this author by impart-
ing its impression or influence to the tissue or organ in its transit
through it, or its elimination by it, (for this is the manner in
which he accounts for the action of medicines upon secerning
organs and tissues, generally) ; in this case, the tissue has the
advantage of its first contact and its transit through it, into the
circulation, as well as its return through the tissue, to be elimin-
ated in its proper form, by the mucous follicles of this surface.
Take, for instance, the action of Turpentine, whose modus
operandi he explains in the manner just given Are we to un-
derstand, that all the Turpentine voided in the alvine discharges,
has gone the round of the circulation and has been secreted, as
Turpentine, by the mucous follicles of the intestinal canal? Be
it so its operation must be the same, and upon the same tissue.
But we prefer to believe, that a good portion of it becomes mix-
ed with, and impregnates, the contents of the canal, and thus
passes by the shorter route, in contact with, and imparting its
influence to, this surface.

But to return There is, in Dysentery, an inflammation of
a mucous membrane, REQUIRING ITS OWN peculiar treat-
ment.

Now, the treatment of this inflamed mucous membrane is to
be derived from that class of remedies, unquestionably, whose
known specific qualities of action, affect the condition of this
tissue, wherever it exists. Then let us see, what articles of the

1858.] Campbell's Lecture on Dysentery. Ill

Materia, Medica, are found to be suitable for supplying the de-
mands conveyed in the proposition here reiterated.

There is Ipecac a " mucous membrane remedy," whose value
as a remedial agent was first disclosed by the benefit derived
from its use in Dysentery; and consequently, this has ever
since been considered, by many, a reliable form of treatment for
this very disease.

It is recorded, that " John Helvetius, grandfather of the cele-
brated author of that name, having been associated with a mer-
chant who had imported a large quantity of Ipecacuanha into
Paris, employed it as a secret remedy, and with so much success
in Dysentery and other bowel affections, that general attention
was attracted to it ; and the fortunate physician received from
Louis XIV., a large sum of money and public honors, on the
sole condition that he should make the remedy public. From
this period it has maintained its standing among the most useful
articles of the Materia Medica."

Dr. "Wood says that " In Dysentery it has been supposed to
exercise peculiar powers, but is at present less used than former-
ly, in doses sufficient to excite vomiting."

Now, these peculiar powers, we would venture to suggest, are
alone" dependent upon the specific properties of this remedy, in
altering the condition of the mucous tissue, wherever it exists
this being a disease whose local element is an inflamed mucous
membrane hence the benefit derived from its use. And if
proof of this proposition is demanded, it may be established
from the experiments of Magendie, with the active principle of
this agent, from which it was shown " to have a peculiar direc-
tion to the mucous membrane of the alimentary canal and the
bronchial tubes. Ten grains of the impure alkali, administered
to dogs, were generally found to destroy life in twenty-four
hours, and the mucous membranes mentioned were observed to
be inflamed throughout their whole extent." And further, it is
stated, that the "same result took place when emetia was inject-
ed into the veins, or absorbed from any part of the body."
And with the same testimony may be placed the effect of the
inhalation of the powder of Ipecac into the lungs, producing
bronchitis, as well as its injection into the veins, giving rise to
pneumonia, as was shown by Magendie's experiments. When

112 Campbell's Lecture on Dysentery. [March,

Ipecacuanha is employed in this disease, it is not used as an
emetic, but as an " anti-dysenteric" for its introduction into
the rectum, without causing vomiting, is said to be just as effi-
cacious as when taken into the stomach ; and that it has been
found to be most beneficial when tolerated. This tolerance is
urged by some practitioners to the extent of causing the
retention of very large doses, without inducing vomiting, even
3j. doses being administered every two or three hours in some
cases.

Although Ipecac is a remedy whose specific properties are
determined to the mucous tissue, and therefore being appropri-
ate in its application to Dysentery ; and although it still has
many advocates yet there are elements to be derived from the
same group of agents, to which it belongs, which are less
objectionable in many respects, and which appear far more
suitable and are more decidedly efficacious in the cure of this
disease.

Now, among this group of remedies, which may be said to be
rationally specific in this disease, we find also, Benzoin, Balsam
Copaiba, Creosote, Turpentine and the like all which are well
known, rightly to merit a place in this class of remedial agents
each presenting sufficient testimony in its favor, to prove its ap-
plicability to the disease under consideration ; and were all other
evidences absent, of the ultimate nature of this disease the fact
that these remedies, whose operations were manifested in the
production of certain phenomena, whether under health or dis-
ease, in the mucous tissues of the body, as found in other situa-
tions the very remarkable results of their exhibition in the
relief of Dysentery, might be taken as rational grounds for de-
termining the situation and character of this affection. And
thus might Therapeutics furnish the link and clue in a broken
and obscure Pathology.

The tincture of Benzoin, or " Tinctura Benzoini Composita"
of the Pharmacopoeias has been recommended in doses of from
f 3ss to f 3ij, as a valuable agent in some of the stages of Dysen-
tery, and our limited experience of a single case would bear
testimony thus far, to the validity of its claims to consideration.
That case was one in which, after a very severe attack of Dy-
sentery, in an extremely feeble constitution, it became compli-

1858.] Campbell's Lecture on Dysentery. 113

cated with Diarrhoea, and the appropriate response to either of
the indications, manifested in the mixed character of the symp-
toms, having failed to relieve, or having appeared even to
aggravate this condition the plan was adopted of treating the
inflamed tissue, irrespective of the number and character of the
discharges, and the effect was magical the patient, a physician's
wife, was convalescent very shortly after the change of treat-
ment, and perfectly recovered. We are aware, that by citing a
single case to establish any point, we are laying ourselves liable
to the charge of driving a post hoc, propter hoc conclusion, but
we give you that isolated fact at what it is worth, supported as
it is by the commendation of the remedy, by others, based upon
a more extended scale of experience ; and would advise you to
bear that fact in mind, to serve you, if ever a similar set of
complex circumstances as above recounted, should demand its
application, as the only alternative.

"We quote from an article* in the London Lancet, the follow-
ing paragraph, viz. " When the functions of the colon are
performed in a healthy manner, the fasces are figured, of a firm
consistence, and of the well-known color. In Dysentery, or, as
is sometimes called, colitis, this function is completely in abey-
ance ; but whether this is produced by the relaxed state of, and
consequent want of tone in, the muscular coat, or from the ex-
treme irritability of the mucous membrane of the intestines, or
of the character of its contents, or all combined, I cannot deter-
mine. The compound tincture of Benzoin I have found, when
administered in this disease, particularly useful in restoring, and
that in a very short time, this- function of the colon. Whether
it also acts beneficially by protecting and sheathing the ulcer-
ated portions of the gut, or by its stimulating qualities induces,
just as it does in chronic ulcers of the surface, the reparative
processes to go on more rapidly, I am unable to determine. The
tincture of Benzoin, I need scarcely say, consists of Benzoin,
Styrax, Tolu, a small quantity of Aloes, and spirit. The dose
generally given is from fifteen to twenty minims." The writer
then reports a number of instances in which he had met with its
striking beneficial effects.

The marked benefit, so long known to be derived from the

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

114 Campbell's Lecture on Dysentery. [March,

application of this balsam, to ulcers and wounds, may have some
reference to its mode of operation, when applied to the sore sur-
face of the mucous membrane, in this disease.

The influence of Balsam Copaiba over the mucous membrane
lining the urethra is familiar to every tyro in medicine. Ac-
cording to Pereira, "it also acts as a stimulant, but in a less
marked manner, to other mucous membranes; namely, the
bronchial and gastro-intestinal membranes." He states further,
that " the greater influence of Copaiba over the urethral than
over other mucous membranes is by some explained thus :
Besides the influence which this receives in common with the
other membranes of the same class, by the general circulation,
it is exposed to the local action of Copaiba contained in the
urine, as this fluid is expelled from the bladder. If this hypo-
thesis were correct, the influence of Copaiba over the mucous
lining of the bladder would be greater than that over the urethral
membrane." Now, the fact is here plainly enough enunciated
that whilst this group of medicines are classified because of their
peculiar property of spending their agency upon the mucous
tissue wherever it exists, there are at the same time individuals
of this group, which although exerting their influence upon this
tissue everywhere, yet, having a more decided control over its
condition in certain parts owing perhaps to the slight modifi-
cation of structure in those special localities, dependent upon the
variable office required of this component tissue to perform, as
involved in the function of its own complex organ. And it is
equally true, that some of the members of this class of agents
are found to be of more restricted, while others are of more
general, applicability : i. e., that some, whilst they act on all
mucous membranes more or less, act upon that tissue in a very
decided manner, only as it exists in one or two situations while
others, operate in a marked degree in all or nearly all its distri-
butions, as, for instance, is the case with Turpentine.

J& regards Balsam Copaiba otherwise, than in its special ap-
plication, Dr. Cullen spoke favorably of its use in hemorrhoids,
about a century ago. He says, " I have learned from an empi-
rical practitioner, that it gives relief in hemorrhoidal affections ;
and I have frequently employed it with success. For this pur-
pose it is to be given, from 20 to 40 drops, properly mixed with

1858.] Campbell's Lecture on Dysentery. 115

powdered sugar, once or twice a day." Since his time, it has
been used, variously combined, with happy results, in other
affections of the intestinal canal, as for instance, "in chronic in-
flammation of the mucous membrane of the bowels, especially of
the colon and rectum." One of the properties of this medicine,
as generally laid down in its history, and as is familiar to every
practitioner, is that of acting somewhat upon the bowels as a
purgative, or rather laxative. And there are to be obtained, by
a perusal of the recorded history of practical medicine, glimpses
of evidence scattered here and there, of the great value of this
agent in the treatment, not only of the chronic, but of every
stage of the disease now under consideration. In fact, the term
chronic, is, for the most part, of arbitrary significance some de-
signating such cases thus, which are not relieved, in what they
consider a reasonable length of time ; while others, especially in
reference to this disease, apply this qualification to such cases as
those in which the symptoms are prolonged by persistent ulcer-
ations in the mucous membrane of the intestine, which owed
their existence to an attack of Dysentery.

Dr. LaHoche, in an essay on this subject, bears staunch testi-
mony to the efficacy of Balsam Copaiba in this disease. As
likewise does Dr. Meigs, of Philadelphia. This is used accord-
ing to Eberle's formula, that is, in emulsion made with sugar
and gum arabic, or dropped upon sugar. A friend of ours, who
is an intelligent physician, informs us, that he has no other
treatment for Dysentery than the Balsam Copaiba ; and that his
success with this agent leaves no room for a desire to improve
his treatment.

Such is the written, as well as the un-recorded testimony in
behalf of this measure ; and although we are not able to bespeak
its adoption, from our own experience, yet, we must say, upon
the testimony of others, and considering the acknowledged at-
tributes of the remedy in relation to our conception of its appli-
cability to the peculiar requirements of the diseased condition,
organ, and tissue involved, we would heartily endorse it, as a mode
of treatment, never to be lost sight of, with reference to Dysentery.

Creosote has recently gained much advocacy in the treatment
of Dysentery. It was first used by Dr. Wilmot, as a remedy in
this disease, in its local application by enema. Thus, it is re-

116 Campbell's Lecture on Dysentery. [March,

corded in Banking's Abstract for 1846, that "In a severe form
of Dysentery which occurred near Tunbridge Wells, and in
which all methods of treatment appeared unsuccessful, the mor-
tality being as high as 25 per cent., Dr. Wilmot thought of
trying Creosote enemata in the strength of 3j. to fxij. of
Starch. This remedy produced a speedy amelioration of the
disease. It will be perceived, that this agent must have acted,
under these circumstances, for the most part, by its immediate
application to the diseased tissue. More recently, valuable re-
sults have been obtained nearer home, and principally in the
West, from the internal or per orem administration of this
remedy.

In our Lecture on the Pathology of Dysentery, delivered in
November, you will recollect, that we had occasion to quote
from an article entitled "Creosote in Dysentery," by Dr. Wm.
H. McMath, which furnished decided proof of the value of that
agent, in the treatment of this disease. We have just had the
good fortune to meet with another very excellent contribution
to the New Orleans Medical and Surgical Journal " An Essay
on the ^Etiology, Pathology, and Treatment of Epidemic Dys-
entery,"* which adds a volume of evidence in favor of the great
consideration to which this agent is entitled, as a remedy for this
disease. The author, after dwelling upon the Pathology, &c,
of the disease, in which we are gratified to find, that some of his
views are in accordance with our own viz., in this, that " A
Dysentery having its origin from the general condition of the
atmosphere differs from the intermitting and remitting fever
only in the intestinal affection, and requires a similar treat-
ment" then makes the following record of his practice, and
that of others, upon the same plan viz : "I have usually open-
ed the treatment by administering some mild purgative, and a
favorite one with me has been a combination of Hydrarg. Cum
Creta and Pulvis Ehei ; assisted, if necessary, with the Syrup of
Ehubarb. After the action of which, I prescribe the following
mixture :

$. Creosote, gtt. x.; Acetic Acid, gtt. xx.; Sulphate of Mor-
phine, gr. ij.; Oil of Sassafras, gtt. iv.; Distilled Water, I j.; in

* By Joseph B. Payne, M. D., of Magnolia, Arkansas.

1858.] Campbell's Lecture on Dysentery. 117

teaspoonful doses every three hours, until the discharges are
checked, and the bowels quieted.*

If there was any visible remission in the febrile symptoms, I
usually anticipate that period with the administration of Quin-
ine. Such is the treatment I have followed, in passing through
two epidemics, and success has crowned it in nearly every effort.
I could enumerate case after case where this course has been
followed, and success the result. I have seen and assisted in
treating in all, more than two hundred cases of Dysentery. In
the October number of the Nashville Journal of Medicine and
Surgery, (page 306,) there is a short article by J. W. Brown, on
the use of Creosote in Dysentery. He says, " Drs. McMath and
Gilder, of Louisville, Arkansas, tell me they have treated as
many as three hundred cases, and in all proving perfectly satis-
factory, under the use of Creosote." Their prescription, as is
given by Dr. Brown, is the same as I have given it, except the
oil of Sassafras, which is an addition of my own, merely to cover
the disagreeable smell and taste of the Creosote, which it effect-
ually does. " Now, if there is any honor due to the builder of
this recipe, and its use advised in the treatment of Dysentery
(which there undoubtedly is), that honor is due to Professor A.
P. Merrill, of the Memphis Medical College. I saw him use it
both in Dysentery and Diarrhoea, with the happiest effects.
When I returned home, I informed my preceptor, Dr. Gilder,

* As to " checking the discharges" with an opiate, we think the Doctor is in
error; and we would here beg leave to object to the Morphine, as an ingredient
in the Creosote mixture as we conscientiously believe the indiscriminate and
unconditional routine of administering Morphine every three hours, to be detri-
mental a drawback to the plan of treatment and that the Creosote in these
cases manifests its curative powers, in spite of the hindrance. Mr. Headland's
opinion, as regards certain effects of Opium, is the following : He says, " Opium
is a diaphoretic ; but it diminishes all the other secretions, and most especially
that of the bowels. It is certain that there are other narcotics and sedatives
which are able to relieve pain, but which neither cause constipation, nor produce
cerebral congestion." And again, " Opium is a general paralizer to muscular
fibre, both of the voluntary and involuntary kind, but particularly of the latter.
And the only reasonable attempt that can be made to explain the action of Opi-
um in producing constipation, is by a reference to this its paralyzing influence on
the coat of the bowel, taken in conjunction with the torpid condition of the gen-
eral system, and suspension of the animal functions, produced by the secondary
action of this narcotic on the nervous forces."

118 Campbell's Lecture on Dysentery. [March,

of the use of Creosote in Dysentery, and we both passed through
the epidemic of 1855, as above-mentioned. Drs. McMath and
Gilder have since used it with unequalled success."

Now, as to the therapeutic properties of this agent accord-
ing to Mr. Headland " Creosote stands, as a medicine, between
Hydrocyanic Acid and Turpentine. It has a double action;
being anodyne, like the former ; and a mucous stimulant, like
the latter." Also, that " Creosote is a sedative, and cannot be
well given in such large doses as to act upon distant parts." As
such a practice would be attended with danger.

It will be perceived from the foregoing, that the treatment of
Dysentery with this element, from among that class of remedies
which exert an influence upon the mucous tissue constitutes it
an " appropriate treatment" the . importance of which is suffi-
ciently established, and it is amply commended to you as such,
by the recorded results of its wonderful operation. Although,
from our want of practical experience with the remedy, we can
furnish no additional support, from our own observation upon
this subject ; yet, we would have you ever to be mindful of the
tenor of the commanding testimonials, in relation to the efficacy
of Creosote in the treatment of Dysentery.

Now, with reference to the modus operandi of this class of
agents, Mr. Headland remarks that " Certain stimulant elimin-
atives are employed for the purpose of checking mucous fluxes,
and so far simulate the action of true astringent medicines. Thus
we administer, with more or less advantage, Aromatics in Diar-
rhooa ; Cubebs,* Copaiba, and Turpentine in Gonorrhoea ; and
Balsam of Peru, and other Oleo-resins in Catarrhal affections.
These medicines may act upon and pass through the glands of the
several mucous surfaces which they affect ; while so doing, they may
stimulate the healthy function and secretion of the glands, and cause
it to displace the morbid one. Dr. Williams thinks that they first
cause dilatation of the vessels of a gland, and that this is follow-
ed by contraction. There is no apparent reason why the latter
effect should succeed the former. But supposing contraction to
take place in this way, then these medicines would be true as-

* We see that Dr. Stokes mentions Cubebs, as being a good addition to prepa-
rations of Balsam Copaiba, when used in Dysentery.

1858.] Campbell's Lecture on Dysentery. 119

tringents. But it cannot be so, for they do not diminish any of the
natural secretions, hut, on the contrary, increase them. Turpentine,
Cubebs, and Copaiba, are diuretics, and it is possible that while
passing out in the urine they may simply stimulate the mucous
surface of the inflamed urethra, and excite it to a healthy action."
And in speaking of eliminatives again, he further remarks, that
"it is laid down as a rule, that they act by themselves passing out
of the blood through the glands, and that while so doing they excite
them to the performance of their natural function."* And as re-
gards their ultimate, special influence over the tissue with which
they come in intimate relation, whether by being applied to its
surface, or by being eliminated through it it may, for conven-
ience, be reduced to the interpretation which attributes it to an
alterative effect ; for beyond this, any speculation possessed of
plausibility, will subserve the purposes of explanation : that is,
" Alterative, because the manifestations of vital action are some-
what different after its use from what they were before."f
Then we would say, that this class of remedies exhibit their bene-
ficial effects by inducing a healthy change in the condition of that
tissue, (when under diseased action,) over which, their influence
is known to have control.

And now, gentlemen, we rest assured that we are not taking
too much for granted, when we express the confidence we feel,
that ere this, your minds are fully persuaded of the truth of the
proposition laid down to you as the basis of the investigations
just made viz., that the rational, the successful, and therefore
the appropriate treatment of Dysentery, is unquestionably to be
derived from that class of remedies, which are known to expend
their activity upon that character of tissue, which is involved in
inflammation, to constitute the intestinal affection embraced in
this disease. And we esteem ourselves most fortunate in being
enabled to adduce such a weight of testimony (which we were
not aware of until instituting our researches,) to maintain the
stability of our position, as have been derived from the experi-
ence of others, with so many of the prominent elements of the
Materia Medica, constituting this class of remedies. It but re-
mains for us, now, to supply you with our own humble testi-

* All these italics are our own. -{-Headland.

120 Campbell's Lecture on Dysentery. [March,

mon y, in a farther substantiation of this position, with regard to
another member of this class the only one in fact with which
we have a practical acquaintance in this application the reme-
dy, which we prefer to all others, as the safest, the best, and
most efficient in its operation upon the affections of the mucous
tissue in general; and which, besides being of the most general
applicability in the affections of this tissue is pre-eminently to
be chosen as the agent for the treatment of Dysentery. This
remedy is Tukpentine !

"We have dwelt to sufficient extent upon the therapeutic
action of this class of agents, with an occasional reference, by
way of example, to this one, to render it unnecessary to detain
you with a repetition of those considerations. The Turpentine
treatment of Dysentery has long been in use, to some extent,
popularly, as well as with the profession ; but always so com-
plicated and obscured by other and antagonistic elements of
treatment, as to have its benefits lost sight of and very soon,
perhaps, to fall into disrepute in each particular case. And
thus, no fixed opinion seems ever to have been entertained as to
its efficiency and mode of action, and no lasting confidence has
been established in its reliability as a form of treatment, until
comparatively recently.

Some years ago, Dr. John Long, of Pleasantville, Kentucky,
made the following statement in the St. Louis Medical and Sur-
gical Journal, viz. "For more than twelve months past, I have
been in the habit of using Turpentine in the treatment of Dys-
entery, as it has occurred in this section of country, and find it

to be a most valuable remedy in this often formidable disease

Dose, ten drops, for an adult, every eight hours ; with mucilagin-
ous drinks and farinaceous diet. I was first induced to resort
to Turpentine in the treatment of Dysentery, at the suggestion
of Dr. Wood, of Philadelphia, who recommends it in Typhoid
fever. During the past summer, I treated thirty cases accord-
ing to the above method, twenty -nine of which recovered and
one died ; the latter resided fifteen miles off, and I did not see
him but once." Some years ago, also, Dr. Wm. C. Brandon, of
Hermitage, Georgia, through the pages of the Southern Medical
and Surgical Journal, advocated the use of Turpentine, com-
bined with Castor Oil, as a treatment for Dysentery. He says,

1858.] Campbell's Lecture on Dysentery. 121

"My usual prescription was 1 ounce of Castor Oil with from 1
to 2 drachms of Oil of Turpentine, for an adult; diminished in
proportion to the age of younger subjects. Often this dose had
to be repeated, sometimes twice, before a fecal dejection could
be procured. The Turpentine was left out in some instances,
and my opinion is, with disadvantage to the patient. I used
no saline cathartics, for in every instance where they had
been used prior to my visit to the patient, I believe they had
acted injuriously, especially where the stomach and small bow-
els were implicated to any great extent."*

And this brings us to consider the Turpentine Treatment, com-
bined with Castor Oil: as thus united it acts upon the inflamed
mucous membrane, and at the same time relieves and prevents
any accumulation in the faecal reservoir, the large intestine,
which is the seat of this local element of the disease. And this
is the treatment, of whose adoption and amendment we spoke, in
our introductory remarks, when considering the u Nature and
Pathology of Dysentery." And, now, we may here recall to
your minds with advantage, the Third condition, existing in the
nature and circumstances of this disease, with its dependent
indication, viz. Third. This mucous membrane lines the interior
of an excretory canal the seat of the inflammation WHICH MUST
BE kept OPEN it will not do to obstruct it ; for besides the ordin-
ary and necessary demands of health, that this prima via should
be unencumbered, and which also has a tendency, (notwith-
standing all interposed efforts,) to convey its contents onward
to their exit if, from any cause, the detritus of the process of
digestion is detained within its calibre, it would become con-
crete and consolidated, and would act as an irritating body to
the inflamed mucous lining especially as every excited con-
traction of the muscular coat of this canal, would compress its
inflamed lining, firmly against this resisting substance, where it
would probably be held for some time, on account of the loss of
normal tone in the mucous and muscular coats at this point, and

* This is a remarkable coincidence of impressions as regards the action of
salts in this disease, with our views given while considering that plan of treat-
ment; and also has some reference to a condition in its pathology, as heretofore
suggested by us especially, as we do not recollect to have had our attention
called to thi article until now.

122 Campbell's Lecture on Dysentery. [March,

would greatly enhance the difficulty therefore, prevent con-
stipation.

Thus, it will be perceived, that the demands of the intestinal
affection are comprised in the Second and Third indications,
which may be treated of in connection the latter being in this
instance involved in, and forming a necessary condition to, the
former that is, whilst the mucous membrane, here, requires the
treatment appropriate to mucous membranes elsewhere, here,
it is besides the lining of an excretory canal, which conveys a
material of more or less solid consistence ; therefore, it is also
necessary to combine with that specific treatment, some peculiar
method of procedure to prevent the irritation of the contained
solid excrement, in its transit through the inflamed canal since
it must pass through ; and this is best accomplished by reducing
its consistency from a solid to a fluid state, preventing its accu-
mulation and solidification, and also, by shielding the sore
surface, if possible, with some emollient or soothing application.
These two indications, then, together with derivative measures,
comprise the treatment of the local or intestinal element of this
disease.

Now, let us see how far these indications have been fulfilled
in the following history of our experience as to this disease, with
our peculiar form of treatment.

At the time we commenced the practice of medicine 10 years
ago the few sporadic cases of Dysentery which occurred from
time to time, were treated orthodoxly, or in accordance with
the most approved modes, prescribed by the text-book authors
of the day many of which cases (a large proportion for the few
that occurred at that time), went their way, secundum artem;
until Dysentery became an opprobrium to our skill an incubus
upon our peace. A year or two afterwards, when the disease
began to appear epidemically, it became necessary to inquire
into the respective value of the various suggestions, as regards
its treatment, which emanated from different sources. If we
mistake not, it was the London Lancet which first directed our
attention to the Castor Oil and Turpentine method. About that
time, we recollect to have been attending a case an old lady,
about 60 years of age the worst case we ever saw, to recover.
We had been called to her, two weeks after the inception of her

1858.] Campbell's Lecture on Dysentery. 163

attack, which she said came on after prolonged constipation, and
found her in that state, which the complication of age, an appa-
rently feeble constitution, and the unabated violence of this
disease, was well calculated to place her. She was on Black-
berry cordial and Laudanum. The tormina and tenesmus were
exceedingly violent, the stools very frequent, imperative, irre-
sistible, and of a purulent character. Altogether, " passing
away " as we thought was impressed visibly, upon every fea-
ture of this case. . . . "Why hadn't she died?1' thought we,
as enormous quantities of opium and astringents foiled to make

any impression on her disease. "Why doesn't she die?"

was the inquiry presented to our minds, when the slightest
quantity of salts purged her almost to death, without abating,

perceptibly, the affection of the large intestine. " Why cant

she die?'1 was the pitying interrogation, when she continued
to vomit small doses of the simple Castor Oil and Turpentine,
without any relief to her excruciating sufferings. It then, first
occurred to us, to saponify the Oil with Soda ; to mix in the
Turpentine; to suspend these in an emulsion of Gum Arabic
and Sugar ; and to add some Sedative or Anodyne, (which did
not contain opium); as well as some Aromatic, to cause it to be
retained by the irritable stomach. The following Kecipe was
the result viz:

$. Castor Oil, Hij.

Bi-Carb. Soda, 5j.

Spts. Turpentine, Iss.

Powdered Gum Arabic, . . . I j.

Loaf Sugar, 5j.

Compound Spts. Lavender, . . I j.

Camphor Water, q. s. to make 8 oz emulsion."
Flavor with oil of Peppermint or Lemon.

Of this, she took 1 tea-spoonful every two hours, and the dose
was gradually increased to 1 table-spoonful, as her stomach was

* Some of the ingredients in the above recipe may be altered, occasionally, with
advantage, for instance, Sweet oil may be sometimes substituted for the Castor
oil; and the proportion of Turpentine may be varied according to circumstan-
ces. The Spirit or the Oil of Turpentine may be used indiscriminately.

About the time we commenced using this recipe for Dysentery, Ave found that
the same formula, with the Castor oil left out, was an excellent mode of adminis-
tering Turpentine in Typhoid fever, and have used it ever since.

7*

164 Campbell's Lecture on Dysentery. [March,

able to bear it ; for, after making an effort to retain the first
dose, the irritability of her stomach seemed rapidly to subside.
And very soon being confident of the opposite result we were
astonished to see the marked improvement in the condition of
the patient who, upon this treatment, steadily advanced to
recovery for verily, " her time had not yet come !"

This Recipe, Gentlemen, has constituted the basis of our inter-
nal treatment of the local affection of Dysentery, ever since
and we have never since found cause to set aside that basis as
it has never yet, forfeited the confidence, thus engendered in it.

We would call your attention to some of the principal ele-
ments in this formula, and their probable effects under these
circumstances, to determine how far they rationally fulfill the
two indications under consideration.

Now, it will be recollected that, in a former Lecture, we en-
deavored to show, that there were four elements or conditions,
making up the sum of that form of disease which is termed
Dysentery, and that, from these, necessarily proceeded the four
consequent indications of treatment.

First. The existence of Fever, dependent upon a cerebro-
spinal condition which was probably the origin of the Dysen-
tery demanding the prevention of that fever. Conse-
quently, on a former occasion, we dwelt to some length, upon
the great importance yea, the indispensableness, of giving
Quinine, as the appropriate remedy for answering this first indi-
cation, which, together with revulsives, constitutes the treatment of
the cerebrospinal element of this disease.

Second. There being disease of a mucous membrane re-
quiring ITS OWN PECULIAR TREATMENT, the action of TURPEN-
TINE was sufficiently considered, as an appropriate agent, for
supplying this second indication, and need not be, here, revert-
ed to.

Third. There is Constipation existing and having a tendency
to persist being an element of the disease and an obstacle in
the way of its relief, (because the retained, inspissated contents
of the canal, constantly irritate the sore surface of the interior
lining of that canal, over which it must pass) therefore, the
third indication was, to relieve and prevent Constipation.

Now, let us examine into the appropriateness of some of the

1858.] Campbell's Lecture on Dysentery. 165

other elements in the formula which we have given you, and
which are combined with the Turpentine, for the fulfillment of
this third indication.

Castor Oil, it is generally accorded, acts principally by lubri-
cation i. e., by anointing the interior surface of the intestinal
canal and allowing substances to pass the more easily over it.
It is also admitted, that it acts as a mild stimulus to the intestinal
mucous membrane, inducing mucous stools and for this reason,
it is thought principally to act upon the large intestine, as this
is the characteristic excretion from this portion of the canal.

The effect of the Soda, which is here combined with the Oil,
would probably be, first, as a solvent of the faecal mass, and if
given in large doses, it acts as a laxative. So, may it be per-
ceived, that the two combined, would probably have the effect
of overcoming the constipation by their laxative effect, in an inof-
fensive manner assisted, if necessary, by exciting the biliary
secretion with the preparation of Mercury, (viz., Blue Mass and
Chalk 1 part of the former to three of the latter,) of which
we have spoken, as the one we preferred to all others, when the
obstinacy of the constipation, as well as other indications of
suspended hepatic secretion, demanded its employment. These,
together then, may be considered the appropriate treatment for
the relief of this condition, in answer to the Third indication.

Some of the secondary effects of the Soda may be considered
of much benefit in this disease. For instance, in connection
with Turpentine it proves a most powerful diuretic, and perhaps
advantageously, as it is known that in all fevers, the secretion
of this great emunctory is more or less suspended. And if the
opinion be correct, which has long been entertained, .that in all
fevers, there is the generation or formation of zymotic elements
in the system, from the more rapid disintegration of the tissues
owing to the consequent over-wrought condition of the whole
organism in that state the effect of these two powerful diuret-
ics, as combined in the formula, should serve the valuable pur-
pose of their elimination from the blood, by the urine.

And further : May there not be some advantage in the alka-
line quality of this agent, which may tend to counteract that
6tate of the fluids of the body, which is favorable for the devel-
opment and maintenance of that condition, in an important

166 Campbell's Lecture cm Dysentery. [March,

portion of the organism, from which results the manifestations
of this disease? This opinion does not seem so "far-fetched,"
when we are able to refer you to an interesting article, in the
Dublin Journal of 1848, with the very pertinent caption of
" Alkaline Treatment of Dysentery" which is too long to quote
entire, but where the author* says in relation to one of his case3
there reported, " The feature of most importance in this case
was the almost magical effect of the alkali in allaying the tor-
mina, tenesmus, and purging, the tincture of Opium appearing
to exert no influence whatever over the disease till combined
with the liquor Potassae ; the patient remarking, when I visited
him in the evening, that the last medicine produced a feeling of
ease and rest from pain quite cheering to him." The writer
had administered 10 minims of the liquor Potassae every se-
cond hour, and applied Turpentine to the abdomen. He also
mentions Soda as one of the alkalies used.

In several cases, wherein the simple Oil and Turpentine
were administered, we have to state, that we did not see such
very remarkable results manifested, or so promptly, as from the
exhibition of the Emulsion. One of these a very bad case
having been treated by a friend, in the former manner, (when,
during his sickness or absence, the case fell into our hands,) was
signally benefited by the change to the Emulsion, and pretty
soon recovered.

The Lavender is used here as an anodyne or sedative, devoid
of any constipating quality yet, having amply sufficient power
to allay, in a remarkable degree, the nervous irritability and
agonizing pangs, consequent upon this torturing disease, by its
anodyne or sedative influence without a narcotic effect. We are
aware that this medicine is pretty generally disregarded, as of no
force, and that it has been consigned to a place among that class
of medicinal agents, contemptuously designated "Old Women's
Kennedies;" but it is our opinion, that this class of our race, are
often the venerable conservators of important, though obsolete,
medical ideas, as well as valuable, though discarded, medicinal
agents and of such, we consider the one in question. There
is in reason no foundation for an objection to this assertion, on
the score of " impossibility," in reference to its activity as the

* D. Kelly, L. A. Mullingar.

1858.] Campbell's Lecture on Dysentery. 167

potent narcotic itself, is but the product of a plant, and that, a
comparatively delicate and succulent one; and where is the
sense of denying to this plant, the credit of its own powerful
virtues ? We do not pretend to say, that their effects agree in
kind, but we have long been of the opinion, that the importance
of this agent, has been very much overlooked. It has been
long in use for " nervous irritability," "palpitation," " hysteria,"
&c. and with good reason. We contend, that it might have
served a valuable purpose, in a more extended application, and
with more decided evidences of its power: as, for instance, for
the purpose of diminishing the irritability of the nerves, conse-
quent upon the effect of other causes and in other localities of
irritation. For we know, that under the operation of such
causes, its continued use has, under our observation, been at-
tended with remarkable results, which have led us to indulge in
the projection of an hypothesis, in relation to its therapeutic ac-
tion, as compared with that of opium. It is this, that while opium
seems to act upon the central portions of the nervous system, as
well as the peripheral portions, but more especially upon the
cerebral mass, inducing a suspension of the functions of this
organ, in somnolence, coma, &c. this other plant, may exhibit
its therapeutic properties, by expending its obtunding influence
upon the nerves, and, perhaps, the spinal cord, (their more im-
mediate termination,) without affecting the brain : or, perhaps
its influence is of a totally different character, and may not be
manifested in similar results.

This is but a theory, concocted for our own satisfaction, in
explanation of the valuable facts, connected with the exhibition
of this remedy and whatever be their philosophy, we deem the
facts have been sufficiently evident to be worthy of remark.

The tranquilizing effect, which has been generally accorded
to this vegetable principle, in ordinary doses, is but a moiety of
the almost paralyzing sedation it is capable of inducing,
when frequently repeated, or administered in sufficiently large
doses. That property would seem to be almost identical with
that of Valerian, and is displayed apparently upon the same
portions of the nervous system. The tranq uilizing power of the
latter agent, is plainly to be recognized, in its marked control
over the subsultus tendinum (if not extreme), of Typhoid fever.

168 Campbell's Lecture on Dysentery. [March,

Really, many practitioners seem to have a proclivity for re-
ducing the practice of medicine to a very simple process viz.,
the application of a very limited number of medicinal agents
by selecting one (the most potent, perhaps,) from each class of
remedies, and for convenience, striving to force its application,
under all circumstances, when the demands of all of these cir-
cumstances, are alone able to be fully supplied from a whole
class of therapeutic agents each agent, probably, being adapt-
ed, from the peculiarity of its properties, to meet one or more of
the varying phases or stages of pathological condition, which
may occur in any organ or sj*stem all which, go to make up
the manifestations of disease, occurring in any particular organ
or set of organs, and, perhaps, requiring the employment of the
whole of that class of medicines, which is known appropriately
to belong to that organ or system.

We might adduce numerous instances of the most unmistaka-
ble and powerful effects, attendant upon the administration of
the Lavender, as forming an ingredient in the formula, above
given you, but one or two will suffice for illustration. For ex-
ample: Mrs. V., an intelligent lady, residing in this place,
during a very severe attack of Dysentery, in which tormina and
tenesmus were excessively harassing to her nervous system,
after taking the Emulsion every three hours during one day,
was entirely relieved of her dysenteric symptoms, but complain-
ed bitterly of the paralyzing effect of the "Laudanum Mixture,"
as she called it saying that, she could not take any more, that
she "could scarcely raise her hand," and "felt such a calmness
and lassitude, that it was distressing" to her. It is a common
thing for patients to call the Emulsion, the " Laudanum Mix-
ture," or insist that they had been taking Laudanum, from the
marked relief they experience; and yet, without being particu-
larly disposed to sleep their mental faculties being altogether
unembarrassed. Again: for example our estimable friend
and your erudite Professor of Physiology, Dr. Miller, stated to
us, that on one occasion he was required to administer to a case
of violent cramp-colic, and there being no other medicine in
reach, he gave the patient from two to three ounces of this
Emulsion, and he was entirely relieved, with an astonishing
promptness. This marked and sudden effect, we could attribute

1858.] Campbell's Lecture on Dysentery. 169

to no other element than the Lavender, acting as a powerful
anodyne, in such quantity. This is an effect pre-eminently
called for in the nature of Dysentery, and most remarkably ap-
propriate for its accomplishment here, is this agent, which is
devoid of a constipating quality.

The Gum Arabic in the formula, would probably have, only
an emollient or soothing effect upon the inflamed mucous surface,
as it may be considered proven by the experiments of Bous-
singault, and others, upon fowls, and of Dr. Wra. A. Hammond,
Surgeon U. S. A., one of the Prize Essayists of the American
Medical Association, in May, 1S57 by experiment upon him-
self that this gum, as well as others, are entirely indigestible
the whole quantity in weight, within a bare fraction of that
ingested, being collectible from the alvine discharges."

Now, Gentlemen, having considered the three first indications,
and also having determined their appropriate requirements, as
regards internal medication, we have but to refer to an import-
ant aid for the relief of the intestinal inflammation viz., that
of derivative measures.

\Ye stated before, that if the inflammation existed anywhere
in the course of the ascending, transverse, or descending colon,
it might generally be detected by manual pressure along the ex-
tent of that organ ; but if in the rectum, its situation was to be
inferred, from the violence of the tenesmus, as well as (when
used) the intolerance of all enemata. Then, the application of a
blister, cupping, or leeches, over the tender part, when situated
in the colon, will be found to be a valuable adjuvant in the
treatment. We have generally used a small blister, the size of
the hand, in the more violent cases. This may be kept open,
with advantage, by poulticing, until the symptoms of the disease
subside ; or may be placed, alternately, over different portions
of the canal, which are found, upon examination, to be affected.
\Ye would deprecate the barbarity of blistering the whole of the
front surface of a man's body, in order to reach the small portion
of surface corresponding to the extent of inflamed structure, in
the interior. "When the disease exists in the rectum, a blister
applied to the sacrum, will very readily influence it, on account
of the anatomical position of that organ. AVe have thought that

* See Prize Essav, in Transactions of Amer. Med. Association, for 1857.

170 Campbell's Lecture on Dysentery. [March,

a blister to the sacrum proved the turning point, in an extreme
case of this kind, where tenesmus was the prevailing symptom.

We would now notice briefly the requirements of the Fourth
condition, and its consequent indication of treatment, viz :

Fourth. There is a state of exhaustion, or, more properly, Fa-
tigue Kegular rest and resuscitation of strength are
TO BE SECURED TO THE patient by whatever means attainable,
provided they can be reconciled to the three other obligations to be ful-
filled in order to indemnify his vital energies for the effect of
the harassing influences preying upon them.

The vast importance of rest, or relief from the racking and
consuming torture, which we sometimes witness in this disease,
should be constantly kept in view, or the patient will often sink
from exhaustion of the vital forces, through neglect in this im-
portant quarter. We once saw a patient treated on the saline
plan, which failing to relieve him, he got no rest at night, and
grew worse every day until he was allowed some Morphine
at night when he slept and appeared much refreshed and re-
vived the next morning. The Oil and Turpentine Emulsion
was now substituted for the Salts, when he rapidly recovered.

A patient with Dysentery should, at all events, be secured
his accustomed rest at night, by every possible means, that he
may have the great advantage, so imperatively demanded, and
so essential to his well-doing, here, of the compensation for the
damage done during the day, by sleep

" Tired nature's sweet restorer, balmy sleep."

And here is the only appropriate place, which opiates can occu-
py, in the treatment of Dysentery. With this object, we prefer
the administration, by enema, of \ to \ gr. of sulph. Morphine,
in from 1 to 2 ounces of cold water, (as the least irritating pre-
paration,) every night at bed-time; which may be repeated, if
necessary, until sleep is induced. It will be perceived that there
is no danger of restoring the constipation, under these circum-
stances, so long as is kept up during the day, the unremitted
application of the other element of the treatment, embraced in
the exhibition of the Emulsion.

The patient's strength should also be supported by nourish-
ment, such as beef essence, chicken soup, corn -meal gruel, etc.;

1858.] Campbell's Lecture on Dysentery. 171

for, until the latter stages, general] j, the stomach and small in-
testines are capable of performing their function of digestion.
After an attack of Dysentery, it may be of importance to instruct
the patient to select such articles of diet, as will be favorable for
preventing constipation, and the consequent re-establishment of
the disease. Ripe fruit, if in season, will prove often an agreea-
ble, harmless and very efficient laxative. We remember the
case of an old lady, about sixty, who, after a very severe and
prolonged attack of Dysentery, and even before she had entirely
recovered, regularly ate a cantelope every day, which she con-
tinued until the season was over for them her physicians, who
allowed her the indulgence, recognizing the fact, that the fruit
could do no harm, as the upper portion of the canal, was not the
part involved in this disease.

Xow, Gentlemen, we have seen the full consummation of the
FOUR indications, which we derived, from the study of this dis-
ease, in accordance with our plan. We will very briefly reca-
pitulate the four cardinal points of treatment, as if in connec-
tion with the management of any particular case.

1st. Give Quinine, in sufficient quantity, and often enough,
to break up the paroxysmal character of the disease. Also ap-
ply sinapisms, or cupping, or a blister to the spine, according to
the severity of the case, or the degree of spinal irritation present.

2nd. Commence immediately, and give the Emulsion, every
hour, or every two, or three, or four hours, according to the
severity of the symptoms ; for the more intense the symptoms, the
more often is it to be given, until they are relieved. If the stomach
is delicate at first, commence with 1 tea-spoonful, and gradually
increase it to 1 table-spoonful, the ordinary dose for an adult ;
but give the Emulsion in every case, whatever may appear to be
the obstacle and continue to give it, until the patient is quite
well, diminishing the dose, or increasing the interval, as he re-
covers.

3rd. If the constipation has been of long standing, or is ob-
stinate probably, from want of action in the liver, as manifested
by the yellow -furred tongue, tenderness on pressure over the
right hypochondriac region, &c. give from 10 to 20 grs. of the
Blue Mass and Chalk, or moderate doses of Calomel, or Blue
Mass though we prefer the former. Also, apply a blister,

If. s. VOL. XIV. NO. III. 8

172 Campbell's Lecture on Dysentery. [March,

when the case is of sufficient severity, over the diseased portion
of the canal, to be kept open, or repeated, if necessary.

4th. If the patient does not sleep at nightr give from a quar-
ter to a half grain of Morphine, in cold water, by injection into
the rectum, at bed-time every night, and repeat if necessary
also have regard to supporting hia strength with nourishment.

Such is the treatment which we have practiced, in every de-
gree of Dysentery , from the time of our first commencing the
use of the Emulsion. And so anxious are we to do justice to a
measure, in which we have such unbounded confidence, that we
hope you will pardon us for introducing, here, some evidences
of its successful application, which are partly derived from our
own experience, and have partly come to our knowledge from
its employment by others.

Should we endeavor to establish its value, by all the testimo-
ny we could furnish, it would be in effect, but the record of
every case of Dysentery, which has occurred within that time,
in our practice, as well as that of your Professor of Anatomy,
our brother and associate, with the exception of but two, if our
memory serves us, which did not terminate fortunately and
which probably owed their result to the existence of a more
serious complication.

But where is the necessity of forcing this testimony from the
result of our own experience, when all this evidence can be
furnished from the practice of our professional friends, whom
we have induced to adopt this mode of treatment, many of
whom have been long in practice, and are occupying such posi-
tions as will command for their medical dictum, that confidence
which admits of no incredulous gainsaying. Many, in this
place, have adopted this plan ; and in various portions of this,
and the adjoining States, there are those,, who have for several
years used, and are still using this, as their only treatment for
Dysentery. A friend in Alabama, who has an extensive prac-
tice, informed us recently, that since receiving our letter, recom-
mending this plan, he has treated all his cases accordingly, and
although he has passed through a severe epidemic of this disease,
has not lost a single case.

Another, in this State, remarked to us, that the overseers
on the plantations, within the range of his practice, thought it

1858.] Campbell's Lecture on Dysentery. 173

necessary, often, only to send to him for a large quantity of
the Emulsion, on the occurrence of several cases of Dysentery,
on their places thus, saving him the trouble of attending.
From this, it may be judged to be a safe practice.

And again : we have it from the most reliable authority, that
a druggist of one of the cities of Georgia, stated, that he had
prepared and sold during an epidemic of Dysentery, sixteen
gallons of the Oil and Turpentine Emulsion, according to this
formula ; and that in this region, it had been peddled about the
country, as a secret remedy in this disease. And here, gentle-
men, we would acknowledge, that it was as much the wish, to
rescue this compound from so illegitimate a prostitution and
foul perversion of its original design, as anything else, that sug-
gested to our minds the propriety of making it more generally
known and to this end, has it claimed your attention.

It now remains for us, but to notice that condition into which
Dysentery often runs, unless timely arrested, and to which we
called your attention in the latter part of our Lecture on the
Pathology of this disease wherein, as we said, the irritation of
the disease in the large intestine, having been reflected for so
long a time, upon the upper portion of the primce vice, we see,
in addition to the purulent or bloody evacuations, a continuous
and wasting Diarrhcea. Higher up, the stomach becomes in-
volved in some instances, and there are loss of appetite, nausea,
and vomiting even of the blandest fluids together with a red,
dry tongue, quick and feeble pulse, entire prostration of strength,
cold extremities and dullness of the mental faculties. And thus,
the vital spark grows dim, flickers and goes out, unless again
rekindled by its appropriate stimuli. The nervous system hav-
ing been over- wrought, loses its excitability becomes paralyz-
ed. The mucous membrane of the large intestine, having been
racked and bruised, remains a passive, purulent, secretory sur-
face.

And further that, in this entire metamorphosis, the charac-
ters of the original disease have disappeared. It is not Dysen-
tery, 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 treatment.

174 Campbell's Lecture on Dysentery. [March,

We can best illustrate this condition and its character, by the
brief report of the following case with the facts concerned in
the history of which, several of our professional friends, in this
place, are perfectly familiar viz :

One of our professional friends, on leaving the city, to be ab-
sent a few weeks, placed several patients in our hands, and
among them, Philip a spare-made mulatto boy, about 20 years

old, the property of Mr. H , stating, that this patient was

in the last stage of Dysentery, and would not long trouble us, as
he was moribund.

We found him in complete prostration, with a quick, almost
imperceptible pulse, red and dry tongue, cold and tremulous
extremities, mental faculties very obtuse, and occasionally wan-
dering and muttering; also, passing watery discharges, with
some pus, involuntarily, and with his stomach rejecting every
thing, apparently without effort.

This case had had the full benefit of the Saline treatment.
We prescribed Brand}^ to be repeated, until his stomach
retained it, and then^to be continued without limit. Also, when-
ever it was apparent that be had had a discharge from the bow-
els, he was to take, by enema, | gr. Morphine in 1 oz. cold
water; and perorem, 5 grs. Bismuth (sub-nitrate) in a spoonful
of cold water. Besides, whenever his stomach could retain it
Beef essence and Rice gruel, freely.

Being now, called away and detained in attendance upon
the wife of a particular friend, we heard nothing from Philip,
until about ten days after our visit to him, when we wished to
be satisfied of the result, and also thought courtesy to our
professional brother required us to go and express to the boy's
" owners, our regret for their loss, &a On reaching his room,
we found it swept out, his bed made up, and a hat lying in
the floor unmistakable evidences, to us, of the reality of our
inevitable convictions. We went to his mistress, stating, that
we were sorry at not finding the patient where we left him, but
really expected nothing else, &c. When, without appearing to
appreciate what we were saying, or even hearing it, she inter-
rupted us with the interrogation "Doctor have you seen
Philip?" Imagine our great astonishment, when she continued
to say "He was sitting on the steps, but a few minutes ago I

1858.] De Witt's Case of Empyema. 175

suppose he has walked out." And so he had, and continues to
walk out and in, to this day.

And here, Gentlemen, you may take a precept, from the
memorable injunction of the heroic Lawrence "Don't give up
the ship!" So, never abandon the frail craft of humanity,
though all the machinery of its proud organization, be o'er-done
and disabled, with battling against the unequal violence of
tempestuous disease! Don't give up this ship though left a
wrecked and powerless victim of the storm's furious rage, drift-
ing headlong toward the boundless ocean of Eternity ! No
never give up the wreck so long as there is any evidence, of a
human life within it for God may bless your efforts!

And now, Gentlemen, in conclusion, having labored to con-
vince you of the fact, that there is an Appropriate Treatment
of Dysentery we hope that you will never be deceived
" by the occasional brillianc}' of a few surprising cures, which
dazzle the minds of men, and blind them to those innumerable
instances of failure, which ought to teach them the madness of
confiding in a practice founded upon no rational principle, and
conducted upon no consistent plan."*

ARTICLE Till.

A Case of Empyema, treated by Injections of Water into the Cavi-
ty of the Pleura. Reported by Sterxes De Witt, M. D., of
Baker county, Ga.

When I first saw the case, the patient, which was a girl, aged
sixteen, had been sick for four weeks was very feeble and
much reduced in flesh: pulse quick and weak; had some fever;
was very restless, could lay no other way than on her left side ;
breath very short and quick. According to the best informa-
tion that I could draw from her parents, she was taken with a
chill after being on the road on a journey five or six days. She
had been confined to her bed for four weeks had been laboring
under febrile symptoms, and had cough, which grew worse ; had

* Hamilton History of Medicine.

176 De Witt's Case of Empyema. [March,

spit some blood. She had felt considerable pain in her left side,
which was in the wall of her chest, rather than deep-seated.
After two days, she had in that locality considerable swelling,
which, in two or three days, had increased to a remarkable ex-
tent, reaching as far as the sternum. On one side, and filling
completely the cellular tissue, around to the spinal column on
the other side. This, however, did not much alarm the parents.
In the lapse of about four days more there had formed over the
false ribs, an abscess about the size of the top of an ordinary
coffee-cup, having the appearance of an enormous boil. This
was the state of things when I first saw the patient.

On examination, I found that the upper swelling was very
hard ; and at about the third intercostal space the motion of the
heart could be seen at a distance of several feet the movement
communicated to the chest, extending over a space of 3 or 4
square inches. My attention was next called to the tumor, low-
er down, which, as I have said, was on the false ribs. This felt
hard, did not fluctuate, was very red, with little tumefaction
around it, except in the upward direction ; here I could hardly be
satisfied that there was any connexion between the two, as the
swelling was diffused from the axilla half way round the body
in either direction, and nearly down to the false ribs, on which
was situated the pointed and more determined tumefaction.

Being inexperienced, and having never seen a similar affection
before, I told the parents I would see the case on the next day,
having determined to operate on the lower swelling, as I had
no doubt it contained pus ; thinking that it could have no con-
nexion with the difficulty above, and suspecting the upper
swelling might, possibly, be an aneurism, of which I knew no-
thing by experience.

The abscess, which I had determined to open, had by this
time got considerably softer and less inflamed. I made an incis-
ion about three-fourths of an inch long, down to the pus, which
flowed freely for several minutes. In the meantime, I had no-
ticed that the upper tumor had wonderfully abated, and the
breathing had become easier, The matter was quite thin, and
darker colored than ordinary pus ; this continued to run from
this opening until the swelling above was almost entirely gone,
I inquired into the state of the patient's bowels, and found that

' 3.] De Witt's Oaue of Empyema. 177

she had not had a passage for several days ; I gave her a gentle
cathartic, and directed a poultice, which had been used hot, to
be applied cold.

I returned on the second day after; the matter had ceased to
be discharged, and the swelling had increased above, aline b
much as at first. On examining the lungs by auscultation, I
found that the patient did not breathe at ail in the left side, and
that the other lung was laboring under great compression
nearly as much so as when I first saw the case ; pulse feeble,
with some fever.

The next day, I saw the patient : the swelling had become as
large as at first, and the breathing very difficult; the pulsation
in the tumor as apparent as before. I immediately decided to
let out the matter ; which I did, by making an opening in the
centre of this pulsating tumor, three-fourths of an inch long.
The matter flowed in a large stream with such force as to jet
from the eral inches; this time it did not discharge

than two quarts of matter in five minutes, and continued to dis-
charge slowly for several days. In the meantime, I bandaged
the body and placed a plaster over the opening to prevent the
ingress of air, removing the same every day, with the patient
reposing on her knees and breast, thereby aiding the discharge
of matter, which was materially facilitated by the introduction of
a small tube through the opening, to expedite the escape of the
matter, which continued to discharge one or two ounces per day
for several days, which discharge did not abate as rapidly as I
had anticipated.

I prescribed Iron by hydrogen, three grains, three times per
day. The patient improved, grew stronger, ate heartily, but
still the discharge did not abate ; the lung did not expand on
the left side, breathing confined entirely to the right side ; left
side seemed to lack its fullness, and the spine was flexed lateral-
ly, the concavity on the affected side. I now tried injection,
first preparing two quarts of tepid spring water, and with
Matson's patent injecting instrument, introduced two or three
inches into the opening threw the entire quantity of water
prepared, into the chest, it escaping around the nozzle of the
ument, after the full ; thus effectually washing

out the part I afterwards bandaged the body as tight as the

178 Typhoid Fever : the Thoracic Form its Treatment. [March,

patient could tolerate it, applying an adhesive plaster to the
opening, and permanently closing it. After this, loosening the
bandage daily.

On this treatment, the lung began to expand, which continued
until the function of the lung was entirely restored. The opening
cicatrized, and the patient was discharged, apparently well.

Typhoid Fever: The Thoracic Form. Its Treatment By Dr.
Behier, Physician to the Hospital Beaujon and Adjunct
Professor to the Faculty of Medecine, Paris. Translated for
the Southern Med. and Surg. Journal, by J. J. West, M. D.,
Demonstrator of Anatomy in Savannah Medical College.

The assemblage of symptoms which, in the course of certain
Typhoid fevers, are manifested on the part of the respirato-
ry apparatus, known as predominant phenomena, constitutes, by
common consent, one of the most serious forms of these affec-
tions. Observed separately in each patient, this form can show
itself under an appearance more or less distinct, and thus evince,
not an epidemic, as it has been too often called by an abuse of
the word, but a peculiar physical constitution. If it is desired
to study attentively the circumstances in which these sorts of
constitution are developed, it would be easy to demonstrate, I
believe, that in the larger number of cases these pathological
manifestations, thus attributed to a certain number of individu-
als, ought to be classed among constitutions influenced by sea-
son, upon which the older physicians insisted so justly, and
the study of which has been perhaps too much neglected in
later times and even at present.

But it is not with this part of the question that I wish to oc-
cupy myself here ; the part upon which I propose to insist,
relates to the thoracic form of continued fevers, and is more
immediately practical. I desire to call attention to a mode of
treatment which has yielded the most satisfactory results in the
cases in which I have put it in use, and which has equally well
succeeded in the hands of another hospital physician, my friend,
Dr. H. Bourdon, to whom I had mentioned it. It is the appli-
cation, in great numbers, of dry-cups upon the thoracic parietes,
and also, and especially, upon the inferior extremities. It was
in reflecting upon the following observations that I was led to
the trial of this means : experience has since demonstrated its
efficacy.

1858.] Typhoid Fever : the Thoracic Form its Treatment. 179

The thoracic phenomena which may be observed in typhoid
fever are of a peculiar nature, of which it is necessary to render
an exact account. Exclusive of cases, very rare however, in
which a phlegmasic complication, a true pneumonia unites itself
to the primitive pathological element, the disorders that are
manifested in the pulmonary organs, are nothing less than a
congestion analogous to that which might occur at different
parts of the surface. These wide surfaces, of a sombre red, not
painful, presenting no augmentation of heat, which may be
observed at diffused points of the skin in subjects attacked by
typhoid fever, and which sometimes occupies the arm or fore-
arm, sometimes the face, the nose or cheeks, can, it seems to me,
explain the mechanism of pulmonary congestions which are
found, but with a variable degree of intensity, in all the subjects
attacked by this disease.

They offer, as cutaneous congestions, the passive character ;
even the toeight plays a part in its development, to which the
attention of pathologists has been called for a considerable time.
These congestions answer, in effect, to that which has been de-
signated at first under the name hypostatic pneumonia, a designa-
tion which Prof. Piorry has since modified into that of pneumonia
hypostatic. At the present time, nothing more is seen in these
states of the lung than a phlegmasia of the parenchyma, a verit-
able pneumonia. The diminution of sound observed on per-
cussion, in almost the whole of the chest behind, and which is
not enough to constitute a true dullness ("matile"), the rudeness
of the "bruit respiratoire," which is far from being a bronchial
souffle, the more marked distinctness of the voice, which does
not amount to broncophony, and the mucous or subcrepitant
rales which persist without offering the true character of the
crepitant, and without passing to the bronchial souffle; all these
signs, I say, indicate plainly a certain augmentation of the
density of the luug, but cannot suggest the idea of a true hepa-
tization. The anatomical examination itself establishes clearly
the order of lesion to which these signs correspond, and it would
now be awkward to consider as a proof of a phlegmasia of the
pulmonary parenchyma, the dark red colour of this tissue, even
after observing that the lung does not contract upon the opening
of the chest, as does the lung in a healthy state; that it is a little
more friable, that it does not crepitate under pressure of the
fingers, and that it sinks in a vessel of water, instead of swim-
ming upon this liquid when a small part is subjected to this proof.
Insufflation, in fact, renders to the lung thus modified, a part
of its normal appearance, which is impossible in the truly in-
flamed lung, and shows clearly that if the lung is densified by
the determination to, and stasis of, a sufficiently considerable
quantity of blood, there is not in the substance of its tissue any

180 Typhoid Fever : the Thoracic For m its Treatment. [March,

effusion of a plastic nature, the only anatomical character of a
phlegmasia. Besides, in a case of simple congestion, a direct
inspection of the incised surfaces permits the recognition of the
different elements which compose the pulmonary parenchyma
elements which, in inflammation, are no longer perceptible, ag-
glomerated and confused as they are by the plastic infiltration
which determines the phlegmasia.

MM. Legendre and Bailly, in insisting upon these distinctions,
have assuredly rendered a great service to the science.

The pulmonary lesions observed in typhoid fever, are then,
the result of a simple congestion, of little intensity in some pa-
tients, very violent in others, either on account of individual
disposition, or of a more general influence. This influence may
even add another element, and in some patients, it is perceived
that to the congested state mentioned, is added an affection
of the bronchiae, a kind of capillary bronchitis of which the finer
rales, and the expectoration of puriform sputa, of almost num-
mular form, with dyspnoea as the most prominent traits. One
of the patients that we have observed, and whose history we
give further on, (obs. 6,) offered an example of this complication.
When it exists, this catarrhal bronchitis, as it has been called,
is a new cause of a more considerable congestion in the pulmo-
nary tissue; it there exaggerates the already existing dispo-
sition.

It is when this congestion takes a considerable development,
whether or not it be exaggerated by the bronchitic element I have
indicated, that the signs of a pulmonary asphyxia appear signs,
the augmentation of which is rarely rapid, but ordinarily gradu-
al. Among these signs should be mentioned the anxious aspect
of the face, the bluish coloration of the cheeks and lips, dilata-
tion of the alae of the nose, more marked dyspnoea, which, how-
ever, hardly ever increases as far as a state of orthopnea ; it is
then that the rales are multiplied in the chest, and a danger
which is immediate and often very difficult to remove, menaces
the patient.

The therapeutic indication in such a case is, then, to free the
lung of blood which flows to and rests there, and serves to ren-
der this organ too passive to expel the liquids which obstruct it,
on account of the elasticity which it has lost and which is neces-
sary to the integrity of its functions. Blood-letting, often prac-
ticed in like circumstances, removes from the pulmonary tissue
a part of the venous blood which "accumulates there, but it
cannot, on one side, be pushed very far without inconvenience
to the general condition of the patient, always under the influ-
ence of an adynamic tendency ; and upon the other side, in
drawing from the patient a part of his strength, these blood-
lettings tend to augment the passive condition of the lung.

1858.] Typhoid Fever : the Thoracic Form its Treatment. 181

These considerations should tend to banish from practice, in such
cases, the use of sanguineous abstractions even the local. It
has been sought again, to fulfil the indication by disengaging a
part of the bronchia of their mucosities, by the use of emetics,
at the same time that tonic preparations, especially those of cin-
chona, aid in sustaining the advantages obtained with the aid of
the concussion produced by vomiting. This treatment is assur-
edly reasonable, but it ought to be limited. Struck with the
insufficiency of these means, I have sought to aid them, and, in
considering the mobility of cutaneous congestions in persons
laboring under an attack of this disease, convinced, above all,
of the congestive nature of the pulmonary disorders, I found
myself forced to discover a means of disgorging the lung a
means not borrowed from a spoliative therapeutics, and only a
simple means of displacement.

I at first thought of employing the Junod cup ; but besides
its never being procured with promptness in our hospitals, it has
the inconvenience of easily producing syncopes, accidents which
might be attended by the saddest consequences in the patients
we have to treat. It was then that I attempted the application
of dry-cups, placed in considerable numbers on the chest, and
particularly upon the inferior extremities. I have gone so far
as to apply on one patient from 60 to 80 of these cups, morning
and evening. The evening application is necessary, for oppos-
ing the return of the congestion removed momentarily by the
derivation already exercised in the morning; and this tenacity
of action is not too much against a disposition equally tenacious.
Under the influence of these cups may be observed very large
ecchymoses, which are formed in the places where the cups had
been placed. These ecchymoses persist during a time more or
less long, but I have never seen them followed by any accident
whatever, although upon some patients the nnmber of cups has
been more than 500 in ten days. iNever have I seen gangrene,
nor even suppuration, against the presence of which evils I have
always prepared myself, especially in my first trials of this
means, which was two years ago. I desired to wait some time,
and to multiply experiments, before publishing the utility of this
mode of treatment.

The following facts will serve as examples in confirmation of
what I have advanced :

Observation I. Typhoid. Fever, of the thoracic form, in a
young woman; emetic ; 120 dry-cu])s in three days. Cure rapid.

Nickley (Sidonie), 20 years, a servant, unmarried, habitu-
ally well regulated, has never borne children, has never had
any other disease than the measles. Actual affection com-
menced May 12th ; its accession was slow ; the patient had pain

182 Typhoid Fever : the Thoracic Form its Treatment. [March,

in the head ; strength diminished ; at the commencement she had
a slight diarrhoea and a little cough ; difficulty of respiration
during several days. She has had no treatment, and has not
even remained in bed until her entrance into the hospital, the
20th May, 1855.

May 21st. 104 pulsations per minute, pulse small, tolerably
hard ; skin hot, face red, cheeks and lips bluish ; eyes promi-
nent, humid ; extreme difficulty of respiration ; sound of the
chest normal ; mucous and sonorous rales very abuhdant on
both sides, especially at the base of the lung behind ; tongue a
little shining; loss of appetite ; abdomen slightly enlarged ; gar-
gouillement in the right iliac fossa; no diarrhoea; some rose-
colored lenticular spots disseminated upon the abdomen and
lower part of the thorax ; head heavy ; great muscular debility.
Prescription: 15 grs. pulv. ipecac; sinapisms upon the inferior
extremities.

May 22nd. Has vomited well; two stools; 112 pulsations,
small; extreme difficulty of respiration ; sound of chest less nor-
mal, without real matite ; expectoration of white mucus; some
rales in whole extent of the chest; face and integument of the
hands still violet ; she breathes better in the almost sitting pos-
ture she has been made to assume. 15 grs. ipecac, 40 dry-cups
upon the thorax.

May 23rd. Abundant vomiting of colorless mucous matter.
Oppression has greatly diminished since the application of the
cups; the skin is still of the same dark red color; headache less;
abdomen soft; skin cool; has a little appetite; 110 pulsations,
small and hard. 15 grs. ext. cinchona, 40 dry-cups.

May 24th. Sound of the chest perfect ; still a few rales at the
base behind; pulse small, sufficiently developed ; skin cool; face
less colored and less anxious; she regains her natural express-
ion. 40 dry-cups, lichen two portions, 23 grs. ext. cinchona.

May 25th. From this time the patiect does well; appetite
has returned; the skin and mucous membranes lose iiioir yiolet
hue ; the respiration is natural ; abdomen soft ; bowels quiet ;
no more headach ; and the 3rd June the patient eats her full
allowance.

This observation offers, at the same time, an example of the
predominance of thoracic phenomena, and the rapid effect of
dry-cups applied in great numbers. The thoracic form was so
plainly the predominant element, that once this order of acci-
dents was removed, convalescence was rapidly established.

Observation II. Typhoid Fever, with adynamic state pre-
dominance of thoracic symptoms ; 4 cups {scarified) ; 160 dry-cups;
extract of cinchona ; cure.

Jette (Francois), 28 years, brick-layer, enters hospital Oct. 16,

1858.] Typhoid Fever : the Thoracic Form its Treatment. 183

1855, "Salle Beaujon/' Xo. 62 : Says he had the same disease
five years since ; remained about two months in the Brick-lay-
ers ward, "hospital Beaujon ;" has lived at Paris since he was
8 years of age. For the last fifteen days has kept his bed with-
out calling a physician or doing anything for himself; has had
severe diarrhoea no epistaxis. This period had been preceded
by a state of general debility and occasional giddiness, which,
however, still permitted him to work.

Oct. 17th. 120 pulsations, pulse small; skin hot; violet co-
lor of the skin, especially of the face and extremities; lips
violet ; nares dusky ; abdomen tympanitic, numerous lenticu-
lar rose-spots ; diarrhoea considerable ; tongue covered with a
grayish coat, very thick ; trembling of the tongue ; difficulty of
speech; no headache; cough frequent, without expectoration;
in the whole extent of the chest, an abundant rale presenting a
mixture of the sibilant and mucous rales; no absolute matile;
sonorousness is only moderate in all the chest, posteriorly ; want
of sleep ; agitated during the night. Ext. cinchona 7-J grains, 4
scarrified cups on the chest.

Oct. 18th. Eestlessness during the night 104 pnlsations ;
skin hot and dry ; tongue trembling; abdomen tympanitic; gar-
gouillement in the right iliac fossa ; violet color of the integu-
ment; troubled respiration; conjunctiva injected; same state
of the chest on auscultation and percussion. Julep, with cxt.
cinchona 30 grains ; 30 dry-cups on the chest ; bath in the ward ;
beef-tea twice.

Oct. 19th. The cups have considerably relieved him they
have left on the chest spots of deep red color, with no trace of
vesication ; tongue trembling, still covered with a thick coat,
but not completely dry ; nares dusky ; diarrhoea abundant, in-
voluntary ; agitation, no sleep ; the cough is less, rales a little
less abundant. Julep, cinchona 10 dry cups.

Oct. 20th. 108 pulsations; skin cool ; desires to eat; dissemi-
nated rales heard in the chest ; cyanosis of the face is less intense.
Julep cinchona, 10 dry -cups on the chest.

Oct. 21st. Does well ; has slept during the night ; wants to
eat; tongue clean ; thorax is sensibly relieved ; rales rarer; less
mucus. 30 dry cups on inferior extremities.

Oct. 22nd. Same state. 80 dry -cups on inferior extremities;
soup four times.

Oct. 23rd. Color of the integument almost normal ; abdomen
soft, indolent ; chest almost freed; diarrhoea still involuntary;
has appetite. Soup four times.

Oct. 24th. Amelioration increasing; tongue clean; respira-
tion normal in the whole extent of the chest; has become more
sonorous ; diarrhoea still involuntary ; has appetite. Injections
of starch and laudanum ; soup four times.

184 Typhoid Fever : the Thoracic Form its Treatment. [March,

Nov. 1st. Appetite strong; 80 pulsations, small; skin cool;
sleeps well; tongue moist; still a little diarrhoea in bed; some
cough, but without rales perceptible to the ear. The state of
the intestines becomes gradually modified, and the patient quits
the hospital about twelve days after, cured.

In this patient, as has been seen, the relief was prompt, espe*
cially at the moment when the cups were applied in great num-
bers (18th October).

The employment of this means has not, however, appeared to
have any effect upon the intestinal phenomena, which continued
many days after the favorable termination of the thoracic symp-
toms.

[The history of the four following cases, would occupy more
space than is necessary to prove the success of this mode of
treatment. I therefore abridge the account of the author, noting
only those complications which might influence the practitioner
in deciding on its employment, and perhaps prevent it, if he had
not the experience of others to support him. Translator,]

Observation III. Typhoid Fever "d forme Thoracique ;"
employment of dry -cups to the number of 460. Cure.

Jan. 31st, 1857. Mary Poussot, domestic. The answers of
the patient are short, announcing an intelligence, either natural-
ly weak, or enfeebled by the disease ; sick fifteen days ; chills,
pains in back and limbs, diarrhoea, want of appetite, great thirst;
cough intense, without expectoration. These symptoms have
existed from the commencement.

Feb. 1st. Actual state, decubitus dorsal ; extreme debility ;
complete immobility rising impossible, even to take medicines ;
face bloated; eyes dull and half closed ; tongue dry, rough, of
a dirty gray in the middle, bright red at the point, lanceolated ;
lips and gums sooty ; upper teeth black ; mouth bitter ; tympani-
tic; gargouillements abundant; five or six stools a day ; pulse
112, small, contracted, regular ; skin hot ; respiration painful ;
humid rales in whole extent of the chest ; cough frequent and
fatiguing; no expectoration; diminution of sonorousness, but
not real matite ; sensation of heat general ; almost complete
deafness; no headache ; continual somnolence ; tranquil deliri-
um ; very numerous spots on the abdomen and the whole of the
chest. 22 grs. ipecac, in three doses, 60 dry-cups on the inferior
extremities, 30 grs. ext. cinchona.

Feb. 2nd. A little better ; is less oppressed ; cough trouble-
gome; less delirium; less somnolence; less diarrhoea; pulse 112.
Eales about the same ; face less bloated. Extract cinchona, 30
grs.; 80 cups on inferior extremities 40, morning and evening.

1858.] Typhoid Fever: the Thoracic Form its Treatment 185

Injection of 12 gtt. laudanum, and 5 grs. musk ; sweetened gum
water.

The cups of yesterday have left large eccbyrnoses upon the
thighs of the form of the glasses used.

Feb. 3rd. A little coma ; sleep agitated ; respiration easier ;
cough less fatiguing and loose; the rales have diminished nota-
bly; expectoration mucous, but not abundant; pulse 96; skin
hot; some tinnitus aurium; giddiness. Same prescription ; 80
cups in two applications; 18 grs. ipecac.

Feb. 4th. In about the same condition; rales "a grosses
bulles," throughout the chest ; pulse 92 ; skin less hot. Same
prescription ; 80 cups ; ipecac.

Feb. 5th. The patient is sensibly better ; pulse 8-4 ; skin less
hot; deafness decreased; rales diminishing; oppression sensibly
ameliorated j coma less ; delirium hardly appreciable ; 80 cups 1
beef- tea twice, soup twice. Same prescription.

Feb. 6th. Oppression hardly exists ; general improvement ;
tongue about the same ; pulse 80 to 84 ; skin without great heat ;
80 cups. Same injection, same prescription.

Feb. 7th. Eespiration free; few rales; no cough ; no expec-
toration; general state satisfactory; pulse 72 to 80; intellectual
state much better. Omit the cups, continue rest of prescription.

Feb. 8th, 9th and 10th. General improvement ; continue
prescription and diet.

Until the 19th, when she left the hospital, there was the same
improvement, with the exception of pain in the right shoulder,
on the loth, which was speedily dissipated by the use of a small
blister.

Observation TV. Typhoid Fever ; vomitives; application of
530 dry-cups on the inferior extremities.

Feb. 19th, 1857. Elizabeth Pausser, aged 22 years, a domes-
tic has resided in Paris six months was confined two months
since ; has never been perfectly well since, on account of too
severe work,

Feb. 20th. Actual state. Extreme prostration ; complete
immobility : gums are brown, covered with sordes to the teeth J
tongue dry, brown in the centre, red at borders and point ;
mouth dry ; deglutition easy; no nausea, no pain in the abdo-
men; four liquid stools, yellow, sometimes involuntary; urine
scanty, difficult and painful to emit; complete inappetence;
thirst great ; sonorous rales throughout the chest * cough fre-
quent; expectoration mucous and tolerably thick: dyspnoea;
pulse 112, small ; skin hot and dry ; severe headache, eyes half
closed; complete deafness; spots on the abdomen pretty numer-
ous. Sweetened gum water, two glasses of seidlitz water in the
morning, 15 grs. ext. cinchona in the evening; beef- tea 4 times.

186 Typhoid Fever : the Thoracic Form its Treatment. [March,

Feb. 21st; Pulse 112 ; skin hot and dry ; tongue very dirty ;
little diarrhoea; thoracic phenomena the same, without any
more intensity. On account of the state of the tongue, tart, an-
timony gr. |, 15 grs. ext. cinchona, for the evening.

Feb. 22nd. Emetic acted three times; little diarrhoea; pulse
112, small, compressible; skin less hot. Same prescription, less
of tart, antimony.

_ Feb. 23rd. Inspiration much more embarrassed. On both
sides, and at the summit of the chest sibilant rales are heard,
mucous rales very abundant everywhere else ; otherwise, same
general state. 30 dry cups on inferior extremities, rest of pre-
scription ut supra.

Feb. 24th. She says that the cups have given her great re-
lief, and asks for them again ; in fact, the chest dilates better,
and respiration is less painful. The pulse is 116, comrpessible ;
skin hot ; tongue more humid ; epistaxis for the first time. 30
dry cups, ext. cinchona 15 grs., beef-tea 4 times.

Feb. 25th. A little delirium; pulse 112; sacral region red;
state of chest nearly the same. 50 cups, injection of 5 grs. musk,
3 iss* laudanum.

Feb. 26th. Less oppression ; the rales and dyspnoea are less
marked ; delirium more calm. 50 cups.

Feb. 27th to March 7th. 50 cups, 40, 40, 40, 30, 30, 30, 30,
30. Other treatment consisted of ipecac, cinchona, wine, beef-
tea, etc., according to indication. On the 28th, she left the
hospital perfectly cured.

Obsekvation V. August 14th, 1857. Eliza Eoger, aged
22 years sick more than a month miscarried ten days since,
at six and a half months ; the lochia flows still. Actual state,
very much like that of Observation IV. 2 glasses seidlitz water,
100 dry cups (50 morning and evening), beef-tea and soup.
The treatment of this case, up to the 21st, was that of the cases
mentioned above, consisting of cinchona, laudanum, enemas,
soups, etc.; 50 dry cups morning and evening, daily. The im-
provement of the patient was marked cough lessening; rales
diminishing ; tongue becoming cleaner ; sleep good ; diarrhoea
less; pulse less frequent. On the 21st, the cups were discontin-
ued, diarrhoea became abundant, but the chest seemed to be
doing well. Laudanum enema.

[Although the cups were no more used in this case, still the

* The original reads 6 grammes, equal to 3iss of our measurement, evidently
an error. From what I have seen of the practice of French physicians, I "would
hardly believe that the amount given was one-fourth of that quantity. They
give opium in much smaller quantities than we do. Translator.

1858.] Typhoid Fever: the Thoracic Form its Treatment. 187

disease having assumed a new phase, demanding a different
course of treatment, and the treatment of this particular patient
illustrating that of the French, generally, I will give the author's
account in full ; and as it was successful in this instance, it may
be of practical benefit to some of the readers of the Journal. Tr.]

Aug. 22nd. The cough became again very painful ; rales
are heard anew throughout the chest ; the sputa are bronchial
with some filaments of brownish blood ; sleep is impossible, on
account of the frequency of stools. Gooseberry syrup ; continue
enema (laudanum gtt. xij.); beef-tea, 4 times.

Aug. 23rd. Diarrhoea still more frequent. Add to prescrip-
tion a potion, with 4 gtt. laudanum.

Aug. 24th. At night, on the 22nd and 23rd, she had some
vomiting, of which no mention was made at the visit of yester-
day. Yesterday evening, the vomiting recommenced, accom-
panied by a liquid diarrhoea, very abundant, white, persisting ;
dejected aspect ; eyes sunken, surrounded by a bluish circle ;
indifference to surrounding objects ; immobility; visage wasted;
speech feeble, slow complains of suffocating; pulse 100, hardly
perceptible ; blue voluminous veins are seen upon the chest ;
skin cold; pulsations of the heart barely perceptible. It is im-
possible to know if the patient urinates, the stools being invo-
luntary, may be mixed with urine. The potion of laudanum
prescribed yesterday was vomited on the spot ; in the evening,
the interne of the ward, prescribed ice; gum julep 3v, with
rum 3 ij ; diet.

Aug. 25th. She vomited but once during the day of the
24th, but in the evening, the vomiting recommenced and lasted
all night. She has had but one stool, which is yellow ; she ap-
pears a little better. Her pulse is a little increased in frequency
(112) ; the skin has resumed its heat ; face less pale, but the eyes
are as much sunken. Same prescription.

Aug. 26th. Eeaction is fully established ; pulse 108 ; skin
hot ; face red ; eyes sunk. Still some vomiting, but no diar-
rhoea. Urinated yesterday. Ice ; beef-tea twice.

Aug. 27th. In the night, vomited considerable quantity of
bile, in which there floated numerous white clots; pulse 108,
small, dicrotic; skin hot; face red; eyes less sunken ; extreme
debility; three diarrhceal stools; tongue moist, lighty white; no
headache ; great thirst. 2 large enemas, with 12 gtt. laudanum
in each ; ice ; soup twice.

Aug. 28th. Pulse 108; skin very hot; vomiting continues;
diarrhoea. Continue enema potion with rum 5iij ; ice; diet.

Aug. 29th. She has again vomited this morning, a green
liquid ; tongue a little swollen, yellowish gray; pressure upon
8*

188 Typhoid Fever : the Thoracic Form its Treatment. [March,

the right iliac fossa determines pain ; abundant diarrhoea ; urin-
ates easily; pulse 100, dicrotic; eyes less sunken, visage good.
The patient says she does not suffer ; aspect better. Continue
the treatment.

Aug. 30th. She has vomited a little, but her visage has as-
sumed its normal aspect ; slept all night and without waking;
mouth bad; diarrhoea; pulse 96, dicrotic. 2 large enemas with
laudanum 12 gtt.; beef-tea 4 times.

Aug. 31st. Has not vomited since ; tongue humid, hardly
white ; thirst ; a little appetite ; no diarrhoea ; sleep good. Laud-
anum enema; half portion (hospital diet).

September 1st. No more vomiting ; no stools for two days ;
aspect good ; face rose color ; eyes not sunken ; pule 96, scarce-
ly dicrotic ; tongue humid ; sleep good ; ate with pleasure. Demi-
portion.

Sept. 2nd. Continues better. One portion.

Sept. 5th. Doing very well ; tongue rose-color, humid ; ap-
petite ; little thirst ; no diarrhoea; pulse 68 ; skin cool. 1 portion.

On the 7th, she ate some unripe grapes, followed by diarrhoea
* on the 8th : that evening vomited a little, also at night. Pulse
96 ; skin hot. 2 enemas, laudanum gtt. xij, in each.

Sept. 10th. This new indisposition was followed by no re-
sults. Left the hospital well.

Here again is seen the modification obtained by the use of the
dry-cups, and the return of the epi-phenomena at the moment
they were suspended ; the intercurrent choleraic symptoms ren-
dered a new employment of this means useless.

In the observation about to follow, the commencement of
which did not pass under my eyes, I will call attention to the
nature of the expectoration, which was at first composed of
sputa of a yellowish color, thick, rounded, nummular, quite an-
alogous to those observed towards the end of the measles, and
which presented afterwards some sanguinolent striae.

The generalization of the rales, their seat the summit, the
lively heat of the skin, the small number and doubtful appear-
ance of the spots all in a woman, blonde, chlorotic could give
rise to doubts, at first sight, upon the diagnosis, and lead to the
impression that we had to do with an acute phthisis. The in-
testinal phenomena, and the march of the disease, assisted us in
avoiding that error.

Observation YI. Typhoid Fever, " d forme Abdominale in
its debut; thoracic phenomena towards the twenty -second day. 200
cups ; ext. cinchona. Cure.

Eliza Legarois, age 15 years, domestic ; always of good health ;
not yet menstruated has lived in Paris only one month. Two
or three days after her arrival at Paris, she was taken with a

1858.] Typhoid Fever : the Thoracic Form its Treatment. 189

bad headache, which persisted, eblouissernents, (to which she is
subject); cough, with oppression ; diarrhoea not abundant ; com-
plexion dull and white, hair light, mucous membranes pale,
continued souffle in the vessels of the neck.

On her entrance, Sept. 23rd, about the eighth or tenth day of
the disease, a typhoid fever "a forme abdominale," with symp-
toms not grave, was diagnosed.

During the first days of October, the cough augmented in
frequency and intensity ; she became more oppressed.

Oct. 11th. Besides the abdominal phenomena slightly mark-
ed, I found, in the chest, numerous rales, offering towards the
two snmmits, characters of the sibilant, and towards the middle,
as far as the base, a mucous stamp, especially on the right side.
Apply 40 dry-cups on inferior extremities; sweetened gum wa-
ter ; ext. cinchona 1\ grs.

Condition of the patient Oct. 12th. Coughs as much as dur-
ing the preceding days, but says she is less oppressed since the
cups were applied, and expectorates more easily. The sputa
resemble those of a bronchitis at the period of coction ; they are
yellowish, thick, rounded, much striated with brown blood,
(proceeding from the fauces,) and in no way analogous to that of
pneumonia : tongue tolerably humid, glutinous, wide at the
points, yellowish-gray at base and middle ; mouth bad ; no ap-
petite; considerable thirst; a little diarrhoea; two to five stools ;
gargouillement pretty abundant in right iliac fossa ; no pain on
pressure of the abdomen ; no well-marked rose-spots ; no sleep ;
pulse 96, skin a little hot. Percussion indicates nothing very
abnormal in the chest, which, however, does not resound well ;
without real matite, especially on the right side. Auscultation
reveals mucous and sonorous rales in all the chest thej^ are sibi-
lant towards the two summits, and mucous at the base and
middle parts, posteriorly, particularly on the right side. Ext.
cinchona, grs. xxx.; pil. opium, gr. ; coffee, f^iv. ; 40 dry-
cups.

Oct. loth. Coughs as much is also oppressed; does not
sleep; same sputa, still sanguinolent, abundant. Same pre-
scription.

Oct. 14th. Oppression a little less; rales still abundant, al-
though less numerous ; tongue cleaner ; pulse less frequent (88),
skin but little hot. 40 cups.

Oct. loth. Still much oppressed ; sonorous rales throughout
the chest; intermixed with less of the mucus ; little sleep, pulse
at 88, skin less warm. 40 cups.

Oct. 16th. Says she is much better ; she respires more easily ;
the rales have much diminished, and the sonorous rales are
rarer; sonorous rale is better marked; cough less painful ; ex-
pectoration easy ; the sputa are less thick, less yellow, but little

190 Tyhhoid Fever : the Thoracic Form its Treatment. [March,

striated; tongue moist, wide, whitish; no thirst; a little appe-
tite ; pulse 68, regular ; skin cool. Omit the cups ; two eggs,
and a little bread ; ext. cinchona 30 grs. ; sweetened gum water
for drink.

Oct. 17th. Pulse 48, regular ; skin cool. It is with difficul-
ty that one hears a few rales in the chest. No diarrhoea ; ex-
pression much better and more gay : on the whole, she does well.
Bordeaux wine, iiiss., cinchona 30 grs., one portion.

Oct. 18th. Pulse 60 ; skin cool : does well. 19th. The pa-
tient feels well, has a good appetite, sleeps well ; only she is
feeble, and when she desires to rise and walk she falls not that
she has attacks of giddiness, but her legs bend under the weight
of her body.

This condition still improves ; the respiration to day (22nd
October) is everywhere pure, without mixture of rales ; no ex-
pectoration : the diarrhoea has disappeared ; pulse from 60 to 64,
it assumes a little consistence; appetite is excellent; debility
and palor are the only symptoms which persist.

I could add to these facts, many others, which would only be
a repetition. I hope those which precede will appear conclu-
sive in favor of the means which I propose which, I repeat,
has given most satisfactory results to my friend, Dr. H. Bourdon,
upon the patients observed by him at the "HopitalLaribosiere."
I will insist upon the complete harmlessness of this mode of
treatment ; never have I observed any local disorder follow the
application of dry cups, and never has this derivation, although
very energetic, determined any trouble in the economy, proba-
bly because it is, so to say, gradually effected. This harmless-
ness is, then, one motive the more, why we should not hesitate
before the employment of this means.

It has been remarked, also, in some of these observations,
(obs. 2, 3, 4,) that somnolence, tranquil delirium and deafness,
have seemed happily modified by the use of this means. I have
seen, in some other cases, the application of dry-cups in great
numbers, calm the tranquil delirium and dissipate promptly
both somnolence and coma, notably, in a little patient of 15
years, observed in October, 1855, at the "Hopital Beaujon."
In these last cases, the cerebral phenomena were predominant,
and nothing very well marked was determined on the side of
the lungs. The utility of this powerful derivative in comatose
forms of the disease, appears to me, more than probable; but I
have not, so far, studied the fact in a sufficiently rigorous man-
ner to form a precise opinion on the subject. As for the ataxic
forms, with violent delirium, in three cases where I attempted to
employ this method, it gave me no result, and the opiate pre-
parations, in doses sufficiently strong, united with musk, appear
to me to be much preferable. [Archives Generates.

1858.] Report on the Epidemic Diseases of Georgia. 191

Report upon the Topography and Epidemic Diseases of the State of
Georgia. By John F. Posey, M. D., of Savannah, Ga.

[Concluded from p. 114, Feb. No.]

Diseases, &c.

The diseases of the eastern part of the first division or tertiary-
formation of Georgia are thus treated of by Dr. P. M. Kollock,
of Savannah, beginning with the Sea Islands :

11 The inhabitants enjoy very great immunity from the diseases
of the opposite main. And such as have few or no brackish
ponds or lagoons, are more healthy than such as contain a greater
number.

" In very wet seasons, the different forms of miasmatic and
bilious fevers prevail to a considerable extent, but they are ex-
empt from every species of malignant and fatal epidemics. I
have never known cholera asphyxia to occur on any of the outer
islands. In winter, sporadic cases of pneumonia are occasional-
ly met with, together with ordinary catarrhal and pleuritic affec-
tions.

M The main opposite the Sea Islands is decidedly sickly, and in
fested by the various forms oi miasmatic disease.

"In winter and spring, epidemic pneumonia, of typhoid type,
is not unfrequent, particularly on the rivers and swamps. In
summer and fall, the various forms of bilious fever, sometimes
congestive, and occasionally exhibiting typhoid symptoms, pre-
vail.

"Passing further inland to the region of sandhills and long-
leaf pines, the inhabitants enjoy a very large share of health, and
when the possessors of the comforts of life, as regards shelter, foody
and raiment, exhibit an embonpoint, a ruddiness of complexion, and
contented, happy expression of countenance, seldom surpassed
in any climate. As a general rule, they are strangers to epidem-
ics of all kinds.

" In winter and spring, cases of pneumonia are met with, and
in summer, particularly in seasons prolific of fruit, there may be
dysentery ; it is rare for severe cases of fever to occur in this
section.

"The winter of 1852 was the coldest that has been known for
many years in this district. Two snow storms occurred at Sa-
vannah, but very little rain. There was no great amount of dis-
ease a few cases of pneumonia occurred in my own practice
and I observed a very strong tendency to the formation of whit-
lows, resulting from slight injuries to the hands.

"Towards August, cases of fever began to multiply in the city
of Savannah and its vicinity, and between that period and the
month of November, very few of the laboring population escaped.

I _ Report cm the Epidemic Diseases of Georgia. [March,

-Daring the month ac-

: : v .- ; -. - : :_. : iz'n =r. :=:". ;jte :; v. :; .=-. =: :.v.^:-. -vere re-
ported; the number increased as the season advanced.
greatest number occurred as the season advanced to the mouth
of October, when h proved fatal in almost every instan:

low fever was bat little known until after the war of
It was not until the winter of 1816 that for^
began to resort to Savannah, and the next summer the harbor
was crowded ; no care was taken to time the arrivals to the
healthy months, and the seamen were strar, _ unaccli-

mated.

In the man - -gust, the veflow Ae out It

was confined to the seamen, and continued until the shipping
departed; there were not many cases. During the folio
ere were few arrivals, and all had left port b^
the wwurr had fairly set in, and there was bat little sickne

In the year 1819 many ships arrived br at many

sliangeis, totally unused to the climate and unacquainted with
the diseases to which they were exposed. Early in the autumn,
the yellow fever commenced its ravages, and in less than a month
the whole number of passengers who had been brough
ship had fallen victims ; the disease A until

an: ~ \\ r.'rr-/: ~r.*. --. *: strsr.rer^

.he beginning of the year K part of the city was

burned down, and the population was consequently crowded into
the narrow Emits left by the fire. The fi the most

part left in a state of total neglect, and ma ered

sinks and vaults remained open, exposed to the weather until
they were filled up by the sand washed into them by the rain,
which was more than usually copious in the latter part of the sea-
son. The excavations made forthefoun: f new build-
ings were highly offensive, particularly duri-

In the latter part of the summer, the
increased to a frightful extent, but its ravages
among the unacclimated, few natives or old resident The

disease continued until late in the win:

In 1821 the yellow fever began as in the year before, and now
attacked the natives and old residents, more of whom died than
the year befc

The citizens were now thoroughly alarmed ; a board of health
was organized, and a system of visitation (A the yards and build-
ings was put in operation; a new sea lent was
made, and the city was thoroughly cleansed, so that the Cathar-
tes aurea and C. atratus, commonly known as Turkey buzzards,
winch were as tame as barnyard fowls, at :tive
scavengers before, became wikL The yellow fever also disap-
peared, and for five years was not seen. The dread of 'tis v

1858.] Report on the Epidemic Diseases of Georgia. 193

tion seemed to have been forgotten, the members of the Board of
Health soon became tired of their "useless*' labors, and ceased
to attend to their duties. An officer was appointed to inspect
the lots, &c. but his visits soon became odious to those who most
needed them, and the city became very exactly in the condition,
as to cleanliness, that it was in before the beginning of the three
years of fever. The Cathaites aur. and atr. returned, and in the
early part of the summer of 1527 they were seen in the most
populous part of the city fighting for offal in the street. Xot Ions
after this, the yellow fever made its appearance and carried off
seven of the most prominent citizens, being all old residents, in
rapid succession. This opened the eyes of the people to the ne-
cessity of a more constant attention to sanitary measures: the
city was again thoroughly cleansed, the buzzards again took to
the woods, and have never returned.

The yellow fever has not since been epidemic until the vear
1S54. when the city being crowded with Foreigners, mostly Irish
laborers, it broke out again with such mortality as to produce
general consternation; however, but few of the acclimated were
severely attacked.

The epidemic spread more widely in the State than it ever had
before.

In the autumn of 1834, the epidemic cholera commenced on
some plantations twelve or fourteen miles above Savannah on the
river, and gradually approached the city, where it continued for
nearly two months, when it ceased its ravages verv suddenlv ;
negroes were the principal sufferers, and upon its appearance" a
few years afterwards, it was confined almost entirelv to them.

Dr. O. P. Bealer, of Effingham County, in a communication
to Dr. Kollock. in 1853. says : " The prevalent disease of the last
year, 1852, was typhoid fever, in the majority of cases, the result
of neglected bilious fever ; it was remarkably fatal ; the deaths
in this county the last year numbered more that those of anv one
year, as far back as the oldest citizens can recollect, and* thev
were principally from typhoid fever.

Dr. T. R. Dunham says, that "the prevailing diseases of Cam-
den County in winter and spring, are typhoid pneumonia and in-
fluenza. These yield during the summer and fall to diarrhoea, re-
mittent and intermittent fevers, accompanied with the most violent
headaches, and great irritability of stomach."

Dr. T. S. Hopkins, of Waynesville, writing of the diseases of
the low lands in Glynn and Camden Counties, in the neighborhood
of the Great Buffalo Swamp (which section, he savs. is healthy
in very wet or very dry seasons.) in the year 1852. says: "The
past season has been extremely wet, and I have onlv to "report, for
the spring months, a mild form of influenza., and for the fall, quo-
tidian and tertian intermittents."

194 Report on the Epidemic Diseases of Georgia. [March,

Dr. H. Briggs, of Troupville, speaking of Lowndes County,
says: "The climate disease which manifests itself more or less,
during some part of every year, is the remittent or intermittent
malarial fever, usually of a mild form, but with occasional cases
of malignant intermittent, congestive, alged, and other varieties
of pernicious fever.

" Hooping-cough, mumps and varicella have repeatedly prevail-
ed in all this region as epidemics.

" Scarlatina prevailed co-extensive with the limits of the county
during the years 1838 and 1839. It has appeared twice since, in
1844 and 1855, but could scarcely be considered an epidemic,
either of the two last times.

"Abscess, in the form of whitlow, furunculus, anthrax, and
deep-seated abscess, has sometimes appeared as an epidemic, more
especially during the summer and fall of 1854, continuing several
months, the ordinary climate fever disappearing altogether during
the time.

"Dysentery appeared as the prevailing disease in the autumn
of 1843, from which time till the spring of 1853, there were only
a few sporadic cases. It has prevailed more or less at all seasons,
and in all parts of the county from that date up to the present. In
some neighborhoods the accompanying fever is of typhoid type,
in others most decidedly inflammatory.

" Rubeola made its appearance in June, 1856, for the first time
since 1837. The disease was of a grave character, often attended
with low form of fever, and dysenteric symptoms, often succeeded
by a most obstinate diarrhoea, oedematous swellings of the lower
limbs a tendency to passive hemorrhages, and sometimes ulcer-
ations and sloughing of the integument.

" Influenza, or grippe, often becomes epidemic. It seems to
act as a predisposing cause of bronchitis, pneumonia, pleurisy and
catarrhal ophthalmia. Sometimes a patient complains of violent
pain in the head for a few hours without any signs of pneumonic
inflammation, quickly followed by prostration, coma, difficult res-
piration from mucus accumulating in the bronchial tubes ; death
soon ensues.

" A continued fever prevailed in the western part of the county
in the latter part of the year 1839, and first half of the succeeding
year. Again in the southeastern part of the county, through all
the winter and spring from November, 1846, to April or May,
1847. A malignant fever and highly contagious typhoid fever
have prevailed in some section of the county more or less every
year since 1850; a half dozen or more cases in one family or
neighborhood, then appear somewhere else. The county has
not been entirely clear of cases of that variety of fever, but very
few months in all the last six years.

" In the spring and summer it very much resembles ordinary

1858.] Report on the Epidemic Diseases of Georgia. 195

remittent for a few days at first. In the colder part of the year
it is usually without any regular remission, a straightout continued
fever from the beginning.

" Puerperal fever is sometimes for a few months much more
prevalent than at others ; I do not, however, believe it has occur-
red as a true epidemic disease.

" The same is true as regards jaundice, uterine hemorrhage
and many other non-febrile diseases.

" Dirt eaters and anaemic patients are always extant."

Dr. G. F. Cooper, of Houston County, in 1853, thus gives the
prevalent diseases of that county., which may be taken as the
sample of all the upper part of the first or tertiary division. " Ru-
beola, diarrhoea, dysentery, and idiopathic fevers," he says, "con-
stitute the list of diseases which have been treated during the last
year.

During the months of April and May, we had an extensive
epidemic rubeola, so called, and in some parts of our county it
was attended with a fearful mortality. This was especially the
case where a typhoid type obtained. Many of the cases which
came under our observation did not possess the usual character-
istics of rubeola, and even those in which the eruption conformed
nearest to the genuine form of the disease, desquamation did not
follow. It appeared to me to be a blending, in many cases, of
rubeola and roseola. The rubeolous eruption was evolved upon
a roseolous base, the latter, I believe, appearing invariably first,
followed by the papulous eruption of measles. The eruption
usually appeared on the third or fourth day, and was shorter Jived
than in genuine measles, particularly in those cases where roseola
prevailed, and was observed to be wanting in that crescentic ar-
rangement laid down by authors. It also attacked a number
who were known to have had rubeola previously. No age, se%
or race was exempt. In those cases where roseola appeared, the
attack was not accompanied by any catarrhal symptoms.

" In all cases there was an unusual proclivity to diarrhoea ; this
appeared to be independent of the eruption, for in many cases
where it was standing out in full crop, diarrhoea would be persist-
ent, with griping pains and vomiting, and not unfrequently, the
former were exceedingly severe.

"It was also remarked that, after the entire subsidence of the
eruption, the diarrhoea would continue for days.

" During the prevalence of this epidemic, there was a high
range of temperature, the thermometer not unfrequently rising
above 90. Rains were frequent; it was almost continually
cloudy, with a high dew-point.

" As is usual in wet seasons, intermittent and remittent fevers
prevailed to a great extent, but we had less typhoid fever than
the previous year."

N. 8. VOL. XIV. NO. III. 9

196 Report on ike Epidemic Diseases of Georgia. [March,

The diseases of the lower part of the second or primitive geolo-
gical division of the State vary considerably, according as the
locality approaches the lower or upper limits of the old settlements
below the mountains.

Dr. Wynn, in a letter to Dr. G. F. Cooper, says : " in Monroe
County they are free from the usually called 'local causes' of
disease, and from their usual consequences, intermittent and bil-
ious remittent fevers, and they have been very rare for several
years.

"In the early spring and winter, we have a little pneumonia,
catarrhal influenza, &c. In summer, enteric affections prevail,
diarrhoea, dysentery, and cholera morbus.

"Our fevers of summer are those that have received among us
the name of typhoid, though I must say I have seen none that I
thought approximated in its symptoms the specific typhoid fever
of the books. But for all the cases that I have seen, I like better
the title of nervous, for they all have wanted the enteric lesion.,
the large spleen, the eruption, &c.

" In fact, they have seemed to me entitled to be considered con-
gestive fever, with cephalic tendency,

"Dr. Hood, of Harris County, says: 'In the spring of 1851,
typhoid diseases became epidemic, and were the prevailing dis-
eases until May, 1852, when we were visited with another and
more fatal form of disease, though I considered it a modification
of typhoid fever."

" Another class, or modification of the same disease, prevailed
at the same time, and with fearful fatality. It presented all the
features of the foregoing, attended with frequent bloody sanious
stools, recurring at regular intervals in many cases, in spite of all
treatment; opium, morphine, tannin, acetate of lead, anodyne
enemata, &c, &c, and continuing week after week, to death or
recovery. The small bowels were evidently the seat of the
disease ; no griping or tenderness in the region of the colon or
rectum."

Dr. Knott, of Griffin, Spalding County, communicating to Dr.
Cooper, in 1853, says: "The most prevalent diseases among us
in winter, are pneumonia, typhoid pneumonia, pleuro-pneumonia,
bronchitis, inflammatory fever, rheumatism, neuralgia, &c. In
spring, diarrhoea, especially among children, dysentery, among all
classes, ages and sexes. In summer and autumn, occasional cases
of bilious fever, with a marked tendency from the first, to run into
the typhoid form. The most remarkable feature of pneumonia,
is its complication with the typhoid form of fever, and in some,
cases, not characterized by marked remissions or exacerbations.
In all the cases of diarrhoea and dysentery, the bilious diathesis
was present, consequently I directed my remedies to that function.

" In the treatment of typhoid fever, as well as pneumonia of

1858.] Report on the Epidemic Diseases of Georgia. 197

like character, my reliance was upon mercurials, with a view to
their alterative effect, and antimonials, as a sedative, combined
with opium, aided by mild saline cathartics, and as valuable aux-
ilaries, counter-irritants."

In approaching the mountainous part of the second division,
it is found that the diseases are more inflammatory in type, seem-
ing to be more the effect of the great and sudden changes in the
temperature and moisture, than of any local causes, especially in
the winter and spring months, but in some places spring inter-
mittents, attributed to malaria, are frequent.

In the summer months, bilious remittents and intermittents are
occasionally met with, and in wet seasons, diarrhoea, cholera mor-
bus, and other disturbances of the digestive function, are not un-
common, especially during the greatest heat.

In the fall of the year, bilious fevers put on a more malignant
form, most commonly with someone symptom, or some complica-
tion seeming to take the lead, and to give character to the disease
in one year, and some other peculiarity in the next : thus, if in
the commencement of a sickly season, we see a case of fever be-
ginning with the usual feeling of lassitude, uneasiness, pain in the
head and back, but with less flush on the skin, and the pulse not
so full and bounding as in other cases, with slow deep breathing,
and a torpid, careless state of mind, with constricted skin "goose-
flesh" on the application of cold air or water to any part of the
surface, indicating an irregular circulation, with determination
to the deep seated bloodvessels we have a case of congestive
fever. And we are exceedingly apt to find it followed shortly by
other cases very much like it. In fact, for some unknown cause,
every disease of whatever kind, even if caused by mechanical
injury, will show more or less proclivity to this same congestion.

Again, if in the beginning of the fall fever season, we see a
case of urticaria running into fever, with great heat of the surface,
anxiety, oppressed breathing, restlessness, and violent pain in the
head and back, we have a case of " rash-fever," which will, most
probably, tax our skill and industry to the utmost: and will doubt-
lessly be followed by like cases during all the remaining season.

Thus we have once in a while, an epidemic fever of one name,
and then of another, as one symptom or another, or one complica-
tion or another may happen to prevail.

Scarlatina, rubeola, varicella, pertussis, parotitis, erysipelas,
dysentery, and some other diseases of minor importance have
prevailed as epidemics at uncertain intervals of time, in the whole
of the primitive division of the State.

We now come to the diseases of the third division of the State,
the transition, or blue limestone region ; the last part of the
State settled.

I am. indebted to Dr. Robert C. Word, formerly of Cassville,

298 Report on the Epidemic Diseases of Georgia. [March,

Cass County, but now of Rome, Floyd County, for all that I can
say on this subject.

Dr. Word prefaces his account of the diseases of this country
by a notice of the domestic habits of the people.

" Much of the disease," says he, " peculiar to the country is un-
questionably due to a disregard of the laws of health. Imprudent
exposure to the multifarious changes of climate, is the most fre-
quent exciting cause of disease in the colder seasons. Though, of
late years, it may be said that a majority of the inhabitants are
well clothed, yet their houses are generally too open to furnish
adequate protection from the chilling moisture of the winter sea-
son. Defective ventilation in cities is, perhaps, not more injuri-
ous to health than excessive ventilation in the country. Much of
disease, also, may be attributed to cold, wet feet, consequent upon
the muddy nature of the soil, for which the country is proverbial,
and to which long custom has rendered the people careless and
indifferent.

" As would be inferred, from the varying circumstances which
we have mentioned, different diseases prevail during different
seasons of the year, and furnish to the practitioner a more diver-
sified experience than is found in some other localities. Catarr-
hal lever, rheumatism, pleurisy, pneumonia, and kindred phleg-
masia?, are common in winter and the early part of spring. Ty-
phoid fever, a few years since, was only observed in winter, and
is still most generally designated, in popular language, as winter
fever. More recently, it has occurred also in summer and
autumn. With the commencement of the heat of summer, a few
sporadic cases of dysentery and diarrhoea make their appearance,
becoming gradually more numerous, until they are so generally
prevalent as to deserve the name of epidemic. Not unfrequently
having so prevailed for a few weeks in June and July, thy subside
for a timer to reappear in a more fatal form during the autumn,
a few cases of remittent and intermittent fever are met with in
the early part of summer ; they usually increase in number and
violence as the season advances, and shortly before the return of
cool weather, occasional examples of the congestive form of this
disease are observed, rarefy, however, at an earlier period. Not
unfrequently these febrile attacks make their appearance during
the suspension which has been remarked in the prevalence of
bowel affections, and continuing conjointly with them, but attack-
ing different subjects until the end of the warm weather.

"The autumn is marked often by the prevalence of influenza,
of a mild form, which some persons have attributed to the great
difference between the temperature of the days and nights at this
period, and others to the constant inhalation of the dust, with
which the atmosphere is loaded.

" The almost regular succession of annually prevalent maladies,

1858.] Report on the Epidemic Diseases of Georgia. 199

and many others of occasional, but irregular occurrence, together
with the marked peculiarities impressed upon all in particular
years, or during particular seasons, by prevailing epidemical or
atmospherical influences, exact an unusual amount of caution
and practical tact in diagnosis.

" A few years after the first settlement of the country, malarious
diseases were uncommon, inflammatory diseases more frequent
than at present, the inflammation of higher grade, and vigor-
ous antiphlogistic treatment better borne, and more successful
than at present. With the clearing up of the land, exposing a
larger surface, covered with a rich vegetable mould, and satura-
ted with the rains of winter, to the action of a summer's sun,
there has been a marked increase of all the afflictions which
malaria is supposed to produce, and a very observable modifica-
tion in the general sanative condition of the population, or in the
character of many diseases which it is not pretended that malaria
originates, but over which it appears to extend its mysterious in-
fluence. Many of the inflammatory attacks, occurring in winter
in the last few years, have been found to assume the livery of this
subtile morbific agent, evincing a decided tendency to periodicity,
and demandimg the administration of quinine. Many others, it
is true, offer no such peculiarity, but are truely and frankly phleg-
masise, requiring for their successful treatment free and bold
employment of the lancet, and all the antiphlogistic expedients so
familiar to the past generation of physicians. This intermingling
of symptoms, blending of lights and shadows, is still more com-
mon in autumn and spring, and more embarrassing, because a
just diagnosis is often difficult, and a mistake highly dangerous.
To subject a patient previously enfeebled my miasmatic influence,
or actually laboring under an irregular form of miasmatic disease,
though simulating, with astonishing accuracy, an acute inflamma-
tion, to the debilitating effects of the antiphlogistic treatment is
not simply unnecessary, but as has been too often sadly demon-
strated, hazardous or fatal, producing prolonged debility, tedious
convalescence, or else speedily, or more remotely death. To
omit to do so, upon the other hand, when an important organ is
truly the seat of active inflammation, is to expose him to immedi-
ate peril, or to the doubtful consequences of the pathological chan-
ges by which that condition is followed. In a more malarious
region, as well as in districts where the influence of malaria is
less marked, the nice discrimination so often demanded here is,
perhaps, less important, but the ability to make it, in this section,
decides between success and the want of it.

" Tubercular disease, although it cannot be said to be preva-
lent amongst us, is by no means unfrequent. Tubercles in the
lungs are more common than in more southern and less elevated
regions, where there are fewer alternations in the weather, and

200 Report on the Epidemic Diseases of Georgia. [March,

less humidity. Experience has shown that the locality is not a
good one for consumptive persons, or those who are predisposed
thereto. Whether originating in the country, or introduced
from abroad, the disease runs rapidly through its various stages
to a fatal termination.

" Typhoid fever, I believe, made its first appearance in this
part of the State in the winter of 1842, at which time a number
of cases were seen in the immediate vicinity of Cassville. For
a few years subsequently, the disease was confined entirely to the
winter season, and it was not until about the year 1846 that it
began to occur in the spring and fall. In the years 1846 and
1847, it prevailed extensively throughout the greater portion of
Cass County. More than sixty cases came under our observation
in those two years, and though the fatality was not very great,
the cases were generally obstinate and tedions, running their
course in a period of from three to six weeks, with a tendency to
a favorable termination when unmolested by drastic remedies.
Most of the fata] cases which occurred we believe to have been
due to the injudicious use of purgative medicines, usually pre-
scribed by the patients themselves before consulting a physician.
Since the period above referred to, the disease has continued to
prevail, varying in extent and violence at different times, and ex-
tending its baneful influence to other and milder maladies. Occa-
sionally it breaks out afresh in different or in the same localities,
complicated with features and peculiarities not previously obser-
ved. Many cases present malarial peculiarities, and are marked
with tertian exacerbations. Others are complicated with pneumo-
nia or rheumatism. It has been followed by the congestive form
of the disease, which in a large majority of cases, proved rapidly
fatal."

Dr. T. J. Word, of Floyd County, in ]853, said that "typhoid
fever has prevailed in Floyd as an epidemic for two or three
years past mostly between the months of October and the begin-
ning of spring, during which time it has taken the field to the ex-
clusion of most other diseases, or compelled them to form an
alliance with it. In the fall, it was occasionally associated with
remittent fever; in the winter with pneumonia. In the nervous,
it was sometimes associated with neuralgia, and in the female,
with hysteria.

" The cause of its general prevalence for a few years past can
only be satisfactorily explained by admitting it to be an epidemic.
Upon no other ground can we explain its appearance in regions
where not one of the local or endemic causes exist to which its
production has been ascribed.

" It occurs in the hilly and broken sections of the country, and
in families who enjoy all the comforts of life, and are exempt from
every apparent local cause of disease. Other causes than confin-

1858.] Report on the Epidemic Diseases of Georgia. 201

ed or vitiated air. decomposing animal or vegetable matter, or
standing water, mast be adduced, as it is known to occur in a
malignant form where none of these causes exist. ' The presence
of the typhoid principle in the surrounding medium exercises a
controlling influence over the cause and duration of other diseases/
In further confirmation of this view is mentioned the increased
or altered sensibilitv of the gastro-intestinal canal to the impres-
sion of cathartics, that part of the economy to which the force
and violence of tvphoid fever is directed. ' The smallest doses of
the mildest cathartics have been known to occasion exhausting
purgation.' ' That there has been for some time an epidemic
constitution of the atmosphere, and that,, under different states and
temperatures, it may produce different effects, and give rise to a
variety of morbid actions according to the predisposition of the
system at the time, does not, I think, admit of a question of doubt.'

" Dysentery prevailed extensively in the years of 1851 an J 852.
During the summer of the last, it was attended with a considera-
ble mortality, especially among children.

"The inhabitants of the valleys and creek bottoms suffered
most. The weather was warm and rather dry during the pre-
valence of the disease.

" During the epidemic last summer, diarrhoea prevailed also,
and not unfrequently was found associated with dysentery in the
same subject. Copious sanguineous or serous discharges would
sometimes alternate with dysenteric discharges. This form of
diarrhoea was usually very prostrating in its effects, and in some
instances proved suddenly fatal. It was attributed by many to
the cholera atmosphere then supposed to pervade the greater por-
tion of the United States. The occurrence of fatal cases of cholera
morbus at the same time give credibility to this opinion.

"The months of July and August seldom pass by without the
occurrence of many cases of bilious dysentery, in some of which
the influence of malaria is very perceptible.

"Influenza, or epidemic catarrhal fever, is of frequent occur-
rence. It may be said to be a regular visitnt of the spring and
fall seasons, each visitation being characterized by some new pe-
culiarity. In the fall of 1851 a form of the disease prevailed,
marked by the following symptoms : pain in the head, back, and
extremities, cold shivering sensations, deep bronchial cough, and
occasional slight fever. All of these symptoms were worse in the
early part of the day. The weather was dry, but had been preceded
by heavy rains ; previous to the rains there was a great drought.

u Neuralgic affections are quite common in this country. They
appear generally to be of malarious origin, and yield to quinine,
cupping, &c. In the colder seasons the disease is frequently blend-
ed with rheumatism, and appears to be developed bv exposure
to cold and damp weather. The facial variety is most common."

202 The Uses of Chlorate of Potash. [March,

I have now finished the work assigned to me, to the best of my
ability, and hope that it may meet the views, and fulfil the require-
ments of the Association.

And now, also, I make my acknowledgements, gratefully, for
the assistance which I have received from those gentlemen of
the profession who have given me the benefit of their knowledge.

To Dr. P. M. Kolcock I am indebted for most of the part be-
longing to the neighborhood of the sea, and through his instru-
mentality to Dr. Bealer, of Effingham, Dr. Dunham, of Camden,
and Dr. Hopkins, of Wayne County.

Dr. H. Briggs, of Troupville, Lowndes County, communicated
all that I have given of Southwestern Georgia.

I owe to Dr. G. F. Cooper, of Perry, Houston County, much of
what I have said of the upper part of the first, and lower part of
the second division.

Dr. Robert C. Word is my authority for all concerning the
third or limestone division.

I have endeavored carefully to distinguish the parts due to
each contributor, as vouching for the correctness of whatever I
have written, whenever it was not from my own observation.
[Transactions Amer, Med. Association, 1857.

The Uses of Chlorate of Potash.

I, On the Therapeutical action of Chlorate of Potash,

WITH A NEW MODE OF ADMINISTEING IT. By Dr. DETHAN,

(IJ Union Medicate, and Brit, and For. Med. Chir. Rev.

II. On the use of Chlorate of Potash in Pregnancy.
{Liverpool Med. Chir. Journal, and Banking's Abstract.)

The use of Chlorate of Potash. In the August number
of the last volume of this Journal we collected from various
sources, several articles on the different applications of the Chlo-
rate of Potash in the treatment of disease. We have since
made frequent tests of its usefulness, and find that it answers an
admirable purpose as a lotion, in many cases of leucorrhoea, and
other affections of the vagina and also in some cases of stoma-
titis, either from mercurial salivation or other causes. In one
instance of sore throat, attended with great fetor, which occur-
red at the end of a protracted case of Typhoid fever, its appli-
cation as a gargle, was followe4 by surprising results. We
understand that Dr. W. L. Felder, of this city, has used Chlorate

1858.] The Uses of Chlorate of Potash. 203

of Potash, internally, strength 3j. to 8 oz. water, for twenty-
years, as a remedy in Typhoid fever. Dose of this solution, as
used by him, was 1 teaspoonful every three or four hours. The
strength of the solution used in all of our cases, above-mentioned,
was two drachms of the salt dissolved in 8 oz. of water. This
was applied to the affected mucous surfaces four or five times
during the day, either as a gargle or as an injection, as the na-
ture of the case required.

We here present to our readers some other applications of this
valuable article, and its use in certain cases of pregnancy. We
do not pretend to explain the manner of its action ; but the facts
here reported, though not entirely conclusive, are certainly very
striking, and should at least arrest our attention.

"Dr. Dethan considers that chlorate of potash is a powerful
sialagogue, and that its elective action on the bucco-pharjmgeal
mucous membrane is well marked. To this physiological action
is added a very remarkable and valuable success in pathology ;
its rapid and incontestable effects in mercurial salivation, by
checking the formidable mercurial affection, have permitted
practitioners to continue the mercury without fear, and thus to
contend without remission against the constitutional infection.
As an especial and incontestable remedy in ulcero-membranous
stomatitis, this medicine need not, according to the physicians of
the Hopital Sainte-Eugenie, be swallowed ; its topical applica-
tion is sufficient, and in a short time the mucous membrane
recovers its normal qualities and functions. Dr. Dethan con-
cludes that the chlorate of potash, administered under a special
form, which would permit the local action to be exercised slow-
ly and certainly, although leaving the medicine to be carried
into the stomach in a state of solution with the mixed liquids of
. the salivary, buccal and pharyngeal glands, would be the mode
of administration which would combine all indications and all
opinions. He therefore suggests the use of the remedy in the
form of pastiles, so that the patient may have at hand a remedy
against the injurious effects of a mercurial treatment which he
may be undergoing. The experiments of Dr. Ricord, and the
publications of M. A. Fournier, testify incontestably in favor of
this successful simultaneous medication. In certain forms of
angina attended with fibrinous exudations, it prevents the inti-
mate adherence of the false membranes to the mucous mem-
brane, and facilitates their expulsion, and assists the action of
emetics. In this affection the topical action of the chlorate, fa-
voured by the bruising between the teeth, the natural solution

204 The Uses of Chlorate of Potash. [March,

in the liquids of the mouth, and its penetration into all the points
interested, will be certainly efficacious. In debilitating diseases,
such as diphtheritis, and gangrene of the mouth, the child will
find an agreeable and reparative kind of food, together with the
most appropriate remedy hitherto discovered, against these dis-

" Every one engaged in midwifery practice will have met
with cases in which the child is carried successfully into the
viable period, but some time between this and the full term of
pregnancy, is born still, or very weakly ; and this perhaps for
several successive pregnancies, without any external or acci-
dental cause to explain the premature death and delivery, and
with no evidence of syphilitic taint in the parents.

" It is in such cases that Mr. Grimsdale (in accordance with a
suggestion thrown out some years ago by Dr. Simpson) has been
in the habit of prescribing chlorate of potass with some appa-
rent benefit.

" Case 1. Mrs. Darbyshire, a stout, healthy looking woman,
get. 34, was delivered of a female child, after a labor of eleven
hours' duration, in the Lying-in Hospital, on the 24th March,
1852. During labor there was a large discharge of very offen-
sive, dark-colored muddy water ; the nurse told me she filled
two chamber-pots with it, besides what escaped in the bed. The
child was with difficulty made to breathe. It was jaundiced
from birth, and died of hemorrhage from the umbilicus, on the
seventeenth day.

" The placenta was diseased ; portions of its maternal surface
were seen to be of a pale yellowish color, and these were firm
to the touch, and penetrated nearly to its foetal surface ; at least
one-fifth of the bulk of the placenta must have been occupied
with these firm pale portions. The centre of each patch was
firmer than its circumference, and it seemed to pass insensibly
and gradually into healthy placental structure, having no accu-
rately defined boundary. On the maternal surface were also
several stellated patches of vessels, distinctly gritty to the touch.

"Dr. Inman kindly examined this placenta under the micro-
scope, and he did not regard the changes observable in it as due
to inflammation, neither was it an instance of fatty degeneration.
This woman had had four previous pregnancies, in which she
had been attended by a midwife at her own home. The child-
ren were all still-born, and said to have been yellow. Of the
state of the after-births I could learn nothing satisfactory.

"About the middle of April, 1853, the patient came to me,
stating that she was five months in the family way, and would
be glad if anything could be done to avoid the birth of another
diseased child. I gave her chlorate of potass, 5 grains three

1858.] The Uses of Chlorate of Potash. 205

times daily, to be increased in a fortnight to 10 grains. She con-
tinued this with but little intermission to the time of her deliv-
ery, on the 13th of August, when she gave birth to a healthy
child, which is now (October, 1855) living and thriving. The
placenta was large, and quite healthy looking. I may remark,
that before commencing the chlorate of potass treatment, I made
careful inquiry as to the probability of any syphilitic taint in
either husband or wife, and could detect nothing in their histo-
ry to warrant any suspicion.

" Case 2. Mrs. Egan, a poor woman, ael 21, pale and rather
delicate looking, presented herself at the dispensary of the LyiDg-
in Hospital, in April, 1855, and stated herself to be four months
in the family way. She said that she had been four times preg-
nant before, and had on each occasion given birth to a dead
child. Her labors had been of no great severity, and of moder-
ate duration ; the midwile who attended her told me that the
children were small, and appeared to have been dead some days;
the after-births, she said, were 'pale in parts, and queer look-
ing.' The husband was a steady working man. I saw him ; he
looked strong, and denied having had syphilis.

" The former pregnancies had been attended with no pain. I
ordered chlorate of potass, 20 grains a day. She continued this
for four months. On the 5th September she was delivered of a
fine healthy child, which is still (October 10th) thriving and
without ailment. The placenta was large and healthy.

" Case 3. Mrs. D., set. 33, of spare conformation, hysterical
temperament, became pregnant about six months after her mar-
riage. After quickening, the movements of the child were dis-
tinct, and increasing in power up to the end of the sixth month
of her pregnancy ; she then began to feel them decidedly weak-
er; not much notice was taken of this, as she had no pain, until
in about three weeks she ceased to feel any movement. I saw
her, and on examining with the stethoscope, could hear no
foetal heart sound. In about a week from this she gave birth to
a dead child, the cuticle of which was beginning to desquamate.
It was well formed, but the skin was wrinkled, and it looked
ill-nourished. The placenta was in parts pale, firmer than na-
tural, and its vessels in these parts deficient in blood.

"In March, 1853, I again saw her; she was then pregnant
three months and a half. I recommended her to take the chlor-
ate of potass at once. She began with 15 grains in the day ;
she had only taken it three or four days when she complained
that it made her head ache. I ordered its discontinuance, but
in a few days again prescribed it without her knowledge ; again
she complained of intense headache, and I left it off for a month.
She tried it once more, but declared it gave her a most fearful
headache, which she could not bear. This second pregnancy

206 The Uses of Chlorate of Potash. [March,

followed as nearly as possible the same course as the first, and
with the same results.

" In December, 1853, she was again pregnant ; I saw her
when she was four months advanced, and wished her to try the
chlorate in smaller doses. She took 3 grains thrice daily with
impunity ; this was continued for three weeks or a month ; she
then increased the dose to 4 grains, and subsequently to 5 grains.
All seemed to go on well. The movements of the child, she
said, were considerably stronger than in her former pregnan-
cies.

" When well into the seventh month, she was riding out in
her carriage, a low, four-wheeled phaeton, when another vehi-
cle ran into them, smashed the carriage, and upset its occupants.
My patient was of course much frightened ; she felt, she stated,
a violent commotion in her inside for some hours, but after that
day did not feel any movement. She was from home at the
time: in two or three days she returned; I then saw her, could
detect no foetal heart-sound, and believed the child to be dead.
In ten days from the date of the accident labor came on, and she
was delivered of a dead child.

" Nothing could be more marked than the contrast presented
between this child and its placenta, and those of the two former
deliveries. The child was plump, and had all the appearance
of a healthy seven months' child ; the placenta was everywhere
soft and spongy and its vessels seemed to have been uniformly
full of blood,

" This lady became pregnant for the fourth time in the begin-
ning of October, 1855. About the end of the third month she
commenced to take the chlorate in 3 grain doses, and gradually
increased it to 5 grains, thrice daily. She was occasionally com-
pelled to intermit its use, in consequence of the headaches, as
before ; but with these exceptions it was persevered in until the
full time of pregnancy, when she was delivered (June, 1856) of
a healthy male child, now living (June, 1857). The placenta
was quite healthy.

Case 4. Mrs. , a stout, healthy-looking woman, came to

me in November, 1854. She was between three and four months
gone in the family way. She had been seven times pregnant
before, but had never given birth to a living child. One child
she carried to nearly the full time; five had been born between
the sixth and eighth month, and one was aborted at an early
period of pregnancy. I ordered her to take the chlorate in 5
grain doses, thrice daily; and after the fifth month especially
enjoined the immense importance of rest; this latter injunction
she seemed determined not to comply with.

" She went on well until February, 1855, frequently stating
that she felt the movements of the child stronger than usual.

1858.] The Phosphates in Tuberculosis. 207

On the 12th, after having kneaded a large pan of dough, and
performed sundry other laborious domestic exercises, labor came
on unexpectedly, and she was delivered in five or six hours of
a living child the first of all her children that had ever breath-
ed. It was a breech presentation ; the child seemed of about
six and a half or barely seven months' development, and only
lived a few hours. The placenta was healthy.

"Case 5. Jane D., set. 86, presented herself at the Lying-in
Hospital, September 12th, 1853. She said that last year she had
miscarried at six months, without any apparent external cause.
The child had been dead some time ; she learned this from the
midwife who attended her. She was now four months advanced.
She commenced the chlorate 15 grains in the day, continued it
on and off during the rest of her pregnancy, and was delivered
of a healthy child at full time.

" I have notes of ten other cases similar to this last. I do not
think they are worth much as evidence; they will, therefore,
scarcely add to the interest of this paper, and I refrain from giv-
ing the details.

"In two cases apparently likely to have received benefit from
the chlorate, and in which it was exhibited as usual, I failed to
perceive any favorable result. In one of the cases, death of the
foetus, and miscarriage, at the seventh month, occurred, as it had
done in three previous pregnancies. In the other, the child was
born dead and ascitic, at eight months and a half, the placenta
being hydropic. The mother had, before taking the chlorate,
given birth to four still-born children in succession.

" Of the nature of the diseased action in these cases, I am not
prepared to say much. It would seem to be located primarily
in the placenta, and to cause the death of the child secondarily,
by the consequent effects on the placental function. The mor-
bid appearances in the placenta would seem to be tolerably
uniform : I can see no evidence of their inflammatory nature ;
and there certainly were no previous symptoms indicative of
inflammation in any of the cases.n

The Phosphates in Tuberculosis. If Dr. Churchill's opin-
ion with regard to the beneficial action of the Phosphates, in
Phthisis, is correct, of course these remedies will be found appli-
cable, at least rationally so, in all the other manifestations of the
strumous diathesis, as the multitudinous affections pertaining to
the eye, the lymphatic glands of the neck and of the axilla;
affections of the hip-joint, knee-joint, elbow, and shafts of the
long bones. Calculating strongly on the chemical action of

208 The Phosphates in Tuberculosis. [March,

medicines within the organism, we are aware, is not always
safe from disappointment; that is, practice does not every time
confirm what theory a/firms; but when experience plainly de-
monstrates what reason will approve, we may ever feel safe in
following their joint indications.

On the Proximate Cause and Specific Remedy of Tuberculosis. By
Dr. John Francis Churchill.

The following is the abstract of a paper which was laid before
the Academy of Medicine at Paris, on the 21st of July, 1857 :

The total number of cases of phthisis treated by the author
amounts to 35. All were in either the second or the third stage
of the complaint that is, they had either softened tubercles or
cavities in the lungs. Of these, 9 recovered completely, the
physical signs of the disease disappearing altogether in 8 out of
that number; 11 improved considerably, and 14 died; 1 still
remains under treatment.

The proximate cause, or at all events an essential condition of
the tubercular diathesis, is the decrease in the system of the
phosphorus which it contains in an oxygenizable state.

The specific remedy of the disease consists in the use of a pre-
paration of phosphorus, uniting the two conditions of being in
such a state that it may be directly assimilated, and at the same
time at the lowest possible degree of oxydation.

The hypophosphites of soda and lime are the combinations
which hitherto seem best to fulfil these two requisites. They
may be given in doses varying from ten grains to one drachm
in the twenty-four hours. The highest dose which I have been
in the habit of giving to adults is twenty grains.

The effect of these salts upon the tubercular diathesis is im-
mediate, all the general symptoms of the disease disappearing
with a rapidity which is really marvellous.

If the pathological deposit produced by the dyscrasy is of
recent formation, if softening has only just set in and does not
proceed too rapidly, the tubercles are absorbed and disappear ;
when the deposit has existed for a certain time, when the soften-
ing has attained a certain degree, it sometimes continues in spite
of the treatment, and the issue of the disease then depends upon
the anatomical condition of the local lesion, on its extent, and
upon the existence or non-existence of complications. The au-
thor has made numerous attempts to modify the local condition
of the lungs by the inhalation of different substances, but has
never obtained any satisfactory result independent of what was
to be attributed to the specific treatment. The hypophosphites
of soda and lime are certain prophylactics against tubercular
disease.

1858.] Non-Mercurial Plan of Treatment in Syphilis. 209

The physiological effects which he has observed to be pro-
duced by the use of the hypophosphites of soda, lime, potash
and ammonia, show these preparations to have a two-fold action.
On the one hand they increase the principle, whatever that may
be, which constitutes nervous force; and on the other, they are
the most powerful of hsematogens, being infinitely superior to
all medicines of that class hitherto known. They seem to pos-
sess in the highest degree all the therapeutical properties former-
ly attributed by different observers to phosphorus itself, without
any of the danger which attends the use of that substance, and
which has caused it to be almost forgotten as a medical agent.
The different preparations of hypophosphorous acid will, accord-
ing to these views, occupy one of the most important places in
the Materia Medica. [Dublin Hosp. Gaz.} and Banking's AbsH.

The Non-Mercurial Plan of Treatment in Syphilis. Read before
the Western Medical and Surgical Society. By Dr. Cahill.

He commenced by narrating a number of cases in which the
constitutional effects of syphilis had been very severe, and had
extended, in spite of treatment, through many years, in all of
which the early stage of the disease had not been attacked by
mercury. After detailing these very carefully, he entered into
the history of this plan of treatment, remarking that most of the
Irish surgeons who had adopted it have since changed their
opinions respecting it. He maintained that the severest and
worst forms of constitutional syphilis occur when no mercury
whatever has been given for the primary disease, and that the
notion that the severe cases of secondary disease are mainly due
to the mercury administered is not founded in fact. Mercury,
to be of use, must be persevered in for at least six weeks, and
to produce its good effects need not to be given lavishly or
recklessly. If attention be not paid to this fact, no permanent
effect is produced, and other forms of the disease, as secondary
or tertiary, are apt to follow immediately after. He recommend-
ed the use of the bichloride in doses of one-twelfth to a quarter
of a grain, together with the inunction of the strong mercurial
ointment, until the gums showed that the system was affected
by the mercury. The bichloride is borne better than any other
form of mercury, and can be continued with safety longer than
any other mercurial preparation, not only in these cases, but
even in scrofulous diseases, in which its use is advisable; hence
its peculiar value. Iodide of potassium, given with iodine, is
the next remedy to be relied upon, though it is chiefly valuable
in secondary and tertiary affections of the periosteum. In ter-
tiary symptoms, the iodide is our sheet-anchor, and mercury

210 Pathology of Convulsions, d-c. [March,

should never be given in such cases to the extent of producing
its specific effects; should a mercurial be required, the hyd. c.
creta is to be recommended in conjunction with the iodide of
potassium. Iron, arsenic, and mineral acids, under certain cir-
cumstances, are useful, especially after mercury has been fairly
tried; these, with the ordinary means of restoring health, as
good food, pure air, and rest, will generally promote a cure.
He then alluded to the difficulty of distinguishing primary
chancre, and the means employed by inoculation, and the pecu-
liar hardness, of the true Hunterian chancre, and to the chance
there was of a chancre in the urethra being overlooked, and to
other sources of error as to the curability of syphilis without
mercury. He concluded with the following observations :

1st. That the severest and most prolonged forms of the disease
have arisen where no mercury has been given for the primary
or early secondary affection.

2ndly. That as no symptoms identical with those of constitu-
tional syphilis are produced by mercury, the notion 'that mercury
is a cause of constitutional syphilis is founded in error.

3rdly. That the administration of mercury may be so regu-
lated as to preclude any of its severe effects ; and supposing any
are produced, it is manifest that they would be less severe than
those caused by constitutional syphilis.

4thly. That the constitutional effects of mercury should be
avoided in tertiary syphilis.

5thly. That the supposed successful treatment of syphilis
without mercury is founded on erroneous diagnosis, or the cases
have occurred in individuals already protected, or the subjects
have been of that class who seem to enjoy immunity from the
worst part of the complaint. London Lancet.

Pathology of Convulsions, with especial reference to those of Children.
Bead before the North London Medical Society. By Dr.
Beynolds (of which the following is an abstract) :

I. All vital actions are accompanied by, and depend on, phy-
sical changes in the living organism.

II. Modifications of vital action depend on modified physical
conditions. Some symptoms of disease are modifications of vital
actions, and there are two general modes in which they are, or
may be, related to the nutrition-change :

1. Negative symptoms i.e. those which consist in the nega-
tion of vital properties, such as paralysis, anaesthesia, etc. may
depend directly on a" solution of continuity," or some other
distinct organic disease ; but

2. Positive symptoms i.e., those which consist in the altera-

1858.] Pathology of Convulsions, &c. 211

tion or excess of vital action cannot depend directly on such
textural condition, but must have for their immediate cause some
modification of the minute interstitial proceasea

III. Convulsions, being essentially modifications of vital ac-
tions, must depend on modifications of physical conditions.
Though no "lesion" is discoverable, we are warranted in the
conclusion that nutrition is affected.

IV. Convulsions depend on modified nutrition changes in the
nervous centres.

V. The proximate cause of convulsions is the same in all
cases when the convulsions are the same ; and the lesions dis-
covered in the nervous centres or elsewhere are not the proxi-
mate causes of convulsions, for they differ in locality and kind,
and have no constant proportion to the symptom in question.

VI. The proximate cause of convulsions is an abnormal in-
crease in the nutrition changes of the nervous centres an in-
crease in relation to time or to mobility.

VII. The remote causes are such as induce the abnormal
increase. There are three general modes in which these causes
operate :

1. The nervous centres may be involved in a general nutrition
change e.g., as during dentition, at puberty, in Bright's dis-
ease, scrofulosis, rickets, etc.

2. The nervous centres may be the seat of special disturbance,
owing to organic lesion, as tumour, spiculae of bone, etc.

3. Eccentric irritations may affect their nutrition through dif-
ferent nerves.

VIII. The diagnosis in convulsions is that of the remote cause,
and the first step is to ascertain to which of the above three ca-
tegories the case belongs. In children, the diagnosis will turn
on:

1. The duration of the paroxysm ;

2. The frequency of its repetition ;

3. Its local or general distribution ; and,

4. Interparoxysmal symptoms.

The last are of the most value ; and the positive or negative
character of the symptoms, together with local distribution, af-
ford material assistance in this process.

IX. The treatment of convulsions is guided by the diagnosis,
and will consist in the removal or palliation of eccentric irrita-
tions, the improvement of general nutrition, and the treatment
of local disease. [Ibid.

9*

212 Editorial, [March

EDITORIAL AND MISCELLANEOUS.

Pacific Medical and Surgical Journal. We have just received
the first issue of this new journal. The present number, in the character
of its papers, its style, and typographical execution, gives promise of this
new comer to our sanctum, being a most valuable addition to the med-
ical literature of the country. " Every civilized nation," to use the lan-
guage of its Editors, " has sent some of the boldest and most enterprising
of her medical scholars, to earn fortunes and fame from the babel popu-
lation of California. In this city, besides numberless American, English,
French, German and Italian physicians, there are medical savans of the
Mongol race, who practice both surgery and medicine." Therefore, we
repeat, this journal must become an important exponent of a variety of
medical opinion, and we look forward to its future success with much
interest. The work is edited by John B. Trask, M.D., and David Woos-
ter, M.D. It is published monthly, at San Francisco, California, at five
dollars per annum, and the editors are also the publishers.

We take great pleasure in placing this new member upon our Ex-
change List, and in welcoming its editors, cordially, into the fraternity
of journalists.

A Manual of Medical Diagnosis : being an Analysis of the Signs and
Symptoms of Disease. By A. W. Barclay, M.D., Cantab et Edin.
Fellow of the Royal College of Physicians, Assistant Physician to St.
George's Hospital, etc., etc. Philadelphia: Blanchard & Lea. 1858,
Pp. 423, 8vo.

In the circle of attainments necessary to constitute the rational and
reliable practitioner, no one of them is more important than a correct
and philosophical system of diagnosis. Without it, all treatment is em-
piricism, every measure, a bare assumption, and Therapeutics itself but a
guess. Of works exclusively devoted to this important branch, our Pro-
fession has at command, comparatively, but few, and, therefore, in the
publication of the present work, Messrs. Blanchard & Lea have conferred
a great favor upon us. Dr. Barclay, from having occupied, for a long
period, the position of Medical Registrar at St. George's Hospital, pos-
sessed advantages for correct observation and reliable conclusions, as to
the significance of symptoms, which have fallen to the lot of but few,
either in his own or any other country. He has carefully systematized
the results of his observation of over twelve thousand patients, and by
hu diligence and judicious classification, the Profession has been present-

1858.] Editorial and Miscellaneous. 213

ed with the most convenient and reliable work on the subject of Diag-
nosis, that it has been our good fortune ever to examine.

We dislike to recommend any book, except a dictionary as " a book
of reference," for no author can ever obtain his full meed of considera-
tion, unless he is read diligently through page by page : but we are
aware that in the present unavoidable relations of the practitioner to the
Science of Medicine, this " reference" phase of a book, is ever a recom-
mendation ; we can therefore say of Dr. Barclay's work, that from his
systematic manner of arrangement, his work is one of the best works " for
reference" in the daily emergencies of the practitioner, with which we
are acquainted ; but, at the same time, we would recommend our read-
ers, especially the younger ones, to read thoroughly and study diligently
the whole work, and the " emergencies" will not occur so often.

To Readers and Correspondents. We have on our table, many
other valuable works, pamphlets and communications, kindly sent us by
publishers and correspondents. The notices of these, together with other
important editorial matter, have necessarily been excluded from our pre-
sent number, on account of the engrossing duties imposed upon us at
this season, by our relations to the Medical College of Georgia. Still, it
will be seen that, we have done some work for the present issue, as the
original and eclectic department will show.

Professor Means. As in the January number of this journal, we
announced that our friend, Professor Alexander Means, had resigned the
Chair of Chemistry in the Atlanta Medical College, we now state that
Professor Means has subsequently withdrawn that resignation, and, there-
fore, retains his connection with that institution.

Professor Means has since, resigned the Chair of Chemistry and Phar-
macy in the Medical College of Georgia.

The candor of Professor Syme, in making this correction through the
London Times, is truly commendable and worthy of imitation, by all
members of our profession, under like circumstance. There is true man-
liness in it.

An Excision of a Mail's Tongue. The following letter has been ad-
dressed, by Professor Syme, to the editor of the Times : " I regret to
learn that an operation which I happened to perform in the Royal Infir-
mary of Edinburg has got into the newspapers; but as it has unfortunate-
ly done so, the public should be correctly informed on the subject. Par-
tial removal of the tongue, for the remedy of Cancer, having been found
worse than useless, it was thought that extirpation of the whole organ
might afford effectual relief; upon this principle I proceeded. The pa-

214 Editorial and Miscellaneous, [March,

tient suffered no bad consequences directly from the operation ; but at
the end of a week, when the external wound was quite healed, died sud-
denly from an internal disease, which might have been excited by any
other irritation in a person of his constitution and habits."

Novel Method of Extracting a Foreign Body from the (Esophagus.
We have before us, in the pages of the Boston Medical Journal, an
account of an extremely ingenious and novel method of extracting a
foreign body from the oesophagus, by Dr. David Rice. " Mrs. Field, a
lady aged 70, while eating chicken soup, accidentally swallowed a piece
of bone the size of an American quarter of a dollar, cut into a triangu-
lar form. The bone lodged in the oesophagus, about two inches below
the top of the sternum. Thinking that it might fall into the stomach,
she neglected to apply for surgical aid, until the fifth day after the acci-
dent. In the mean time, she had swallowed neither food nor drink,
both regurgitating back into the mouth with every attempt to do so."

The Doctor was called on the fifth day, but was unable to remove the
foreign substance by any instrument which he had at his command.
He finally took a piece of sponge of such a shape, as when dry, to fill
about half of the tube, and introduced it rapidly in a dry state, then, by
introducing a little water into the mouth, the sponge became moistened,
and enlarged it to twice its natural size, completely filling the gullet.
On drawing it out the bone was brought with it, much to the gratifica-
tion of patient and practitioner.

There is a certain readiness of invention and expedient which is neces-
sary to a surgeon, and without which he will often be nonplused and
harassed. The same means cannot be applied to every case, and com-
mon sense, with a share of ingenuity, frequently is all that is necessary
to overcome difficulties which seem to be very great. It is desirable to
have in our minds the expedients which have been resorted to by others
in difficult cases, for we are liable at any time, to have a case to which
they are precisely applicable. We conceive that this mode of swabbing
the gullet from below upward, by introducing a dry sponge below a
foreign body, allowing it to imbibe moisture and then withdrawing it,
might be applicable to a great many cases where the substance could
not be removed by other means. [Buffalo Med. Journal.

[We add, from memory, to the above, a very ingenious device of Dr.
E. Leroy Antony, of Georgia, for removing a certain kind of foreign
body from the throat. The patient by some means had swallowed a
fish-hook ! (what will not people swallow ?) it had passed out of reach
and became fixed in the gullet by the barbed end, in the efforts of the
patient to relieve himself by pulling at the line which was attached to
the hook and hung out of the mouth. Dr. A. removed the foreign body
by passing a drilled bullet down the oesophagus upon the line, which,
when it arrived at the hook-end, disengaged the barb, and protected the
soft parts from being wounded with it, during its removal from the

1858.] Miscellaneous. 215

throat. As Dr. Flint remarks, " it is desirable to have every possible
expedient in our mind" this last is also one which certainly deserves
recording and recollecting.]

Surgery in San Francisco. Dr. E. S. Cooper, of this city, has recent-
ly ligated the primitive carotid artery in two cases, the external iliac
in one, the axillary in one, removed a large fibro-cartilaginous tumour
from the uterus ; made the Caesarian section in one ; exsected parts of
three ribs, and removed a foreign body from beneath the heart ; exsected
the sternal extremity of the clavicle and a portion of the summit of the
sternum ; together with the exsection of nearly all the joints, in different
cases, all successfully.

This embraces a list of formidable operations, which, being attended
with favorable results, are worthy of note. This uniform success in
operations of such magnitude, must, in part, be attributed to the effects
of our climate, which, for the recovery of patients after receiving serious
injuries, is, at least, unsurpassed in any part of the w<

There have been many other capital operations succ 5sfully performed
in various parts of this State, which we are unable, for want of data from
the operators, to specify. There is no country in the world, where, in
the absence of war, mutilation and deformities from injuries are so com-
mon and so serious, as in California ; and it is n emarkable
that our surgeons have opportunities of practice which can be found only
in the hospitals of other countries. [Pacij

On the Temperature of the Body in Intermittent Fever. By Dr. S. Th.
Michael. These observations were made in different types of intermit-
tent fever, and repeated at intervals of five minutes, so as to determine
with exactness the precise variations of temperature.

Their result is that the temperature begins to rise at the rigor, and rises
by slow degrees; and that after this it falls by slower degrees, and with
intermissions. At the commencement of the rigor, and at the end of
the period of sweating, the temperature is below the natural standard,
sometimes to the extent of some degrees, sometimes to certain portions
of a degree.

In the majority of cases, the maximum elevation was between 32 and
33 Reaumur, rarely below, more frequently above. The highest point
ever attained was 33.4 Reaumur.

After the administration of sulphate of quinine the temperature did not
attain to the same degree of elevation as previously ; and during conval-
escence it remained below the normal standard, or only occasionally be-
came raised to the fraction of a degree above it. [Archivfur Physiolog.
Heilkunde. Ranking $ Abstract.

Glycerine in Corns. These troublesome things Mr. TVakley is in the
habit of treating, at the Royal Free Hospital, by the application of gly-
cerine, which has the effect of soft (filing them, when they are easily
scooped out. We saw as many as -<\enteen corns entirely removed in
twelve days in this manner. [London Lancet.

216 Miscellaneous. [March,

"On the Signs of Pregnancy? It seeins strange that Dr. Montgome-
ry should have deemed it necessary to write so elaborate a treatise on
this subject, when the old sage of Cos summed up the whole matter in
three lines. Thus, in the 41st Aphorism of Hippocrates, we find the
following :

" If you wish to know whether a woman is pregnant or not, instead
of supper, give her hydromel (water impregnated with honey) at bed-
time ; if she experiences griping pains in the abdomen, she is pregnant ;
otherwise, she has not conceived."

Hippocrates, in another place, refers to a matter of some importance
in its bearings on the duration of pregnancy. He states that his own
father knew not his mother for two years before his birth ! We believe
that the Roman law was somewhat liberal in cases of ])rotracted gestation,
"but the Greeks must have had some very peculiar notions on the subject,
if theyi rauked the birth of this reputed 18th lineal descendant of^Escul-
apius" (the latter, son of Apollo,) among the legitimate ! [ Western
Lancet.

Rev. Sidney Smith on Hag Fever. In a letter to Dr. Holland, the
eccentric Dean of St. Paul, thus gives his personal experience in this
complaint :

k> I am suffering from my old complaint, the hay fever (as it is called.)
My fear is, perishing by deliquescence ; I melt away in nasal and lachry-
mal prorluvia. My remedies are warm pediluvium, cathartics, topical
applications of a watery solution of opium to the eyes, ears, and the in-
terior of the nostrils. The membrane is so irritable that light, dust, con-
tradiction and absurd remark, the sight of a Dissenter anything sets
me sneezing ; and if I begin sneezing at twelve, I don't leave off till two
o'clock, and am heard distinctly in Taunton, when the wind sets that
-way a distance of six miles. Turn your mind to the little curse. If
consumption is too powerful for physicians, at least they should not suf-
fer themselves to be outwitted by such little upstart disorders as the hay
fever; [Ibid.

Anaisthesis by " Projection? To avoid the accidents due to excessive
inhalation of the anesthetic agent, and especially to insure that the ma-
terial should be mixed with the requisite amount of air, Dr. Heurteloup,
known in surgery for the invention of Lithotripsy, has contrived an ap-
paratus for this end, (having in hi> experiments made use of chloroform).
The apparatus is like a syringe with a small bellows for throwing in air
in place of the piston, and having a gauze partition on which the chloro-
form is poured. The working of the bellows throws a steam out of the
small end in a jet, which contains more or less chloroform, according as
the discharging tube is brought more or less near to the bellows. The
jet is established only on working the bellows, and there is no waste of
chloroform during the operation. [American Jour, of Sci. and Arts.

Incontinence of Urine. M. Trousseau seems to have most unboun-
ded confidence in the efficacy of Belladonna in the treatment of incon-
tinence of urine. A girl ast. 19, entered the hospital, who voided her

1858.] - . '

urine two or three times during the night. He commenced with 1 cen-
tigramme (gr. .1543 Troy) of the extract, and in the course of a few
weeks, increased the dose to 18 centigrammes. He insists upon the
continued use of the medicine for several months after the incontinence
had ceased, as a return of the difficulty may otherwise be anticipated.

[ Western Lancet.

A New Property of Camomile. Camomile {anthemis nobilis) is de-
scribed in all treatises of materia medica as emollient digestive, fortify-
ing. <fcc but none point out a most precious virtue, just announced as
pertaining to it by M. Ozanam, whose paper on the subject was presented
to the Academy of Sciences at its last sitting by M. Cloquet. This vir-
tue consists in preventing suppuration when the local disease is not too
far advanced, and in gradually stopping it when it has existed for a long
time. For this purpose it is administered in powerful doses of five, ten*
and even thirty grammes of the flower in a litre of water, the infusion
to be drunk in the course of the day, and to be continued until the cure-
be effected. Compresses moistened with the infusion may be locally
applied ; they aid in the cure, but are not necessary the infusion alone
taken internally, being quite sufficient. In support of his assertion, M.
Ozanam quotes a number of cases in which this mode of treatment was
successful. [London Times.

On the use of Manganate of Potass as a Caustic in Cancer. B7
TVeedox Cooke. Mr. Weedon Cooke speaks highly of manganic acid.
in combination with potassa as a base, as the caustic in the treatment of
cancer. It produces, he says, much less pain than any other caustic, and
no ill-consequences of any kind. It is a dark-green powder, which may
be dredged on the ulcerated surface by means of a pepper-castor.

[Lancet.

Duration of Cancer. A case of some interest presented itself at the
Cancer Hospital, on the 25th of August, in the person of a female, aged
seventy-four years, the subject of cancer of the left breast for twelve
years. She had been a patient at this hospital since its foundation, with
this exception of the last three years, during which time she had been in
good health. She came to show an ulcerated tuberculous mass in the
same breast, the size of a small pear, otherwise the disease has dried up
and disappeared. She still looking a hale and hearty old woman. [lb.

MedicalJoumals in the United States. We think there is a crrowin<r
disposition to lessen the number of our medical journals to improve
their quality and a decreasing disposition to publish them for nothing: !
lianiiest improvement in the tone and character of almost
all our exchanges, and we notice that several have already raised their
price: we think these features in our journalism are pioper and com-
mendable. Medical periodicals, if published at all, must be paid for in
some way and if afforded to subscribers at a price actually less than
the paper and printing cost, somebody roust make up the deficit,
this can very readily be afforded sometimes, by parties who have special

218 Miscellaneous.

interests to advance, just on the same principle that we get a flood of
almanacs annually thrust under our doors gratis, for the sake of calling
our attention to their author's individual skill, or wonderful nostrums;
but we doubt if the true interests of legitimate medicine are to be ad-
vanced by the publishing of our journals on such principles.

[Cincinnati Lancet and Observer.

Artesian Wells in Sahara. (Athen., No. 15G2.) The Moniteur Al-
gerien brings an interesting report on the newly-bored Artesian wells in
the Sahara^Desert, in the province of Constantine. The first well was
bored in the Oasis of Oued-Rir, near Tamerna, by a detachment of the
Foreign Legion, conducted by the engineer, M. Jus. The works were
begun in May, 1856, and, on the 19th of June, a quantity of water of
4,010 litres per minute, and of a temperature of 21 Reaumur, rushed
forth from the bowels of the earth. The joy of the natives was unbound-
ed ; the news of the event spread towards the South with unexampled
rapidity. People came from long distances in order to see the miracle ;
the Marabouts, with great solemnity, consecrated the newly-created well,
and gave it the name of "the well of peace." The second well, in Te-
makin, yielded 35 litres, of 21 temperature, per minute, and from
a depth of 85 metres ; this well was called " the well of bliss." A third
experiment, not far from the scene of the second, in the Oasis of Tamelhat,
was crowned with the result of 1 20 litres of water per minute. The Mara-
bouts, after having thanked the soldiers in the presence of the whole
population, gave them a banquet, and escorted them in solemn procession
to the frontier of the Oasis. In another Oasis, that of Sidi-Nached, which
had been completely ruined by the drought, the digging of " the well of
gratitude" was accompanied by touching scenes. As soon as the re-
ioicino: outcries of the soldiers had announced the rushino- forth of the
water, the natives drew near in crowds, plunged themselves into the
blessed waves, and the mothers bathed their children therein. The old
Emir could not master his feelings ; tears in his eyes, he fell down upon
his knees, and lifted his trembling hands, in order to thank God and the
French. This well yields not less than 4,300 litres per minute, from a
depth of 54 metres. A fifth well has been dug at Oum Thior, yielding
108 litres per minnte. Here a part of the tribes of the neighborhood
commenced at once the establishment of a village, planting at the same
time hundreds of date-palms, and thus giving up their former nomadic
life. The last well is that of Shegga, where soon an important agricul-
tural centre will spring up. There is no doubt but that these wells will
work in these parts a great social revolution. The tribes* which, after
the primeval custom of their ancestors, kept wandering from one place to
another, will gather round those fertilizing springs, will exchange the
herdsman's staff for the plough of the farmer, and thus take'the first steps
towards a civilization, which, no doubt, will make rapid progress in Nor th-
em Africa. [American Jour, of Science and Arts.

The Boston Transcript says, the following by Oliver W. Holmes, is
the finest simile ever written : " The mind of a bigot is like the pupil of
the eye ; the more light you throw upon it, the more it contracts."

SOUTHERN

MEDICAL AID STJBGICAL JOUMAL.

(NEW SERIES.)

Vol. XIV.] AUGUSTA, GEORGIA, APRIL, 1858. [No. 4.

ORIGINAL AND ECLECTIC.

ARTICLE IX.

A Lecture upon Hemorrhoidal Affections. By L. A. DuGAS, M.D.,
Professor of Surgery in the Medical College of Georgia.
Taken down by J. F. B., medical student.

Gentlemen :

I will direct your attention to-day to the subject of Hemor-
rhoids, commonly called the Piles. And in order that you may
understand the anatomical relations of the parts implicated, I
have brought before you these very handsome models of dissec-
tions of the rectum, exhibiting its blood-vessels, nerves, muscles,
&c. It is not my intention to enter upon a minute description
of these structures, but I merely desire that you may keep your
eye upon these models, in order that you may understand more
readily what I have to say upon the disease under considera-
tion.

Hemorrhoidal affections show themselves in different forms.
In some the disease consists essentially in a varicose condition
of the hemorrhoidal veins, with or without a similar amplifica-
tion of the capillaries and arterial radicles, and is entirely con-
fined to parts above the verge of the anus. This, therefore,
constitutes what is commonly called internal Piles, in contra-
distinction of another variety called external Piles, in which, as
the term indicates, there are external manifestations of the disease
in the form of one or more small globular tumors of a deep red
or bluish hue, situated at the verge of the anus. These two

K.S. VOL. XIV. NO. IV. 10

220 Dugas. Lecture on Hemorrhoidal Affections. [April,

forms of the disease are attended with a very considerable de-
gree of vascularity in the mucous membrane of the lower end of
the re&um, and, not unfrequently, with a relaxation of this
membrane, more or less marked, which may in some cases allow
it to protrude during the expulsory efforts of defecation.

The hemorrhoidal tumors to which we have referred, may be
formed either by an extraordinary dilatation of the veins, or,
what is-more common, by an exudation of blood into the subcu-
taneous cellular tissue. If the opening from which the blood
has issued be sufficiently free, the blood contained in the little
sac or tumor may remain fluid ; but if, on the contrary, the
blood has been derived from mere capillaries, it may coagulate.
Hence it is that, upon opening these tumors, we sometimes find
them filled with a coagulum, whereas in other instances nothing
issues but liquid blood. It is thus, also, that we may account for
the fact that while in some cases these tumors may be dissipated
by pressure, in others they do not diminish in size by this means.
When the extravasated blood has become thus coagulated, it op-
erates somewhat like a foreign body, and provokes more or less
inflammatory action of a very painful character. In general,
however, after the painful stage of the disease, occasioned by the
distention of the tissues, has ceased, the coagulum dissolves and
is gradually removed by absorption, with the exception of small
fibrinous concretions, which remain in the form of slight indur-
ations, sometimes projecting beyond the general level of the parts
These little indurated teats will sometimes become chafed and
exquisitely sensitive, giving the patient a great deal of annoy-
ance long after the subsidence of the acute symptoms.

You have all heard of persons said to be affected with blind
Piles, and others with bleeding Piles. The term blind Piles is
applied simply to those hemorrhoidal affections which do not
bleed whereas the bleeding Piles are those in which the con-
gested blood-vessels relieve themselves by an issue of blood
during defecation, and occasionally at other times. Now this
issue of blood usually occurs from the mucous membrane just
within the sphincters, although it may sometimes flow from
the verge of the anus. When it occurs during defecation, it
is manifestly induced by the expulsory efforts, which very
materially increase the turgescence of the mucous surface. It

1858.] Dugas. Lecture on Hemorrhoidal Affections. 221

is therefore important, in such cases, that these efforts be not
prolonged unnecessarily, in order that the hemorrhage may not
be excessive, and by its daily repetition seriously impair the
patient's health, as is too often the case. In the cases in which
the bleeding does not coincide with defecation, it is most apt to
take place when the patient is standing or walking, and conse-
quently when the vessels are exposed to the gravitating influence
of the superimposed column of blood. It will therefore very
rarely occur when the patient is in the horizontal position. In
some very rare instances the hemorrhage proceeds from above
the sphincter ani, and may accumulate in the rectum until it
produces a desire to stool, when the patient may pass off a large
quantity of blood in a state of semi-coagulation. And this may
be repeated at intervals so short as to become alarming. I have
seen two cases of the kind which proved very troublesome. In
general, however, the flow of blood shows itself externally, and
it may sometimes be felt trickling down the thighs of the patient
as he walks along.

Hemorrhoidal affections are often complicated with prolapsus
ani, or a ^disposition on the part of the lower end of the rectum
to protrude during defecation, or whenever the patient remains
long in the erect position. This adds very much to the annoy-
ance of the disease, as well as to the difficulty of its manage-
ment.

I have now given you the leading features of this disease, and
you may perhaps expect me to say something of its causes, or
rather of its remote causes. I may as well tell you at once that
\ do not know them ; and yet, hemorrhoidal affections are sup-
posed by some to be induced by hepatic disease obstructing the
portal circulation, and consequently inducing a congestion of
the veins constituting the origin of the vena portarum. We are
not told, however, by the advocates of this theory, why it is that
the blood-vessels of the rectum suffer more under such circum-
stances than those of the other portions of the alimentary canal.
Moreover, we know that a very large majority of those affected
with hemorrhoids furnish us no evidence whatever of hepatic
derangement. Hemorrhoidal affections are also attributed to
constipation _and to sedentary habits; whereas every practi-
tioner of observation is aware that they very often occur in

222 DuGAS. Lecture on Hemorrhoidal Affections. [April,

persons whose bowels are perfectly regular that they not un-
frequently occur during a relaxed condition of the bowels, and
that they affect the active as well as the sedentary. The fact is,
Gentlemen, that this is a very common disease, at least in this
part of the world ; and I do not think it an exaggeration to say
that eight persons out of ten, between the ages of twenty-five
and fifty, suffer more or less with this infirmity. I should have
said white persons ; for it is a remarkable fact, that our negroes
are so rarely affected with this disease that I do not recollect to
have seen more than two or three of them suffering with it, in a
practice of five and twenty years, although one half of our popu-
lation consists of this class of people. Whether this exemption
of the negro race can be traced to any anatomical peculiarity or
not would be a subject of interesting inquiry.

You must have observed, that I restricted the liability to this
disease to the period of life extending from the twenty-fifth to
the fiftieth year. I did so, because it very rarely shows itself
before twenty-five years of age, and that it usually declines
and ceases to be troublesome at about fifty years of age. We
know, that with the advance of age the rectum, and especially
its lower extremity, diminishes in capacity and in relaxation,
often to such a degree as to render the act of defecation more
or less difficult, and even to make it a source of real annoy-
ance to the very aged. This species of atrophy may perhaps
account for the cessation of hemorrhoidal troubles with ad-
vancing age.

With regard to the treatment of this disease you will find
quite a diversity of opinion in the profession, and no lack of
specifics in the newspapers of the day. I need not detain you
with a critical appreciation of the various plans suggested, but
will at once proceed to give you the course I usually pursue in
the management of these affections. This must necessarily vary
according to the circumstances of the case. At the commence-
ment of the disease, it usually shows itself in the form of attacks
more or less acute, which, after having continued a few weeks,
will gradually subside, leaving the patient under the impression
that he is cured, and will not have any return of the affection.
It is then that he is willing to certify to the efficacy of the last
remedy used, especially if he has procured it from a Charlatan

1858.] DuGAS. Lecture on Hemorrhoidal Affections. 223

or nostrum vender. But the occurrence of one attack is almost
invariably the precursor of others, after the lapse of months or
even years. A knowledge of this fact should make you ex-
ceedingly cautious in your prognosis, and you will always be
on the safe side if you will honestly state to your patient that
although you may relieve him, you cannot promise a radical
cure, or an immunity from subsequent attacks, unless the patient
be near the age at which the disease will probably cease spon-
taneously.

These acute attacks are generally attended with the formation
of one or more hemorrhoidal tumors at the verge of the anus,
intensely painful during the act of defecation. The pain con-
tinues after defecation, and the patient complains of a sense of
burning and throbbing in the part affected, which is increased
by the erect position, but may even continue to annoy him
when in bed, to such a degree as to prevent any quiet sleep
during the night. We have here the usual manifestations of
inflammatory action, set up by the effusion of blood in the sub-
cutaneous cellular tissue and the influence of distension. It is
under such circumstances that we find the patients resorting to
the various pile ointments heralded by the newspapers, or using
some similar application under the direction of their medical
adviser. These ointments usually consist of a combination, in
various proportions, of opium or some of its preparations, with
finely pulverized gall-nuts or other vegetable astringents and
sugar of lead or alum, rubbed up with lard or simple cerate. * I
must confess that I have never derived any advantage from
these applications, and that I believe that the popular error in
regard to their efficacy is the result, as already intimated, of
their use at the period at which the disease is about to subside
of itself. The same may be said of the use of rhubarb lozenges,
sulphur, cream of tartar, and other remedies in popular favor.
During the intensity of the disease the application of leeches is
highly recommended by some, and may afford temporary relief,
but the leech bites will sometimes rather increase than lessen
the pain. I am in the habit of directing, in such cases, that the
patient shall remain in bed that the bowels be emptied by a
full dose of rhubarb, and then kept quiet for several days by the
use of small doses of opium. The preference is given to rhu-

224 Dugas. Lecture on Hemorrhoidal Affections. [April,

barb over other cathartics, and especially over saline cathartics,
because the discharges it occasions are less excoriating. Under
the effects of a dose of salts the dejections are as painful as
though the patient were passing boiling water over the affected
part. Poultices of corn -meal, or of bread and milk, should be
hept constantly applied to the anus, either hot or cold, accord-
ing to the preference of the patient. It is somewhat singular,
that while some patients derive most relief from hot applications,
others, on the contrary, find them intolerable and are materially
benefitted by the cold. Certain poultices are supposed by some
to be peculiarly beneficial, and I have known cases relieved by
the application of the leaves of plantain, rue, or wormwood,
bruised in the form of a poultice, after other applications had
failed. Poultices made with infusion of red oak bark will also
be found sometimes advantageous in the latter stages of the
attack. If there be any protrusion of the intestine, this should
be anointed with a little sweet oil, or sperm oil, (which is less
apt to be rancid,) and gently forced up by the patient with his
fingers as often as it may occur. This procc-ss, which is some-
times very painful, will be very much facilitated if the patient
will place himself upon his knees and breast so that his pelvis
may be elevated and allow the rectum to gravitate towards the
abdomen. I have already advised that the bowels be kept quiet
after having been emptied, but when this is no longer compati-
ble with the comfort of the patient, the rectum may be washed
out with cold water ; or, if he cannot tolerate the introduction
of the canula, he should take a smaller and merely laxative dose
of rhubarb, to be followed, as before, by the opiates. My object,
you perceive, is to avoid as much as possible the disturbing and
irritating influence of defecation. The patient should therefore
use animal food, which leaves less fecal matter than vegetable
substances. Under these directions the attack will usually run
its course with as little suffering as possible ; but you will now
and then find cases in which the unmitigated pain may warrant
a trial of other means, such as sitting over boiling water, or steam
generated by pouring water upon a hot brick. This will some-
times give considerable relief, and may be repeated as often
as the patient's inclination may direct. I have sometimes
known the so-called u Pain-killers " to act advantageously in

1858.] Dugas. Lecture on Hemorrhoidal Affections. 225

subduing the morbid sensibility of the parts. These nostrums,
you know, consist of a concentrated tincture of capsicum and
morphine, or of capsicum and morphine mixed with lard. The
liquid is the better preparation of the two. When applied, it
occasions intense smarting for a-while, which gradually sub-
sides and may leave the patient considerably relieved.

In the acute attacks, attended with bleeding, there may or
not be any protruding tumors, and the hemorrhage usually pro-
ceeds from the mucous surface above the verge of the anus. In
these cases the act of defecation is more or less painful, and there
is a disposition on the part of the patient to make strong expul-
sory efforts, not unlike those provoked by a mild attack of dys-
entery. And it is then that the blood issues either in a distinct
jet or stream, which will cease with the act of defecation. The
lower end of the rectum and the verge of the anus may become
very sore, as though chafed by the contact of the feces.

In treating acute attacks of this kind, I would adopt the same
plan as above indicated, with the exception of the poultices, in
lieu of which I would advise ablutions with cold water, or sitting
a few minutes in cold water three or four times each day.

"We now come to the consideration of the treatment of the
disease when chronic, and of the rules to be observed between
the acute attacks. In the first place, let the patient be fully im-
pressed with the importance of keeping his bowels perfectly
regular, that is to say, of having one stool every day : nothing
will conduce more to bring about this state of things than the
observance of a stated hour at which he will invariably go to
stool, whether he feels any desire to do so or not. If he finds
that he cannot have an evacuation naturally, or that he is com-
pelled to make strong expulsory efforts to accomplish his pur-
pose, he should throw up a small quantity of cold water into the
rectum, ten or fifteen minutes before the appointed hour. By
so doing, he will find that the bowels will gradually acquire the
desired habit of punctuality. The patient should bear in mind
that nothing is more injurious to those subject to Piles, than
long sitting and protracted efforts at stool. He should therefore
not remain more than a few minutes, and make but slight ex-
pulsory efforts, and if he cannot thus promptly and readily emp-
ty the rectum, he should desist and wait until the next day,

226 Dugas. Lecture on Hemorrhoidal Affections. [April,

being careful not to allow this to interfere with his regularly
appointed hours.

The selection of the hour is not a matter of indifference, for
if this be fixed in the early part of the day the injurious effects
of defecation will continue to be felt, or even become aggravated
by the erect position and exercise during the remainder of the
day. If, on the contrary, this act be performed at night, or just
before retiring to bed, the horizontal position will favor the sub-
sidence of the congestion, and the restoration of the parts to
their normal condition. Without a due observance of these
little matters of detail, especially in cases attended with a dispo-
sition to protrusion, all your other directions will often fail to
give relief. Again, the patient should use cold water ablutions
on rising from bed, and on retiring at night; and if the case
be troublesome, this should also be done at noon, especially
during the summer.

You will sometimes be consulted for cases of long standing,
in which the protrusion of hemorrhoidal tumors or of folds of
the intestine will have become almost habitual, at least when the
patient is in the erect position. In these cases, if the patient is
compelled to attend to his business, it may become necessary to
resort to mechanical means of support. The patient should
wear during the day, and sometimes even during the night, an
anal supporter, which may be made as follows : Let a belt be
carried around the body so as to rest upon the hips, and buckle
in front ; attach to the back part of this, a strap, which is to pass
down to the perineum and here bifurcate, so that one end will
pass on each side of the scrotum, and be buckled to the belt in
front. To that portion of the perineal strap which corresponds
to the anus, the anal supporter should be fixed. This may con-
sist of a ball of cotton thread about an inch and a half in diame-
ter, and covered with oiled silk for the purpose of cleanliness ;
or it may be made of wood, well polished, and of the shape of a
half globe, the convexity being towards the anus. This maybe
oiled and easily kept clean. By applying this bandage with
sufficient firmness, the patient may attend to his business with
very little inconvenience, until the means above recommended
shall have had time to improve the condition of the parts.

You perceive, Gentlemen, that I have thus far recommended

1858.] Felder, on the Uses of Chlorate of Potash. 227

no surgical operation in the management of these affections ;
but you will recollect that I have repeatedly endeavored to in-
culcate the doctrine that the duty of the surgeon is not so much
to perform operations as it is to avoid their necessity. And yet
there are several surgical procedures recommended in the differ-
ent stages of this affection. For instance, it is advised by some
to lay open, to excise, or to ligate the hemorrhoidal tumors. I
have never had occasion to resort to either of these expedients,
except in those cases in which small indurated teats continue to
fret the patient. I then clip them off with a pair of scissors.
The use of ligatures is unjustifiable in any event, as being more
painful and hazardous than cutting instruments. You will find
it recommended by high authorities to excise the protruding
portion of the mucous membrane, or to apply to these, concen-
trated nitric acid, and even to destroy them with the actual
cautery. "While these practices may perhaps be justifiable in
hospital practice, where the hygienic observances I have advised
cannot be enforced, I have never been compelled to have re-
course to them, nor do I think it probable that you1 will be less
fortunate, if you should think proper to adopt my views.

ARTICLE X.

Remarks on the 4Uses of Chlorate of Potash. By W. L. Feeder,
M. D., of Augusta. Ga.

[We are much pleased to find that the casual reference to our
friend's name, in connection with the above subject, in our last
number, has resulted in so valuable a report of his personal ex-
perience in the therapeutical applications of Chlorate of Potash.
We may really feel encouraged to try the same device on some
other occasion. Edts.]

Messrs. Editors In your issue of the March number of the
Southern Medical and Surgical Journal, I find my name men-
tioned in connection with an article, or a few remarks of yours,
upon the subject and use of the Chlorate of Potash. I do not
complain of your having done so, but if I had known of
your intentions, or had thought for a moment that you were

228 Felder, on the Uses of Chlorate of Potash. [April,

acquainted with the fact of my having long since used the
medicine, I would certainly have given you all the information
in my power upon the subject of its use, and my experience
with the remedy, and thus have saved the necessity of intruding
myself upon your notice, or of appearing upon the pages of your
Journal. In as much, however, as you have thought proper
(from some source of information, which I can readily imagine)
to advert to my use of the article in a limited and imperfect
manner, I would beg leave to exercise the privilege of being
correctly reported, as to the quantity used and the diseases for
which I have administered it.

Chlorate of Potash has long since been a favorite remedy with
me in the treatment of almost every form of fever, and especial-
ly in those periodical fevers denominated remittent, or, as they
are called in some places, " Country fevers" or " Santee fevers."

My attention was drawn to the remedy, specially, in August,
I think, eighteen hundred and thirty- two, in the Case of a youth,
then, by the name of Gr***** L***, who was under treatment for
remittent fever by Dr. H. I was requested to visit the patient
with the attending physician. I thought that the Chlorate of Pot-
ash would admirably suit the case, and fill all the purposes then
indicated ; accordingly, I gave it in the following manner :
R . Chlorate of Potash, 2 drachms ; Infusion of Serpen taria Yir-
giniana, 8 ounces. Of this, a tablespoonful was given every two
or three hours, until its discontinuance should be ordered. It
had a "fine effect, and in three or four days he was in a situation
to take quinine and brandy also, and he speedily recovered. I
have used it also in typhoid fevers, (symptomatic, for I do not
believe in the idiopathic forms of typhoid,) with the finest re-
sults, and believe that under some circumstances, it constitutes in
the list of remedial agents one of the very best remedies, and
exerts an influence in low forms of fever that no other remedy
possesses.

In these low forms of fever it is used as recommended above,
although I find it necessary sometimes to combine with it a little
tinct. opii. acetat. The dose for an adult is a tablespoonful eve-
ry two or three hours: less to younger persons about the
quantity you represent in your article at my hands.

I have used the remedy repeatedly in Scarlet fever, and espe-

1858.] Felder: on the Uses of Chlorate of Potash. 229

cially in the malignant forms, both internally and as a gargle for
the ulcers about the mouth and throat I consider its use im-
portant, however, in any of the varieties of Scarlet fever, and
when properly administered, will produce its full share of benefit.
It is used as above advised in these affections, when taken in-
ternally ; but when used as a gargle, I make it much stronger,
and use it with Sage tea, if convenient, in preference to the
Snake-root tea, it is a matter of very little consequence, how-
ever, whether used with either a little cold water will answer
every purpose to dissolve it. As a cleanser of ulcers, especially
after the use of the Xit. silver, it has no superior. From three
to four drachms of the potash with eight ounces of pure water,
or with either of the teas, is the usual strength in which I have
used it. I would not hesitate, however, to use it much stronger^
either externally or internally. I have applied it to indolent
ulcers of the legs, and in one instance to a chronic ulcer of long
standing, with much benefit, in the form of powder. I have
likewise used it in obstinate cases of salivation from mercury
with decided benefit, and in one case, especially, that seemed to
baffle every other remedy, and threaten the life ef a very inter-
esting child, who had been worse salivated than I ever saw one,
before or since ; it relieved and healed the ulcers kindly, and I
believe was the only remedy, out of many, that saved her life.
The case, however, resulted in very great deformity, and has
been a source of great unhappiness to the individual who ad-
ministered the calomel. He was unacquainted with the action
of mercury and "did not know that it would make the mouth
sore, much less produce sloughing," and thereby permanently
entail miserable deformity.

In the various vaginal irritations and ulcerations of the os and
cervix uteri, it will exert a very happy influence, and may be
relied upon, if perseveringly used, in counteracting leucorrhceal
discharges produced from irritations, and very often heal such
ulcers promptly.

In a case of ulceration of the os and cervix, in which I tried it
for a very long time in this city, its effects were accompanied
with results highly flattering, and the patient seemed to be ra-
pidly recovering, until neglect of her person, growing out of the
fact that she was not able to have the care and attention that

230 Musgrove. Cases of Poisoning. [April,

such cases require, and consequently the local affection became
aggravated, her constitution failed, and the case terminated in
death. I was not in attendance at the time of her death, nor
had I been for many months previously, consequently can
say nothing upon the subject of her condition at the time of her
death.

I have said all that I conceive to be prudent and proper in
an article of this sort ; however, I could mention much more
concerning its effects in that scorbutic or spongy condition of
the gums, accompanied with hemorrhage, in typhoid fever.

I am now treating a child with ulcerous sore mouth, with this
salt of potash, and as soon as I satisfy myself fully of its use in
gangrenous ulcerations about the mouth as well as the aph-
thous conditions not only of the mouth, but extending to the
pharynx and along the oesophagus to the stomach and bowels,
I may trouble you at some future time, with a publication
setting forth my views of the utility of this salt in the two last
mentioned conditions, &c.

By reference to an article of mine upon Yellow fever, pub-
lished in the Southern Medical and Surgical Journal, for 1855,
October number, the use of Chlorate of Potash in the treatment
of that disease will be seen.

( ARTICLE XI.

Poisoning by Phytolacca} Radix (Poke Root) -four cases. Re-
ported by ~W. C. Musgrove, M.D., of Midville, Ga.

Messrs. Editors, I have been intending, for some time, to
write an article for the Journal, but want of time has been the
chief cause of delay in my so doing ; and, even now, I shall
wish it considered a u resume" of my practice for the month of
January a generality rather than a speciality.

The month of January has been a peculiar one with us
spring-like very wet, and but few cold days. By reference to
my weather register, we have had

Rain, Cloudy, Fair, Variable,

7 days. 11 days. 11 days. 2 days.

1858.] MrsGROTE. Cases of Poisoning. 231

The diseases usual to the season have been wanting : it is true,
we have had catarrhs, but as yet I have seen but three cases of
pneumonia, two of which were typhoid. The cases which have
been under treatment for the month, may be classified thus :

Apoplexy 1 Chronic Gastritis 1

General Nervous Irritability 1 Delivery of Placenta 2

Miscarriage (3 months) 1

Midwifery 7

Do. Twins, (male and female). . 1

Reducing Luxation Humerus 1

Erysipelas 1

Typhoid Fever ... 1

Pneumonia 3

Puerperal Fever

Dj-srnenorrhoea

Asthma

Convulsions

Congestion of the Brain

Phytolacca Radix, Poisoning by 3

Fraeture Right Ramus of Pubis. 1

The detail of some of these cases would be not altogether un-
interesting. I send you now, however, only the case of poison-
ing by the Phytolacca^ Radix (Poke Root) :

January SO. Visited four negro children, belonging to Mr.
J. S. J.; found three of them extended on a blanket before the
fire, almost cold and pulseless, narcotized', the pupil contracted ;
the muscles greatly relaxed, as in a very drunken man ; the
breathing slow, and scarcely any motion in respiration percept-
ible. About 1 o'clock, P.M., the little negroes were taken with
vomiting, which continued, at intervals, until I saw them, at 6
P.M. They were aged 10 years, 8 years, 4 years, and 16
months. The eldest was relieved by the emesis, and the young-
est was severely hypercaihar sized.

Prescription. Boiled milk, cold, in small quantities ; as soon
as the stomach was quieted to give a dose of oil and turpentine,
and stimulate with beef-broth and brandy. " Rubbing the cold
surfaces with dry mustard, and if re-action was not induced, to
use spts. turpentine, mustard cataplasm for the youngest, and
carb. ammonia.

January 31. Found 10, 8 and 4, convalescing finely, but
the 15 months child sinking dying about 10 A.M.

The children had been eating the Poke Root, mistaking it
for the Artichoke. There was no convulsive action in these
cases.

[As the Poke Root is an abundant product of our Southern
States, and the liability to poisoning by it very great, we regard
Dr. Musgrove's brief report as quite important to practitioners
in these regions. Edts.]

232 Lecture on Influenza. [April,

Clinical Lecture on Influenza. By W. T. Gairdner, M. D.
Physician to the Eoyal Infirmary, and Lecturer on Clinical
Medicine, Edinburgh.

I invite your attention to-day to a subject of great importance,
and very directly suggested, not perhaps by any one case now in
the wards, but by a combination of circumstances which you
have witnessed during the last fortnight. It is to the prevalence
of certain diseases in our hospital wards, which, taken collective-
ly, amount to the proof of an epidemic morbid tendency ; that is'
to say, which show, by the extent and manner of their diffusion,
the existence of a morbid influence operating temporarily upon
the population at large. I cannot, indeed, show you in the wards
a single typical case of this epidemic disorder, as it is seen so fre-
quently outside, unless it be that of the woman just admitted into
the fever ward. But, although I cannot place before you the
ordinary forms of the epidemic (because these are commonly too
mild to be admitted into hospital,) I can show you its accidents
and complications in sufficient number to furnish a text for some
remarks on its nature and prevalence.

You may recollect that, at the beginning of the month, we had
very few acute cases of disease, though there were many interest-
ing chronic cases, chiefly of abdominal affections, and almost
all of organic diseases. The few acute cases that we had were
fevers, and these almost all of one kind, viz., enteric typhus, about
which I may have more to say at another time. Now, on the
other hand, the wards are crowded with more or less acute cases
of disease ; and most of these diseases are of the chest. Let me
enumerate a few of them.

There is the case of the woman already noticed as having been
admitted to the fever ward. She is a healthy -looking young
woman, who has been occupied as a domestic servant. She was
seized, a few days ago, with shivering, succeeded by headache,
pains in the limbs, sickness. Along with these there was a cer-
tain amount of catarrh, which has now settled (not very severely
however) upon the chest. The fever is now intense, and very
much out of proportion to the severity of the catarrh. Headache
persists, the skin is hot, the tongue loaded, the color dingy, and
the general aspect of the patient certainly goes far to justify her
being sent to a fever ward. Nevertheless, I believe it will turn
out not to be a case of fever, in the ordinary acceptation of the
term ; but of the current epidemic which I will take the liberty
of calling, if it has not already been called Influenza.

Had this been the first case of influenza presented to my notice,
it might have passed for one of continued fever or typhus. But
even then I should have remarked its singularly abrupt invasion,

1858.] Lecture on Influenza. 233

the great amount of prostration in this early stage, the extreme
severity of the headache and articular pains, as being rather out
of character in any fever to which we have lately been accustom-
ed. Knowing what I do of other cases, I have no doubt these
symptoms are owing to influenza. The only question is. whether
this woman may have influenza and fever combined. This ques-
tion must remain open for the present.

Now, by considering this case of catarrhal fever, or of feverish
cold (if you like to call it so,) in relation with the other facts to
which I shall allude presently, you will draw for yourselves the
picture of the epidemic, as we have it.

The first indication we had of anything out of the usual course
was, perhaps, that downward tendency of several of our cases of
phthisis, which, you will recollect, I remarked to you more than a
fortnight ago. It does not always happen that cases of phthisis
are the first to show a tendency to influenza, and in this instance,
it may have been a coincidence ; but it is a curious coincidence,
that, when we had picked out four cases of phthisis as fit subjects
for trying the new remedies the hypophosphites of lime and
soda and had noted them carefully for that object, three out of
the four should have been seized with acute symptoms, within a
short period of our commencing the novel treatment. I told you
at the time, that I had no reason to blame the remedy for this
result, and that it was probably a mere coincidence ; I am now
disposed to believe that it was one of the first manifestations of
the morbid influence of which we have since seen so much.

[Two of these patients have since died ; one went out relieved ;
another survives, considerably enfeebled, but without acute symp-
toms.]

On the 11th ol November, we saw together a casein the
female general ward, of very old-standing chest disease, apparently
emphysema of the lungs, in which acute symptoms had super-
vened, and the patient appared to be in extreme danger from res-
piratory oppression, with feverishness and bronchitis. Under a
very simple treatment, this woman is now improving; but her
case is, no doubt, one of the epidemic in a debilitated subject.

Shortly before this case was admitted, a bov was brought to
the waiting-room screaming with pain, which he referred to his
left side. He was also very feverish. He had not much catarrh,
but auscultation left us in no doubt that there was a degree of dry
pleurisy on the left side, and also a friction sound, not so well
marked, over the pericardium. Under moderate leeching and
opiates, he was soon convalescent; but the respiratory friction
sound continued loud and characteristic, and we have detained
him in the ward mainly for your benefit. I had some doubts, at
first, whether this boy had not suffered perforation of the lung ;
but it was not so. I do not say it was a well-marked case of in-
fluenza, but I mention it by the way.

234 Lecture on Influenza. [April,

The next case was that of a boy from the Industrial School,
who had gone through a distinct attack of feverish catarrh before
we saw him. The traces remained in the form of bronchitis of the
smaller tubes, or rather, I suspect, a tubercular condition of the
lung, with bronchitic signs. This boy has probably had an un-
sound chest for some time. He is better, however; indeed nearly
well.

About this time, I thought it right to pay a visit to the Indus-
trial School, as I had seen several cases of feverish disorders from
thence, which the head-master sent up for my inspection. I
found thirteen or fourteen boys smartly ill with cold of the head
or chest, and several of them plainly very feverish. Coughs re-
sounded on every side ; and squill mixture, with paregoric and
ipecacuanha, were greatly in demand. None of the cases were,
however, dangerous.

On November 14th, I directed your attention to a very acute
case of bronchitis, or broncho-pneumonia, admitted two days be-
fore. The fever was very intense on admission, but had quite
subsided, before you saw the patient, under the treatment by con-
siderable doses of tartar emetic, employed by Dr. Yellowlees from
the commencement. The patient, a young girl of seemingly sound
constitution, recovered rapidly the large doses of tartar emetic
being replaced by a simple cough mixture, with small doses of
antimonial wine, after the lapse of about 48 hours; as soon, indeed,
as the fever shows signs of retreating. No other medicine was
required in this case.

Very different was the result of treatment, or rather of the
neglect of treatment, in another case in the same ward. A young
woman, the mother of a family, was seized with acute bronchitis,
and lay many days neglected. She was then seen by Dr. Watson,
who after blistering the chest and administering some internal
remedies, sent her into the hospital. In this case, seen by us
only at an advanced stage, the fever had assumed a hectic char-
acter. Occasional flushes overspread the face ; there was marked
dyspnoea and lividity ; sweating was very severe every night,
and sometimes in the day ; and prostration very considerable.
She has since had acidulous drinks, antispasmodics and opiates,
and is better; but her convalescence is very slow, fever is not
subdued, and I greatly fear that the seeds of tubercular disease
have been laid in this case. She flushes whenever she is spoken
to, and is very nervous. [This patient was lately dismissed, as
she felt it necessary to go home to her family ; but she is very
unfit for household duties, and will probably be so for some time.]

Two other cases of chronic catarrh, with acute exacerbation,
were admitted into the male ward, and were seen by you on
November 18th. Both of these were street-porters, and men
above 60 years of age by no means temperate in their habits.
I will not, however, dwell upon them.

1858.] Lecture on Influenza. 235

The same day, November 18th, brought under your notice, for
the first time, two extremely interesting cases of acute disease,
having the imprint of the epidemic tendency.

One of these was a case of acute pneumonia, or pleuro-pneu-
monia, in a previously healthy man of 28 years of age. The dis-
ease had run a course of many days previous to admission, having
begun in symptoms altogether like simple influenza, succeeded,
at the end of a week, by pain in the right side of the chest and
difficulty of breathing, with shivering fits. We found the whole
lower lobe on the right side more or less consolidated, the sputum
rusty, and the fever considerable. The night of admission, before
treatment had been well begun, pain occurred on the opposite
(left) side, at the lower part ; and this aggravation was attended
with a pulse of nearly 140 in the minute, at one period, and with
respirations between 50 and 60 in the minute. So soon, however,
as the tartar emetic began to take effect, these symptoms subsi-
ded ; and next day we noticed the pulse at 78, and the respira-
tions at 32, the skin cool and moist, and the general state quite
satisfactory ; though a certain amount of dull percussion, with
some consonating rale, existed at the lower part of the left lung,
and the physical signs on the right side were unchanged. In
another day, the line of dull percussion in the right lateral region
was lower by an inch and three quarters, and from this period
the convalescence may be said to have begun. The operation
of the grain-doses of tartar emetic here was most prompt and sat-
isfactory ; and as the fever and dyspnoea have entirely subsided,
the pulse being 72 and the respirations 26 in the minute, I am of
opinion that we may now suspend the remedy, and leave the cure
to be completed by nature. [The convalescence was uninterrupt-
ed. The patient left on 2d December, perfectly well]

The other case which we saw for the first time on the 18th,
was that of a woman in the fever ward. This patient, a domes-
tic servant, aged 28, of rather corpulent habit, always enjoyed
good health till a fortnight ago. At that time she was seized
with pains in the head, back, and limbs, with a feeling of lassitude
and exhaustion, which confined her to bed for three or four days ;
but at the end of that time she was somewhat better, and tried to
resume her ordinary work to very little purpose, as in a day or
two more she took to bed again, and has been feverish ever since.

I believe that this case is one of enteric typhus, or typhoid
fever as it is often called. I make this diagnosis, however, chief-
ly on the ground that certain rose-colored spots, which you saw
me mark on the skin yesterday, bear a strong resemblance to the
characteristic eruption of that fever. Should these spots contin-
ue to appear, we shall feel sure of our diagnosis ; although there
is at present not a trace of abdominal complication, and all the
more prominent symptoms are thoracic, so that there is little doubt
10*

236 Lecture on Influenza. [April,

the epidemic tendency is showing itself strongly in this woman.
There are, in fact, the following very formidable symptoms :
great acceleration of the respiration ; dingy lividity of counten-
ance, with flushed cheeks ; small and very frequent pulse ; con-
siderable pain in the chest, not localized ; some delirium ; and I
have little doubt that some peculiar form of broncho-pneumonia
is present, as there is a scanty sputum, deeply tinged with purple
blood, and we find, on examination, limited dullness on percussion,
together with consonating respiration and rale in both backs, at
the lower part of the lungs. It is easy to see in this case enteric
fever, complicated writh influenza, and with very serious, though
ill-defined, acute diseases of the lungs a very ominous conjunc-
tion, and all the more so as the debility of the patient forbids the
employment of active remedies, and we must confine the treat-
ment to regulated stimulation. I must say, that the state of this
woman appears to me perilous in the extreme.

[The sequel of this case justified our fears. On the 21st she
was visited, on account of my unavoidable absence from town, by
Dr. W. Begbie, who marked out additional rose-spots, thus re-
moving all doubts as to the diagnosis. The chest symptoms,
however, still predominated ; there had only been one stool, and
that a natural one, since admission ; and there was no pain or
tenderness of the abdomen to any appreciable extent. On the
night of the 21st a very loose stool was passed containing blood.
Another followed next day, and another the succeeding night,
the blood being in large quantity, notwithstanding the application
of ice to the abdomen, and the administration of acetate of lead,
writh opium, internally. On the 23d, at visit, she was manifestly
sinking. She had been very restless and delirious, and had three
other stools, largely composed of blood. The tongue was dry
and brown, and the pulse almost imperceptible. There was no
additional embarrassment of breathing, and I did not examine
the back ; but over the right front there was marked dulness on
percussion, with feeble tubular respiration and consonating rale.
She died on the morning of the 24th.

Post-mortem examination showed numerous enlarged and con-
gested patches of Peyer in the ileum, in a state of ulceration and
sloughing; with enlarged, congested and softened mesenteric
glands. The lungs were in an extremely curious and almost in-
describable condition ; the right lung almost entirely devoid of
air, flaccid, evidently collapsed, but showing throughout, on sec-
tion, much congestion, and here and there patches of haemorrha-
gic condensation ; the bronchi loaded with mucus deeply stained
with blood. In the left lung there was a good deal of collapse at
the base and root ; but on the whole, not much disease. In
neither lung was there anything like ordinary hepatization, and
the pleurae were quite smooth, and free from exudation. The spleen,
as usual, was large and soft.

1858.] Lecture on Influenza. 237

It is worth noticing, that the nurse of the ward, a most careful
and attentive person, was under the impression that this patient
was menstruating two or three days before death, and that the
patient herself had a similar impression. The examination of the
uterus and ovaries showed that this impression was erroneous.
The mucous membrane was pale throughout ; a gelatinous mass
of mucus occupied the cervix uteri, and there was no recent cor-
pus luteum. It is evident that the stains of blood from the bowels
had led to a mistake in this particular.]

The only other case worth mentioning in illustration of the
epidemic tendency, is that of a little girl, admitted on the 19th, as
she had been several times before, on account of disease of the
heart. She has, I think, a contracted mitral orifice ; and with
this there is associated, at present, a great deal of lividity, with
feverishness, and marked prostration of strength ; the consequen-
ces, no doubt, of influenza acting upon organs predisposed to dis-
ease. I should think badly of this case if I had not seen it before ;
but this girl has repeatedly got over attacks considerably worse
than the present in a very short time. She had all that elasticity
of constitution which appears to be the exclusive endowment of
youth ; and she is in every respect a very good and hopeful little
patient. [She recovered in a few days.]

Let me now review these facts. Here, within the space of less
than a fortnight, you have seen admitted into our wards (with an
average population under 40) no fewer than 11 cases of febrile
disease, associated with pulmonary symptoms of one kind or other.
Most of these, no doubt, were complicated cases, and only one of
them could be called simple influenza. But this is because simple
influenza is usually too rapid and too mild a disease to be admit-
ted to an hospital. We see here, not the disease, but the conse-
quences and complications of the disease. j In private and in dis-
pensary practice we see the disease itself.

[Of these 11 cases of chest affection,
1 was double pleuro-pneumonia ;

1 was pleurisy and pericarditis ;

2 were very acute bronchitis, or broncho-pneumonia, in one

with a probable tubercular complication ;
1 was sub-acute bronchitis, certainly with tubercular ante-
cedents ;

3 were sub-acute bronchitis, supervening an old emphysema
of the lungs ;

1 was sub-acute bronchitis, supervening upon old valvular
disease of the heart ;

1 was enteric typhus, with very acute pulmonary complica-
tion; and

1 was influenza, pure and simple.]
While we have been watching these cases together, I have

238 Lecture on Influenza. [April,

seen many and heard of many more, cases of the simple and ordin-
ary form of the disease. Not a few of yourselves have had it,
and two or three have been seriously ill. Most of the cases that
I have seen, however, have been remarkable for the sharpness and
suddenness of the attack, and not less so for the rapidity of the
passage from a state of feverish prostration to convalescence. I
have found a man with a pulse of 130 at night and next day he
has been up and about. This, of course, only happens with sound
constitutions. In one or two instances, it has appeared to me
that an emetic, given in time, has anticipated or cut short the
attack. Certainly it has been followed by great relief. For the
rest, the bed, or, in mild cases, the sofa, restricted diet, laxatives
where required, and liberal doses of opium where there is much
restlessness and exhaustion, seem to me to comprise all the neces-
sary treatment of ordinary cases of influenza, even when severe.
In the complicated cases no rule can be laid down. Some are
very amenable to remedies, others run their course in spite of
treatment. You have seen illustrations of both kinds in these
wards.

The most characteristic symptoms of influenza are intense
feverishness, usually with great tendency to chilliness or shiver-
ing, until the patient takes to bed, and reaction is fairly establish-
ed. Then come racking headache, with pains in the back and
limbs, which sometimes constitute the principal source of suffer-
ing; extreme sensation of debility; total prostration of appetite,
with less of thirst than is usual in fever ; and with these, coryza
or mild catarrh, bronchitis, broncho-pneumonia, as the case may
be. But though catarrh is frequent, and may be severe, the
disease is essentially a fever, not a catarrh. Nay, the catarrh may
be absent, or insignificant ; not infrequently it is so. In one of
the cases I saw among yourselves, there was absolutely no ca-
tarrh ; in another it was very slight. And I saw two very
curious cases a few days since, which enable me to put this point
yet more strongly. The catarrh may, in fact, be absent in the
very case in which you would a priori, expect its occurrence. A
gentleman, who has been long afflicted with spasmodic asthma,
with intervals, however, of fair good health, and with no appreci-
able organic disease of the chest, came to me after he had been
struggling for several days with debility and prostration, with chil-
liness and feverish sensations. These were with him the only
manifestations of influenza. [He afterward, at an interval often
days, had a slight cold in the head, without fever ; in the mean-
time his whole family sickened with feverish colds, some of them
with chest affection, from which he himself remained exempt
throughout.] In another case, a gentleman, who also suffers
from habitual asthma and bronchitis, and in whom I suspect a
morbidly enfeebled heart, sent for me in a great hurry on account

1858.] Lecture on Influenza. 239

of the alarming prostration, produced by this strange and inex-
plicable "influence." He was, however, more friqhtened than
hurt ; in a couple of days he was convalescent, and the amount
of bronchitis in his case never gave me the slightest uneasiness.

Even the complications in influenza are not always of a catarr-
hal kind, nor even confined to the chest. Ten years ago, in con-
nection with a great and general epidemic of influenza, I witness-
ed in this hospital a succession of cases such as I have never seen
since that time. In the course of a few weeks there occurred, I
forget exactly how many, but upward of half a dozen cases of in-
flammation of all the great serous membranes conjointly double
pleurisy, pericarditis, peritonitis. Most of them were fatal ; indeed,
they seemed to come into the house only to die ; so rapid, so in-
controllable were the symptoms, that no time was given for the
application of remedies, even had remedies been clearly indica-
ted.

It is somewhat remarkable, that the great epidemic influenza
of 1847-8 began at the same time of the year with the present
one, almost to a week. You will find an account of it in the
excellent monography of Dr. Peacock, of London.* That epidem-
ic however, came upon a population wasted by typhus and other
forms of fever, and not yet recovered from the famine and desti-
tution caused by the blight of the potato, and the high price of
grain in 1845-6. Scurvy, dysentery, and fever, preceded the
influenza on that occasion, and cholera followed not very long
after. Notwithstanding the recent money-crisis, and the distress
likely to follow among certain classes of the working population,
we may hope that we are at present more favorably situated than
we were ten years ago. A short time will show whether the
present epidemic is to bear comparison with the last or not. Hith-
erto it has been of a very mild character, comparatively speaking.
I have myself seen only one fatal case a man who had been for
some time in poor health, and who died of a chest complication,
not very unlike that of our case of enteric fever. I do not know,
indeed, that this can fairly be called a death from influenza, though
I believe influenza to have been mixed up with the fatal result.

{From a Clinical Lecture on Friday, November 27th, 1857.)

Since I spoke to you about influenza a week ago, there have
been only two additions to the list of acute diseases which appear
to have had their origin in it one a case of pleuro-pneumonia,
admitted only two days ago, treated both before and after admis-
sion by calomel and opium, and already in process of resolution ;
the other a case of genuine influenza, with all the usual symp-

* On the Inflnenza, or Epidemic Catarrhal Feyer, of 1847-8. London 1848.

240 Lecture on Influenza. [April,

toms, and which like the former one, was sent up to the fever
ward, as lying under suspicion. I have directed her to be put in
the closet, apart from the other patients ; and we shall make a
point of parting with her as soon as possible. So far as the
wards are concerned, the epidemic does not appear to have made
rapid progress this week.

I have received the Kegistrar-General's report of mortality in
London for the week ending November 21st. It is worth while
to compare the indications in this report with those derived from
our own observation as regards Edinburgh. For this purpose, I
have drawn up a table of those diseases whose mortality appears
to be notably above the average of the season, and have calcula-
ted the existing mortality as against the corrected average of ten
years. The correction I speak of is made thus : The Registrar's
table gives the mortality of each disease during the forty-seventh
week of the present year, and during the corresponding week of
ten previous years ; from these he deduces an average, which
occupies a separate column. But before you can use this aver-
age as against the number of the present year, you must in every
case raise it by one tenth, to make allowance for the increase of
population, which, it is calculated, increases by one tenth in five
years.

Now, the past week has in London been one of unusual mor-
tality for the season ; seeing that the corrected average for ten
years makes the total mortality of the forty-seventh week of the
year 1211 ; while during the past week it has been 1382. This
very considerable extra mortality appears to be due chiefly to
bronchitis, pneumonia, and phthisis, to which may be added
whooping cough. All of these are 20 or more in excess of the
average mortality of the season ; and bronchitis is in excess by
the very large number of 123, showing a mortality much more
than double the corrected average of the ten years. These four
diseases together have a mortality 188 in excess of the average ;
while the entire excess of deaths for the week is only 171 ; the
difference being, of course, made by diseases which are below the
average, especially typhus, scarlatina, and smallpox, which have
at present a low mortality. The other diseases which, though to
a smaller extent, have contributed notably to raise the mortality
of the past week above the corrected average, are croup (with
which I have included laryngitis,) scrofula (the disease of the
young,) and apoplexy, with paralysis, the diseases of the aged ; to
which we may add that somewhat vague condition called atrophy
(mostly infantile,) and that still more vague cause of death called
age. Both of these are considerably in excess ; and these with
the other causes stated, go to show that the mortality of the past
week in London has fallen heavily on the two extremes of life.
This indeed is always the case with influenza.

1858.]

Lecture on Influenza.

241

But are we justified in assuming the existence of influenza as
a cause of death in these cases, especially when we look to the
fact, that not more than 9 deaths are recorded in all London du-
ring the past week., as having occurred from influenza ? I think
we are ; because we may be sure that an epidemic condition
which raises the whole mortality by one seventh, which more
than doubles the deaths from bronchitis, and largely increases
those from other acute diseases of the chest, while the aged and
the young, the apoplectic, paralytic, and consumptive, suffer out
of proportion to the rest of the population such an epidemic con-
dition, I say, has essentially the characters attributed to influenza,
bv whatever name it may be called. The small number of deaths
under the special head of influenza, therefore, is only one proof
out of many that the Registrar-General need not have been at the
trouble of making a separate class of what he calls zymotic or
epidemic diseases. The epidemic tendencies of a given period
must be sought, not in any particular class, but in an intelligent
consideration of the whole mortality list. Medical men are slow
to report a death from influenza when it can be properly placed
under any other title. It is, however, the fact (as 1 know from
other sources,) that influenza has been unusually prevalent in
London.

Table deduced from the Registrar-General's Returns (London)
for the week ending November 21, 1857 ; showing the rate of
mortality in the forty-seventh week of the year 1S57. in regard
to those diseases which are above the corrected average of the
same week for ten years :

Whooping cough

Croup and Laryngitis.

Influenza

Scrofula

Phthisis

Apoplexy

Paralysis ,

Bronchitis

Pleurisy ,

Pneumonia.

Atrophy

Age...'.

All Causes ,

Average
Mortality.

Actual
Mortalita.

Excess

Excess
percent.

33.5

53

20

58

13.4

26

13

94

3

9

6

6.5

13

7

137.6

159

21

15

25.6

33

1

29

22.7

31

8

36

103.6

227

123

118

2.6

7

4

104.2

127

23

22

30.6

38

7

24

49.6

57

7

15

1211.4

1382

171

14

Additional Remarks, Dec. 19th. The epidemic mortality in
London appears to have attained its culminating point, in the
week ending December 6. in which the mortality from all causes
was 1428; from bronchitis 242, from pneumonia 129, and from
phthisis 168. Considered with reference to the season, however,
this mortality is by no means so much in excess as that indicated

242 Lecture on Influenza. [April,

in the above table ; and we may therefore possibly conclude, that
the epidemic has passed its maximum in London. The next week
shows a considerable decline. It is worthy of remark, that all
the gentle hints and solicitations of the Registrar-General in the
Weekly Reports, have not succeeded in raising the cypher of in-
fluenza above 22. In the year 1847, the stated deaths from influ-
enza for the corresponding week were 198, those from bronchitis
343, from pneumonia 306, and from all causes 2454. The epi-
demic of 1847-8 was, therefore, immensely more fatal than the
present one, so far, at least, as we have hitherto gone.

It appears from the returns of the Registrar-General (London)
for the quarter ending September, 1857, that the mortality from
acute diseases of the chest was considearbly below the average
during the past autumn. It began to exceed the decennial aver-
age, however, in the month of October ; and during the latter
week of that month and the beginning of November, the increase
was considerable, although not such as to give a decidedly epidem-
ic character to the mortality. It was only in the second week of
November that the total mortality began to be decidedly in excess
of the decennial average.

In Scotland, the Registrar-General's returns show a very large
advance on the mortality from pulmonary diseases during the
month of November, 1857, as compared with the preceding month.
Thus, in October, the deaths from bronchitis in the eight princi-
pal towns of Scotland were only 76, while in November they were
151, or almost exactly double. Pneumonia in the same period in-
creased from 53 to 76 ; while phthisis has only advanced from 212
to 228. The increase, as regards brnnchitis, is most marked in
Aberdeen, next in Greenock, next in Dundee, next in Glasgow,
and next in Edinburgh. Influenza scarcely appears in the returns,
numbering only 3 in October, and 7 in November.

The weather was, on the whole, fine in November, and not
very dissimilar from that of the preceding month. The barome-
tric pressure was somewhat higher than in October, viz., 30.143
inches against 29.817 inches. The mean temperature was nearly
six degrees less, viz., 45. 1 against 51. 0, The rainfall was some-
what greater, and there was somewhat more of easterly winds.
It is worthy of remark, that the mean developement of ozone, as
tested at Greenock, was decidedly less in November than in Octo-
ber.

It would be interesting to know to what extent the inland dis-
tricts of Scotland have been affected with influenza, and whether
its manifestations have been simultaneous with those in the cities
or not. From circumstances which have incidentally come to
my knowledge, I am inclined to believe, that in some places in
the neighborhood of Edinburgh the appearance of influenza, in an
epidemic form, was considerably later than in the city itself.

[Edinburgh Med. Jour. Boston Med. and Surg. Jour.

1858.] Report on Practical Medicine. 243

PRACTICAL MEDICINE.

[Professor Austin Flint has prepared for the North American
Medico-Chirurgical Keview, the following report of selections
from various Journals. The six following papers are some of
those which refer to Fevers, and we transfer them to our pages
for the benefit of our readers.

No man in this country has contributed more, in the way of
faithful statistical observation to the department of Fevers, and
no one, in our opinion is better prepared, than Dr. Flint to re-
cord what is truly valuable on the subject, for the consideration
and guidance of others.

" The purpose of this report," says Dr. Flint, "is to notice the
more important of the contributions to practical medicine, con-
tained in the medical literature during the past year," 1857.

Fever articles are ever acceptable to practitioners in a Fever
region, and we, therefore, make no further apology for our se-
lections below. Edts.]

Report on Practical Medicine for the year 1857. By Austin Flint,
M. D., Professor of Clinical Medicine and Medical Pathology
in the University of Buffalo.

Remitting Fever of Children. In a paper read at a meeting
of the Society of Statistical Medicine, in the city of New York,
Dr. J. Lewis Smith presents some considerations in reference
to the nature of the disease denominated infantile remitting fever,
and to the proper mode of treatment.

The most eminent European writers (Barthez, Billiet, and
West) describe, under this title, a form of disease which they
deem identical with the continued fever of adults. Drs. Stewart
and Condie, of this country, authors of works on the diseases of
children, which are extensively read, regard the affection as
symptomatic of intestinal irritation or inflammation. Dr. Smith
has treated many cases both in private and dispensary practice,
and has been led to form an opinion of the pathology of the dis-
ease differing from the views of the writers just referred to. The
cases which he has studied occurred in the upper wards of the
city of New York, which, as he states, are in an eminently mala-
rious situation. He regards the disease as in a large proportion
of cases miasmatic. He gives the following facts in support of
this opinion :

" 1. The disease is very prevalent in spring and autumn, and
rare in mid-summer and mid-winter, like malarious affections.

K. 8. VOL. XIV. NO. IV. 1 1

244 Report on Practical Medicine. [April,

There are certain streets where I have known it to prevail
almost like an epidemic in the vernal and autumnal months. If
the disease were, as Dr. Condie states, 'in every instance, either
a gastro-enteritis, an ileitis, or an entero-colitis,' how can this
influence of the seasons be explained?

" 2. Often, not always, the remissions are more marked than
would be likely to occur in a symptomatic fever. The child
may appear almost well in the morning, but in the afternoon
and evening exhibit such intensity of symptoms as to cause the
greater anxiety on the part of the friends.

"3.. The symptoms are not altogether such as we should ex-
pect to find in a purely local affection. The patient will, it is
true, when asked where he feels the pain, sometimes place his
hand on the abdomen, and pressure upon the abdominal parietes
not unfrequently produces great distress. Dr. Condie alludes
to this tenderness, evidently believing it to be a symptom of
inflammation. But I have always been satisfied that it was
neuralgic, from the fact that pressure on the lumber vertebrae,
and frequently on the chest and limbs, caused as much suffering
as when it was made on the abdominal walls. The patient, if
old enough, will complain, too, of aching in the head, back, and
limbs, which is more the symptom of an independent fever than
of inflammation.

" Again, constipation is ordinarily present, unless in the last
stages of the disease. Intestinal irritation or inflammation, suf-
ficient to cause so intense and protracted a fever as is often
present, would be more likely to cause diarrhoea.

" 4. Children, even nursing infants, take intermittent fever ;
why, then, may they not take remittent fever, from malaria?
In my class at the dispensary, children with these diseases are
frequently brought in together.

"5. I have found that measures directed' to the alimentary
canal, beyond simple purgation, do more harm than good. They
fail to ameliorate symptoms ; they awaken and distress the child.
Moreover, when remissions occur, quinine will materially
abridge the disease.

" 6. Death seldom occurs from this affection. In one or two
fatal cases which have fallen under my observation, this result
followed convulsions and coma; and Dr. Stewart remarks, ' Dis-
sections have furnished but little light on the morbid condition
of the system in remittent fever; for on a fatal termination, the
transmission to the brain is the ordinary course of the disease.'
The mode of death, then, and the post-mortem appearances, do
not comport with the doctrine that the intestines are the seat of
the morbid process.

"Dr. Condie does not agree with Dr. Stewart, but attributes
death to inflammation of the intestines. I do not think that the

1858.] Report on Practical Medicine. 245

remittent fever which I have treated, if uncomplicated, ever ter-
minates in this way, for I have never seen a case in which ab-
dominal symptoms did not yield to simple measures.

" 7. Continued fever of the adult is of rare, and infantile re-
mittent of frequent occurrence in the locality of my practice.
The latter is not then identical with the former, as it appears to
be in London and Paris, from the descriptions given by Rilliet,
Barthez, and West.

"The above facts appear to me conclusive that the form of
infantile remittent fever, which it has been my lot to treat, has
been generally of a miasmatic character.

" It is very important to understand the nature of this affection,
as the treatment will vary according to the theory we adopt. If
living in a malarious region, we embrace the Broussian views
of the American authors whom I have cited, and treat the fever
as a local disease, we shall fail to ameliorate the symptoms, and
be mortified and discouraged by the result, if I may judge from
my own experience. My reliance at present is mainly on ex-
pectant measures, till remissions occur, and then on the exhibi-
tion of quinine. In cases thus managed, convalescence has been
more speedy and certain than when opium, calomel, and counter-
irritation have been employed to remove intestinal irritation or
inflammation.

" At the risk of appearing presumptuous, I have thus present-
ed a theory of infantile remittent fever not, indeed, novel, for
Taylor attributes one variety of it to miasm, but different from
that contained in any American and most European treatises on
diseases of children. I am the more anxious that the true nature
of the disease should be understood, because I believe that the
accepted doctrine is exceedingly pernicious to practitioners in
malarious regions, and especially to the younger members of the
profession who rely more on books than experience for guidance.
The fact, too, that remittent fever has been in my practice the
most frequent affection of early life, in the vernal and autumnal
seasons, gives additional interest to the subject." [New York
Jour, of Medicine, Jan. 1857, p. 106.

On the Different Methods of Treating Intermittent Fever, with the
Results of Treatment in Sixty-nine Cases. By Austin W.
Nichols, M. D., of Buffalo.

The object in this paper is to study the effect of treating cases
of intermittent fever without resorting to the preparatory treat-
ment by emetics, cathartics, etc., which are still deemed impor-
tant by many practitioners ; and also to institute a comparison
as regards relapses and the duration of the disease, between a

246 Report on Practical Medicine. [April,

section of country where the disease prevails to a great extent
every year, and a region not malarious.

Of the 69 cases, 46 were treated in a malarious section, and
23 in a region not malarious.

Of the 46 cases occurring in a malarious section, 17 were treat-
ed at once with quinia, in doses sufficient to arrest speedily the
paroxysms, and 29 received preparatory treatment viz. ipecac-
uanha and calomel, or calomel combined with either rhubarb or
jalap. Relapses were observed in 14 of the latter and in 4 of
the former cases, the ratio being as 1 to 4| in the cases which
did not receive, and 1 to 2^ in the cases which received the
preparatory treatment. The average duration of the disease,
dating from the commencement of the use of quinia, was found
to be less in the cases which did not receive preparatory treat-
ment, being a fraction over six days; while in the cases which
received preparatory treatment, the average duration was a frac-
tion under eight days. Adding the period occupied by the
preparatory treatment, the r^tio is as 6 to 8 days.

Of the 23 cases occurring in a region not malarious, all had
no preparatory treatment. Of these cases, in ten, previous at-
tacks had occurred. In the latter, the average duration of the
disease, after treatment was commenced, was 3| days. In ten of
the recent cases, the average duration was 2 days. Of the
latter, relapses were observed in two cases ; of the former in
three cases.

Comparing the results as regards duration and relapses in the
cases occurring in the malarious section and not receiving pre-
paratory treatment, and in the cases occurring in the region not
malarious, the contrast is striking : the average duration in the
former being 6j days, and the average of relapses 1 in 4 ; in
the latter, 2} J days, and the average of relapses 1 in 3| cases.
These results are greatly in favor of the region not malarious.

The reporter analyses his collection of cases with reference to
the types of the disease ; the number of paroxysms in each type ;
the number of relapses and the duration in each type. He also
analyses separately the cases of tertian type.

The following summary embodies the practical conclusions
which he deduces from the results of his analytical investiga-
tion :

"From the foregoing analysis it will be seen that in cases of
first attack the duration is somewhat less, and the number of
cases relapsing about one-half that in cases having had one or
more prior attacks. In a section of country where this fever
is prevalent to a great degree every year, or in a malarious region,
the duration is nearly three times that in a country not malari-
ous, and the relapsing cases occur as frequently even under the
same plan of treatment. It will be found that in a malarious

1858.] Report on Practical Medicine. 247

region the treatment of patients by quinia alone not only dimin-
ishes the number of paroxysms and abridges the duration of the
disease, but that fewer relapsing cases occur than where a pre-
paratory course of treatment has been adopted. Even in the
analysis of 40 tertian cases, although the duration of the number
of paroxysms is nearly the same under the two different methods
of treatment employed, yet the cases of relapse are found to be
nearly twice as numerous where the preparatory plan was adopt-
ed"{Buffalo Med. Journal and Month1 y Review of Medical and
Surgical Science, January, p. 460.)

Treatment of Remittent Fever. By Jxo. Herbert Clairboxe,
A. M., M. D., Petersburg, Virginia.

The practice of Dr. Clairbone, in cases of remittent fever, is
embraced in the following quotations from an article entitled
" Periodic vs Typhoid Fever."

" It is in the treatment of these cases the ' triple base' of Mail-
lot so accurately expresses the indications to be fulfilled r-viz.
1 To combat the visceral lesions ; to oppose the return of the
paroxysms; to prevent the occurrence of relapses.' To carry
out the first, it may be only necessary, if the patient be seen in
the paroxysm, to administer six or eight grains of the mild
chloride of mercury, with as many of Dover's powder, and one
or two of ipecac, applying a dozen or two leeches to the head or
stomach, according to the force of the reaction and its concen-
tration at either point. The early occurrence of the remission
will afford opportunity to exhibit the anti-periodic, which will
effectually meet the two latter. Fifteen or twenty grains of the
sulphate of quinine given in one dose at this time, or in two
doses of a few hours' interval, will usually cut short an attack.
Indeed, I have seen it succeed, in summarily effecting this end,
after the disease had already continued unabated for more than
a week, and when a dry tongue, nervous tremors, and incohe-
rency of language had apparently ushered in the typhoid stage.
After two or three days of treatment, if the fever still continue,
which is sometimes the case, we have found smaller doses of
quinine, five or six grains, exhibited in the remission, to answer
a very good effect gradually neutralizing the poison of the
disease, and hastening convalescence, without inducing any of
the disagreeable symptoms of cinchonism. We sometimes com-
bine the quinine with calomel, ipecac, and opium, at its first
administration ; and where there is much visceral engorgement,
the antiperiodic is often thus more effectual.

"Cases subjected to this treatment in their early stages have
not generally, in our experience, { run into typhoid fever.' Of

248 Report on Practical Medicine. [April,

nineteen cases, not selected, but transcribed from our note-book
of last September, the average duration of treatment was six
days. Six more days would cover the average period of con-
valescence. * * * * *

" When the fever has persisted for 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 twenty-four 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 visicatory over the abdomen.
We continue the use of the antiperiodic, however, exhibiting
three grains of quinine or an ounce of the infusion of cinchona
and serpentaria every six hours, alternating sometimes with
fifteen or twenty drops of oil of turpentine.

" With regard to the use of purgatives. We have found them
generally not only unnecessary, but positively prejudicial at any
stage of the disease, and evincing, even the mildest of them,
aptness to induce irritation of the bowels."

Treatment of Scarlatina. By James D. Harper, M. D., Minden,
Louisiana.

After describing briefly the characters of an epidemic of scar-
latina which prevailed in Minden in May, 1856, Dr. Harper
gives the following account of his method of treatment, and the
results.

"Of the 40 cases under my care during the epidemic, there
were 19 of simplex, 12 of mild anginosa, and 9 aggravated cases
of anginosa, some of which threatened to assume the malignant
form. In some of the cases, seldom anything was employed
beyond a saline laxative, repeated from time to time, as circum-
stances demanded. When the arterial excitement was very high,
cold water to the head and throat, cooling drinks, and gargles of
flaxseed and vinegar, constituted the treatment in a majority of
the simple cases ; in others, the chlorate of potash was added to
the treatment, as recommended by Dr. Watson, with the hap-
piest effect. The twelve mild cases of anginosa yielded pretty
much to the same treatment as those of the simple form, the
more lavish use of cold water, and the occasional application of
nitrate of silver or sulphate of copper, with the probang, con-
stituting the essential difference in the treatment of these two
forms of scarlatina. The troublesome itching of the skin, which
is apt to supervene upon the appearance of the eruption, can be
relieved to some extent by sponging the surface with cold water,
which does away with the intolerable heat ; brans of different

1858.] Beport on Practical Medicine. 249

kinds may be rubbed upon the body, and thrown into the bed
of the patient, which soothes for a time.

41 The nine cases, alarming in their character, underwent in the
early stages, to a certain extent, the same treatment as those of
the mild form ; but as they advanced, the more threatening be-
come the symptoms, such as great difficulty of breathing, from
glandular enlargement, combined with a viscid and tenacious
secretion, choking up the larynx ; a more frequent pulse ; ex-
treme restlessness and jactitation, doubtless arising from obstruc-
tion in the air-passages, with some disposition to diarrhoea, and
evident tendency to congestion of the brain ; in some, these
symptoms were recognized at an early period ; in others, were
deferred until desquamation had commenced. The head and
throat trouble was the distinguishing feature in these cases; pulse
ranged from 125 to 180, with more than usual heat about the
head, attended at times also by slight incoherency, and nervous
twitchings of the fingers and eyelids. There is but little doubt
that in most of these cases the excitement of the brain evidently
arose from the condition of the throat; these symptoms were,
however, promptly met, not by sponging, but by pouring cold
water out of a pitcher, or some other convenient vessel, upon the
head, giving the water a fall of from 4 to 12 inches ; this was
continued from 15 to 40 minutes at a time, or until the pulse
was reduced 20 or 30 beats in a minute, and the head became
cool. At this crisis, the patient would more frequently than
otherwise go off in a refreshing sleep, lasting half an hour, more
or less. Reaction manifested itself by the same restlessness, in-
coherency, and hurried respiration, but which would always give
way to the impression of the water, thereby placing the patient
in a condition highly favorable for recovery, other things being
equal. In some of the cases chlorine was used as a stimulant
and antiseptic with good effect.

"There was a condition of the throat which gave rise to much
trouble, even after desquamation had in some instances almost
subsided, and the patient otherwise convalescing; it was where
the ulcer was so low as to be beyond the reach of the probang,
and the little patient, not knowing the importance of raising the
foul secretions, swallowed them, whereby the s}'stem became
thoroughly inoculated with the animal poison, generating that
condition of system well known as typhoid, and in one instance
producing, as I am well convinced, that characteristic feature of
the diseased state of the glands of Peyer, similar to that which
accompanies genuine enteric fever, with a pulse from 125 to 180,
a tympanitic abdomen, and considerable excitement about the
brain. Cases of this character were treated pretty much as those
of enteric fever, at the stage where similar symptoms were
present, with the addition of cauterizing the ulcer of the throat,

250 Report on Practical Medicine. [April,

if accessible, which is most certainly the source of the mischief.
A nourishing diet was given, also brandy or port wine, with a
free use of chlorine, to rid, as much as possible, the secretions of
their obnoxious properties. When the respiration became em-
barrassed or hurried, from flatulency, turpentine was adminis-
tered ; if any threatening of brain disease appeared, the patient
was subjected to the cold water, and continued until such symp-
toms were allayed.

" This condition of things lasted from six to ten days. The
motions from the bowels consisted mostly of secretions from the-
throat, occasionally tinged with faecal matter ; but so long as the
throat remained in an ulcerated state, diarrhoea was invariably
present; it could only be temporarily checked, as the source of
the malady had to be reached before any permanent benefit
could be realized, proving that the diseased throat and enteric
symptoms bore the relation of cause and effect.

"The sequelae of ' scarlet fever' are generally a source of much
interest and uneasiness to the physician. Indeed, there is no
one disease which presents a longer catalogue of secondary affec-
tions than scarlatina. Of the various diseases which are likely
to follow scarlet fever, dropsy in some form is, according to my
observation, the most frequent. Of the various forms of dropsy,
anasarca is probably the one generally met with; it ordinarily
makes its appearance from the last stages of desquamation to
the third or fourth week following. Medical opinion is yet un-
settled as to the form of scarlatina most apt to be succeeded by
dropsy. Of the fifty-six cases enumerated, there were eight
cases of anasarca, all of which supervened upon mild cases of
scarlet fever, not one severe case of scarlatina resulting in dropsy
of any kind. In the dropsies following this eruptive fever there
is an almost total inaction of the kidneys, an inertness which
seldom attends the disease originating from a different cause ;
it readily yields to active hydragogue cathartics and diuretics
the one to produce copious watery evacuations from the
bowels, while the other incites the kidneys to increased action.
An exclusive milk diet should be rigidly adhered to throughout
the complaint. When the lower extremities are swollen to any
great extent, a bandage applied, beginning at the toes and ter-
minating at the knee, or high up the thigh, if preferred, has been
found highly useful in reducing the effusion. After the effusion
has been in a great measure removed, if the patient is perceived
to be in an anaemic condition, some one of the mineral acids, or
ferruginous preparations, should be immediately resorted to.
A varied and nutritious diet, in this state of the system, is ad-
missible.

" It is stated that the dropsies which follow scarlatina are some-
times dependent upon, or associated with, that peculiar uraemic

1858.] Report on Practical Medicine. 251

state known as 'Bright's Disease;' if so, then a case thus de-
pendent on, or associated with ' Bright's Disease,' would be
found more difficult of cure than those which came under my
notice.

"Various speculations have been indulged in regard to the
prophylactic virtues of atropa belladonna in scarlatina. There
are few who place implicit reliance in its preventive properties ;
others, again, firmly believe that it has the unmistakable power
of modifying, if not preventing, an attack ; while others, whose
statements are equally reliable, denounce its virtue in prevent-
ing or modifying the disease, and, in this respect, as worthy
only of the source from which it emanated.

" I gave belladonna, during the epidemic of 1856, to 20 child-
ren ; 19 of them took it as directed, and one irregularly. Of the
20 children, the one only who neglected to take the medicine
as directed had the disease ; most of the 19 who escaped were
not only exposed to the epidemic influence, but to direct conta-
gion.

11 With this experience, I have ranked myself with that class
of the profession who, without relying implicitly on the preven-
tive powers of belladonna, yet deem it highly useful in modify-
ing and arresting, to some extent, the dreadful ravages of scar-
latina." {New Orleans Medical and Surgical Journal, May, 1857,
pp. 743746.)*

Hospital Treatment of Yellow Fever in New Orleans. By E. D.
Powell, M. D., Brunswick Co., Ya.

Dr. Powell states that, having been a resident of the Charity
Hospital in New Orleans in 1855, he had an opportunity of
comparing different methods of treating yellow fever, and the
plan which appeared to him most successful was the following :
A hot mustard foot-bath was promptly employed. Next, the
infusion of orange-leaves given freely as a drink, and continued
during the attack. As a purgative, castor oil combined with a
few drops of laudanum. This was administered soon after the
admission of the patient. Ice applied to the head to relieve cere-
bral symptoms, if the later supervened ; also, local blood-letting,
by cupping or leeching. ( Virginia Medical Journal, June, 1857,
p. 470.)

* An interesting article by Dr. Lutton, of Aurora, Indiana, on the diversity of
symptoms in scarlatina maligna having already appeared in the pages of this
journal, (North American Medico-Chirurg. Review,) No. for Nov., p. 912, is not
here introduced.

252 Report on Practical Medicine. [April,

Epidemic Fever characterized by mild Erythematic Pharyngitis.

During the months of January, February, and March, 1857,
there prevailed, in the city of Buffalo and its vicinity, a form of
fever accompanied by mild pharyngitis, having a career of from
three to five days, and generally, if not invariably, ending in
convalescence. In a report made to the Buffalo Medical Asso-
ciation by the reviewer, the results of an analysis of twenty-three
recorded cases coming under his own observation were given,
and the question of the identity of the disease with scarlatina,
discussed. From the results of the analysis, the following de-
ductions were drawn by the reporter: "The disease was an
epidemic fever, characterized by mild erythematic inflammation
of the fauces as a constant local complication. Its character as
esentially a fever is established by the febrile movement being
in so marked a degree out of proportion to the local affection ;
in other words, evidently not being symptomatic of the latter,
and by its running a definite although a brief career. It is a
fever of from three to seven days' duration. Its epidemic char-
acter is sufficiently apparent. It has prevailed more or less ex-
tensively in the city for about two months, reaching its acme
gradually, declining gradually, and at length disappearing, af-
fecting both sexes and different ages without notable discrimi-
nation. As an epidemic fever its symptomatic features were
very uniform. The erythematous affection of the fauces consti-
tutes the only positive character, aside from the brief duration
of the febrile career. The other symptoms uniformly present
were only those incident to febrile movement ; and the symp-
toms observed in a few cases viz. the convulsions in one case,
the retraction of the head in one case, etc., were only incidental
events, not intrinsic elements of the disease. The small patches
of white exudation observed in some of the cases do not suffice
to establish any relation of the local affection to that called diph-
theritic by Brettonneau and others. The occurrence of several
cases repeatedly in the same family does not suffice to prove
that the disease was propagated by contagion, since this fact is
explicable on the supposition of the patients being equally ex-
posed to an epidemic influence, and there being a marked dis-
crepancy in the intervals separating the cases necessarily occur-
ring in the same family.

The disease was considered as a species of fever distinct from
scarlatina, on the following grounds : 1. The uniform absence
of the scarlatinous eruption on the exterior surface. 2. The
uniform absence of any connection with well-marked cases of
scarlatina, occurring either previously or subsequently. In no
instance was the disease preceded or followed by scarlatina in
the same family. 3. Several of the persons affected being adults

1853.] Liability of Xegroes to Epidemic Diseases. 253

and persons beyond middle life. 4. Medicine was in no in-
stance followed by the sequels of scarlatina viz. rheumatism,
serous inflammation, and especially dropsy. 5. In several in-
stances the persons affected had had scarlatina.

Professor Eochester at the same time made a report on the
same subject. Between January 6th and April 4th he had noted
thirty-seven cases. In many instances he had been led to ob-
serve irregular intimacy in the febrile movement. The subjects
in ten cases were of all ages and conditions. He regards the
communicability of the disease as probable. If communicable,
the period of incubation is short, the disease manifesting itself
in some instances within twenty-four hours after exposure. In
many of his cases the patients had had scarlatina. Two children
who were very ill with scarlatina had this form of fever a month
after their recovery. (Buffalo Med. Journal, May, p. 718.)

Liability of Xegroes to the Epidemic Diseases of the Soutli.

The fact is so glaring, and so universally admitted, that I am
really at a loss to select evidence to show that there is no accli-
mation against the endemic fevers of our rural districts. Is it
not the constant theme of the population of the South, how they
can preserve health ? and do not all prudent persons, who can
afford to do so, remove in the summer to some salubrious local-
ity, in the pine-lands or the mountains ? Those of the tenth
generation are just as solicitous on the subject as those of the
first. Books written at the Xorth talk much about acclimation
at the South ; but we here never hear it alluded to out of the
yellow-fever cities. On the contrary, we know that those who
live from generation to generation in malarious districts become
thoroughly poisoned, and exhibit the thousand Protean forms of
disease which spring from this insidious poison.

I have been the examining physician to several life-insurance
companies for many years, and one of the questions now asked
in many of the policies is, uIs the party acclimated?" If the
subject lives in one of our southern seaports, where yellow fever
prevails, and has been born and reared there, or has had an at-
tack of yellow fever, I answer, '' Yes." If, on the other hand,
he lives in the country, I answer, *'No;" because there is no ac-
climation against intermittent and bilious fevers, and other
marsh diseases. Now, I ask if there is an experienced and ob-
serving physician at the South who will answer differently ? An
attack of yellow fever does not protect against marsh fevers, nor
vice versa.

The acclimation of negroes, even, according to my observa-

264 Substitute for Human Milk. [April,

tion, has been put in too strong a light. Being originally natives
of hot climates, they require no acclimation to temperature, are
less liable to the more inflammatory forms of malarial fevers, and
suffer infinitely less than whites from yellow fever : they never,
however, as far as my observation extends, become proof against
intermittents and their sequelae. The cotton planters throughout
the South will bear witness, that, wherever the whites are at-
tacked with intermittents, the blacks are also susceptible, though
not in so great a degree. My observations apply to the region
of country removed from the rice country. We shall see, fur-
ther on, that the negroes of the rice-field region do undergo a
higher degree of acclimation than those of the hilly lands of the
interior. I know many plantations in the interior of Alabama,
South Carolina, Georgia, Mississippi, and Louisiana, on which
negroes of the second and third generation continue to suffer
from these malarial diseases, and where gangs of negroes do not
increase. (P. 376.)

And again : Certainly, negroes do suffer greatly on many
cotton plantations in the middle belt of the Southern States ;
and I have seen no evidence to prove that negroes can, in this
region, become accustomed to the marsh poison ; and my obser-
vation has been extensive in four States. A question here
arises : Is there any difference in types of those malarial fevers
which originate in the flat tide-water rice-ilands, and those of
the clay- hills, or marsh fevers of the interior? I am inclined to
think there is. Indigenous Races, p. 376; Art. "Acclimation,"
etc. By J. C. Nott, M. D., of Mobile, Ala. [North American
Medico- Chir. Review.

On a Substitute for Human Milk. Bv William H Cummixg
M.D.

[The following, on a most important department of Hygiene,
is from the pen of one, in whom we are gratified to recognize
one of the alumni of the Medical College of Georgia. Dr. C.
has devoted much attention to the subject of which he treats,
and his views are reliable, for they are the result of the most
intelligent personal observation and diligent experiment.]

Artificial lactation is the subject of this paper. In order to
prepare our minds for its proper consideration, it will be well to
examine the natural function in its normal state.

Lactation exists as a function only among the Mammalia.
These derive their title as a class from the existence of the organs

1858.] Substitute for Human Milk. 255

of this function. "Whether they spend their lives in the water
or on the land, whether they swim or creep, or walk or climb,
or fly, they all have milk-producing organs; they all suckle
their young.

And yet there are foreshadowings of lactation far down the
scale of being. The bees and wasps and ants prepare a supply
of food for their young, and the larva on his emergence from the
egg, finds this provision near at hand and amply sufficient for
his wants.

Many birds bring insects and worms to their yet unfledged
young. The swallow and the wren are familiar examples of
this. Nothing can exceed the diligence and assiduity with
which they devote themselves to this important work of artifi-
cial lactation. The pigeon comes still nearer to the mammalia
in this matter, for it supplies to its young an abundance of part-
ly digested food. The fact has not escaped notice, and "pigeon-
milk " is the name of this article of diet.

The truth is, that most animals leave the egg or the womb in
a state of development in which they are unable to obtain and
use the ordinary food of their kind. In most cases their or-
gans of locomotion do not enable them to obtain this food. The
larva of the bee cannot fly, the puppy cannot walk, the monkey
cannot climb, the beaver cannot swim. Nor can they in most
cases masticate and digest such food as their parents use. The
teeth are ordinarily still within the gum, and do not appear for
some time after birth. Most of these animals therefore abso-
lutely require for their sustenance and growth a peculiar food
suited to their actual condition.

What then is lactation ? It is the secreting from their own blood,
in organs then, and then only active, and the furnishing to their
newborn young, a liquid food suited to the various degees of
their development at birth, and the continuing to furnish the
supply, until the young animal has become able to use the ordi-
nary food of his race.

This secretion is continued much longer in some animals than
in others. The young are not born in the same state of develop-
ment. The young of the Marsupials leave the womb while yet
in an embryotic state. The ruminants stand at the other ex-
treme. Between these the other orders range themselves. In
order to fix this fact in our minds, let us compare those animals
with which we are most familiar. Compare the rat, tlie puppy,
the kitten, with the colt, the lamb, the calf. Blindness, weak-
ness and deformity mark the former ; while the latter are able
to see and hear and walk. How soon do the young ruminants
follow their dams, skipping and running as they go. The states
of development at birth are thus seen to vary greatly.

The nature of the future food of the young animal has an im-

256 Substitute for Human Milk. [April,

portant connection with the length of lactation. The digestion
of grass and grain and roots requires more gastric energy than
that of worms and insects and flesh. In conformity with this,
is the fact, that the graminivorous animals furnish milk to their
young until the latter are very much more developed than the
carnivora are when they are weaned.

We have used the word Milk. What is Milk ? It is a gen-
eral term for the various products of the mammary glands of
different animals. It is the name for the food furnished by these
mothers to their young. Milk is a white, obaque, oily liquid,
its color is not pure white, but verging on yellow. In some
animals it is sweet, containing notable quantities of sugar. But
in all it contains three great constituents butter, cheese and
water.

We have said that milk is suited to the wants of the young
animal. It consists universally of two classes of food; oily
materials containing no azote, and caseous substances holding
in combination mineral salts, and admirably adapted to the
growth of the body.

It is suited to the wants of the young animal. What is the
first want of a new-born animal of this class? Warmth. He
has been, during the previous stages of his existence, surround-
ed by tissues of the temperature of 100. He is now out in
the open airf or in still colder water, the heat of his body rapidly
radiated or conducted into these cooler media. This loss of heat
does not lower his temperature, for there is an internal supply.
At the moment of his birth, respiration commenced, and the
oxygen of the air combining with the oil of his body, evolves
heat sufficient to replace that which is lost. But this consump-
tion of oil cannot be long continued, unless the supply be re-
newed. The body will be soon reduced to a state of extreme
emaciation, and death from cold must follow.

A supply of oil is then the first want of the young animal.
The lamp of life must be fed, or it will speedily go out. The
milk contains oil in proper proportion for this purpose. This
oil is butter.

But not only must the vital heat be maintained, the tissues of
the child must grow. The materials for the growth of the tissue
are supplied by the casein or albuminous portion of the milk.
The name casein is applied to a group of substances having an
almost identical chemical composition. Indeed it has until re-
cently been supposed to be identical. But it has been ascertain-
ed by Quevenne, that while their organic composition seems the
same, they hold in combination different proportions of mineral
insoluble salts. Thus, phosphate of lime (the bone earth) exists
in different proportions in suspended casein, in dissolved casein,
in albumen, and albuminose. These four substances also differ

1858.] Substitute for Human Milk. 257

in the effects produced upon them by different agents. Thus,
while suspended casein is coagulated by a small quantity of ren-
net, the dissolved casein, the albumen, and the albuminose are
unaffected by it. Thus, while the albumen is coagulated by
ebullition of the milk, the other three constituents of the casein
are unaffected. Xitric acid produces the same effect without
the agency of heat.

-In the present state of our knowledge on this subject, we can
only say that these four substances, by the action of the gastric
juice, seem to be all converted into albuminose, and to be in this
form absorbed into the system.

Thus constituted, having both azotised andunazotised elements
the milk is suited to supply the wants of the animal, and to pro-
mote his growth and development.

These general statements concerning lactation are applicable
to the function as existing in the woman. An element which
is not universally but very generally found in milk, exists in
human milk in the proportion of 0.075, we refer to the sugar.
Of the uses of the sugar we are not so well informed. There is
reason to believe that it contributes principally to the mainte-
nance of the heat of the body.

AVe come now to the subject of artificial lactation. Some-
times by the death of the mother, more frequently by her fail-
ure to secrete enough milk, the child is deprived of the needed
supply. Something must be done for the famishing infant. In
a few cases, we may have recourse to another woman for the
needed food. Few good nurses, however, can be found. In
the cities, there are by no means enough to supply the demand
for human milk ; in the country, they can scarcely ever be ob-
tained. In this country we can find no permanent, reliable sup-
ply of milk, except that furnished by the cow. The question
is, Can artificial lactation be successfully performed by means of
the milk of the cow? This is a question of great interest to
medical practitioners, as well as to parents.

In using cow's milk as a substitute for the natural food of in-
fants, great difficulties are found. These arise from the differ-
ence of composition of the two kinds of milk thus :

{Butter, 38.59 C Butter, 20.76

Casein, 40.75 While Hwnan Milk is J Casein, 14.34

Sugar, 53.97 composed af 1 Sugar, 75.02

Water, 866.69 ^ Water, 889.88

If we so dilute cow's milk as to reduce the butter to 20.76, we
shall have 21.92 of casein, or 50 per cent, more than in human
milk. This excess of casein leads to serious indigestion, with
consequent gastric and intestinal disorders.

If, on the other hand, we reduce by still farther dilution the
casein to 14.34, we shall have only 13.58 of butter, or less than

258 Substitute for Human Milk. [April,

two-thirds of the proper proportion. This deficiency of butter
does not produce such immediate disturbance as we have stated
to follow the excess of casein, but its permanent influence is
most injurious.

First, because there is a deficiency of the material needed for
the production of heat. If the temperature of the body be
lowered, all the functions languish, and the child is unable to
resist the hurtful influence of atmospheric changes.

Secondly, this deficiency of butter implies a corresponding
deficiency of the phosphureted oil (lecithine) of the milk, the
proper and peculiar nutriment of the nervous system, which ex-
ists in butter in the proportion of 8 per cent, or one-twelfth. If
there be a deficiency of one- third of the butter, there will be of
necessity, a corresponding deficiency of one-third of this phos-
phureted oil. As the child, during the first year of his life,
should take from 1,000 to 1,400 lbs. of milk containing from 20.
76 to 29.06 lbs. of butter, the annual deficiency of this phosphu-
reted oil would be from 0.5536 to 0.7749 lb.; that is, from nine
to twelve ounces. The natural consequence of this deficiency of
nerve food is failure of nervous energy, and imperfect performance
of nerve functions. The various processes languish, and calori-
fication, circulation, absorption, digestion and secretion all feel
the depression.

The proper remedy for these evils, is to provide a milk much
richer in butter than the ordinary milk of the cow. If we leave
a quantity of cow's milk at rest for four or five hours, and then
carefully remove and examine the upper third, we find that it
contains about 50 per cent, more butter than at first. In round
numbers, the butter is to the casein as 57 to 40, or as 100 to 70.
Now this is the relation between these two substances in human
milk. If we then so dilute this new milk as to reduce the casein
to 14.34 thousandths, we shall have 20.76 thousandths of butter.
This is just what we need (with the addition of sugar) as an
accurate imitation of human milk, and, therefore, a good substi-
tute for it.

Take, then, ordinary cow's milk and let it stand for four or
five hours. For a child three months old, 2 \ quarts will be
needed. Take the upper third, (l pints,) and add to it 2 \ pints
of water; sweeten it with the best sugar, of which 2| ounces
will be required. It should be made somewhat sweeter to the
taste than ordinary cow's milk.

A child three month old will take from 48 to 60 fluid ounces,
daily, in six or seven doses of a half pint each.

It should be given from a bottle suction being the only proper
mode of feeding for a young child.

Its temperature should be from 100 to 104. It should be
warmed again if it becomes cool while the child is taking it.

1853.] Substitute for Human Milk. 259

The child should be early trained to pass 6 or 8 hours at night
without feeding.

The kind of bottle, which for cheapness and convenience is
most advantageous, is a plain 8 ounce vial, of an elliptical form.
The artificial nipple is best made by rolling a quill in soft mus-
lin and forcing this into the neck of the vial, leaving about three
fourths of an inch projecting from the neck. The ease with
which the muslin may be unrolled and thoroughly washed, gives
this arrangement a superiority over every other, especially in
warm weather. The quill also may be readily cleaned.

The child should be fed at intervals of three or three and a
half hours. [Regularity in this respect is very advantageous.

During the first month, the child needs food of different com-
position. There should be more butter in proportion to the
casein. In order to obtain this increased proportion of butter,
let the upper eighth of the milk be taken instead of the upper
third. This milk contains from 70 to 80 thousandths of butter.
It should be diluted with 2.6 parts of water.

For a

child from 3 to 10 days

old.

Milk 1000

Water 2643

Sugar

243

"

*

10 to 30

<<

"

<(

2500

(<

225

u

<<

1 month old.

"

"

2250

"

204

it

<t

2

K

"

1850

"

172

tl

<

3

it

tt

1500

<

144

<<

"

4

it

it

1250

ti

124

It

tl

i.

5
6

tl

a

1000
875

it

104
94

II

"

7

tl

"

750

"

84

II

"

9

tt

it

675

f

78

If

n

11

tl

"

625

tt

73

if

tt

14
18

it

tt
it

550
500

ti

67
63

By thus gradually diminishing the proportion of water, we
furnish the child a milk containing an ever-increasing propor-
tion of nutritive matter.

How long should artificial lactation be continued ? The only
answer to this is, " until the child has become able to use ordina-
ry human food." The child should be fed with milk until his
organs of mastication and his powers of digestion render it best
for him to have other food. And at what age does this condi-
tion exist ? Children vary so much in the rate of their devel-
opement, that no answer can be given applicable to all cases.
In a vigorous child the first dentition is usually completed at
two years of age. Sometimes this appearance of the full com-
plement of teeth takes place six months earlier, and sometimes
six months later. Whenever this first dentition is completed,
the child has the full masticating apparatus of childhood, and
may receive other food than milk. In many cases, lactation
must be continued until the age of three years. And it may be
safely presumed, that no food will be found so suitable for the
11*

260 Substitute for Human Milk. [April,

tardily-developed child as that which divine wisdom has prepar-
ed for the purpose of promoting this development. As an
article of food for adults, milk is of great value. Entire races
of men rely upon it, and it seems, when thus largely and per-
manently used, to promote strength and vigor. For the forma-
tion of teeth and bones, its phosphate of lime is indispensable,
and no other food suited to a feeble child contains so much in
intimate union with organic elements.

Nothing has been said of any other mode of artificial lacta-
tion. This omission is not accidental. The truth is, that milk
is the only material that inspires or even warrants any hope of
real success. But this is not meant to say that all children reared
otherwise die, but that good, physiologically good results do
not follow the use of any other food. Children may survive
months of arrow-root or other farinaceous food, but a normal,
healthy, happy, vigorous, steady, ever-advancing development
was never yet attained in this way. The human stomach has
no creative power. The materials must be furnished, or the
building cannot rise. Lecithine must be given, or the nervous
energy declines. Without phosphate of lime, how shall the
teeth and bones be made ?

If we examine the constitution of the blood, we shall find
what materials go to make the human body. What are these ?
Oxygen, hydrogen, carbon, azote, chlorine, fluorine, iodine,
sulphur, phosphorus, silicon, potassium, sodium, calcium, mag-
nesium, iron and manganes. Of these sixteen substances, all
are found in milk. And not only so, but they exist in the milk
in the same combinations as in the blood. Not only have we
chlorine and sodium, but we have chloride of sodium ; not
merely phosphorus and calcium, but phosphate of lime already
prepared for use. Not only have we oxygen and hydrogen and
carbon, but we have ten different oils already existing in the
milk. We have four different protein compounds, each holding
in combination a definite proportion of phosphate of lime. Thus,
and in all probability thus only, can this invaluable, but inso-
luble salt be introduced into the tissues, and give strength and
firmness to the frame. Why, then, with this evident adaptation
of milk to the development of the body, should we look for
other articles of food? Among all the substances now used,
none can make any such claim. Indeed, it may be safely said,
that milk is an article standing alone, prepared expressly for
this one purpose, and challenging all competition.

If the attempt made in this paper to show that the milk of the
cow may be so modified as to suit the peculiar wants and condi-
tion of the infant, has been at all successful, there is ground for
hope that much'suffering may be relieved, and many lives saved.
The subject is one of great importance, and demands the earnest

1858.] Empyema Treated by Injections. 261

consideration of the medical profession. To them the eyes of
anxious and sorrowful parents are turned for help ; if aid can
be given, let it not be withheld. [American Med. Monthly.

Empyema Treated by Injections. By David PsiNCK, M. D., of

Jacksonville, 111.

[The following case presents some analogy to the one reported
in our last number, by Dr. Sternes DeWitt, of Baker county,
Georgia. Dr. DeTTitt reports a definite and very large quanti-
ty of pus. In this case the amount is not designated.

Dr. De Witt treated his case successfully, by large injections of
cold water into the cavity of the pleura, which we would much
prefer to the use of Iodine injections, recommended in the fol-
lowing report : Edts.]

The perusal of Dr. Brainard's case of cure of empyema of the
pleural cavity by injections of iodine (A. II". M. and S. Jour, for
November), has induced me to record a case of mv own in your
valuable Journal.

Little Henry Lurton, aged four years, the third child of heal-
thy parents, and of healthy constitution himself, had an attack
of pleuritis of the right side, and was left entirely to the aid of
the vis medicatrix nature?, under the guise of infinitesimal doses
for about six weeks, when, on the 2Sth of J;<nuarv, 1856, I was
called upon for surgical interference.

At this time the enlargement of the right side was very obvi-
ous to the eye, and the sound was dull on percussion.

Frequent and quick pulse and daily fever and nightly sweats
were present, while the little patient could breathe only in the
sitting posture, and his sleep was in the rocking chair.

A considerable quantity of pus was discharged through the
canula left in the orifice made by the trochar, giving immediate
and inexpressible relief.

Feb. 9th. The puncture had not been kept open, and the
demand for a second puncture became urgent. The amount dis-
charged was somewhat smaller than before. The opening was
from this time prevented from closing by the daily introduction
of a tent, upon the withdrawing of which, a considerable quan-
tity of ill-conditioned pus would be discharged.

As nature seemed not to be making good progress with the
case, it was resolved to see if the behaviour of iodine would be
as good here as in other cavities. On the 25th of March, two
drachms ( 3ij) of strong tincture of iodine were thrown in by a

262 On the Escharotic Treatment of Cancer. [April

small glass syringe. This was done after the tent had been with-
drawn, and the pus collected during the preceding twenty-four
hours had pretty well escaped ; the tent was again introduced as
usual, to be daily withdrawn as before.

The injection was repeated at intervals of about a week, for
five times, when the discharge had pretty much ceased. The
respiratory murmur could be heard throughout the whole ex-
tent of the lung ; all sign of disease has disappeared, and by the
middle of May the boy was at play with his top. [Chicago Med.
Journal.

On the Escharotic Treatment of Cancer. By Professor Syme.

After some sour comments upon Dr. Fell's mode of treating
cancer, and upon the conduct of the surgeons of the Middlesex
Hospital, in allowing so irregular an experiment to take place
under their auspices, Mr. Syme proceeds to state his own opin-
ion upon the escharotic treatment of cancer and to offer certain
practical rules upon the treatment of cancer generally.

"If," he says, "caustic is ever used for destroying malignant
textures, it should, therefore, be of such power and so employed
as to strike at once to the root of the evil, and I am able to sug-
gest efficient means for this purpose.

"Mons. Yelpeau, in speaking of the caustic made by mixing
sulphuric acid with saffron, expresses his persuasion that it would
be the best of all escharotics except for its expense and the diffi-
culty of confining its action within certain limits. It occurred
to me that sawdust would supply the place of saffron, and my
assistants at the hospital ingeniously devised the following ef-
fectual means of restraining the extent4 of action. A solution
of gutta percha in chloroform is applied to the skin for some
distance around the part to be attacked ; then a thick piece of the
same material, with an aperture cut in it of the requisite size,
and softened by exposure to heat, is pressed firmly so as to ad-
here everywhere to the surface thus prepared ; a thin piece is
next glued round the edge of the opening, so that, when support-
ed by a stuffing of lint, it may form a wall enclosing the diseased
part. Concentrated sulphuric acid, with about an equal weight
of sawdust stirred into it, until the admixture assumes a homo-
geneoes consistence equal to that of thin porridge, is lastly ap-
plied, in quantity proportioned to the extent of thickness con-
cerned. In the first instance, as the pain is acute, opiates or
chloroform may be used ; but after a short while, so little uneasi-
ness is felt that the patient can easily allow the caustic to remain
for ten or twelve hours, when it will be found that the whole
diseased mass, though covered with skin and several inches in

1858.] Syrup of the Superphosphate of Iron. 263

depth, has been reduced to a cinder, presenting the appearance
of strongly compressed tow. Under poultices, the slough sepa-
rates in the course of days or weeks, according to its depth, and
the sore then heals without any trouble. If, therefore, patients,
from an unconquerable dread of cutting, should prefer the
escharotic treatment, or if the circumstances, on any other ac-
count, should seem to render this method eligible, the procedure
just described may be found useful.

11 In conclusion, I beg to offer the following principles or prac-
tical rules for the treatment of cancer :

"1. The treatment of cancer may be divided into curative and
palliative.

11 2. The curative treatment should not be undertaken when
the local disease is so seated or connected as to prevent its com-
plete removal ; when the lymphatic glands are affected ; and
when the patient's general health is deranged.

"3. Removal may be accomplished by means of the knife,
escharotics, and ligatures.

" 4. Of these means, in general, the knife is best, and ligatures
the worst.

"4. Escharotics may be used with most advantage when the
disease is superficial.

" 6. Escharotics, employed with a curative view, should al-
ways destroy the whole morbid part by one application.

" 7. The palliative treatment is generally best accomplished
by means of soothing applications and attention to the general
health.

11 8. When the local disease is very troublesome, it may some-
times be relieved for a time by destruction of the morbid growth.

"9. The best agent for this purpose, and also with a curative
view, is concentrated sulphuric acid properly applied." [Edin-
burgh Med. Jour., and Banking's Abstract.

Syrup of the Superphosphate of Iron. By Alexander Cush-

MAN.

The very favorably mention made in the European Medical
Journals, of this new remedy induced some of our physicians to
send out during the past year, and obtain a supply for the pur-
pose of testing its effects.

The result was so far satisfactory that many others wished to
introduce it in their practice, and the English supply being ex-
hausted, I found it necessary to prepare it myself, which I did
according to the formula of Mr. Greenish, of London, as specified
in the U. S. Dispensatory, under the article on Ferri Phosphati.
A paper in the American Medical Gazette for January, also

264 Syrup of the Superphosphate of Iron. [April,

brought it more generally before the profession here, and it ap-
pears to be attracting much attention wherever it is heard of.
Hitherto the precipitated phosphate of iron has been but little
employed owing to its repulsive color, but when as at present
it is dissolved in an excess of phosphoric acid, and formed with
sugar into a clear white syrup, as inviting to the eye as agreea-
ble to the taste, there is reason to anticipate that its use will
become very popular.

A careful and somewhat troublesome manipulation is requisite
in the preparation of this syrup, in order to produce a perfect
result. There is a strong tendency to reaction between the sugar,
and the acid, which will sometimes cause a precipitation of the
iron, sometimes a granulation of the sugar, and sometimes a
partial decomposition of the latter, resulting in a reddish or
brown color, more or less dark. Experience and care in regula-
ting the heat only will prevent these accidents. When however,
once perfectly formed, there is no tendency to decomposition, as
it is not affected by the atmosphere or by light, nor does it show
any disposition to ferment. The variable quality of the phos-
phoric acid of the shops, is also a fact to be guarded against.
Out of twenty-three parcels which I have examined, only four
have proved to be of standard strength. That this is no unusual
case, may be seen by comparing the following analyses, showing
the proportions of Anhydrous acid and water in the specimens
examined by four different authors.

Kose. Peligat. Dulong. Berthol.

P.O. 92-790-52 .... 8745 .... 82-92 .... 75
H.O. 7-3 948 .... 12-55 .... 17-08 .... 25
If the acid used is not of sufficient strength to dissolve the
phosphate of iron immediately, it forms an insoluble white com-
pound, probably the tribasic phosphate which cannot be made
use of. On the other hand, an over excess of acid renders the
resulting syrup disagreeably sour, and of course gives an uncer-
tainty to the preparation which should not exist, besides increas-
ing the likelihood of decomposition in the sugar. Each new
parcel of acid should therefore be tested before use, to determine
the exact amount required to neutralize a given quantity of the
precipitate phosphate, before proceeding to make up any large
amount.

It may not be amiss in this connection, to quote a few of the
cases given under the authority of Greenish as showing the pe-
culiar class of diseases in which the superphosphate of iron has
been successfully administered in England.

" Case 1. A University Student, very weak, emaciated with
loss of appetite, diarrhoea followed by obstinate constipation of
frequent occurrence, palpitation of the heart, loss of memory,

1858.] Syrup of the Superphosphate of Iron. 265

countenance sallow, frequent headache, which would continue
for hours, and quite incapacitate him from mental exertion. The
syrup of the superphosphate of iron was prescribed three times
a day. In about ten days he expressed himself to be an altered
man; the headache had not recurred, his apetite improved, his
strength was greatly increased indeed, in about a month he
was perfectly well, and was enabled to compete, and successful-
ly so, for several prizes which in his former state would have
been quite impossible. He has continued well ever since.

" Case 2. A young lady had for some time suffered greatly
from painful and defective menstruation ; her general aspect was
palid, with a marked green tinge. There was great pain and a
sensation of sinking in the back with copious leucorrheal dis-
charge, great headache, especially in the erect position or walk-
ing. For these reasons, she was unwilling to exert herself; she
complained much of languor, and it was said by those acquaint-
ed with her, that of late she had become very dull of apprehen-
sion ; she had no appetite, could not take animal food, and what
she did take always laid heavy on her stomach ; constipation
was always more or less present, except when she took power-
ful purgatives, which very much weakened her. The syrup
was prescribed in doses of a teaspoonful three times a day. In
about a week she was much improved, and by the end of a
month the menses recurred without pain, and in larger quantity
than she had seen for weeks. From that time all her disagreea-
ble symptoms had disappeared, and she has continued well ever
since.

" Case 3. A young man, suffering from carious softening of
one of the bones of the wrist, and who had been long under med-
ical treatment, as a last resource was recommended to take the
syrup of superphosphate of iron. He did so with the greatest
success. The wrist was subsequently injured a second time in
playing cricket, and the disease recurred ; he was again ordered
to take the syrup of the superphosphate of iron, and the disease
was again arrested, and the use of the wrist completely restored
in a short time.

" Case 4. A child two years of age, was affected with weak
ankles, and to such an extent, that his walking powers were
materially interfered with ; his feet turned in and upon them-
selves continually. The syrup was suggested and tried, and in
the course of a very short time, the ancles appeared to have ac-
quired much power, the child being enabled to walk perfectly,
uprightly, and firmly, upon them ; the case indeed progressed
to a perfect cure in about a month."

266 Syrup of ilie Superphosphate of Iron. [April,

These cases tend to establish the truth of the theory, that the
waste of nervous energy and mental power occurring in many
diseased states of the system, arises from a deficiency of phospho-
rus and iron in the tissues of the brain and nerves, which this
preparation is calculated to supply most promptly and adequate-
ly, presenting those substances, as it does, in a state of chemical
combination most easily assimilated by the blood.

It is certainly known that iron and phosphorus are among
the most important constituents of the body.

" The brain consists essentially of phosphoric acid and oil, and
a due proportion of the first is necessary to the integrity of the
mental functions. Iron exists in the blood as a phosphate, but
the digestive powers are sometimes so weakened that they cannot as-
similate other preparations of iron, and convert them into the phos-
phate required.11 " In some cases of weakness the amount of the
phosphates excreted, is so much greater than that contained in
the food taken, that the phosphates of the living tissues are preyed
upon for a supply ', especially the brain, the richest in phosphorus
of all the organs. Hence madness, loss of memory 1 and various
other disorders of the mental organization."

u As in tubercular disease the fatty tissues are preyed upon,
and cod-liver oil, and other highly carbonized substances, have
proved useful in supplying the waste, so there are cases where
the superphosphate of iron may act in a similar manner, by giv-
ing directly to the system the amount of phosphorus and iron
necessary to prevent any injurious overdrain, and allowing time
for recuperation by the natural forces."

The proportions of the syrup used in the above case, as of
that prepared by myself, are forty grains of the phosphate of
iron to each fluid ounce of syrup. This gives the full dose of
five grains of phosphate to the teaspoonful, or fluid drachm. Its
effects, as I have been informed by several of the physicians who
have already tried it, are remarkably prompt in this dose. For
children it is sometimes diluted with two or three times its bulk
of simple syrup flavored with orange flower water, or with gin-
ger or some agreeable fruit syrup. All the bitter and astringent
tinctures and infusions unite with it without decomposition, so
far as I have tried them, so that tincture of cinchona, rhatany,
&c, may be prescribed with it in any desired proportion. Add
to these facts that it does not injure the teeth or blacken the
stools, and it presents advantages simply as an eligible mode so
administering iron, apart from the theoretical claims adduced
above, which must give it a high place. [Am. Druggists1 Circular.

[We feel much inclined to say here to our readers "Bead
this again." It certainly presents matters of weighty importance
for our consideration. Edts.]

1858.] Abdominal Typhus of Children. 267

On the Abdominal Typhus of Children. By Dr. Edmund Fried-
rich, of Dresden.

The following analysis of Dr. Freidrich's work on "Der
Abdominal Typhus der Kinder," is from the pen of Dr. E.
Noeggerath.

u The author," writes the reviewer, "having been for some
years house-physician in the hospital for sick children of Dres-
den, Saxony, has made a collection of observations relating to
typhus fever in children, which were taken partly from personal
experience, partly from notes recorded in the day-books of the
hospital. It comprises an analysis of 275 cases of typhus fever,
occurring during twenty -one years, in a number of 14,868 chil-
dren, which makes 1 out of 54, and speaks sufficiently for the
importance of the disease in this age of life.

" In the historical portion of the work, the author points out
the fact, that an accurate knowledge of this affection was first
derived from German and French physicians, while there exist-
ed, even now, pretty incorrect notions of this disease among
English authors, with the exception of Dr. Underwood.

" The following sections comprise very interesting and thor-
oughly elaborated articles, in regard to statistics, etiology, symp-
tomatology, course, complications, diagnosis, prognosis, and
treatment of the disease. In all these particulars, we find the
author has fulfilled everything that could be expected of a man
of his diligence and skill. In order to give the reader a correct
idea of the work, we will endeavor to present' a condensed state-
ment of its contents, and the conclusions to which it leads.

" 1. Abdominal typhus is by no means a rare disease among
children, and is observed among them in a sporadic, as well as
in an epidemical form.

"2. It more often attacks male than female children.

"3. The number of fatally ending cases is smaller among
children than among grown people ; and, again, greater among
female than male patients.

u 4. In the very first years of life the disease is rare ; becomes
more frequent from the second year, and reaches its greatest ex-
tent from the sixth to the eleventh year. From that it decreases
again up to the time of puberty ; mortality is greatest from the
first to the fourth year.

"5. Boys generally die sooner from the disease than girls,
because the fever commonly has a more rapid development
among the first.

" 6. Abdominal typhus and scarlet fever exclude one another,
so that while one of these epidemics is raging, the other disap-
pears, or is seen only in isolated cases.

k. s. vol. xrv. no. rv. 12

268 Abdominal Typhus of Children. [April,

"7. Typhus epidemics have been observed in small circuits,
which seized exclusively upon children, while grown persons
were not taken at all, or only in some isolated instances.

"8. The pathological lesions among children are about the
same as in grown persons, especially in regard to enlargement
of the spleen. But in children there is very rarely found a de-
posite of material in the intestinal tube, or genuine typhus ulcers.
There are generally found only a few single infiltrated follicles
in the glandular placques, which return to the normal condi-
tion, without even leaving a cicatrix, by a resorption of the
infiltrated matter, or, more often, by rupture of the follicle open-
ing into the intestinal tube. The rupture and discharge into
the intestinal canal is generally observed only to a small extent.
Moreover, the formation of ulcers in the mucous membrane of
the pharynx, oesophagus, trachea, &c, is of rare occurrence
among children.

" 9. As decided causes of the disease, we have to consider
poverty, uncleanliness, improper food, and, above all, impure
air, and a damp, dark abode. Moreover, acclimatization, sud-
den change of the former mode of living, entrance into new
conditions of life, have their influence upon the origin of the
disease. Still, the most important point is the character of the
epidemical constitution. Scrofula seems to be not favorable for
the development of typhus fever among children.

" 10. The most reliable symptoms are the tumor of the spleen,
diarrhoea, meteorismus, and the abdominal gurgle. Fever, ac-
celerated respiration, and catarrh of the bronchial tubes are
equally constant symptoms. The scarce and trifling intestinal
hemorrhages at the beginning of the disease establish the fact,
that the local disease is unaccompanied by a severe congestion.
Seldom does the typhus fever of children invade with chills, as
is the case with grown people. Delirium and drowsiness are
generally present, but not very intense. Koseola is often ob-
served, not so much a papulous eruption, and at a later period,
sometimes miliaria are seen. The extent of the exanthema does
not seem to depend upon the intensity of the disease.

" 11. Abdominal typhus generally appears in a milder form
among children, its duration being from sixteen days to several
months.

"12. Its complications with parotitis, phlebitis, and hemor-
rhages, are far more seldom odserved in children than in grown
persons. During recovery, measles, smallpox, and other erup-
tions may be developed,

"13. The most common termination is recovery, which gen-
erally proceeds very fast, while tuberculous, gangrene, intestinal
ulceration, abscess, or atrophy of the mesenteric glands are
of rare occurrence among children. Tubercles, if present in

1858.] Acute Internal Inflammation. 269

small quantities, seem to be liable to calcination during typhus
fever.

" 14. The most important points in diagnosis are the enlarge-
ment of the spleen, the roseola, the increased temperature of the
skin, the diarrhoea, the meteorismus, the painfulness about the
abdomen, the coecal gurgle, the bronchial catarrh, the symptoms
of cerebral disturbance, and the prevailing epidemic.

"15. The following symptoms are of the greatest importance
in prognosis, which is generally favorable : the character of the
epidemic, the external conditions of life, age, and sex. Compli-
cations and remaining diseases prove often more dangerous than
the fever itself in its greatest intensity.

"16. Experience has taught that the expectant treatment is
the best that can be pursued. It is impossible to cut short ty-
phus fever ; still, medium-sized doses of calomel, given from the
fifth to the eighth day of the disease, have a decidedly good
effect upon its course. Under all circumstances, we must spare
the strength of the children, and let them have nutritious food
in good season." [N. Y. Jour, of Med., and Banking's Abstract.

Remarks upon the Treatment of Acute Internal Inflammations. By
R B. Todd, M. D., F. R. S., Physician to the King's College
Hospital.

The case of Jane Cook, aged twenty- two, affords a good illus-
tration of the phenomena of disease in its most acute form. She
has had pericarditis in connection with rheumatic fever, some
degree of endocarditis, and pneumonia with consolidation of
about a fourth of the posterior part of each lung.

This patient is rapidly recovering, and, indeed, in an illness
of unusual severity, she has had no serious drawback. On the
2nd of July rheumatic symptoms first showed themselves in pains
and swelling of the lower joints. On the 6th of July a pericar-
dial friction sound was first heard over the base of the heart,
which soon became distinctly audible over its whole anterior
surface. On the 7th bronchial breathing was heard at the pos-
terior part of the lower third of the left lung, and on the 10th
the right lung was similarly affected and to an equal extent.
On the 12th vesicular breathing began to be audible in both
lungs, and the bronchial breathing to disappear.

Now this patient was treated in the manner in which (with
but slight modification) I have been for some years in the habit
of dealing with similar internal inflammations, especially those
of the lungs and heart. Although my practice in such cases is
now pretty well known, and I am proud to think is practised by

270 Acute Internal Inflammation. [April,

very many of my pupils in various parts of this city and of the
country, it may be useful if I take this opportunity of explaining
to you the principles upon which it is based.

On admission, while yet it was uncertain how far the rheuma-
tic symptoms would extend, she was treated with alkalies and
mild saline purgatives. Bicarbonate of potass in doses of from
twenty to thirty grains were given every four or six hours, and
very soon opium was freely given, when the cardiac affection
manifested itself. As much as one grain of opium was given
every fourth hour. Care was taken to keep the bowels open by
giving an aperient draught daily of sulphate and carbonate of
magnesia. Counter irritation was employ d over the situation
of the inflamed lungs by means of stupes of flannel soaked in
turpentine ; these were applied twice or thrice a day, and the
region of the heart was freely blistered.

A principal and very important part of the treatment to
which, as most of you know, I pay very special attention, is that
which I may call the dietetic portion. The object of this is to
support the vital powers of the patient and to promote general
nutrition, during the time when those changes are taking place
in the frame which tend to check or to alter the morbid process,
and to convert it into a healing process.

When a patient suffers from pneumonia, the tendency is for
the lung to become solid, then for pus to be generated, and at
last for the pus-infiltrated lung-structure to be broken down and
dissolved. Such are the changes when matters take an unfavor-
able course. On the other hand, recovery takes place, either
through the non-completion of the solidifying process, or by the
rapid removal, either through absorption, or a process of solution
and discharge of the new material, which has made the lung
solid.

It will scarcely be affirmed, even by the most ardent believer
in the powers of the Therapeutic art, that any of the measures
which are ordinarily within our reach, such as the administra-
tion of certain drugs, or the abstraction of blood, or the applica-
tion of blisters, exercise a direct influence in effecting these
changes. Save in the case of antidotes, which directly antago-
nise the proximate cause of the morbid state, medicines promote
the cure of acute disease by assisting and quickening some natu-
ral curative process. And he is the wisest practitioner, and will
be the most successful therapeutist, who watches carefully the
natural processes of cure in other words, who studies the phe-
nomena, both anatomical and physiological, which accompany
them, and of which, indeed, they consist.

Let me therefore, exhort you to look very carefully to this as
a part of your clinical study. If you will be on the look-out, you
may often meet with cases of acute disease which recover with

Acute Internal Inflammation. 271

little or no medical treatment, and von may observe and note
the clinical phenomena which they exhibit.

Allow me to anticipate your observation on this point, and to
point out what you may look for in cases of pneumonia, and
what you will certainly find in almost every instance.

First, the hot, often burning skin, which is so generally pre-
sent in the first stages of pneumonia, will be exchanged for one
bedewed with moisture, generally to the extent of free sweating.

Secondly, along with this sweating process there will be one
of increased flow of urine, and very often a free precipitate of
brick-dust sediment, lithate of soda, more or less deeply colored.

Thirdly, not unfrequently expectoration becomes freer, the
sputa are more easily discharged, they lose their characteristic
reddish, rusty color, and often they become very profuse and
even purulent. Now and then the purulent sputa are so abun-
dant that it is difficult to imagine that they can have come from
any other source than an abse

Fourthly, the chemical characters of the pneumonic sputa ex-
hibit an interesting contrast with those of the urine. In the
heights of the inflammatory state, the sputa contain common
salt (chloride of sodium) in abundance, andthe urine is entirely
devoid of it. As the inflammation becomes resolved the salt
returns to the urine and leaves the sputa.

Lastly, while all these changes are going on, the physiological
functions which have been disturbed by the local malady, grad-
ually approach their normal state. The quickened breathing,
the accelerated pulse, the unnatural general generation of heat
gradually subside. As all these admit of being measured by
numbers, you should tabulate them in your records of cases,
and you will find on each succeeding day (under such circum-
stances as I am now referring to) the figure assignable to each
function gradually become lower until you arrive at the normal.

Xow is it not plain from all this that the process of resolution
of pneumonia is a distinct natural process, afiected by the vari-
ous physical agencies which are concerned in the nutrition of
the lung ? A material with clogs the air cells and minute tubes
is removed, chemical changes of the most marked and obvious
kind accompany the deposition and the removal of this material,
and certain functions of excretion become strikingly augmented,
as if for the purpose of getting rid of some noxious matter out
of the circulation. A more exact and minute analytic chemis-
try than we have at present will, at some future time, beyond
doubt, detect more minute changes in the blood, and determine
the exact nature of the discharged matters.

One other remark I must make in connection with this sub-
ject. These acute internal inflammations are very often I sus-
pect always connected with the undue prominence of some

272 Treatment of Phagedenic Ulcers. [April,

peculiar diathesis the gouty or the rheumatic, for instance
sometimes the scrofulous. Of these diatheses the main charac-
teristic is the generation of some peculiar morbid matter which,
when accumulated in undue quantity in this or that organ, gives
rise to inflammation in it. And the determination of the mor-
bid matter to the lung, or the pleura, to a joint or a muscle, will
often depend on the direct influence of cold, or of an unwanted
amount of exercise, or of some mechanical injury. The evil is
to be remedied by the diminution of the intensity of the diathe-
sis. This is done naturally, and is to be imitated artificially, by
the elimination of the morbid element through the channels of
augmented excretions, such as the sweat, the urine, and the se-
cretions of the alimentary canal.

You will perceive, then, that my argument may be thus
summed up. Internal inflammations are cured, not by the in-
gesta administered, nor by the egesta promoted by the drugs of
the physician, but by a natural process as distinct and definite
as that process itself of abnormal nutrition to which we give the
name of inflammation. What we may do by our interference
may either aid, promote, and even accelerate this natural ten-
dency to get well ; or it may very seriously impair and retard,
and even altogether stop, that salutary process.

If, then, this view of the nature of the means by which inflam-
mation is resolved in internal organs be correct, it is not unrea-
sonable to assume that a very depressed state of vital power is
unfavorable to the healing process. Indeed, if you watch those
cases in which nothing at all has been done, or in which noth-
ing has been done to lower the vital powers, you will find that
the mere inflammatory process itself, especially in an organ so
important as the lung, depresses the strength of the patient each
day more and more. [Archives of Med., and Amer. Med. Monthly.

On the Treatment of Phagedenic Ulcers by Irrigation. By Dr. J.
Sutherland, Surgeon to the 8th Kegiment of Native In-
fantry.

When Dr. Sutherland was putting this mode of treatment in
practice in the regimental hospital at Dinapore, he was not aware
that a similar mode of treatment had been adopted by Mr. Cock
at Guy's Hospital (v. " Abstract," XXIY. p. 120). Dr. Suther-
land was led to adopt this plan of treatment by an observation
of the case first in order.

Cases. A young soldier, a Seikh, had been under treatment
for intermittent fever with enlarged spleen, and was taking
iodide of iron and quinine ; at this time a slight sore situated
over the spleen took on a phagedenic character, spread rapidly,

1858.] Treatment of Phagedenic Ulcers. 273

and threatened to involve a large portion of the abdominal pa-
rietes ; the usual treatment, constitutional and local, was adopted,
with little effect in arresting the spread of the ulceration ; there
was considerable fever and great pain in the dark and inflamed
ring around the sore, nitric acid had been applied without effect,
and the patient was very importunate for relief; morphia was
given at bed- time to allay pain and procure sleep ; under these
circumstances it occurred to me that benefit might be derived
from a continuous washing away of the morbid discharge as it
was formed, and that water, made slightly warm, would be a
bland application to the extremely irritable sore; accordingly I
decided on having a continued dripping of tepid water over the
foul ulcerated surface ; [this was effected by allowing the water
to flow along a skein of thread, one end being placed in a vessel
of water above the level of the bed, another end of the thread
(or, what answers the purpose nearly as well, a strip of calico)
being placed over the sore.

The result of this treatment surprised me ; an almost immedi-
ate arrest of the phagedenic ulceration took place, and pain and
irritative fever quickly abated ; from this time the cure was ra-
pid, the sore granulated kindly, and in about ten days a large
ulcerated space was filled up with healthy granulations.

The second case in which the remedy was used was equally
satisfactory ; the patient, a weak young man of a strumous dia-
thesis and a constitution tainted with syphilis, had a bubo in the
left groin, extensive sinuses (in the groin), had been laid open
and the sore was healing favorably when it suddenly took on a
phagedenic character and spread in all dir actions, forming an
extensive sore, which, extending upwards, threatened to pene-
trate the abdomen ; having observed the satisfactory result of a
continuous dripping of water over an ulcerated surface in the
case above detailed, I was led to subject this patient to the same
treatment; the result was equally gratifying, an immediate arrest
to the spread of the ulceration took place and the sore healed
rapidly ; quinine, ammonia, with tinctura opii, which had been
given some days previous, were continued for a short time, but
no other local remedy was used to complete the cure.

The third case was that of a sepoy of the 1ST. I.; this man

was admitted into the station hospital with an extensive ulcer
on the right hip of eighteen months' standing ; according to the
statement of the patient, he had been fourteen months under
treatment in his regimental hospital, and, all applications hav-
ing failed to heal the sore, he got leave to visit his home that
change of air might do him good ; the sore becoming worse, he
applied for admission into the station hospital in this place ; the
ulcer was superficial, with jagged edges and unhealthy flabby
granulations ; there were several small, deep, foul ulcers around

274 Treatment of Cicatrices from Burns. [April,

the large ulcer, at distances varying from one to five inches ; the
patient was, at first, very unwilling to submit to the treatment
(as it required him to lie in a constrained position), asserting,
with much appearance of truth, that he had not benefited by all
that had been done for him before ; he has been under treat-
ment since the third instant, and the large sore has completely
healed under the irrigating system, all the smaller ulcers have
also healed, with the exception of two that could not be subject-
ed to the treatment, owing to their position.

I think it probable, from the nature of the ulcers, that the ad-
dition of sulphas zinci or nitras argenti to the water would have
expedited the cure, but I was unwilling to make the addition,
as I wished to try the action of pure water alone on the sores.
[Indian An. of Med. Science, and Ranking\s Abstract.

On the Treatment of Cicatrices from Burns. By Mr. Skey, Sur-
geon to St. Bartholomew's Hospital.

On a recent occasion, we had an opportunity of seeing the
plan adopted by Mr. Skey, at St. Bartholomew's Hospital, for
removing the contraction of tissues consequent upon a burn.

The patient was a little girl (Emma B , set. 6 years), the

front of whose neck had been burnt some years before, and had
so contracted as to produce a number of distinct bands, running
from above downwards, without very great deformity. The
contraction resulting from the burn was treated, whilst the girl
was under the influence of chloroform, by making a number of
short transverse incisions in various parts of the cicatrized tis-
sues, which gaped as they were made. This plan Mr. Skey has
found very efficacious in some eight cases, all of which have
done very well. It has certainly the advantage over dissecting
up portions of cicatrized skin, in that there is no danger nor risk
of sloughing an accident which not unfrequently makes a case
worse than if nothing whatever had been attempted.

On a subsequent visit, we found these transverse healing well,
without any appearance of contraction of the cicatrix. She lay
upon a flat bed, with her head considerably lower than the
shoulders, and the wounds are dressed with narrow pieces of
strapping, so as to approximate the ends of a cut to each other
not the sides and lengthen out the old cicatrix as much as pos-
sible. [Lancet, and Ibid.

Diphtheritic, or Malignant Sore Throat.

Benjamin Godfrey reports four cases of this disease, and be-
lieves the order, in which its symptoms generally occur, to be
this: Shivering; intense depression; dryness and tingling of

15:-5 " P"-'- : " ."""- :~ v>i -.',-:::'. .:/'..",:':: :~ m^m:.m; _"'

fli^* l^EKMfcl^ nares alio! <f^rs :

whitish spot on die manual membmneof

deepening in color bb Ike

dLstkse appears to u?. Godfrey no

membrane, neither iimdiing lac

tore. The glandular enllargemondi is

tk. Its dsagsftosfae diffiaeoce from

L Tne absence of all ferer, i Absence of ill not, S. PapOba

c:me :;::- m; :^::0 ~ >\ iesmmmmm ::' me :m__e

me: me m>v;.m ....fires :zi m mmmme v.z.: imf me ms:m:f

:;m_f 7.-:mm me":mml mi ': mm :i> ~m :m : :: -_r_ .mmm.:-

-r~'::^r. mi if ;mmm so.mr:.: mm :07mm r Im m-
:re:m mi :m.i iem-ess;::: if .mm mm_ec :~ me :e;:ef:mm ::

r- * :-r~ "' sdrl-: mrer. ::me :oi-mse ::' -L^...l. 'm mm

:,:-::: mm i.:C mmmm :.: mo mm. :.i:::^:i mi iimmi
aspn jnria. The mam point in the treatment k to aajupiMt Ac
:..^.i-'i 10-mrs, :t rmmmmif ,:: :::::^ mi :.: meoi: mf
mrmi :f:m mmme m :m immmmm :: :m 5r;:: romeom

;mi:m:'s pmu-eos is :m mmm: mm ii_r i;.-f-;mm mi me if-
l-:esmm.~7mm ,:o;m: ioime me l-r^v_ :=*. mm:; resm;
mm: -o: mmi :01m; mmmmm ,c;v,:C "1 _mmmm ;: me mi-
m"_s emmoi .is 1 mmjmi s-mm.m m erem mm _ :. momej
believes die tinctnre of a^nkMoride of iron die best remedy.

Onf^e Pr&xaJs^^^ By Pm

Dbsoubaix

Professor Beraobaix, Suigeon to d St Jea% BraoBel^

iiims 1 series ;: imors ';::: mis si mo; "-mi. me :':'_:vz:

1. ItktodnfrofasaigeQmtoaeehv ty the hmpranremart of

m memm.-e mm :im<. :.; :"m.me me mms" m:me-is ::'
memmim me eiiem:: ;.; mooveo me zem :: irmemim ::
me s-:::rv .mi: i mm ~'i:.:z me im rmre imoemm is smi
imme imjormism immieo 1; im imis.

2. Ooold the great amgical opemtMins be rendered fern dan-
gerens in diomadfo^ inserrentLoa c* szr^rr womb] b?
much, more deudy and more fiwjnenisi'T m&sstec i
tbe praetiao^ex now often is obfrgnd to remain a
:m ;:' i:-;:-ier< v.-r.m imij m-me :m

S. Tke dajager of great perij^^
sanaces concerned, bat to the nnmber and Tomine of the

276 Prevention of the Ill-consequences of Operations. [April,

4. When the division of veins proves mischievous, it does so
by giving rise, through a mechanism the nature of which it is
not always easy to appreciate, to the production of purulent in
fection, one of the most fearful consequences of traumatic lesions.
The great danger and extreme frequency of this complication
justify the efforts made for its prevention or removal.

5. There are two directions, both perhaps equally good, by
following which we may succeed in rendering pyaemia of much
less frequent occurrence. The first of these consist in improving
and rendering less uncertain the process of healing by the first
intention ; and the second in so modifying the divided surfaces
as to convert them into a lesion of continuity of far less danger-
ous character.

6. Metallic caustics, at least in the immense majority of cases,
do not give rise to purulent infection ; but they are not applica-
ble to certain operations as, e.g., amputations.

7. It is rational, then, when seeking for substitutive or modi-
ficatory means for the prevention of pyaemia, to resort to such
as most resemble caustics in their mode of action, and yet are
exempt from the disadvantages of these therapeutical agents.

8. The tincture of iodine would seem to possess properties en-
abling it to fulfil these indications, seeing the deep-seated modi-
fication it impresses on the tissues, and the plastic effects it gives
rise to. It does not act upon the ligatures, and therefore does
not give rise to the danger of secondary hemorrhage. When it
is applied to bleeding surfaces after an operation, it induces a
general hyposthenic effect of short duration, and a local hypos-
thenic effect, which imparts peculiar characteristics to the gran-
ulations and cicatrization.

9. The most remarkable results of this hyposthenization are,
the much less indolence of the wound, the slight amount of
suppuration, the notable diminution of the general reaction, and
the maintenance of a condition approaching that of health.
These phenomena offer no impediment to rapid cicatrization.

10. The discharge from the surface of the wound is consider-
ably diminished as a consequence of the application of the tinc-
ture ; but this does not prevent artificial hemorrhage, or the loss
of blood from the large veins.

11. The putridity of the wound becomes evidently diminish-
ed ; and when the tincture is applied to the divided extremities
of the veins, these become corrugated and narrowed, and then
agglutinated. If phlebitis arises, it is obliterative and adhesive,
not suppurating.

12. The application of the tincture to the sawn surface of the
bones does not lead to necrosis.

13. The tincture imparts no preservative power against pyae-
mia when an open venous orifice, through which pus may be

1858.] Treatment of Ununited Fracture. 277

easily, so to say, mechanically introduced, exists at any point of
the surface.

14. In ordinary cases, even the tincture is no certain prevent-
ive of purulent infection. When, after it has been applied, we
find the vicinity of the wound remaining very painful, we
should suspect a commencement of phlebitis, and the course of
the pain should be carefully inquired into.

15. It should be remarked, that as the general hypostheniza-
tion which results from the application of the tincture exhibits
itself in symptoms, comparable to a certain point to those pro-
duced by chloroform, prudence is required in the simultaneous
or successive employment of the two substances. Perhaps this
is the principal defect of the iodine.

16. The injection of the tincture into the veins is immediately
fatal. It induces an entirely peculiar coagulation of the blood,
incapable of being confounded with any other pathological or
spontaneous coagulation.

17. Nevertheless, this medical substance cannot, when applied
to a bleeding surface, be carried in substance into the current of
the circulation, unless, indeed, venous orifices be maintained
open by adhesions. It is absorbed in the state of an alkaline
iodide, and may be found in such a state of combination in the
blood and urine. The amount ordinarily absorbed exerts no
ill-effect upon the economy. [Presse Med. "Beige, Med. Chir. Bev.
and Banking's Abstract.

On the Treatment of Ununited Fracture. By Mr. Syjie, Professor
of Clinical Surgery in the University of Edinburgh.

" When there is merely a slight degree of mobility at the seat
of injury, so that, although quite sufficient to prevent any useful
exercise of the limb, it may require some care for its detection,
there will be a favorable prospect of success, even after the ex-
piry of several months, through the employment of means for
the complete prevention of motion ; and I have put upon record
cases in which even the thigh-bone was rendered perfectly rigid
by this simple expedient, in circumstances of apparently a very
hopeless character, from the long duration of flexibility. But
when the extremities of the bone remain quite separate, or even
overlap each other, and are surrounded by a sort of fibrous cap-
sule with cellular interstices, so that they admit of hardly less
free motion than if there really were a joint between them, it is
evident that merely preventing motion could not possibly prove
sufficient for the production of an osseous union. It has been
supposed, that the difficulty thus presented might be overcome
by rubbing the ends of the bones together ; by stirring up the
texture connecting them through the agency of needles or teno-

278 Treatment of Ununited Fracture. [April,

tomy knives ; by passing setons through the flexible medium of
union ; and by inserting pegs of ivory into the respective osse-
ous surfaces. But, so far as I am able to form an opinion on
the subject, all of these means are absolutely useless, and owe
any share of credit that they may have acquired to the preven-
tion of mobility which is conjoined with their employment. In
short, I believe that the procedures in question cannot accom-
plish recovery in any case not remediable by the enforcement
of rest, and that they consequently, must always be useless, if
not injurious. There is still another mode of treatment, which
consists in cutting off the ends of the bone, so as to obtain two
fresh osseous surfaces, and place the limb in a condition simi-
lar to that of a compound fracture recently inflected; and
this, I feel persuaded, affords the only reasonable ground for
expecting success in cases not amenable to the influence of im-
mobility. It is true that the experience of this method has not
hitherto been at all satisfactory, through want of due attention
to some circumstances in the mode of procedure, which must in
a great measure determine the result. Of these may be special-
ly mentioned an imperfect removal of the ends of the bone, and
a want of complete immobility after the operation. The follow-
ing case will, I hope, tend to illustrate the importance of attend-
ing to these points.

Case. " J. H , aet. 34, a private of the Foot, while

discharging some duty in the Kedan, on the 8th of December,
1855, after the occupation of Sebastopol, was blown up by a
Eussian mine, which had escaped detection, and, in addition to
some slighter injuries;, sustained a fracture of the left arm be-
tween two and three inches above the elbow. He walked up
to his regimental hospital, where splints were applied, and re-
tained for a month, when, there being no signs of union, the
ends of the bone were rubbed together, and supported by a
starched bandage. He left the Crimea on the 3d of February,
and was sent to the hospital at Eenkioi, where a seton was
passed through the seat of fracture, and retained for five weeks
without any benefit. On the 20th of May he proceeded home-
wards, and, after a long voyage of nearly two months, arrived
at Portsmouth, whence he was transferred to Chatham on the
17th of July. No attempt to restore rigidity was made there,
and at the end of two months he was dismissed the service, with
a pension of one shilling per day, in consideration of his disabil-
ity, which was regarded as equal to the loss of a limb.

"In the hope that relief might still be afforded, he applied to
me on the 22nd of January last, nearly fourteen months from
the date of the injury ; and finding that the arm was entirely
useless through the extreme mobility of the ends of the bone,
which overlapped each other to the extent of more than an inch,

1858.] Reproduction of Bones and Joints in Whitlow. 279

I resolved to adopt the only procedure that, in my opinion,
afforded any reasonable prospect of remedy under such circum-
stances, which was to remove the ends of the bone, and after-
wards maintain the most perfect rest. In preventing the motion
of a joint, it is a most important principle, never to be forgotterj,
that as most of the muscles pass over two articulations, it is im-
possible to keep any one perfectly quiet without placing the
whole limb under restraint. Proceeding under this impression,
my first step was to have the arm put in an easy position, with
the elbow bent at a right angle, and then covered from beyond
the shoulder to the tips of the fingers with pasteboard and
starched bandages, so as to form a case, which, when it became
dry, effectually prevented the slightest movement in any of the
joints. This case was next cut up on one side from end to end,
so as to allow the arm to be taken out of it, and undergo the
requisite operation, which was performed under chloroform.
An incision having been made along the outer edge of the tri-
ceps, I exposed the upper end of the bone, and sawed off a
portion of it sufficient for obtaining a complete osseous surface.
The lower end, lying anterior to the shaft in a sort of capsule,
could not be subjected to the saw, but was removed, to the ex-
tent of more than an inch, by cutting pliers. The arm was
then supported by a couple of splints, and the patient lay quietly
in bed for a fortnight, when the limb was placed in its paste-
board case, in which an aperture had been made over the wound
then nearly healed, and discharging a very little matter, that
soon ceased entirely. The patient, feeling that the slightest
motion was impossible, even if he had wished it, was relieved
from any further restraint, and no longer remained in bed. At
the end of a month, or altogether six weeks from the date of the
operation, which was performed on the 30th Jannary, the limb
was examined, and found to be quite straight, with a firm osse-
ous union ; so that the patient was able to leave the hospital,
not only with his comfortable pension, but also with a perfectly
useful arm." [Edinburgh Med. Jour., and Ibid.

Reproduction of Bones and Joints after their Removal in cases of
Whitlow.

Some time ago Dr. Toland, of California, claimed the discove"
ry of this important fact in surgery. In the February number*
1858, of the Buffalo Medical Journal, we find, however, that to
Professor Dudley, of Lexington, Kentncky, is due the credit of
having made the discovery, and to Professor Hamilton, of Buf-
falo, N. Y., is due the credit of having first promulgated the idea
through the medium of the medical journals. Doubtless we
shall soon have some more discoverers in the field. But this is
all right. We say, " honor to whom honor is due."

280 Case of Transfusion. [April,

During five years practice in the country, it was our lot to
encounter a great number of these cases of paronychia among
the plantation negroes. Indeed, strange as the idea may seem
to some, we are sure of having witnessed the disease once in an
epidemic form. Throughout an entire neighborhood the disease
was strictly prevalent, and we can now call to mind several ne-
groes who lost the first phalanx of two or more fingers in one
season. Of course the vast majority of the cases lost the first
phalanx, as every overseer and old woman in the country ima-
gine themselves fully competent to treat, or rather cure whitlow
or bone felon. When the doctor is called in, the bone is loosen-
ed from its attachments, and he has no alternative but to remove
it. When we first encountered the cases, such was the degree
of the disease of the surrounding tissues, we amputated the end
of the finger ; but observation soon taught us that this proce-
dure materially diminished the value of the cotton-picker, as the
finger was not only considerably shortened, but the stump, un-
protected by the nail, was continually subject to injury. We
then resorted to the plan of picking out the dead bone, and the
only deterioration the hand suffered was comparatively slight
shortening of the finger. In no instance have we ever seen any
thing approaching reproduction of the bone and this notwith-
standing we have carefully supported the finger by means of
splints and bandages. \N. Orleans Med. News and Hosp. Gaz.

On a Case of Transfusion, By John Wheatcroft, Esq., M. R.
C. S, L .S. A., Cannock.

In the Lancet of October, there appeared a case of transfusion
of blood, which operation I again performed successfully on the
25th inst. The following are the particulars :

I was summoned to see Mrs. , aged thirty-two, on the 24th

instant. I found her in an almost exsanguined condition. A ter-
rible gush of blood per vaginam had suddenly occurred, followed
by coagula two or three pounds in weight. Her neighbors with
difficulty got her up stairs, and again haemorrhage set in frightful-
ly. I found her lying on the bed in a state of great exhaustion ;
face white and anxious ; lips blanched ; skin and extremities cold ;
pulse small, very feeble, and rapid, 120 per minute.

I immediately plugged the vagina, administered the yolk of
egg with a little brandy, enjoining upon the attendant strict at-
tention to the ordinary methods adopted in uterine haemorrhage.
On visiting the case four hours afterwards, I found the plug right,
and the bleeding had been arrested ; a little more colour in the
lips; the pulse 100, but small and thready; complained much of
giddiness and severe uterine pain: she was three months ad van-

1858.] Pulmonary and Bronchial Tuberculosis. 281

ced in pregnancy. I then gave her small doses of tincture of
opium, but vomiting having supervened, every dose, together
with the egg, was rejected. Small doses of sulphuric ether arrest-
ed the sickness. I left her, apparently going on favorably, but in
four hours was again hastily summoned. She had complained of
severe expulsive pain, violent retching accompanied it, and ex-
pelled the plug, together with a large coagulum ; the flooding re-
commenced, and I found her lying in a large pool of blood. I
could detect no foetus either in the bed or the vigina ; the os uteri
was too high to be reached ; the skin and extremities had again
become cold, the surface of the body as white as snow ; pulse
almost imperceptible ; the breathing gasping ; face very anxious ;
great restlessness ; loss of vision ; eyes sunk and leaden.

Ably assisted by J. Blackford, Esq., and Mr. Samuel Wheat-
croft, I transmitted about two pounds of blood from the husband.
The change was immediate (I had previously replugged the va-
gina;) the colour returned to her lips, the eye became brilliant,
the pulse distinct and firm, the restlessness vanished, the breathing
became normal, and she now looks, with the exception of her
whitened skin, as well as I ever saw her. Although complaining
of giddiness and tightness across the brow, she is quite cheerful.
The fetus has not been expelled. I have removed the plug, and
there is not a drop of blood to be seen. The plug here was as
valuable as the transfusion.

Permit me to suggest the trial of this operation in the last stage
of low typhus and the colapse of Asiatic cholera when every other
means have failed. [London Lancet.

Pulmonary and Bronchial Tuberculosis.

Every physician acquainted with the methods of physical
exploration and we readily believe every one is now-a-days
ought to know, that tuberculosis is not at all uncommon in chil-
dren. The symptoms are generally known ; the prognosis not
so unfavorable as in adults. This statement is affirmed by Dr.
J. Schwartz, of Berlin, who reports to have repeatedly succeed-
ed, by careful regulations as to their diet, and some well-adapted
pharmaceutical remedies, in restoring to health children of from
two to five years, who were already considerably emaciated,
and subject to hectic fever. Against the attack of hectic fever
he warmly recommended, as Skoda did before him, the sulphate
of quinine, with small doses of Dover's powder. Besides, he
gives cod-liver oil and armara, which he says are too little thought
of in our time, and have been too readily forgotten. [Journal
fur Kinderkrankheiten) and N. Y. Jour, of Med.

282 Editorial. [April,

EDITORIAL AND MISCELLANEOUS.

Medical College of Georgia Appointment of Professor Joseph
Jones. The Chair of Chemistry and Pharmacy in the Medical College
of Georgia, recently vacated by the resignation of Professor Means, has
been promptly filled by the unanimous election of Dr. Joseph Jones,
Professor of Chemistry and Physics in the University of Georgia,
and formerly, Professor of Medical Chemistry in Savannah Medical
College.

Dr. Jones has for years, most ardently devoted himself to original Che-
mical and Physiological Investigations. His labors have been crowned
with such brilliant success, that to praise them, on the present occasion,
could not certainly add to their universally acknowledged merit. His
contributions to Chemical and Physiological Science have been present-
ed to the Profession in papers bearing the following titles :

1st. Abs+ract of Experiments upon the Physical Influences exerted by
Living, organic and inorganic, Membranes upon Chemical Sub-
stances passing through them by Endosmose. Read before the
Academy of Natural Sciences, Philadelphia, October 25th, 1854.
[Accompanied by lithographic illustrations from original drawings
by the author, from appearances under the microscope.]

2nd. Observations upon the Kidney and its Excretions in different ani-
mals. Published April, 1855, in the American Journal of Medical
Sciences. [With twenty wood cut illustrations.] Pp. 42, 8vo.

3rd. The Digestion of Albumen and Flesh, and the Comparative Anato-
my and Physiology of the Pancreas. Published in the Medical
Examiner, Philadelphia, May, 1856. Pp. 20, 8vo.

4th. Physical, Chemical, and Physiological Investigations upon the Vital
Phenomena, Structure and Offices of the Solids and Fluids of Ani-
mals. Published in the American Journal of Medical Sciences,
Philadelphia, July, 1856. Pp. 64, 8vo.

5th. Investigations Chemical and Physiological, relative to certain Amer-
ican Vertebrata. Referred by the Smithsonian Institute to Profes-
sor Samuel Jackson, Professor Joseph Leidy, and Professor Jeffries
Wyman, with Professor Joseph Henry, Secretary of the Institute,
as Commissioners ; accepted by them March, 1856, and subse-
quently published by the Smithsonian Institute. 4to., pp. 137.
[This work is embellished with 27 wood cut illustrations. It was
published and distributed at the expense of the Institute.]

Prof. Jones is a native of Liberty county, Georgia. He relinquishes
his chair in Athens, where his relations have been of the most agreeable

1858.] Editorial 283

and encouraging character, for the sole purposes, as he states, of devoting
himself more entirely, than he can at present, to Medical Science in its
Chemical and Physiological departments, and with the view of assisting
in elevating the standard of Medical attainment at the South. He will
make Augusta his place of residence, and his course will be eminently
practical and instructive, especially in the important departments of
Medical, Physiological and Pathological Chemistry.

In the next number of this Journal, we shall present to our readers
an elaborate and most valuable contribution from his pen, on the
subject of the Chemical and Physiological Relations of the Blood to
Diabetes. As Editors, we congratulate our readers and ourselves, on so
valuable an accession to our corps of contributors.

American Medical Association. The eleventh Annual Meeting of
the American Medical Association, will be held in Washington City, on
Tuesday, the 4th day of May, 1858.

The American Medical Association has, for years, ceased to be an ex-
periment ; its wise deliberations, its judicious suggestions for the advance-
ment of medical science, and for the improvement of medical education
and medical ethics, have fully vindicated its right to be considered, the
highest and most authoritative tribunal, in the medical sciences, in the
land. The time is past, when it may be doubted that its efforts have
wrought an improvement in the status of the profession ; there are too
many evidences of the diligent investigation and research, of independent
experimentation, directly growing out of the spirit which this body has
infused, for it to be longer doubted, that it has done much good. No
one will hesitate to admit, that since its establishment, American medi-
cine has assumed a form, and presents a character of its own and a spirit
of its own, highly progressive, energetic indeed, American. Not only is
this change witnessed at home, but is observed elsewhere. The valuable
Transactions of this Association are distributed everywhere, and may be
now found in the Libraries of the Scientific Institutions, throughout
Europe. It is important then, that this body should, in its present
dignified position, use great care and judgment in its deliberations.
There are many important questions to come up before them at
Washington some of these are vitally connected with the interests
of the Profession. We have not time nor space at present, however,
to present any of these subjects properly, and therefore close our
remarks with the confident hope that all questions will be discussed
and determined in the best and wisest manner for the general good of
the Profession.

11*

284

Editorial.

[April,

Medical College of Georgia Annual Commencement. The un-
diminished prosperity of the Medical College of Georgia, even under
the multiplication of institutions throughout the country, we are sure,
must be a subject of great satisfaction to its many friends and alumni,
and also to those engaged in a liberal competition in the same field. At
the last Commencement, the degree of Doctor of Medicine was conferred
on sixty-one candidates, whose names we take pleasure in here recording :

Toliver Dillard,

of

Georgia.

J. H. Ruddell,

oi

' Georgia.

Henry Kinnebrew,

u

tt

L. C. Wisdom,

tt

tt

J. J. Denson,

it

tt

Wm. Hadden,

tt

tt

A. G. V. Doney,

u

tt

R. B. McRee,

tt

tt

A. H. Mathers,

a

Florida.

W. A. Childress,

tt

u

R. J. Healey,

<t

Alabama.

J. Y. Bradfield,

tt

tt

S. M. Simmons,

u

Georgia.

P. L. Blakely,

tt

S.Carolina.

Wm. J. Colley,

ft

tt

G. W. Chisholm,

tt

Georgia.

J. W. Lowman,

ft

S. Carolina.

G. W. Pitts,

tt

tt

A. H. Read,

u

Alabama.

H. W. Culver,

it

Alabama.

R. C. Johnson,

tt

Georgia.

E. G. Scruggs,

tt

Georgia.

A. J. Speer,

tt

S. Carolina.

R. M. Hitch,

tt

tt

J. L. Rucker,

it

Georgia.

J. B. Harvley,

u

S.Carolina.

A. J. Flowers,

it

tt

J. R. McAfee,

tt

Georgia.

"W. R. Armor,

ii

tt

J. F. Donehoo,

tt

tt

T. A. Raines,

(i

tt

H. C. Edmunds,

N

S.Carolina.

J. T. Sego,

ii

tt

J. H. Gibson,

it

Florida.

A. A. Delaigle,

ii

tt

E. G. Kirkland,

ft

Georgia.

S. B. Mills,

ii

tt

B. S. Hudson,

ii

tt

J. W. Rhodes,

u

tt

J. F. Martin,

if

tt

A. T. Jenkins,

ii

tt

John Herren,

it

Alabama.

B. F. Stanley,

ii'

tt

J. M. Howell,

ii

Georgia.

S. W. Gardner.

a

Mississippi.

J. S. Smith,

it

S.Carolina.

Wensley Hobby,

it

Georgia.

J. W. Traylor,

it

tt

J. S. W. Johnson,

it

tt

Solomon Newson,

ii

Georgia.

J. R. Cox,

ii

tt

M. R. Cassaday,

it

Alabama.

T. A. Power,

it

S.Carolina.

T. 0. Powell,

ii

Georgia.

G. W. Coxwell,

it

Alabama.

S. A. Tomkins,

it

S.Carolina.

Patrick Todd,

it

S. Carolina.

F. A. Driver,

ti

Alabama.

W. B. Reynolds,

it

Georgia.

J. D. Patten,

ii

S.Carolina.

J. S. Johnson,

tt

Alabama.

R. M. Tindall, M.D., of Mississippi, a graduate of Memphis Medical
College, was also admitted adeundem gradum by the Board of Trustees.

Savannah Journal of Medicine. We have just received the Pros-
pectus of the above new Journal. It will be published bi-monthly, in
Savannah, and Edited by Juriah Harriss, M. D., Professor of Physiology
in Savannah Medical College, and J. S. Sullivan, M. D. with R. D. Ar-
nold, M.D., Professor of Principles and Practice of Medicine in Savannah

1858.] Editorial 285

Medical College, as associate Editor. We wish for this Journal in pros-
pectu, a safe and speedy birth, and from the character and ability of its
Editorial corps we may hope for it a successful career. We will present
our readers with a more extended notice when we have seen the first
number, and we will be happy to place it upon our exchange list.

A Syllabus of Lectures on Materia Medica : delivered at Atlanta Medical
College, by J. G. Westmoreland, M. D., Professor of Materia Medica,
&c, in that Institution.

We have received, through the courtesy of the author, the above vol-
ume. It is creditably gotten up, and presents a compendious resume of
the author's Lectures, and will doubtless be found of much assistance to
those attending Lectures in the Atlanta Medical College.

Medical Society of the State op Georgia. The next annual
meeting of our State Medical Society will be held at Madison, on the
second Wednesday in April.

We quote the following from the minutes of the last meeting, held in
this place, in order to remind the several Essayists of their respective ap-
pointments :

"The Committee on Essays, made the following report of Subjects and
Essayists for the next meeting which was received and adopted.

Dr. J. G. Howard, of Savannah On Uterine Disease.

Dr. E. J. Roach, of Pulaski On the Propriety of Surgical Operations
about the Joints.

Dr. H. F. Campbell, of Augusta On the Rectal Administration of Medi-
cine.

Dr. J. M. Green On the Value of Escharotics in the Treatment of Cancer.

Dr. R. D. Arnold, of Savannah On the Pathology and Treatment of Yel-
low Fever.

Dr. Ira E. Dupree, of Twiggs On the Treatment of Prolapsus.

Dr. Eben. Hillyer, of Atlanta On the Physiology of Menstruation.

Dr. V. H. Taliaferro, of Atlanta On Obstetrical Surgery.

Dr. X. F. Powers, of Thomson On Diseases of the Skin.

Dr. W. S. Meire, of Madison On the Use of Alcohol in Typhoid Fever.

Dr. R. Campbell, of Augusta On Wounds of the Abdomen.

Dr. I. P. Garvin, of Augusta On Nervous Irritation of the Stomach.

Voluntary Communications from any member of the Society are earn-
estly requested, and will be gratefully received."

We sincerely hope there will be a full attendance, and that the con-
tributions, both by appointment and voluntary, will exceed those of any
previous meeting.

286 Editorial [April,

Our Exchanges. Editorial Changes, Fusions, Enlargements, &c,
<fec. We are much gratified to see that there has been great improve-
ment in the character, style and spirit of our exchanges generally,
American Medical journalizing, we may indeed feel proud of. There is
manifested on the part of contributors, much improvement in the way of
research and independent investigation ; and also on the part of Editors,
great industry, discrimination and courtesy ; each to a degree, we think
we may safely say, with few exceptions, unsurpassed by any period during
the last ten years. We sincerely regret, that the suggestion made some
years ago by our able predecessor, Prof. L. A. Dugas, of some periodical
work annually or semi-annually, embodying the contributions of American
Physicians, has not been more fully carried out. A work entirely and
strictly devoted to this object would be of great value to the readers and
writers of this country, and would greatly enhance the credit and repu-
tation of American writers among their brethren in Europe. The Ameri-
can Journal of the Medical Sciences (of which we present no distinct
notice at this time), has for years, with great fairness, presented a careful
abstract of all American contributions which the editors deemed worthy
of record ; but we conceive that the republication of entire articles, which
could only be done in a work devoted to the purpose, would better com-
pass the above object, than any other plan which could be adopted.

The North American Medico-Chirurgical Review. This excellent
Bi-monthly comes to us in an improved dress. The January number,
which contains over two hundred pages, presents many valuable Reviews,
Criticisms and Analyses of works, besides much valuable original matter.
In the Report of their able collaborator, Prof. S. Weir Mitchell, on the
Progress of Physiology and Anatomy, we find that a new feature is intro-
duced, which will enhance the value of the journal. " It is proposed,"
says the reporter, " in future, to present once a year, a complete analyti-
cal Review of the general progress of Physiology and Anatomy. At the
same time, and as an essential part of this task, we shall endeavor to
point out with care whatever advances in these sciences are due to the
annually increasing labors of our own countrymen." We have been
not a little surprised, that so discriminating a reporter as Dr. Mitchell
should have been content with only a frequent reference, to the articles
of Professor Joseph Jones, of Georgia, and that he did not embody a
full abstract of his views and results ; for his, have certainly been the
most elaborate, thorough and creditable experimental investigations
into the chemical changes of the blood and other fluids of animals, which
have ever been presented, so far as we are aware of, by any American
Physiologist. It may be said, however, that it is probable that their

1858.] Editorial. 287

great bulk and the permanent form in which these have been published
by the Smithsonian Institute, rendered their presentation in the present
report, a matter both of great labor and at the same time a work of
super errogati on.

We are much gratified at the favorable notice taken of Dr. W. A.
Hammond's laborious and almost self-immolating investigations on the
" Nutritive Value and Physiological Effects of Starch, Gum and Albu-
men," as presented in his Prize Essay before the last meeting of the
American Medical Association. And lastly, we may be here allowed also
to express our gratification at the manner in which he has been pleased
to allude to our own humble labors.

We take great pleasure in commending the above Bi-monthly Review
to the favorable consideration of our readers, for its able review articles,
for its analyses, and for other valuable matter, more particularly suited
to this more permanent form of periodical medical literature.

The Charleston Medical Journal and Review. This valued ex-
change, has recently passed from the hands of its former able Editor,
Dr. C. Hapholdt, and will hereafter be edited by J. Dickson Brims,
M. D. Dr. Bruns is most favorably known to the Profession as the au-
thor of a most interesting and able pamphlet, entitled, " Life ; its Rela-
tions, Animal and Mental." We congratulate the readers of this Journal
upon his accession to the chair Editorial. It is published by-monthly.

The Nashville Journal of Medicine and Surgery. Professor Paul
F. Eve has retired, and Professor W. K. Bowling has associated with him
in the Editorial conduct of this valuable work, Drs. R. C. Foster and
George S. Blackie, as assistants. WTe heartily wish our friend, Dr. Eve,
all the otium cum dignitate of retirement, and welcome the other dis-
tinguished gentlemen most cordially into the body Editorial. We con-
gratulate Dr. Bowling that he. still finds pleasure and satisfaction in his
literary labors, and ourselves, that we still find him among our confreres.

The American Medical Monthly, published in New York, and The
American Medical Gazette, also published in New York, have, like our
own Journal, been benefitted by an addition to the number of their pages,
without any change of Editors.

The Cincinnati Medical Observer and The Western Lancet have
united under the title of " Cincinnati Lancet and Observer." The present
work will be edited by Prof. George Mendenhall, John A. Murphy, M. D.,
and Edward B. Stephens, M. D. Drs. Blackmail and Lawson, both able
journalists, have withdrawn, but there can be no doubt, that the present
work will be ably sustained by their successors.

288 Editorial [April,

The Peninsular Journal of Medicine and The Medical Independ-
ent, both published at Detroit, Michigan, have effected a happy union.
The Independent was sustained for one year by our friends, Prof. Moses
Gunn and L. G. Robinson, M. D., and now becomes amicably incorpora-
ted with its competitor, under the comprehensive title of " The Peninsu-
lar and Independent Medical Journal.'1'' May this friendly adjustment
of their mutual difficulties serve to inspire the Peninsular, with a spirit
of amiability and liberality towards its more distant confreres, and may
the ink "spilt" in the former contests of these two journals, serve, like
the blood of Patriots, to cement more firmly their present union. This
is but " the expression of a pious wish." We regret that Professor Zina
Pitcher, the late distinguished President of the American Medical Asso-
ciation, is no longer in this corps of editors ; we hope that his retirement
may be as happy, as his editorial life has been courteous, dignified and
useful.

The New Orleans Medical News and Hospital Gazette, one of our
most valuable exchanges, has undergone a change of Editors, and is now
under the management of Profs. D. Warren Brickell and E. D. Fenner.
This journal, from its commencement, has been most ably conducted,
and the recent association of our excellent friend, the veteran Fenner, in
its Editorial conduct, augurs well for its future success. Dr. Fenner has
the credit of having been the first to establish a Medical Periodical in
New Orleans. The several volumes of his " Southern Medical Reports,"
are most useful contributions to Medical Science, as well as enduring
monuments of the pel severing industry and great ability of their author.

The New Orleans Medical and Surgical Journal. This excellent
Bi-monthly Journal and Review still maintains its high position in the
comparative estimation of our exchanges. The work has passed into
the hands of Drs. W. Stone, J. Jones, and S. Chaille, who have also be-
come assistant Editors, while Dr. Bennett Dowler still retains the posi-
tion of Editor-in-chief.

The Memphis Medical Recorder. We have on a former occasion
noticed the resignation of Prof. A. P. Merrill from the Editorship of this
journal, and also at that time signified our great satisfaction with the
appointment of our friend, Professor Daniel F. Wright, to that position.
Whatever may be the future changes and improvements in this highly
useful and creditable work, we here earnestly express the wish that he
may still wield a pen for its pages, and long remain as now, our valued
and courteous confrere;

1858.] Editorial and Miscellaneous. 289

The Southern- Journal of the Medical and Physical Sciences.
The Editor of this Journal, Professor EL 0. Curiy, of Knoxville, Term.,
who has ably sustained the work for several years, suggests certain
changes in its arrangement and management, which will be doubtless
beneficial to himself and to the journal. As the work has as yet under-
gone no change, we defer, till some other number, a more extended
notice of it.

The Medical and Surgical Reporter. TTe have just seen, in the
Boston Medical and Surgical Journal of March 25th, that " the Reporter
is about to be removed from Burlington, X. J., to Philadelphia, and that
Dr. "William B. Atkinson, of the latter city, who has for some time past
been a regular contributor to its pages, will be associated with Dr. Butler
in its editorial management." We think, too, that Philadelphia presents
a good opening for a monthly journal. The Reporter has ever been an
agreeable visitor with us, and whether it comes from Burlington or from
Philadelphia, we shall greet it with the same welcome.

There have occurred doubtless other changes in our exchanges, which
we at present omit from their having escaped our notice as thev occur
to us, we will take great pleasure in recording them.

Forensic Medicine. M. Collongues, in a note presented to the Acade-
miedes Sciences {Comptes Rendus, 21st Dec. 1857, p. 1048), points out
the usefulness of knowing whether there is a peculiar sound or not to be
found if death exists. He has already announced that during life there
is in all the parts of the body a peculiar sound, which may be heard
easily by the application of the ear, or with the help of averv small
stethoscope. This sound disappears after death, but not immediatelv.
It may last five, ten, and even fifteen hours after the last beating of the
heart. It disappears gradually, and according to the author, its com-
plete absence from all the superficial parts of the body, is a positive si^n
of death. In an amputated limb it persists a few minutes. [Nem York
Journal of Medicine.

Fistula in Ano in Relation to Pulmonary Tuberculosis. Bv P. H.
Strong, M. D. Dr. Strong embodies in the following formula the doc-
trine generally held with regard to this subject :

M The relations of fistula in ano to pulmonary tuberculosis are such,
that its presence, either as antecedent to or coexistent with the latter, is
a desideratum, and to be sedulously cherished, having reference to its
(pulmonary tuberculosis) prevention in the one case, and to its cure or
favorable modification in the other."

Dr. Strong argues against the correctness of this doctrine, first, that it
is based mainly on the belief of a revellant influence being exerted by
the fistula, while an enlightened pathology and clinical observation teach

290 Miscellaneous.

that such an influence is of little or no value in preventing: or retarding
the progress of pulmonary tuberculosis ; second, other and "kindred affec-
tions, scirrhus aud melanosis, depending alike on a blood dyscracy, are
not affected generally by revellent or derivant discharges ; third, the
doctrine originated when erroneous views prevailed respecting the causes,
nature, and management of tubercular affections.

Conceding that tubercular matter is discharged, as it were vicariously,
by means of the fistula, he contends that the proper object for therapeu-
tics in this affection is not to eliminate the material, but to remedy the
dyscrasy, by removing the condition on which it depends. [Buffalo
Med. Journal.

Discovery of the Tomb of Hippocrates. The JEsperance of Athens
states, that near the village of Arnaoutli, not far from Pharsalia, a tomb
has just been discovered, which has been ascertained to be that of Hip-
pocrates, the great Physician, an inscription clearly enunciating the fact.
In the tomb a gold ring was found, representing a serpent the symbol
of medical art in antiquity as well as a small gold chain attached to a
thin piece of gold, having the appearance of a band for the head. There
was also lying with these articles a bronze bust, supposed to be that of
Hippocrates himself. These objects, as well as the stone which bears
the inscription, were delivered up to Housin Pasha, governor of Thessaly,
who at once forwarded them to Constantinople. [Late Foreign paper.

A Compliment to the Doctors. Dr. Jackson, the elder, of Boston,
meeting his old friend Josiah Quincy, (both past eighty years of age,)
on the side-walk, accosted him with, " Well, Mr. Quincy, how much lon-
ger do you intend to live?" "Till I send for a doctor," was the quick
reply. "And when rid you send for one, last?" inquired Dr. J. "Just
eighty-six years ago !'-' answered Mr. Quincy, adding the precise date of
his birth.

A young man in Georgetown, D. C, who last week took four grains of
Strychnine for the purpose of committing suicide, was saved by the inha-
lation of an ounce and a half of Chloroform. Either of the doses would
have killed him separately between them both, he lived. [Druggist's
Circular.

Glycerine. Dr. Cotton, of Brompton Hospital, has employed this ar-
ticle exclusively, and testifies against its efficiency in phthisis, pronouncing
it greatly inferior to cod-liver oil. [American Med. Gazette.

Sup>ra-renal Capsules. The cogenital absence of these organs has
been found in a man, who always had a white skin, lived up to 40 years,
and died of a malady of the chest. He worked as a joiner, was married,
and had three sons. (See Glasgow Med. Journal for July last.) Ibid.

Value of a Young Lady's Teeth. The Paris courts value a young
lady's teeth at 8,000 francs. An English governess was recently knock-
ed down by a carriage, and lost by the accident all her teeth. She
brought on an action of damages, and the tribunal awarded that amount.

SOUTHERN

MEDICAL AND SURGICAL JOUMAL.

(NEW SERIES.)

Vol. XIV.] AUGUSTA, GEORGIA, MAT, 1S58. [No. f.

ORIGINAL AND ECLECTIC.

ARTICLE XII.

Case of Diabetes Mellitus. Treated by Joseph Jones, A.M., M.D.,
Professor of Physics and Natural Theology in the University
of Georgia, Athens ; Professor of Chemistry and Pharmacy in
the Medical College of Georgia, Augusta ; formerly Professor
of Medical Chemistry in the Medical College of Savannah.

Irish laborer, entered the Savannah Marine Hospital and Poor
House, July 17th, 1857 : age 24 ; height 5 feet 7 inches ; light
hair, blue eyes, scanty reddish yellow whiskers ; greatly ema-
ciated arms and legs resemble those of a skeleton; ankles
cedematous. Weight, in health, 140 lbs. ; now, it cannot be
more than 90 lbs.

Complained of continued pain in his head and bones, loss of
strength, a voracious appetite, insatiable thirst, disordered diges-
tion and a continued and exhausting diarrhoea.

Had no fever and no enlargement of liver or spleen. Upon
physical exploration the action of the heart and lungs appeared
to be normal.

The attempt was made to arrest the diarrhoea. Hope's mix-
ture produced a temporary effect, but did not arrest the waste of
tissue. Opium, chalk mixture, and the usual remedies for diar-
rhoea were administered. They checked the diarrhoea tempora-
rily, but did not arrest the waste of tissue and loss of muscular
and nervous force.

His diet was strictly guarded. It was found that the greater,
portion of the meat which he ate, passed entirely through the ali-

N. 6. VOL. XIV. NO. V. 13

292 Jones, on Diabetes Mellitus. U&&J,

mentary canal, and was voided in the form of fetid undigested
masses.

The patient was placed upon farinaceous diet arrow -root,
rice, and boiled milk and rice. Under this regimen, the stools
became less numerous, and improved in appearance, but the
destruction of tissue and loss of power was not arrested.

External applications had no effect whatever upon the pain
in his head and limbs. Strychnia, in small doses, failed to
strengthen his digestive apparatus and nervous system.

This treatment was continued for three weeks, and during this
time his progress was steadily downwards. His tissues continu-
ed to waste away, and his strength every day grew less.

August 7th. Pulse 70. ) Temperature of Atmosphere, 81F.
V " " Hand, 96J

Kespiration 19. ) " under Tongue, 100

August 8th. Pulse 64. ) Temperature of Atmosphere, 81F.
I " " Hand, 97 i

Eespiration 18.) " under Tongue, 100

Examination of Urine. Keaction slightly acid.
Specific gravity 1040.
Of a light straw color, clear limpid, resembling the urine of
a female suffering with hysteria. The resemblance extended
only to the color and amount passed, The high specific
gravity of the urine of this patient, at once distinguished it from
the abundant light colored urine often passed by hysterical
females. The amount of urine passed by this patient during the
24 hours varied from one to one and a half gallons an enor-
mous quantity, considering his reduced state, and the large
amount of solid matters held in solution in the urine.

Trommer's, Moore's, and the fermentation tests and the rapid
formation of the Torula Cerevisiae, gave unequivocal evidence
of the presence of grape sugar in large amount.

Chemical analysis showed that the specific gravity of the urine
was due, in great measure, to the large amount of grape sugar
which it held in solution.

Examination of Blood. Specific gravity of Blood, . . 1043*2
Specific gravity of Serum, . . 1022#2
Coagulation of the blood commenced in a few minutes after it
was drawn, and the clot was firm.

1858.]

Jones, on Diabetes Hellitus.

293

Under the microscope, the colored corpuscles were normal in
color and form. They had a great tendency to stick together
and form rolls, as in the blood of inflammation, and in the blood
of the horse.

This phenomenon resembled, in all respects, that which oc-
curs in well marked cases of inflammation.

The colorless corpuscles appeared to be deficient in numbers.

Serum of a light straw color. When the serum was mixed
with an equal quantity of water, and treated with a few drops of
hydrochloric acid, sufficient to neutralize its alkaline reaction,
no coagulation took place, even after prolonged boiling.

Nitric acid produced prompt coagulation of the albumen of
the serum.

WATER

In 1000 parts of Blood, 838*510
" " " " Serum, 922-341
(l)u " " " Liquor

Sanguinis, - - 919*039
(2)" 1000 parts of Liquor

Sanguinis, - - 887*339

SOLID MATTERS
In 1000 parts of Blood, 161*490
" " " " Serum, 77*659
(1)" " " " Liquor

Sanguinis, - - 80*961
(2)" 1000 parts of Liquor

Sanguinis, - - 112*661

FIXED SALINE CONSTITUENTS

In 1000 parts of Blood, 9*061

u u Serum, 5*319

(1} " " " " Liquor Sanguinis, 5*325

(2) " " " " Liquor Sanguinis, 7*181

" Blood Corpuscles of 1000 parts of Blood, 4*443

" 1000 parts of Dried Blood Corpuscles, 47*916

" " " " Moist Blood Corpuscles, 11*981

" " " " Dried Residue of Blood, ------ 56*108

" " " " " " " Serum, -<---- 68*488

(1) " " " " " " " Liquor Sanguinis, - - 68*493

(2) " " " " " Liquor Sanguinis, - - 63*739
" Solid Matters of Serum of 1000 parts of Blood, - - - 4*519

1000 Parts of Blood Contained

Water, 838*510

Dried Blood Corpuscles, 92*702 i !?riecJ W** *** ' 8^9

1 ) b l.xed Saline Constituents, - 4*443

Fibrin, -_.... 2*806

Albumen 40 539 1 Dlied 0ranil- Matters, - 48*157

j Fixed Saline Constituents, - 1*382

Extractive Matters,- - 16-003 1 ^P1?'' "* " 1JJ!

[ Fixed Saline Constituents, - 3*137

294 Jones, on Diabetes Mellitus. [May,

1000 Paets of Blood Contained

.) Water 278-106

Moist Blood Corpuscles, 370-808 V Dried Organic Residue, - 88-259

) Fixed Saline Constituents, - 4-443

^ Water, - - - - 560-404

Ait ) Dried Organic Residue, - - 48*157

Liquor I DUmen' j Fixed Saline Constituents, - 1-382

Sanguinis, 629-192 f Extractive and ) Dried Organic Matters, 12-866

Coloring Matt'rs, j Fixed Saline Constituents 3-137

Fibrin, 2-606

1000 Parts of Moist Blood Corpuscles Contained

Water, 750-001

Dried Organic Matters, --- 238-018

Fixed Saline Constituents, 11-981

(1) 1000 Parts of Liquor Sanguinis Contained

Water, - 919-039

Albumen .... 59-737 l Organic Residue, - - - 58-110

' ) Fixed Saline Constituents, - 1-620

Extractive and Coloring ) Organic Residue, - - - 13-670

Matters, - - - - 17-345 j Fixed Saline Constituents, - 3-682

Fibrin, 3*302

(2) 1000 Parts of Liquor Sanguinis Contained

Water, 886-740

ah, ho ^00 ) Organic Residue, - - - 76*537

Albumen, . - - - 78- ,33 J- Fixsed Saline Con^ituents> . 2-196

Extractive and Coloring ) Organic Residue, - - - 24*484

Matters, - - - - 29*469 ) Fixed Saline Constituents, - 4*985

Fibrin, 4-459

The method of analysis employed in these investigations has
been described by the author (') in his Inaugural Dissertation for
the degree of M. D. in the University of Pennsylvania, and in
his Chemical (2) and Physiological Investigations, published by
the Smithsonian Institution, and is similar in many respects to
that employed by MM. Becquerel (3) and Eodier, Bowman, (4)
and others. (5)

(1) Physical, Chemical and Physiological Investigations, upon the Vital Phe-
nomena, Structure, and Offices of the Solids and Fluids of Animals. By Joseph
Jones. (American Journal of Medical Sciences, July, 185G, p. 46.

(2) Investigations, Chemical and Physiological, relative to certain American
Vertebrata. By Jos. Jones. Smithsonian Contributions to Knowledge. 1856.

(S) Pathological Chemistry, by MM. Becquerel and Rodier. Translated by
S. T. Speer, M. D. London : 1857, p. 19, et. sq.

(4) Bowman's Medical Chemistry, pp. 145-194. Philadelphia : 1850.

(5) Simons Chemistry of Man, p. 142. Philadelphia: 1846. Lehmann's Physi-
ological Chemistry. Translated by G. E. Day. Cavendish Society pub. vol. ii.,
pp. 153-280. London. 1851-1854. See also American ed., edited by Prof.
Rogers, vol. 1, pp. 541-648. Manuals of Blood and Urine. By Griffith Reese
andMarwick. Philadelphia: 1848.

1858.] Jones, on Diabetes Mellitus. 295

All physiological chemists have failed to ascertain with abso-
lute accuracy the amount of solid matter in the serum of 1000
parts of blood.

The proportion by which this is determined, although the
closest approximation to the truth that can be made in the pre-
sent state of science, is founded upon the erroneous assumption
that all the water of the blood exists in the liquor sanguinis.
C. Schmidt has shown that three-fourths of the colored blood
corpuscles are composed of water. Hence, to obtain the relation
of the moist blood corpuscles to the liquor sanguinis, we must
multiply the dried residue of the corpuscles by 4.

Physiological chemists possess no method by which the blood
corpuscles can be determined with absolute accuracy.

It is evident, from these facts, that when we attempt to calcu-
late the moist blood corpuscles and liquor sanguinis of 1000
parts of blood, whatever error entered into the calculation of the
solid matters of the blood corpuscles, will be increased four fold,
whilst the error in the calculation of the constituents of the
liquor sanguinis will increase, not only in a direct ratio to the
errors in the calculation of the blood corpuscles and solid mat-
ters of the serum of 1000 parts of blood, but also in a definite
ratio to the actual increase or decrease in the 1000 parts of moist
blood corpuscles. That error exists in this method of analysis
is rendered evident when we calculate the constituents of 1000
parts of liquor sanguinis, from the data obtained by subtract-
ing the moist blood corpuscles from 1000 parts of blood, and
considering the remainder liquor sanguinis.

The results thus obtained do not correspond with those
obtained from the actual analysis of 1000 parts of liquor san-
guinis.

To render this error evident in the present method of analysis,
I have in this and subsequeut analyses, stated the actual an-
alysis of 1000 parts of liquor sanguinis, and that calculated
from the constitution of the liquor sanguinis determined in 1000
parts of blood, by the subtraction of the moist blood corpus-
cles.

The former, by actual experiment, is always marked (1) ; the
latter, by calculation, is always marked (2).

We will now compare this analysis of the blood of our diabetic

296

Jones, on Diabetes Mellitus.

[May,

patient with 1st, analyses of normal blood, and 2nd, with
analyses of abnormal blood.

The following is given by Lehmann,(6) as the standard con-
stitution of healthy human blood.

1000 Parts of Moist Blood Cor-
puscles contain

Water, 688-000

Solid Constituents, - - 312-000
Specific Gravity, - - -1088-5

Haematin, 16-750

Globulin & Cell Membrane, 282-220

Fat, 2-310

Extractive Matters, - - 2-600
Mineral Substances with-
out Iron, - - - - 8-120

1000 Parts of Liquor Sanguinis

contain
Water,- ----- 902-900

Solid Constituents, - - 97-100
Specific Gravity, - - - 1028-

4-050
78-840
1-720
3-940
8-550

Fibrin,

Albumen, - - - -

Fat,

Extractive Matters, -
Mineral Substances, -

The following are the physiological limits of the variations of
the constituents of the blood, as established by the researches of
MM. Becquerel (7) and Kodier.

In 1000 F

'arts

OF

Blood,

The Water may vary - - -

from

760-000 to

800-000

" Specific Gravity of the Blood
" Globules

may vary

" 1055-

1063-

u

u

u

120-000 "

150-000

" Fibrin -

u

u

u

2-000 "

3-500

" Solid Matters of the Serum

u

u

u

90-000 "

105 000

" Cholesterine -

u

u

u

0-075 "

0-150

" Animal Soap,

u

a

u

1-000 "

2-000

" Serolin -

<i

M

u

0-010 "

0-030

" Chloride of Sodium

u

U

u

2-000 "

5-000

" Soluble Salts

a

u

a

1-500 "

4-000

" Phosphates -

a

u

u

0-500 "

1-000

In 1000 Parts

OF

Serum,

The Specific Gravity of the Serum

may var)

' from 1027- to

1032-

" Water of the Serum -

M

u

u

880-000 "

900-000

" Solid Matters -

U

u

u

100-000 "

120-000

Albumen -

70-000

90-000

The following is the typical formula of the constitution of the
blood in health, adopted by MM. Becquerel(8) and Kodier:

(6) Lehmann's Physiological Chemistry, English ed., p. 160, vol. ii. American
ed., p. 546, vol. i.

(7) Pathological Chemistry of MM. Becquerel and Kodier, English ed., p. 90.

(8) Pathological Chemistry, by MM. Becquerel aud Rodier. Eng. ed., p. 81.

1858.]

Jones, on Diabetes Mellitus.

297

Analysis of 1000 Parts of Serum.

Specific Gravity of Se-
rum, 1028-000

Water, 908*000

Albumen, - - - - 80-000

Extractive Matters and

Free Salts, - - - 12-000

Analysis of 1000 Parts of Blood.
Specific Gravity of the

Blood, 1060-000

Water, 781-600

Globules, 135-000

Albumen, 70-000

Fibrin, - 2-500

Fatty Matters, Extractive

Matters & Free Salts, - 10-000
Phosphates, - - - - 0*550
Iron, 0-350

If we carefully compare the analysis of the blood of our pa-
tient with these analyses of normal blood^we will find

1. The specific gravities of the blood and serum are much
lower than the normal standard.

2. The colored corpuscles are diminished in numbers, the
dried corpuscles being only 92*702, and the moist blood corpus-
cles 370*808, whilst in health the dried corpuscles generally
average 135*000 and the moist corpuscles 540*000.

3. The albumen of the liquor sanguinis is much less than
normal, being only 49*539 in the 1000 parts of blood, whilst
in health, it ranges from 70 to 90.

4. The extractive and coloring matters are 12*866, and are
greater in amount than normal. When we compare the ex-
tractive matters with the diminished albumen and blood corpus-
cles, it is evident that they are far more abundant than normal.

5. The fixed saline constituents are normal in amount as
compared with normal blood, but increased when compared
with the diminished albumen and blood corpuscles.

It is important that we should, in the next place, compare the
blood of this patient, reduced in flesh and strength to the last
degree, with the blood of individuals whose blood has been
depraved, and forces exhausted by other diseases.

The following examples, are selected from numerous analyses
of the blood of patients suffering with malarial fever, which I
conducted in the Savannah Marine Hospital and Poor House,
during the last summer and fall :

Case I. Intermittent Fever, neglected. Irish laborer, entered
the Savannah Poor House Sept. 23rd : age 22 ; height 5 feet 8
inches. Had been working in the marshes along the Savannah

298

Jones, on Diabetes Mellitus.

[May,

river, and suffered with chill and fever for two months, during
which time he had no medical attendance. Complexion sallow ;
tongue, lips and gums pale; digestion impaired. Complains of
great weakness. Flesh not much redtfced, but feels soft and
unnatural.

Examination of Blood. Blood watery in appearance coagu-
lated slowly in 30 minutes. Eeaction decidedly alkaline. In
the specific-gravity-bottle filled with blood, the colored corpus-
cles gravitated towards the bottom and left above a light yellow
transparent clot. After standing 20 hours, the clot had con-
tracted but little, and its consistency was very weak. Serum,
of a light yellow color.

Specific Gravity of Blood, - - - - 1030*5
Specific Gravity of Serum, .... 1021-3

WATER

In 1000 parts of Blood, 877-553
" " Serum, 927-757

(1) Liquor

Sanguinis, - - 925-725

(2) "1000 parts of Liquor

Sanguinis, - - 911-124

SOLID MATTERS
In 1000 parts of Blood, 122-447
" " " "Serum, 72-243
(1)" " "Liquor

Sanguinis, - - 74*275
(2) "4000 parts of Liquor

Sanguinis,
" in Serum of 1000
parts of Blood -

88-876
68-435

(1)
(2)

(1)
(2)

FIXED SALINE CONSTITUENTS
In 1000 parts of Blood, ....
" " " Serum,
" " " Liquor Sanguinis, -
" " Liquor Sanguinis, -
Serum of 1000 parts of Blood, -
1000 parts of the Solid Matters of Blood,
" " Serum,
" " Blood Corpuscles,
" " Liquor Sanguinis,
" " Liquor Sauguinis,
" Blood Corpuscles of 1000 parts of Blood,
" 1000 parts of Moist Blood Corpuscles,

N <i

U U

3
3
3

3
27
45

3
44
44

0

0

1000 Parts of Blood Contained
Water,

Dried Blood Corpuscles, 51 987

Fibrin,

Albumen and Extractive
and Coloring Matters,

68-335

877-
Dried Organic Residue, 51-
Fixed Saline Constituents, 0'

I-
Dried Organic Residue, 65*
Fixed Saline Constituents, 3'

316
326
328
965
141
083
901
240
779
612
175
841

553
812
175
925
194
141

1858.] Jones, on Diabetes Mellitiis. 299

1000 Parts of Blood Contained

\ Water, ... 155 861

Moist Blood Corpuscles, 207 948 V Organic Residue, - 51-612

) Fixed Saline Constituents, 0-175

1 Water, - - - 721-692
| Albumen and Extractive
Liquor Sanguinis, - 792-052 \ and Coloring Matters, 65-194

I Fixed Saline Constituents, 3-141
J Fibrin, - - - 1-925

1000 Parts of Moist Blood Corpuscles Contained
Water, --.-----. 749-51S

Dried Organic Matters, - 249-154

Fixed Saline Constituents, 0-841

(1) 1000 Parts of Liquor Sanguinis Contained

WTater, 925-725

Albumen, Extractive and Coloring Matters, - - 68-817

Fibrin, -.------- 2-032

Fixed Saline Constituents, - - - - - 3-326

(2) 1000 Parts of Liquor Sanguinis Contained.
Water, .-----.-- 911-167
Albumen, Extractive and Coloring Matters, - - - 82-312

Fibrin, ..-..-. 3-965

Fixed Saline Constituents, ------ 2-430

The urine of the patient was of low specific gravity, dimin-
ished in amount, and contained no grape sugar.

Case II. Intermittent Fever, neglected terminating in Bilious
Remittent Fever, and complete alteration of the Chemical Constitu-
tion of the Blood and Tissues.

German Butcher, entered the Savannah Poor House Sept.
25th : age 23 ; height 5 feet 10 inches ; weight, in health,
180 lbs.

His present weight cannot be more than 110 lbs. Has been
suffering with chill and fever for two months, and has had no
medical attendance. Sallow, anaemic complexion; flesh and
strength greatly reduced; nervous and muscular forces very
feeble. Was brought into the Hospital in a comatose state.

Stimulants, sinapisms, cut cups to the temples and back of
neck, and blisters to the epigastrium and back of neck, aroused
him from this comatose condition.

A few days after his entrance into the hospital, a large abscess

300 Jones, on Diabetes Mellilus. [^aj,

formed upon the side of his head, in - the region of the ear, and
joint and angle of the inferior maxillary bone.

Notwithstanding that this abscess was lanced, the pus formed
an entrance into the external meatus auditorius.

Large masses of the cellular tissue and muscles sloughed
away, and the angle and superior portion of the inferior maxil-
lary bone were almost completely stripped of flesh. The abscess
compelled him to lie upon the opposite side of his body, and
the arm upon which the weight of the body rested swelled enor-
mously, until it appeared to be ready to burst, and finally the
skin over the biceps muscle changed to a black color, and
sloughed off in a single night, leaving the red quivering mus-
cles entirely exposed.

The biceps muscle sloughed entirely off from its lower attach-
ment. Large ulcers appeared in various parts of his body.

The patient lingered, supported by tonics, nutritive diet and
stimulants, for three weeks.

After death, his liver presented a color a shade lighter than
the slate color of the malarial fever liver, and in many parts it
was regaining its normal hue. The spleen was enlarged and in
many parts completely degenerated in structure, being convert-
ed into pus and a substance resembling cheese. The surface of
the spleen was covered with effused coagulable lymph, and
bound to the liver by bands of coagulable lymph. The border
next to the liver contained an abscess about the size of a wall-
nut, filled with pus. The whole substance of the spleen was
consolidated, and those portions which were not degenerated,
resembled, when cut, the liver of malarial fever. The stomach
showed the marks of chronic inflammation.

The glands of Peyer, in the lower portion of the intestinal
canal, were enlarged, but pale, and not more congested with
blood than usual.

Examination of the Blood of this patient four days after his en-
trance into the Hospital. Blood coagulated slowly. In one spe-
cimen, the coagulation was remarkably slow, and the blood
corpuscles gravitated towards the bottom of the vessel and left
above a clear, golden colored clot. This transparent portion of
the clot was about I of an inch in thickness.

Serum, of a deep golden color. Eeaction of serum, alkaline.

1858.]

Joxes, o/i Diabetes Mtllitus.

301

Specific Gravity of Blood,
Specific Gravity of Serum,

1036-6
1023-6

WATER
In 1000 parts of Blood, B40-511
" " " Serum, 913 950
(1)" " "Liquor

Sanguinis, - - 912 665
(2) " 1000 parts of Liquor

Sanguinis,

882-723

SOLID MATTERS
In 1000 parts of Blood, 159*489
" " " " Serum, 86-050
(1)" " M "Liquor

;anguinis, - -

86-973

(2)" 1000 parts of Liquor

Sanguinis, - 117 '27 7
Solid Matters of Serum of

1000 parts of Blood, 79-135

(1)
(2)

(1)
(2)

FIXED SALINE CONSTITUENTS

In 1000 parts of Blood, -
* " Serum, -
u " Liquor Sanguinis, -
" " Liquor Sanguinis, -
' " Solid .Matters of Blood,
' " M " Serum,

" " " " " Liquor Sanguinis,

I " " " Liquor Sanguinis,

II " M M " Blood Corpuscles,
" " Moist Blood Corpuscles, -

Blood Corpuscles of 1000 parts of Blood,
" Serum of 1000 parts of Blood, -

5-796

2-647

2-653

3-493

36-341

30-178

30-205

29-850

42-914

10-723

3-409

2-357

1000 Parts of Blood Co>-tai:ved
Water, --.------.

-rv j ti jp i ~c\ A*>-t ) Dried Organic Residue,

Dried Blood Corpuscles, 79-43/ > . , ^ ?. n ... '

r $ rixed Valine Constituents,

Fibrin -

Albumen, Extractive and > Dried Organic Residue, -

Coloring Matters, - 79-096 V Fixed Saline Constituents,

840-511

76-023

3-409

0-877

76-703

2-387

1000 Parts of Blood Contained
Moist Blood Corpuscles, 317-748

} Water,

18 V Dried (

) Fixed \

Organic Residue, -
Saline Constituents,

1 Water, -
Dried Organic Residue, -
Fixed Saline Constituents,
Fibrin, -

238-271

76-028

3.409

602-240

76-708

2-387

0 677

1000 Parts of Moist Blood Corpuscles Cotalxed
Water, .----..-. 749-873
Dried Organic Residue, ...... 239-284

Fixed Saline Constituents, ..-.-. 10-728

302

Jones, on Diabetes Mellitus.

[May,

(1) 1000 Parts of Liquor Sanguinis Contained
Water, -...--.-. 913-022
Albumen, Extractive and Coloring Matters, . - - 83-303

Fixed Saline Constituents, - i - - - - 2-647

Fibrin, - - 0-928

(2) 1000 Parts of Liquor Sanguinis Contained
Water, ...---.-- 882-723
Albumen, Extractive and Coloring Matters, - - - 112-433
Fixed Saline Constituents, ------ 3-498

Fibrin, .--.---.. 1-285

Case III. Bilious Remittent Fever. American Seaman, na-
tive of Boston, entered the Savannah Marine Hospital Sept.
26th : age 21 ; weight 150 lbs. ; height 5 feet 10 inches. Mus-
cular system moderately well developed.

This is his first trip to Savannah. Has been sleeping at night,
on the deck of the ship in the open air. The captain compelled
all his men to sleep on board the ship, which was lying along
the low marshy shore below the city.

This patient was brought in comatose, and has been passing
his urine and feces in bed.

Sept. 29th. Jjies in a stupor ; complexion sallow ; teeth coat-
ed with sordes; tongue perfectly dry and as rough to the feeling
as the surface of a newly sawed board. Pulse 120 ; Eespira-
tion 22.

Examination of Blood. Blood coagulated slowly. Serum, of
a deep golden color.

Nitric acid showed that this color was due to the presence of
bile.

Eeaction of serum, alkaline.

Specific Gravity of Blood,
Specific Gravity of Serum,

1040
1022

WATER

In 1000 parts of Blood, 833-449
" ii c< Serum, 912-386
(1)" "Liquor

Sanguinis, - - 910-798
(2)" 1000 parts of Liquor

Sanguinis, - - 875-813

SOLID MATTERS

In 1000 parts of Blood, 166-551
u u u ( gerum, 87-614

(1) " " Liquor

Sanguinis, - - 89-203

(2) "1000 parts of Liquor

Sanguinis, - - 124-187
"Serum of 1000 parts

of Blood, - - 80-033

1858.]

JONES, on Diabetes Melliius.

303

FIXED SALINE CONSTITUENTS

In 1000 parts of Blood,
" Serum,

" Liquor Sanguinis,
M Liquor Sanguinis,
" Dried Blood Corpuscles,
" Moist Blood Corpuscles,
" Dried Residue of Blood,
" " " M w Serum,

Serum of 1000 parts of Blood, -

U

u

(i

(1)

II

H

tl

(2)

m

H

M

m

M

N

u

II

II

u

II

II

6-314
6*620
6-630
8-759
6-595
1-646
37-909
75-558
5-747

1000 Parts of Blood Contained

Water, ......... S33-449

Tk j oi j n i o- nco ^ Dried Organic Residue, - 84-400

Dr.ed Blood Corpuscles, 8o.968 { Fixed ^ ConstitueMs, 0-567

Fibrin, . . . ... . . . 1-450

Albumen, Extractive and ) Dried Organic Residue, - 74-1S6

Coloring Matters, - 80-033 ] Fixed Saline Constituents, . 5-747

1000 Parts of Blood Contained

} Water, .... 258-804
Moist Blood Corpuscles, 343-872 V Dried Organic Residue, - 84-400

} Fixed Saline Constituents, - 0-567
^ Water, - 574-646

| Albumen, Extractive and
Liquor Sanguinis, - - 656*128 J- Coloring Matters, - - 74-185

| Fixed Saline Constituents, - 5-747
J Fibrin, .... 1-450

1000 Parts of Moist Blood Corpuscles Contained
Water, .-.------- 752-646

Dried Organic Residue, ------- 245-239

Fixed Saline Constituents, ---... 1-648

(1) 1000 Parts of Liquor Sanguinis Contained
WTater, ....... 910-797

Albumen, Extractive and Coloring Matters, . - - - 80-996
Fixed Saline Constituents, ------ 1-587

Fibrin, - 6-620

(2) 1000 Parts of Liquor Sanguinis Contained

Water, - 875-813

Albumen, Extractive and Coloring Matters, - - - 113-064
Fixed Saline Constituents, ..-.-- 8-758
Fibrin, - 2-209

Lender the use of stimulants, sulphate of quinia, and nutri-
tious diet, this patient recovered, slowly. He was confined to
his bed three weeks, and at the end of this time, exhibited

304 Jones, on Diabetes Mellitus. [May,

the effects of the bilious remittent fever, in his pale, sallow,
anaemic countenance, pale lips and gums, and tottering gate.

The violent nature of the malarial fever, contracted by sleep-
ing in the open air in the low marshy land bordering our fresh
water rivers, is forcibly illustrated by the subsequent history of
the crew to which this patient belonged.

A few days after his admission into the hospital, the captain
weighed anchor and sailed for New York. Before getting well
out to sea, himself and the whole of his crew were taken sick.
There was not a man with strength to work a pump or furl a
sail. Fortunately a small vessel perceived their signals of dis-
tress, and towed them into Darien. Before reaching this port
the captain and five out of seven of the crew had died. There
were but two remaining out of eight, and these were extreme-
ly ill.

If we compare the blood of these cases with that of health,
and with the blood of the patient suffering with diabetes melli-
tus, we will observe the following points of agreement and
disagreement :

1. The colored blood corpuscles are diminished greatly and
rapidly in malarial fever. This destruction of the colored blood
corpuscles is far more rapid in malarial fever than in diabetes
mellitus.

2. The salts of the colored blood corpuscles are diminished
to a remarkable extent in malarial fever whilst they are normal
in amount in the blood of diabetes mellitus.

3. The blood coagulates slowly, and the clot is soft, in mala-
rial fever whilst the reverse was the case in this specimen of
diabetic blood.

4. The fibrin is often diminished in malarial fever, and the
serum presents a golden color whilst in this case of diabetes
mellitus the fibrin was slightly increased and the color of the
the serum was normal.

That the poison of malarial fever induces profound changes
in the colored blood corpuscles, and other constituents of the
blood, I have demonstrated by the following facts :

(a). The urine of patients suffering with malarial fever con-
tains an increased quantity of iron. The increase of the iron
in the urine is subsequent to the destruction of the colored cor-
puscles in the blood.

1858.] JoXES, on DiuLetes Mellitus. 305

(b). In examinations of the organs after death, from all the
forms of malarial fever intermittent, remittent and congestive
I have observed that the dark blood of the spleen and liver do
not change to the arterial hue when exposed to the action of the
oxygen of the atmosphere.

After death from phthisis, cirrhosis of the liver, organic dis-
ease of the circulatory apparatus, and apoplexy, and mechanical
injuries, as far as my observations extend, the blood of the
spleen and liver always change to the arterial hue when ex-
posed to the action of the oxygen of the atmosphere.

(c). Animal starch accumulates in the malarial-fever liver
whilst grape sugar, as far as my observations extend, is absent.
I have tested the livers of malarial fever for grape sugar and
starch. An abundance of starch (9) was obtained, without a
trace of grape sugar.

The livers were set aside, and examined after intervals of
twelve hours. The last examination was made thirty-six hours
hours after the first. At every examination the result was the
same an abundance of animal starch, and no grape sugar.

These facts are important, not only in their bearing upon
malarial fever, but also in their bearing upon diabetes mellitus.
M. CI. Bernard (! ) has demonstrated that the transformation
glycogenic hepatic matter (animal starch) formed by the liver,
into glucose, is the result of the action of a special ferment,
which is formed and exists in the blood, independent of the
liver.

From the facts which we have previously stated, it is evident
that in malarial fever, this ferment is destroyed, whilst the liver
still possesses the power of transforming the nitrogenized and
non-nitrogenized elements into animal starch.

We have now facts sufficient, to draw important distinctions
between malarial fever and diabetes mellitus.

(9) So abundant is this animal starch in the malarial fever liver, that if a small
particle of the substance of the liver be mashed upon a glass slide, treated -with
a saturated solution of iodine in alcohol, and viewed under the microscope, nu-
merous beautiful blue masses ot this animal starch, colored by the iodine, will be
seen. If the fibrous capsule be torn off from the surface of the liver, spread upon
a glass slide, and treated with tincture of iodine, these blue masses will be seen
scattered amongst the meshes of the fibrous tissue. With reference to the dis-
covery of animal starch, see Ameriean Journal of Medical Sciences, Oct. 1857,
p. 549.

(10) Moniteur de Hopitaux, April 14, 1857 ; also, American Journal of Medical
Sciences, July, 1857, p. 208

306

JONES, on Diabetes Mellitus

[May,

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1858.] Joxes, on Diabetes Meltitus. 307

~\Ve have now all the necessary facts for the intelligent treat-
ment of this case.

The indications in the treatment of this case of diabetes melli-
tus are

(1). To strengthen digestion.

His stomach fails to digest the nitrogenized elements the
very substances which he needs, to supply the rapid waste of his
tissues.

(2). To afford the organic and inorganic materials of structure.

(3). To quiet and strengthen the nervous system.

(i). To arrest the destruction and transformation of the ele-
ments of the blood, tissues and food, into animal starch and
grape sugar.

(1). To strengthen Digestion. Meat passed entirely through the
alimentary canal, without being digested. This is clear evi-
dence that the gastric and pancreatic juices do not perform their
offices. The active and essential principle of the gastric j uice
being pepsine. this must first be supplied. If pepsine and an acid
be supplied, digestion will take place in a weak, diseased stom-
ach, as well as in the healthy stomach. The truth of this asser-
tion has been established by the experiments of Dr. L. Corvisart
of Paris, (T l) to whom the profession is indebted for the intro-
duction of pepsine into the practice of medicine.

Andral, Longer, (12) Billet, Barthez, (13) Grisole, Herard,
Togel, Schiff, Josi, Lecointe, (,4) Ballard, (15) Bertholet, (16)

(11) "Dyspepsie et Consomption usage de la Pepsine," by Dr. L. Corvisart.
Paris, IS 54.

" Recherches ayant pour but, d'administrer aux malades qui ne digerent point
des aliments tours diffires par le sue gastrique des animaux/' Comptes Rendus,
Aug. 16th, 1S52 Sept. 6th, 1S52.

Etudes sur les Aliments et Nutriments Xouvelle Methode pour le traitement
des malades dont l'estomac ne digere point." L'Union Medicale, 1854, p. 17.

(12) In typhoid fever. Bulletin Gen. de Therap. t xlvil p. 320.

(13) Sur Tapepsie (on absence de digestion) chez lezenfans. et sur le traitement
de cette maladie par la pepsine. L'Union Medicale, Jan. 12th, 1S56.

(14) Observation d'un cas de consomption ultime, traitee par la Poudre Xutri-
mentive, Bulletin Gen de Therap. L xlix. p. 268.

(15) Artificial Digestion as a Remedy in Dyspepsia, Apepsia, and their resulta.
By Edward Ballard, M.D., London, 1857. This valuable work contains the me-
thod of preparing the pepsine. and also the report of numerous cases of disordered
digestion, successfully treated with pepsine, by Dr. Ballard and other practitionere
of medicine.

(16) In Dyspepsia of a year's duration.

13*

308 Jones, on Diabetes Mellitus. [May,

Cahagnet, (' 7) Parise, (l 8) Huet, (' 9) Chambers,(2 ) Nelson (2 *)
and others, (2 2) have testified to the efficacy and value of pepsine
in various diseases.

The fourth stomach of ruminants (rennet bag) is generally
recommended as a source of pepsine. In hospital practice, how-
ever, I preferred to employ the stomach of the pig, for two
reasons :

The pig is an omniverous animal. Its food and digestive
process resembles more nearly that of man, and consequently
its gastric juice must be better adapted to his wants.

For hospital purposes, the stomach of the pig can be much
more readily obtained and prepared, than that of the cow or
sheep.

When pepsine can be obtained pure from the apothecaries, or
when the physician has time to prepare it himself, the Poudres
Nutrimentives (2 3) of Corvisart is by far the most elegant and
portable preparation.

(1*7) In Dyspepsia and Vomitings of several years' duration.

(18) In Dyspepsia of early Pregnancy.

(19) Gastralgia after food of several years' duration.

(20) Practical Lectures on the Management of Digestion in Disease, by T. K.
Chambers, M.D. London Lancet, Aug., 1857, p. 101 Sept. 1857, p. 180, Am. Ed.

(21) On Mellitic Diabetes in reference to its Treatment by Rennet or Liquor
Pepticus Prsep., by David Nelson, M.D. London Lancet, Aug. 1857, p. 118, Am..
Edition.

(22) Rennet in Diabetes Mellitus, by Dr. James Gray. Glasgow Med. Journal,
Oct. 1856. See also American Journal of Medical Sciences, Jan. 1857, p. 2 5.

(23) The following are the directions, given by M. Boudalt, for the preparation
of the medicine : "Take a sufficient number of rennet bags (the fourth stomach
of the ruminants), open and reverse them, and wash them under a thin stream of
cold water ; scrape off the mucous membrane, reduce it to a pulp, and macerate it
in distilled water for twelve hours ; filter ; add to the liquor a sufficient quantity
of acetate of lead, and after separating the precipitate, pass through it a current
of sulphuretted hydrogen ; filter again ; evaporate at a low temperature to the
consistence of a syrup, which is mixed intimately with starch pulverized, and
dried at a temperature of 100 centig. In this state the gentle application of heat
will reduce it to a dry mass re'adily reducible to a powder of uniform efficacy. "

The power of the pepsine thus obtained, varies, and before the use of a speci-
men, we should first test its transforming power. The standard dose is that quan-
tity of the powder, which when acidulated with three drops of lactic acid and
added to 15 grammes (225 grains) of water, would transfer 6 grammes (90 grs.)
of fresh fibrin finely cut up, and kept in a bottle, at a temperature of 40 centig. r
for twelve hours, with occasional shaking. The average dose of the "Poudre
Kutrimentive" is 15 grains. It may be taken dry or in solution, in unfermented
bread, or in a spoonful of soup, or in sweetened water. It should always be ta-
ken with, or at the commencement of the meal on which it is to act. Ballard on
Artificial Digestion, p. 10. See also, Memoire sur le principe digestif, les prepa-
rations nutrimentives, et les moyens propres a reconnaitre et a mesurer leur ac^
tion. Acad. Imp. de Med., Seance du 14 Fevrier, 1854, et Moniteur des Hopitaux,
16 Fevrier, 1854.

1858.] Jones, on Diabetes Mellitus. 309

*$. Cut a pig's stomach into thin slices, and pour upon it
one pint of vinegar, and preserve from decomposition (if the
weather be warm), by surrounding with ice.

The pepsine and vinegar will reduce the tissues of the stom-
ach to a uniform mass, or rather, fluid. Dose, f 5j. three times
a day, mixed with cold mutton or beef soup.

This preparation is useful for hospital purposes, because it is
easily prepared, and at the same time is more efficacious than
the pepsine ordinarily sold in the shops.

Chambers^4) and other (25) have shown that much of the
pepsine now sold, possesses but feeble transforming powers.

Pepsine is not the only substance concerned in the digestion
of albumenoid substances.

The connective tissues and muscular fibres are disintegrated
and softened, but never completely dissolved by the gastric juice.

The ultimate fibrilla3 of muscles which have escaped the ac-
tion of the gastric juice pass into the small intestines, and are
there digested by the pancreatic juice.

M. L. Corvisant(2 6) communicated to the Imperial Academy
of Sciences, April 6th, 1857, a Memoir on the Power of the
Pancreas to Digest Azotized Food, in which he confirmed the
assertion of Purkinge and Pappenheim, that the secretion of the
pancreas is endowed, like the gastric juice, with the property of

The following is the mode adopted and recommended by Dr. James Gray of
preparing the rennet:

" The stomach of a calf (and the younger it is the better,) is gently washed
with water, taking care not to injure the mucous membrane; it is then salted,
tied up and allowed to dry. After this, it is cut into small pieces, macerated in
a pint and a half, or two pints of water, according to the size of the stomach, for
four days or longer in winter, shaking it at intervals ; the fluid is then poured off
and bottled, and to test its power, a spoonful may be added to a pint of warm
milk, which, if it curdles, it is now fit for use. A little spirits, or decoction of
sparrow-grass, may be added to make it keep. The dose of rennet thus prepared
is a tablespoonful, three, four, or six times a day, about half an hour after each
meal, and during the process of digestion, followed shortly after by an alkali, to
neutralize the lactic acid formed. That which I recommend is the alkaline tri-
basic phosphate of soda; but the carbonate of potash will answer very well,
either alone or combined with the tincture of nux vomica, in five or ten drop
doses." Glasgow Medical Journal, Oct. 1856. See abstract of paper in Amer.
Jour, of Medical Sciences, Jan. 1857, p. 215.

(24) Experiments upon Artificial Digestion, by T. K. Chambers, M. D. London
Lancet, Aug. 1857, p. 133, Am. ed.

(25) Experiments upon the Action of Pepsine, by Edward H. Sieveking. Med.
Times and Gazette, April 4, 1857. See, also, American Journal of Med. Sciences,
26 July, 1857, p. 212.

Monitenr des Hopitaux, April 21st, 1857. See, also, American Journal of Med.
Science*, July, 1857, p. 206,

310 Jones, on Diabetes Mellitus. [May,

dissolving azotized food, and demonstrated that the pancreatic
juice in disintegrating albumenoid elements, effects in them a
transformation identical or analogous to that which the stomach
produces.

The pancreatic juice acts only on those portions of the food
which have escaped the action of the gastric juice, and at the
same time it has no effect upon the digested products of the
stomach.

When separated, the pancreatic and gastric fluids exercise
their functions in full, and when mingled in their pure state,
the two digestions are arrested. The two ferments, pepsine and
pancreatine, destroy each other.

In the alimentary canal, this is prevented. 1st, by the pylor-
ous which separates the two ferments. 2nd, by the gastric
digestion during which the pepsine is destroyed. 3rd, by the
bile which destroys in its course the activity of the pancreatine.

It is evident, therefore, that the pancreatine, or the pancreatic
juice, so far from assisting digestion, would retard it. M. S.
Corvisart states that he had failed to receive any benefit from
the administration of pancreatine for the relief of derangement
of the digestion in the intestinal canal.

In this case of diabetes mellitus, I employed a preparation of
the pancreas of the pig, prepared in the same manner with
the stomach. No beneficial results were produced, and it was
abandoned and the pepsine retained.

(2.) To afford the organic and inorganic materials of structure.

As usual in the treatment of diabetes mellitus, the patient was
furnished principally with animal food eggs, mutton, beef, &c.

Bread and rice were allowed more frequently, however, than
in the practice laid down in the books.
$ Phospate of Iron, . .
" a Lime, . .
" Soda, . .
" " Potassa, . " iv.
Mix and administer three times during the day, in the soup
containing the pepsine. These salts were given because they
form important constituents of the blood corpuscles, muscles and
brain, and nervous system.

$ Cod-liver oil, tablespoonful three times a day.

grs.

1>

u

iv.

u

vi.

1858.] Jones, on Diabetes Mellitus. 311

Cod-liver oil is indicated in the treatment of diabetes mellitus
for two reasons :

To supply the fatty matters which have been consumed.

There is a close connection between phthisis and diabetes.

Writers upon this disease state that, in the majority of cases,
phthisis makes its appearance before death.

(3.) To strengthen and quiet the nervous system.
The depressed spirits, fretful, peevish temper, impaired mem-
ory and intelligence, loss of sexual propensity, and complete
exhaustion of nervous power, call for those remedies which will
act both as tonics and sedatives to the nervous system.

To accomplish these objects, opium and strychnia should be
given simultaneously.

$ Strychnia, grs. ij.

Extract of Gentian, . . . " 3 ij.

Mix and divide into 100 pills; one pill three times a day, to be
gradually increased, according to the strength of the patient
and effects upon the nervous system.

Strychnia not only exerts a tonic influence upon the digestive
organs, and muscular and nervous systems, but also exerts a
direct influence in diminishing the amount of sugar formed.

# One grain of opium at bed-time, and one grain in the
morning, at 9 o'clock.

Opium quiets the nervous irritability of the patient, and con-
trols the diuretic influence of the sugar in the blood. It checks
the excessive discharge, but does not prevent the production of
sugar. Nevertheless, its action upon the nervous system ren-
ders it one of the most valuable of the secondary means.

As a stimulant and tonic to the digestive organs, f I ij. of bran-
dy were administered, three times a day, in a cup of the officinal
infusion of quassia and soda.

Aug. 10th. Pulse, 74. Temperature of Atmosphere, 88 F.

" under Tongue, 98

Aug. 11th. Pulse, 78. Temperature of Atmosphere, 81 F.
Eespiration, 16, " under Tougue, 99 J

August 12th. Slight improvement of digestion. Bowels are
not moved so frequently. He is exceedingly weak, and com-
plains of pain in his head and bones.

812 Jones, on Diabetes Mellitus. [May,

August 19th. Complains of great weakness and thirst; is in
a profuse perspiration ; says that his digestion improves, but his
strength does not increase. The brandy causes him to sleep
and perspire too freely, and is probably the cause of the increas-
ed flow of urine and loss of strength.

The experiments of George Harley, M.D., (2 6) and M. Ber-
nard, (2 7) have demonstrated that alcohol, ether, chloroform,
methylated spirit, and ammonia, introduced into the duodenum,
or injected directly into the portal vein, will excite an increased
secretion of sugar. Healthy animals thus operated on were
rendered for a time diabetic. This fact is important, not only
in the treatment, but also in its bearing upon the causes of dia-
betes mellitus.

Drunkards are said to be peculiarly liable to this disease.

Pulse 84, Eespiration 17, Temperature of Atmosphere, 90 F.

" under Tongue, 104

The acceleration of the pulse may be due to the action of the
alcoholic stimulants. "We will discontinue the brandy and sub-
stitute 10 grains of carbonate of ammonia, three times a day, in
a cup of the infusion of quassia and soda.

The carbonate of ammonia is administered, first, as a stimu-
lant, and second, as a means of diminishing the amount of grape
sugar.

Some chemists (2 8) have supposed that the occurrence of alka-
line carbonates is necessary for the decomposition of sugar in
the animal economy, and that in diabetes the passage of glucose
into the urine is due to a want of alkalinity in the blood.

(26) " Contributions to the Physiology of Saccharine Urine. On the Origin and
Destruction of Sugar in the Animal Economy, by George Harley, M.D." British
and Foreign Medico-Chir. Review, July, 1857, p. 144.

(27) Gazette Medicale de Paris, Mai 10, No. 19, 1856, and Schmidt's Jahrb., vol.
xciii. p. 24, 1857.

(28) Chimie applique a'la Physiologie et a la Therapeutique, Par M. le Docteur
Mialhe, Pharmacien d' l'Empereur. Paris, 1856.

In this work, Mialhe, after examining the various hypotheses which have been
proposed to explain the nature of diabetes mellitus, comes to the conclusion that
its true cause is a deficiency of alkali in the blood. To the objection that the
blood of diabetic patients is never either neutral or acid, but always alkaline in
its reaction, Mialhe answers that it is difficult to determine the amount of the
alkalinity of the blood; and again, that part of the alkaline reaction of this
fluid is derived from the presence of alkaline phosphates which possess no power
of decomposing glucose. He is inclined to consider that the alkaline carbonates
are deficient or absent, the phosphates remaining intact, thus preventing the
fluid from exhibiting anything but an alkaline reaction.

In the treatment of diabetes he acts strictly u^on these indications, and pre-

1858.] Jones, on Diabetes Mellitus. 313

Direct experiment does not supp*::; this theory, for the re-
searches of C. G. Lehmanri, (39) Bouchardat and Bernard, (30)
have proved on the contrary, that the blood of diabetic persons
preserves its alkalinity, and that the alkalies of the blood do not
promote the oxidization of sugar to the extent asserted.

Direct experiment and clinical facts, on the other hand, have
shown that, in certain derangements of the nervous and circu-
latory systems and of the constituents of the blood, the produc-
tion of grape sugar is increased and it passes into the urine ;
and farther, that the alkaline carbonates diminish the proportion
of sugar in the urine of diabetic patients.

We may then employ the alkaline carbonates in the treatment
of diabetes mellitus, although their action upon glucose in the
animal economy is not well understood, and probably differs
both in degree and kind from that asserted by Mialhe.

August 20th. Feels very weak, and complains of a pain in
the region of his liver. Bowels are still irregular, but improving.
Pulse, ... 72. Temperature of Atmosphere, 83 F.
Inspiration, 14 " " Hand, .... 97

" under Tongue, 100

August 26th. Improving in strength and spirits. Digestive
function restored. Slowly gains flesh. Digests large quantities
of meat with ease.

$. Cane sugar ixij. during the 24 hours.

scribes lime water, magnesia, vichey water, bicarbonate of soda, alkaline and
vapor baths, flannel, friction, exercise, animal diet^ and sometimes sudorifics.
M. Mialhe relates the case of an Italian professor of music, afflicted with diabetes
mellitus. Under the alkaline treatment the sugar rapidly diminished and the
patient recovered.

(29) Prof. C. G. Lehmann injected a solution of grape sugar, prepared from
starch, into the veins of 37 dogs and rabbits, and in every instance grape sugar
appeared in the urine; and the reaction of the urine was acid. The sugar pass-
ed so rapidly into the urine, that it was frequentlj* detected five minutes after its
injection, and then when only O'l of a gramme was injected.

Caustic, alkalies, and their carbonates, associated with grape sugar, were also
injected into the veins of rabbits.

Notwithstanding the caustic, alkalies and the carbonates, the urine not only-
contained grape sugar, but also exhibited an acid reaction.

Prof. Lehmann also injected dilute solutions of tartaric and citric acids into the
stomachs of rabbits and dogs, fed on food poor in alkalies. Although the blood
was thus rendered poor in alkalies, while at the same time vegetable acids were
introduced, still not a trace of sugar appeared in the urine. Physiological Chem-
i.-try, by Prof. C. G. Lehmann. English Ed., voL hi., p. 233. American Ed.,
vol. ii., p. 357.

These experiments have been repeated by Uhle, with similar results. Dis.
Iuaug. Med. Lips., 1852. p. 19.

(30)Moniteur des Hopitaux, May 14, 1857.

314 Jones, on Diabetes Mellitus. [May,

Hoppe's(3 1) Investigations upon the action of cane sugar upon
the animal economy have established the following facts :

1. No trace of grape sugar was found in the urine or feces
during continued feeding with cane sugar.

2. When sugar and meat were given together, the weight of
the animal increased much more rapidly than when meat alone
was given.

3. When sugar and meat were consumed, urea was excreted
in smaller quantity than when meat alone was taken.

4. By exclusive sugar diet, the excretion of urea was de-
pressed to its lowest amount.

5. By the presence of much sugar in the blood, the albumin-
ous substances are preserved from oxidization.

The albumen thus stored up appears to be decomposed during
the development of fat. In this manner sugar produces fatten-
ing, only when, at the same time, albuminous substances are
liberally supplied.

6. The temperature of the body was not increased, by the
addition of sugar to the allowance of meat.

7. The health of the animals experimented on, was in no way
injured by feeding on large quantities of cane sugar, in addi-
tion to a liberal supply of meat.

September 23rd. Has continued steadily to improve in health
and strength, and is now able to walk about the hospital grounds
and assist in nursing the patients.

The amount of urine voided daily has diminished.

October 20th. His muscular and nervous forces have increased
greatly. His face and limbs have filled out. His spirits are ex-
cellent; and he says that he is now as fleshy as in health.

He is able to act as assistant nurse, and often sits up all night
with those patients who require his services.

The amount of urine excreted daily has greatly diminished,
and ranges from seventy to ninety fluid ounces.

The grape sugar has diminished greatly in amount, but has
not entirely disappeared.

At this date I resigned the charge of the Savannah Marine
Hospital and Poor House.

(31) F. Hoppe, on the Influence of Cane Sugar in Digestion and Nutrition.
Virchow's Archiv., vol. x., pp. 144, S. S., 1856.

1858.] DuGAS. New Principle of Diagnosis. 315

It is evident, that sufficient time had not elapsed to warrant
the assertion that this case was cured ; nevertheless, the reme-
dies used produced decided beneficial effects, and were the
means, in Providence, of arresting the disease, when the patient
appeared to be in the last stages of diabetes mellitus, and upon
the borders of the grave.

I have endeavored to give a simple statement of the facts ob-
served in this case, the plan of treatment pursued, and the reasons
which led me to the adoption of this mode of treatment.

Although this is but a single case, the treatment of which was
not even conducted to its termination in complete health, or
death, still, I am persuaded that, in the present state of Medical
Science, every successful effort to arrest so formidable a disease
as Diabetes, even for a few months, will be considered worthy
of an examination by Practitioners of Medicine.

AETICLE XIII.

A Xew Principle of Diagnosis in Dislocations of the Shoulder-joint.
E y L. A. Dcgas, M. D., Professor of Surgery, in the Medical
College of Georgia.*

Having for a number of years inculcated in my lectures the
principles contained in this paper, I was requested to reduce
my views to writing, for the benefit of our classes, and according-
ly published an article on the subject in the March number, for
1856, of the Sout/iern Medical and Surgical Journal, p. 131.
The object of this communication is to present the American
Medical Association with a brief expose of this interesting sub-
ject, and to accompany my remarks with pictorial illustrations,
calculated to impress the eye as well as the understanding of the
reader.

The principle of diagnosis to which I refer may be enuncia-
ted in the following language : If the fingers of the injured limb
can be placed by the patient or by the surgeon upon the sound
shoulder, while the elbow touches the thorax, there can be no dis-
location; aud if this cannot be done, there must be a dislocation.
In other >vords, it is physically impossible to bring the elbow in

* The above Report was read before the American Medical Association, and
printed in the loth Volume of the Transactions.
K.s. vol. xrv. no. v. 14

816

DUGAS. New Principle of Diagnosis.

[May,

contact with the sternum or front of the thorax if there be a dis-
location ; and the inability to do this is proof positive of the ex-
istence of dislocation, inasmuch as no other injury of the shoul-
der-joint can induce this inability.

In order to make these propositions apparent, I beg leave to
present drawings taken from the skeleton, showing the relative
position of the bones in the natural state, and in the several dis-
locations of the shoulder. The evidence thus obtained in sup-
port of my principle, would be still stronger if the bones were
invested with their normal coverings and attachments.

Let us then look at Fig. 1, and we may observe, that while
the head of the humerus occupies the glenoid cavity, and the fin-
gers rest upon the other shoulder, the elbow and lower end of
the humerus lie upon the thorax without difficulty, because of
the circumstance that the head of the humerus, when in its natu-
ral position, is removed several inches from the ribs. In con-
sequence of the rotundity of the thoracic walls it is physically
impossible that both ends of the humerus should at the same
time come in contact with the chest. We see, therefore, in Fig.

Fig. 1.

1, that in the absence of any dislocation, the upper half of the
bone does not touch the thorax, and that the lower half does so
without the least difficulty.

1853.] Dug AS. New Principle of Diagnosis. 317

Fig. 2.

By now referring to Fig. 2, which represents a dislocation into
the axilla, we find that, the fingers being placed upon the oppo-
site shoulder, the elbow is forced so far forwards that it cannot
touch the thorax. In this state of things, the upper end of the
humerus alone touches the ribs, while the lower end is propor-
tionately removed from the chest. Any attempt to force the
elbow against the thorax must be fruitless, unless at the expense
of a disruption of all the soft parts by which the head of the hu-
merus is held down ; for, as I have already stated, it is physical-
ly impossible for both ends of the humerus to touch the thoracic
walls at the same time.

We have represented, in Fig. 3, a dislocation forwards or be-
low the clavicle ; and here again we find the upper end of the
humerus resting upon the ribs the elbow being consequently
removed from the chest. The upper half of the humerus touches
the thorax, and so long as this is the case, it is physically impos-
sible for the lower portion of the humerus also to do it. In dislo-
cations of this kind, it is very difficult to carry the fingers upon
the opposite shoulder, even though the elbow be allowed to pro-
ject forward, because of the resistance offered by the strong mus-
cles which pull back the humerus. I have, however, represen-
ted the bones of the skeleton in this position, for the purpose of

318

DuGAS. New Principle of Diagn

osis.

[May,

showing the effect, in case it could be assumed, in the living
subject.

Fig. 3.

Dislocations of the humerus upon the dorsum of the scapula,
although very rare, should still be carefully studied. I have,
therefore, represented this accident in Fig. 4, by which it may

Fig. 4.

be seen that the same principles are applicable also to it. Here,

1858.] Dugas. New Principle of Diagnosis. 319

as well as in the other instances, it is only the upper end of the
humerus that touches the thorax, and the elbow projects strong-
ly forwards. In this dislocation, it might be possible to bring
the elbow against the side of the trunk, by carrying the hume-
rus down parallel with the axis of the body ; but any contact
of the elbow with the chest is impossible, if the fingers be directed
towards, or placed upon the sound shoulder, for then the form
of the thorax would offer an insuperable obstacle.

Having now, I trust, sufficiently demonstrated the truth of
the proposition that it is physically impossible to bring the elbow
against the front of the thorax in dislocation of the shoulder, I
would simply add, that it is equally true, that no other injury
of the shoulder-joint than a dislocation can induce this physical
impossibility. It is obvious, that a mere contusion of the soft
parts may render motion of the joints so painful as to deter the
patient from the effort necessary to carry the fingers upon the
other shoulder. But there can be no difficulty on the part of
the surgeon in placing the limb in this position, and an anaesthe-
tic might be used, if desirable, so as to render manipulation pain-
less. The same may be said of fractures of the upper end of the
humerus, of the acromion, of the coracoid process, and of the
neck of the scapula. In neither of these accidents can there be
any physical impediment in the way of bringing the elbow in
contact with the front of the chest, for in neither of them can
the upper end of the humerus be so fixed against the ribs as to
make it impossible for the lower end to touch the chest. Nothing,
therefore, but a dislocation can prevent the limb from being
placed in the position indicated.

If it be justly esteemed a matter of great importance to be in
possession of correct principles of diagnosis in occult diseases, it
is certainly not the less so with regard to surgical accidents, es-
pecially when these demand prompt interference. Our profes-
sional records unfortunately establish too conclusively the im-
perfection of our diagnostic resources in injuries of the joints, to
permit any indifference on the subject. If, therefore, the views
here presented may facilitate, in the least degree, the detection
of injuries confessedly more or less obscure, my object will have
been attained.

320 Supra-renal Capsules and Bronzed Skin. [May,

Supra-renal Capsules and Bronzed Skin. By George Harley,
M. D., F. R. C. S. London.

[The following condensed analysis of the above paper published
in the British and Foreign Med. Chir. Review, presents a compre-
hensive resume of the various opinions and experimental results
upon the subject. It is by Dr. Austin Flint, Jr., and is transfer-
red from the Buffalo Journal. Edts.]

The Supra-Renal Capsules. By Austin Flint, Jr. Medical
practitioners have always occasionally met with a disease affect-
ing the color of the skin and accompanied by extreme emacia-
tion, of the pathology of which they were utterly ignorant. We
ourselves had an opportunity of seeing such a case in the wards
of Prof. Flint, at the Buffalo Hospital of the Sisters of Charity.
In this case, as far as our memory serves us, the patient was ex-
ceedingly emaciated ; had cough and extensive pulmonary disease,
and was affected with a brown discoloration of the skin, which
was general, with the exception of spots over the body of dazzling
whiteness, which were of irregular shape, and varied in size from
that of a sixpence to a dollar, or in a few places were even lar-
ger. The patient died a few days after his admission into the
wards, but no autopsy was made.

A short time after this, we saw a notice of a monograph by Dr.
Addison, on " The supra-renal capsules and iheir connection with
Bronzed Skin." Dr. Addison has made a number of post-mortem
examinations of patients who where affected with this peculiar
discoloration of the integument, which he denominated " Bronzed
Skin" and invariably found associated with it a disease or disor-
ganization of the supra-renal capsules, by which their function
was entirely abolished. As Addison was the first to point out
any connection between bronzed skin and disease of these organs,
it has been proposed that the disease shall be called "Addison's
Disease," as albuminuria connected with organic diseases of the
kidneys was named after its distinguished discoverer, Dr. Bright.
Physiologists, as is well known, have never been able to deter-
mine definitely the function of the ductless glands or the blood
glands, as they are sometimes called ; which are the spleen, thy-
noid and thymus glands, mesenteric glands and the supra-renal
capsules. These organs have all the anatomical characteristics
of ordinary glands, with the exception of ducts ; and, as owing to
this, their secretion, if they have any, cannot be subjected to
analysis, their role in the economy has remained almost unknown.
In none of these, however, has the obscurity been so great as in
the case of the supra-renal capsules. The brilliant experiments
of Bernard in regard to the Glucogenic function of the liver,

1858.] Supra-renal Capsules and Bronzed Shin. 321

which so surprised and delighted the scientific world, and which
made such an advance into the pathology of that hitherto unac-
countable disease, diabetes mellitus ; gave a new impulse to the
study of the ductless or blood glands; as by these experiments
Bernard has shown that the liver, in addition to its office as a
bile secreting organ, formed sugar within its substance, which
was given up immediately to the mass of blood without the inter-
vention of an excretory duct : since this was discovered, it has
been shown that the liver also produces fat de novo, though as
much is not known about this function as about the production of
sugar. Thus the liver, in addition to being an ordinary gland,
possessed of an excretory duct, is in reality a blood gland like the
spleen, or supra-renal capsules.

A great proportion of the energy of the investigations into the
functions of the ductless glands hasbeen directed towards the spleen,
and it is now supposed, and on pretty good foundation, that the
spleen and mesenteric glands have an important office in the for-
mation of blood globules. The physiology of the supra-renal cap-
sules, however, had still remained buried in its original obscurity.

Upon the appearance of the excellent monograph by Dr. Addi-
son, observers in all parts of the world set themselves to work upon
the physiology of the supra-renal capsules ; the paper of Addison
having thrown some light on the subject, and seeming indeed to
establish some connexion between these organs and the formation
of pigment, or the regulation of its deposition. The Physiologists
who have made known to the world the results of their experi-
ments, are Gratiolet, Brown Sequard, Philipeaux, and Dr. Harley,
of University College, London. The experiments of these gen-
tlemen, whose names our readers will recognise as belonging to
men eminent in this department, have led them to somewhat dif-
ferent results : we had the pleasure of listening to lectures by Dr.
Brown Sequard on this subject a year ago, when he seemed to
prove that the supra-renal capsules were essential in the highest
degree to life, even more so than the kidneys themselves ; as an
animal survived for two or three days after the extirpation of the
kidneys, but it lived for a few hours only after the removal of the
supra-renal capsules. Brown Sequard also showed that animals
from whom these organs had been removed, were convulsed and
affected with that peculiar nervous phenomenon which is known
as " turning," this turning always being in the same direction.
He also asserts that death supervenes too rapidly to be due to
inflammation of the peritoneum, and indeed, on examining this
membrane after death, no evidences of inflammation are observed.
Brown Sequard performed experiments in the presence of his
audience, and we had an opportunity of witnessing the phenome-
na which he described.

The most elaborate and satisfactory paper on this subject which

322 Supra-renal Capsules and Bronzed Skin. [May,

we have yet seen, is from the pen of Dr. Harley, and appeared
in the last number of the British and Foreign Medico-Chirurgi-
cal Review. Thk article we have carefully perused, and it was
this which led us to make the preceding observations. Think-
ing this subject to be of great importance to us as Physiologists
and Pathologists, we have been thus extended in our remarks, and
will give a brief recapitulation of the more important results at
which Dr. Harley has arrived ; this we deem the more appropri-
ate, as it is probable that many of our readers do not have an
opportunity of seeing the above mentioned periodical.

In anatomical structure, these organs present no very striking
points of difference from some of the ordinary secreting glands of
the economy ; they are formed of a medullary and cortical sub-
stance like the kidneys. There is a peculiarity however in their
chemical constitution. " In the beginning of the last year, M.
Vulpian communicated to the Societie de Biologie the discovery
a very peculiar reaction possessed by the super-renal capsules of
vertebrated animals. He found that an aqueous solution of iodine
brought in contact with the medullary substance gave rise to a
beautiful rose color. And further, that the greater portion of
oxidizing agents acted like the iodine solution, although in a
minor degree. Even the oxygen of the air, under the influence
of light, produced the same effect. I have repeated M. Vulpian's
experiment on the medullary substance of the supra-renal capsules
of sheep with success ; but am equally at a loss with the author
to form an opinion as to the nature of the substance which pos-
sesses the strange property alluded to. We as yet know so little
regarding the nature of color and coloring matter, that it would
be futile to attempt to draw any conclusions with regard to the
import of the rose colored reaction above spoken of."

" Not being able to separate the coloring matter, M. Vulpian,
in concert with M. Cloez, proceeded to extract the " immediate
principles" of the supra-renal bodies; and these gentlemen have
recently communicated to the Institute de France as the result of
their united labors, the discovery of hip-puric and tanrocholic
acids in the supra-renal capsules of herbiverous animals. But as
these substances have been abundantly found in different parts of
the animal body, their discovery in the latter organs, although in-
teresting, unfortunately throws no light upon the nature of their
functions."

Dr. Harley has since seen a communication from Prof. Vir-
chow, in which he confirms the observation of M. Vulpian with
regard to the rose colored reaction, and also mentions that he has
found senecine in the medullary substance.

The question arises whether the supra-renal capsules are or-
gans peculiarly essential to foetal existence and developement.
It was formerly supposed that this was the case, and the argu-

1858.] Supra-renal Capsules and Bronzed Skin. 323

ments in favor of this idea, were the great relative size of these
bodies in the foetus, and their small size in adults. Meckel states
that at the third month, the supra-renal*capsules and kidneys are
of equal size, at the sixth month as 2 to 5. at birth as 1 to 8, and
in adult life as 1 to 28. Later observations, however, by the
author, Brown Sequard, and others, show a different result in the
case of some of the mammalia. Dr. Harley has been confined in
his observations to the cat, having examined thirteen foetal and
six adult capsules. Without giving the figures and calculations,
we will give the results at which Dr. Harley has arrived and in
which he confirms Ecker, Frey, and others: "The weight of
the supra-renal capsule in the kitten at birth is to that of the kid-
ney as 1 to 57.3 ; and in the adult as 1 to 54.8. But as so few
adult capsules and kidneys were employed, it may be perhaps
better to take the average of the whole six that were examined,
which would then give us the relative weight of three organs in
the full grown animal as 1 to 46.49.

" We shall find by a very simple calculation that the kidney
was after birth increased 12.35 times in weight, while the supra-
renal capsule at the same time has increased 14.87 times in weight.
What conclusion are we to draw from this fact ? We here see
that the supra-renal capsules increase in size, as age advances, at
a greater rate than the kidneys. I must here speak with caution
however. Small statistics are dangerous data to draw conclusions
from, and perhaps a larger number of observations might furnish
us with different results."

Thus our readers will see that Ecker, Frey. and Brown Sequard,
whose observations are here confirmed by Harley, have develop-
ed an exceedingly important fact in relation to the probable com-
parative activity of the function of the supra-renal capsule, what-
ever it may be, in foetal and adult life: conecting the doctrines
promulgated by Meckel, that these organs in the mammalia dimin-
ish after birth, both in relative size and activity of function.

We now come to experiments, bearing^directly on the function
of the supra-renal capsules. The first experiment was on an
adult cat, from which the right capsule was removed. The ani-
mal survived nine days after the operation, and on post mortem
examination, no cause of death could be discovered.

Another experiment was made on a white cat, from which the
capsules were removed. This died in twenty-four hours, and on
examination there were found all the indications of peritonitis.

Another experiment was made on a small white coach dog,
from which the left capsule was removed. It died on the twelfth
day, and on examination, signs of peritonitis were discovered.

An experiment was then made on two Guinea pigs, in one of
which the abdomen was opened, and the amount of injury
which the parts would suffer by the removal of the supra-renal

321 Supra-renal Capsules and Bronzed Skin. [^ay,

capsules, was inflicted, the wound sewed up, and the capsules al-
lowed to remain; the fellow, which was of the same age, sex, and
development, was then deprived of the capsule on the correspond-
ing side. Both these animals died within twenty-four hours after
the operation. The same experiment was then repeated on two
cats. The cat from which the supra-renal capsule (the right,)
was removed, lived two days; the other died during the third
night. In the abdomens of both, signs of peritonitis were dis-
tinctly visible.

The next experiment was made on a bull terrier dog, by re-
moving one of the capsules without applying a ligature to the
vessels, the body being enucleated with the fingers. The dog
remained in the author's possession for five months, and did not
suffer from a day's illness.

The next experiment was of exceeding interest : it was on a
large torn cat, in which, on opening the abdomen, the right cap-
sule was rough and hard as a stone : it was enucleated with the
greatest facility. The same operation was repeated on the other
side with a similar result. On making a section of the capsules,
it was found that a considerable portion of the medullary, as well
as of the cortical substance, had become replaced by a calcareous
deposit, consisting chiefly of carbonate of lime. The remaining
portion of the gland contained so much fibrous tissue, that the
normal structure might be said to have entirely disappeared. iVs
the operation on this animal had been performed with the utmost
facility, and there had been no haemorrhage, or any apparent in-
jury done to the surrounding parts, except the tearing through the
vessels and nerves, the author felt sanguine of success. His as-
tonishment was great therefore when, arriving at the college next
morning, he found the cat dead. The post mortem examination
revealed nothing, though the blood was searched for signs of
phlebitis, examined for crystals, and for the flakes of pigment des-
cribed by Brown Sequard. As it has been found by Ludwig and
HafFer, that section of the splanchnic nerves will kill animals in
one or two days, and according to Brown Sequard, mere
pricking or cutting of the semi-lunar ganglion proves fatal to rab-
bits in thirty hours, while division of the sympathetic in the
neighborhood of the kidneys causes death in twenty-three hours :
in absence of other proof of death, it is probable that it resulted
from injury done, in tearing out the capsules, to the ganglionic
system of nerves.

The extirpation of the right is more fatal than the removal of
the left capsule, as it proved by experiments which the author has
cited, but which it is unnecessary for us to state. M. Gratiolet
thought that this fact was to be explained by the proximity of the
liver, and the occurrence of hepatitis; at first Dr. Harley was
of this opinion, but he now very justly concludes that it is due to

1858.] Supra-renal Capsules and Bronzed Skin, 325

another cause. The right semi-lunar ganglion, which is much
larger than the left, lies (in the dog and cat) directly beneath the
supra-renal capsule; while the smaller left semi-lunar ganglion is
placed on the left cms of the diaphragm, and internal to the supra-
renal body. Thus it will be immediately seen that a removal of
the right capsule will do more mischief to this ganglion, and this
injury has been shown by Ludwig, H after and Brown Sequard
to be sufficient to produce death in a short time.

As it is generally the case in the removal of double organs, that
if one be left it becomes hypertrophied from being compelled to
perform a double function. Dr. Harley was anxious to observe
if this was the case as respects the supra-renal capsules. He
accordingly removed the right capsule from a cat, which had
made an excellent recovery from the operation of removing the
left about a month before. Nothing unusual, however, was
observed : on the morning of the third day it died, and on open-
ing the abdomen, two of the lumbar lymphatic glands were ob-
served very much enlarged, and presenting a peculiarly beautiful,
semi-transparent, lobular appearance.

Dr. Harley performed another experiment on a piebald rat,
with reference to the same point. The right supra-renal cap-
sule was removed, and the animal made a rapid recovery, being
in excellent condition at the end of six weeks. The left cap-
sule was then removed, and compared with others taken from
animals of the same species and age, in order to ascertain if it
had become hypertrophied. But in this, as in the case of the cat,
there was no very marked difference in either its size or appear-
ance. From the effects of the latter operation the animal speed-
ily recovered, and ultimately became very fat and healthy
looking.

An experiment was made on a white rat, in order to observe
if any change would take place in the color of the hair and skin.
Both capsules were removed at an interval of nine days. The
animal lived sixteen days after the last operation, and during that
time the color of the hair and skin was carefully watched, with-
out discovering any alteration, excepting that the neck became
denuded of hair, was covered with a luxuriant crop of young hair,
about an eighth of an inch long.

The foregoing experiments, which we have presented in as con-
densed a form as was consistent, cannot fail to strike every one
as extremely interesting, and leading to some very important
conclusions. Brown Sequard has maintained that it is impossi-
ble for an animal to live for more than forty-eight hours at the
farthest, after it has been deprived of its supra-renal capsules.
The experiment of Dr. Harley fully controvert this statement,
and in addition, M. Philipeaux, of Paris, has removed the spleen,
supra-renal capsules, and the thyroid body from the same animal,

326 Apoplexy and Hemiplegia. pJay,

which afterwards recovered.- Dr. Harley brought with him from
Paris a young rat, the offspring of a mother which had been de-
prived of spleen and supra-renal capsules. Brown Sequard is also
probably in the wrong in supposing that the convulsions and turn-
ing which followed his experiments, were due to the removal of
the supra-renal capsules ; as Dr. Harley has not observed it in
his experiments, and is confirmed by a private letter from Profes-
sor Virchow, who has also failed to notice this phenomenon.

We had the pleasure, from the politeness of Dr. Brown Sequard,
of examining certain microscopic crystals, which he invariably
found in the blood of animals from which he had removed the
supra-renal capsules. These crystals wTere unlike the ordinary
blood crystals, being pale and needle shaped. Dr. Harley makes
no allusion to this occurrence.

Finally we present the conclusions drawn by Dr. Harley from
the results of his experiments.

1st. The supra-renal capsules are not solely fetal organs.

2d. The supra-renal capsules are not absolutely essential to life.

3d. The removal of the right is generally more fatal than remo-
val of the left capsule.

4th. That convulsions do not necessarily folloiu the removal of
the capsule.

5th. That the absence of this function (in rats), is attended
neither by great emaciation nor debility.

6th. That when death follows upon the extirpation of the supra-
renal bodies, it is in most cases in consequence of the injury done to
the neighboring tissues ; perhaps most frequently the mutilation of
the ganglionic system of nerves.

7th. Absence of the function of the supra-renal bodies, is not
proved to have any special effect in arresting the transformation of
hcematin, or in increasing the formation of blood crystals.

8th. The suppression of the supra-renal capsular function is
not attended by any increased depjosit of pigment in the shin in its
appendages (in rats).

9th. The problem of the connection of b?*onzed skin and supra-
renal capsular disease is more likely to be solved in the dead house
than in the physiological laboratory.

To lohat Degree are the Intellectual Faculties affected in cases of
Apoplexy and Hemiplegia f By Benjamin W. M'Ceeedy,
M. D., Physician to Bellevue Hospital.

This inquiry, irrespective of its medico-legal relations, is of
interest and importance to the medical practitioner. Dr.
M'Creedy brings to bear upon it the results of an analysis of

1858.] Apoplexy and Hemiplegia. 327

cases collected from different authors, as well as instances falling
under his own observation, and communicated to him by medi-
cal friends. From an examination of " a collection of cases of
apoplexy," by Mr. Copeman, of London, published in 1845, he
arrived at the following conclusions : " In all, out of a record of
two hundred and fifty cases, fifty cases have been taken in which
the patient had recovered from the first effects produced W the
apoplectic stroke. They are all the cases contained in the book
in which such recovery had taken place, and in which the cases
were clearly of an apoplectic character. Yet in no one of the
cases is there the slightest indication that the patient was left
with a mind, I will not say reduced to a state of imbecility, but
impaired in any marked degree. They all as far as the mind is
concerned, with the exceptions to be mentioned, recovered ; re-
covered perfectly ; were restored to their usual state ; returned
to their previous occupations. In two instances the faculty of
speech was either deranged or lost, and in those instances their
physicians assert that the faculty of language, not reason, was
deranged. In the third^rn stance the patient is stated to have
recovered with an impaired memory, and with some confusion
of thought ; but a merchant, seventy-three years of age, who
after partial recovery from a severe apoplectic seizure, is enabled
to labor for his support by writing for the weekly papers, may
be esteemed to have still possessed a fair share of intellect and
energy. The second attack left him yet more prostrate, very
much weakened in body, and unable to do anything for the
support of his family. From the third attack he never recover-
ed ; still there is nothing like imbecility : he lies for months in
a feverish condition, alternating between coma and delirium, and
even a few days before his death he partially recovered and
talked in a rational manner with his wife."

The foregoing conclusions are corroborated by the results of
an examination of a series of cases contained in Andral's Clin-
ique Medicale, and in the Anatomie Pathologique of Cruveilhier.
These cases, like the preceding, are quoted in brief detail by the
writer. In expressing the results of this examination, the writer
says: "Here then, are sixteen cases in which the condition of
the intellect before the attack was obscured, in which the nature
of the disease was verified by post-mortem examination being
all that are contained in the Clinique Medicale of Andral, and the
Anatomie Pathologique o Cruveilheir, and reported by men whom
every one will allow were competent, careful, and conscientious
observers in which the hemorrhage was situated in almost
every part of the brain, presenting every degree of severity com-
patible with the continuance of life, many of them liviDg for
years after the occurrence of the apoplectic seizure, and yet in
only two of these was there any decided improvement of the
mind noticed."

828 Apoplexy and Hemiplegia. [May,

The writer adds : " Perfectly in accordance with this have
been the results of my own observations. At Bellevue, the
great pauper hospital of the city, there are always a number of
hemiplegiacs ; but since my attention has been directed to the
subject, I have seen no case in which hemiplegia has been the
consequence of a well-marked apoplectic seizure, in which I
have found the intellect seriously impaired. In some of these
cases the first impression of the observer is wholly unfavorable
to - the intelligence of the patients; the distorted countenance,
the impaired speech, and the motionless tears or laughter, give
them an appearance of utter imbecility ; yet a patient examina-
tion will commonly discover an amount of intelligence en-
tirely unexpected." * * * - " From the facts given above,
no other conclusions can be drawn than that any impairment of
mind, as a direct consequence of apoplexy, after the patient has
recovered from its primary effects, must be an exceptional occur-
rence. That the apoplectic seizure may hasten the approach of
senile atrophy of the brain is, as before stated, probable ; when
atrophy has already commenced, an apoplectic attack may un-
doubtedly quicken its progress, and, in such a case, the friends
of the patient would naturally attribute the rapid decay of the
mind wholly to the apoplectic seizure. This, I think, I have
myself seen ; and as apoplexy becomes more common as life
advances, such cases may not be unfrequent. The confusion of
mind, the difficulty in pursuing a train of thought, of which
apoplectics are apt to complain, is to a great extent the mere
result of diminished nervous energy. They comprehend well,
and judge correctly, but, before their general health is confirm-
ed, they can no more think continuously than they can take a
long walk, or perform any other act demanding a considerable
expenditure of nervous force. It is not the brain specially that
is affected it is the system at large. Of all the faculties, memory,
either special or general, is most apt to be impaired, and this
impairment patients are always ready to admit and complain of.
As the patient recovers, the memory commonly improves ; and
if no new attack supervene, this improvement is progressive for
years." * * * "Whence, then, arises the number of imbeciles
who are to be found in every almshouse? Partly, doubtless,
from the cases already mentioned, in which senile atrophy is
prematurely caused, or its progress hastened by the occurrence
of apoplexy. And let us recollect the state of isolation and
neglect from which such persons frequently, often necessarily,
suffer, is in itself a main cause of a weakened intellect: the mind
rusts out for want of exercise."

The writer details a series of cases in which, while the hear-
ing remained unaffected, the patient's consciousness entire and
no delirium, the faculty of speech was either lost or perverted.

1858.] Apoplexy and Hemiplegia. 329

He remarks on these cases as follows: " Here, it will be seen,
are eleven well-marked cases of hemiplegia, three of them com-
plicated with epileptic convulsions, and all of them with loss or
perversion of the faculty of speech. Besides the cases here re-
corded, three more have come to ray knowledge the subjects of
which, I believe, are still living. This shows conclusively the
loss of speech, as an accompaiment of hemiplegia, to be no very
rare occurrence. Of the whole fourteen cases, two have perfect-
ly recovered the use of speech; two have recovered it to a par-
tial and limited extent ; the others still, I believe, remain speech-
less. From the cases recorded in the journals to which I have
access, I believe that recovery from perversion of the faculty of
speech is more common and perfect than when the power of ar-
ticulation is either wholly lost or confined to a few monosyllables.
Direct medication, except in so far as it improves the general
health of the patient, seems to have no effect on the lost faculty ;
more is to be hoped for from careful, long continued, and well-
directed exercise of the local organs by the patient himself."

The foregoing conclusions are certainly at variance with the
views inculcated by medical writers and commonly held by prac-
titioners. The general belief is, that after an apoplectic seizure,
as a rule, the mind is more or less impaired, and in severe cases
the patient is apt to fall into a condition of partial or complete
imbecility. Epilepsy is also supposed to tend intrinsically to
induce deterioration of the mental faculties in proportion to the
frequency and severity of the paroxysms. Assuming that the
writer's conclusions are correct, it is in a great measure owing to
the pervailing error on the subject that the faculties of the mind
are in a certain proportion of instances, permanently damaged ;
and it becomes a very important point in practice to enjoin, un-
der judicious restrictions, that degree of exercise of the mental
faculties which shall secure their healthful if not vigorous activi-
ty. This practical point is especially applicable to the manage-
ment in cases of epilepsy. The reviewer has long entertained
the opinion that, in this affection, the mental deterioration which
is frequently observed is not due so much to an intrinsic tenden-
cy of the malady as to the isolation and inactivity incident to it.
With reference to epilepsy, the author of the highly interesting
paper which we have reviewed, states that he has ''repeatedly
seen and prescribed for a person who has had epilepsy for thirty-
three years, occurring several times in every month, and some-
times eight and ten times a day ; in whom, though there is obvi-
ous enlargement of one side of the head, and much headache,
and the tongue bears the marks of countless lacerations, yet it
is impossible to discover in this person the least change in her
mental condition." He adds, that "both the medical profys-
eion and the judicial bench of the city can each furnish at least

330 On the Medicinal Hypophosphites. [May,

one illustration of the distinction and usefulness to which
persons who have been, or still are, subject to epilepsy, may
attain." [New York Jour, of Medicine.

Remarks on the Medicinal Ilypophosphites* By William Proc-
tor, Jr.

[In our last number, we presented to our readers, a striking
article from Dr. Churchill, on the use of the Hypophosphites, in
the treatment of Tuberculosis. We here transfer to our pages a
paper in which these several salts and their mode of preparation
are described. Edts.]

The recent researches of Dr. Churchill into the therapeutic
character and value of the hypophosphites in tuberculosis, some
account of which will be found at page 143 of this number, have
attracted much attention from physicians, and many inquiries
have been made after these salts ; and it is believed that a notice
of the processes for preparing them, and some formulas for their
prescription, will be acceptable to the readers of the Journal, es-
pecially, as from their hitherto unimportant position among phar-
maceutical chemicals, no mention is made of them in works most
accessible. The salts which have been used are those of lime,
soda, potassa and ammonia. In the sequel a notice is given of
these, of the hypophosphite of sesquioxide of iron, and of hypo-
phosphorus acid.

The hypophosphites, according to Gmelin, are mostly crystal-
lizable. They cannot exist without a certain proportion of water,
which is equally true of the acid itself, which in its most concen-
trated form contains three equivalents of water, one of which is
replacable by bases. When heated till decomposed, these salts
emit phosphuretted hydrogen. They are permanent in the air as
regards oxidation ; but when heated in solution, especially if free
alkali is present, they are decomposed into phosphates and hydro-
gen gas. They are nearly all soluble in water, and several of
them in alcohol, and readily reduce the soluble salts of silver and

Sold

Hypophosphite of Lime is the most important of these salts, as it

not only, by oxidation in the economy, will afford phosphate of
lime in a nascent state, if needed, but its reaction with the carbo-
nates of the alkalies give a ready means of obtaining the alkaline
hypophosphites. When phosphorus is boiled with milk of lime it

* The Hypophosphites are manufactured in quantity by Hennell Stevens, of
Philadelphia, who is successfully directing his attention to the supply of new
chemicals for medicinal use, and fine chemicals in general.

1858.] On the Medicinal Uypophosphites. 331

gradually disappears, with evolution of spontaneously inflamma-
ble phosphuretted hydrogen, which explodes as it reaches the at-
mosphere with the formation of water and phosphoric acid. When
the strong odor of phosphuretted hydrogen ceases to be given off,
the liquid contains, besides the excess of lime, nearly half of the
phosphorus as phosphate of lime, and the remainder, deducting
the considerable portion which has escaped into the air as phos-
phuretted hydrogen, as hypophosphite of lime. According to
Wurtz, more than one equivalent of water is decomposed, and
the phosphuretted hydrogen is accompanied by free hydrogen.
If this be true, the source of the super oxidation of so much of the
phosphorus is traceable to the resulting oxygen; but Rose is of the
opinion that this oxygen is derived from the atmospheric air in
contact with the boiling liquid. When the process is conducted
in a flask, it requires a constant ebullition of the liquid to prevent
the explosion consequent upon the entrance of the atmospheric
air. To avoid this result, it has been found safer to employ a
deep, open vessel. The constant evolution of gas and vapor,
which keeps a froth on the surface, excludes the atmosphere in a
great degree, so that the yield is not much diminished, whilst the
safety and easiness of the process is greatly increased. The pro-
cess should be conducted under a hood with a strong draught, or
in the open air, to avo id the disagreeable fumes which are evolv-
ed.

Take of Lime recently burned 4 lbs. av.

Phosphorus 1 lb. "

Water, 5 gals.

Slake the lime with a gallon of water, put the remainder in a
deep boiler, and as soon as it boils add the slaked lime, and mix to
a uniform milk. The phosphorus is now added, and the boiling
is kept up constantly, adding hot water from time to time, so as
to preserve the measure as nearly as may be, until it is all oxidi-
zed and combined, and the strong odor of the gas has disappeared.
The mixture froths much, and but little of the phosphorus reaches
the surface. Then filter the solution through close muslin, wash
out that portion retained by the calcareous residue with water,
and evaporate the filtrate till reduced to six pints. The concen-
trated liquor should now be re-filtered to remove a portion of car-
bonate of lime which has resulted from the action of the air on
the lime in solution, and again evaporated till a pellicle forms,
when it may be crystalized by standing in the drying room, or
the heat may be continued with stirring till the salt granulates,
when it should be introduced into bottles.

Hypophosphite of lime is a white salt with a pearly margarin-
like lustre, and crystalizes in flattened prisms. Its composition,
according to Wurtz, is CaO ,-|-2HO,PO, the water being essen-
tial to the salt. It is soluble in six parts of cold water, and in not
14*

832 On the Medicinal Hypophosphites. [May,

much less of boiling water ; it is soluble slightly in diluted alco-
hol, but insoluble in alcohol sp. gr. .835.

Ilypophosphate of Soda is prepared by double decomposition
between hypophosphite of lime and crystalized carbonate of soda.

Take of Hypophosphite of lime 6 oz.

Crystalized carbonate of soda - - - - 10 "
Water, a sufficient quantity.

Dissolve the hypophosphite in four pints of water, and the car-
bonate in a pint and a half, mix the solutious, pour the mixture
on a filter, and lixiviate the precipitate of carbonate of lime, after
draining, with water, till the filtrate measures six pints. Evapo-
rate this liquid carefully till a pellicle forms, and then stir con-
stantly, continuing the heat till it granulates. In this state the
salt is pure enough for medical use; but if desired in crystals,
treat the granulated salt with alcohol sp. gr. .835, evaporate the
solution till syrupy, and set it by in a warm place to crystalize.

Hypophosphite of soda crystalizes in rectangular tables with
a pearly lustre, is quite soluble in water and in ordinary alcohol,
and deliquesces when exposed to the air. Its composition is NO
-|-2HO,PO.

Hypophosphate of Potassa is prepared by the same process as
that given above for the soda salt, substituting 5| ounces of gran-
ulated carbonate of potassa, in place of 10 ounces of crystalized
carbonate of soda, and using half a pint instead of a pint and a
half of water to dissolve it.

Hypophosphite of potassa is a white, opaque, deliquescent salt,-
very soluble in water and alcohol. Its greater tendency to absorb
moisture renders it less eligible for prescription than the soda salt.
Its composition is KO-|-2HO,PO.

Hypophosphate of Ammonia is prepared from hypophosphite of
lime and sulphate or carbonate of ammonia.

Take of Hypophosphite of lime - 6 oz.

Sesqui-carbonate of ammonia (translucent) 7.23 oz.
Water, a sufficient quantity.

Dissolve the lime salt in four pints of water, and the ammonia
salt in two pints of water, mix the solutions, drain the resulting
carbonate of lime, and wash out the retained solution with water.
The filtrate should then be evaporated carefully to dryness, then
dissolved in alcohol, filered, evaporated and crystalized.

This salt is deliquescent in the air, very soluble in alcohol and
water, and when carefully heated evolves ammonia, and leaves
hyd rated hypophosphorus acid. The composition of this salt is
NH3-|-2HO,PO.

Hypophosphite of Sesquioxide of Iron. This salt may be obtain-
ed in the form of a white gelatinous hydrate, by precipitating a
solution of hypophosphite of soda or ammonia with one of sesqui-
sulphate of iron. The precipitate should be well washed with

1858.] On the Medicinal Hypophosphites. 333

water and dried at a moderate temperature. It is necessary to
avoid using a hypophosphite containing any alkaline carbonate
or the precipitate will be contaminated with free sesquioxide.
Thus prepared, this salt is a white, amorphous, tasteless powder,
like the pyrophosphate, soluble in hydrochloric acid, and in free
hypophosphorus acid.

Hypophosphorus Acid, So far as we are aware, this acid has
not been employed, in a free state, by Dr. Churchill, but it is high-
ly probable that it may come into use, should the favorable results
claimed for its salts be substantiated by new observations. Any
claims which phosphoric acid may possess as an agent to supply
the waste of phosphorus and phosphates in the human economy,
will be more than equalled by this acid. Hypophosphate of bary-
ta is the salt which is most eligible for the preparation of this acid,
but it is more convenient to prepare it from the lime salts
viz:

Take of Hypophophite of lime - - - - 480 grains.
Crystal ized Oxalic acid - - - - 350 grains.

Distilled water 9 fluid oz.

Dissolve the hypophosphite of lime in six ounces of the water and
the acid in the remainder, with the aid of heat, mix the solutions,
pour the mixture on a white paper filter, and when the liquid has
passed add distilled water carefully, till it measures ten fluid
ounces, and evaporate this to 8^ fluid ounces

The solution thus prepared contains about ten per cent, of terhy-
drated hypophosphorus acid (HO-|-2HO,PO) a teaspoonful
representing 6 grains of the acid, which contains 2| grains of
phosphorus. The dose of this acid solution will probably vary
from ten minims to a teaspoonful.

It is proposed to give several forms in which the hypophosphites
may be conveniently administered, and a few hints to the physi-
cian in reference to prescribing them.

The soluble salts of mercury and silver are reduced by contact
with the hypophosphites. All soluble sulphates and carbo-
nates are incompatible with the lime salt, and should not be asso-
ciated with it in prescriptions, if phosphate of lime is indicated in
the case. The iron salt when dissolved by excess of acid is col-
ored black by gallotannic acid and drugs containing it, but is not
blackened by the tannin of cinchona, catechu and krameria;
hence any preparation containing it may be associated with Pe-
ruvian bark. The hypophosphites of soda, potassa and ammonia,
are more or less deliquescent, and when prescribed in powder it
should be with proper precautions to avoid moisture, as by asso-
ciation with a considerable excess of sugar of milk. The lime
salt may be mixed with either this sugar or ordinary sugar. None
of these salts are soluble in cod-liver oil ; and if given with it, they
should be dissolved in syrup, and mixed by agitation. Where

334 On the Medicinal Eypophosphites. [May,

lactin and glycerin are indicated in the treatment of phthisis or
dyspepsia, any of these salts may be very elegantly associated in
the form of syrup.

Syrup of Hypophosphite of Lime.

Take of Hypophosphite of lime, an ounce.

Water, nine and a half fluid ounces.
White sugar, twelve ounces.
Fluid extract of vanilla, half a fluid ounce.
Dissolve the salts in the water, filter, add the sugar, dissolve by
aid of heat and add the vanilla. The dose is from a tea-spoonful
(3 J grs.) to a table-spoonful (14.,) according to the circumstances
of the case, three times a day.

Compound Syrup of Hypophosphite. The following formula
has been made in view of the double purpose to which these salts
are directed by Dr. Churchill, viz : the increase of nerve force, and
the elevation of the tone of the several functions concerned in
alimentation and nutrition ; and will afford an agreeable means
of testing practically their merit. The iron salt is presented in
a form well adapted for entering the circulation, whilst the acid,
besides exerting its solvent power, adds to the agreeable taste of
the preparation.

Take of Hypophosphite of lime, 256 grains.

Hypophosphite of soda, 192 "

Hypophospite of potassa, 128 "

Hypophosphite of iron* (recently precipitated) 96 "
Hypophosphorus acid solution, q. s. or 240 "

White sugar, 12 ounces.

Extract of vanilla, \ ounce.

Water, a sufficient quantity.
Dissolve the salts of lime, soda and potassa in six ounces of
water; put the iron salt in a mortar, and gradually add solution
of hyphosphorus acid till it is dissolved ; to this add the solution
of the other salts, after it has been rendered slightly acidulous
with the same acid, and then water, till the whole measures 9 fluid
ounces. Dissolve in this the sugar, with heat, and flavor with
the vanilla. Without flavoring, this syrup is not unpleasant, being
slightly saline, and not at all furruginous. Any other flavoring
may be used, as orange peel, orange flower or ginger. It is also
suggested to physicians that glycerine may be used, wholly or
partially, in sugar when indicated, six ounces and a half of gly-
cerine being substituted for twelve ounces of sugar. The object
of acidulating the saline solution is to decompose any alkaline

*/This quantity 96 grains, of hypophosphite of iron is obtained when 128 grains
of hypophosphite of soda dissolved in 2 ounces of water is decomposed with a
slight excess of solution of persulphate of iron, and the white precipitate will
wash on a filter with water.

1858.] Diphtherite or Malignant Sore Throat. 335

carbonates which may be present and which have been noticed
by the writer in some of the commercial soda salt. The dose of
this preparation is a teaspoonful three or four times a dav. A
teaspoonful contains 2 grains of the lime salt, 1| of the soda salt,
1 of the potassa salt, and of a grain of the iron salt, besides a
little hvpophosphorus acid. [American Jour, of Pharmacy.

Reports of Cases of Diphtherite, or Malignant Sore-throat. By
Benjamin Godfrey, M. D., M.RC.S.L.

Case 1. J. B , a little boy, aged two years. He had been

healthy and strong through life, with the exception of the tri-
vial ailments incident to childhood. Five months ago he
suffered from discharge of pus from the ear, with occasional
epistaxis. These ailments soon passed away, and he continued
pretty well until the present attack.

Oct. 17th. The child complained of cold in the head; dis-
charge of yellow mucoid matter from the nose, with occasional
haemorrhage, dyspnoea, and dysphagia; great drowsiness and
extreme languor. The tongue was slightly coated, but not in-
jected; the skin was moist and comfortable ; the pulse quick
and feeble, 120 ; pupils dilated. On examino.tion of the throat,
a small, whitish spot was observed on the mucous membrane of
the right tonsil, about the size of a pea ; bowels constipated.
Ordered the sixteenth of a grain of extract of belladona, with
one grain of carbonate of ammonia, every three hours; a rhu-
barb and jalap powder at bedtime.

18th. The patient is much weaker ; dyspnoea greater, but
dysphagia less. The spot has become of an ashy hue, extending
over the right tonsil, and slowly creeping ov;r the uvula. Pulse
130. Kepeat the mixture.

19th and 20th. The discharge from the i?Dse and mouth has
-increased very acrid, and of a highly offensive odor; the
throat externally is much swollen ; the parotid and sub- maxil-
lary glands are much enlarged ; both tonsils are coated with the
ulcerative process; pulse 130; tongue coated, white; bowels
nicely relieved, but great exhaustion and prostration is apparent.
Ordered carbonate of ammonia and tartrate of iron every three
hours; port- wine and beef- tea in abundance.

21st. Still getting weaker; almost pulseless; extremities
cold; face palid and anaemic; throat very much swollen exter-
nally. Ordered warm fomentations; milk, wine, and beef-tea,
and ten minims of the tincture of sesquichloride of iron every
three hours.

22nd. Less swelling of the throat externally. The black
gangrenous mass is sloughing away, and a line of demarcation

336 Diphtherite or Malignant Sore Throat. [May,

is visible, of healthy granulations springing up to throw off the
dead foetid mass, and to restore health to the diseased part.
Dyspnoea less ; dysphagia now but slight. Eepeat the medicine
and nourishment.

23rd and 24th. Very much better. Several pieces of highly
offensive dead material have passed away. Pulse stronger;
tongue nearly clean; bowels relieved; pupils less dilated, but
still drowsy and very weak.

Day by day the little sufferer improved, and gathered strength
each day. The only drawback to his recovery was an occasion-
al attack of epistaxis, which blanched the restored color of the
cheeks and enfeebled the returning powers. Iron and quinine
with strong beef-tea and wine, were freely given, but exhaustion
soon set in, and he died on the 3rd of November, a fortnight
after the attack, anaemiated and exhausted.

Case 2. B. B , residing in the same house. He was a

strong, well-built boy, of excitable temperament, and affection-
ate disposition. He was taken ill on the 22nd of October. He
complained of great languor, chilliness, stiffness of the neck, dys-
phagia, and headache. The tongue was white, but the papillae
were not more- prominent than they are in irritation of the
stomach. The throat was much swollen externally, and on the
tonsil a small ashy spot was seen. No heat of skin ; no dryness,
but the palms of the hands were moist aud comfortably warm;
pul ; 3 quick and weak, 130. Ordered the belladonna and ammo-
nia fixture ev^ry three hours.

Oct. 23rd. Bowels freely moved; throat much worse; spot
very much extended, and the breath extremely foetid ; discharge
from the nose great ; pupils much dilated ; urine free and nor-
mal. Ordered to gargle well with warm water, alternating with
the chloride-of-zinc gargle. Wine and beef- tea to be freely taken,
and ten drops of the tincture of muriate of iron every three hours.

24th. Throat more swollen ; dysphagia greater, and dpspncea
also increased. Applied nitrate of silver solution, ten grains to
the ounce, to the throat with a sponge probang. Small pieces
of black disintegrated mucous membrane came away. Com-
plains of the wine and beef-tea burning his throat, and causing
his ears to tingle.

25th. The throat is one black gangrenous mass, the odour
of which is very disagreeable. His powers are fast failing.
Takes half a pint of port wine a day, with beef-tea, &c. Milk
also in abundance.

26th. Fast sinking. Throat exceedingly swollen ; dyspnoea
greater than dysphagia; pupils much dilated; extreme drowsi-
ness, yet perfectly sensible when aroused. He continued failing
till the 27th, when he expired.

1858.] Diphtherite or Malignant Sore Throat 337

Case 3. J. B. , aged seven years, brother of the patient

before mentioned. lie was attacked with the same disease, with
precisely the same order of symptoms. He was treated with
chlorate of potash and cascarilla the former part of the illness,
and nitro-muriaticacid and gentian the latter part; but in seven
days from the time he was attacked he also died.

Case 4. In the same house was a young lady who had
watched over the before-mentioned children, and on the 28th
she was also taken ill. The first symptoms were, Shivering,
and intense prostration, so powerless that she could not stand;
tingling of the throat, back of the nares, and in the ears; the
throat became dry, and deglutition became difficult. On exam-
ining the throat, there was the plague-striken spot on the left
tonsil. Ordered four ounces of port wine and strong beef-tea,
with the nitro-muriatic acid and cascarilla mixture.

Oct. 29th. The spot is much increased, extending over the
uvula. Powers en febled ; pulse 120, very feeble; tongue white
eand furred; skin cool and moist; bowels regular; urine scanty,
but natural. She can scarcely breathe through her nose. The
discharge is increased from the mouth and nose, and the breath
is become foetid. Ordered the chloride-of-zinc gargle, and
thirty drops of the tincture of the sesquichloride of iron in infu-
sion of Columbia root. Strong hydrochloric acid was applied
with a glass rod to the ulcerated surface. Several large pieces
sloughed away.

30th. Pulse very feeble, and bodily power failing. The
whole of the soft palate and back of the throat is covered with
the sloughing mass. The ears and Eustachian tubes are very
tender and painful. Deglutition is performed with great effort
and pain. The nares are extremely painful, and the discharge
acrid and disagreeable. Applied again the muriatic acid. Or-
dered half a pint of port wine a day, with eggs and beef-tea, and
to continue the medicine.

31st. Still getting weaker. Pulse 130, irritable; skin cold
and clammy; the wine passes down her threat like liquid fire,
giving great pain. Ordered wine and beef-tea ad libitum ; the
iron to be increased in quantity, three drachms of the tincture
to be taken every day.

Nov. 1st. Better; throat less swollen, and dysphagia less;
bowels well moved; dyspnoea less. At every gargle, pieces of
dead material came away. Steaming her nose and throat over
hot water has relieved her much. Skin beautifully warm and
moist.

2nd and 3rd. The throat is granulating quickly; several
large pieces have been thrown off; fcetor less, and appetite im-
proving ; pulse 120, fuller and more regular.

338 Diphtherite or Malignant Sore Throat. [May,

From this time she began gradually to improve; each day
pieces of morbid material were brought away. The throat healed
up in the course of a week or two perfectly, and day by day her
powers improved, and she left my care on November 15th, quite
recovered.

Remarks The disease appears to me to be confined to the
mucous membrane, neither touching the muscular nor glandu-
lar structure. The glandular enlargement is due to sympathetic
irritation, the same as we see often in other parts of the body ;
thus a wound in a leg producing an enlarged gland in the groin.
The question has been asked " Is it scarlet fever without the
rash!" This, I think, is answered 1st, by absence of all fever ;
2ndly, absence of all rash ; 3rdly, papilae of the tongue not en-
larged; and 4thly, no desquamation of the cuticle after the
disease passes off. Yet, on the other hand, scarlet fever existed
in the adjoining house. It differs also materially from cynanche
tonsillaris. In that disease the abscess forms within the tonsil,
and bursts its way out. But in diphtherite, the morbid change
commences on the surface of the mucous membrane, and is con-
fined solely to that covering. The extreme and rapid depression
is only equalled by the depression of malignant scarlet fever, or
the collapse of Asiatic cholera. Each patient that died appeared
to sink from exhaustion and partial asphyxia.

Treatment. The main point to keep in view is to support the
patient's powers, and check as far as possible the inroad of the
disease. The former by stimulants and tonics ; the latter by
the application of the strong mineral acids. The question may
arise, might not tracheotomy have been successfully employed
to relieve the dyspnoea. My reply is, that the depression of the
patient's powers was far greater than the dj^spncea, so that the
operation would have been unsafe. That depression did not
result from the blood being imperfectly aerated is shown by the
depression appearing before the dyspnoea. The dilatation of
the pupil did not depend upon the belladonna given, for it exist-
ed as a marked symptom in every case. As regards remedies,
I believe the tincture of sesquichloride of iron the best. The
essentials of the disease, or the symptoms in the order they occur,
are these : Shivering, intense depression ; dryness and tingling of
the throat, nares, and ears; external swelling of the glands; a
whitish spot on the mucous membrane of the tonsil, gradually deepen-
ing in colour as the disease progresses ; dysphagia and dyspnoza ;
dilated pupil; impending asphyxia, and death.

[London Lancet.

1858.] Case of Tetanus. 839

Report of a Case of Tetanus occurring in Bellevue Hospital under
the care of Dr. Jas. R. Woodj Visiting /Surgeon. By J. J.
Campbell, M.D., House Surgeon.

Eebecca H., aged 38, pretty good constitution, but of intem-
perate habits, was admitted into Bellevue Hospital, at 4 P. M.,
February 7th, 1858, with severe burns of both lower extremi-
ties, caused the evening before by getting her clothes on fire.
When admitted, she was suffering a great deal of pain, and her
stomach was so irritable that she could scarcely retain any of the
nourishment and stimulants that were given her. Her pulse
was frequent and feeble, and she had slept none the night pre-
vious. Stimulants and anodynes were given freelv, and her
limbs were ordered to be dressed with cotton soake* in equal
parts of linseed oil and lime water.

Feb. 8th. Did not sleep any last night, although she had
taken the eighth of a grain of morphine every hour since her
admission ; her stomach still remains irritable ; her pulse con-
tinues frequent and weak, and her limbs feel easier. Sub-nitrate
of bismuth, opium, and a small quantity of carbonate of ammo-
nia, ordered in pills, to be given with the view of allaying the
irritability of her stomach. Beef tea and rare boiled eggs direct-
ed to be taken in small quantities at a time. Stimulants and
anodynes to be continued as before. This course of treatment
was persevered in, but she did not improve much until February
11th, when she was able to retain all the nourishment that was
given to her. Her pulse still remained frequent, although it
was stronger than when she came into the hospital. She rested
better at night, and continued doing well in every other respect
from this time until the morning of February 15th, when she was
attacked with the symptoms of trismus, that I first noticed by
directing her to put out her tongue, which she could not do to
any extent, as she could not separate her jaws more than three
quarters of an inch. On inquiry, I ascertained that she had
some stiffness in the muscles of the back of the neck. I then
desired her to swallow a little beef tea, which she did with great
difficulty and a feeling of choking. Morphine, in half-grain
doses every two hours, was ordered to be given, and her allow-
ance of stimulants increased.

At 11.30 A. M. she was seen by Dr. Wood, who directed that
she should be put upon a stimulant, anodyne and anti-spasmo-
dic course of treatment. Twenty ounces of brandy and a pint
of madeira wine were ordered to be given in the twenty-four
hours. The morphine was given pretty freely by the mouth ;
but as she could not swallow as much of the stimulants as was
directed, they had to be in part injected into the rectum with two

.s. vol. xrv. ko. v. 15

340 Case of Tetanus. [May-

ounces of lac assafoetida and one drachm of tincture of opium
every two hours. She was also directed to be kept as quiet as
possible. *Her pulse at this time was 128, quick and moderate-
ly fall, and her respiration a little more frequent than it had
been for a few days past. There was not much increase in the
severity of the symptoms up to 10 P. M. At 11 P. M. she com-
menced sleeping, and continued doing so until 2 A. M., after
which she remained wakeful.

9 A. M., February 16 pulse 128, quick and moderately full ;
respiration 24; cannot separate her jaws more than one-third
of an inch ; has great difficulty in deglutition ; muscles of the
neck quite rigid ; head drawn back, and does not appear to
suffer much when undisturbed. She has had no spasms except
of the muscles of the back of the neck. Same treatment contin-
ued.

6 P. M. With the exception of a little more difficulty in swal-
lowing, is in much the same condition that she was this morn-
ing.

Feb. 17th, 9 A. M. Slumbered a little during the night ;
pulse 132, quick and weak ; respiration 34 ; rigid spasm of all
the muscles about the jaws and neck, and cannot drink from
the feeding cup ; and all the fluid she swallows has to be inject-
ed into her mouth with a small syringe. Her face assumes a
livid hue during each attempt at deglutition. Has to lay on her
side, owing to the strong contraction of the muscles on the back
of her neck. Loud rales, produced by the air passing through
the secretions in the mouth, can be heard while standing by her
bedside. Her bowels moved during the night for the first time
since the 14th. At 1.45 P. M., was seized with a convulsion
that affected the whole body, but more especially the muscles of
the back and neck.- Well-marked opisthotonos remains. Her
jaws are rigidly closed, and she cannot swallow anything. At
3.40 P. M., has had another general convulsion that lasted for
about a minute. At 4.45 P. M., has had another convulsion like
the two former. Pulse 120, and weak ; respiration 45, and is
perspiring quite freely. Chloroform was tried, and the muscles
closing, the jaws relaxed a little. From this time until twenty
minutes of six, when she died, she had a great many convul-
sions. Just as she was breathing her last, all her muscles became
quite flaccid. During the two hours preceding her death, one
ounce of the tincture of opium with very near a pint of brandy
and wine were injected into her rectum. She remained rational
until the last moment of her life.

Her burns looked healthy all the time.

Post mortem 39 hours after death. Slight rigor mortis. Some
venous congestion of the vessels of the brain aud spinal cord.
About two ounces of serum escaped on opening into the dura

1858.] Tetanus relieved by Amputation. 3-il

mater of the brain and cord. No other condition noticed in
these parts. The right side of the heart, especially the right
auricle, was distended with black, clotted blood, while the left
side contained but very little. This organ felt normal. No ul-
ceration could be detected in either the stomach or duodenum.
The colon contained a great deal of scybalae. The bladder was
empty and contracted. [American Med. Monthly.

A Case of Tetanus Relieved by Amputation. By W. W. ANDER-
SON, M.D., ofStateburg, S. C.

Chavis, a strong, athletic negro man, in the prime of life, the
property of Col. Richard Singleton, in the month of January,
18-io, was lifting a long, heavy inch plank, with a ten-penny nail
driven to the head through one end of it. The plank acciden-
tally slipped out of his hands and fell on his foot. The nail
penetrated his great toe near the joint, and between the joint
and toe-nail. The next day he went to his work as usual ; but
a day or two afterwards his master, passing by, found him sitting
by the road-side, and learning the cause of his leaving his work,
ordered him to go home and poultice his foot. He did so, but
continued to suffer considerable pain and uneasiness until the
loth of the same month, when I was called to see him, about
five days after the accident. I found him in pain, with symp-
toms of approaching tetanus. An incision was made in the
course of the wound, and spirits of turpentine applied. The
usual remedies, such as mercurial purgatives, blisters, the free
administration of opiates, etc., were followed up actively, but to
no purpose. Violent spasms came on, accompanied with pain
in the back of his neck, and constriction of his chest and abdo-
men. The spasms increased in violence and frequency every-
day, until the opisthotonos was so great that his head and heels
were brought nearly into contact with each other during the
spasms, and he was unable to swallow in the intervals of the
paroxysms. So great were the debility and exhaustion, that I
considered the case hopeless, and expressed this opinion to Col.
Singleton, but said I wished to try the effects of amputation, as a
last resort, to which he readily consented. Having only a
pocket-case of instruments at hand, I rode to a carpenter's shop
not far off, and borrowed a fine tenon saw, and immediately on
my return began the operation. With a bistoury I made an
incision around the toe, through the skin, and immediately over
the joint, dissected up the integument, and turned it back; then
completed the incision to the bone, and sawed it off between
the joints, tied the artery, drew down the skin, and secured it
with adhesive plaster, A soft compress over the stump, and

342 Researches on the general Paralysis of the Insane. [May,

bandage, completed the operation. After a little rest, he swal-
lowed a large dose of laudanum, and was ordered to be kept as
quiet as possible. I now dissected the toe, and following the
course of the wound, found at the bottom of it, imbedded in the
cartilage near the joint, what I at first supposed to be the point
of the nail ; but on further examination, it proved to be a hard
piece of black leather, which had been punched from the man's
shoe by the blunt nail, and deposited there. No inflammation
was apparent in the cartilage ; but there is little room to doubt
that this minute piece of hard leather was the cause of all the
mischief. In a short time after the operation the spasms began
to abate, and in a day or two ceased altogether. The patient
was now convalescent. The toe healed kindly, and the man
recovered his usual health. I saw him from time to time after-
wards, for several years, a strong healthy negro.

[Charleston Med. Journal.

New Researches on the general Paralysis of the Insane.

This affection, which has been, for the first time, well described
by some French physicians, among whom particularly Bayle and
Calmeil, has lately been the object of a very remarkable inaug-
ural dissertation by M. Linas. One of the principal questions
examined by this young physician, concerns the nature of this
disease. Is it the effect of an inflammation of the encephalon or
of its membranes, as Bayle, Delaye, Calmeil, Parchappe and
others admitted, or is it a purely nervous affection of the brain,
as Lelut and others have maintained ?

Already Bayle had opened one hundred corpses of paralytic
insane, and Calmeil forty-seven. They had found the meninges
of the convexity of the cerebal lobes opaque, injected, hardened,
infiltrated with serosity, and offering frequently granulations or
false membranes. M. Linas has opened one hundred and four-
teen bodies of paralytic insane. In twelve cases he has found
the pia-mater excessively injected. The cerebral substance was
quite full of blood, the grey matter being from an intense red to
a dark violet. In twenty -eight cases, besides the preceding al-
terations, there were adhesions between the convolutions and
the meninges. In seventy-four cases, the meninges were infil-
trated, opaqe, and as tough as a fibrous membrane ; the cortical
substance of the brain, sometimes violet, sometimes yellowish,
according to the degree of the paralysis, always softened, less
thick than in normal brains; the white substance injected, and
sometimes infiltrated ; the convolutions me.igre, and the whole
mass of the brain more or less atrophied.

In thirteen cases, besides the preceding alterations, there was

1858.] Transfusion of Blood. 843

one or many small circumscribed places where the encephalitis
had been more violent than elsewhere. In eight cases there
were also effusions of blood.

From these facts, it results positively that the paralysis of the
insane depends upon a chronic inflammation of the brain and its
meninges. Whether the disease begins in the membranes, as
Bayle had said, or in the brain itself; as M. Calmeil maintains,
is a question of comparatively little importance. The great point
is, that the brain is always inflamed. M. Calmeil has ascertain-
ed with the microscope, that in doubtful cases, when the brain
did not seem to be much altered with the naked eye, there were,
nevertheless, all the microscopical appearances of inflammation.
M. Linas relates cases to prove, that an acute encephalitis may
cause the paralysis of the insane.

As regards the first symptoms of this affection, M. Linas de-
clares, that sometimes intellectual disorders first appear, and in
other cases, muscular paralysis and insanity appear at the same
time. It has been said that there was always what is called by
the French, ambitious delirium. But Parchappe, Trelat, Lasegue,
have shown that there are exceptions to this rule, and that, there-
fore, there is nothing specific or essential in this symptom. M.
Linas goes farther, and he calls this opinion a paradox. Ac-
cording to him, the delirium of paralytic insane has sometimes
the monomaniac form, sometimes the hypomaniac, and in other
- the maniac; but he acknowledges that ambitious ideas are
extremely common. [New York Jour, of J.

ion of Blood.

I have communicated several papers on this subject to the
rices (see Cbmptei li Not. 185 7, p.

925), to the Societede Biologie, and to the CercU ,ces.

It is known that Blundell had found that a dog, bled almost
to death, can recover, even if blood of a mammal of another spe-
cies, be transfused into its veins; but that after a few days death
always comes ; while the blood of another dog being employed
for the transfusion, may reproduce a lasting life.

Messrs. Prevost and Dumas declare also that mammals cannot
be recalled permanently to life after a great loss of blood, if trans-
fusion be made with blood of mammals of a species different
from theirs. They state also, that the blood of animals transfused
in the veins of birds, and vice verso, produces almost immediate
death, after having caused violent convulsions. M. Eayer af-
firms, also, that the blood of man kills rabbits, after having
produced convulsions. DiefTenbach has sometimes seen animals
recover after transfusion of blood of animals of other species, but

844 Transfusion of Blood. [May,

never when they were in a state of apparent death after a con-
siderable loss of blood. Bischoff also has never succeeded in
restoring to life mammals that had lost a great deal of blood, in
transfusing blood of birds in their veins.

An important fact, found by Bischoff, should, however, have
opened the way to more successful results in transfusion. He
ascertained that the arterial blood of mammals can be injected in
the veins of birds, without killing them, while the venous blood
causes rapid death. I have found that venous and arterial
blood do not differ one from the other, except on account of the
different quantities of carbonic acid and oxygen they contain.
Both may kill, if they are rich in carbonic acid ; both may not
have any injurious influence if they contain a great quantity of
oxygen. Numerous experiments have led me to the following
conclusions :

1st. That arterial or venous blood from an animal of any one
of the four classes of vertebrata, containg oxygen in a sufficient
quantity to be scarlet, may be injected, without danger, into the
veins of a vertebrated animal of any one of the four classes,
provided that the amount of injected blood be not too consid-
erable.

2nd. That arterial and venous blood of any vertebrated ani-
mal, being sufficiently rich in carbonic acid to be almost black,
cannot be injected into the veins of a warm-blooded animal,
without producing phenomena of asphyxia, and most frequent-
ly death, after violent convulsions, provided that the quantity
of injected blood be not below one -five-hundredth of the weight
of the animal, and also that the injection be not made too slowly.

The reasons for which Blundell, Bischoff, and others have
failed to restore a lasting life after the transfusion of blood of an
animal of a species different from that of the transfused one, are:
1st, That the blood employed was not fresh ; 2nd, that it was in
too large a quantity ; 3rd, that it was injected too quickly ; 4th,
that it was too rich in carbonic acid, and too poor in oxygen.
The greatest causes of failure were this last one, and after it the
quantity of blood.

From my experiments I have arrived at the conclusion, that
there is no danger in employing the blood of dogs, cats, or other
mammals in transfusion in man. Besides, I have ascertained,
after Dieffenbach and others, that defibrinated blood is as good
as blood containing fibrin. As regards the quantity of blood, I
think that four or five ounces would be as much as can be need-
ed for an adult man or woman. It is not necessary to warm the
blood, but it may be useful to do it in some cases. The blood
to be transfused, either that of man or of mammal, should be
received in a large open vase, and whipped at once, then passed
through a thick cloth. If it is not injected at once, it must be

1858.] Indications and Treatment of Croup. 345

either whipped again, or, at least agitated to be charged with
oxygen just before transfusion, wh:ch can be performed with
any kind of syringe. The injection must be extremely slow,
and if after the injection of two or three ounces, there is
increase in the respiratory movements, it is well to stop for ten
or fifteen minutes before finishing the transfusion. [New York
Journal of Medicine.

On Indications and Treatment of Croup.

According to Luszinsky, of Vienna, there are four indications
to be followed in croup, which are 1st, to alter the peculiar
crasis of the blood. This indication requires anaplastics, of
which hepar sulphuris, sulphate of copper, and tartar emetic are
either too uncertain, or too dangerous, because repeated vomit-
ing would be injurious by congestion of the brain, and mercury,
which readily injures by producing diarrhoea, salivation and
general mercurialisrn. Better than all of them, are alkalies,
which Luszinsky seems to have recommended prior to Lemaire
and Marechal, of Paris. The hydrate of potash or soda is most
antiplastic, but they are not easily tolerated; the bicarbonate is
the most digestible, but the abundance of carbonic acid in the
chemical composition of the bicarbonate of potash or soda dimin-
ishes the medicinal effects of the alkalies; therefore he gives the
carbonate of potash or soda, from one half of a drachm to two
drachms every day. 2nd To prevent the localization of the
inflammation in the larynx. This indication requires no bleed-
ing, nor leeches, but in the first stages of the disease, cold ap-
plied to the laaynx, and large blistering plasters, kept in suppu-
ration for some days. 3rd To remove the spasm of the larynx
by narcotics. 4th To destroy or remove the pseudo-membranes
which have been formed. The best caustic in these cases is a
solution of from four to eight grains of nitrate of silver in an
ounce of water, which is to be applied by a brush. Emetics are
necessary, where pseudo-membranes are loose, or beginning to
loosen, in the larynx or bronchi. {Journal fur Kinderkrank-
heiten, and Ibid.

On the Abuse of Irritating Applications in certain Forms of Oph-
thalmia. By Mr. Ceitciiett.

There was recently a case under Mr. Critchett's care, in the
Royal Ophthalmic Hospital, in which the greatest benefit has
been derived from desisting from the measure which had pre-
viously been employed. The patient is a lad of eighteen, to
whose eyes, for four years past, stimulating drops had been daily

346 Epilepsy treated by Ligation of Artery. P^&y,

applied, on account of chronic inflammation and thickening of
the conjunctiva. His eyes had been kept in a state of constant
irritation, and when admitted his vision was very imperfect, on
account of superficial vascularity of the cornea. He had been
sent up from a considerable distance in the country. Mr.
Critchett directed the eyes to be left quite alone, a single seton
thread being introduced in each temple. The improvement
was extremely rapid, and within a week the greater part of the
vascularity had cleared away. No doubt the seton has had
some good influence ; but, looking at the rapidity of the cure, it
seems certain that the chief agent has been the rest from injuri-
ous applications. Cases more or less similar are constantly pre-
senting themselves, in which, with a perverseness worthy of a
better cause, irritating collyria have been employed for periods
far too long. \Med. Times and Gaz., and Banking's Abstract.

Epilepsy treated by Ligation of the Common Carotid Artery. By
C. Angell, M. H., of Pittsburg, Indiana.

Dr. AngRl has resorted to ligation of the common carotid
artery on one side in two cases of epilepsy. The first operation
was performed in July, 1857. The patient, a male, was twenty
years of age, about five feet in height, large head, short neck,
sanguine temperament, and of full habit. Epilepsy had existed
for three or four years, the fits progressively becoming more fre-
quent and severe. He had become partially idiotic. He had
from fifteen to twenty fits during the forenoon of the day on
which the operation was performed. The day after the opera-
tion he complained of difficulty in swallowing, and the left side
became incompletely paralyzed. The paralysis continued, with
difficulty of articulation and swallowing, till the next day, when
he died in a comatose condition. The epileptic paroxysms did
not recur after the operation.

The second operation occurred a few days after the first.
The patient, a male, was forty years of age, of a full habit and
sanguine temperament. Epilepsy had existed for seven years.
For the last three years the paroxysms had recurred almost daily.
The mind was much affected. He recovered from the operation
satisfactorily, and had no return of the epilepsy for twenty- two
days. At the end of that time he had a paroxysm on two suc-
cessive days. Seventeen days after this a third paroxysm occur-
red, and about a month afterwards a fourth. These four parox-
ysms were all that had taken place up to the time of writing
the report, a period of a little more than two months. The
paroxysms after the operation differed from those which occur-
red previously as regards premonitions. Prior to the operation,

1858.] Removal of a Large Uterine Polypus. 347

lie had no warning of their approach; but after the operation,
a sensation of dizziness preceded the attacks for several minutes,
giving him time to provide against falling.

The patient declared that he felt better than at any time
during the three years ; some of his friends thought that there
was a decided improvement in his general appearance and men-
tal condition.

The report is made too recently after the operation to warrant
any conclusion as to its permanent value in this instance.

[Xorth- Western Med. and Surg. Journal.

A Large Uterine Polypus removed by the Curved Ecraseur vriih
Double Action.

A woman fifty years of age, who had been suffering from
frequent uterine haemorrhage during the last two years, was ad-
mitted into the Samaritan Hospital ten days ago, under Dr.
Savage's care. Many examinations had been made elsewhere
previously by various surgeons ; but a polypus, if suspected,
until the day before her admission, was probably quite out of
reach. A swelling could even now be scarcely made out by the
finger introduced far into the os uteri. Sponge tents were intro-
duced daily. On the third day the tumour became more distinct,
and then rapidly distended through the dilated os into the vagi-
na. On the fourth day it could be felt in size and shape like a
large jargonel pear (its neck not much less than its body,) extend-
ing into the uterus to be attached somewhere towards its back
part. On the fifth day the polypus was lain hold of by a pair
of ring forceps, the loop chain of the ecraseur being passed over
the handle of the forceps, slipped up, and was drawn tight, pre-
cisely as the cord in the ordinary operation by ligature, and the
tumour was brought away without pain or haemorrhage. Dr.
Savage observed that the unwieldly look of the instrument was
suggestive of much pain and difficulty ; but its curve fell into the
hollow of the sacrum with the utmost facility, and its point as
readily passed into the uterus as high as he thought necessary.
As the chain is flexible only on one side, much careful manipu-
lation was required before it could be got where he thought it
ought to be. Before working the handle which tightened the
chain, the single fore- finger readily ascertained that nothing
improper was included. The handle was worked at half-minute
intervals as soon as decided resistence showed that contraction
had commenced. The tumour came away in six minutes.
From first to last the patient said she felt no pain whatever.
The haemorrhage has not appeared. Dr. Savage said he had
heard of two cases of polypus thus treated in this country, but

348 On the Functions of the Thyroid Body, [May,

believed they had not been recorded. He had several times seen
M. Chassaignac remove parts highly vascular with his ecraseur
without the least hemorrhage, and thought as the plan he had
adopted in this case was equally safe as the ligature, without any
of its obvious annoyances, he would add his testimony to its
value through the Medical Society. Dr. Savage strongly recom-
mended an instrument with the double action, the finishing
improvement of the inventor, M. Matthieu. [London Lancet.

On the Functions of the Thyroid Body. By Dr. P. Martyn.

Dr. Peter Martyn has communicated to the Koyal Society
some very ingenious speculations as to the use of this remarka-
ble body. He first called attention to the necessity of rigidity
in all round instructions. This is accomplished, he thinks, by
the thyroid gland, which, being pressed upon by the muscles,
during the act of speaking, becomes gorged with blood, and
presses upon the larynx, rendering it tense. Furthermore, he
believes this so-called gland acts as a loader. In musical instru-
ments, loaders are used to render the vibrations slower and long-
er, and the tone in consequence fuller, louder and deeper. They
thus give to the voicing part of a small instrument the power
and quality of a large one. The human organ of voice is only
three inches long, and yet " has the same power as, and better
quality of tone than, the instrument which more nearly ap-
proaches it the French horn which is nine feet, or the 'vox
humana' pipe of a moderate-sized organ, which is from four to
eight feet long. This economy of size in the human organ has
always been wondered at, but never, that I know, explained."
Finally, the author of the paper believes that by the varying
shape, bulk, destiny and pressure of this body, it aids materially
in producing the qualities of modulation and expression belong-
ing to the human voice. [Amer. Jour, of Med. Science.

Treatment of Intermittent Fever.

There is a means of treatment of fever and ague, which is by
far too much neglected. It consists in applications of the cold
shower-bath a little before fever sets in. Although we do not
admit, as it might be concluded from a paper of M. L. Fleury,
that every case will be cured by this mode of treatment, we
think that the facts mentioned by this able physician are worthy
of attention. He states that he has treated, during the last ten
years, one hundred and fourteen patients, and that they all have
been cured, only by cold shower baths, and that there has not
been a single return of the disease. Forty-three were recent

1858.] Uterine Haemorrhage. 349

cases, having existed from two days to three months; seventy-
one were old and rebellions cases. In all these last cases there
was an enlargement of the spleen, or of the liver, or both ; there
was anaemia or even a cachectic state.

One single shower-bath has often been enough to effect the
cure. It has never been necessary to give more than five show-
er-baths. Not only is periodical fever cured by this means, but
all kinds of periodical affections may also be cured in the same
way.

When the periodical attacks are stopped, there are irregular
ones, in most of the cases, as long as the engaged viscera have
not been brought down to their normal volume. In these cases
local douches have been applied twice a day, on the hepatic or
splenic regions. [Comptes Rendus de V Acad, des Sciences, and
New York Journal of Medicine.

Injection of Liquor-Ferri Sesquichlorati in Uterine Hemorrhages.

Dr. Breslau's case of injection of liquor-ferri sesquichlorati
shows the efficacy of this treatment in certain cases of excessive
uterine haemorrhage. A woman, 45 years old, had worn a pes-
sary for a long time, which she had given up on account of pain
and hemorrhages. Examined, there were found five grape-
shaped polypi around the os uteri, with ulceration. These were
removed by Siebold's scissors, and potassa fusa applied to the
ulcerations. The haemorrages remitted somewhat. The uterus
was, however, entirely bent upon itself, and the menses returned
in great excess. The cavity of the uterus was somewhat enlarg-
ed. The return of the menorrhagia reduced the patient to an
extreme degree of anaemia. Ergot of rye failed to effect any
contraction of uterus or arrest of flooding. Two possible condi-
tions presented themselves to Dr. Breslau: 1st, The five polypi
attached to the cervix favored the presumption that there exist-
ed a similar warty hypertrophy of the lining membrane of the
uterus ; 2d, There might be a destructive ulcerative process of a
malignant character going on in the same structure. In the
first case, the currette of Recamier seemed indicated, in order to
scrape the uterine membrane clean from the presumed excrescen-
ces. In the second case, it seemed necessary to bring a caus-
tic and styptic agent in direct contact with the diseased mem-
brane. To answer this latter indication, he selected the liquor-
ferri sesquichlorati of the Bavarian Pharmacopoeia. Having
first straightened the retroflected uterus by the sound, and in-
serted an elastic catheter as far as the fundus, he injected one
ounce and a half of the liquor-ferri, diluted with an equal quan-
tity of water. The injected fluid was retained in the uterine
cavity for a minute and a half by the pressure of the fingers at

350 Statistics of Coiling of the Funis. [^ay

the os around the catheter. During the operation, the patient
felt a dull labourlike pain which lasted for two hours. The hae-
morrhage, which had hitherto been unintermitting, now sudden-
ly stopped, and was not renewed. After some days, brown,
crumbling clots were discharged, but no fluid blood. Seven
months afterwards there had been no return of menorrhagia.
The patient menstruated regularly every twenty-one to twenty-
four days; and through internal administration of steel and
quinine, recovered robust health.' [British and Foreign Medico-
Chirurgical Review. New Orleans Med. News and Gazette.

Statistics of Coiling of the Funis. By Dr. Weidemann.

Dr. Weidemann states that among 28,430 deliveries the funis
has been found coiled around the child in 3,379 instances. In
3,230 of these it was coiled around the neck, and in 149 around
other parts of the body. Of the 3,230 cases, 2,546 consisted in
a simple coil, and in 684 there were severe coils. In relation to
the causes of this occurrence, it is interesting to notice that of
1,788 cases occurring at the Marburg Midwifery Institution, the
funis was in 80 (1:22.2) under 15 inches, and in 183 above 25
inches (1:9.71) in length ; that in 54 (1.33) there were very little
liquor amnii, and in 41 (1:43.6) there was very much; in 165
(1:10.8) the child was under 5 pounds weight, and in 28 (1:61.7)
it was 8 pounds. Therefore, among the favoring causes of the
occurrences may be mentioned a long funis, abundance of liquor
amnii, and a small child.

Among 2,930 infants born at Marburg, 182 (1:16.09) were
dead, 251 (1:12.41) were still-born. Of 725 born with coiled funis,
45 (1:16.11) were dead, and 72 (1:10.%) were still-born. Of the
45 dead-born, in 18 only could the death be referred to this alone,
i. e., only 1:40.2 in the 725 examples of coiling. From an ex-
amination of the figures derived from the midwifery institutions
at Dresden, Gottingen, Wiirsburg, Berlin, and Marburg, it re-
sults that of 13,720 new-born infants, 902 (1:15.21) were born
dead ; while in the 1,217 instances of coiling of the funis, 31
children were born dead, whose death could be attributed to that
circumstance, giving a proportion of 1:39 to the coilings, and
1:19 to the number born dead.

Thus, as (1) the 16th child among new-born children in
general, as well as among those in which coiling has taken place,
is born dead ; as (2) the 12th child among the new-born in gen-
eral, and the 10th among those around whom the funis is coiled
is born still-born ; and as (3) in one child in 40 only can this
coiling be regarded as really the cause of death, it is evident that
this accident does not occupy a very prominent place. [Monatsch.
fur Geburtskunde, and Med. Times and Gaz.

1858.] Case of Diabetes Traumaticus. 351

Case of Diabetes Traumaticus. Translated for the Charleston
Med. Jour, and Review.

Dr. Herman Itzigsohn reports the following case in Virchmtts

Archiv, for April 1857: A Mechanic, aged thirty-eight years,
unmarried, previously in good health, received a year ago, a
blow from the blade of a hatchet on the top of the head, a little
to the left of the median line. He immediately suffered from
incontinence of urine ; but he could void it copiously on making
a strenuous effort. Gradually diabetes manifested itself. Inor-
dinate thirst supervened, the patient drinking sixteen quarts of
fluid daily, which naturally produced a corresponding flow of
urine. He dieted himelf on bacon, which he craved more than
any other kind of food. At this time yellow discoloration of
the conjunctivas announced disorder of the liver, which condi-
tion was further indicated by swelling and uneasiness in the
hepatic region.

This case is in two respects worthy of notice : firstly, for its
traumatic origin ; secondly, for the tardy appearance of the liver
affection. In accordance with Bernard's theory, it may be sup-
posed that a splinter of bone was driven into the fourth ventricle,
or that an extra vasated clot occurred there ; although it is not
probable, as there was not the slightest appearance of the brain
being injured, either by shaking of the head, or any other
irregular movement ; neither was there vertigo nor headache at
any time. It remains yet to be proved whether diabetes is to
be traced primarily to a diseased brain, and secondarily to the
liver, or not. The expression of opinion is desirable on so im-
portant a question.

Condition of the Nerves in Degenerated Tissues. Translated for
the Charleston Med. Jour and Review.

In Yischow's Archiv, Band XL, Heft 2, p. 200, we find the
following summary of the researches of Fred. Marfels. The
author examined the condition of the nervus vagus in four
human subjects, the victims of pulmonary phthisis and maras-
mus. He ascertained that the fatty degeneration does not attack
the nerves immediately; but that the metamorphosis begins
in developement of cells, which in the nerve fibres itself should
normally proceed. He describes the same as nucleus-holding
cells of the size of the small colorless blood corpuscles, which lie
in the midst of the fibres, for the most part without any interven-
ing granular substance ; and, strange to relate, he finds that
neither potash, ether, nor iodine decompose them. Once when
examining the ischratic nerve, he found these cells even inside

352 Calcareous Salts in the Treatment of Rickets. [May,

the axis cylinders, which observation corresponds with the dis-
covery made in some of the lower animals of the existence of
cells in the nerves, partly granulated and non-nucleated, and
partly transparent, clear and nucleated, strung together in the
central cord of the nerves. The author did not find nuclei in
the sheath of the primitive nerve-fibres in man ; but in animals
he thinks he saw them, where the nerve-sheaths appear to be
filled by these fibres. Twice he observed the escape of the nerve
contents from the sheath, when at the same time he saw the
above alluded to cells.

Calcareous Salts in the Treatment of Rickets.

Dr. W. Budd, of the Bristol Koyal Infirmary, states (British
Medical Journal, Jane, 1857, p. 514) that he has derived better
results, in the treatment of rickets, from the compounds of lime,
than from any other remedial means. In cases short of rickets,
too, where children with large heads, tumid bellies, and pasty
complexion, whose spines are too weak to support their bodies,
who are slow in intellect, and backward in teething, and have
reached the age of eighteen months or more, without showing
any desire to take to their feet, the beneficial influence of calca-
reous compounds is equally manifest. In such cases, Dr. Budd
gives five or ten grains of phosphate of lime, in chalk mixture,
thrice daily, adding a simple chalybeate if anosmia is palpably
present. At the end of a fortnight, the improvement of the
patient is generally conspicuous. Dr. Budd believes that the
deterioration in the teeth of the rising generation is due to the
insufficient supply of the inorganic constituents of these organs
in the food of children, and suggests that children in cities
should be fed, in part, during dentition, on biscuits containing
a proportion of salts of lime. [Virginia Med. Journal.

On Lead Colic. By M. Briquet.

Avery interesting communication has been made to the Aca-
demie de Medicine, by M. Briquet, physician of the Cbarite
hospital. The object of the paper is the nature and treatment
of lead colic. What is the seat of the violent pain which then
exists f Is it the digestive canal the muscles of the abdomen
the diaphragm ? Is the spinal cord affected, as Laennec and
Barbier admitted? Is the pain purely neuralgic, as maintained
by Andral and Grisolle? M. Briquet affirms, from researches
made on forty-four patients, that the pain is in the muscles of
the abdomen, sometimes in one, sometimes in many. He says
also, that there is in some cases a real hyperesthesia of the skin

1858.] Editorial and Miscellaneous. 353

in the neighborhood of the painful muscles. In some patients,
however, the reverse exists : the skin is anaesthetic. He affirms
that constipation has no influence whatever on the abdominal
pain. He proposes in another paper to relate cases to prove that
the application of galvanism to the painful muscles usually takes
away the pain at once. We can assert that it is perfectly true
that the pain may disappear immediately in cases of lead colic,
after one application of an electro-magnetic current. [Ibid.

EDITORIAL AND MISCELLANEOUS.

Editorial. On account of the space occupied this month by an un-
usual amount of original matter, and the space given to the minutes of
the State Society, our Editorial matter must be deferred for the next
month.

Minutes or the Annual Meeting of the State Medical Society.

Madison, April 14th, 1858.

The Society assembled at 10 o'clock, in the Town Hall, in Madison,
and was called to order by the 1st Vice-President, Dr. H. F. Campbell,
of Augusta.

The following regular members were present : Drs. J. G. Westmore-
land, M. H. Oliver, John W. Jones, T. C. H. Wilson, Thos. S. Powell,
W. T. Hollingsworth, W. S. Meiere, Jos. P. Logan, A. Means, V. H.
Taliaferro, G. L. McCleskey, Henry F. Campbell, Eben. Hillyer, J. K
Simmons, Juriah Harriss, E. E. Jones, DeSaussure Ford, S. G.Anderson,
Win. Louis Jones.

The minutes of the last annual meeting, held in Augusta, April 8th,
1857, were read and approved.

The rules were suspended, and upon written application, the following
gentlemen were duly elected members of the Society :

R. T. Pulliam, A. J. Shaffer, J. N. Coe, L. J. Green, A. M. Parker,
Isham 'H. Ragan, J. H. Conaly, F. S. Colley, S. J. Saffold, L. T. P. Har-
well, L. G. Anderson, J. M. Boring, R. J. Stewart, S. H. Dean, S. H.
Smith, L. S. Means, A. M. Boyd, W. F. Westmoreland, H. W. Brown,
B. M. Smith, H. J. Walker, Wm. H. Philpot, Wm. B. Crawford, Gasby
Night.

The election of officers being next in order, a ballot was ordered, and
the following gentlemen were elected for the ensuing year :

Dr. J. P. Logan, of Atlanta, President ; Dr. H. J. Ogleby, of Madison,

354: Miscellaneous. [May,

1st Vice-President; Dr. John T. Banks, of Zebulon (Pike county), 2nd
Vice-President ; Dr. Eben Hillyer, of Rome, Treasurer and Secretary.

On motion, a committee of two were appointed to conduct the Presi-
dent elect, Dr. Joseph P. Logan, to the chair ; which being done, he
returned his thanks to the Society, in a few appropriate remarks, for the
honor conferred upon him.

Dr. E. H. W. Hunter, of Louisville, was, by ballot, elected to deliver
the Oration at the next annual meeting. Dr. G. L. McCleskey, of Mad-
ison, as his alternate.

The selection of delegates to the American Medical Association being
next in order, a committee of five, consisting of the following gentlemen,
were appointed to nominate them, and report at their earliest conven-
ience : Dr. Ford, Dr. Harriss, Dr. W. F. Westmoreland, Dr. Simmons
and Dr. Boyd.

Society then adjourned until 2 o'clock P. M.

AFTERNOON SESSION.

Society called to order by the President.

Dr. Hillyer, by appointment, read an essay upon the Physiology of
Menstruation.

The committee to appoint delegates to the American Medical Asso-
ciation, reported the names of the following gentlemen : Juriah Harriss,
of Savannah ; W. T. Hollingsworth, of Morgan ; F. S. Colley, of Wal-
ton ; W. G. Bulloch, of Savannah ; H. F. Campbell, of Augusta ; H. M.
Boyd, of Cave Spring ; Eben. Hillyer, of Rome ; B. M. Smith, of Atlanta ;
C. B. Nottingham, of Macon ; R. Q. Dickinson, of Albany ; E. M. Pen-
dleton, of Sparta ; James Green, of Macon ; J. F. Banks, of Zebulou.

The essay of Dr. Meiere being called for, he responded in a very inter-
esting article upon the use of Alcohol in Typhoid Fever.

Society adjourned till 7 o'clock P. M.

Society met, pursuant to adjournment.

Dr. W. F. Westmoreland moved, that the mode of appointing Essay-
ists and subjects be changed. That each gentleman appointed be allow-
ed to write upon any subject of his own selection.

Upon motion, Drs. Campbell, E. Jones Oliver, W. F. Westmoreland,
and Dean, wrere appointed a committee to nominate Essayists for the next
meeting.

The report of the late Treasurer, Dr. Nottingham, for the years 1856-
185V, were received and adopted.

A ballot was ordered, to determine upon a point for the next annual
meeting, which resulted in the selection of Atlanta.

1858.] Miscellaneous. 355

Dr. J. G. Westmoreland moved, that two hundred copies of the Con-
stitution, By-Laws, Roll of Members, (fee., be ordered to be published in
pamphlet form, for distribution among the members of the Society.

Dr. Meiere moved, as a substitute, that all the medical journals in the
State be requested to publish the Constitution, &c, in their columns
which substitute was carried.

The Committee on Essays reported the names of the following gentle-
men, as Essayists for the next annual session of the Society :

Dr. H. W. D. Ford, Dr. H. F. Campbell, Dr. Robert Campbell, Dr.
Smith of Griffin, Dr. E. Hillyer, Dr. Stewart of Pike county, Dr. G. B.
Night, Dr. S. H. Dean, Dr. W. F. Westmoreland, Dr. W. H. Doughty
of Augusta, Dr. Juriah Harriss, Dr. J. G. Howard, Dr. R. D. Arnold,
Dr. V. EL Taliaferro, Dr. Joseph A. Eve, Dr. A. M. Boyd, Dr. Joseph P.
Logan, Dr. H. W. Brown, Dr. J. M. Green, Dr. T. B. Ford, Dr. G. L.
McCleskey.

On motion of Dr. Means, it was passed, that the report of any inter-
esting case, or other communication, would be gladly received from any
gentleman by the Society.

The following report was received from Drs. Bulloch, and Arnold, a
committee appointed by the Savannah Medical College, to solicit the
co-operation of the Society in procuring the legalization of dissections, for
medical and surgical purposes, and the modification or repeal of the laws
now in force against it :

To the President and Members of the Medical Society of the State of
Georgia :

Gentlemen We, the undersigned committee, have been appointed
by the Faculty of the Savannah Medical College, and instructed to con-
fer with you, asking your concurrence in a movement having for its
object the passage of a law by the Legislature of Georgia, legalizing dis-
section for the purposes of medical and surgical study.

To effect this great object, we would most respectfully solicit the So-
ciety to unite wTith us in a petition to the Legislature, at their next session,
to pass an Act rendering it lawful for the Professors and Teachers in
Medical Colleges and Schools in this State, to receive for Anatomical
study the unclaimed bodies of persons dying at public hospitals and other
kindred institutions. Such a law is in force in other States.

Accompanying this, will be found a copy of the Statute enacted by the
Legislative Assembly of the State of New York.

The New York law concedes, as you will observe, very little else than
the single point of legalizing dissection. Even this may be of immense
practical service, by ridding us of the annoyance to which we may be at
any time exposed, whilst the possession of a dead body, even for scientific
purposes, is, according to the existing law, equivalent to a crime to which,
evil disposed persons might at any time call public attention.

Is it not the bounden duty of the State to see that the Medical Profess-
15*

356 Miscellaneous. [^a7

ion of the land, who are the true missionaries to suffering humanity, lack
nothing needful for their efficiency and usefulness, without the necessity
of going out of the State to obtain this knowledge not forgetting that
it is this profession alone that can be brought to bear on the waste of
human life.

The public demands that the medical institutions shall furnish it with
good and accomplished physicians and surgeons, yet it has set its face
against the only means of obtaining them. But at the present time, un-
der its present prosperity and attainment, there is that advancement made
in other branches of learning and science there is that enlightened poli-
cy in legislation upon all matters of general interest and improvement,
that we have a right now to expect and to ask for some measure, some
means, whereby we can procure material for dissection in some legitimate
manner, that we may be enabled to make that progress and advancement
in our profession that will raise it to that rank and standard it so nobly
bears in other sections of our land.

We wish to be relieved from this false and dangerous position that
affixes upon us the stigma of felons, in the acquisition of anatomical
knowledge, and all these difficulties and excessive annoyances under
which we are laboring, and which we are now obliged to encounter and
overcome, to make that progress and advancement in our profession that
operates only to favor our more faithful discharge of duty. This is not
for the exclusive advantage of me medical man : it seeks no other benefit
than that which it wishes all others to enjoy : it is for the common good.
Every intelligent man, whether professional or non-professional, cannot
but admit that the interests of society imperatively demand the study of
practical anatomy. Then why should not the State make a suitable
arrangement by law. Is there any reason why we should stand in this
matter behind New York, Massachusetts, Michigan, and many other
states, in an enlightened policy. Considering the rights of the medical
profession, in the just and proper estimate of its value, and in comparison
with the privileges that are extended to it in other states, let there be
removed from our Statute books those laws repressing the study of Sci-
ence laws that should exist only in darker ages that now put a barrier
in the way almost ruinous to the pursuit of anatomical investigation, and
continually threatens and exposes us to a most disgraceful and ignomini-
ous punishment !

We would prefer securing the passage of a more liberal law than that
of the New York Act, so that if our views on this subject accord, any
petition your honorable body may think proper to make, calculated to
facilitate the passage of a bill, through the Legislature, would meet our
hearty concurrence.

WM. G.BULLOCH, M.D.
R. D.ARNOLD, M.D.

The following was passed, offered by Dr. Taliaferro, of Atlanta :

Resolved, That the thanks of this Society be tendered to Col. C. R.
Hanleiter, editor of the National American, for his presence on this occa-
sion, and for the interest he manifests in the elevation of Medical Science,
by the exclusion from the columns of his paper, the advertisement of all

1858.] Miscellaneous. 357

quack medicines, secret remedies and criminal drugs, which too frequent-
ly pollute the public press.

The following, passed, offered by Dr. Dean :

Resolved, That the thanks of this Society be tendered to the town
authorities of Madison, for the use of their Hall to the Trustees of the
Presbyterian Church for the use of their Church building to the Physi-
cians and citizens, for their courtesy and attention to the members of this
Society.

The following letter, to the Society, from Dr. Arnold, was presented
and read by Dr. Harriss :

Savannah, April 11, 1858.
To the Officers and Members of the Med. Society of the State of Georgia :

Gentlemen My engagements with Savannah Medical Journal have
prevented, and will prevent me from fulfilling the appointment of the
Society, in writing an article on the Pathology and Treatment of Yellow
Fever. I think I can do the subject more justice, in carrying out the
plan I have formed, of giving in successive numbers of the Journal a full
history of our terrible epidemic of 1854, for which my notes taken at the
time are ample.

I respectfully request to be discharged from the further consideration
of the subject.

Respectfully yours,

R. D.ARNOLD.
The request of Dr. Arnold was granted.
On motion, the following was passed :

Resolved, That this Society do now adjourn, to reassemble in the city
of Atlanta, on the second Wednesday of April, 1859.

EBEN. HHLYER,M.D.,

Secretary.

New Febrifuge. Azderach Bark. Dr. W. R. Cornish, of the Bengal ar-
my, (Indian Annals of Med. Science, Oct. 1856,) states that the Margosa
or Neem tree has long enjoyed a considerable reputation in India as a
febrifuge, and that it belongs to the natural order Meliaceae and genius
" Azadirachta." It is probably the Melia Azederach of our Pharmaco-
poeia, and which under the name of Pride of India is so extensively em-
ployed as a shade and ornamental tree in the Southern States. Here the
bark is used as a vermifuge. Dr. C. describes the bark as being nearly
white internally and purple externally. When chewed, in its recent
state, its taste is at first sweetish, followed quickly by a powerful and
lasting bitter. Dr. C. employed the bark during six months with nearly
all the fever patients that came under his care, in the form of decoction,
(the strength of which is not given,) from one to two wine-glassfuls being
administered repeatedly before the accession of the paroxysm. Dr. Cor-
nish considers that the active principal resides more especially in the light
colored inner bark, the dark exterior being highly astringent, owing to a
tannin analogous to that in catechu. [American Jour, of Pharmacy.

858 Miscellaneous. P^ay>

Ampelopsis Quinquefolia, or Virginia Creeper. The common Am-
pelopsis, or Virginia Creeper, so ornamental as a deciduous climbing plant
in our woods and on many; walls in this city, is recommended by Dr. J.
McCall as a remedy in dropsy. The bark of the vine is the part employed,
and it should be gathered late in the Autumn, wThen the berries are fully
ripe and the leaves begin to turn red and fall. It should be dried in the
shade and preserved carefully from moisture. The Ampelopsis is readi-
ly known by the quinate division of the leaf. Its creeping character and
frequent occurrence on the same tree with Rhus radicans, or poison vine,
should lead the collector to avoid substituting the latter, which has a
three-lobed leaf.

In its physiological effects it appears to " stimulate absorption and the
elimination of matter through all of the outlets of the system rather than
to act on any particular secretion, though by some it is stated to be ac-
tively diuretic."

Dr. McC. esteems the Ampelopsis a valuable addition to the materia
medica ; it is not unpleasant to take, though in taste it is acrid and
persistent. Its infusion and decoction are quite mucilaginous. [Mem-
phis Jour, of Medicine.

Cancer in a Woman aged Eighty Years. Soap and Lead Plaster in
Schirrus. The same day that we saw the foregoing cases, wre observed
a woman, eighty years of age, at the Cancer Hospital, with well-marked
scirrhus of the left breast, which appeared about a year ag*o. Notwith-
standing her great age, she had the blooming, healthy cheeks of a country
girl of eighteen ; her general health was perfect, and under the use of
tonic remedies, and soap and-lead plaster spread on leather, with a little
camphor, the cancer has diminished in size, and its progress is complete-
ly arrested for the piesent. This is by no means an exceptional case of
the arrest of the progress of cancer at this hospital ; for we have observed
several in whom the disease has been kept stationary for years, with no
other inconvenience than the presence of the tumour in the breast, and
the knowledge on the part of the patient that it was still there. The
soap-and-lead plaster is one of the principal agents in effecting this desi-
rable object ; the lead appears to possess some peculiar influence in the
disease. [London Lancet.

Powdered Chlorate of Potash as an Application to Ulcers, etc. For
some time past, at the Metropolitan Free Hospital, Mr. Hutchinson has
employed the powdered chlorate of potash as an application to cachectic
ulcers. In most cases it appears to exert a very beneficial influence,
speedily inducing cicatrization ; and it is very convenient of use. The
cases in which it has best suited have been some of ulcers of the leg,
open buboes, simple sores on the skin of the penis, and cracked nipples.
In the latter it answers admirably. The salt should be powdered very
fine and dusted into the sore with the finger. It produces sharp smarting
for a short time, but the pain soon subdues. In most cases suitable for
its use it is also desirable to prescribe its internal administration; but
with a view to making the experiments more conclusive, in the cases
upon which Mr. Hutchinson founded his opinion of its efficacy, no other
treatment was adopted. [lb.

1858.] Miscellaneous. 359

Ulcerated Larynx in Typhoid Fever, Producing General Emphyse-
ma. It was thought to exemplify an occasional complication of ty-
phoid fever. The ease was one of a boy who lately died under Dr. Ad-
dison's care, at Guy's Hospital. About the twelfth day of his illness his
neck was observed* to be emphysematous, and in a few hours the face,
arms, chest, &c, were in a like condition. This continued for ten davs,
when he died. Besides the usual affection of the ileum, there was found
at the back part of the larynx a sloughing ulcer, which communicated
with a space between the oesophagus and trachea. Through this line
the air had penetrated into the mediastinum, and so to the general sub-
cutaneous tissue of the body. Considering the rarity of emphysema from
such a cause, the case might be thought to be unique or accidental, but
(Dr. Wilkes believed) for various reasons, it was probably not so. In the
first place, emphysema had been alluded to by various writers as an occa-
sional occurrence in typhoid fever, though the cause was unknown ; and
secondly, a peculiar disease of the larynx had been described by various
pathologists as a part of typhoid fever. In all probability, then, these
two affections stood in the relation of effect and cause, and, therefore,
although this was the first case of the kind he had witnessed, it afforded,
in all likelihood, an explanation of an occurrence which rarely, though
sometimes, happens in the course of typhoid fever. [lb.

A Venereal Badge. M. Renaud states the following fact in a feuille-
ton of the Gazette des Hopitaux : In Servia, a woman who is found to
be suffering from syphilis, can claim admission into an hospital, or has
the privilege of being treated at home by any medical man she chooses
to call in. When she is attended at her own residence, she is obliged to
wear a necklace fastened in front with a seal, which must be broken be-
fore the necklace can be removed. The clandestine breaking of this
seal is severely punished ; and any one coming in contact with the woman
thus marked, must plainly see in what state of health she is. It is to be
regretted that like measures are not in force in other parts of the East,
where prostitution is carried on without any control. [lb.

Case of Congenital Hypertrophy of the Tongue, and Amputation.
This case was reported by Dr. Morrogh, of New Brunswick, X. J., and
occurred in a girl seven years old. At birth the hypertrophy was moder-
ate, but it had increased more or less rapidly till reaching its present
dimensions ; the tongue was found protruding two inches outside the
jaws. It measured two inches across the teeth, and was of a corres-
ponding thickness. The papilla? of the protruded portion were enlarged,
and the mucous membrane was thickened and indurated. On the under
surface was a ragged, hard ulcer, produced by the pressure of the teeth.
These were pressed forward considerably out of their natural position.
The horizontal rami of the inferior maxilla were curved downwards so
that, when the molar teeth came in contact, a space of about one inch
remained between the upper and lower incisors. By this the girl was
enabled to masticate and swallow without difficulty. After theexample
of Dr. Harris, of Philadelphia, who, after endeavoring to amputate in a
similar case by ligature, in 1829, performed the same operation, in 1835
by a double flap incision, checking the hemorrhage by ligature, Dr. Mor-

360 Miscellaneous. [May,

rough operated by removing a V shaped portion from the anterior mid-
dle part of the tongue, and ligating the ranine artery. Although copious
hemorrhages followed, the patient went home well, on the sixth day after
the operation. [Medical and Surgical Reporter.

Transcendental Medicine; the Divine Unconscious. It is not man
who cures disease by means of his conscious spirit ; but it is the divine
Unconscious in man. The same power which fashions his organism, and
daily recreates it in depths of mystery, is alone that which brings him
back from sickness to health ; and all that man's inventive mind has
learnt in the healing art, for long centuries, limits himself to providing
means to facilitate, to further, and in general, perhaps, to render possible,
the task of this divine Unconscious. . . We cannot, by an immediate ex-
ercise of skill, cure the most trivial cut of the finger ; the healing of even
such a wound as this depends on a formation of new organic substance,
of which formation the divine Unconscious is alone capable; at most we
can either hinder or further this process, and in the accomplishment of
the latter aim lies the essence of the surgical art. [Dr. C. G. Carus :
Ueber Lebanmagnetismus. London Lancet.

Slitting up the Lachrymal Canals. The practice of slitting up the
lachrymal canals and their orifices, originally introduced by Mr. Bow-
man, for the treatment of certain cases of epiphora, still continues to be
extensively employed at the Moorfields Ophthalmic Hospital. It is adapt-
ed to all cases in which either the punctum is narrowed or displaced
outwards, and these constitute a very numerous class. In almost all
cases of long-continued tinea tarsi, in which, by degrees, the thickening
of the lower Jid has everted its edge, this simple procedure relieves the
patient of his most troublesome symptom. Mr. Critchett has recently
had made some grooved steel probes for this operation, which materially
facilitate its performance. The silver ones formerly employed being
necessarily very small, were unsteady as guides to the point of the knife.
The steel ones, on the contrary, give it good support, and their groove
is of great advantage in securing that it shall glide easily in the right
direction. To secure smoothness of surface, and prevent rusting, the
steel probes are gilt. A Beer's knife is the best, and with these instru-
ments the operation is one of extreme ease. [Med. Times and Gazette.

Rules Respecting the Treatment of Primary Syphilis. It seems to be
now pretty generally acknowledged, in hospital practice, that mercury
should be given only in those cases in which the chancre presents marked
induration, and that in all others secondary symptoms should be waited
for before having recourse to specific treatment. In a large majority of
sores not attended by induration, no constitutional phenomena will follow ;
and to discriminate'between those likely to be so followed and the harm-
less class, is admitted to be impossible. There is, therefore, no altera-
tive, except we would give mercury very often unnecessarily, but to wait
in these cases until the real nature of the affection shall have been made
manifest. In the non-indurated class, local stimulants, as sulphate of
copper, lunar caustic, or the acid nitrate of mercury, are the oldand
ttll favorite remedies. If the chancre be seen within a week of its origin,

1858.] Miscellaneous. 361

whether induration have already commenced or not, vre believe most sur-
geons would destroy it freely either by nitric acid or some other caustic.

[Med. Times an:! Gazette.

New Antiperiodic. Dr. R. S. Cauthorn, of Richmond, Va., gives an
account of the root of Apocynum Cannabinum, as a powerful antiperio-
dic. This power of the root was discovered by an herb doctor, by the
name of Ragland, and the medicine is called "Dr. Raglard's Root of
Man" by the people who had used it. About six grains of the root is
administered in the form of powder or pills, preceded in cases of ague
by a dose of calomel. Dr. Cauthorn expresses much confidence in the
virtue of the Apocynum Cannabinum, and he may be correct in his infer-
ences ; but as his own observations were only extended to six cases it may
be well to get further information before admitting it to the rank claimed
for it by Dr. Cauthorn, which can readily be effected, as the plant is
found all over the Middle States. [Richmond Stethoscope.

Corrosive Sublimate and Collodion as an Escharotic. Dr. Macke uses
a solution of a drachm of corrosive sublimate in an ounce of collodion
as an eschrrotic to remove small exerescences, which it is desirable to get
rid of without using the knife. It is applied by means of a camel's hair
brush. When the inflammation is high, it may be abated with cold
water applications without interfering with the action of the caustic, the
eschar is then thrown off in from three to six days, with slight pain, and
the author has not noticed absorption to take place during its contact.

[Hay's Journal.

Gelatinized Chlorform. Dr. Massart (Revue de Therapeutique) gives
the following process for making chloroform jelly for facilitating its use
as a local anaesthetic, viz : Take equal parts of white of egg and chloro-
form, shake the mixture and let it stand for three hours. Or take one
part of white of egg and four parts of chloroform, put them in a bottle,
which is then plunged in a water bath of the temperature of from 120
to 140 Fahr., when gelatinization occurs in four minutes. This prepara-
tion is applied by rnbbing the painful part, and its power of affording re-
lief is said to be remarkable. Dr. Massart prefers the cold process. If
allowed to remain long in contact with the skin, it produces incipient
cauterization. [Boston Med. Journal.

Foul Ulcers of the Legs. A woman at St. Mary's Hospital, whose
entire leg had been in a state of ulceration for years, with islands of skin
here andthere, has had it effectually healed up, by Mr. Coulson, by wrap-
ping a piece of linen around it wet with a lotion of the sulphate of soda,
and a bandage over all. Mr. Coulson thinks the bandaging and rest have
proved as serviceable as anything else used. [Ibid.

Yeast in Scarlet Fever. Some years ago my attention was directed
to the use of yeast in scarlet fever, by an article in your Journal from the
pen of Dr. Smith, of Baltimore. I have given it this last winter in fifty-
three cases, and all have recovered. These were all the cases in my

362 Miscellaneous,

practice. Together with the yeast, inunction has been employed in two
thirds of them.

I believe that the free use of yeast may prevent a bad type of the dis-
ease. It was given, at the outset, every two or three hours, in doses from
a teaspoonful to a tablespoonful, and continued until desquamation.

[A. S. McClean. Boston Med. and Surg. Journal.

Poison Census. The Medical Times states, that in the four years,
from 1848 to 1851, the deaths by poisoning ranged from 444 to 447 each
year. In the three subsequent years, 52, '53, and '54, the number of
deaths by poisoning was 370, 409, and 398. This decrease is attributed
by Dr. Farr, to a certain extent, to the effect of the Legislative restrictions
from the " Sale of Arsenic Act." [Druggists Circular.

Edinburgh Celebrities from an American Point of View. Dr. Simp-
son, a short thick man, with what General Massey calls "body of Bac-
chus and the head of Jove," really a very fine head, covered with long
black curls, seamed with gray, a round Scotch face, high cheek-bones,
penetrating mild eyes and curious prim mouth, deep sunk between the
nose and chin, like that of Cicero. And there is no reason why it should
not, for the doctor, too, is eloquent in his own sphere. He persuades
nervous females into good health, and amuses all by his genial humour
and stories. He is a bold experimenter, and has hit upon other things
than chloroform. Many tales of his benevolence are told. The poor
never apply to him in vain. Not a few of his own profession envy him,
and assail his reputation for the love of novelties, etc.; while, on the other
hand, the disciples of mesmerism and the water cure declare he could
say something in their favor, if he had the courage and the good will. Pro-
fessor Syme, the first operator alive, is a clean made, gentlemanly man,
with a finely formed, baldish head a most concise, decided individual,
sharp, curt, and unceremonious as his own knife, but always going direct
to the heart of the matter, never wasting a drop of blood or a drop of ink,
or a single word. He is not much addicted to giving drugs. He likes
to see what he is about, and has no fancy for poisoning people at random
with the preparation of chemistry. A colleague of these two, and an
opponent of the former in reference to homoeopathy warfare in Scotland,
a tall, compact, swarthy, bushy-haired man, dexterous at controversy,
and capable of making a clear extempore statement, in a style that many
lawyers would envy. [Scottish American Journal.

Wendell Holmes on Controversy. " If a fellow attacked my opinions
in print would I reply ? Not I. Do you think I don't understand what
my friend, the professor, long ago called the hydrostatic paradox of con-
troversy? Don't know what that means? Well, I'll tell you. You
know that if you had a bent tube, one arm of which was the size of a pipe
stem, and the other big enough to hold the ocean, water would stand at
the same hight in one as in the other. Controversy equalizes fools and
wise men in the same way and the fools know it."

The London Lancet says " that Quacks bear the same relation to the
Medical Profession, with that of the pediculus to the human being on
whom it preys."

SOUTHERN

MEDICAL AND SURGICAL JOURNAL.

(NEW SERIES.)

Vol. XIV.] AUGUSTA, GEORGIA, JUNE, 1858. [No. 6.

ORIGINAL AND ECLECTIC.

ARTICLE XIV.

Observations on Malarial Fever. By Joseph Jones, A.M., M.D.,
Professor of Physics and Natural Theology in the University
of Georgia, Athens ; Professor of Chemistry and Pharmacy in
the Medical College of Georgia, Augusta ; formerly Professor
of Medical Chemistry in the Medical College of Savannah.

PRELIMINARY OBSERVATIONS.

In the present state of Medical Science, the complete investigation
of all the effects and phenomena of 'disease, is impossible.

Imperfections in our instruments ; imperfections in our methods
of analysis and the complicated nature of the phenomena, render
physiological and pathological investigations difficult and uncer-
tain.

The truth of this assertion may be established by an examina-
tion of the relations of animated beings to exterior inorganic
bodies, to each other, and to the physical and chemical forces.

Organized animate bodies are composed of inorganic elements,
and are governed by all the laws and phenomena of inorganic
bodies, and are absolutely dependent, for their existence, upon
inorganic bodies. They have, however, a new set of phenome-
na, dependent upon the vital force; and in animals we have
another set of phenomena, dependent upon the existence of the
nervous system and intellectual faculties; and in man we have
another set of phenomena, dependent upon the combination of
the intellectual with moral faculties.

K. S. VOL. XIV. KO. VI. 16

364 Jones, on Malarial Fever. [June,

Inorganic bodies, with their properties, form the necessary
conditions for the existence of plants and animals, just as the
properties of cohesion nnd gravitation form the essential condi-
tions for the existence of the universe, in its present arrange-
ment.

The phenomena of living beings, plants and animals, are
therefore more complicated, and less general, than those of
inorganic inanimate bodies.

Without entering into an enumeration of all the distinctions,-
between inorganic bodies and animated beings,- it may be statedr
that inorganic bodies are homogeneous in structure, and would
remain forever at rest, and unchanged, physically and chemi-
cally, unless acted upon by extraneous forces ; whilst, on the
other band,, all vegetables from the simple cell, to the most highly
developed, and all animals from the simple cell animalcule, to
the complicated organism of man, have arisen from cells, and
are composed of cells, variously developed, and grouped so as
to form organs, and systems of organs, and apparatus, capable
of accomplishing definite results, when moved by the proper
chemical and physical forces.

The acts of development, nutrition, secretion, excretion and
propagation are peculiar to plants and animals, and are directed
by the vital force which is incorporated with, and presides overr
every molecule of living organized matter, directing all its
physical and chemical changes, so that amidst innumerable and
unceasing changes the individuality of every organ, apparatus
and animal is preserved. Physical and chemical forces exist
independently of the vital force. The vital force, on the con-
trary, cannot exist and manifest its peculiar effects, without
matter and the physical and chemical forces.

The germination and development of vegetables and animals1 and
the maintenance of their life actions, depend essentially upon the
correlation of the vital, chemical and physical forces.

The study of complicated, highly developed plants, and animals,
involves the consideration of their origin, development, structure,
and relations to exterior bodies involves the consideration of the
chemical and physical properties of the elements, and combination
of elements, entering into their constitution, and the relations of the
constituents of their bodies to the surrounding medium involves

1858.] JONES, on Malarial Fever. 365

the consideration of the relations of the vital, chemical and physical
forces and intellectual and moral faculties involves the considera-
tion of die relations of animated bodies to the forces of the sun.

These phenomena may be studied with a greater degree of
precision in the lowest orders of plants and animals, whose
structures are simple.

As we rise in the scale of vegetable and animal existence the phe-
nomena of life become more complex and less general, and the
conditions of existence become more complicated and restricted. The
truth of this proposition is illustrated in a forcible manner, by
the relation of vegetable and animal existence, to the distribu-
tion of the forces of the sun upon the surface of our globe.

Thus, as a general rule, after the inorganic elements and
moisture have been supplied, the luxuriance and perfection of
plants depend upon the intensity of the forces of the sun. The
more complicated and perfect the vegetable structures, the closer is
their dependence upon the proper supply and balance of the physical
forces. The converse of this proposition is also true.

The truth of this proposition is established by a reference to
the distribution of plants upon the surface of our globe, and upon
mountains which rise to a great height in tropical countries.

Whilst, in equinoctial and tropical countries, where a suffi-
cient supply of moisture combines with the influence of heat and
light, vegetation appears in all its magnitude and glory ; on the
other hand, in polar regions and upon the summits of lofty
mountains, all the more complicated forms of vegetable existence
disappear, and lichens and microscopic plants take the place of
the majestic forests and impenetrable jungle.

In the tropics, the lowest orders of plants are comparatively
rare, whilst in the polar regions and upon the summits of moun-
tains they form almost the entire vegetation. The plants which
first form upon barren rocks and lava streams, and coral islands,
are those of the most simple organization. The simply organ-
ized lichens covering the bald-granite rocks are familiar to every
resident of a primitive region.

Along the sides of Etna, Ischia, Vesuvius, and other volca-
noes, lava streams are seen stretching in all directions, which have
flowed down like rivers. These lava streams are of different
agea, and many of them were formed within the memory of

366 Jones, on Malarial Fever. [June,

man. An investigation of these lava streams affords an oppor-
tunity of determining the gradual distribution of vegetables.
Some are still naked others have only a few plants, scattered
here and there, in hollows and crevices, and in others the de-
caying plants are forming a soil.

According to the observations of Professor J. F. Schouw,^)
the plants which first settle upon the naked lava, and form a
soil for the more complex, are especially those lower and simply
organized plants called lichens. Certain succulent and fleshy
plants, as the Indian fig (Opuntia vulgaris), which are nourished
chiefly by the carbonic acid and aqueous vapor of the air ab-
sorbed by the stem and leaves, are also amongst the earliest
inhabitants of the lava streams. Geology also teaches that the
lower orders of plants appeared first upon our globe.

As the luxuriance and perfection of plants depend upon the tem-
perature of the surrounding medium and the intensity of the forces
of the sun, so also the perfection of the nervous system ; and of all the
organs and apparatus, and the activity and intelligence of animals,
correspond, in a great measure, to the rapidity of the physical and
chemical changes going on in the molecules of their bodies, and to the
relations of the physical and chemical and vital forces, and to the
temperature which they are able to maintain, regardless of that of the
surrounding medium.

As the chemical changes become feeble, and the temperature of
animals descends and becomes dependent upon, that of the surround-
ing medium, they become more simple in their organization and mode
of life, the conditions of their existence become less restricted, and they
resemble closely the simple forms of vegetables, and in the twilight of
existence, zve can scarcely distinguish between the lowest forms of
plants and animals.

If we examine the relations of the physical and chemical
agents to the animal kingdom, we will find that the most sim-
ply constructed animals, many of which are devoid of a nervous
system and special organs of sense, as the infusoria, are, as in the
case of the simply organized plants, the most widely distributed
over the face of our globe, and are at the same time far less
dependent for their existence upon the temperature of the sur-
rounding medium.

(1) Schouw's Earth Plants and Man. Bohn's Scientific Library.

1858.] Jones, on Malarial Fever. 367

Infusoria occur in immense numbers in every situation : in
stagnant pools, in marshes, in mud of rivers, in peat earth,
twenty feet below the surface ; in the structures and fluids of
living animals and vegetables, in putrifying organic matter, in
the bed and waters of the ocean, in snow, in ice, and in boiling
springs. Sir John Eoss, in the year 1840, picked up some
brash ice, of a brown yellow color, in the Arctic regions, not
far from Mount Erebus, which was supposed to contain allu-
minous matter, ejected in fine ashes from the volcano. Speci-
mens were brought home in sealed glass vessels, and forwarded
to M. Ehrenberg. This microscopist found the coloring matter
to consist of myriads of infusoria, almost the whole of which
reachad Berlin in 1844, in a living state.

Here we see that these microscopical animals, after having
been frozen and thawed out, lived without food for four years.

Certain species of these animalcules have been found living
and propagating in boiling springs, and some of them have been
observed to recover, after drying in vacuo along with chloride
of calcium and sulphuric acid for twenty -eight days, and after
exposure to a heat of 248. (2)

The infusorial animals were created at an early geologic
period, and a large number of the fossil species which compose
the Polirschiefer and semi-opal of Bilin, are found at the pre-
sent time living and propagating in the seas and oceans. The
infusoria form a chain connecting (he organic life of distant ages of
the earth, and demonstrating, conclusively that the distribution of
animals, and the power to survive physical changes, depends upon
their development.

The simpler the structures, the feebler the vital, nervous and
physical forces, the less complicated the conditions of existence.

The gelatinous medusas (Gelly fishes) occur in such vast num-
bers in the cold Greenland sea, that they impart an olive-green
color to the sea, rendering the water dark and opaque in com-
parison with the ordinary cerulean hue.

(2) See experiments of Doyere, in Mem sur les Tardigrades, et sur leur propriete
derevenir a'la vie, 1842, pp. 119, 129, 131, 133. Also, Ehrenberg's Die lufuSions-
thierchen, als vollkomme Organismem, 1838.

(3) See Remarks on the real occurrence of Fossil Infusoria, and their extensive
diffusion, by Prof. Ehrenberg, J. C. Poggendorffs Annalen der Physik and Chimie,
vol. xxxviii., No. 5. Taylor's Scientific Memoirs, vol. 1, 1837, pp. 400 to 413 ;
also, vol. 3, 1843, pp. 219-376.

868 Jones, on Malarial Fever. [June,

The space- allotted to this article will not allow us to enter
more fully into the consideration of the distribution and relation
to the physical forces, of the other members of the invertebrate
kingdom.

These facts are sufficient to illustrate for this class of animals,
this law, which has an immediate bearing upon our investiga-
tions.

Cold-blooded vertebrate animals, although more highly or-
ganised than invertebrate animals, still show remarkable pow-
ers of enduring extremes of heat and cold, without death. Fish
may be frozen and again thawed out without a destruction of
life. The rapidity with ivhich the absence of heat is attended with
loss of sensibility and death, is directly proportional to the develop-
ment and perfection of vertebrate animals.

The relations, between the physical, chemical and vital forces,
are strikingly exhibited in certain cold and warm-blooded ver-
tebrated animals, which become torpid or hybernate during
the winter season. In this state, all the chemical and physical
actions are of the most sluggish character. The heart scarcely
beats, the frequency and force of the action of the heart, and
flow of the circulation, is greatly diminished, if not entirely
stopped. The amount of carbonic acid thrown off from the lungs
is greatly diminished, and all the chemical and physical changes
of the elements of the tissues, and fluids and organs of these an-
imals, are retarded.

If the temperature of a warm-blooded animal be reduced in
like manner, all its physical, chemical, and vital actions will be
depressed, and the active animal will be reduced to the condi-
tion of a sluggish cold-blooded animal, and death will rapidly
ensue. There is, however, this great difference between the
cold and warm-blooded animal the conditions of the existence of
the latter are far more restricted than those of the former.

The chemical changes of the cold-blooded animal are slow,
and it can exist without food for weeks and months, whilst a
few days starvation is fatal to the warm-blooded animal.

These facts demonstrate conclusively that the conditions and phe-
nomena of life are complicated and restricted, in exact accordance
with the development and perfection of the organs and tissues of an-
imals, and the rapidity of the chemical and physical changes of the
molecules of their bodies,

1858.] Jones, on Malarial Fever. 369

To understand the bearing, complication and imperfections of pa-
thological investigations, ice must take a general view of the most
important phenomena and relations of man. Those who would at-
tempt to investigate pathological and physiological phenomena, must
first form clear concepAions of the phenomena to he investigated, and
the perfection of the methods and instruments capable of being em-
ployed in these investigations.

Man is composed of inorganic elements, prepared and grouped
into definite compounds in the vegetable kingdom, by the com-
bined actions of the vital force, and the physical and chemical
forces of the sun.

Man is governed by all the laws and phenomena of inorganic
bodies, and is absolutely dependent for his existence upon the
existence and mutual relations of inorganic bodies.

As all the motions, in the various forms of inorganic matter upon
the surface of our globe, are excited by the forces of the sun, in like
manner, all the forces of man, are dependent through vegetables, upon
the forces of the sun. As there can be no creation of force in inor-
ganic matter, independent of the Deity, so man, although an active
being, cannot create any force, however feeble, any more than he can
create or annihilate a particle of matter. His forces are the result-
ants of the chemical changes of those substances, which, in the veget-
able kingdom, have been elevated into a state of force by the action of
the sun.

The mechanical power which man, or any animal, is able to
exercise, is exactly proportional to the amount of food consum-
ed, assimilated and chemically altered in the production of the
nervous and muscular forces. The power of a well-constructed
steam-engine, is exactly proportional to the amount of fuel con-
sumed, or, in other words, is exactly proportional to the amount
of chemical action. The amount of chemical action is exactly pro-
portional to the amount of force derived from the sun, and expended
in grouping the molecules of matter, in such a manner, as to be capa-
ble of chemical change and development of physical force. The
power of falling water which turns the water-wheel, and accom-
plishes various mechanical operations, is the resultant of the
combined actions of gravity, and the heat of the sun. The laws
of physics apply as well to the human machine in action, as to the
changes in Oie exterior universe.

370 Jones, on Malarial Fever. [June,

Man is the most perfect engine that has ever been constructed
for the same amount of chemical combinations and decomposi-
tions, he produces a much greater amount of work than the
most perfect engine.

Man has other phenomena besides the physical and chemical.
He is a machine and something more. The generation, devel-
opment, constitution, and structure of man is similar to that of
all vegetables and animals.

Man, in common with vegetables and animals, is endowed
with vital force, and like them is dependent for his existence
and action upon exterior bodies, and the physical and chemical
forces.

Man, in common with all animals, and in contra-distinction
to vegetables, possesses a nervous system, endowed with special
sensibilities.

The nervous system is the apparatus which relates man and
animals to the exterior world, and also relates the various or-
gans and apparatus to each other, in such a manner, that amidst
an innumerable number of complex actions, unity and harmony
result.

Man possesses not only a vital force, an organism composed of inor-
ganic elements, perfect in its mechanical structure, and material arrange-
ments of its parts, and a nervous system endowed with special sensibili-
ties ; but he also possesses an intelligence endowed with special faculties,
capable of receiving impressions from the motions of exterior bodies, and
of exciting the forces by which it is surrounded, and a moral nature
which relates him in a peculiar manner to the universe.

The possession of moral and intellectual faculties combined,
distinguishes man from every other form of matter, and every
other being upon our globe.

The immaterial, intellectual, moral soul of man has no direct
communication with the exterior world. The mind receives
impressions, transmits its volitions, and excites the mechanical
structures of the engine by which it is environed, through the
nervous system which is endowed with special sensibility. The
impressions of exterior bodies, upon the nervous system, is always
attended by a change of the structure of the nervous system.

All the organs of sense are excited by changes of matter.
The excitement of the nervous system and transmission of the

1858.] Jones, on Malarial Fever. 371

impressions are attended by a change of matter. Every act of
the mind which excites the nervous sytem, is attended by a
change of the chemical elements of the nervous system. Every
action excited in the mechanical apparatus by the nervous system
is commenced and sustained by a physical and chemical change
of the elements of the muscular system, and nutritive fluids.
The intellectual and moral faculties of man work only through and by the
physical and chemical forces ; they are distinct from matter, they excite
matter to action, they direct and control the actions of matter.

By his intellectual moral nature, man overcomes all the barriers and
obstacles of nature, not by a suspension or alteration of her immutable
laws, but by peculiar applications of those forces and laws.

The material portion of man is composed of the same elements as the ex-
terior world. It is governed by all the astronomical and chemical and phys-
ical laws of inorganic bodies, and comprehends within itself all organic
nature. The size of his organs, the strength of his muscles and
bones, and the vigor of his forces, have all been constructed
with exact reference to the force of gravity, the size of our
globe, and its relations with the sun, and all other worlds in the
universe. Man revolves with the earth and planets around the
sun, and the whole system moves forward in space at the annu-
al rate of one hundred and fifty millions of miles, around a dis-
tant unknown centre. Like plants and animals, his existence
is dependent upon the length of the day, and of the year, which
are dependent upon the adjustments of the solar system. His
existence, through plants, is absolutely dependent upon the
intensity of the forces of the sun. If the distance from the
earth to the sun be increased or diminished, the structure of
many inorganic bodies w^ould be changed, the conditions of. ex-
istence would be correspondingly altered, and all vegetable and
animal life would be destroyed.

The molecules composing the structures of man, like the im-
mense masses of matter which are scattered through space, are
in a state of unceasing activity. As each star has its own ap-
propriate motions, its own peculiar offices to perform, so each
molecule of matter, each organ and tissue in the body of man,
has its own peculiar motion, its appropriate office to perform.

A$ the universe is governed by a Being, infinite in wisdom
and in power, who constructed, controls and directs matter and

372 Jones, on Malarial Fever. [June,

all its chemical and physical actions, so the material part of man,
this little world, is governed by an intelligence distinct from
matter, which works by and through matter, and moulds exte-
rior material nature, after the ideal creations of its own interior
immaterial nature. Man then is a type of the universe. It is evident,
therefore, that to understand the phenomena of man in health and disease,
and his relations to the universe, we must comprehend the phenomena and
mutual relations of all animate and inanimate bodies, terrestrial and
celestial

If the phenomena of man in health be thus complicated, how
much more complicated must they be in disease, where the com-
plex constitution of his solids and fluids may be altered in many
ways, and the relations between the vital, chemical and physical
forces deranged.

Any one of the normal constituents of his body may be deranged,
and occupy different relations to each one of the other constituents.
As these constituents are numerous, the resulting derangements
may be correspondingly numerous. The forms of this class of
diseases may be as numerous as the different positions which the
elements may be made to assume towards each other.

Any one of the elements of his body may be in excess or deficiency, and
the diseases may be as numerous as the elements themselves, and at the
same time totally different from the diseases arising from an alteration in
the relative positions of the elements.

Foreign morbific agents may be introduced into the fluids and solids,
which will excite abnormal changes in the elements of the solids and fluids.
The number of diseases of this class will correspond to the num-
ber of distinct morbific agents. Combinations of these morbific agents
may produce still more numerous and complicated diseases.

The Creator has associated the vital force with a definite constitution of
matter. Whatever interferes with this constitution, interferes with the
action of the vital force. Whatever interferes with the vital force, neces-
sarily disturbs its relations with the physical and chemical forces. If
the balance of the forces, their correlation be disturbed, the chemical ac-
tions between the elements may not only be deranged in kind, but also in
degree, and the generation of the physical forces which work the machine-
ry, and the manifestation of the intellectual and moral phenomena will
be correspondingly altered.

One or two, or all of these causes of disease may act atpnce,
or successively, and thus render the results still more complex.

1858.] JoXES, on Malarial Fever. 373

The relative intensity of the effects of disease will depend upon the
perfection of the constitution and relations of the organs, tissues and ap-
paratus, and upon the power and correlation of the vital, chemical and
physical forces. As no two human countenances are exactly
alike, as no two temperaments are exactly alike, as the chemical
actions and forces of different individuals vary, so also will the
effects of disease vary.

The nervous system is the last and most perfect work of the
vital force, and thus the index of the power of the vital force.

The nervous system not only forms the medium of communi-
cation between the intellectual faculties and the exterior world,
but it also forms the medium of communication between the
organs and apparatus, solids and fluids of the economy. That
the nervous force is nothing more than a higher development of
the vital force, is evident, from the fact that plants, and the sim-
ply constructed animals, which are devoid of a nervous system,
are capable of carrying on the offices of generation, develop-
ment, digestion, assimilation, nutrition, secretion, excretion, and
preserving a definite form amidst unceasing changes. Many of
the simply organised animals, although without a nervous sys-
tem, still possess sensation and voluntary motion. The nervous
system appears only when the parts of the machinery are com-
plicated, and need a special means of communication.

The development and perfection of the nervous system cor-
responds exactly to the development, perfection and complica-
tion of the organs and apparatus.

This fact is true of the animal kingdom in its successive
degrees of development, and also of the successive stages of the
development of the solids and fluids of each individual highly
organized animal. Physical and chemical actions take place in
a similar manner in all animals, simple or complex ; they differ
only in intensity. The higher the animal, the more complicated
its parts, the more rapid the chemical changes and consequent
generation of the forces, and the greater is the necessity for some
special apparatus endowed with a high vitality, which will bring
all these complex organs and actions into relation. Unless the
actions of different organs can be telegraphed (so to speak) to
each other, confusion in a complicated organism will necessarily
result. Thus, if the amount of blood circulating through any

374 Jones, on Malarial Fever. [June,

organ, and the chemical actions, are too great, how can they be
regulated without some medium of communication with the
other parts of the system, and some means of regulating the
chemical and physical actions ? To the nervous system is dele-
gated this property of regulating the actions of the organs and
apparatus, and thus regulating the amount of oxygen and blood
supplied to the organs and tissues and apparatus.

The blood supplying the nutritive elements of the tissues
and organs, and the materials for the secretions and develop-
ment of the forces, and oxygen being the active agent in all
the chemical actions of the bodies, it is evident that whatever
disturbs the constitution of the nervous system, necessarily
disturbs the functions of the apparatus and organs and pro-
duces corresponding alterations in their secretions and excre-
tions. As the integrity of the nervous system depends upon
the integrity of the blood, in like manner, whatever alters
the constitution of that fluid, will produce aberrated action in
the nervous system, and in turn, this disturbance may extend
itself indefinitely.

Disease then, whether arising in the organs, or in the blood, or origin-
ally in the nervous system, will always be attended by aberrated nervous
action. The most prominent symptoms of disease therefore will be con-
nected with the nervous system. In all our investigations into the
causes and effects of disease, we should always remember, that the origin
of the disease may be connected with derangements in the constituents of
the blood and all the organs, independent altogether of the nervous system.
Thus in malarial fever, the poison, whatever it be, is rapidly
destructive of the colored blood corpuscles, and destroys the
ferment in the blood, which converts the animal starch into
grape sugar, it also produces profound alterations in the struc-
ture of the spleen and the blood which it contains. Now,
these effects, in the beginning, may take place entirely indepen-
dent of any alteration in the nervous system.

The nervous system will be secondarily affected, and its ac-
tion seriously disturbed, and this disturbance will give rise to
a distinct set of phenomena, but it is evident that the cause and
origin of the disease lies back of this disturbance.

In the investigation of the origin, causes, effects and treatment of
disease, the constitution of all the fluids and solids of all the organs and

1858.] Jones, on Malarial Fever. 375

tissues, of the blood, secretions and excretions, should be carefully as-
certained and compared with the standard of health. All the chemical
and physical changes, and the relations of the vital and physical forces,
should be ascertained.

The temperature, the amount of chemical change, the alterations in
every organ and tissue should be determined How can these
things be accomplished when physiologists and pathologists
are not acquainted with many chemical changes going on in
the body : when they dispute about the origin and offices of
some of the most important constituents ; and know little about
the origin and offices of the extractive matters of the blood and
urine: when they are ignorant of the offices of the spleen,
supra-renal capsules, tlrymus and thyroid glands : when they
cannot even explain the mode of origin, propagation and death
of the solitary gland cells of the blood, which elaborate the
materials for the nervous and muscular systems : when they
possess no absolutely accurate method of analyzing the blood,
or of determining the amount of the products thrown off from
the lungs and skin ? It is important that we should know and
acknowledge our ignorance and weakness.

At the very outstep, I acknowledge that these physiological
and pathological investigations, which I hope to present from time
to time, are imperfect in many respects. They could not be
otherwise in the present state of science, and especially when
I had to act as physician and surgeon to one hundred patients,
and at the same time, conduct the investigations.

I have determined to present them in their imperfect con-
dition, because they were instiuted with a desire to discover
the truth, and with the hope that I might acquire during their
prosecution, sufficient knowledge to point out to the young mem-
bers of the profession, the difficulties and methods of conducting
such investigations ; and because they were conducted at a sacri-
fice of much time, money, and health.

" Art is long and time is fleeting,

And our heaits though stout and brave,

Still like muffled drums are beating
Funeral marches to the grave."

/ think and hope that they will at least demonstrate the impossibility of
the successful investigation, of all the phenomena of disease, by a single
individual, and lead to unity and concert of action amongst investigators.

376 Jones, on Malarial Fever. [June,

In pathological investigations, we need in this country, above all things,
an organised corps, who would make a division of labor. We should
have a separate investigator for the careful examination of each
one of the following subjects :

The analysis of the urine (1); blood (2); determination of animal
temperature (3) ; functions of skin and lungs (4); record of symptoms
and treatment (5) ; meteorologic, geologic* and topographical investiga-
tions, and record of mortuary statistics (6) ; examinations chemically and
microscopically of the structure and alterations in the nervous system
after death (7) ; and of the liver and bile (8) ; of the alimentary canal
with its secretions and excretions (9); and of the kidneys and the other
organs (10). _

If a corps of intelligent, generous-minded observers would act
with zeal and unity, the results' for medicine would be of the
most momentous character. It would, in time, rank amongst
the exact sciences, and the physician would become a true pro-
phet ; and instead of the frequent disagreement between theory
and practice, and between rival schools, we would have harmo-
ny; instead of distrust in the public, and even in the minds of
physicians, themselves, we would have confidence.

These investigations were conducted in the Savannah Marine
Hospital and Poor-house, and two hundred and fifty patients
suffering with the different forms of malarial fever, came under
my observation.

I would here acknowledge my obligations to my friend and
former colleague, Dr. Eichard D. Arnold, Professor of the The-
ory and Practice of Medicine in the Savannah Medical College,
for his kindness in resigning into my hands, the charge of the
Savannah Marine Hospital and Poor-house.

I would also, return my thanks to Theodore McFarland, M.
D., and Mr. Eobert Myers, student of medicine, in the Savan-
nah Medical College, for valuable assistance during post-mor-
tem examinations.

The medical topography of Savannah will be considered more
fully hereafter. The following brief statement will give a gen-
eral idea of the medical topography.

Savannah is situated on the Savannah river, eighteen miles
from its mouth, upon a sandy plain, elevated forty-two feet
above half tide. On the north, this plain is terminated abruptly
by the Savannah river, a turbid stream, pursuing its sluggish

1868.] Jones, on Malarial Fever. 577

course through the low-grounds and rice-fields of South Carol i-
na and Georgia. On the east and west, the city is flanked by
extensive tide-swamps, formerly under wet culture, at the pre-
sent time under dry culture. The sandy plain extends for sev-
eral miles beyond the city. Savannah, therefore, is surrounded
on all sides, except the south, by malarious districts.

Section I. Intermittent Fever.

Case I. Seaman, entered Savannah Marine Hospital Sep-
tember 29th, 1857; native of New York; age 22; height 5 feet
4 inches; weight 140 lbs. ; black hair, and florid complexion;
handsome, intelligent countenance; sanguine nervous tempera-
ment. Has never been sick before. Has been in Savannah
two weeks, and this is his first visit. Slept on board the ship
the first week, and the last week slept at the "Sailor's Home,""
on the bay. Says that he was taken sick four days ago, with
chill, vomiting, and pains in all his bones, and has had a chill
every day since., commencing regularly at 12 o'clock M. Had a
chill this day, commencing a few minutes after 12 o'clock M.
Says that he took three blue pills and castor oil, night before
last. This medicine operated twice.

7 o'clock P. M., Sept, 29th. Has fever, and complains of pains
in his joints. Slight tenderness upon pressure of epigastrium ;
tongue clean, moist, red at tip and edges; papillae enlarged and
of a bright red color. Eeaction of saliva decidedly acid.

Pulse 120. Respiration 32, full, thoracic.

Temperature of Atmosphere, 79F.

11 Hand, 10333'

11 under Tongue, 106

$. Calomel, grs. xij.; sulphate of quinia, grs. vij. Mix, and
administer immediately, and follow with castor oil in four hours.
As soon as fever remits, give sulphate of quinia, grs. v., every
three hours, up to grs. xxv. During fever, give soda powders
(pulveres effervescents tartarizati). Diet, gruel and flaxseed tea.

Sept. 30th, 1 o'clock P. M. Medicine operated freely, and
says that he is much better, but complains of weakness. Tongue
presents the same appearance; skin cool and relaxed; face not
so much flushed.

Pulse 70, regulafr. Respiration 22, regular and gentle.

Temperature of Atmosphere , 68F.

" Hand, 92

" under Tongue, 99 5'

Amount of urine passed the last 18 hours, grains 23,220.

Amount of urine excreted each hour, grains 1,290.

Calculated amount of urine for 24 hours, grains 30,952.

Reaction of urine decidedly acid.

378 Jones, on Malarial Fever. [June,

This is characteristic of the urine df fever ; the acidity is in pro-
portion to the severity of the attack. The acidity is more intense in
remittent than in intermittent fever, and still more intense in conges-
tive fever, than in intermittent and remittent fever.

Color of urine, light orange. Urine passed last evening and
night up to 11 P. M., specific gravity 1011, color a shade higher
than that passed this morning. Specific gravity of urine passed
from 11 o'clock P. M., last night, up to 1 o'clock P. M., this dav,
1008.

Uric acid in whole amount of urine passed in 18 hour, (grs. 23,220). grs. 1-0035
" " calculated " " " " " 24 " (grs. 30,952). " 1-3376

Uric acid in 1000 parts of the night urine, (sp. gr. 1,011) 0-0494
" " " " " " morning " (sp. gr. 1,008) 0*0396

Up to this time, 1 o'clock P. M., has taken 20 grains of sulph-
ate of quinia, and the action of this medicine may be connected
with the marked diminution of the uric acid.

The urine was set aside and examined under the microscope
after successive intervals. After standing 48 hours, there was a
small light yellow deposit, which, under the microscope, was
found to consist of small vegetable cells of several shapes glo-
bular, elliptical, and acicular. When viewed under a low mag-
nifying power, these cells resembled a collection of globular and
acicular cystals of the urates of ammonia.

A careful examination under the microscope, with the appro-
priate chemical re-agents, demonstrated that they contained no
uric acid or inorganic salts, but were of vegetable origin. The
size of the cells were many times less than those of the torula
cerevisiae.

5 o'clock P. M. Half an hour ago was taken with chill and
vomiting. Now the chill appears to be subsiding, the shaking
and contraction of the muscles is diminishing. Extremities cool,
whilst the head and trunk are hot and pungent to the hand.

Pulse 108. Kespiration 30, labored, thoracic.

Temperature of Atmosphere, 74 F.

11 Hand, 91

" under Tongue, 1055'

Instead of a reduction of temperature in the trunk and head dur-
ing chill, there is a decided elevation. The sense of cold arises from
a want of circulation in the capillaries of the extremities.

The patient had taken 20 grains of the sulphate of quinia be-
fore the chill came on. This did not arrest, but delayed the chill
for several hours.

3. Spirits of Mindererus f I iss. in sweetened water.

8i o'clock P. M. Says that he is more comfortable.

Pulse 108. Eespiration 32, not so thoracic and labored as
during the chill, but still thoracic and labored.

1858.] Joxes; on Malarial Fever. 379

Temperature of Atmosphere, 73F.

" Hand, 103.5

11 under Tongue, 105

Slight tenderness upon pressure of epigastrium. Eeaction of
saliva decidedly acid. Tongue red at tip and edges; papillae
enlarged and red.

Amount of urine passed from 1 P.M., (8 hours), grs. 5,100.
Calculated amount for 2-i hours, grs. 15,300.
Amount of uric acid in 5,100 grs. of urine, grs. 2.
" ii ii a u 15^00 " 6.

Uric acid in 1000 parts of urine, 0-3921.

Specific gravity of this specimen of urine excreted during the
chill, 1020. Color normal. Reaction decidedly acid.

The uric acid has increased in amount during the chill and
commencement of the fever : when compared with the former
specimens of urine, it is, however, still below the standard of
health. If the diminution of the amount of uric acid be due to
the action of the sulphate of quinia, it shows that this action of
this remedy pointed out by Ranke, 3 is not necessarily attended
with a disappearance of the chill.

Amount of urine excreted hourly during last 24 hours, grains
1,180.

Amount of urine passed in the last 24 hours, ending Sept.
30th, 8 o'clock P. M.. grs. 28,320.

Amount of uric acid in grs. 28,320 of urine, grs. 3.0035.

$. As soon as fever remits, give sulphate of quinia, grs. v.,
every three hours, up to grs. xx. Diet, gruel.

October 1st, 11 o'clock A. M. Says that he is better, and has
no pain, except a slight headache, and was in a perspiration all
night. Fever intermitted at 12 P. M.

Skin cool. Pulse 76. Respiration 23.

Temperature of Atmosphere, 70 F.

" i " Hand, 95

" under Tongue, 985'

Has taken 15 grs. of sulphate of quinia since the intermission
of the fever.

$ . Continue sulphate of quinia up to grains xxv.

Diet, mutton soup, gruel and tea.

Reaction of saliva slightly acid. Reaction of urine decidedly
acid. Urine clear, no deposit, and a shade higher colored than
normal.

Specific gravity of the urine passed during the first half of the
night, 1010.

Specific gravity of the urine passed subsequent to 12 M., last
night, 1012.

- . . i*

(3) Medical Times and Gazette, May 30, 1857, p. 54a
n.b. vol. xrv. no. vi. 17

380 Jones, on Malarial Fever. [June,

Amount of urine passed during the last 15 hours, grs. 19,209.

Calculated amount of urine for 24 hours, grs. 30,734.

Amount of urine excreted each hour, grs. 1280.

October 2nd, 11 o'clock, A.M. Says that he feels badly ; had
no chill yesterday evening, but the fever came on at 7 o'clock,
P. M. Suffered with headache, and was restless, without sleep
during the night. Skin soft and moist ; slight tenderness upon
pressure of epigastrium; tongue redder and dryer than yester-
day, but still soft and moist ; reaction of saliva, acid ; face flushed.

Pulse 84. Respiration 32.

Temperature of Atmosphere, 74 R

" Hand, 100. 5'

" under Tongue, 102

The fever is subsiding. Urine of a deep orange color : higher
colored than yesterday ; turbid, with slight deposit. Reaction,
alkaline, after standing 20 hours; it was acid when first voided.
The deposit is due to the precipitation of the alkaline and
earthy phosphates, in combination with the ammonia, generated
during the decomposition of the urea.

As far as my experience extends, the rapid change from the acid to al-
kaline reaction of the urine is, in malarial fever, a sign of convalescence.

Every specimen of urine excreted during the active stages of malarial
fever, which I havd examined, gave a decided acid reaction, and the in-
tensity of this reaction corresponded to the intensity of the disease. As
the disease declined, the reaction of the urine oecame less acid, and the
tendency to fermentation, and the development of an alkaline reaction
increased.

Amount of urine passed during the last 24 hours, grs. 15,810.
" of uric acid in 15,810 grs. of urine, grs. 9.300.

Specific gravity, 1020.

Uric acid in 1000 parts of urine, 0.588.

Amount of urine excreted hourly, grs. 658.

Has not had a movement of his bowels since the operation of
the calomel.

^ Calomel grs. vi; sulphate of quinia grs. vi; castor oil in
four hours. After the action of the calomel, commence with
sulphate of quinia, grs. v, every three hours up to grs. xv.

October 3rd, 11 o'clock, A.M. Says that he feels much better,
and has " no pain, except a slight soreness in his bones." Tongue
clean, moist, and only a shade redder than normal. Papillae
still enlarged, red and distinct. Reaction of saliva, acid. No
pain upon pressure of epigastrium. The fever intermitted yes-
terday afternoon, and he has had no return.

Pulse 62. Respiration 20.

Temperature of Atmosphere, 74 F.

" Hand, 96

" under Tongue, 985'

1858.] JOXES, on Malarial Fever. 381

Color of -urine a shade lighter than normal, and in 22 hours
after it was voided, let fall a copious light yellow deposit of tri-
ple phosphate and urate of soda. 20 hours after it was voided,
its reaction was decidedly alkaline. It was acid when first
voided, but much less acid than during fever. The urea has
also undergone decomposition much more rapidly, because it
has become decidedly alkaline in the same time in which the fe-
brile urine remained decidedly acid. When first passed, the
urine was clear, devoid of sediment. The deposit in the urine
which had stood over night, was due in a great measure to the
precipitation of the phosphates, by their union with the ammo-
nia generated during the decomposition of the urea.

Amount of urine passed during the last 24 hours, grs. 18,180.
Specific gravity 1010.

Amount of urine excreted hourly, grs. 757*5.

Uric acid in grs. 18,180, of urine, grs. 8*100. Uric acid in
1000 parts of urine, 0"445.

$. Officinal infusion of Virginia snake-root, fixviii. ; sulph.
of quinia, grs. xv. Mix. Tablespoonful every three hours.
Diet, mutton soup and boiled rice.

October 4th, 11 o'clock A. M. Much better. Has had no
return of chill and fever. Tongue clean and papillae not so dis-
tinct and red. Bowels opened twice.

Pulse 60. Respiration 20.

Temperature of Atmosphere, 725'F.

" Hand, 96

" under Tongue, 995'

Reaction of urine after 18 hours strongly alkaline. It emits
ammonia. "When a rod dipped in hydrochloric acid is held over
the urine, it emits heavy fumes of hydrochlorate of ammonia.
Heavy light yellow deposit.

Amount of urine passed during the last 24 hours, grs. 20,520.
" " " " hourly, grs. 855.

Specific gravity, 1018.

R. Officinal infusion of quassia and soda. Continue snake-
root tea.

October 5th, 11 o'clock A. M. Has had no return of fever,
and complains of nothing except weakness. Tongue clean,
moist and soft; papillae still redder and more enlarged than
normal ; skin soft and cool ; reaction of saliva acid.

Pulse 62. Respiration 21.

Temperature of Atmosphere, 70DF.

" Hand, 96

" under Tongue, 9933'

Urine normal in color. Specific gravity 1015. Amount of
urine excreted hourly, grs. 1268.

3S2 Joxes, on Malarial Fiver. [June,

Amount of urine passed in last 24 hours, grs. 30,450.
" " Uric acid in grs. 30,450 of urine, grs. 15,000.

Uric acid in 1000 parts of urine, 0*492.

After standing 12 hours, alkaline reaction and a light yellow
deposit.

This patient continued to improve, and left the hospital on the
following day. He returned to the same locality on the bay,
and was exposed to the damp north-east winds blowing over
the river and low grounds of South Carolina.

He returned to the hospital October 18th, with an attack of
chill and fever, of the same type as the one we have just describ-
ed. The chill came on every day.

The annexed Table will present a condensed view of the phe-
nomena observed.

In this case there was a close relation between the state of the skin,
pulse, respiration and temperature of extremities and trunk.

A rapid full pulse, hurried thoracic respiration, and dry shin,
was attended with a corresponding elevation of temperature.

If the functions of the organs and apparatus be properly per-
formed, a full and rapid vigorous circulation and respiration
must be attended by the rapid absorption of oxygen, and exha-
lation of carbonic acid gas, and correspondingly rapid chemical
changes, and development of heat.

A slow pulse and respiration, and cool moist shin, was accompa-
nied with a lovj degree of heat.

During the cold stage (chill) there was a rapid feeble pulse, full
thoracic rapid respiration, and a hot trunk and cold extremities.

During the rapid thoracic respiration, oxygen is supplied in
abundance, and enters into the blood, which is confined during
the cold stage, almost entirely to the trunk and large organs.
The temperature of the trunk is correspondingly elevated. This
elevation of temperature does not extend to the extremities, be-
cause the circulation of the blood in the blood-vessels and capil-
laries is feeble. The surface of the extremities look bluish dur-
ing the cold stage, because the supply of oxygen being withheld
in great measure, the change from the venous to arterial hue
does not take place.

We hope to demonstrate hereafter, by numerous careful ob-
servations, that the determination of the relations of the circula-
tion, respiration, and temperature or chemical changes in mala-
rial fever, is of the greatest importance, in enabling the practi-
tioner of medicine to understand the nature and treatment of the
different forms of this disease, and predict with a great degree of
certainty its course and termination. Whenever, as in congestive
fever, there is a want of corresponaence between the circulation, respi-
ration and chemical changes, the patient is alvjays in danger. A
patient with a rapid feeble pulse, and rapid thoracic respiration and

1858.]

Joxes, on Malarial Fever.

383

Calculated amount of Uric
Acid excreted in 24 hrs.

Calculated amount of Urine
excreted in 24 Lours.

Uric Acid.

Specific Gravity.

o -<

<N .-I
O O

O oc o

o

Hours.

C-i

Urine excreted in

o 5
o o

1-1 (M

o o o

00 cn o

00 o o

i-i iM CO

Urine excreted hourly.

XT- IC 00
VQ U5 SO
X> 00 <N

Uric Acid excreted in 24
hours.

o o
o o
,-i . o

CO

<

Urine excreted in 24 hours, grains.

o cs
CM o

CO CO

oo

CM O

o

CM CO

Temperature under Tongue.

o o o o

OS iO 1O00
O O O OS

o >o CO
o o o

oo oo

Temperature of Hand.

c
o o o o

CN .-I C3 0

Cft o o>

o o

SO SO
OB C5

Temperature of Atmosphere. ,

o o o o
x :t C

W3

o o o

* <M O

Respiration

Pulse.

2 S'O

-5 a a s-s-s-i

If*

esi

c3 cJ

g g

O O

a

5 .-5
S--H >jt

* ' '~ bC ^
60 W>- 5.2 ^

ja 3 g^

= - 0 '>-= "3
f2\S*o boaa an "c

O

Hour of Day.

00 .-H i-i

Day of Month.

Month .

384 Jones, on Malarial Fever. [June,

low temperature {sluggish chemical- changes), is always in great
danger. A full rapid pulse, and rapid thoracic respiration, and
correspondingly high temperature, are always favorable symptoms,
provided there be no complication, as congestion of the brain. The
severity of malarial fever is by no means proportional to the height '
of the fever {animal temperature). Asa general rule, the higher the
fever {temperature), the more readily does the attach yield to treat-
ment, and the less serious the effects. High temperature signifies
active chemical changes, and an effort on the part of nature to break
up and consume the poison, and a power of resistance.

It is the want of a high temperature which is the most dangerous
symptom in malarial fever.

In this case, the amount of urine excreted corresponded with
its specific gravity, or degree of concentration. Considering the
situation and diet of the patient, the amount of urine did not
differ greatly from the standard of health.

The urine is affected by so many varied external and internal
conditions, that the amount excreted exhibits great fluctuations
even in health.

No two observers agree with reference to the amount excreted
in definite periods. Thus, Lecanu, from examinations of the
urine of 16 individuals, living upon mixed food, estimated that
the amount of urine discharged in 24 hours, ranged from 8085
grains to 84,973 grains.

Becquerel found that the mean daily quantity passed by four
men, was 19,511 grains, and that by four women, was 21,130
grains.

Lehmann, from experiments instituted upon himself, estimat-
ed the quantity discharged daily, at from 18,829 grains to 22,299
grains.

According to the valuable experiments of Dr. William A.
Hammond, instituted upon himself, the amount of urine excreted
under a mixed diet, ranged from 19,684 grains to 22,756 grains,
with a mean of 20,898 grains; under a diet of albumen, from
12,325 to 21,592, with a mean of 17,738 grains ; under a diet of
starch, from 14,339 to 23,352, with a mean of 18,427 grains ; and
under a diet of gum, from 20,516 to 23,721 grains, with a mean
of 21,538 grains.

The only accurate method of determining whether or not the
urine be increased or diminished, is, to refer it to the standard
of health, in the individual examined. In hospital practice this
is, in the majory of cases, impossible, and we are compelled to
be content with approximate results.

In this case, during fever and under the action of sulphate of
quinia, the uric acid teas greatly diminished, and on the other hand,
when the fever declined, and the action of the sulphate of quinia
ceased, the amount of uric acid increased beyond the normal standard.

1858.] Jones, on Malarial Fever. 385

From the microscopical and chemical examination of several
hundred specimens of urine excreted during the different forms
of malarial fever, I found it, as a general rule, to be true, that
in the mode of treatment which I adopted, the uric acid appears
in much larger quantities in the urine of convalescence, than in
that excreted during the fever, even when the sulphate of qui-
nia had been withheld, or sparingly administered The major-
ity of specimens of urine excreted during fever, which were set
aside and examined, under the microscope, at successive inter-
vals, gave no deposits of the crystals or salts of uric acid, whilst
specimens of the urine of convalescence very soon gave evidence
of the presence of uric acid, by letting fall deposits of urate of
soda and ammonia.

These facts explain the nature of the so-called critical discharges
of malarial fever. The urine excreted during fever is generally de-
ficient in uric acid and the earthy salts, whilst its acidity is increas-
ed, and it will remain for a great length of time ivithout undergoing
decomposition. flfe

The urine of convalescence, on tJte other hand, is rich in uric acid
and the earthy and alkaline salts, and readily undergoes decomposi-
tion. The deposit of the urates of soda and ammonia, and the pre-
cipitation of the triple phosphate, by the ammonia generated during
decomposition of the urea, form the so-called critical discharges.

As a general rule, the urine excreted during the hot stage of
intermittent fever, is poorer in uric acid than the urine of remit-
tent fever, and I have known cases in which, daring fever, the
uric acid disappeared almost entirely.

In several cases of congestive fever, the urine contained only
traces of uric acid, and in one case, which terminated fatally, the
disappearance of the uric acid was attended with the disappear-
ance of the urea.

Dr. Ranke (4) slates in Ms article vjpon the physiological action of
sulphate of quinia, that according to all observers, there is in ague an in-
crease of uric acid. My observations do not correspond with this asser-
tion, if it is intended to apply to the active stages of intermittent, remittent
and congestive fevers. The fact that uric acid increases during conva-
lescence from malarial fever, demonstrates conclusively that the diminu-
tion of the amount of uric acid by sulphate of quinia is an attending
circumstance, and not necessarily one of the beneficial, remedial modes of
the action of this medicine.

Case II. Englishman : entered the Savannah Marine Hos-
pital Oct 9th, 1857 ; age 27. Has been in America thirteen
years. Height 5 feet 10 inches ; weight 145 lbs. ; muscular sys-

(4) Medical Times and Gazette, May 30, 1858, p. 537.

386

Jones, on Malarial Fever.

[June,

J

tern well developed ; sanguine temperament. Occupation, stew-
ard on ship. Has been in Savannah three weeks.

Says that he was taken yesterday at 12 o'clock M., with cold
feelings and headache. The chilly feelings lasted four hours,
and were succeeded by fever, which continued until 4 o'clock
A. M. this morning. Two and a half hours after the subsidence
of the fever (8 J o'clock A. M.), he shook violently. This chill
was followed by fever.

Now, 8 o'clock P. M., fever is subsiding.

Pulse 98, full but soft.

Temperature of Atmosphere, 72F.

" " Hand, 1025'

" under Tongue, 103

Tongue moist ; skin in a profuse perspiration.

Says that he took, last evening, a dose of salts and cream of
tartar, which operated twice this morning.

3. When fever goes off, give sulphate of quinia, grs. v., every
three hours, up to grs. xx.

October 10th, 12 o'clock M. Vhere was a complete intermis-
sion of the fever about 2 o'clock A. M. this morning. At this
time the sulphate of quinia was commenced, and he has taken
grs. xv.

Amount of urine passed the last 16 hours, grs. 6,144.
" " " hourly, grs. 321-5

Calculated amount of urine for 24 hours, grs. 9,216.

analysis i.

In grs. 6,144 of
Urine (16 hrs.)

In grs. 9,216, cal-
culated for 24 hrs.

In 1000 parts of
urine,

Urea,

Uric Acid,

Fixed Saline Constituents,

226-980

0-600

40-200

340-470

0-900

60-100

36-943
0-097
6-542

Specific gravity of urine 1024 clear, no deposit, light red
color. Keaction decidedly acid.

Microscopical examination of urine.

After Standing 12 hours, no deposit.

" " 36 " a very slight, light yellow deposit.

After standing 60 hours, the surface was covered with a pel-
licle, which under a magnifying power, of 210 diameters, was
found to consist of small oval cells, about the size of the human
blood corpuscle. There were also other elongated elliptical cells,
the short diameters of which did not differ from those of the
globular cells. Many of the elongated cells had a vibratory
motion. The deposit at the bottom consisted of these globular
elliptical acicular cells, and a few crystals of triple phosphate.

That these cells were organized bodies, was demonstrated by

1858.] Jones, on Malarial Fever. 387

the action of chemical re-agents under the microscope. Not a
trace of uric acid was found in the pellicle and deposit. The
bottle containing the urine had been kept closely stopped.

12i o'clock, P.M. A chill is just coming on. The thermo-
meter, placed in his hand, indicated 91^ F. Simultaneously
with the increase of the chill, it commenced to descend, and in
15 minutes stood at 87j.

In 15 minutes his hand lost 4 F. He feels very cold, but
does not shake. The extremities feel cold, whilst the surface
of the head and trunk feel hot and pungent. When the bulb of
the thermometer was simply placed between the skin and flannel
shirt, and gently pressed against the surface of the chest, it
commenced to rise rapidly and in a few moments indicated
103 F. i

When placed in the arm-pit, it rose rapidly to 107 F.

Pulse 100 ; not so full as during fever, but small and threaded.

Eespiration 26, full thoracic.

Temperature of Atmosphere, 685' F.

11 Hand, 875;

in Axilla, 107

Tongue pointed, but moist, and not much redder than usual.
Skin dry, with a purplish mottled appearance, as if the circula-
tion in the capillaries was retarded. Says that he has " dull
pains wandering around his loins up to his chest." Complains of
great thirst. His stomach is so irritable that I could not ascer-
tain the temperature under his tongue. I made seven un-
successful attempts. At every trial the contact of the bulb of
the thermometer, with the base of the tongue, excited violent
retching and vomiting. I applied a sinapism over the region of
the spinal column, 18 inches in length, and 3 inches in breadth,
also, one over the epigastrium, and administered brandy and
snake-root tea, f 5ij. The brandy and snake-root tea were vo-
mited up in a few moments. In half an hour alter their appli-
cation, the mustards aroused the capillary circulation in the
extremities.

His surface does not present the mottled appearance ; the heat
has in a great measure returned to his extremities, the cold
sensations have disappeared, and "he feels warm all over."
The temperature of his hand is now 99. In half an hour, the
temperature of his extremities has risen 115'. The temperature
under the arm pit is still 107.

The temperature of the hand does not correspond fully with
that of the trunk, and reaction is not yet fully established.

Has just passed urine. Clear, limpid, of a light straw color.
Reaction acid. Specific gravity 1003. Amount of urine void-
ed, grains 7021.

388 Jones, on

Malarial Fever.

[June,

ANALYSIS II.

7021 grains of Urine
contained,

lOOC

parts of Urine
contained,

Urea,

Uric Acid,

Fixed Saline Constituents,

39-551
0-420
9-800

5-650
0-059
1-395

J

Nitrate of urea remarkably silky and white.

Microscopical Examination. The urine was poured into a
closely stopped bottle, and set aside for 60 hours. At the end
of this time the surface had a pellicle, and there was a small,
light yellow deposit.

The pellicle consisted entirely of the globular, elliptical and
vibrating cells, observed in the former specimen. The deposit
also consisted of these cells, and a few, beautifully formed, prys-
matic crystals of triple phosphate.

The fact, that the bottle was kept closely stopped, does not
prove that the germs of these cells originated in the urine, for
the bottle, in which the urine was first deposited, remained open
during the voiding of the bladder, and the germs of these vegeta-
ble bodies were, without doubt, then received from the atmos-
phere.

This specimen of urine is interesting, because it was passed at
the close of a chill, and was probably excreted by the kidneys,
during the existence of the cold stage. It was much lighter in
color than that passed during fever : in fact, it resembled the
urine of hysterical women, in its light color and low specific
gravity. The urea and uric acid were diminished, whilst the fixed sa-
line constituents were relatively increased.

If the diminution of the uric acid was due to the action of the 15 grains
of sulphate of quinia, which he took this morning, then the fact is demon-
strated that the diminution of the amount of uric acid oy the sulphate of
quinia, has nothing to do with the cure of intermittent fever.
v $. During fever, give soda powders. As soon as fever re-

mits, give sulphate of quinia, grs. v., every three hours, up to
grs. xxx. Do not wait for the complete intermission of the fever.
Diet, gruel and flaxseed tea.

7 o'clock P. M. The fever is abating, and his skin is in a
slight moisture. The circulation is fuller and more regular, and
the temperature more equally distributed.

Temperature of Atmosphere, 67F.

" Hand, 102

Amount of urine passed since 12| P. M., (6^ hours,) grs. 5,075 ;
high colored, resembling new madeira wine. Keaction decided-
ly acid.

Specific gravity 1015.

1858.]

Jones, on Malarial Fever.

389

Nitrate of urea white, silvery.

Amount of urine excreted hourly, during last 6} hours, grs.
780.

Calculated amount of urine for 24 hours, grs. 20,300.

Actual amount of urine excreted during the last 24 hours,
grs. 18,240.

Amount of urine excreted hourly during the last 24 hours,,
grs. 760.

ANALYSIS IIL

5075 grs. of Urine,
passed in 61-2 hrs.
contained grains.

Urea, . . .
Uric Acid, .
Fixed Saline
Constituents.

99-425
0-250

28-500

20,300 grs. calculated
amount of Urine for
24 hrs. contain'd grs.

397-700
1-000

114-000

1000 pts. of
Urine, con
tained grs.

18,240 grs of Urine,
passed during last
24 hrs. cont'd grs.

19-586
0-049

5-615

365-956
1-270

78-500

Microscopical examination of the last specimen of urine ex-
creted during the last 6} hours, up to 7 o'clock P. M.

After standing 60 hours a slight deposit fell, consisting of the
vegetable cells, previously described, and prismatic crystals of
triple phosphate.

Chemical reagents failed to give any evidence of the presence
of uric acid in this deposit. His fever still continues. This
specimen of urine therefore was excreted during fever. The
patient has taken no sulphate of quinia since 11 o'clock A. M.,
this morning.

It is important to note, that, in this case, the uric acid is diminished,
both in the cold and hot stages.

October 11th, 10} o'clock, A.M. Says that he is much better.
There was a complete intermission of the fever this morning, at
5 o'clock, A.M. The subsidence of the febrile excitement was
attended with a profuse perspiration, which continued up to 8
o'clock, A.M. At the present time his pulse is 88, and respira-
tion 22. Tongue moist and soft ; skin relaxed and soft ; bowels
were moved this morning.

Has taken 20 grains of sulphate of quinia since the intermis-
sion of the fever.

ty Sulphate of quinia, grains v. ty Snake-root tea f Sxviij,
sulphate of quinia grains xv : mix. One tablespoonful every
four hours. Half diet: beef soup, rice and tea.

Amount of urine passed during the last 15} hours, grs. 9144.

Specific gravity, 1^16.

Amount of urine passed hourly during the last 15} hours,
grs. 590-

Calculated amount of urine for 24 hours, grs. 14630.

390 Jones, on Malarial Fever.

[June,

ANALYSIS IV.

9144 grains Urine
excreted during
last 15> hours,
contained, grs.

14620 grains Urine
calculated for 24
hours, contain-
ed, grains,

1000 parts Urine
contained

Urea,

Uric Acid,

Fixed Saline Constituents,

157-140

3150

40-500

251-424

5-040

64-800

17-185
0-344
4-429

Chemical and microscopical examination of the urine passed
during the last 15 hours. Specific gravity 1016. Color, deep
orange inclining to red, with a heavy, light-yellow deposit.
Eeaction alkaline. It has changed rapidly from acid to alkaline
since it was voided. This is characteristic of the urine excreted dur-
ing convalescence from intermittent fever. During the active stages of
malarial f ever, the urine is always decidedly acid, and retains this reac-
tion for many hours, and in severe cases, for several days, even in the
heat of summer. When the fever intermits and the skin is moist and re-
laxed, and the patient is convalescent, the urine then excreted, rapidly
undergoes decomposition, dnd in a few hours the reaction changes from
acid to alkaline. I believe this to be one of the most certain
signs of convalescence in malarial fever.

The deposit in this specimen of urine was found, under the
microscope, to consist of well formed, prismatic crystals of triple
phosphate, and globular acicular crystals of urate of soda, and
the globular and elliptical cells previously described. When
the deposit was treated with hydrochloric and acetic acids, un-
der the microscope, an abundant crop of crystals of uric acid
appeared. This is the first specimen of urine in which the de-
posits have contained uric acid.

The chemical analysis of the urine also shows that the uric acid is more
abundant than in the urine of the hot and cold stages, notwithstanding that
the patient was under the influence of 20 grains of sulphate ofquinia.

October 12th, 11 o'clock, A. M. Continues to improve.
Missed the chill, but had a slight fever in the evening.

Pulse 84. Eespiration 20. Countenance, complexion, skin,
and temperature, normal.

$ Quassia and soda. Continue snake-root tea : full diet.

The urine through mistake was not preserved for examination.

1\ o'clock, P. M. Pulse 92; skin moist and cool.

Amount of urine passed during the last 9 hours, grs. 15120.

Specific gravity 1008. Orange color.

Amount of urine passed during each hour, grs. 1680.

Calculated amount of urine for 24 hours, grs. 40219.

October 13th, 10 o'clock, A. M. Says that he is quite well.
Had no fever last night, and rested well. Tongue and skin
normal in appearance ; reaction of saliva slightly acid ; during
the height of the fever, it was decidedly acid.

1858.]

JoXES, on Malarial Fever.

391

Respiration 16. Pulse 68.

Temperature of Atmosphere, 78F.

"Hand, 98

" under Tongue, 99

Amount of urine excreted during last 14^ hours, grs. 13662,

Specific gravity, 1012.

Amount of urine excreted hourly, grs. 942.

Calculated amount of urine for 24 hours, grs. 21859.

Amount of urine excreted hourly during the last 24 hours,
grs. 1199.

Actual amount of urine excreted during last 24 hours, grs.
28782.

ANALYSIS V.

13662 grs. of Urine
excreted in 11%
hours, contain-
grains,

21859 grs. of Urine
calculated for 24
hours, contained
grains.

100 parts of Urine
contained,

Urea,

Uric Acid,

Fixed Saline Constituents,

101-850

2-025

29-700

162-960

3-240

47-520

7-188
0-148
2-173

Reaction of the urine alkaline, in 12 hours; color normal;
light yellow deposit. Under the microscope, this deposit con-
sisted of a few prismatic crystals of triple phosphate, globular
crystals of urate of soda, and vegetable cells.

October 15th. Dressed up and walking in the hospital yard.

Pulse 64. Respiration 16. Reaction of saliva, slightly alka-
line.

Amount of urine passed during the last 24 hours, grs. 16320.

Color normal ; no deposit in 18 hours. Specific gravity 1020.

Reaction acid. Urine excreted hourly, grs. 680.

ANALYSIS VI.

Grains 16820 of Urine ex-
creted in 24 hours,
contained, grains,

1000 parts of Urine con-
tained,

Urea,

Uric Acid,

Fixed Saline Constituents,

488-880

9-600

115.200

29-818
0-588
7-058

The patient had no return of fever, and was discharged the /
next day.

The following table will present a condensed view of the re-
sults obtained.

't^UOJ^

cnto ton

TflUOJ^ JO ^UQ

<S .O^

iC(ijo.moH

axioiaapj

o o

3 5

a

-2-3 3
o o

ga 3

'King 50 3XVX

eepj

uoi^Jidsay;

' * gjgijdsouriy jo a.m^Jaduiaj,

pa^if jo aan^iadraajQ

anSuoj, Japuti eatvituadarex

OS CO Ol eo
CO (35 '-' -*

toot to^
O to o ^

sanoi{ ^3 UT Pa

^9.10X9 eui.ij} jd^unotny

-saq f g tit pa^9J0X9 usafi

s.moq

f g ui p9}9jox9 ppy oi.ifl

sanoq t5 ui

s^uatvji'isuoQ atnjtfg paxyj

UI p9;9.I0X9 9XIUX1

w
w

"sanojj

o o o o

O K> 00 O

o> o
o to
o o

^TABJf) OUlDedg

"B9JX1

ppy ouq

oo *- oo to
o to o o

to tf*. l-1

H-" O rf-

oo to <3

S: S

'S^TOtVjpSUOQ 8UITB g p9XTj[

^j.moq p9^9aox9 anjjQ

sanoq t3 UT paiiaaox
anufi jo ^utb pg^popQ

sxivao sanoq

f% J0J pa:jTllOTt?0 'B9Jl

skivhd

sanoq f 5

ioj p^BTnoj'eo ppy oij_q

ainoq j> aoj paiitf jtiotbd

Kin^tHriSUOQ 9Ul[1?g P9XIJ

/ , .' !

1858.] Jones, on Malarial Fever. 393

The most striking phenomena in this case were those mani-
fested during the cold stage. The temperature of the extremi-
ties was 19^ degrees below that of the trunk. The temperature
of the trunk was elevated 8 degrees above, while the tempera
ture of the extremities was depressed 10 degrees below the
normal standard.

Similar phenomena have been manifested by every case of
intermittent fever which I have examined during the cold stage.

The phenomena of the cold stage will be illustrated by the
following cases, which were carefully examined, just as they
occurred in the hospital, without any selection.

Case III. Seaman : aged 55, height 5 feet 4 inches, small,
spare man. Has been in the hospital for several months, suffer-
ing with an affection of the eyes.

This case has originated in the hospital.

Chill came on one hour ago : he is still shaking violently,
and his lips and hands look blue. Pulse 100. Kespiration 36
to 50, varies with each quarter of a minute ; irregular, thoracic,
labored.

Temperature of Atmosphere, 715' F.

" Hand, 92

'' under Tongue, 104

Case IV. Seaman: aged 38, height 5 feet 8 inches, light
hair, blue eyes, sallow complexion. Looks as if his liver was
out of order. Says that he " has had chills off and on from the
16th of July to the present time, October 12th." His first attack
of intermittent fever was contracted in the swamps of the Peedee
River, S. C. Tongue clean and pale ; lips pale, anaemic. This
patient presents the true malarial hue, and his blood is deficient
in colored corpuscles. In the present attack of intermittent
fever, he has a chill every day.

October 12th. This morning had a chill, followed by hot
fever. During the febrile excitement, his pulse was 108 and his
respiration 32 to the minute. As soon as the fever remitted,
xx grs. of sulphate of quinia were administered. The sulphate
of quinia delayed the chill ; it did not appear at the regular hour
on the 13th inst., but came on at 4 o'clock, P.M., on the 14th inst.

I commenced the examination about 15 minutes after the com-
mencement of the chill. Lips and fingers pale, and of a bluish
color ; extremities cold, whilst the trunk is hot to the touch.
Patient is shaking all over.

Pulse 92, feeble. Respiration 32, thoracic, labored.

Temperature of Atmosphere, 77 5' F.

" Hand, 91

" under Tongue, 103

Jones, on Malarial Fever. [June,

A small amouut of urine was excreted at the close of the cold
stage, and commencement of the general elevation of tempera-
ture, (equalization of the actions of the general and capillary
circulation,) which had a normal color. Specific gravity 1023,
and decided acid reaction, and under analysis exhibited a large
increase of uric acid.

Analysis viii. 1000 parts of urine contained Urea, 21-825
Uric acid, 1*467 Fixed saline constituents, 7436.

This specimen of urine is in striking contrast with that ex-
creted, under precisely similar circumstances, in Case ii. During
the sweating stage the reaction of his skin was neutral. As a
general rule, I have found it to be acid in the various forms of
malarial fever. Eeaction of saliva, as usual, acid.

October 15th. Complete intermission of fever.

Pulse 80, fuller. Respiration 20, regular.

Temperature of Atmosphere, 715'F.

" Hand, 96

" under Tongue, 98

/

"1/ Case V. Frenchman, aged 45 : brown hair and eyes ; height

5 feet 7 inches; weight 130 lbs. Thin, spare man. Had an
attack of intermittent fever, commencing Sept. 15th.

This case was treated in the Savannah Poor House, and yield-
ed to the ordinary remedies, and the patient was discharged in
the course of ten days. He returned to a miasmatic situation,
on the Savannah river, and was attacked again with intermit-
tent fever. He entered the Hospital and Poor House Oct. 7th,
and stated that for the last four days, he had had 'dumb ague,"
which came on every day at the same hour, (11 o'clock A. M.,)
and lasted two hours.

A purgative, followed by xxv. grains of sulphate of quinia,
was administered. This delayed the "dumb ague" until Oct.
9th, 3i o'clock P. M. (28 hours).

Examination commenced half an hour after the commence-
ment of the " dumb ague." Lips and fingers purplish ; extremities
cold ; head and trunk warm. Complains greatly of the sensa-
tions of cold, but shakes far less than in the former cases
recorded.

Pulse 92, so feeble that it is with difficulty felt, and with still
greater difficulty counted. The vibrations of the pulse resemble
those of a fine thread. Respiration accelerated and irregular.

Temperature of Atmosphere, 75 F.

" " Hand, 83

" under Tongue, 101 5'

6| o'clock P. M. Reaction has taken place, and he now has
fever.

Pulse 96, much fuller than during the chill, but weaker than
in a frank open case.

1858.] Jones, on Malarial Fever. 395

Temperature of Atmosphere, 70 F.

" " Hand, 101 75'

under Tongue, . . 102 75'

In this case, which was far more serious than any which we
have yet recorded, the urine was of a high color and specific
gravity, and correspondingly rich in urea and extractive mat-
ters. The uric acid was slightly increased.
Oct. 10th. Intermission of fever.

Temperature of Atmosphere, 70 F.

" Hand, 97 5'

" under Tongue, 98 5'

Case YI. Irishman ; black hair, black eyes ; height 5 feet
10 inches ; weight 150 lbs. In health, florid cAnplexion.

Has been suffering with intermittent fever for four days.
Chills have been slight. The present chill (Sept. 23d) is slight.

Temperature of Atmosphere, 79F.

" " Hand, 90

" under Tongue, 102

Case VII. Seaman Englishman : brown hair, brown eyes ;
florid complexion in health, now his complexion is anaemic ;
weight 146 lbs. ; age 25 ; height 5 feet 6 inches.

Sept. 10th. Entered the Savannah Marine Hospital, with
bilious remittent fever, and from this date until the 19th inst.
was extremely ill.

This patient recovered so as to be able to walk about the
hospital yard. jSTotwithstanding the administration of tonics
and iron, his complexion was pale, anaemic, and he complained
of a severe and continual pain in his head.

Cut cups, external applications and internal remedies, failed
to relieve the pain in his head. On the 4th of October he was
taken with a severe chill, followed by high fever. This returned
every day.

Oct. 6th. The chill has been on him one hour, and the hot
stage is just coming on. Pulse 110, feebler than after the com-
plete reaction, but stronger than during the lowest depression
of the cold stage. Kespiration irregular, thoracic, panting
45-50. Muscles trembling violently.

Temperature of Atmosphere, 70F.

" Hand, , ... 97

" under Tongue, 104

Case VIII. Irish laborer : stout, well formed man ; sanguine
temperament ; light hair, blue eyes, florid complexion ; height
5 feet 9 inches ; weight 190 lbs.

This is his second attack of chill and fever this season.

V. B. VOL. XTV. FO. VI. 18

396 Jones, on Malarial Fever. [June,

Sept. 18th, 11 A. M. Chill is now just going off. Pulse 112.
Respiration 28.

Temperature of Atmosphere, 90 5' F.

" Hand, 100

" under Tongue, ..*.,... 104
Sept. 19th, 2 P. M. Apyrexia complete. Pulse 68. Respi-
ration 24.

Temperature of Atmosphere, 91 F.

" Hand, 97 5'

" under Tongue, 99

Recovered from this attack commenced work upon a steam
Tug, and slept on board, in the Savannah river, at night. Re-
turned to the hospital with a third attack of intermittent fever.

October 2nd,^ P. M. Has a chill and is shaking violently.
Pulse 120, in sitting posture. Respiration 22, in sitting posture.

Temperature of Atmosphere, 79 F.

" Hand, 89

" under Tongue, 102 25'

Oct. 3rd, 2 P. M. Has high fever. Pulse 100. Respiration
26, thoracic.

Temperature of Atmosphere, 77a 5' F.

" " Hand, 105

11 under Tongue, 106

Oct. 4th, 2 P. M. Apyrexia complete. Pulse 58. Respira-
tion 20.

Temperature of Atmosphere, . . . . . . . . 76 F.

" " Hand, 96 5'

" under Tongue, 98 5'

From these and many other examinations of the phenomena
of intermittent fever, I have deduced the following conclusions,
the importance and bearing of which will be more fully pointed
out hereafter.

(1). The higher the temperature of the trunk, during the cold stage,
the more rapid will he the equalization of the circulation and temperature.

(2). The higher the temperature of the trunk, during the cold state, and
of the extremities and trunk during the subsequent hot stage, (stage of
equalization of the circulation and chemical action,) the milder and shorter
will be the attack. A high temperature in imiermitteut fever is then a
favorable symptom.

Whether the high temperature signifies an effort on the part
of nature, to break up, chemically alter, destroy, and throw off
the malarial poison ; or whether the high temperature be signi-
ficant of nothing more than vigorous, vital, nervous, physical
and chemical forces, nevertheless the determination of the cor-
relation of the respiration, circulation, and temperature (chemi- ,
cal action), affords the most valuable information to the medical
practitioner.

1858.] Jones, on Malarial Fever. 397

Having already extended this article over much more than
the space allotted, I will leave the discussion of these subjects to
a subsequent article.

Before closing, it is necessary that I should state the methods
by which the Temperature, Pulse and Eespiration were deter-
mined.

The pulse and respiration in these and subsequent investiga-
tions, were, unless stated otherwise, always determined in the
recumbent posture.

All the temperatures recorded in these and subsequent inves-
tigations, were determined by the same instrument. This ther-
mometer was compared with standard instruments, and found to
be accurate. The thermometer was always allowed to remain
under the tongue, in the hand, or under the arm-pit, for some
time after it was stationary, and all the observations were taken
and recorded at the bed-side, under my own hand and eye.

The greatest care was exercised in determining the tempera-
ture ; the patients were in all cases, unless stated otherwise,
lying quietly in bed, and protected from all currents of air. The
importance of attending to these circumstances, are strikingly
illustrated by the following experiments, which I performed
upon myself.

Athens, January 23rd, 6 o'clock A. M. Lying in bed, just
after waking from sleep. Pulse 76. Respiration 15.

Temperature of Atmosphere of Chamber, . . . 45 F.

11 " Atmosphere 28

11 Hand, 95

in Axilla, ; . . 98

Dressed myself and took a walk of two miles, over several
hills, in thirty minutes. The ground was frozen and covered
with frost. During the walk, my hands were bare and freely
exposed to the atmosphere. At first, the sensation of cold was
unpleasant, but towards the end of the walk, reaction appeared
to take place and they felt much warmer.
Pulse 90. Respiration 20.

Temperature of Atmosphere, 30 F.

" Hand, 78

" in Axilla, 98

During the walk, the pulse had gained 14, and the respiration
5, to the minute. The temperature in the hand had fallen 17,
whilst that in the axilla had remained stationary. The respira-
tion, in bed, was gentle and regular. The respiration, after
walking in the cold, was accelerated, full and vigorous.

Here we see that a diminution of the temperature upon the

''exterior was attended by a corresponding change in the move-

1 ments of the circulatory and respiratory systems. They became

398 On the Use of Iron. [June,

more active, in order to receive, and distribute more rapidly, the
oxygen, and remove, with corresponding rapidity, the increased
products of the increased chemical changes.

It is also worthy of note, that the increased circulation and
respiration was not attended with a rise of temperature, because
the radiation of heat from the surface of the body, more than
balanced the increased generation of heat, consequent upon the
increased chemical change.

I took breakfeast, and then walked three miles over several
hills, in 40 minutes. My hands were kept in the over-coat
pocket during the walk.

Pulse 88. Eespiration 26.

Temperature of Atmosphere, 45 F.

" Hand, 97

of Axilla, 985'

January 24th, 4 o'clock, P.M. After sitting and writing for
several hours in a cold room, without fire, my right hand, which
was freely exposed moving over the paper, felt very cold and
stiff.

Pulse 76. Eespiration 16.

Temperature of Atmosphere, 48 F.

"Eight Hand, 75

" in Axilla, . 985'

In this experiment the right hand lost 22 in the course of
two hours.

These experiments demonstrated, conclusively, the absolute
necessity of adhering rigidly to a uniform method of ascertaining
the pulse, respiration, and temperature in health and disease.

In comparative investigations, the truth will not be obtained
without the most scrupulous and unremitting attention, to the
position and state of the patient, and all the surrounding cir-
cumstances.

(To be continued)

On the Use of Iron. By Isaac Casselberry, M. D., Evans-
ville, Indiana.

A brief notice of the anatomy and physiology of the blood will
make its morbid changes during fever more evident.

Anatomy. The blood is a living fluid tissue, which is formed
and matured by the organizing force of the automatic nervous
system out of the organizable constituents of the maternal blood
during embryotic life.

After birth, the organizable elements of the blood are derived
from the food, which is decomposed by the gastric juice. These

1858.] On the Use of Iron. 399

elements are then transformed and rearranged by the organizing
force of the automatic nervous brandies of the stomach, and
constitute chyme.

This is conveyed into the duodenum, in which additional or-
gnnizalJe elements are received from the liver and pancreas.
The whole mass is then transmuted and reformed by the organ-
izing force of the automatic nervous branches of the duodenum
into chyle.

This is absorbed by the lacteals, in> which it undergoes a con-
tinued series of molecular changes and combinations, until it is
deposited in the subclavian vein.

The blood consists of a vast number of cells, which are the
agents the automatic nervous system employs to perform its func-
tions in the human organism. These differ in form, size, and
functional endowments, according to the varied duties they are
designed to fulfil.

For practical purposes, they may be arranged into two classes ;
one of nutrition or reproduction, the other of secretion or removal.
When the human organism is at maturity and in health, these
processes should maintain a relation of exact equivalence.

Physiology. The cells of nutrition are endowed with an elec-
tive force, by which they select and attract the nutritive elements
of the blood, which they transform and rearrange into molecular
combinations. These combinations undergo a continued series
of molecular changes and recombinations, until they attain matu-
rity, when the elements they have elaborated are appropriated
and form constituent parts ot the tissues, with which they possess
identity of elementary composition and arrangement.

The cells of secretion are, likewise, endowed with an elective
force, by which they select and attract the effete or worn-out
elements which they transform and arrange into molecular com-
binations. These combinations undergo a continued series of
mutations, till the elements they possess are completely elabora-
ted in the capillaries of the depuratory glandular systems, in which
they are coalesced and removed from the blood as secretory
products. The form of force by which they are coalesced is a
specific endowmenj of each of these glandular systems, by which
this important change is produced. One depuratory system can-
not, therefore, compensate for deficient function in another only
so far as the elements conveyed to it are identical with those
of its own secretion.

The blood gives each tissue the means of repairing itself: first,
by furnishing it with material of new growth ; secondly, by re-
moving from it those elements of its composition which have
become worn out and useless. Were this the whole history of
the blood, its investigation in disease would be comparatively
easy. But it undergoes progressive changes analogous to the

400 On the Use of Iron. [June,.

growth of the solid tissues. The new materials it obtains from
the food are not blood at the time of their addition; they are
crude immatuie products which subsequently mature.

The automatic nervous system endows the blood with a power
to resist changes, convert crude material into its own elements,
and perpetuate its own elementary composition and molecular
arrangement. Physiology teaches that the abundance oi cell
developement measures the activity and constancy of growth ;
and that this developmental activity in the blood is infinitely
greater than in any other tissue. Cell-germs abound in the fluid
of the thoracic duct. But they attain their maturity and fulfil
the purpose of their creation only when received into the blood.

Not only does the blood grow, but its growth must precede
that of every other tissue in the organism. It grows, then the
other tissues grow at its expense.

Its functions in health will show sufficiently what peculiar dif-
ficulties attend any investigation of its changes in disease. The
extreme rapidity with which all its changes transpire, and the
minute quantities in which several ingredients exist, oppose great
obstacles to the research ; but these are greatly enhanced by the
physiological fact that all the elements of the blood correspond
to different periods of time, to different degrees of developement,
and to different developemental cells.

Viewed as an object of scientific research, human life exhibits
itself in a series of manifestations, the connection and recurrence
of which are determined by the changes which the food and the
oxygen absorbed from the atmosphere undergo in the organism
under the controlling influence of the automatic nervous system ;
for the first condition of life is the assimilation of nutritive mate-
rial, and the second is that of a continual absorption of oxygen
from the atmosphere. The intensity, the integrity, the quantity,
and the quality of the molecular combinations and rearrange-
ments of the elements of the blood depend on the mutual action
of the oxygen of the atmosphere and the elementary constituents
of the food.

The most convincing experiments have proved that the human
organism is absolutely incapable of producing an elementary con-
stituent, such as carbon or nitrogen, out of substances which do
not contain it; therefore it follows that all kinds of food, to pro-
duce the tissues and maintain them in a normal relation with
each other, must possess the elements of which the tissues are
composed. Fibrine and albumen, the chief ingredients of the
blood contain seven chemical elements, among which are oxygen,
carbon, hydrogen, nitrogen, phosphorus, and sulphur. The se-
rum retains in solution sea salt and the salts of potassa and soda,
in which the acids are carbonic, phosphoric, and sulphuric.

The globules of the blood contain fibrin and albumen, with a

1858.] On the Use of Iron. 401

red coloring matter in which iron is a constant element. They
are formed out of the elements contained in the serum; because
it is the atmosphere, and supplies the material for cell develope-
ment, which is constantly taking place within this fluid. Hence
it is the most important branch of hematology.

The chief constituents of the blood are compounds, in which,
the relative proportions are invariable. These compounds are
the nascent state of the tissues, and maintain a relation of mutual
dependence on each other. The blood could not become organ-
ized, nor could it promote the growth of tissues without the
existence of albumen in the serum; because the globules are de-
veloped in this fluid at the expense of its albumen, and they carry
the oxygen which they absorb from the atmosphere into every
tissue of tf:e organism, where it determines the changes which
may transpire.

Oxygen is necessary to the growth and maturity of the tissues ;
it is necessary for their conservation ; and it is necessary for their
conversion into lifeless compounds ; but it can only be introduced
by the agency of the globules. These can only attain a condi-
tion favorable to the reception and conveyance of the oxygen
at the expense of the primary elements of the blood, which are
obtained from the elementary constituents of the food.

The absorption of oxygen and the secretion of carbonic acid
gas constitute the visible functions of respiration, and the vast ab-
sorbent and secretory capacity of the lungs depends on the im-
mense expanse of absorbent and secretory cells brought in prox-
imity to the oxygen of the atmosphere at each inspiration, and on
the quantity and quality of the molecular combinations of the
elements of the blood which are developed during that period.

The food must contain and supply the elements of which the
blood is composed ; they must undergo normal transformation ;
they must grow and mature normally, before the necessary quan-
tity of oxygen can be absorbed to consume them by combination.
For a more enlarged consideration of this interesting subject the
reader is invited to an essay in the American Journal of the Med-
ical Sciences, for July, 1855, on the Physiology of the Automatic
Nervous System, in which 1 maintain the unity and mutual con-
vertibility of all the different forms of external force and of all the
different forms of the automatic nervous force, and to another
essay in the same Journal for April, 1856, in which I endeavored
to show the causes of fever, and explain the mode in which
they produce diseased transformation of the tissues.

Pathology. From these physiological facts, it is evident that
fever may assume a vast multiplicity of forms, which are mani-
fested by characteristic symptoms. These have often been mis-
taken for the disease itself; and the error has been magnified and
perpetuated by giving them names which have been commemo-

402 On the Use of Iron. [June,

rated by learned authors. Symptoms are like sentinels on duty ;
they guard the organism, evince the existence of disease, indicate
the avenues of its approach, and the degree of resistance offered
by the organism, manifest its progress, portray its pathology, and
proclaim its triumph or announce its extermination. Clothed in
the attire of fancy, marshalled by the mandates of theory, mantled
by the nomenclature of authors, they are often received and en-
tertained in the mansion of affliction instead of the disease.

Fever is a diseased transformation of all the tissues , but the fluid
tissues suffer the most, because the solid tissues are formed in
them and of them. The blood contains not only -the nutritive
elements, but also the effete constituents of the transformed solid
tissues. Both the nutritive and the effete elements are formed,
matured, and appropriated by cellular combinations.

These are the agents of the automatic nervons force acting on
the organizable constituents of the food, and blood, or upon the
organizable elements of the transformed tissues.

The activity, the quantity, and the quality of the molecular
combinations depend on the intensity and integrity of this force,
manifested as nutritive attraction, molecular affinity, and effete
repulsion. The nascent state of this force in any of these forms
are easily transmuted ; and both the developmental cells and the
molecular combinations, to the formation of which it contributes,
as the formative or organizing force, will partake of the abnormal
mutation. Hence the vast number of symptoms which arise
during the incipiency and course of fever. The cells of nutrition
neither grow nor mature normally; nor are their constituents
appropriated to the nutrition of the tissues normally. From the
diminished quantity and feeble intensity of the organizing force
of the automatic nervous branches of the digestive and assimila-
tive organs, the organizable elements of the food are not decom-
posed, transformed, rearranged, and absorbed in normal quantity
and quality ; only a small amount of nutritive material is receiv-
ed by the lacteals out of which blood may be formed and devel-
oped ; and the molecular combinations of the cells, containing this,
are so imperfect, that they cannot undergo mutations with normal
force and celerity.

Imperfectly developed by molecular combination, the nutritive
constituents of the blood often aggregate in some of the capillaries,
in which they then constitute excessive and perverted nutrition,
or inflammation. This is of frequent occurrence during the
progress of fever, and merits the anxious and careful considera-
tion of the physician.

During fever the secretory cells are neither formed, developed,
nor matured normally ; nor are the elements which they should
normally aggregate and elaborate depurated from the blood; be-
cause the nutritive elements neither absorb a normal quantity of

1858.] On the Use of Iron. 403

oxygen from the atmosphere, nor does that which is received
undergo normal molecular combinations on account of their im-
perfect molecular developement.

The imperfectly combined oxygen, when it is not consumed
by molecular combination with the protein elements of the blood,
acts upon those elements of the solid tissues exciting the sensa-
tion of pain, when it consumes branches of the sensitive nervous
tissue, producing irregular and involuntary muscularactions, when
it consumes those of the excito-motory, and creating the sensa-
tion of thirst oppression, and suffocation, when it consumes only
those of the automatic nervous system.

During the incipiency of fever, the effete elements of the blood,
therefore, undergo a series of abnormal transformations, and are
chiefly retained in the blood ; a lesion of nutrition and secretion
exists, the organizing force of the automatic nervous system, which
in a normal state, creates, maintains, and governs the cellular
formation and coalescence of the elementary constituents of the
blood is increased, decreased, or perverted ; there is a lesion of
capillary circulation ; the blood recedes from the external capil-
laries and accumulates chiefly in the portal venous system ; a
diseased transformation of all the tissues is present; Fever exists;
it is manifested by symptoms; these assume a great multiplicity
of appearances and forms, according to the pathological condition
of the tissues.

There is no longer a perfect equilibrium between the processes
of waste and repair ; neither a normal quantity of food is desired,
nor could it be assimilated, were it ingested; every tissue,
therefore, suffers for appropriate nourishment.

Those more immediately concerned in the processes of nutri-
tion most early evince the requirements of food, or the necessary
elementary constituents for the repair of their tissues.

As the automatic nervous system creates, governs, and main-
tains all the tissues by ils organizing force acting on the organi-
zable elements of the food and blood, it is the first tissue to
manifest the want of nourishment by lesion of the different forms
of its force.

Quinine supplies nutritive elements to this tissue, and by this
gives its different forms of force increased intensity. Its phys-
iological effects on the organism are an increase of the develop-
mental intensity and celerity of the cells, and a promotion of their
molecular combination and coalescence, by which the transfor-
mation of the nutritive cells is increased, and those of secretion
augmented. When a diseased transformation exists, it should,
therefore, be carefully administered, and its effects sedulously
investigated.

In the June No. of the Cincinnati Medical Observer for 1857, I
have given my views of the use of quinine in fever; and in the

40 J: On the Use of Iron. [June,

July No. of the American Journal of the Medical Sciences for 1857,
I have discussed, at some length, the use of water in fever.

In the latter essay I have maintained that the hydrogen of the
water combines with the imperfectly combined oxygen in the
blood, forms water, and is removed from the blood in the form
of sweat or perspiration ; while the oxygen of the water com-
bines with the carbon of the blood, evolves heat, and is secreted
in the form of carbonic acid gas.

The attention of the reader is invited to each of these essays.

After the employment of appropriate remedial agents, and the
removal of the more manifest symptoms of fever, there often re-
mains an impoverished condition of the blood, which is a fertile
source of local dependent forms of disease, especially when, during
the progress of fever, a chill from time to time occurs. The
condition of the blood is sensitively evinced by lesion of nutrition,
loss of nervous energy, want of appetite, muscular debility, and
more or less perversion of secretion ; and it is caused by deficient
developmental intensity of the molecular combinations of the elements
of the blood.

The large proportion of albumen generally found in this
morbid condition of the blood, is the result of defective cell-growth ;
because there is more nutritive material in the serum than could
have remained there, if the normal proportion of blood-cells had
been developed out of it. The evidence is, therefore, almost
conclusive, that the albumen which exists in the blood does not
grow and mature normally, or it would be consumed by molecu-
lar combination.

The causes of fever, how slight soever they be, retard the
developemental intensity and activity of the blood cells; and if
they be long continued, frequently repeated, or of great disturb-
ing force, they impair the normal molecular changes of the blood,
and transmute them, with more or less celerity, into the different
forms of chemical force, when life may soon become extinguish-
ed. If the abnormal mutations be arrested, a period of time
must transpire before the different forms of the organizing force
of the automatic nervous system can attain normal tranquility
and intensity; because the tissue of this system has suffered for
normal nutrition; and its different forms of force have been so
disturbed and so transmuted, that time is required for them to
regain normal intensity and a controlling influence over the mole-
cular combinations of the blood.

When this is obtained, all the forms of the organizing force
are united in purpose, harmonious in action, and conspire to
promote the conservation and well-being of the organism. But
they require organizable elements to elicit their action; and the
lesion of nutrition opposes the attainment of this grand object by
not supplying all the constituents necessary to the developmental
intensity of the blood-cells.

1858.] On the Use of Iron. 405

Although so minute, these cells always act harmoniously ; they
elaborate the constituents of the blood in a continued series of
succession ; each performs a definite and distinct duty ; but the
blood must contain all the elements, of which the tissues are com-
posed, or these cells cannot be normally transformed and rearran-
ged ; they cannot grow and mature normally, because the absence
of a single organizable element would disturb the unity of purpose
and the concert of action between the different forms of the organ-
izing force, and thereby impede the molecular growth and develop-
ment of the whole. This is precisely what always transpires
during the incipiency of fever; and it is perpetuated throughout
its course. The lesion of nutrition may be slight, but it is suffi-
cient to produce and maintain the continued absence or imma-
ture condition of one or more constituents of the tissues.

The developement of the blood must, therefore, be imperfect ;
and this imperfection will always be commensurate with the de-
gree and duration of the nutritive lesion.

The dependence of the capillary circulation upon the normal
molecular combinations of the elements of the blood always pro-
duces a lesion of this circulation proportionate to the abnormal
mutations, which transpire from imperfect developement of the
globules.

There is, therefore, always present more or less anaemia in fever;
because the morbid changes of the molecular combinations of
the constituents of the blood prevent its introduction into the
capillaries in normal quantity by nutritive attraction ; and although
the arterial system may be bounding and throbbing, these vessels
convey an absolutely diminished quantity of blood to the capilla-
ries.

The mechanical force of the muscular action of the heart and
arteries is derived from the cellular changes of the elements of
the blood at the ultimate termination of their muscular fibres ; so
that it must be diminished in intensity when these molecular
mutations do not take place with normal force and celerity from
deficient developement of the globules.

Enfeebled action of the heart and arteries is, therefore, always
present in fever. Their mechanical force is diminished; they
only propel a quantity of blood to the external capillaries equal to
their propulsive intensity ; and as this is not equal to the whole
quantity of the blood, a certain portion must regurgitate from the
heart, at each systole, in the portal venous system.

The morbid accumulation of blood in this venous syste^pro-
duces an anaemic state of the external capillaries.

These abnormal states of the circulation perpetuate fever, be-
cause only a small quantity of nutritive material can be elabora-
ted and introduced into the blood on account of the capillary
lesions ; and the molecular mutations of the blood in the depurato-

406 On the Use of Iron. [June,

ry glands are, consequently, so abnormal, that what already exists
is very imperfectly depurated.

Only a limited quantity of oxygen is absorbed ; but that which
is received is not normally consumed by combination. Imper-
fectly consumed by combination, it combines with the solid tis-
sues, producing their death and decomposition by conversion into
lifeless compounds.

Fever, attended by the symptoms which arise from these states
of the solid and fluid tissues, is called typhus or typhoid. It is
frequently observed in the southwestern States in the autumn,
when the days are hot and the nights cool, especially if fever
with intermittent symptoms prevailed during the preceding sum-
mer.

Throughout the southwestern States, fever, with chills at irreg-
ular periods, is often of protracted duration ; and, during its course,
the spleen is liable to become hypertrophied, and the blood poor
and attenuated. When the spleen is greatly hypertrophied, and
soft and yielding upon pressure, large granular globules, two or
three times the size of the natural colourless corpuscles, may
frequently be oberved in great abundance in the blood ; and
usually the ordinary colorless corpuscles are in great excess in
this condition of the spleen. Southwestern physicians, who have
unfortunately employed bleeding from a large orifice in the treat-
ment of inflammation of the lungs, when the spleen is in this
pathological condition, can bear witness to the frequency of these
appearances of the blood.

When this patholigical state of the blood exists, the hepatic
functions are always more or less disturbed by the morbid accu-
mulation of blood altered in quality in the hepatic capillaries.
This disturbance, when it is of long duration, is usually manifest-
ed by a yellow appearance of the skin, clay-colored discharges
from the bowels, and scant high-colored urine, alternated with
green fetid evacuations from the bowels, and large quantities of
yellow sedimentary urine.

A serous diarrhoea sometimes supervenes upon these conditions,
when the sufferer is rapidly exhausted by the continuous drain of
serum. Cruveilhier, Becquerel and Rodier, Andral and Gavaret,
have conclusively shown that the attenuation of the blood by
bleeding decreases the quantity of the corpuscles, while the other
constituents undergo little change in their proportion either to
each other or to the entire mass.

Thp same law prevails in respect to hemorrhage and many
exhaustive forms of disease. The attention of the profession is
particularly invited to monorrhagia, as it affects women who
reside on our southwestern alluvial bottoms. With them the hem-
orrhage often alternates with serous diarrhoea, when general anae-
mia is soon produced and pervades every tissue of her organism.

1858.] On the Use of Iron. 407

The human female has a peculiar law of blood-development.
During about thirty years of her life she forms biood enough for
herself and an infant. If she be pregnant or suckling, this redun-
dant blood formation fulfils its purposes by nourishing her organ-
ism and that of her infant; but if she be neither pregnant nor
suckling, the large blood formation, which is normal to her for
these purposes, becomes excessive in their absence, and tends to
effect its own cure by means of recurrent hemorrhage for the mu-
cous membrane of the uterus, which attends the discharge of
unfertilized ova from the Graafian vesicles, and constitutes men-
struation when it is normal, and menorrhagia when it is abnor-
mal from the excessive quantity of blood discharged. Lesions
of this process most usually occur from general causes affecting
the development of the blood ; and among these, in the south-
western States, the most universal are those vicissitudes of the
atmosphere which produce fever. The morbid influences of the
climate or locality impoverish the blood and produce the patho-
logical conditions which arise from the want of cell development
of the blood-corpuscles.

The anaemia which so often takes place about the period of
puberty in young women in the western States, consists essential-
ly in deficient growth of blood-cells ; and it is of much more fre-
quent occurrence than is generally apprehended. During the
autumn, teething children often suffer of a serous diarrhoea of
protracted duration. This is perpetuated by the want of develop-
mental activity of the globules.

The plysiological effects of iron conclusively evince, that it
promotes the development of the blood cells and accelerates their
maturity. This is in accordance with a general law of the
human organism, that the specific stimulants of cell growth in
every tissue are elements identical with the natural contents of
the cells, or convertible into them.

The globules of the blood contain increments of iron obtained
from the food ; and from the physiological facts that these are
always present in normal blood, it is self-evident that iron is
absolutely necessary to animal life.

From the physiological fact that the globules do not contribute
to the nutrition of the tissues until they have attained maturity ;
that they will not mature normally without certain increments
of iron: that when these are normally present they greatly pro-
mote the developmental intensity and activity of the blood-cells ;
that they increase the capacity of these cells for the absorption of
the oxygen of the atmosphere and for the secretion of carbonic
acid gas from the blood, by which the gobules assume a bright-
red colour ; that the blood in this manner oxidized is conveyed
and introduced into the capillaries, in which its elements are
transformed, matured, and appropriated to the nutrition of the

408 On the Use of Iron. [June,

tissues, evolves animal heat, and absorbs the effete constituents
of the transformed tissues ; and that the pathological states which
are produced are those which are dependent on imperfect mole-
cular development of the globules, and the consequent deficient
oxidation and depuration of the blood; we can appreciate the
cause of the perverted condition of the different forms of the
automatic nervous force, the abnormal forms this force assumes
in the molecular combinatian of the elements of the blood, when
all development is deficient, and the best means to effect its
tranquility and early restoration.

Iron is the most efficient agent to promote the normal restora-
tion of these lesions, because it supplies the element required to
promote the growth and maturity of the protein globules. The
effects of few medicinal substances are more immediate or more
remarkable than that which results in disease from deficient cell
development from the exhibition of iron.

Every physician has observed how soon, under the influence
of this remedy, patients recover their normal complexion. A
chemical analysis of the blood explains this sufficiently. F.
Simon relates a case in which, after a few weeks of treatment,
the proportion of blood globules rose from 32 to 95 in the thou-
sand ; Herberger, one in which it rose from 38 to 98 ; Andralr
one in which it rose from 46 to 95.

Iron is seldom administered in a metallic state. It is usually
oxidized, and combined with a vegetable or mineral acid. The
compounds formed by combination of iron with the vegetable
acids are less powerful and efficient than those by mineral acids.
The citrate and tartrate of iron are mild in their action, and they
may, therefore, often be given before the stronger compounds.
We not unfrequently observe that the stronger compounds of iron,
when first administered, apparently increase all the anaemic
symptoms, especially those referable to the stomach and head.
The potassio-tartrate of iron may be given along with the bitar-
trate ofpotassa, when there is oedema of the ankles, or of the cel-
lular tissue generally. This is a valuable compound of iron in
the anaemia of females, when there is local effusion in the cellu-
lar tissue.

Several of the compounds of iron are often given in larger
doses than is necesary when the design is to promote the absorp-
tion of the iron into the blood. This observation applies espe-
cially to the carbonate, sulphate, and mutriated tincture. The
regeneration of the globules, when much diminished in quantity
and altered in quality, must require considerable time.

That the efficacy of a ferruginous compound is not in propor-
tion to the quantity of iron it contains is shown by the fact that
many mineral waters are very powerful, though they contain less
than a grain in the pint. This fact clearly evinces the necessi-

1858.] On the Use of hua. -AU9

ty of the greatest care in the selection of the compound we are
about to employ ; because the efficacy of iron often depends on
the compound used and its mode of administration. Deficient
cell-growth, which occasions the necessity for the employment
of iron, causes a vast multiplicity of symptoms, which are pro-
duced by the functional disturbance of the visceral glands. The
compound of iron should, as nearly as possible, be adapted to the
particular state of the digestive organs, that it maybe readily
absorbed and elaborated with the nutritive elements of the blood ;
for this is the only mode by which iron can promote the growth
and maturity of the blood. Sir James Murray first recommended
the administration of iron in the following mode: Dissolve one
drachm of the bicarbonate of soda in four ounces of water; then
add to this one drachm of the muriated tincture of iron. The
draught should be taken during effervescence. It should be re-
peated three or four times a day. Although the quantity of iron
is small, yet it is in a state of subdivision so minute as to favour
greally the absorption of each increment. The double decompo-
sition which takes place forms, as one of its products, muriate of
soda. This saline is most congenial to the development of the
globules.

During the protracted continuance of fever, diarrhoea, dysente-
ry, or any other form of disease, during the autumn or winter in
the Southwest, the use of iron according to this suggestion of Sir
James Murray, is often attended with the greatest efficacy, espe-
cially when the fever, or other form of disease, assumes what is
usually termed a typhoid form. The iron should be administered
every three or four hours, alternated with other appropriate reme-
dies. The minute quantities of iron and muriate of soda thus
presented to the digestive and absorbent glands, which have been
so long deranged and weakened, stimulate and promote the
growth and maturity of their cells, and thereby favor the diges-
tion and accelerate the absorption of any nutritive or medicinal
substance. This will be celarly evinced by the increased secre-
tion, which will take place in a day or two from the beginning of
the use of the iron. The biliary, uninary, and cutaneous secre-
tions will be greatly augmented ; the tongue will become more
moist, the thirst less urgent, and the sleep more tranquil.

When inflammation exists, iron should be used cautiously and
carefully. When fever, dysentery, or diarrhoea assumes what is
called a typhoid state, iron is of the greatest efficacy, because it
stimulates and promotes the growth and maturity of the blood-
cells. The matured blood-cells absorb and elaborate more oxy-
gen from the atmosphere ; an increased transformation of the
elements of the blood ensue ; the capillary circulation is accelera-
ted and augmented, and increased secretion from all the depura-
torv glandular systems takes place.

410 Treatment of. Menorrhagia with Ergot. [June,

When a typhoid state exists in any form of disease, western
physicians have often prescribed for several days without observ-
ing scarcely any effect from the medicine they had directed. Let
them employ iron, as here directed, and in a day or two, each
medicinal article will begin to manifest its characteristic effects
on the organism.

Muriated tincture of iron is a very efficacious compound in the
treatment of menorrhagia. Its use should be continued for a
considerable time. It may often be employed with the greatest
advantage in fever with typhoid symptoms.

Iodide of iron is a preparation which combines in some degree
the properties of iodine with those of iron, though the latter pre-
dominate. It seems to promote the secretions more than any
other compound of iron. When it is not too stimulating it is
one of the best tonics in the anaemia of phthisis and scrofula;
and from my experience of its effects in these affections in this
climate, it is never too stimilating. It may be advantageously
employed in all cases of anaemia combined with enlargement of
the lymphatic glands. It changes the molecular condition of in-
durated glands and promotes their absorption. It may be used
advantageously in the chronic form of many diseases, in which
calomel should have been employed during the acute state.

The citrated aromatic wine of iron possesses the most agreea-
ble odor and taste of any medicinal compound of iron. It is
seldom rejected by the most delicate stomach. I have directed
it for children and young persons in various forms of disease with
debility, and I never found it disliked or rejected, and its repeti-
tion is more generally desired.

When excessive secretion from a relaxed state of the mucous
membrane in chronic bronchitis exists, combined with wine of
ipecacuanha, it is of peculiar efficacy. In all diseases which arise
from deficient developmental activity of the blood-cells, it is a
remedy of great value. There are many other compounds of
iron of peculiar value and great efficacy ; but I cannot extend
the limits of this paper by a definite notice of them.

When we contemplate the effects of the climate of the alluvion
districts in the southwestern States in the production of an im-
poverished condition of the blood, the frequency with which this
state of the blood is met with in these localities, and its injurious
consequences to the organism when allowed to continue, the value
of iron in the promotion of the growth and maturity of the blood-
cells, and the consequent removal of this condition of the blood,
can scarcely be sufficiently appreciated.

1858.] On Chorea arid Myelitis of die Chord. 411

Lecture on Chorea and Myelitis of the Chord. By Thos. Addisox,
M. D., F. E. C. P., Senior Physician to Gay's Hospital.

Gentlemen. There is that case in the bed, No. 15, that boy,

J. B , aged 11 years a delicate, strumous boy that moves

about like a frog or a lizard thrown into half a hundred contor-
tions, and which you recognise at once as hemiplegic chorea.
There is that poor boy, I say, so curiously afflicted ; the case is
one of great interest. You observed, no doubt, some of you,
when first I saw him, how carefully we listened to the action
of the heart, and how I felt the skin. I will explain why I did
so as we go along.

Now, whenever I see a young subject the victim of chorea,
I always suspect that it had its origin in rheumatism. I felt
this boy's skin to discover if he had that sweaty surface, so
characteristic of rheumatism. I listened to the heart, and what
did I find? Loud mitral bruit. And what do we learn in going
over the previous history, as noted by the clinical clerk? "We
find that about three years ago he had rheumatism ; and here
I may tell you> that you will often find, under the name of
severe "growing pains," that you have had, in point of fact, a
veritable attack of rheumatism. Are we to believe this mitral
bruit was the result of rheumatism, or not?

Believe me, rheumatism is a very eccentric disease ; I know
none more so. There is no disease, perhaps of which we know
really so little as rheumatism in its pathological essence and
nature! An old physician of considerable experience was
asked What cure is for rheumatism? His answer was laconic:
"The cure for rheumatism is six weeks/" In other words,
rheumatism must be let cure itself. I have cut rheumatism
and rheumatic gout short in less than half the time with colchi-
cum or the powdered cormus and sulphate of magnesia, and
other things; but I am not so certain that cutting rheumatic
gout short by potent measures is quite the same thing as curing
it. Let us, however, at all hazards mind the heart in these cases.

Eheumatism is a queer or eccentric disease, I have said.
Now, it is my belief that rheumatic disease, whatever it is, some-
times attacks the skin alone. It is my firm belief that it some-
times attacks the heart alone. I know the rheumatic skin well ;
and I am satisfied also about the ravages committed by this
so-called rheumatic inflammation in the endocardium and peri-
cardium, and that, too, without any pain to attract attention.
I see the rheumatic skin ; and when I do, I almost with cer-
tainty predict rheumatism, which is sure to supervene. One
may sometimes find the heart inflamed, by itself, but you will
do well to look out for rheumatism in the joints and their syno-

u. 8. vol. xiv. vo. vi. 19

412 On Chorea and Myelitis of the Chord. [June,

vial or ligamentous tissues. This pericarditis is of a marked
kind, with no pain about the heart.

But you say, What has all this to do with chorea? Well,
what the relations are is not clearly made out; but that there
is a connection or relation is perfectly evident. If we look at it
in this way, we find, for instance, in acute endocarditis, the
patient's manner is often very remarkable, more so than *in
pericarditis; he may be even quite delirious or laboring under
decided cerebral complications.

Some ability and ingenuity are shown by Dr. Kirkes and
others in tracing certain clots or shreds of fibrinous matter, as
washed from the endocardium into the brain, causing irritation
there. On the continent, I find they look on the matter in a
less mechanical way, and they say a poison say, like that of
some other serous effusions is carried to the brain from the
rheumatic deposit in the endocardium. I am afraid we have
too many analogies in pyaemia and other affections to give stabil-
ity to this hypothesis.*

There are several curious associations, I have said, between
the brain and heart, epilepsy, for instance, affects the heart.
Sometimes, a fit of epilepsy extends itself in a violent tumult of
the heart. I was consulted some time ago by a gentleman a
manufacturer at Huddersfield, or somewhere down there for
some curious functional derangement of the heart. I told his
family doctor it was epilepsy of the heart ; and I believe my
friend thought I did not know what I was saying, and smiled at
me ; but the epilepsy of the heart, with those curious fits of un-
consciousness he could not understand; and how puzzling they
are you will find when you get into private practice ; so that
you cannot give too much attention to them. Well! these
anomalous fits of unconsciousness and tumultuous palpitation
ended, nevertheless, in regular fits of epilepsy some of the
most marked, perhaps ever seen. I do not pretend to explain
how this is brought about; I only know the practical bedside
fact. The relations of the fit in epilepsy itself are very peculiar ;
but emotional influences will produce palpitation of the heart;
and, I suppose, in some such way, epilepsy produces it as a

* Chorea is derived from the word choros, a dance. During the middle ages,
we learn from Hecker, sundry choreic ravings attacked the peasants at Kolbig,
Erfurt, and Utrecht, in 1374. At Aix-la-Chapella the sick thus seized "appear-
ed to have lost the control over their senses, and were only relieved by swathing
the body," and various incantations common at the time. These choreic ravings
were mixed up with various religious ravings, evidently the reflection of sundry
broken images, as from the broken mirror of some popular impression of the day.
The name "St. John's Dance" was given to chorea, as it was at one time thought
chorea, originated in the revels of that festival and St. Vitus's dance, because of
the cures effected at the celebrated chapel of St, Vitus. This disease continued
two centuries. Paracelsus (no very reliable authority) give9 a long description
of the epidemic, and the Arabians called it a palsy.

1858.] On Chorea and Myelitis oftiu 413

sort of first of three warnings." Emotional influences or fright
will cause chorea : in fact, it is the most common of all causes
of the disease. A dog runs after a child ; a ghost story is told
by a foolish nurse; a house takes fire, and child is exposed to
danger; the child, perhaps, is seized with chorea: some horri-
ble agitation * is set up in the emotional (or central) parts of
the brain, and chorea tits are the result. The complication or
connection of chorea and heart diseases is so common that I
always look for it. See in that case of gout, on the other hand,
in that poor woman in the other part of the ward, you can
scarcely tell it from rheumatism : she has renal disease, with
gout in her foot; but her heart is perfectly free, and, in all pro-
bability will continue free. How curious these peculiarities are !

Yet gout and rheumatism are pathological first cousins; but
why does one affect the heart, the other not? I cannot tell you.
Well, we gave this boy a mild mercurial first, to settle all right
in the prim* vice, and we shall follow that up with the sulphate
of zinc, in which I have great faith as a remedy in chorea. At
Guy's at least, we have not yet hit on any thing equal to it.

These poor patients with chorea are often very ludicrous, but
very distressing to observe. I have seen four or five deaths from
the excessive exaggeration of the chorea spmptoms ; like lizards
or eels, such patients are contorted into a myriad of forms ; they
glide* and twist and tumble about the floor and out of bed or into
the fire! I have known chorea to begin with pregnancy, and
go on increasing as the poor big-bellied woman got bigger and
more unwieldly, and only yield when the uterus became empty
again ! Dr. Hamilton once thought purgatives cured chorea :
but I do not believe this is invariably found. Sulphate of zinc
or oxide of zinc is the remedy we have made out as most valua-
ble at Guy's. I have known a patient take of sulphate of zinc
(not oxide, mind) so much as eighteen grains four times a day.
My attention was once drawn by the late Dr. Chambers to a
peculiar cast of countenance such patients acquire who are taking
these very large doses of zinc : you know, of course, the dark
tint or tinge produced by nitrate of silver, the dark line of the
gums by lead, kc. We were attending a patient for another
disease altogether, and though Dr. Chambers could not describe
what it was, he said, to one in the apartment, ;'Why you are
taking zinc, are you not?'' and it turned out that he was. The
nearest idea I can give you of the zinc complexion of the face
is. that it is destitute of the freshness and cherry redness of rude
health, and the skin of the face assumes a glossy sameness of

* It was recently stated that a young man dropped dead of fright, at a theatre,
on seeing the Ghost in 'Hamlet' stalk forth for the first time on the stage; and
a similar case of death from fright, not long since formed the subject of a coroner's
inquest.

414 Causes of Pneumonia. [June,

tint very like pewter; in fact, Dr. Chambers knew the "pewter
face" very well ; it requires the light to fall in a particular
direction, and then you will see it : the hint may be of use to
you. We will now say a few words about the patient in the
bed No. 20. He has been in the habit, he tells us, of carrying
heavy loads on his head ; this I need not say, produces a strain
on the muscles about the neck, and pressure on the veins. Well,
lie has had fits of unconsciousness, and now has excessive pain
of a neuralgic character in his limbs. We had a man not long
since under care, you recollect, with what I called, " ligamen-
tous rheumatism." I have seen more than once this sort of liga-
mentous rheumatism attacking the delicate ligaments, the odon-
toid, and others of the articulation of the axis occipital bone and
others of the axis and atlas ; in one case of a boy it threatened
to end in universal paralysis, as the thickened membranes no
doubt pressed on the medulla oblongata, producing a somewhat
common disease, myelitis of the medulla oblongata or chord, or
perhaps mechanical pressure. In a woman with the same
disease I verily believe we saved her life by keeping the head,
almost in splints, perfectly quiet. We will adopt the same plan
in this poor man ; we shall support him and prescribe cod-liver
oil and tonics, and you will see the result. [Medical Circular.

On the Causes of the Pneumonia which supervenes upon Laryngo-
tomy. By Professor Schuh.

All surgeons of experience are aware that pneumonia is some-
times observed after the performance of laryngotomy or trach-
eotomy : but observers are by no means agreed upon the causes
of this. Most persons, however, seem of opinion that the opera-
tion itself does not bear any direct casual relation to this occur-
rence. Professor Schuh entirely differs from them, and the per-
formance of a very large number of operations upon the air-pas-
sages, during his twenty-three years' attendance at the Vienna
Hospital, enables him to speak with authority upon the subject.
Although a great advocate for these operations under a variety
of circumstanses, he is convinced that the altered position and
amount of the column of air that is admitted into the lungs is
not unfrequently the sole cause of the supervening pneumonia.
The following are the grounds for this opinion:

1. The air, after the operation, enters the lungs by a shorter
passage, and by one that is straight in place of being curved, as
before ; and it does not pass through an aperture which is alter-
nately widened and contracted, as is the case with the rimaglot-
tidis. The column of air, too, which passes through the canula
is larger than that which traverses the glottis, for if a smaller

1858.] Causes of Pneumonia. 415

canula were employed, it would be liable to dangerous obstruc-
tion. We have thus two important changes in the mechanical
conditions of respiration ; and the lung becomes exposed to the
pressure and impulse of a large column of air, arriving more
rapidly bv a shorter passage. This, so tender and vascular an
organ will not always support, and inflammation may be easily
excited, just as it may when, in the operation of paracentesis
thoracis, the fluid is too rapidly drawn off, and the lung is too
suddenly exposed to the pressure of the air. 2. Experience
confirms what a priori might have been expected. Any one
who has very frequently performed the operation, must have
met with cases in which the patient has complained of the
admission of too large a quantity of air, and has only felt at ease
when the opening of the canula has been diminished a third or
a half by sticking-plaster. If such an indication of an intelli-
gent and observant patient be neglected, pneumonia will follow.

3. The author has lost several patients in whom, at the time of
its performance, no signs of pneumonia could be detected, and
who seemed to be going on very well to the tenth or even
twenty-first day. ]S"ot only did no other cause for the devel-
opment of the pneumonia exist, but this was also always found
on the right side this being on account of the greater width
and shortness of the right bronchus more exposed to the impulse
of the air. The disease does no come on actively, but is indi-
cated by some -acceleration of respiration and slight fever.
Physical examination, however, shows that very considerable
infiltration has taken place; and the neglecting to institute this
may be a cause that many pneumonias have been overlooked.

4. Cases of cut-throat, in which the larynx is wholly or partially
divided, also strikingly exhibited the danger of opening into the
air passages, such patients not infrequently perishing in a few
days of pneumonia, this ahvays commenced on the right side,
and in even fatal cases being usually confined to that side. It
may also spring up in smaller wounds of this part, if these be
not kept carefully closed either by sutures or suitable dressings
and bandages.

To the question whether pneumonia after laryngotomy can
be prevented, the answer is, that it can in many cases, but not
in all. For this purpose no wider canula should be employed
than is necessary to maintain uninterrupted respiration ; and as
soon as the patient can breathe freely enough through the mouth,
and can both breathe and speak when its orifice is closed, it
should be changed for a smaller one, or its opening should be
partly closed by plaster. When the breathing continues per-
fectly easy, the canula being stopped, before this is entirely
removed it should be allowed to remain in, completely stopped,
during twentyfour hours, care being taken that it should not

416 Causes of Pneumonia. [June,

project inwardly, so as to narrow the normal passage for the air.
The temperature of the room should never be allowed to sink
below 66^ Fahr.

It is often exceedingly difficult to determine the time when
the canula should be finally removed. After such removal, the
patient may continue to breathe quite easy for from two to
eight days, when the difficulty gradually returns, until it be-
comes as bad as ever. If even a couple of days have passed,
the re-introduction of the canula can seldom be accomplished,
and then only by first passing through the canula a conical obtur-
ator, which can better overcome the elasticity of the edges of the
cartilage. The longer the canula has remained prior to removal,
the more readily may it be re-introduced. The recurrence of
dyspnoea is especially to be apprehended when we have reason
to suspect ulcer of or around the rima, open abcesses, and sinuses
beneath the mucous membrane. Tumefaction rapidly diminish-
es, and the normal permeability is soon re-established; but on
the admission of the stream of air to the diseased part by the
withdrawal of the canula, the former difficulties may soon be
reproduced. Hence, when the diagnosis can be established, the
canula in such cases should be retained during several weeks,
in order to give the surfaces time for healing. According to
Professor Schuh's experience, pneumonia never comes on after
the first twenty-one da}'s are passed, and the canula may then
be worn for months or years without inj ury. On the other hand,
the Professor has lost cases by removing the canula too late,
pneumonia unexpectedly appearing. The sensibility of the lung
to the unusual arrival of air, is especially great when the difficul-
ty of breathing that has given rise to the operation has been of
long duration, and the organ has become enfeebled by venous
congestion and a diminution of the contractile powers of its cells.

In a case in which Professor Schuh performed laryngotomy
in order to facilitate the removal of a large pharyngeal polypus,
the patient who had suffered for months from a difficulty of
breathing, was quite well on the day of the operation. The
canula having, however, been left in during twenty-four hours,
pneumonia was detected by auscultation within this period.

Thus, it results from what has been said, that pneumonia is
sometimes a consequence of breathing through an artificial
opening ; and by due regulation of the size of the volume of
air, the temperature of the room, and the timely removal of the
canula, it may usually be prevented. This, however is not
always the case, for the condition of the patient may require a
long retention of the canula, the lung may be excessively sen-
sible to the changed mechanism, and art has as yet furnished
no apparatus as a substitute for the alternated dilatation and
contraction of the glottis. [Wien Wochensch., and British and
Foreign Med. Chir. Rev.

1858.] Editorial and Miscellaneous. 417

EDITORIAL AND MISCELLANEOUS.

THE AMERICAN MEDICAL ASSOCIATION.

This National Medical Congress of our Republic held its eleventh
annual meeting in Washington, (D. C.,) beginning May 5th, 1858.

The Association met in the Lecture-room of the Smithsonian Insti-
tute, and was called to order at a quarter past 11 o'clock A. M., by Dr.
Condie, of Philadelphia, when the Chair was taken by the President,
Dr. Paul F. Eve, of Nashville, Tennessee. Vice-Presidents, Breckenridge
of Kentucky, Reese of New York, and Campbell of Georgia, were also on
the platform ; and at their table were the efficient Secretaries, Drs. Fos-
ter of Tennessee and Semmes of this city [Washington]. Rev'd Byron
Sunderland, D. D., at the invitation of the President, offered an eloquent
and appropriate prayer, invoking the blessing of Almighty God upon the
Convention.

The meeting was then addressed by Dr. Harvey Lindsley, of Washing-
ton, Chairman of the Committee of Arrangements. His welcome was
warm and open-hearted, and expressed in language chaste, beautiful and
appropriate; and was indeed but the earnest of that abundant hospitali-
ty the members were to receive during their sojourn at the Capital.

The number. of delegates and permanent members present was larger,
we think, than ever assembled on any similar occasion, excepting, per-
haps, the meeting in 1853, held in the city of New York. The names
amounted to over four hundred, on the calling of the roll at the first
session.

On the calling of the roll by the Secretary, State by State, as it had
been made out, up to the commencement of the meeting, the following
number of delegates responded :

Maine 2, New Hampshire, 8, Connecticut 18, Vermont 1, Massachu-
setts 40, Khode Island 5, New York *73, New Jersey 25, Pennsylvania 66,
Delaware 4, Maryland 24, District of Columbia 25, Virginia 8, North
Carolina 8, South Carolina 10, Georgia 12, Alabama 1, Kentucky 0,
Tennessee 7, Indiana 6, Illinois 12, Michigan 3, Iowa 3, Missouri 4, Ohio
14, California 1, American Medical Society of Paris 1, U. S. Navy 2.
[When the name of Dr Harvey, who has come from California expressly
to attend this convention, was called, there was a loud applause.] Other
members were announced at different times during the day, and when
the Association adjourned there were four hundred and six names regis-
tered.

Dr. David M. Reese, of New York, now presented and read a written
apology for having recommended for a position in Blockley Hospitalr

418 Editorial and Miscellaneous. [June,

Philadelphia, Dr. McClintock, who had been expelled from the Associa-
tion for a violation of the ethics and the etiquette of the Profession, by-
lending himself to the quackery of Patent Medicines.

On motion of Di;. Condie, of Philadelphia, the apology was accepted,
and ordered to be entered upon the minutes.

Dr. Bryan, of Philadelphia, who had also recommended Dr. McClin-
tock, made a verbal adoption of Dr. Reese's apology, the reception of
which was warmly debated. Dr. C. C. Cox, of Maryland, opposed, and
Dr. Condie advocated the reception. Dr. A. B. Palmer, of Michigan,
moved the previous question on a motion to refer the subject to a com-
mittee, which was lost. The apology of Dr. Bryan was then accepted.
[It was rumored in the hall that Dr. McClintock will be reinstated during
the session of the Association.]

The President, Professor Paul F. Eve, of Nashville, Tennessee, then
delivered, in a clear voice and with pleasing oratorical effect, his annual
address to the Association. This paper, which is a most able review of
the history of the Association from its beginning to the present time,
most eloquently and conclusively vindicates that body from the charge
of having accomplished but little, and is eminently calculated to inspire
its members with pride in view of what they have accomplished in the
past, and with energy and determined high purpose for the future. It is
fortunate that, by the unanimous action of the Association, such a paper
is to be recorded in the next volume of the Transactions and every
journal should record it, as an encouragement and a stimulus to the
American Medical Profession. It shall be presented to our readers in
our next number, as a separate paper.

Dr. Grafton Tyler, of Georgetown, D. C, chairman of the committee
on prize essays, reported that the essays received were three in number,
each of which had been examined with great care ; considering, first,
the intrinsic merits of each essay, and then their merits in relation to
each other. The first prize was awarded to " an essay on the clinical
study of the heart's sounds, in health and disease," bearing the motto
"Clinica clinice demonstrandum." The second prize was awarded to
" an essay on vision and some of the anomalies as rendered by the oph-
thalmoscope," bearing the motto " Dux kominum medicus est."

Dr. Tyler then proceeded to open the sealed envelopes bearing the
above-named mottoes, and containing the names of the writers of the
essays. The first was written by Dr. Austin Flint, of Buffalo, New York ;
and the second by Dr. Montrose A. Pallen, of St. Louis, Missouri. This
is the second time Dr. Flint has won this distinguished honor, and the
third time that it has been awarded to Buffalo since the association was
organized, eleven years ago.

1858.] Editorial and Miscellaneous. 419

On motion, the report of the committee was accepted and adopted.
Doctors Flint and Pallen were then invited to give resumes of their
essays, which they did, and each of the gentlemen was listened to with
marked attention on the part of the association.

Among other gentlemen, Dr. Peter Parker, ex-commissioner to China,
and assistant-surgeon Frederick A. Rose, of the British Navy, were unani-
mously elected '* members by invitation."

The latter gentleman, Dr. F. A. Rose, of the British Navy, who so no-
bly volunteered his services on boafd the United States ship Susquehan-
na, at Port Royal, and who came in her to New York, devoting himself
to the sick crew, was unanimously elected a "member by invitation,"
and invited to take a seat upon the platform. [Applause.] It was an-
nounced that Dr. Rose had left the city.

Dr. Francis G. Smith, of Philadelphia, chairman of the committee on
publication, made his report, showing the expense of publishing the an-
nual volume.

Dr. Caspar Wistar, of Philadelphia, presented his annual report of
receipts and expenditures, showing a balance on hand of $806. Accom-
panying the Treasurer's report was a resolution providing that the back
volumes on hand, when over two years old, shall be sold at two dollars a
volume, and that volumes V, VII, VIII, and IX, of whieh there are a
surplus, be sold at $5 a set to any member.

A report was made by the committee on nominations, which was ac-
cepted ; and the association then elected the following officers :

President, Dr. Harvey Lindsley, of Washington City. Vice-Presi-
dents, Drs. W. L. Sutton, of Kentucky ; Thomas 0. Edwards, of Iowa ;
Josiah Crosby, of New Hampshire; and W. C. Warren, of North Caroli-
na. Secretary, Dr. A. J. Semmes, of Washington City. [The other
Secretary will be elected when the location of the next association is
selected.] Treasurer, Dr. Caspar Wistar, of Philadelphia.

On motion, Drs. Flint, of New York, Gross, of Pennsylvania, and
Gibbes, of South Carolina, were appointed a committee to conduct the
President elect to the chair.

Dr. Lindsley, having been introduced to the association by the retiring
President, Dr. Eve, made a few pertinent remarks, acknowledging the
honor as the highest he had ever been called upon to receive, and the
highest that any medical man in America can receive. [Applause.]
Unaccustomed to preside over so large a body, and having had but little
practice in presiding over smaller assemblages, he must throw himself
upon the forbearance of the association, and look to the members for
support in the discharge of his official duties. [Applause.]

On motion, the thanks of the association were voted to the retiring
x. 8. vol. xiv. yo. vu 20

420 Editorial and Miscellaneous. [June,

officers for the able and impartial manner in which they have discharged
the duties of their respective offices. [Applause.]

On motion, the ex-presidents of the association present were invited to
take seats on the platform.

The committee on medical topography and epidemics was called by
States. A paper from the member from Maine stated that he will report
next year. There was no response from New Hampshire, Vermont,
Rhode Island, Connecticut, or Massachusetts. Dr. Smith, of New Jer-
sey, read an able report on New Jersey, and the association then ad-
journed until this morning at nine o'clock.

Evening Hospitalities. At eight o'clock in the evening the dele-
gates and the ladies who have accompanied them paid a visit by invita-
tion to the Executive Mansion. The East Room, with the adjacent suite
of drawing rooms, were brilliantly lighted, and were filled by about five
hundred gentlemen, representing all sections of the country, and a hun-
dred or more ladies. One of the delegates had seen upwards of four
score years others have but just entered upon the practice of their
profession.

The President received his guests, as they were successively presented
by Dr. Cornelius Boyle, chairman of the committee of arrangements, with
his accustomed cordiality, and afterwards moved about in the East Room,
engaging in conversation with the gsoups there gathered. The entire
cabinet was present, with J. B. Henry, Esq., Marshal Selden, and Com-
missioner Blake.

From the Executive Mansion the delegates generally proceeded to
Georgetown, where they were hospitably entertained at the residences
of Dr. Grafton Tyler, at the corner of Gay and Washington streets, and
of Dr. Riley, No. 91 Gay street. A cordial welcome and good cheer
awaited them at the houses of each of these distinguished practitioners.

There was a large number of arrivals at the different hotels last even-
ing, and an interesting session may be expected to-day.

SECOND DAY.

The Association was called to order by the President, Dr. Harvey
Lindsley, and A. J. Semmes, one of the Secretaries, read the minutes of
the first days proceedings ; which were adopted.

On motion of Dr. Watson, of New York, Dr. Delafield, of New York,
one of the first officers of the association, was invited to take a seat on
the platform.

On motion of Dr. Atkinson, of Virginia, an amendment to the consti-
tution was received, providing that no person shall be recognized as a
member or admitted as a delegate at meetings of the association who
has been- expelled from any State or local medical association, until re-
lieved by action of such State or local association. [Applause.]

1858.] Editorial and Miscellaneous. 421

An abstract of the report on medical literature was then read by Dr.
A. B. Palmer, of Michigan ; which report was, on motion, accepted and
referred to the committee of publication.

On motion, Dr. N. Bozeman, of Alabama, was elected a member by-
invitation.

The report on medical education was now presented by the chairman,
Dr. James R. Wood, of New York. This is an able and judicious
paper, of which we can at present only give a summary, hoping, in some
future number, to transfer the whole of it to our pages. Dr. Wood, in
our opinion, acted with good judgment, in referring many of the details
of medical education to a convention of professors of colleges. This,
certainly, instead of disfranchising the schools, as was apprehended
might be attempted at the present meeting, is decidedly a step taken
the other way. This measure is the more to be appreciated, coming as
it does, from Dr. Wood, who, though not connected with any college,
knows well how to estimate the exigencies and the requirements of medical
teaching, in our country, from his long and intimate relation to this de-
partment, in the position he has so creditably filled in Bellevne Hospital.

The subjects discussed in this report are the following: 1st, primary
medical schools ; 2nd, the number of professorships in medical colleges ;
3rd, the length and number of tenns during the year ; 4th, the requisite
qualifications for graduation ; 5th, such other subjects of a general char-
acter as to give uniformity to our medical system. Having reviewed
these propositions at length, the committee have arrived at the following
conclusions :

First. Primary medical schools should be encouraged ; but, as office
nstruction will continue to be sought by students, practitioners should
either give them necessary advantages of demonstrations, illustrations,
md recitations, or if not prepared to do so, they should refer them to
such primary schools, or medical men, as will give them proper instruc-
tion.

Second. The number of professorships should not be less than seven
viz : a Professor of Anatomy and Microscopy, Physiology and Pathology,
Chemistry, Surgery, Practical Medicine, Obstetrics, and Materia Medica.

Third. There should be but one term annually, which should com-
mence about the 1st of October, and close with the March following, thus
lengthening the term to six months. The commencement of the term,
in October, should be uniform in all the colleges throughout the country.
During the session there should never be more than four lectures given
daily.

Fourth. The qualifications for graduation, in addition to those now
required by the schools, should be a liberal primary education, and at-
tendance upon a course of clinical instruction in a regularly organized
hospital.

In order to give our medical colleges an opportunity to consider the

422 Editorial and Miscellaneous. [June,

recommendations here advanced, and that this body may have the ad-
vantage of their wisdom and their mature views, before any definite
action is taken upon them, your committee submit to the association the
following resolutions :

Resolved, That the several medical colleges of the United States be
requested to send delegates to a convention to be held at on

the day of for the purpose of devising a uniform system of

medical education.

Resolved, That the present report af the special committee on medical
education be referred to such convention for its consideration.

Resolved, That said convention of delegates from the several colleges
of the United States be requested to submit to the meeting of this asso-
ciation in May, 1859, the result of their deliberations.

On motion, the report was accepted and referred to the committee on
publication, the accompanying resolution being laid on the table.

The committee on nominations reported Louisville, Ky., as the place
of meeting in 1859, and nominated Dr. S. S. Bemis, of that city, as se-
cond secretary. They also nominated the following standing commit-
tees:

Committee on Publication Dr. F. Gurney Smith, Pa., chairman ; Drs,
Caspar Wistar, Pa. ; A. J. Semmes, D. 0. ; S. M. Bemis, Ky. ; S. L. Hol-
linsworth, Pa. ; S. Lewis, Pa. ; H. F. Askew, Del.

Committee on Medical Literature Dr. John Watson, N. Y., chairman;
Drs. L. A. Smith, N. J. ; C. G. Comegys, Ohio ; R. W. Gibbes, S. C. ; W.
M. McPheeters, Mo.

Committee on Prize Essays Dr. J. B. Flint, Kv., chairman ; Drs.
M. Goldsmith, N. J.; H. Miller, Ky.; Calvin "West, Ind.

Committee on Medical Education Dr. G. W. Norris, Pa., chairman ;
Drs. A. H. Luce, 111.; E. R. Henderson, S.C. ; G. R. Grant, Tenn.; T. S.
Powell, Ga.

Committee of Arrangements Dr. R J. Breckenridge,Ky., chairman ;
Drs. G. W. Ronald, B. M. Wible, D. W. Goodall, D. D. Thompson, N.
B.Marshall, G. W. Burglass, R. C. Hewett, and A. B. Cook, all of
Kentucky.

The report was accepted, the nominations were confirmed, and the
committee received permission to sit again.

After considerable discussion, it was decided that the meeting go into
a committee of the whole, to reconsider the acceptance of the apology
presented on the day previous by Dr. Reese.

Dr. T. O. Edwards, of Ohio, now took the chair.

It was now moved, to read the remonstrance of the Philadelphia Medi-
cal Society, in which all the circumstances of the recommendation of
Dr. McClintock by Dr. Reese, and his appointment to office in Blockley
Hospital, were fully set forth.

Dr. Biddle, of Philadelphia, protested against the reading of the re-
monstrance, as a violation of plighted faith.

1858.] Editorial and Miscellaneous. 423

The remonstrance was however read. It was a long document, giving
a detailed account of the recommendation by Dr. Reese of Dr. McClin-
tock for a position in Blockley Hospital, after the last-named gentleman
had been guilty of selling quack nostrums, and had thus committed an
offence against the ethics of the profession.

Dr. Humphries of Indiana, moved that each member of the commit-
tee of the whole be restricted to five minutes, allowing Dr. Reese what-
ever time he wished to defend himself in.

Dr. Phelps showed that a ten-minutes rule was now in force. Dr. Cox
moved, as an amendment, to make the time fifteen minutes ; which
amendment was lost, and the original motion of Dr. Humphries was then
carried.

Dr. Reese then ascended the platform, and made a statement of his
position from the commencement of the controversy. He considered
his apology of the day previous a satisfactory one, but was willing to
make it more so if it was objected to. He had not brought the subject
before the association ; but had been given to understand that if he
made the apology which he had made, the remonstrance would not be
offered. During his remarks there was a demand for the reading of the
apology ; which was read, as follows :

To the Officers and Members of the American Medical Association :
The undersigned, one of the vice-presidents of the American Medical
Association, having during the interval since our last annual meeting,
certified to the professional fitness for the charge of the Blockley Hospi-
tal, at Philadelphia, of an individnal who had been expelled from this
body for a violation of our code of ethies, after consultation with the
other officers, and yielding to the advice of other personal friends, desires
to say to the association now assembled

1st. That in giving said certificate, he was prompted solely by motives
of sympathy and humanity to a fallen brother, who had been a personal
friend prior to his offence ; and that he did not realize, acting under the
impulse of the moment, that hMs individual act could be construed by
the profession as indicating hostility to his brethren.

2d. That while his own mind is clear that his certificate contained
only the truth, and that under his peculiar relations to the party con-
cerned, he could not withhold his certificate, of medical qualification,
consistent with conscience and duty, yet he is ready to concede that
he had no abstract right to relieve the party from the censure of the
association until this body had restored him to his fellowship.

3d. That so far from intending any disrespect to the association, or
to its act of discipline, the undersigned had publicly sustained and de-
fended both. He therefore disclaims the inference from his certificate

424 Editorial and Miscellaneous. [June,

that he intended to recommend to a high professional office a man whom
the association had excluded, and thereby nullify the action of this
body.

And, finally, with these statements and disclaimers, the undersigned,
while retaining his own opinion of the rectitude of his motives, and of
his duty, under the peculiar circumstances of the case, is nevertheless
prepared to defer to the judgment of those whom he knows to be his
friends, that he erred in doing what he had no right to do, in view of his
official position in the association, and is hence called upon to offer this
explanation and apology to his brethren.

(Signed) DAVID M. REESE.

It was moved to refer the apology and remarks of Dr. Reese to a spe-
cial committee of seven, to report to-morrow morning. Dr. Atlee, of Lan-
caster, and other gentlemen urged delay.

Dr. Condie hoped that a committee would be appointed to give the
subject a careful consideration.

Dr. Cox, of Maryland, after complimenting Dr. Reese as an able prac-
titioner and an experienced editor, whose labors have been of great value
to the profession and to the country, said that he did not consider the
statement full and satisfactory. The offence was not an unpardonable
one, but the violation of that code of ethics which is the life of the pro-
fession should be properly atoned for. [Applause.] The apology was
good enough, but it carried as its sting the mental reservation which
Dr. Reese persists in. Nay, in his journal, issued simultaneously with
this meeting, and circulated here, he says : " Having done right in certi-
fying to the labors of our quandam friend McClintock, we resented the
unmerited censures of our Philadelphia brethren." This completely stul-
tifies the effect of the apology.

Dr. La Roche, of Philadelphia, explained his action and that of the
Philadelphia county society in the matter.

Dr. Pain, of Vermont, Dr. Cox, and Dr. Bond made some rather sharp
remarks. Dr. Davis of Massachusetts, thought that Dr. Reese had but
to admit that he had done wrong, and ask pardon without any mental
reservation.

Dr. Reese said that he had intended to make a satisfactory apology.
Such was his earnest wish and desire, and he wished to frankly state
that he had no mental reservation, neither did he attempt to conceal
anything. He made the statement which had been read without reser-
vation and without evasion. [Applause.]

Dr. Conte expressed his entire satisfaction, as did numerous other gen-
tlemen, several crossing to where Dr. Reese was sitting and shaking
hands with him.

1858.] Editorial and Miscellaneous. 425

The committee of the whole then rose, and the chairman reported to
the president that the committee had heard and discussed the apology of
Dr. Reese, and that they considered that it was "ample, full, complete,
and satisfactory."

On motion, the report of the committee was received and adopted.

The case of Dr. Bryan then came up, when it was suggested that his
apology should be in writing, he expressing a willingness to make one as
ample as was that of Dr. Reese..

Dr. Reese then drafted an apology, but several gentlemen insisted
that he should insert the word " regret." Dr. Reese declined, stating
that no gentleman would apologize for that which he did not regret, and
that he would never be dictated to by any gentleman, even if the prison-
door stood open on his right hand, and the stake was at his left hand.

Dr. Wood (who was greeted with loud applause) stated that he had
been with the side which had offered the apology, but he did not con-
sider the apology complete without the insertion of the word " regret."

Drs. Bonner, Clark, of New Jersey, Hard, of Illinois, Parker, of New
York, and other gentlemen participated in an exciting debate on the
necessity of having the word " regret" inserted.

Dr. Reese added the following sentence, " and regrets that he has in-
curred the displeasure of his brethren." This was not favorably received.

Dr. Boyle, chairman of the committee of arrangements, here announ-
ced that arrangements had been made by which delegates who had pur-
chased tickets on their way to the convention over the following roads
could return free by exhibiting their cards of membership : Pennsylva-
nia, Wilmington and Manchester, Illinois, Central, Northeastern South
Carolina, and Richmond and Petersburg.

The apology of Dr. Reese was again taken up, and discussed with
spirit, although there was no manifestation of bad feeling on either side.
At length he presented the following :

" The undersigned regrets that he certified to the professional quali-
fications for Blockley Hospital, Philadelphia, of an expelled member of
this body, and hereby offers this apology for his departure from the
ethical code."

This was received with loud applause, and on motion of Dr. White,
accepted as an ample and satisfactory apology.

Dr. Bryan submitted a similar apology, which was also accepted, and
then the committee adjourned until to-day at nine o'clock, A. M., evidently
well pleased that this question was finally disposed of.

THIRD DAY.

The President, Dr. Lindsley, having called the Association to order at
half-past 9 o'clock, Dr. Grant, of New York, asked leave to present a

426 Editorial and Miscellaneous. [June,

complaint against the New York Medical College, but on information by
Dr. Edwards, that a Committee on Ethics would be recommended by the
Nominating Committee, he withdrew the request.

The appointment during last year of Dr. George Hayward, of Boston^
as a delegate to represent the American Medical Association, in kindred
societies in Europe, was announced by Dr. Eve.

Medical Education. Dr. Hamilton, from the Committee of Delegates
from medical schools and colleges, to whom was referred the report of
the Special Committee on medical colleges, reported the following pre-
amble and resolution:

Fully appreciating the value and importance of the resolution under
which they were appointed, but a majority of the gentlemen constituting
this committee not being authorized by the medical faculties of the sev-
eral colleges with which we are connected to act as their representatives
in this matter, and therefore regarding it quite impossible to secure a
convention of delegates in the interim of the meetings of the association :

Therefore, Resolved, That we recommend to all the medical colleges
entitled to a representation in this body, that they appoint delegates,
especially instructed to represent them in a meeting, to be held at Louis-
ville, on Monday, the day immediately preceding the convention of the
American Medical Association, for the year 1859, at ten o'clock, at such
place as the Committee of Arrangements shall designate.

The report was accepted, and the preamble and resolution were pass-
ed ; after which, several gentlemen claimed the floor, but the president
decided that the reports of special committees were in order, the reports
of committees on Medical Topography and Epidemics having previously
i)een referred to the Committee on Publication without reading.

Dr. Foster Jenkins, of New York, read a report on the Spontaneous
Umbilical Hemorrhage of the newly born ; which was read and referred
to the Committee on Publication.

Marriages of Consanguinity. Dr. S. .M, Bemis, of Kentucky, read
an able and learned report on the " Influence of Marriages of Consan-
guinity upon Offspring.

Stone contributed to the Washington Monument. Dr. John L.
Atlee, from the committee appointed at the annual meeting at Richmond,
in May, 1852, to procure a stone with a suitable inscription to be insert-
ed in the Washington National Monument, made a final report. It
stated that Mr. Haldy, a marble mason of the city of Lancaster, Penn-
sylvania, had in his employment a young man, Mr. J. Augustus Beck, a
native of Litiz, Pennsylvania, who had given unmistakable evidence of
genius as a sculptor. At the suggestion of the late lamented Dr. A. L.
Pierson, of Salem, Massachusetts, (made at the meeting in New York,
just ten days before his death,) the design of the celebrated painting of
Girodet Tricoson, representing Hippocrates refusing the presents of the

1858.] Editorial and Miscellaneous. 427

Persian king, Artaxerxes, and his invitation to leave Greece, and reside
and practise among her enemies, was selected. This was sculptured
upon a block of Vermont marble, with the motto, " Vincet Amor
Patrice" and the stone is now at the monument grounds. The entire
expense was $1,000, of which one half was paid to the young artist.
The amount contributed by members individually was 8501.30; the bal-
ance was voted from the treasury of the society. Accompanying the
report was a letter from the Secretary of the Washington National Mo-
nument Association, and a resolution of thanks to the railroad compa-
nies by whose liberality the stone was brought from Lancaster to Wash-
ington, free of charge. The report was accepted, and the resolution was

Dr. Palmer, of Buffalo, read a report, made by Dr. E. Andrews, of
Chicago, Illinois, on the " Functions of the different portions of the Ce-
rebellum."

Dr. Campbell, of Georgia, read a report on " The Nervous System in
Febrile Diseases," which was accepted, and referred to the Committee
on Publication.

Dr. J. Marion Simms, of New York city, read an abstract of his report
on the "Treatment of the Results of Obstructed Labor," illustrated
with a series of magnified illustrations.

Committees for the ensuing year. Dr. Edwards, from the Commit-
tee of Nomination, offered the following list of committees for the ensu-
ing year, which was accepted, and the committees were chosen :

Special Committee on the Microscope. Drs. Holsten of Ohio, Dal ton
of New York, Hutchinson of Indiana, Stout of California, and Ellis of
Massachusetts.

Special Committee on Medical Jurisprudence. Drs. Smith of New
York, Hamilton of Buffalo, Crosby of New Hampshire, Purple of New
York, and Mulford of New Jersey.

Committee on Quarantine. Drs. Harris of New York, Moriarty of
Massachusetts, La Roche of Pennsylvania, Wragg of South Carolina, and
Fenner of St. Louis.

Committee on Surgical Pathology. Dr. James R. Wood of New
York, chairman.

Committee on Diseases and Mortality of Boarding Schools. Dr. C.
P. Mallengly of Kentucky, chairman.

Committee on thevarions Surgical Operations for the Relief of Defect-
ive Vision. Dr. Montrose A. Pallen of St. Louis, chairman.

Committee on Milk Sickness. Dr. Edward A. Murphy of Indiana,
chairman.

Committee on Medical JEihics. Drs. John Watson of New York, Dal-
ton of Massachusetts, Emerson of Pennsylvania, Hamilton of New York,
and Gaillard of South Carolina.

Dr. Edwards also reported from the Committee of Nomination, the
following resolution, in reference to the restoration of Dr. Bailey :

428 Editorial and Miscellaneous. [June,

Resolved, That a committee of nine be appointed by the chair to wait
on the Hon. Howell Cobb, Secretary of the Treasury, and respectfully to
request the restoration of Dr. M. J. Bailey, as inspector of drugs and
medicines for the port of New York.

Dr. Edwards followed his resolution by an elaborate and eloquent ar-
gument, giving his opinion of the importance of the office of inspector,
and urging that it was obligatory on the association to insist on the re-
instatement of Dr. Bailey, as one eminently qualified to discharge its
duties.

Dr. Tyler, of Georgetown, rose to reply to the remarks of Dr. Edwards,
he acknowledged the important service Dr. Edwards had rendered the pro-
fession in procuring in Congress the passage of the law for the inspection
of drugs and medicines, but when it was proposed to appoint a committee
to wait upon an executive officer of government, and dictate to him, he felt
that it would be turning aside from the purpose for which this associa-
tion was organized.

A rather protracted argument here succeeded, in which substitutes
were offered for the first resolution, and in which the following gentle-
men engaged : Dr. Bolton of Virginia, Dr. Cox, of Maryland, who offered
the following substitute :

Resolved, That the appointment of inspectors of drugs and medicines
in the various ports of the United States, should, in the opinion of this
association, have regard to the essential, moral, and scientific qualifica-
tions of the candidates, and not to considerations of personal favoritism
or political bias.

Dr. Tyler, of Georgetown, supported the resolution of Dr. Cox as a
fair compromise. He believed that the appointment of the committee
would transform the association into a mere political machine, and con-
cluded by strongly urging the passage of the resolution offered by Dr.
Cox. Dr. Dunbar, of Maryland, strongly opposed the resolution of the
Nominating Committee, and asked if it was the duty of that committee
to nominate a candidate for inspector-general of drugs at New York.
[Laughter.] The discussion of this question here became very general,
and rather noisy, the following gentlemen engaging Dr. Bachelder of
New York, Dr. Parker of Virginia, Dr. Wilcox of Connecticut, Dr. Jew-
ell of Pennsylvania, Dr. Wood of New York, Dr. Rodgers of New York,
and Dr. Sayer of New York.

The resolution as amended was then carried by a vote of 79 ayes to
52 noes.

Resolved, That a committee of nine be appointed by the chair to wait
on the Hon. Howell Cobb, Secretary of the Treasury, and respectfully to
request the restoration of Dr. M. J. Bailey as inspector of drugs and
medicines for the port of New York at the same time disclaiming all
political considerations.

1858.] Editorial and Miscellaneous. 429

Dr. Gibbs, of South Carolina, moved that Professor Henry be request-
ed to favor the association with his views on Meteorology, at such time
during the session as he may select : carried.

Dr. Campbell, of Georgia, moved that the Secretary place on record
an expression of the regret with which this association has learned the
death of Dr. Marshall Hall of London, Dr. Claiborn R. Walton of Au-
gusta, Dr. S. W. Granton, Dr. T. Y. Simmons of Charleston, S. C, Dr. J.
K. Mitchell of Philadelphia, and other members deceased, since the last
annual session : carried.

Vote of Thanks. On motion of Dr. Phelps, the following resolutions
were passed unanimously, the members rising :

Resolved, That the thanks of this association are eminently due to the
Regents and Professor Henry, of the Smithsonian Institution, for the
ample and convenient accommodations afforded for the transaction of
business.

Resolved, That the Committee of Arrangements are entitled to our
praise and highest appreciation of their exertions to promote the comfort
of the members and best interests of the association.

Resolved, That to the physicians of Washington and Georgetown and
the faculty of Georgetown College we accord the homage of our sincerest
thanks for their elegant hospitalities extended to the members from
abroad, by which the pleasure of their sojourn here has been so greatly
enhanced.

Resolved, That we feel assured that the impressions on the tablet of
memory received here, in our national metropolis, in this the first year
of the second decade of the association, will long remain an evidence of
the urbane attentions received, not only from the Chief Magistrate and
other public functionaries of our glorious Union, but of private citizens
and the community at large.

Resolved, That the manifestations of union of heart and purpose in the
action of this session, inaugurate a new era, and call for devout acknow-
ledgement to Divine Providence, and presage, as we trust, not only a
bright future for the association, but also as contributing to the perpe-
tuity and prosperity of our great national confederation.

On motion of Dr. Anderson, of New Jersey, it was unanimously re-
solved that the thanks of the medical association be presented to Rev.
Dr. McGuire and his faculty of the College of Georgetown for their very
cordial reception and entertainment of the association at the College
yesterday.

Dr. Arnold, of Georgia, then exhibited specimens of a new method of
medical preparations of some membrane incomprehensible to the report-
er, but which was evidently very interesting to the association.

On motion of Dr. Foster, of Tennessee, it was resolved that after 1860,
Dr. Hamilton have the privilege of using his report on H Deformities after
Fractures," published in the Transactions, for a work which he proposes
to publish.

430 Editorial and Miscellaneous. [June,

Dr. Campbell, of Georgia, was not aware, until he had just heard
permission granted to Dr. Hamilton, that he had trangressed in repub-
lishing in a work a report which he had contributed to the Transactions
of the association. [Cries of " regret it," " regret it."] He did regret it,
and asked the sanction of the society : which was granted.

Dr. Dunbar moved to reconsider the vote appointing a committee to
request the reinstation of Dr. Bailey, and Dr. Morgan seconded it, but
as Dr. Parker had been invited upon the platform, the motion was ruled
out of order.

Dr. Parker's Chinese Hospital. Dr. Peter Parker, ex-commission-
er to China, was then introduced, and was received with applause. He
exhibited some curious specimens of calculi, as the results of thirty-eight
operations upon Chinese. They were of various shapes and composition,
and weighed from a few drachms up to three, seven, and eight ounces,
his description of the operations by which these calculi were removed
was deeply interesting, and it was gratifying to learn that out of the thir-
ty eight patients all but five or six recovered perfect health.

Dr. Parker proceeded to state that he has treated in China, at the hos-
pital under his charge, fifty-three thousand cases. Pictures of the most
curious cases he had brought to this country, and they were on exhibi-
tion in the room below. At no very distant period he hopes to place in
a permanent form the results of his labors, with illustrations. [Applause.]
Among other cases, he had probably performed upwards of a thousand
operations for cataract. On one day he operated in sixteen cases, the
youngest being a mere child, and 'the oldest on old lady seventy-nine
years of age. She came, led by a servant, submitted heroically to opera-
tions on both eyes the same day, and in a fortnight had her sight per-
fectly restored. [Applause.] In acknowledging a vote of thanks, Dr.
Parker said he had among his patients all classes, from members of the
imperial family down to beggars. His greatest difficulty had bee to
persuade his patients that he could not cure all diseases.

Reconsideration of the Dr. Bailey Resolution. Dr. Dunbar
claimed the floor, and urged the reconsideration of the vote appointing
a committee to wait on the Secretary of the Treasury, and solicit the
reinstation of Dr. Bailey.

Dr. Payne, of Virginia, opposed the reconsideration.

Dr. Tyler advocated it, and asked if this association was formed to
wait on executive officers, and to dictate to them who they shall remove,
and who they shall appoint. Many gentlemen around him, he was assur-
ed, had voted for the resolution without due reflection, and he trusted
with confidence in their sober second thought. [Applause.] The press
and the profession, he felt confident, would denounce this association if it

1858.] Editorial and Miscellaneous. 431

entered into the wide field of politics. It was instituted to promote the
great cause of science, not to join issue with government. [Applause.]

Dr. Morgan also advocated a reconsideration. He was not a partisan.
Although he resides in Washington, he has no personal acquaintance
with the President or the Secretary of the Treasury, but he was confi-
dent that they would not have m^e the change without good reason,
and it was not the mission of this association to criticise or to attempt
to change their views.

Dr. Palmer, after stating how little regard he had for the opinions of
the press, inquired as to the present incumbent of the office. Is he capa-
ble?

Dr. Watson, of New York, said that Dr. Bailey had had his circulars
out since his "rotation," and the subject had been twice before the
Academy of Medicine, who have ignored it.

Dr. Burns of Brooklyn, said that he was not a politician, and that he
was a personal friend of Dr. Bailey, but he hoped that the vote would
be reconsidered.

A member from California relates his experience there on a question
as to the superintendent of a lunatic asylum. In his opinion the less
the association had to do with politics, or with expressions of opinion
on political appointments, the better. (Applause.)

Dr. McXulty, of New York, said that the question had been twice
before the New York Academy of Medicine, and twice been voted down.
The present incumbent, whom it is sought to oust, is a German by birth
and education. He can read the invoices in whatever European language
they may be sent, and he makes his own analyses, which it is reported
the ex-inspector did not do.

After some il parliamentary'' skirmishing, it was decided to reconsi-
der by a vote of 51 ayes to 32 noes. And, on motion, the subject was
then indefinitely postponed.

The association then took a recess of two hours, for dinner.

Evening and Closing Session. The association was called to order
at five o'clock, P. M., by Dr. Sutton, one of the vice-presidents, who took
the chair.

The amendment to the constitution, proposed at the annual meeting
at Nashville, had been made the " special order." They were

1st. Amend the third article of the constitution, in relation to meetings,
by inserting after the words " first Tuesday in May," the words kk or the
first Tuesday in June ;" and also inserting after the words M shall be de-
termined," the words " with the time of meeting." 2d. In article 2,
omit the words "medical colleges," and also the words "the faculty of
every regular constituted medical college, or chartered school of medi-
cine, shall have the privilege of sending two delegates."

432 Editorial and Miscellaneous. [June,

Each amendment was separately discussed, and each was lost by a
large vote. An amendment proposed at Philadelphia in 1856 providing
for ihe establishment of a permanent secretaryship, was lost by a vote of
53 ayes to 84 noes.

On motion of Dr. Foster, of Tennessee, the secretary was directed to
collect all the by-laws, and have the^i printed in the next volume.

An attempt was made to introduce a motion endorsing the accoustics
and ventilation of the new Capitol extensions, but it was ridiculed by Dr.
Sayer, and was withdrawn.

Various additional votes of thanks were passed, and, at ten minutes of
seven, the association adjourned sine die.

The account of the 11th aunual meeting presented in the foregoing
pages, we have condensed mainly from the very accurate report found
in the Daily Washington, Union, adding such passing comments as the
performance of the hurried task would allow. Many of the measures
therein developed, receive our hearty approval, while others, did we have
time and space, would have received from us, comments conveying a
far different opinion.

Whatever may be our opinion of the deliberations of the association,
all are constrained to admit that it has vindicated its power and influ-
ence in the profession all over the land, and the opinion which we ex-
pressed some months ago, that " to trangress its wise and benevolent
counsels is to suffer loss of position," could not have been more fully
verified, than by the results of the session just closed at Washington.

Books, Journals, and Pamphlets received. "We have received a large num-
ber of Books, Pamphlets and Journals, besides communications for our own pages,
the notices of which, together with almost our entire miscellany, have been ex-
cluded by the space devoted to the minutes of the annual meeting of the Ameri-
can Medical Association. We shall endeavor to do justice to these works in our
next issue.

Coffee and Lemon Juice in Ague. M. Von. Holsbeek draws attention
to a mode of treatment he has found useful. Infuse an ounce of well-
roasted coffee in three ounces of boiling water, and having strained the
fluid, acidulate it with lemon-juice. The whole is given at once, five
hours before the paroxysm. ' Presse Beige,1 and Med. Times and Gaz.

Local Application in Eczema of the Face in Children. Dr. Behrend
in a note on the treatment of eczema, recommends the employment of
the following combination as a remedy for the numerous scales which
frequently cover the face of children : Cod-liver oil, half an ounce ; car-
bonate of soda, half a drachm. Mix. Gaz. Hop, and Dublin Hospital
Gazette.

1858.] Editorial and Miscellaneous. 433

A New Anaesthetic. The subject of the following letter we deem of such deep
interest, in a surgical point of view, that we have inserted it, although we have
not space for those comments which its great importance evidently demands.
Should electricity take the place of chloroform and amylene, in Surgery, how
incalculable will be the result of the experiments here detailed.

Electricity in Extracting Teeth. By D. S. Cuase, M.D., D.D.S., of Augusta, Ga.

To the Editors of the Southern Medical and Surgical Journal :

Gentlemen, HaviDg been experimenting with electricity in some of the more
painful operations of Dental Surgery, and believing the subject to be new to
most of your readers, I send you, in a few lines, the result of my observations
made in extracting more than fifty teeth, for different persons, within the last
two weeks.

The Eirst Case in which I tried it, I removed seven teeth, all firmly set five
molars and two cuspidati or eye teeth. In extracting the first tooth, too much
electricity was applied, and the patient complained of pain from the shock, but
not from the removal of the tooth. In the second tooth too little was applied,
and the tooth itself gave pain. After this, we were able to regulate the quanti-
ty, so that neither the electricity nor the extraction of the tooth gave much pain.
Patient not at all nervous, and frequently expressed herself highly pleased with
the operation. The feeling experienced during the extraction of the teeth, as
she expressed it, was a benumbing sensation about the tooth, which appeared to
be attached only to the gum.

Second Case. Extracted six teeth. Patient somewhat debilitated from previ-
ous suffering with her teeth, and quite nervous. Suffered considerable pain
during the operation, but would not allow one to be extracted without electricity.

Third Case. Extracted four teeth. Patient suffered but little pain.

Fourth'' Case. Extracted a molar tooth, that had been previously broken, for a
highly intelligent gentleman from a neighboring village. He was much pleased
witli the operation, and was very enthusiastic in his praises of electricity as
applied to Dental Surgery.

Fifth and last Case, that I will report at present Extracted ten teeth for an
elderly lady. Expressed no fear during the operation, and seemed to treat the
affair as a mere trifle, which might be attended to any morning, without much
inconvenience.

The general expression by those who have tried it, seems to be in favor of
electricity in extracting teeth.

In some of the cases mentioned above, the gums were lanced by the same pro-
cess, by connecting one pole of the battery with the handle of the lancet, while
the patient held the other the hand of the operator being protected by a silk
glove.

I would here suggest that electricity may prove a valuable agent in the hands
of the sprgeon, in mitigating the pain of surgical operations. Who will try it?

The machine in use by myself, at the present time, is the compound magneto-
electric machine, the same as used by physicians for medical purposes ; but I
have no doubt that voltaic or galvanic electricity will answer the purposes of the
surgeon, better than the magneto-electric current, as the shocks of the former
follow each other in such rapid succession, as to appear like one continuous
current, while the latter is more or less interrupted, causing some trembling, and
jerking of the muscles.

434 Editorial and Miscellaneous.

How to keep Rooms cool in Summer. Lord Rosse has denied the
absurd prediction, that the approaching summer will be an extraordina-
ry hot one. Still, it may be well that medical men should be forearmed
with the means of cooling their own and their patients' rooms. A flat
vessel rilled with water, and on which are floated branches of trees
covered with green leaves, is a very pleasant and efficacious means, and
is much employed in Germany. The suspension of Indian matting,
previously damped, at the open window, tends much to diminish the
heat. The matting may be imitated by any kind of plaited glass.

London Lancet.

Pressure in Phlegmasia Dolens. In relating the case of a young woman
who had suffered from phlegmasia dolens, and in whom the superficial
veins continued much swollen, M. Trousseau cautioned his pupils against
applying in similar cases firm bandages. The deep-seated veins being
obliterated, this enlargement of the superficial ones is a necessary conse-
quence, and compressing them by a firm bandage would completely in-
terrupt the circulation of the limb. A moderate degree of pressure,
however, is admissable, as giving support to the walls of the superficial
vessels, and preventing their becoming varicose. Ibid, and Med. Times
and Gazette.

Death of Dr. R. Q. Dickenson. We deeply regret that it becomes
our duty to record the death of our worthy and now lamented friend,
Dr. R. Q. Dickenson, of Albany. The following notice, we (for want of
space and on account of its late arrival) have been obliged to condense
from a well written sketch prepared by one, who, like ourselves, knew
him well and loved him well.

Obituary. Died, recently, in Albany, Baker county, Dr. Roger Q.
Dickenson, aged 61 years.

Dr. Dickenson was born in Spottsylvania, Virginia, and was a graduate of the
University of Pennsylvania of the year 1826. He was one of the oldest and most
successful practitioners in our State, having been for more than thirty years en-
gaged in the humane and benevolent ministrations of our Profession. Some five
years ago he was elected President of the Medical Society of the State of Georgia,
the duties of which post he discharged with dignity and honor. None enjoyed
the annual meetings more than he did, for his heart and soul were fully enlisted
in every measure which could advance and elevate the Medical Profession. The
medical men of his own community will feel, sensibly, his loss : there, he was
personally and intimately known. Being the oldest physician in the community,
he was revered and honored by them all ; his kind and gentle manners won their
hearts, and they must feel that, in the death of their elder brother, each has lost
an able counsellor a kind and warm hearted friend.

Albany, Dougherty Co.. Oa., May 20th, 1868. S. S. C , M.D.

SOUTHERN

MEDICAL AND SURGICAL JOURNAL.

(NEW SERIES.)

Vol. XIV.] AUGUSTA, GEORGIA, JULY, 1868. [No. 7.

*

ORIGINAL AND ECLECTIC.

ARTICLE XV.

Observations on Malarial Fever. By Joseph Jones, A.M., M.D.,
Professor of Physics and Natural Theology in the University
of Georgia, Athens ; Professor of Chemistry and Pharmacy in
the Medical College of Georgia, Augusta ; formerly Professor
of Medical Chemistry in the Medical College of Savannah.

[Continued from p. 398 of June No. 1848.]

In the preceding article we stated briefly, some of the difficul-
ties attending pathological' and physiological investigations, and
acknowledged the imperfections of the present researches. We
are about to present numerous analyses of the urine ; and before
doing this, we would candidly acknowledge the sources of error
in attempting to determine the amount of urine excreted during
any stated period, as 24 hours. When the bowels are frequently
moved, it is almost impossible to ascertain, even approximately,
the amount of urine excreted.

When the patient is delirious, and passes his urine and feces
in the bed, it is impossible to ascertain either the amount or
character of the urine. Even when the bowels are not moved,
and the patient retains his faculties and a considerable amount
of strength, it often happens that, during the night, the nurse
will neglect to attend to the passage, and preservation of the
excretions in the proper vessels.

It often happens, from a combination of such circumstances,
that the urine of the most fatal, important and interesting cases
escapes our examination.

These difficulties, in hospital investigations, cannot readily be
overcome, and will often invalidate the conclusions drawn from
individual cases. Our duty, then, is to obtain as wide an induc-
tion of facts as possible, and thus eliminate or equalize, as far as

N. 8. VOL. XIV. NO. VII. 21

436 Jones, on Malarial Fever. [Jutyj

possible, the errors, and draw our conclusions, not so much
from individual cases as from the whole assemblage of facts.
From our copious notes on "more than two hundred cases of
malarial fever, we have determined to present a condensed
statement of those which presented points of interest to the
physiologist, pathologist and practitioner of medicine.

Our limits will not permit us to enter into a minute account
of the method of analyzing the urine. In view of the numerous
excellent treatises upon this subject, accessible to all, this would
involve an unnecessary consumption of space and time. We
will simply state the method, with full references to the appro-
priate authors.

The urea was separated in the form of the nitrate,^) and

(1) Lehmann's Physiological Chemistry, Eng. Ed., vol. i., p. 159. Amer. Ed.,
vol. i., p. 149.

Mitscherlich in Annalen derPhysik und Chemie, Von Poggendorff, Bd. 31, S. 303.

Kidneys and Urine, by J. J. Berzelius. Translated by Boyle & Learning, M.D.
Philadelphia, 1843, pp. 66-83.

Hand Book of Chemistry, by Leopold Gmelin. Translated by H. Watts, Cav.
Soc. pub. London, 1852. Vol. vii., p. 363.

Simons Chemistry of Man. Philadelphia, 1846, p. 39*7.

Becquerel's & Rodier's Pathological Chemistry. Trans, by Speer. Lond. 185*7.

The student of medicine desirous of entering into similar investigations upon the
urine and blood, will find not only all the details of anatysis, but also invaluable
information in the following works and articles: Anleitung zur Qualitativen
und Quantitativen Zoochemischen Analyse, Von E. Von Gorup Besanez. Nurn-
berg, 1854. Anleitung zur Qualitativen und Quantitativen, Analyse des Harns,
Von Carl Neubauer. Wiesbaden, 1854. Heintz: Lehrbuck der Zoochemie. Ber-
lin, 1853. Schlossberger : Lehrbuch der Organischen Chemie mit besonderer,
Rucksicht, auf Physiologie und Pathologic Stuttgart, 1854. Robin et Verdeil :
Traite de Chimie Anatomique et Physiologique, ou des Principes immeditas Nor-
maux et Morbides que constituent le Corps de l'Homme et de Mammiferes. 3 vols.
Paris, 1853. " A Course of Practical Chemistry," arranged for the use of Medical
Students, by Wm. Ordling, M. D.. London, 1854. Bird, on Urinary Deposits.
Philad. 1854. Bowman's Medical Chemistry. Philad. 1855.

For Leibig's valuable memoir " On Certain Urea Compounds, and a new me-
thod of determining the Chloride of Sodium, and the Urea in the Urine," see
Ann. der Chem. und Pharm., vol. lxxxv., pp. 289-328. See translation of this
memoir in vol. vi. of the Quarterly Journal of the Chemical Society. Limpricht,
on the Influence of Allantoin on the determination of Urea by the method of
Liebig. Ann. der Chem. und Pharm., vol. lxxxvii., p. 99.

Kletzinsky, " On the Comparison of the Values of the Different Methods of
Determining the Quantity of Urea." Heller's Archiv. fur Chem. und Mikrosk.,
p. 252. Jahrgang, 1853.

" A New Method of Determining the Amount of Urea, by Dr. E. Davy." Phil.
Mag., June, 1854. Medico-Chir. Rev., Oct. 1854. "The Detection and Estima-
tion of Urea, by Ragsky." Ranking's Abstract of Med. Sciences, 1845. Part II,
p. 90. Beitrage zur Kenntniss der Urinabsonderung bei gesunden. Inaugural
Abhandlung. Von Aug. Winter. Giessen, 1852. Beitrage zur Kenntniss der
Urinabsonderung bei Gesunden schwangern und kranken Personen. Inaugural
Abhandlung. Von Friedr. Mosler. Giessen, 1853. Klinische Untersuchungen
uber den Stoffwechsel, bei gesunden und kranken menschen uberhaupt und den
durch den Urin insbesondere. Von Prof. J. Vogel. Gottingen, 1853. Studien
zur Urologie. Von Dr. F. Fr. Beneke. (Archiv. des Vereins fur gemeinschaft-
liche Arbeiten. Band i., Hefte 3 and 4.) Gottingen, 1853.

1858.] Jones, on Malarial Fever. 437

every care was taken to secure accuracy in the results. The
amounts of the constituents in all these analyses, from the causes
previously stated, will be under-rated, and never over-rated.

The urine was always analyzed a short time after its passage.
This precaution is necessary in a warm, moist climate, like that
of Savannah. In the heat of summer the urea is often, espe-
cially in the urine of convalescence, rapidly decomposed into
carbonate of ammonia. In one case of malarial fever, where
the patient was suffering with a stricture and irritation of the
bladder, every trace of urea disappeared from the urine in
twelve hours.

I have endeavored, scrupulously, to exclude from these pa-
pers, every analysis the result of which was influenced by
changes, in the urine, subsequent to its excretion by the kidneys.
Uric acid was determined in the usual manner, by precipitation
with hydrochloric acid.

The inorganic matters of the urine were determined accord-
ing to the simple and accurate method of M. Lecanu. The
amount of the coloring and extractive matters was obtained by
substracting the weights of the urea, uric acid and inorganic
matters, from the solid matter of the urine, carefully and accu-
rately determined.

The analyses of the blood were conducted according to the
method previously described by the author.

Case IX. October 9th, 8 o'clock, P.M. Seaman : age 40,
height 5 feet 10^ inches, weight 170 lbs. Auburn hair, blue
eyes, florid complexion ; sanguine temperament ; well developed
muscular man. Native of Sweden. Has been in New Orleans,
Panama, and other southern ports, but has never been sick be-
fore.

This is his first trip to Savannah ; has been sleeping on the
bay; was taken with chill and fever two days ago, and has
suffered much with painsin his head. Yesterday vomited bile.
Tongue slightly coated with white fur. Now his skin is in a
good perspiration. Twenty minutes ago, his skin felt very hot
and dry to the touch. Supposing that his temperature was
several degrees above the normal standard, I hastened to the la-
boratory to obtain my thermometer ; I was detained twenty
minutes, and when I returned, to my surprise, his skin felt moist
and cool under the hand, in comparison with the previous ob-
servation.

438 Jones, on Malarial Fever. [July,

Pulse 86 ) Temperature of Atmosphere, 72 F.

[ " " Hand 100

Respiration. ..23 ) " under Tongue 10175'

The rise of the thermometer in his hand (the hand as usual was kept carefully-
closed around the bulb,) was irregular. It rose to 100, and at this point was
stationary for several minutes : it then fell gradually to 98, and again rose gra-
dually to 100. In this case we see that the reduction of temperature was
simultaneous with the relaxation of the skin and flow of perspiration.

Is the remission of the fever due to the restoration of the
functions of the sudoriparous glands, which collectively expose
a surface of tubing 1,570,000 inches, or nearly 28 miles in
length? Is the morbific agent, or agents, which have disturbed
the chemical actions and correlation of the forces eliminated by
these glands?

If the intermission is due to the restoration of the functions of
the sudoriparous glands, what excited them to action ? Is the
phenomena connected with the nervous system alone, or with
chemical and physical changes in the structure of the morbific
agents, and of the blood and secretions and excretions ? If the
reduction of temperature be not dependent upon the restoration
of the functions of the sudoriparous glands, what retarded the
chemical actions by which the physical forces are generated?
If the chemical actions developing an unusual amount of heat
were excited by the introduction of foreign elements, may not
the foreign elements themselves have entered into these chemi-
cal actions, and been so altered, that they have been for a time
rendered inert?

That a special end is accomplished, in malarial fever, by an
elevation of temperature is proved by the fact that the cases
which manifest the highest temperatures, are as a general rule
attended with little or no danger, whilst in those cases, as con-
gestive fever, where there is a depression of temperature, the
danger is always imminent.

It is true that the sudoriparous glands have much to do with
the regulation of the temperature for the water which they elim-
inate from the blood during its evaporation, abstracts one thou-
sand degrees of heat from the surface of the body and the
surrounding atmosphere. This heat is expended in the mecha-
nical action of keeping asunder the particles of water, and is
hence insensible to the thermometer.

The experiments of Dr. South wood Smith, (2) at the Phoenix
Gas Works, and of MM. Berger, Delaroche, (3) Fordice, Blag-
den, (4) and others, (5) have shown that when animals and man

(2) "Philosophy of Health," vol. II. pp. 391396.

(3) " Experiences sur les Effets qu'une forte Chaleur produit sur l'Economie."
Paris, 1805, and Journal de Physique, tomes lxxiii., lxxi., et lxxvii.

(4) "Philosophical Transactions." 1775. .

(5) Magendie's Experiments upon the Influence of Hot air on Animal Life.
Ana. Jour. Med. Sciences, January 1845, p. 183.

M. Constantine James, on the effects of the hot moist air of the baths, or

1858.] Jones, on Malarial Fever. 439

were subjected to great external degrees of heat, the tempera-
ture of the body was regulated by the evaporation from the
surface of the skin and lungs. When the air was dry, individ-
uals were able to endure, for a considerable length of time, a
temperature of from 250 to 350 degrees, without injurious ef-
fects, and without any great elevation of temperature. The
loss of water from the surface of the body was correspondingly
great, and by its evaporation maintained the temperature of the
interior at the normal standard. If, however, this evaporation
be interfered with, by saturating the air with aqueous vapor, the
temperature rose rapidly, and the individuals died in a short
time.

The rapidity and force of the circulation and respiration also,
have much to do with the increase or diminution of temperature
in the active stages and in the intermission of malarial fever. This
will be established in future by numerous examples.

Examination of Urine passed one hour after these observations, when the sweat-
ing stage was fully established. Reddish orange color, scant. Reaction acid.
Specific gravity, 1028.

1000 parts of Urine contained:

UnVAcid\\\\\\\\\\\\\\\\'20^6U^e imo"nt * lr.on Weired to be
Fixed Saline Constituents. .16-245 ) shShtly lnci>eased-

Microscopical Examination. After 18 hours, no deposit, reaction still acid.
After 60 hours, a light yellow deposit of a few prismatic crystals of triple phos-
phate, and numerous globular acicular crystals of urate of ammonia, and small
globular and elongated vegetable cells and vibrones.

When this deposit was treated with hydrochloric acid, numerous crystals of
uric acid appeared under the microscope.

Has no pain upon pressure of epigastrium, but has a tendency to vomit.

fy Apply sinapism to epigastrium. Calomel grs. xij., sulphate of quinia grs.
vi., mix ; administer and follow with castor oil in four hours. As soon as fever
intermits, give sulph. of quinia grs. v. every three hours, up to grs. xx.

October 10th, 1 o'clock, P.M. Medicine operated well ; much
better, sitting up; skin and tongue normal; pulse 64; respira-
tion 24. Has taken 20 grains of sulphate of quinia.

I> Quassia and soda. Full diet.

8 o'clock, P.M. Had a chill one hour ago, which lasted thir.

stoves, of Nero, at Pozzuoli, Gazette Medicale, 27th Avril, 1844. "W. F. Edwards

on Animal Heat. Cyclopedia of Anatomy and Physioloy, vol. ii. pp. 649 684.

John Davy, on Animal Temperature. Philosophical Transactions, 1814. Edin-
burgh Philosophical Journal, Jan. 1826. See also, Researches Physiological and
Anatomical, by Dr. John Davy, London, 1839, vol. i. pp. 141 248. Experi-
ments of Tillet and Duhamel. -experiments on the servants of a baker at Roche-
foucault in Angoumois. Mem. Acad. Scien. pour 1764, p. 186, et seq. Experi-
ments of Dobson at Liverpool ; Phil. Trans, for 1775, p. 463, et seq. Observations
on the effects of High Temperatures, by Bell of Manchester. Manchester Mem.
vol. i. p. 1, et seq. Currie on application of Water at different Temperatures.
Phil. Trans, for 1792, p. 199, et seq. Experiments of Delaroehc, Jour. Phys. t.
lxiii. p. 207. Nicholson's Journ., vol. xvii. p. 142. 215. Jour. Phys., t. lxxi.'p.
289, and t. lxxvii. 1. Lavoisier on Transpiration, Mem. Acad., pour 1790. John
Reid on Respiration, Cycloped. of Anatomy and Physiology, vol. iv. pp. 325 368.

440

Jones, on Malarial Fever.

[July,

ty minutes. His extremities are just recovering their normal
temperature, $ As soon as fever remits, give sulph. of quinia
up to grs. xx. Urine light orange color, scant and concentrat-
ed. The amount was not determined on account of the action
of the medicine.

October 11th, 11 o'clock, A. M. Had fever all night, and
vomited three times. Fever intermitted this morning, at 4
o'clock, A.M. Suffered greatly with pain in his head during
the fever. This moderated greatly after the subsidence of the
fever. No tenderness of epigastrium; tongue clear and a little
redder at its tip and edges than normal.

Pulse 70. Respiration 20. Has taken 10 grains of sulph. of quinia this morn-
ing. ~fy Continue sulph. of quinia up to grs. xxv. Diet, beef soup and tea.

Urine passed during fever, of a deep orange color. Specific Gravity 1020.
Reaction decidedly acid.

Amount of Urine passed during the last 15 hours, 10200 grains.

" hourly " " " 680 "

Calculated amount of Urine for 24 hours, 16320 "

Urine excreted in
15 hours, grs. 10200
contained, grs.

ANALYSIS IX.

Calculated am't of Ui ine
for 24 hours, grs. 16320,
contained grs.

1000 parts of
Urine contain-
ed,

Uric Acid,. . .

Fixed Saline

stituents. . ,

Con-

0-800
9*7-000

1-280
155-200

0-078
9.509

We see that, notwithstanding the diminution of the uric acid
under the action of the sulphate of quinia, the chill and fever
returned.

After standing 40 hours, the urine let fall a moderately heavy
deposit of triple phosphate and vegetable cells.

Oct. 12th, 11 o'clock A. M. Says that yesterday afternoon,
between the hours of 3 and 6 o'clock P. M., he "had cold chills
running over his body, which did not, however, amount to a
regular shaking chill." These chilly feelings were not followed
by fever, but by a profuse sweat.

Pulse 76. Respiration 20, soft and gentle. Tongue clean ; skin moist and cool.
fy. Quassia and soda. Snake-root tea. Full diet.

Urine passed during the last 24 hours of a deep orange color, with a heavy
light-yellow deposit of triple phosphate and vegetable cells. Sp. Gr. 1020.
Amount passed during the last 24 hours, grains 12,240

(I it

hourly, "

510

ANALYSIS X.

Urine excreted in 24 hours,
grs. 12,240 contained grs.

1000 parts of Urine
contained

Uric Acid,

1-200
48-000

0-098

Fixed Saline Constituents, . .

3-921

The uric acid is still far below the normal standard.

8 o'clock P. M. Has no fever ; skin moist and cool ; pulse
regular. Urine orange colored, and of high specific gravity.

Oct. 13th, 11 o'clock, A. M. Up and dressed. Says that he
"had no fever last night, but did not rest well ; his dreams trou-
bled him. After rising this morning suffered with vertigo, and

1858.] Jones, on Malarial Fever. 441

vomited mucus." Tongue normal ; skin cool ; pulse 60 ; respi-
ration 16.

Amount of Urine passed during the last 15 hours, grains 4136. J Orange color'd.

Calculated amount for 24 hours, " 6617. >- Specific gravi-

Amount of Urine excreted hourly, ' 275.7 ) ty 1034.

Reaction, after standing 15 hours, decidedly alkaline. N05 and Hcl. produced
a powerful effervescence by the liberation of the carbonic acid from the carbon-
ate of ammonia resulting from the decomposition of the urea. Up to this time
the reaction of the urine, after standing the same length of time, has been acid.

Uric acid in urine of 15 hours, (grs. 4136) 0'800

" " Calculated amount of urine for 24 hours, (grs. 6617) 1.280
" 1000 parts of urine, 0193

A few hours after its deposition the urine let fall a heavy light-yellow deposit
of penniform and prysmatic crystals of triple phosphate and globular and elonga-
ted vegetable cells. The weather has been damp and cloudy for two weeks, and
the wards of the hospital are crowded with patients, and this will account for the
rapid propagation of these vegetable organisms. This patient left the hospital
on the succeeding day.

Case X. October 5th, 11 o'clock A.M. American seaman,
age 16 ; weight 125 lbs. ; light brown hair, blue eyes, florid
complexion ; sanguine temperament. From cutter Taney, which
has been lying at the ship-yard in the low lands east of the city.
Four nights ago he slept on the Savannah river in an open boat.
Has not felt well since, and thinks that this was the cause of his
sickness. The next morning he felt badly ; had pains in his
bones and back, but no chill. These uncomfortable feelings
were followed by fever, which intermitted yesterday morning.
This morning he had a slight chill, followed by fever.

Has high fever now. Xo tenderness upon pressure of epigastrium, Pulse 120.
Respiration 40.

Temperature of Atmosphere, 72 F. ) Skin hot, dry and pungent to the

" " Hand, 10575' > hand; lips parched and dry ; tongue

" under Tongue,. .. . 106 ) red, dry, and rough to the feeling.
Reaction of saliva acid.

Here is a bounding, rapid pulse full, heaving, rapid respira-
tion, and a correspondingly high temperature. These symp-
toms, together with the hot, pungent skin dry, parched lips
red tongue, and flushed face, although striking, as a general
rule, should never alarm the practitioner, as long as they are
not complicated with obstinate vomiting, or cerebral symptoms.

In cases of malignant (congestive) malarial fever, on the other
hand, there is, as far as my observations extend, a want of co-
ordination between the actions of the circulatory and respiratory
systems, and the rapidity and character of the chemical changes.
The heart attempts to propel the blood it beats rapidly, (flut-
ters 140 to 160 times in a minute,) but the blood does not flow
readily through the capillaries, because the chemical changes are
in a great measure arrested, and in many cases perverted. In the
present case, on the other hand, there is a correspondence in all
the actions, the rapid circulation and respiration are attended with
correspondingly rapid -chemical changes and high temperature.

442

Jones, on Malarial Fever.

[July,

R; Calomel grs. viij., castor oil in 4
hours, fy Bicarbonate of potassa, 3iv.
Citric acid 3ij., water ffxxiv., mix and
drink ad libitum during fever. Diet
Gruel and flaxseed tea.

$: As soon as fever remits, give sulp.
of quinia grs. v. every three hours, up
to grs. xx.

October 6th, 1-J- o'clock, P. M. Says,
that he is much better, feels very well,
and has no pain anywhere. Medicine
operated twice, freely. No tenderness
upon pressure of epigastrium. The fe-
ver intermitted last night, and he rested
well. Tongue moist, soft, and clean;
papillae slightly enlarged and distinct;
skin moist and relaxed. Pulse 64. Res-
piration 20.

Temperature of Atmosphere, 73 F.

" Hand 945'

" under Tongue 99

Urine light orange color. Sp. Gr. 1022.
Reaction of saliva acid. Has taken 15
grs. Sulph. of quinia.

R; Sulph. of quinia grs. v.

October 7th, 1 o'clock, P. M. Deci-
dedly better, up and dressed. Tongue
clean and normal. Pulse 62. Respira-
tion 20.

Temperature of Atmosphere, 72 F.

" " Hand 9475'

" under Tongue 9920'

fy Snakeroot tea, tablespoonful every
four hours.

ty Quassia and soda. Full diet.

Amount of urine passed during the
last 24 hours, grs. 8240. Sp. Gr. 1030.
Am't of urine passed hourly grs. 343-3.
Reaction acid when first voided. In 16
hours the reaction changed to alkaline,
and a heavy light yellow deposit was
thrown down.

Octr. 8th, 2 o'clock, P.M. Continues
to improve. Tongue and skin normal.
Pulse 52. Respiration 24.

Temperature of Atmosphere, 73 F.

" " Hand 982'

" under Tongue 995'

Ri Continue quassia and soda.

Amount of urine passed in the last 24
hours, grs. 8721. Sp. Gr. 1026. Amount
of urine passed hourly, grs. 363.3. Re-
action changed from acid to alkaline in
14 hours . The patient states that he
ordinarily drinks but a small quantity
of water, and hence the concentrated
state of his urine.

Spec. Gravity
of Urine.. .

Urine excret-
ed hourlv . .

Urine excret-
ed in
24 hours. . .

to *

o o

ec eo
o <>
co eo

JT- OS

oo o

Temperature
under
Tongue. . . .

Temperature
of
Hand

O O

1Q 1Q

o o

os cs

OS Ci

O O

OO CO
OS OS

Temperature

of
Atmosphere. .

Respiration . .

o o o

CO <N CO CO
- .C- - -

Pulse

o

Hour of Day .

wo
5j5

Sb&D

2 *

IM53 8.

i ' " c -^ :

'do '

(L, 2

Day#of Month g

Month.

1858.] Jones, on Malarial Fever. 443

October 9th, 12 o'clock, M. Has been walking about the
Hospital grounds. Pulse t -piration 24.

Amount of urine passed during the last 24 hours, grs 15912

" hourly " 663'8

Reaction alkaline in 10 hours. In 16 hours threw down heavy light yellow-
deposit Sp. Gr. 1024.

The foregoing table (Case X., Table 3,) will give a condensed
view of the phenomena.

Case XI. American seamaq, native of Maine; weight 140
lbs. height 5 feet 8 inches; age 19; light hair and blue eves;
fair complexion. Has been in Savannah for three weeks. Was
taken with chill, followed by fever, yesterday at 12 M. Had
another chill this morning at 4 o'clock A. M.

October 10th, 11 o'clock A. M. Has a high fever now, and
complains of pain in his head and bones. Skin Very hot, but
moist. Pulse 112 ; respiration thoracic, labored ; tongue slight-
ly coated with fur.

fy. Calomel grs. x, Sulph. of quinia grs. vi. Mix, and administer immediately,
and follow with castor oil in four hours, fy. Soda powders.

7 o'clock P. M. The fever still continues unabated. Pulse
and respiration still greatly excited. Urine clear orange color-
ed. The urine excreted during the febrile excitement of the
milder forms of malarial fever, is generally of a lighter color than
that of the intermission, or of remittent fever. Specific gravity
1022. Xitrate of urea clear, silvery. Eeaction of urine decided-
ly acid.

Amount of urine excreted during the last 10 hours, grains 9198.

Calculated amount for 24 hours, '* 22075.

Hourly amount of urine excreted, " 919.

ANALYSIS XL

Urine excreted in
10 hours, grs. 9198
contained grains

Calculated amount of

urine for 24 hours, grs.

contained grains

1000 parts
of urine con-
tained

Urea,

222-520

3-960

87-300

534-C4S

9-504

209-520

24-843

Uric Acid,

0*430

Fixed Saline Constituents,

9-492

Microscopical examination of this urine which was excreted during high fever.
After standing 72 hours the urine still retained its acid reaction. After standing
72 hours, there was a small cloudy, mucus-like deposit. Under the microscope,
this consisted of nothing but vegetable cells.

October 11th, 1 o'clock P. M. Medicine operated freely. Com-
plains of great weakness. Still has pain in his head. Tongue
moist, soft, and slightly coated with white fur. Papilla? red, en-
larged and distinct. Skin cool and moist. Pulse 74. Respira-
tion 26. Has taken 10 grains of the sulph. of quinia.

fy. Continue sulph. of quinia up to gr& xx. Diet, beef soup, gruel and tea.
On account of the action of the medicine, the whole amount of urine was not pre-
served. Specific gravity 1027. After standing 36 hours, its reaction changed
from_acid to alkaline, and a moderately heavy deposit of vegetable cells, with a

444

Jones, on Malarial Fever.

[July,

few crystals of triple phosphate and urate of soda, were thrown down. Hydro-
chloric acid showed the presence of uric acid in the deposit. It is probable that
these vegetable cells, in many cases, have much to do with the fermentation of
the urine, for this change takes place most rapidly in damp warm weather, which
is favorable to the growth of these cells.
Color of urine orange.

{1000 parts of urine contained:
Uric Acid 0'194
Fixed Saline Constituents 16*508

October 12th, 11 o'clock, A.M. Much better, has no pain in
his head ; still complains of weakness. Skin cool and moist.
Pulse 72, regular. Respiration" 20.

l$c Quassia and soda. Snakeroot tea. Full diet.

Amount of urine passed during the last 7 hours, grs. 3580 [ g ^r 1023

" " " " hourly " 511*4 J ^'

Reddish orange color. Reaction acid. After 48 hours the reaction was still
acid, and it was without deposit.

Calculated amount of urine for 24 hours, grs. 12177.

ANALYSIS XIII.

Urine excreted in 7
hours, grs. 3580, con-
tained, grains,

Calculated am't urine
for 24 hours, grs. 12177
contained, grains,

1000 parts of
urine contain-
ed,

Urea

132-068
1-750

21-700

452-729
5*999

74-387

39-207

Uric Acid

0*488

Fixed Saline Con- )
stituents [

6*060

8 o'clock, P. M. Continues to improve. Skin soft and nor-
mal. Pulse 64, normal. Respiration, normal. Urine, straw-
colored. Specific Gravity, 1020.

Amount passed in the last 9 hours grs. 5100

666.6
5120
8192
341*3
10220
.425-8

hourly.

Oct. 13, 11 o'clock, A.M.

Am't of urine passed in the last 15 hours, grs.

Calculated amount for 24 hours. . ." "

Urine excreted hourly "

Am't of urine excreted in the last 24 hours, "
hourly

Sp. Gr. 1024. Color normal. After 24 hours no deposit. Reaction acid.

ANALYSIS XIV.

Urine excreted in ] 5
hours, grs. 5120, con-
tained, grains,

Calculated am't urine
for 24 hours, grs. 10220
contained, grains,

1000 parts of
urine contain-

Uric Acid

Fixed Saline Con-
stituents

2-750
46-000

4-400
73-600

0-637
8-984

In this case, considering the conditions of perfect rest, and
almost entire deprivation of food, the urea was increased in
quantity, during both the fever and the intermission. The
amount of uric acid was diminished under the action of the
sulphate of quinia.

Case XII. Irish laborer; stout, well made man, remarkably
large chest; brown hair; florid complexion; weight 192 lbs. ;
height 5 feet 8 inches. Has been in America five years. Re-

1858.]

JONES, on Malarial Fever.

445

sided in New York city four years ; and during the last twelve
months has resided in Savannah. During the summer has been
working along shore, and running up and down the Savannah
river in a flat.

August 27th, 1857. Entered the hospital with a quotidian.
For several hours after his entrance, was stupid could not an-
swer coherently. Pulse 104; respiratiou 24, labored, thoracic.
Tenderness upon pressure of epigastrium. Tongue slightly
furred, but normal in color and moist. The warm bath, cut
cups to the epigastrium and a purgative, aroused him from his
stupor. On the next day, his pulse was 104 ; respiration 38 ;
temperature of hand 102, and skin hot, but moist. Sulphate of
quinia was freely administered during the intermission of the
fever. Had no retnrn, and left the hospital in a few days. Ke-
turned to the same miasmatic situation on the Savannah river.

Entered the hospital again Sept. 17th, 1 o'clock P. M., with
high fever, which had been preceded by a chill last evening.
Twelve grains of calomel and six grains of sulph. of quinia were
administered. The fever intermitted during the night, and
twenty grains of sulphate of quinia was administered, in five
grain doses, at intervals of three hours. This did not arrest the
chill, which came on the next day, Sept. 18th, at 11 o'clock A.M.
2 o'clock P.M. Chill is just going off.

( Temperature of Atmosphere, 905' F*

Pulse 112. Respiration 28. \ " " Hand, 100

( " under Tongue, 104

~fy. Soda powders. As soon as fever remits give sulphate of quinia grains v,
every three hours, up to grains xx.

September 19th, 2 o'clock P. M. Complete intermission of
fever. During the last 38 hours has taken 46 grains of the
sulphate quinia.

{Temperature of Atmosphere, 91 F.
" Hand, 975'
" under Tongue, 99

Amount of Urine passed during the last 24 hours, grains 18,144

" ' " hourly " 756

Reaction acid. Sp. Gr. 1008, clear, limpid color a shade higher than normal.

ANALYSIS XV.

Urine excreted in 24 hours,
grs. 18144 contained grains,

1000 parts of Urine
contained,

Water,

17626-878

517-122

226-980

2-880

231406

53856

971497

Solid Matters,

28-503

Urea,

12-584

Uric Acid,

0-158

Extractive and coloring matters.
Fixed Saline Constituents,

12290
2-969

There was no return of fever, and the patient was discharged.
He obtained employment upon a steam -tug, which plied up and
down the river, and slept on board at night. Was taken with
a chill, followed by high fever, on September 29th.

446 Jones, on Malarial Fever. [July,

October 2nd. Has just entered the Hospital, 2 o'clock, P.M.,
and is shaking with a chill. Pulse 120 in the sitting posture.
Kespiration 22 in the sitting posture, labored, thoracic.

Temperature of Atmosphere. . . .79 F. \ Lips and hands purplish, he is shiv-

" " Hand 89 > ering violently: hands feel very cold.

" under Tongue 10225' ) The intermissions between the chills

have been about 16 hours. $ Mustards to extremities. Ifc Spts. of Mindererus
and brandy and snakeroot tea, of each a tablespoonful every half hour until re-
action is established. Ifc Calomel grs. xii., sulph. of quinia grs. vii., mix and
administer as soon as reaction is established, and follow with castor oil in four
hours, fy Sulph. of quinia grs. v. every three hours, up to grs. xxv., commence
as sdon as there is the slightest tendency to a remission.

October 3rd, 2\ o'clock, P.M. Mustards and stimulants cut
short the chill, and hastened the febrile action. Medicine oper-
ated well, and he feels much better. Has taken 22 grains of
sulphate of quinia. Complains of ringing and pain in his head.
Pulse 100, full. Eespiration 26, thoracic, labored.

Temperature of Atmosphere . . . .776'F. ) Tongue red at tip, but moist and

" Hand 105 [-soft. Reaction of saliva, slightly

" under Tongue 106 ) acid. Skin dry.

fy Stop sulph. quinia until the fever intermits. ^ Soda powders. Diet, gruel.

October 4th, 2 o'clock, P.M. Has no fever: feels much bet-
ter. Pulse 58. Eespiration 20, regular and gentle.

Temperature of Atmosphere. . . .76 F. ) Urine of a deep orange color, and

" " Hand 965' > decided acid reaction. Am't passed

" under Tongue 985' ) in the last 24 hours, grs. 14112. Am't

passed hourly, grs. 588. Sp. Gr. 1008.

Says that during the night he was in a profuse perspiration.
Has taken 15 grains of the sulphate of quinia this morning.
October 5th. Has had no chill.

R; Quassia and Soda. Urine reddish orange color. Sp. Gr. 1016.

Amount of urine passed in the last 24 hours grs. 15290

hourly " 635

Eecovered sufficiently to act as nurse and servant about the
Hospital. Although apparently well and capable of much mus-
cular exertion, this patient complained of a continual pain in
his head.

October 14th, 2 o'clock, P.M. Chill came on at 11 o'clock,
this morning. Now has high fever. Pulse and respiration
much accelerated, and skin hot.

fy Calomel grs. xii., sulph. of quinia grs. vi., castor oil in four hours.
# Citrate of potassa mixture during fever.

October 15th, 2 o'clock, P.M. Apyrexia complete. Skin
relaxed and cool. Pulse and respiration near the normal stand-
ard.

Urine excreted during the febrile excitement, normal in color.
Specific gravity 1002. Amount of this urine voided during the
last twelve hours, grains 35,070. Says that " during the nightfhe

1858.] Jones, on Malarial Fever. 447

drank large quantities of water, and felt a constant desire to
urinate."

ANALYSIS XVI.

Grains 35070 of Urine excreted during 12
hrs. of febrile excitement, contained grs.

1000 pte ofU-
rine contained

Urea,

166-005
A trace few small crystals.
58-360

4-743

Uric Acid,

A trace.

Fixed Saline Constituents,

1-696

This attack also yielded readily to the sulphate of quinia, and
up to the time that I resigned the charge of the Savannah Ma-
rine Hospital and Poor House (October 20th), this patient had
had no return of fever.

This case presents several points of interest. The phenomena
of the cold stage have been noticed and compared with similar
phenomena in a former article. (See page 396.) At the pre-
sent time we will call attention to the fact, that during the fe-
brile excitement the uric acid diminished greatly in amount,
with and without the action of the sulphate of quinia, and in the
last analysis (xvi.) disappeared almost entirely, notwithstanding
that only vi. grains of sulph. of quinia had been administered,
and that in conjunction with an active purgative. The follow-
ing cases will show that the uric acid is frequently diminished
during the febrile excitement of intermittent fever, independent-
ly of the action of the sulphate of quinia.

Case XIII. Irish laborer, age 40 ; height 5 feet 8 inches ;
weight 145 lbs ; brown hair ; grey eyes ; sallow complexion ;
occasionally indulges too freely in ardent spirits. Was in the
hospital ten days ago with intermittent fever. After leaving
the hospital, he obtained work along the river, at Fort Pulaski,
and was much exposed to the* sun. "Was taken with pains in his
head and back, and fever, yesterday afternoon at 4 o'clock P. M.
Now, Aug. 17th, 12 o'clock M., there is an intermission. Pulse
66: respiration 20, skin moist and cool, tongue slightjx furred.
$. Castor oil.

Aug. 18th. Complains of great thirst, and pains in his head
and back. Tongue coated in the middle with yellowish fur,
pointed and red at the sides and tip ; skin hot and dry.

( Temperature of Atmosphere 90 F.

Pulse 100. Respiration 36. -j " "Hand, 106

( " under Tongue 106

fy. Calomel grs. vi, Tartrate of Antimony gr. i, Xitrate of Potassa grs. xxx.
Mix, and divide into six powders one powder every three hours. 8 o'clock P.M.
Skin hot, but softer, with a tendency to moisture. Pulse 104 ; respiration still
thoracic and labored.

Aug. 19th. Fever intermitted this morning about 2 o'clock
A. M. Now, 12 o'clock M., pulse 70 to minute, soft and nor-
mal. Respiration 22, normal.

448 Jones, on Malarial Fever. [Juty*

Temperature of Atmosphere, 90 F. j Tongue normal in size, papillae not
" under Tongue, .. . 98 (enlarged, covered with yellowish fur.

Urine passed last evening and night, during the fever, clear, of a light yellow
color, resembling the urine of hysterical females. This resemblance extended
also to its densit}T. Specific gravity 1005. Amount passed during six hours of
febrile action, grains 7035. When one thousand grains were carefully tested for
uric acid, only a small trace, just evident to the eye, but inappreciable in weight,
was exhibited, after the most careful manipulation.

Urine passed this morning, after complete subsidence of febrile action, orange
colored. Sp. Gr. 1014. When concentrated, it exhibited the extractive matter
in much larger amount than in the urine of fever.

As a general rule, the extractive and coloring matters are less
abundant during the active stage of intermittent fever, than
during the intermission. They appear to be consumed during
the active chemical changes of fever. The nitrate of urea form-
ed from the urine excreted during the active stages of intermit-
tent fever, is silvery white. The nitrate of urea formed from
the urine excreted during the intermission is dark, discolored
with coloring matter, and the crystals are not so well formed.
The former kind of urine, when evaporated and concentrated,
generally has a yellowish or brownish color, whilst the concen-
trated urine of the intermission, assumes the color of a very
strong decoction of over-parched coffee.

Amount of urine passed during 7 hours of the intermission, grs. 6084
Uric Acid in " " " " " " " 0.48

Uric Acid in 1000 parts of urine, 0.08
The microscopical examination of these specimens of urine resembled in most
respects, the examinations of urine excreted under similar circumstances.
& Sulph. of quinia and snakeroot tea. $ Cut cups to small of back.

August 20th. Complains of pain in his back, and restless-
ness. Skin moist, tongue slightly coated with white fur, flat,
papillae not enlarged. Pulse 86. Eespiration 27.

( Temperature of Atmosphere. .87F.

Urine high colored, Sp. Gr. 1017. -J " "Hand 100

( " under Tongue. . . 101

Amount of urine passed during the last 24 hours, grs. 14120

" Uric Acid excreted " " " " " 5.600

" # " " in 1000 parts urine 0.400

August 21st. Much better. Pulse 72. Eespiration 17}.

Urine normal in color. Sp. Gr. 1009 ( Temperature of Atmosphere. .80F.

Amount passed during the last < " "Hand 96

24 hours grs. 14126 ( " under Tongue 98

Heavy deposit of prismatic crystals of triple phosphate. When held in the
sun-light, the urine appeared to be glittering with thousand particles of bright
shining silver.

August 22nd. Skin, pulse, tongue, respiration, and circula-
tion, normal. Urine normal in color. Specific Gravity 1011.

Amount excreted during the last 24 hours grs. 11132

Uric Acid " " " " " " 6.500

" " in 1000 parts of urine " 0.500

Concentrated urine of a dark, almost black color.

1858.] Jones, on Malarial Fever. 449

Case XIV. American seaman, age 40 ; weight 160; height
5 feet 9 inches ; florid complexion ; light hair ; sanguine nervous
temperament. Has been in the Hospital for two months, with
stricture of the urethra. There were several strictures, and the
passage of the catheter painful and difficult.

The urethra and bladder were so irritable, and the sufferings
of the patient so great, that the catheter could be passed only at
intervals of several da}rs. The passage of the catheter was al-
ways followed by an attack of chill and fever. During the last
two months, this patient was treated for five attacks of intermit-
tent fever, each one of which succeeded, and appeared to have
been excited by the irritation of the bladder and urethra.

The Savannah Marine Hospital and Poor-house is situated in
a malarious district. Three hundred yards to the southeast
opens a large sewer from the city, and a short distance beyond,
where this sewer discharges its contents, is a body of low,
swampy land. The situation of the Hospital is also lower than
that of a portion of the city, and during a hard rain, a large
body of water flows down and accumulates in the street between
the hospital and the park. This statement is farther sustained,
by the fact, that nearly all the inmates of the hospital suffering
with other diseases, even the consumptives, were attacked during
this season with malarial fever. Although this patient was not
acclimated, still, in health, the dose of malaria was not sufficient
to produce general disturbance of the chemical actions and
physical and nervous forces. Whenever his system was excited
and enfeebled by the irritation of the urethra and bladder, then
the characteristic phenomena of the action of the malarial poison
were manifested.

October 11th. This patient left the hospital several days ago,
became intoxicated, and slept all night in the open air. He was
taken to the guard-house by the mounted police, and remained
there until this morning, when he was sent to the hospital in a
state of great febrile excitement. Says that he " had a severe
chill this morning at 9 A. M., which lasted four hours, and was
attended with vomiting. Pulse 140, full, bounding. Inspira-
tion 32, thoracic, panting. Skin hot, pungent; face flushed.
The temperature was not determined, but it must have been at
least 107 under the tongue. Urinary secretion abundant, and
orange colored during the febrile action. Specific gravity 1008.
After careful manipulation, with more than 1000 grains of urine,
only a trace of uric acid was discovered.

The decomposition of the urea was far more rapid in this case,
than in any other which I have thus far examined. Every
trace of urea disappeared in 24 hours. This rapid change was
due to the catalytic actions of the perverted secretions of the
urethra and bladder.

[To be continued]

450 McDaxiel. Tapping in Ovarian Dropsy. [July,

ARTICLE XVI.

Tapping in Ovarian Dropsy. By E. McDaniel, M. D., of

Laurens District, So. Ca.

Mrs. B., 34 years of age : of strong constitution the mother
of seven children was attacked with ovarian dropsy in 1841 ;
died the 4th of January, 1858, making sixteen years from the
commencement of her disease to the termination.

Mrs. B. was treated by several experienced physicians, for
upwards of two years. The accumulation, still increasing, and
the disease becoming more alarming, a consultation was called
November 10th, 1843, and the operation of tapping was per-
formed, for the first time, by Dr. E. C, with the evacuation of
thirteen quarts of water. From that time to the termination
of the case, she was tapped two hundred and nineteen times,
with the evacuation of four hundred and ninety five gallons of
water.

Dr. E. C. continued to perform the operation of tapping, for
a number of times, when the instrument was given up to the
Eev. Mr. B., her husband, a very intelligent man, who perform-
ed the operations up to the time of her death, and who kept a
correct statement of the number of times that she was tapped,
and the amount of fluid evacuated at each operation.

Mrs. B. gave birth to two daughters during her illness the
first one, March 22nd, 1843, which lived and did well ; the se-
cond, was born June 19th, 1845, which lived a few hours, and
expired; the operation being performed twelve times up to this
date.

Four years previous to her death a tumour made its descent
into the vagina, filling the whole vagina, which interfered very
much with the convenience of the patient in a sitting position.
A physician was called in the tumour, or sack, was pierced,
with the evacuation of eight quarts of water, to the great alle-
viation of the patient. During her illness, she was tapped
twenty-nine times, per vaginam, yielding from five to twelve
quarts of water at an operation.

For the last few years, being the family physician, and being
called to see Mrs. B., who suffered much in the latter period of
her disease, I found that, after the operation of tapping, inflam-

1858.] Green. Case of Malformation. 451

mation of the sack had ensued several times, but was combated,
successfully, by a strict antiphlogistic treatment inflammation
ensuing again after the two hundred and eighteenth operation,
proved rapidly fatal.

At the earnest solicitation of the patient, she was tapped a few
hours before she expired.

I report this case to the Profession, on account of the frequent
number of tappings, and the aggregate amount of water that was
evacuated. As far as my knowledge extends, such a case is
rare, if it does not exceed any on record.

ARTICLE XVII.

Remarkable Case of Malformation. Reported by Wm. A. Green,
M. D., ofStarkville, Ga.

Was called to Mrs L , Monday, January 5th, 1858. Had

been in labour with her second child. Nothing unusual occur-
red during gestation or parturition. She gave birth to a child,
over the average size, which cried lustily, seeming to indicate
every function was regularly and properly performed. Upon a
close examination, the following deformities were found to
exist :

The spine began a curvature at the superior third of the cer-
vical vertebra?, in a direction towards the right h}<pochondrium,
to the top of the sacrum. The concavity of this curvature was
filled with two or three sac-like appendages, containing, appa-
rently, a fluid and gas, movable and compressible. "A want of
the spinous processes of three or four contiguous vertebras, is
not a very uncommon species of monstrosity." "This consti-
tutes spina bifida." "There is, usually a soft, fluctuating tumour
in the situation of the malformed bones, caused by water, con-
tained within the sheath of the spinal marrow." Vide Rams-
bothams Obstetrics. (Keating.) Appendix M. p. 622. Below,
upon each side of the sacrum, were two appendages, resembling
the mammae of woman. In front, between the point where the
umbilicus was attached, and the symphisis pubis, was a protru-
sion of intestines, within the peritoneal sac, reducible by pres-
sure, but returning when removed. Immediately under this

V. S. VOL. XIV. NO. VII. 22

452 Acclimation, &c. [July,

hernia, the urine trickled, continuously, from two or three small
openings, which could not be entered by the smallest probe.
Below this, and hanging pendent from the middle of the symphi-
sis pubis, were the testicles, perfectly formed. There was no
trace, nor any portion of the penis. Behind the symphisis pubis,
in juxta-contact, and at the extreme anterior portion of the
perinaeum, was an anus, well formed, through which the fasces
passed. About an inch and a half behind this, at the point of
the os coxcygis, was another anus, that, upon examination,
proved to be imperforate a cul de sac.

The face of the infant, when first born, was perfectly black,
but is changing to a mulberry hue. Numerous marks are upon
itsbodyr such as are frequently seen upon children. Every
other portion of the child seems perfectly and symmetrically de-
veloped. Its bowels are regular; it is healthy, and rapidly
growing. The complete, entire, absence of the penis, or any
portion of it the unusual, unheard-of positions of the anus, tes-
ticles and anomalous passage of the urine, are extremely remark-
able and interesting. The bladder has no urethra, through
which to pass its urine, so these apertures must come in direct
contact withy and even enter the fundus of the bladder.

Acclimation ; and the Liability of Negroes to the Endemic Fevers
of the South. By E. D. Fenner, M. D., Professor of Theory
and Practice of Medicine, N. O. School of Medicine.

In the last {March) number of that influential and widely-cir-
culated journal, the North American Medico- Chirurgical Review,
we find an extract from the work of Nott and Gliddon, on
the Indigenous Races of Mankinds expressing observations and
opinions on the above subjects so entirely different from our own,
and as we believe, so wide of the truth, that we have concluded
to invite the special attention of Southern physicians to them,
with the view of ascertaining, if possible, to what extent such
opinions prevail. We do this in no captious spirit towards our
talented and esteemed friend, Dr. Nott ; but solely for the pur-
pose of eliciting truth on a subject of vital importance. ^ Constitu-
ted as men are, they cannot be brought to see things in the same
light, nor to reason alike from given premises ; yet there must
be truth on one side or the other in all such discussions, and
when it cannot be satisfactorily demonstrated, we have to receive

1858.] Acclimation, Ac. 453

as truth the concurrent observations and conclusions of the
largest number of equally competent observers and thinkers.
The following is the extract alluded to :

" The fact is so glafing, and so universally admitted, that I am
reallv at a loss to select evidence to show that there is no acclima-
tion against the endemic fevers of our rural districts. Is it not
the constant theme of the population of the South, how they can
preserve health ? and do not all prudent persons, who can afford
to do so, remove in the summer to some salubrious locality, in
the pine-lands or the mountains ? Those of the tenth generation
are just as solicitous on the subject as those of the first. Books
written at the North talk much about acclimation at the South;
but we here never hear it alluded to out of the yellow-fever cities.
On the contrary, we know that those who live from generation
to generation in malarial districts become thoroughly poisoned,
and exhibit the thousand Protean forms of disease which spring
from this insidious poison.

"I have been the examining physician to several life-insurance
companies for many years, and one of the questions now asked
in many of the policies is, l Is the party acclimated?' If the sub-
ject lives in one of our Southern seaports, where yellow fever
prevails, and has been born and reared there, or has had an attack
of yellow fever, I answer, ' Yes.1 If, on the other hand, he lives
in the country. I answer. 'No;' because there is no acclimation
against intermittent and bilious fevers, and other ma&h diseases.
Now, I ask if there is an experienced and observing rMysician at
the South who will answer differently ?"*

Dr. Nott here proclaims that "there is no acclimation against
the endemic fevers of our rural districts? and boldly asks M if there
is an experienced and observing physician at the South who will
answer differently ?"

With all due deference we feel bound to reply that there is at
least one, and we believe thousands, not only of physicians, but
planters, too, who differ with him on this question. We were
born and raised in the South, and have practiced medicine in the
country, in villages, and in the city of New Orleans. We have
been a planter also, and have had no ordinary opportunities to
observe the effects of acclimation, not only on the white and
black races of men, but also on the lower animals, and we must
express the opinion, that, but for the attainment of a greater or less
degree of acclimation, the extensive malarious region of the South-
ern and Southwestern States never could have reached its present
state of population and improvement. So far from the fact bein^
"glaring and universally admitted that there is no acclimation
against the endemic fevers of our rural districts," as is maintain-
ed by Dr. Nott, we contend that exactly the converse opinion
obtains; hence the additional value attached by all practical men

454: Acclimation, &c. [July,

in these parts, both country and city, to the acclimated negro,
horse, ox and milch cow. Perhaps it would not be going too far
to say that even the dogs, turkeys and chickens have to undergo
acclimation before they can do well here, i

We thought the fact was universally admitted that all immi-
grants from more Northern regions to the South were very liable
to suffer from the endemic fevers, for the first two or three years
of their residence, but that after that period they obtain compara-
tive immunity, and in the course of time may enjoy as good
health here as they did where they came from, and some of them
much better. They become habituated to the climate and its dis-
eases, and may live as long as the Creoles, or natives, who certain-
ly make no contemptible display of longevity in the mortuary
statistics of the country.

There appears to be a slight inconsistency in some of the re-
marks of Dr. Nott respecting the acclimation of negroes and their
liability to the endemic fevers of the South. In one place he says
negroes are " comparatively exempt from all the endemic diseases
of the South." In another "The acclimation of negroes, even
according to my (his) observation, has been put in too strong a
light." * * * * "They never become proof against inter-
mittents and their sequelae." # # * * " Whenever the
whites are attacked with intermittents, the blacks are also suscep-
tible, though not in so great a degree." And again : "Certainly
negroes do suffer greatly on many cotton plantations in the mid-
dle belt of* the Southern States ; and I have seen no evidence to
prove that they can, in this region, become accustomed to the
marsh poison." Dr. Nott applies these observations to the region
of country removed from the rice country, and adds : " We shall
see further on that the negroes of the rice-field region do under-
go a higher degree of acclimation than those of the hilly lands of
the interior." Upon this he throws out the suggestion that there
may be "difference in the types of those malarial fevers which
originate in the flat tide-water rice-lands, and those of the clay
hills, or marsh fevers of the interior."

Dr. Nott says in a note : " A medical friend, (Dr. Gordon,) who
has had much experience in the diseases of the interior of Alabama,
South Carolina and Louisiana, has been so kind as to look over
these sheets for me, and assures me that I have used language
much too strong with regard to the exemption of negroes. He
says they are quite as liable as the whites, according to his obser-
vation, to intermittents and dysentery." On a closer examination
of the different remarks of Dr. Nott, above quoted, we confess
ourselves somewhat at a loss to decide which side of the question
he has raised, they tend chiefly to support. First comes the gen-
eral remark that " there is no acclimation against the endemic
fevers of our rural districts ;" then, " negroes are comparatively

1858.] Acclimation^ &c. 455

exempt from all the endemic diseases of the South ;" again, " ne-
groes do suffer greatly on many cotton plantations in the middle
belt of the Southern States, and he has seen no evidence to prove
that they can, in this region, become accustomed to the marsh
poison;" and finally, "that the negroes of the rice-field region do
undergo a higher degree of acclimation than those of the hilly
lands of the interior."

A reviewer of Dr. Xott, in the Southern Medical and Surgical
Journal for January, 1858, says at page 22 : " We must differ
from the learned author when he affirms that negroes are compar-
atively exempt from all the endemic diseases of the South. Such
is certainly not the case in this section of Georgia, (Augusta,) and
in the adjacent portions of South Carolina and Alabama, where
every planter knows that his negroes suffer, equally with the
whites, annual attacks of intermittent and remittent fevers, dys-
entery, malarial pneumonia, etc. This writer then goes on to
*' out-Herod Herod" in his opposition to malarial acclimation,
reaching the ne plus ultra when he says : "We may safely affirm
the liability to our fevers is in a direct ratio with the length
of time the individual has resided in the malaria district, and that
natives are the most susceptible." * * * * " Negroes born
and reared upon the plantations of Georgia and South Carolina
are fully as liable to fever as new comers, and we think much
more so." But finally, he concurs with Dr. JSTott, that in the
most malarious portions of the whole malarious region, the low
country, "negroes do become acclimated and comparatively
exempt from fevers." From this he infers also with Dr. Nott,
" that the low-country fever, like yellow fever, must then be essen-
tially different from any form of fever in the upper sections of the
Southern States."

Now, to our apprehension, the attainment of more perfect ac-
climation in the latter region is more justly attributed to the
steady continuance than to any peculiarity of the febrific cause ;
for we find no material difference in the types of fever prevailing
here and the uplands.

There are malarious seasons as well as malarious regio?is, and it
appears to us that in those climates and localities where the
operation of the morbific cause is most continuous, the effects
should be most durable. Thus, by the inherent conservative
powers of the animal constitution, it is capable, in the course of
time, of habituating itself to the deleterious influence of deadly
poisons, as is actually witnessed in the use of opium, strychnine,
-arsenic and corrosove sublimate. The following quotations from
respectable authorities will serve to show how widely different
from the commonly received opinion on the subject of acclima-
tion are the positions held by both Dr. Nott and his reviewer.

Dr. E. M. Pendleton of Sparta, Georgia, in an interesting

456 Acclimation, &c, [July?

paper " on the susceptibility of the Caucasian and African races to
the different classes of disease," published in the Southern Medical
and Surgical Journal for November, 1849, after showing the
greater liability of children than adults to idiopathic fevers, re-
marks: "But why the adult should be less liable than young
persons is not so easily determined, unless young people in mias-
matic districts have to undergo a kind of acclimation, as foreign-
ers, and afterwards become less subject. I have observed that
parents seldom have fever where they have lived a long time in
unhealthy sections, while their children are frequently every one
prostrated at once. Inquire of them, however, and you will find
that in former years they were equally as subject to it as their
children seem to be in later days,"

From Dr. LaRoche's valuable work " on Pneumonia and Ma-
laria" we take the following : Speaking of the protection afford-
ed by acclimatization, he says : " That such a protection is thus
obtained, to a. greater or less extent, in regard to all malarial and
some other forms of fever, no one who has examined the subject
with attention will feel disposed to deny. By long habituation to
infectious localities, and to the high temperature of hot regions,
the system becomes acclimatized, and thereby acquires the power
of tolerating perfectly and permanently the poison, or of elimina-
ting it as soon as received, without succeeding reaction. The
observation is of old standing. Pliny, nearly twenty centuries
ago, called attention to the fact, that they who are seasoyxed can
live amid pestilential diseases" and the statement has been con-
firmed by all subsequent observations." P. 403.

Dr. La Roche goes on to show correctly that '; the dangers of
infection to strangers is in proportion to the coldness of their
native land that the protective influence of acclimatization is lost
by a prolonged residence in cold climates that the children of
the natives and acclimatized do not enjoy the same advantage
in regard to protection as their parents, but acquire them rapidly
as they advance in age, etc ;" the most of which he also shows to
be equally true of yellow fever. P. 404-5.

Dr. Nott says: "An attack of yellow fever does not protect
against marsh fevers, nor vice versa!' This isvery true, but we
go further still. We maintain that a mere attack of yellow fever
does not protect completely against the same disease. To effect
this purpose there must be a good strong attack one that is capa-
ble of modifying the system and leaving a permanent impression.
So, likewise, with malarious or country fevers. It requires longer
exposure and often numerous attacks before the human system
becomes seasoned to the deleterious influence of malaria. Yet
La Roche demonstrates the fact by voluminous testimony, and it
fully accords with our observation, that persons who have lived
long in Southern malarious districts suffer much less from yellow

1858.] Acclimation, &c. 457

fever, when first exposed to it, than those from the North who have
not been thus seasoned. What does this prove, if not that there
exists a consanguinity between the types of fever?

The following extract, from Watson's Lectures, present this
subject in its proper light :

" Another tact worthy of notice, in respect to the agency of the
malaria upon the human frame, is that it affects strangers much
more readily and decidedly than the natives of the place. In
other words, habit mitigates the injurious effects of the poison.
Persons become seasoned to it. At Walcheren, though almost
every adult among the lower classes had labored, in the course of
his life, under the endemic intermittent, yet they were infinitely
less subject to it than strangers: and they will not believe that
their beloved birthplace is unhealthy. Sir Gilbert Blane says
that persons of education, and even medical men, denied indig-
nantly that this country was less healthy than any other; and
attributed the sickness which raged among our troops to some
trivial circumstance of diet or habits, and not to any insalubrity
of the air. This is a curious moral feature, but a very general
one. In the pestilential plains of Estremadura the superstitious
natives, unable or unwilling to account for a disease of a type so
uncommon, among the soldiers, from any unwholesomeness of the
air, declared that they had all been poisoned by eating mushroons.
It was found, also, at Walcheren, that the strangers who survived
the first attacks became thereafter much less liable to the endemic
fevers. The French general, Monnet, who had held the command
at Flushing for several years, had acquired a knowledge of this
fact, and endeavored to turn it to practical account. He recom-
mended that troops should not be frequently changed ; for when
it was the custom to send batallions from Bergen-op-Zoom every
fourth night in succession, to work on the lines of Flushing, these
men never failed, upon their return, to be taken ill in great num-
bers. General Monnet therefore advised, however displeasing it
might be to the officers, that a stationary garrison should be re-
tained at Walcheren, in order that the men might be habituated
or seasoned to the air, {acclimates) and he adduced the instance
of a French regiment which suffered in the second years of its
being stationed there only one-half the sickness and mortalitv
which it suffered during the first year, and hardly suffered at all
in the third year." P. 446.

Dr. Watson then speaks of the generally injurious effects of
malaria, besides the violent and distinct forms of fever it produ-
ces in new comers, and gives the following testimony in respect
to the exemption of negroes :

"One remarkable exception is mentioned by Dr. Ferguson.
From some peculiarity or idiosyncrasy (which he conjectures
may be somehow connected with the texture of the skin) the negro

458 Acclimation, <&c. [Ju^7

appears to be proof against endemic fevers. To him marsh
miasmata are in fact no poison,- and hence his incalculable value
as a soldier, for field service, in the West Indies. The warm,
moist, low and leeward situations where these pernicious exhala-
tions are generated and concentrated, prove to him congenial.
He delights in them, for there he enjoys life and health, as much
as his feelings are abhorrent to the currents of wind that sweep
the mountain-tops, where alone the whites find security against
endemic fevers."

There is doubtless much truth in the remarks of Dr. Ferguson,
but his assertions are altogether too strong for our temperate re-
gion. Malaria is certainly & poison to the negro as well as the
white, but it is less deleterious to the former, and he more readily
becomes seasoned to it.

It would seem that those types of idiopathic fever which, ac-
cording to Dr. Campbell's plausible theory, depends chiefly on
disorder of the cerebrospinal system of nerves, as all the well-
marked paroxysmal fevers are more subject to recurrence and
require a longer period for acclimation than those of the continued
types, as yellow typhoid, typhus and the eruptive fevers, measles,
scarlatina, variola, varicella, etc. Quotations on this subject
might readily be multiplied to any extent, but, perhaps, to little
purpose. The testimony would be found to be very conflicting,
and difference in opinion would still remain.

To show that we have not penned these remarks in a spirit of
captious criticism, but only for the purpose of eliciting the expres-
sion of opinion by others on the subject, we will now give our
own views in regard to acclimation, published in our first volume
of Southern Medical Reports, (1849.) Nearly ten years of addi-
tional observation has only served to strengthen the opinions here
expressed :

"In connection, it may be expected of us to say something in
regard to what is termed ' acclimation.1 This term is in very
common use, and is well understood to mean the habituation of a
person to a special climate.

" It is but reasonable to suppose, that man, ' the master-piece
of his Creator,' and ' the inheritor of the earth,' was designed to
live in every portion of the globe which is supplied by the hand of
nature with the means of subsistence, or accessible to commerce
and tMe arts. Yet, so great is the difference of soil, climate and
attendant circumstances, in the various regions between the
tropics and the poles, that no race of animals is capable, at once,
of enjoying equal health in them all. There is required a certain
adaptation of the constitution to each, which can only be attain-
ed through the gradual changes effected by time and exposure.
Independent of the peculiarities of climate, soil, water, etc., to be
found indifferent regions, it is presumable that there exist in the

1858.] Acclimation, &c. 459

atmosphere over certain localities, deleterious gasses, effluvia, or
emanations from the earth, which exert their most powerful
effects upon the living system when it is first exposed to their in-
fluence; but to which the system may become gradually inured
in the process of time. To become accustomed to these peculi-
arities of soil, climate and noxious effluvia, is what we term being
seasoned or acclimated; and it is wonderful to witness the capa-
bilities of the human system in this respect. There are but few
individuals who can make a great change of residence with per-
fect impunity. With the great majority of people, it is done at
the peril of their lives; but the effects are very different upon dif-
ferent constitutions. Some do not become seasoned until they
have suffered the severest form of endemic fever belonging to the
climate and locality ; others become gradually and thoroughly
acclimated without even suffering an open or severe attack.
There are persons who have resided in New Orleans twenty years
without ever having had yellow fever, whilst others have had it
two or three times. Strong attacks of the severest forms of our
remittent, bilious and yellow fever seems to cause a modification
of the system, which secures to the individual a greater or less
immunity from subsequent attacks. Attacks of the milder forms,
as ordinary intermittents, effect no such immunity ; but. on the
contrary, when frequent, lead to permanent engorgement of the
spleen, and cause an increased liability to the complaint. The
term acclimation is just as familiar to the inhabitants of all the
Southern portions of the Mississippi valley, as it is to the citizens
oi New Orleans, and is used to express the same idea, viz : that
persons coming from a Northern climate and settling there are
very liable to have attacks of fever during the first two or three
years, but afterwards become quite exempt. This fact is so well
known as to cause a considerable difference in the valuation of
negroes, and even horses and cattle. An acclimated negro, horse,
or milch cow, commands a higher price than an unacclimated
one. We shall not, at this time, attempt to explain the nature of
the change effected by acclimation, nor the manner in which it is
brought about; but it is a fact confirmed by long experience and
common observation.

" Believing, as we do, that yellow fever is only one of the forms
or types of endemic, malarious fever, witnessed almost annually
in this city, and less frequently at many other places in the South,
we may stare the fact, that those who have suffered severe attacks
of it, or even mild attacks, during severe epidemic seasons, cer-
tainly remain quite secure from subsequent attacks; especially if
they continue to dwell in the same locality. But that they are
equally as secure as those who have had small-pox, measles or
hooping-cough, as is maintained by some physicians, we cannot
for a moment admit. Our own observation, if we have seen

460 Syphilitic Inflammation of the Retina. [July?

aright, is at variance with this position. It is a common remark
among persons who thought themselves acclimated, when attacked
by fever again, during a sickly season, to say, that ' if they were
not certain of having once had yellow fever, they would think they
had it again.' The truth is, they did have it again;* and if, by
neglect or malpratice, the disease had run on to a dangerous stage,
or to death, all doubt would have been removed. But, fortunate-
ly, the partial acclimation attained so fortifies the system against
the malign influence of the morbific cause, that the tendency to
death is not near so strong as in unacclimated subjects ; therefore,
most generally, they are easily relieved, and come to the conclu-
sion they have not had yellow fever a second time.

" It is a common belief, both in the profession and out of it, 'that
the Creoles, or natives of New Orleans, do not have yellow fever
at all ; but in our accounts of the epidemics of 1847 and 1848, we
have given the testimony of some of the most respectable physi-
cians to the contrary.f

" From the foregoing remarks it follows, then

" 1. That persons coming from more northern latitudes to this
have to undergo an acclimation or seasoning, before they become
secured in the enjoyment of good health.

"2. That this acclimation may be attained without sickness;
but that, most generally, it requires the endurance of one or more
spells of the customary endemic fevers.

" 3. That an attack of the endemic yellow fever effects greater
security against subsequent attacks, than any form of fever seen
in the country ; but the remark is applicable, in some degree, to
all of them, excepting the ordinary mild intermittents.

" 4. That persons may have yellow fever more than once,
though it is evident that those who have had one plain attack,
usually have little or nothing to dread from subsequent attacks.

" 5. That Creoles or natives of New Orleans, may have yellow
fever though generally they have it in a very mild form.

" So much for our present views of acclimation. The subject
is full of interest, and we shall probably recur to it, from year to
year, as our .experience is enlarged." [New Orleans Med. News.

Syphilitic Inflammation of the Retina.

The revelations of the ophthalmoscope bid fair to add a pecu-
liar form of retinitis to the acknowledged role of symptoms due
to constitutional syphilis. A fortnight ago we noticed a very
interesting case, in which lymph had been seen deposited on the
retina of an infant, the subject of hereditary syphilis. A few

* Dr. Harrison says he had known persons to have yellow fever two or three
times, but he never knew such eases to terminate fatally.

f Xew Orleans Medical and Surgical Journal, 1848 and 1849.

1858.] Errors in Relation to Hysi 4.61

days afterwards Mr. Critchett admitted a second case, in which
a girl, whose history and appearance led to the belief that she
was the subject of the same kind of taint, was losing sight in
both eyes, from the punctate effusion of lymph on the retina.
Two other cases are attending Mr. Critchett's clinique, in which,
in connection with acquired syphilis, retinitis with effusion
has occurred. In one the effusion is in the form of isolated
white dots; but in the other the whole visible extent of retina
is cloudy and opaque, the optic nerve itself being but dimly
seen. It is worthy of note, that in neither of these cases has
there been any iritis or affection of the anterior parts of the
globe. \Omodei Annali Universalis and Med. limes and Gaz.

On some of the prevalent Errors in relation to the Predisposition to
Hysteria. By M. Briquet.

M. Briquet believes that most writers have been indebted
more to their imaginations than to the observation of facts for
the pictures they have drawn of this disease. It has been attrib-
uted by most of them either to unsatisfied sexual desires, or to
excessive excitement of the uterus and its appendages, and a
fanciful etiology to correspond has been invented. The object
of this paper is to show that these and other preconceived ideas
have no solid foundation in fact.

1. The hysterical constitution, about which so many positive
assertions have been made, has in fact no existence the affec-
tion occurring in women having the most opposite external ap-
pearances. The author examined 425 cases of hysteria in this
point of view; of these, as regards height, 127 were tall, 168
medium size, and 106 short; as to strength, 99 were strong, 36
medium, and 26 weak ; as to flesh, 194 were stout, 106 medium,
and 92 thin and spare ; as to color, 220 were fair, and 164 dark,
27 haviag the hair light, 39 black, 177 light chestnut, and 188
deep chestnut. In 168 the face was pale or 'brownish, and in
174 fresh colored. Thus it will be seen these were the ordinary
varieties met wTith amoug women in general.

2. The temperament is also various enough. The following is
the classification M. Briquet made of 383 cases. In 143 it was
lymphatico-sanguineous, in 125 lymphatic, in 91 nervous or
lymphatico-nervous, in 12 bilious, and in 11 sanguineous. These
are evidently very much the proportions that are found in fe-
males of 15 to 30, part inhabitants of the country, and part of
the towns, as was the case with these. At all events, there is
no temperament that can properly be called hysterical.

3. Moral disposition. That which is not discoverable in the
physical constitution of hysterical females is, however, very evi-

462 Errors in Relation to Hysteria. [July,

dent in their moral disposition. So much is this the case, that
of 430 cases occurring to the author, not more than 20 at the
utmost have not manifested it. The characteristic of this is
marked impressionability, foreshadowed in childhood by great
timidity, excessive susceptibility to blame, and a disposition to
shed tears easily.

4. Mode of life. Another of the axioms that have been laid
down as undoubted, is, that hysteria is the prerogative of the
wealthy and luxurious, and that poverty is a security against its
occurrence. It is a complete error ; the common people being
the subjects of hysteria in almost a double proportion to the
other classes. At a particular epoch M . Briquet visited all the
female patients in the medical and surgical wards of La Charite,
with the exception of those suffering from epilepsy, apoplexy,
insanity or delirium. The number amounted to 203, and of
these 65 were hysterical (38 with convulsive paroxysms), 49
were impressionable, and 89 only were neither hysterical nor
impressionable. Thus, among the common people there was 1
woman in 5 who had hysterical paroxysms, and 3 out of every
8 were the subjects of hysteria. So far from being exaggerated
the statement is rather below the truth. But where is the prac-
titioner who meets with 3 cases of hysteria among 8 of his pri-
vate patients? According to the experience of many M. Bri-
quet has consulted upon the subject, there is about 1 in 8 or 10
in the easy classes of society, not alluding to the very highest.
The charms and simplicity of a country life, too, have been suf-
ficiently praised, and nervous diseases have been said to be the
almost exclusive afflictions of civic life. M. Forget, in 1847,
somewhat startled this belief by showing how frequently hyste-
ria occurs among the simple Alsatian peasantry. M. Briquet
has obtained cognizance of the place of abode and of early edu-
cation in 324 cases of hysteria, and of these 168 were town born
and bred, and 156 from the country the majority of these lat-
ter having in childhood labored in the fields. In the case of 42
of these country girls their mothers had been hj^sterical, 29 suf-
fering from paroxysmal attacks. Professor Lebert, of Zurich,
also assures the author that hysteria is just as often seen in the
poverty-stricken cantons of Switzerland as in the most flourish-
ing ones. A too tender and luxurious education has been as-
signed as a predisposing cause; but of 81 cases of hysteria
occurring before the age of puberty, in 21 the harsh treatment
they had been subjected to was the principal cause of the dis-
ease. A third portion of the author's collection of cases had
been submitted to ill-treatment or privation during childhood.
In place of a tender education being assigned as a predisposing
cause, it would be more just to stigmatize a harsh one.

5. Continence has been stated by many authors as an unnatu-

1858.] Errors in Relation to Hysteria. 463

ral condition, predisposing to hysteria; but when it is remem-
bered that the majority of cases occur between 12 and 20, we
naturally ask at what age it becomes unnatural, as also for the
explanation of the occurrence of the disease in 86 children under
12 years of age. Various authors since the time of" Galen have
deplored the fate of widows, as the necessary victims of hysteria ;
but in point of fact their solicitude has been little needed, inas-
much as among 375 cases collected by Landovzy, only 12 of the
subjects were widows, as were only 14 in the author's own -430
cases, i.e., 26 in 800 cases, or 1 in 30. Of the authors 14 cases,
fcoo, in 6 the hysteria appeared on the day of the husband's
death, and in 4 during the first month after it, and should sure-
ly with more probability be referred to moral emotion. Hyste-
ria has been said to be, on the one hand, common among nuns,
and, on the other, rare among women who give free vent to
their sexual desire. But in point of fact it is rare in convents,
and is chiefly found in those in which there is great fasting and
maceration. The reverse position so strongly maintained by
authors may also be disposed of. Thus, of 300 hysterical fe-
males above the age of 15, 139 were married or kept women,
and among them had 367 children, not counting miscarriages.
Among the 161 remaining, very few resigned themselves to
continence. At the Lourcine, where syphilitic workwomen and
servants repair, among 424 patients, 169 were hysterical. As to
prostitutes, of 197 applying to St. Lazare on account of syphilis,
106 were hysterical, 28 xevy impressionable, and 65 neither
hysterical nor impressionable. It results from all this that con-
tinent women are rarely hysterical, those who do not observe
continence are frequently the subjects of hysteria, while those
who pursue the extreme of incontinence are the most liable of
all. The reason is obvious. Among these different classes of
women, the first lead peaceable lives, the second have much to
go through, while the last are a prey to frequent and violent
emotions. Next we may consider the effects of marriage on
hysterical women, which, to judge from the statements made,
have been truly remarkable. But among M. Landovzy 's and
the author's 800 cases, in only 29 instances did decided advant-
age follow marriage, notwithstanding the complex character of
the modifications ensuing upon this state.

6. Menstruation and affections of the uterus. This class of in-
fluences has been raised to the highest rank by those writers
who are determined at placing the seat of hysteria in the uterus.
1. This has been supported by the supposed effects of normal or
abnormal conditions of the menstruation. From the author's
observations, however, made on 411 hysterical women, in but
136 had there been any derangement of the menses. Of 237
deliveries of hysterical women, in but 12 were there any convul-

464 Alarming Head Symptoms relieved by Quinine. [July,

.sive paroxysms, some of which too might have been examples
of eclampsia, 2. According to authors, it is common to observe
hysteria in affections of the uterus. JNTow these diseases are ex-
ceedingly common, and the connection ought to be easily de-
monstrable. But this is not the case, for Landovzy and other
partisans of the opinion are able to collect but some 40 cases of
the affections of the genital organs giving rise to hysteria few
enough as compared with the thousands of cases daily occurring.
Practitioners, moreover, having much to do with the various
female diseases entirely deny such connection.

[U Union Medicate, and Med. Times & Gazette.

Alarming Head Symptoms relieved by Quinine. By Mr. R. L.
Bowles, of Folkstone.

Case. H.W. B , a medical man, stout, strong, and healthy,

set. 28, and married, was attacked on the evening of July 6th,
on his way home from the cricket-field, with most severe head-
ache. He had walked, in the course of the day, about sixteen
miles, besides having played for two hours at cricket. The day
was hot and sultry. On arriving at home, he went to bed, but
the severity of the pain in his head prevented his sleeping. He
had also great intolerance of light. During the next two days
he continued much in the same state, with the addition of occa-
sional delirium. It was at this time I was called in, and found
my patient complaining of severe splitting pain in the forehead,
which was much increased by talking or moving. He earnestly
requested me to leech or bleed him, having a conviction that he
was suffering from congestion of the brain. The pulse was from
46 to 48 in a minute, soft, and occasionally intermitting; the
skin cool and moist; the tongue cedematous and pale, with a
soft white fur on its surface ; the face, which was occasionally
flushed (though without a corresponding heat of skin), wore a
singularly indifferent and solemn expression ; the ocular con-
junctiva was healthy in appearance. He had become restless
and irritable, and was constantly throwing himself about in bed.
His bowels had been acted upon by a seidlitz draught. A mix-
ture of ammonia, sulphuric ether, and camphor julep, was now
prescribed to be taken every four hours, and a full dose of liquor
opii at bedtime.

July 9th, 8, A.M. The patient had passed a comfortable
night, and appeared much relieved, his countenance wearing a
more natural expression. In the afternoon, however, the symp-
toms retufned in all their severity. The opiate was omitted at
bedtime. A blister was applied to the neck.

July 10th. In the morning I found that he had been deliri-

1858.] Ttsts for Saccharine Urine, dr. 465

ous, and had passed a restless night; the pain and intolerance of
light were quite as distressing; and he was unwilling to take
nourishment of any kind. The bowels were confined, and the
tongue had now a "brownish coat on the back part. The blister
had risen well. A physician, a friend of my patient, called to
see him ; and, believing the case to be of the nature of sun-
stroke, advised eight leeches to the temples, which were accord-
ingly applied, but with no relief to the symptoms. He was now
a good deal depressed.

July 11th. He passed a restless night. The bowels were
freely relieved by a pill of calomel and colocynth, but each ac-
tion of the bowels appeared rather to aggravate the headache.
The opiate was given at bedtime, and a mixture of sulphuric
ether, valerian and camphor ; with beef-tea ad libitum. This
treatment afforded considerable relief, and gave him a comforta-
ble night.

July 13th. Severe symptoms again returned, which were
partially relieved by repeated doses of the stimulating mixture.
Mr. Eoscow (who now saw the case with me) advised disulphate
of quinine, in three-grain doses, to be taken at intervals of two
or three hours ; care being taken to give the first dose of quinine
when the headache was at its minimum. The effect was ma-
gical. The first dose prevented the paroxysmal return of head-
ache, and, with its continuance, a rapid general improvement
took place.

_ July 16th. My patient was convalescent, the pulse having
risen to its normal standard.

Twelve months ago my patient was living in the island of
Greneda, and for nearly two months he suffered severely from
repeated attacks of intermittent fever, for which he had taken
large doses of quinine with great advantage. [British Medical
Journal, and Banking's Abstract.

On the various Tests for Saccharine Urine, and on the Varieties
of Diabetes. By Dr. A. Becquerel.

Dr. Becquerel draws attention to certain fallacies that may
arise in the employment of the potassio-cupric liquid of Barres-
wil, the solution ofTrommers, or caustic potash, as tests for
sugar in the urine. The following, method, he states, prevents
all fallacy : To a measured quantity of urine say thirty parts
add a similar quantity of solid acetate of lead in crystals say
two parts; heat being applied, a dirty-white precipitate is at once
obtained ; this liquid is to be filtered, and the filtrate treated with
the sulphate of soda in excess say four parts. The second
mixture is to be again heated ; the sulphate of lead is precipita-

466 Tests for Saccharine Urine, &c. [July,

ted, and a clear, transparent liquid remains, which contains the
sugar, if any was present, the urea, and some saline matter. The
potassio-cupric solution is not reduced, nor liquor potassas turned
brown, unless sugar is present in this liquid. If albumen is
present in the urine, the acetate of lead carries it down with the
other organic matter contained.

After various remarks on the purely chemical aspects of the
question, Dr. Becquerel passes to the consideration of diabetes;
which he regards either as idiopathic or symptomatic. The
former is characterized by the presence of a notable amount of
sugar in the urine, which is increased in quantity ; there is ex-
cessive thirst and hunger, with other morbid phenomena. In
the latter the presence of some sugar in the urine is an accessory
symptom, following upon other diseased conditions; like albu-
minuria, it is associated with a great variety of diseases. In
these cases the sugar is never very considerable, though it may
amount to as much as 25 or 26 per 1000 ; while in idiopathic
diabetes it rises to 60 and even 80 per 1000. In symptomatic
diabetes neither the quantity nor the density of the urine is
materially increased.

Dr. Becquerel divides the conditions with which symptoma-
tic diabetes may be associated into five categories : 1. Diseases
of the brain and cord. 2. Diseases of the liver. 3. Diseases
accompanied by dyspnoea. 4. The presence of lactation. 5.
Various diseases.

Among nearly two thousand patients, whose urine the author
has caused to be examined at the Hopital de la Pitie, he has
found five cases belonging to the first category ; they were res-
pectively, 1. A case of myelitis in a woman, aged thirty-seven,
who died tetanic, and had sugar constantly in her urine. 2. A
case of general paralysis in a woman, aged fifty-four, with tem-
porary convulsive affections, during which the urine was sac-
charine. 3. Amaurotic amblyopia, with a paralytic condition
of the lower extremities, in a man, aged fifty-one; urine perma-
nently saccharine. 4. A man, aged sixty-two, closely resemb-
ling the last case. 5. A young woman, aged twenty-two, with
meningo-cephalitis, during which there were 8 to 12 grammes
of sugar per 1000 in the urine. Eecovery : five weeks later,
return of the same symptoms, when there was no sugar or albu-
men in the "urine. Death ensued, and the diagnosis was con-
firmed by the autopsy.

Dr. Becqueral reports three cases of liver disease accompa-
nied by diabetes. 1. A man, aged fifty-three, with chronic gas-
tritis and chronic hepatic congestions, had 20 to 28 grammes of
sugar per 1000. 2. A man, aged fifty-four, with pulmonary
emphysema, and consecutive chronic congestion of the liver i
the sugar was detected for six months, and then disappeared.

1858.] Fatal Disease of Appendix Yermiformis. 467

3. A young man aged nineteen, with slight enteritis and blen-
norrhagia (there is no further statement about hepatic disease :)
being a sugar-refiner, he consumed nearly a kilogramme of
sugar (about l^lb.) daily. Sugar was found in his urine during
the whole time of his stay in the hospital.

Dr. Becquerel expected to find sugar frequently in diseases
accompanied by embarrassed breathing, but failed to do so en-
tirely.

He found sugar in the urine of nine women recently deliver-
ed, in whom the lacteal secretion was established. It was also
met with in the two following cases, which do not come under
any of the preceding heads :

1. Female, aged thirty-five, affected with cancer of the neck
of the womb, not ulcerated. 2. A man aged fifty-four, affected
with extreme anaemia, the result of poverty. [Z' Union Medicate,
and British and Foreign Med. Chir. Rev.

Fatal Disease of the Appendix Yermiformis. Dr. Caspar Wister
read the following paper before the College of Physicians of
Philadelphia :

The appendix vermiformis exists only in man and two supe-
rior species of the quadrumana, the orang and the ape. It is the
type of the prolonged caecum common to all other mammiferous
animals. During fetal life it is continuous with the caecum, and
of the same size, and is developed from the cul de-sac of the latter.
Bishoff admits that the earliest recognition of its origin wras by
Meckel, in a foetus seven lines in length.

The appendix is ordinarily three inches long, with a diameter
of two lines, but is subject to great variety of size as well as
position. Occasionally it is entirely absent, while Welga has
seen it nine inches long, with many convolutions, and Autenrieth
four, and as large as the colon.

It is entirely enveloped by the peritoneum, which forms for it
also a true mesentery, holding it loosely in position. The muscu-
lar coat is not in bands, as in the colon, but surrounds it as in the
rectum. The lining membrane is continuous with that of the
caecum, and forms a valve at the entrance, the falciform edge of
which looks towards the right and downwards. This valve, in
most instances, prevents the introduction of foreign bodies,
but permits free exit to mucus, of which in adults there is a large
supply, with rarely any admixture of alimentary matter ; in infants,
on the contrary, it is filled with meconium. The glands within
are very numerous, and of the solitary variety. The extremity
of the appendix is found at times in the pelvis, more commonly
1 posterior to the colon ; its position is entirely uncertain.

N. 8. VOL. XIV. NO. VII. 23

468 Fatal Disease of Appendix Vermiformis. [July,

The function of this body is supposed to be similar to that of
a gland ; it furnishes an acid secretion which causes the chyme
in the caecum suddenly to acquire the property of reddening lit-
mus paper.

The subject of the following notice was a boy of five years of
age, fair skin, light eyes and hair, and delicate physical develop-
ment, the son of a father lately dead with phthisis.

This child was visited professionally on the first of November ;
he was at that time out of bed and in his ordinary dress. His ex-
pression was languid; he had much fever, with a pulse of 130;
his tongue was covered with a slight- white deposit, through which
the papillae were projecting, the tip and edges being unusually red.
He complained of pain in the abdomen, describing it vaguely as
"stomach ache," without giving it any locality. This pain was
spasmodic, recurring at short intervals ; sharp and griping, but
followed by complete relief. At this time there was no pain upon
pressure, or soreness over the abdomen. On the afternoon of the
day but one preceding, an ordinary walk had been followed by
complaints of much weariness, and in the course of the night by
the first expression of pain, and this without any chill. Through-
out the following day there had been some fever and pain, but
this was not thought of sufficient gravity to require medical in-
terposition. There had been no motion of the bowels during the
forty-eight hours immediately preceding the first professional visit ;
and at that, time the case had the aspect of an ordinary slight
attack of colic, with the sympathetic fever natural to a child of
sensitive organization, teeming with sympathies ready to respond
to any slight disturbance of the economy. A mercurial purgative
wasdirected, and a febrifuge at intervals. There had been no
unusual article of diet taken, except a moderate quantity of chest-
nuts. The night was much disturbed, with an increase of both
fever and pain; the latter still in paroxysms.

The morning of the 2d, in consequence of the purgative not
having operated, a copious enema was administered, which pro-
duced a large fecal discharge, none of it of a dry or impacted des-
cription, but contained distinct evidence of the operation of the
mercurial. The child expressed a sense of relief; and, after a
dose of oil and a fomentation adjusted over the seat of pain, he
was confined to bed.

The following morning Nov. 3d, there was a spontaneous
motion of the bowels, without any improvement; there was now
tenderness over the abdomen although during the paroxysmal pain,
pressure with the hand was grateful. This pain continued the
chief subject of complaint, engrossing the child's mind, and pro-
voking constant expression of distress. We commenced frequent
doses of small quantities of calomel, with full proportions of
ipecacuanha and opium, and employed gum in solution largely as
a diet.

1858.] Fatal Disease of Appendix Vermiformis. 469

On the 4th, the symptoms were more grave, greater pain upon
pressure, some tympanitis, and soreness attending all motion of
the person ; the spasmodic pain still, however, caused most com-
plaint, and recurred at short intervals. Leeches were now applied
over the entire abdomen, all other treatment being continued
except the use of ipecacuanha ; this was withdrawn in consequence
of slight vomiting. After leeching there was less complaint of
pain upon pressure, and soreness and nausea disappeared, while
stimulation was found necessary.

On the morning of Nov. 5th, he presented excessive tympani-
tis, constantly recurring paroxysms of pain, great restlessness,
sunken features, some tenderness upon pressure, and a pulse of
140. The child was, after consultation with Dr. Wood, placed
under the full effect of opium, with an increase of the mercurial,
and a blister over the abdomen. The rectum was relieved of a
large accumulation of gas by the introduction of a catheter, but
all motion of the bowels was in vain solicited. Under the full
effect of the opiate there was less exhibition of pain and restless-
ness, without any arrest of disease: tympanitis greatly increased,
and compressing the stomach caused regurgitation of fluid, and
much depressed the vitality of the entire organism.

Nov. 6. Small quantities of oil of turpentine, with full doses of
the officinal solution of morphia, were administered, accompanied
by further stimulation. Gradual sinking under the unchecked
march of disease, aided by the accumulation of gas, terminated
in death on the 7th of the month, seven days after the commence-
ment of treatment; this being the result of a disease deficient in
symptoms sufficiently distinct for satisfactory diagnosis, and only
decided in the steadiness with which it resisted treatment.

After death the abdominal cavity was found dry, with indica-
tions of peritoneal inflammation, consisting most conclusively in
a few patches of pasty lymph upon the intestinal surfaces. There
was an engorgement of the vessels of the intestines, but being in
longitudinal bars from the diaphragm to the pubis over the entire
mass, there was some doubt as to the time of its occurrence, par-
ticularly as signs of incipient decomposition existed elsewhere.
The intestines, from the pyloric orifice of the stomach to the sig-
moid flexure of the colon, were greatly distended with gas, and
contained, besides, a large amount of fluid fecal matter. The
stomach was empty and much contracted, the accumulation of
gas having pressed it against the diaphragm, and in so doing
caused the latter to encroach upon the thoracic viscera, thus ren-
dering the last hours of life a most painful exhibition. The lining
membrane of the intestinal canal was healthy throughout, and the
cause of death was not manifest until the appendix vermiformis
was examined. This was perforated at the lower extremity ; the
opening being large, with ragged edges, indicating ulceration, and

470 Fatal Disease of Appendix Vermiformis. [July,

partially filled by a plug of concrete matter of the size and much
the shape of a date-stone, composed of small seeds, many of these,
from figs, associated with concrete matter deposited in layers, and
arranged in concentric circles.

In this instance, the extremity of the appendix rested in the
pelvis upon the rectum, immediately over the fundus of the blad-
der; here an effusion of the contents of the intestines had occur-
red, but in small quantity, owing to the plug having filled the
ulceration it had caused in the appendix.

The matter effused had given rise to excessive inflammation
and the formation of much lymph, an attempt having been made
to form an abscess and inclose the offending fluid. This deposit
of lymph extended over a surface of three inches in diameter, was
dark in hue, passing into gangrene; and, although adhering
strongly to the intestinal surfaces, left them, when removed,
healthy in appearance. Those surfaces of the sigmoid flexure of
the rectum facing each other in the natural position were strong-
ly adherent for a distance of three inches, and consequently pre-
vented peristaltic motion at this point. This explained the reten-
tion of gas after the peritoneal symptoms became decidedly
marked, although there had been a free passage of fecal matter in
an early stage of the disease.

Again, the son of a very distinguished physician of this city,
twenty-two years of age, passed Sunday evening in the society of
his family and a small collection of his father's friends; he was
gay and apparently in good health.

A few days previously he had complained of vague pains in the
abdomen, not however of a degree to attract particular attention.

He retired on the evening above mentioned without any
unusual sensations, but awoke before daylight with intense colic.
This increasing, his father sent for a medical friend, after exhaust-
ing his own resources and failing to procure relief. Throughout
Monday the symptoms of colic continued without abatement, and
as the day wore on only presented indications of peritoneal com-
plication. There was a large, though not excessive accumulation
of gas, the most prominent feature of the case being excruciating
pain from which only partial relief was procured by complete nar-
cotism. The bowels resisted every attempt to procure evacuation
of their contents after the earliest stage of the disease.

On Monday night and Tuesday morning the agony of the
patient began to abate, but only to be followed by collapse, with
cold damp surface and failing pulse ; he gradually sank, and died
in the course of the morning, after an illness of thirty hours.

The abdomen was found after death much distended by gas,
free from effusion, and not affording any evidence of excessive
peritoneal inflammation. The effect of disease in this case could
be traced with much confidence, as the examination was made on

1858.] Fatal Disease of Appendix Yermiforrnis. 471

Tuesday afternoon, a few hours after death, and but a short time
was allowed for decomposition to embarrass investigation.

The appendix was much distended at its lower extremity by a
concrete mass composed largely of raisin seeds. Its walls had
not been perforated, and contained, with the foreign matter, an
accumulation of pus, the whole forming a mass the size of a wal-
nut. The appendix partially embraced the illium, adhering to it
strongly, and completely strangulated the small intestines ; which
were," for a distance of six feet above, of a dark mahogany colour
and passing into gangrene. At the point of strangulation there
had been much inflammation with large effuion of lymph ; the
walls of the tumor were thin, bursting under pressure of the fingers ;
but, having retained its contents during life, there was no dis-
charge of foreign matter into the peritoneal cavity giving rise to
peritonitis and masking the earlier symptoms of colic, as in the
case just described.

Moreau cites a case identical with this, the ilium having been
strangulated by adhesion of the appendix to the mesentery ; while
Marteau has seen the jejunum, and Scarpa the colon, embraced
in the same manner and with a like effect.

Klockhof reports a case in which the appendix adhered to the
colon by its extremity, thus forming a loop through which the
small intestines had passed, producing strangulation.

Merling, in examining a subject, found the appendix adherent
to the colon by the lower extremity, and forming a free commu-
nication between different sections of the intestine, but was
unable to learn anything of the previous history of the individual,
or under what train of symptoms this union occurred, evidently
followed by entire recovery.

Again, the appendix is at times metamorphosed into a hydro-
pic capsule, as reported by Rokitansky, from the presence of a
concretion in the tube closing the canal and preventing escape of
the mucous secretion. This causes the extremity to become
dilated, and the mucus to pass into the condition of a serous
membrane secreting an albuminous fluid.

Besides the foreign matter collecting in the appendix mechan-
ically, tuberculous and typhoid deposits are laid down at times in
its walls, giving rise to ulceration. When, in addition to these
varieties of disease, we consider the fact, that a long time may
be required to establish the existence of serious symptoms, since
it is asserted that a concretion may exist and only give rise to
blennorrhcea, a correct diagnosis is only equalled in difficulty bv
its importance. Ulceration of the* appendix is not necessarily
fatal, but forms abscesses at times pointing in various directions,
according to the variety of directions assumed by the appendix;
and it is of great moment that these should be anticipated and dis-
charged at the earliest period possible, and the risk of an infernal

472 Inflammatory Diseases of the Respiratory Organs. [July,

rupture of their walls diminished. In the cases cited above, the
earliest symptoms were of colic, excepting the obstinate con-
stipation, the bowels having been freely evacuated without relief.
In both, the earlier symptoms were overlaid by peritonitis ; while
in one there was an attempt to form an abscess, the constitution
failing before it was accomplished. [Transactions of the College
of Physicians.

Treatment of Inflammatory Diseases of the Respiratory Organs.

Dr. Semple read before the Medical Society of London (Janu-
ary 16th, 1858) a paper on this subject. He commenced by
observing that the treatment of pneumonia was formerly sup-
posed to consist almost solely and essentially in the abstraction
of blood from the arm ; but that in the present day, not only in
this, but in other inflammatory diseases, the use of the lancet
was but seldom resorted to, and by many practitioners it was
abandoned altogether. It became a question whether this great
alteration in treatment was due to the varying fashion of the day,
or to the fact that disease had, in fact, altered its type, and
therefore required very different treatment from that formerly
adopted. He (Dr. Semple) was inclined to believe that disease
had really altered its type, for he and others had, at the com-
mencement of their professional career, bled patients very con-
stantly, and certainly with good results, but at present the
operation of venesection was not so much required. He had
been for the last three years connected with the Northern Dis-
pensary, where all the usual forms of disease presented themselves
to his notice, and he had recommended bleeding only once
during the whole of that period in that institution. The fact
appeared to be, that the sthenic inflammatory diseases were
dying out amongst us, and that asthenic complaints were taking
their place. The cholera which visited this country in 1832,
was certainly a disease of depression, and this was immediately
followed by the influenza, a disease of the same depressing c! ass,
and, like it, requiring a tonic plan of treatment. Since the date
referred to, neuralgia, also a disease of depression, had become
almost epidemic; carbuncles and carbuncular boils were at pre-
sent decidedly so ; and Bright's disease, the disease of the supra-
renal capsules giving rise to the bronzed skin, and the disorders
classed under the head of fatty degeneration, were all much
more prevalent than formerly, even if we do not admit them to
be new diseases. In fact, it now became a question whether
bleeding should ever be practised at all, and he (Dr. Semple)
was as cautious in ordering a patient to be bled as a surgeon
would be in deciding upon the amputation of a limb. Never-

1858.] Inflammatory Diseases of the Respiratory Organs. 473

theless, although the cases which were met with in practice
required in general the adoption of tonic and stimulating treat-
ment, it was by no means proved that all forms of disease were
characterized by depression; for cases of a sthenic type still
presented themselves, and demanded the application of antiphlo-
gistic measures. The remarks made upon the treatment of
inflammatory diseases in general were particularly applicable to
those of the respiratory organs, which are essential to life, and
the inflammations of which require the most prompt and judi-
cial medication ; still it was impossible that any stereotyped
rules could be laid down for the treatment of these affections,
which may present the most opposite therapeutical indications.

The author then related the case of a lady in whom the treat-
ment by bleeding, calomel, and tartrate of antimony was adopt-
ed for an acute inflammation of the larynx and trachea, extending
to the bronchial tubes, substance of the lungs and pleurae. This
treatment not having at first produced a well-marked effect, the
antiphlogistic plan was changed for a stimulating one, and car-
bonate of ammonia and brandy were employed while the acute
symptoms still continued. The result was, that the patient be-
came decidedly worse, and appeared to be on the point of death
by suffocation; Luton again changing the plan, and resorting to
bleeding, low diet, and tartrate of antimony, the disease gradu-
ally subsided, and the patient, who is now alive and well, was
restored to perfect health, without any trace whatever of the
previous illness.

Dr. Semple wished that it should be understood that he had
no dogmatic views to offer upon the treatment of the inflamma-
tory diseases of the respiratory organs. He could not advocate
indiscriminately large bleedings, profuse mercurialization, and
repeated doses of tartar-emetic; nor, on the other hand, could
he approve of the universal adoption of the plan of stimulating
such cases by brandy and carbonate of ammonia; and it was
difficult to determine which would be the greater error of the
two. He believed that many cases of pure sthenic inflammation
still presented themselves in practice, although they were by no
means so common as they formerly were; and in such instances
the abstraction of blood, and the administration of mercury, of
the alkalies and tartar-emetic, will effect a cure. But there are
in the present day a great number of epidemics, contagious, and
diathetic forms of disease, which are, it is true, accompanied by
inflammation, but of a low or asthenic character, and these re-
quire tonics, alteratives and stimulants. Undue depletion ought
to be avoided in persons who are the subjects of the gouty, the
venereal, or the scrofulous diatheses ; and whenever an v of these
affections co-exist with, or precede inflammation, the disease
ought not to be considered as of a sthenic character, and the cure

474 Foreign Body in the Nasal Passage. [July?

should be sought rather by correcting the prevailing morbid
taint in the system than in indiscriminate depletion; and some
of these constitutional maladies, especially scrofula, required
cod-liver oil, iodine, iron, meat, wine, and beer.

The paper concluded with a sketch of the treatment of pneu-
monia as it presented itself in children, in vigorous adults, in the
inhabitants of towns and cities, in persons labouring under fever,
in its typhoid form, and in its complication with tubercular
phthisis, in each of which cases, although the name of the disease
was the same, yet the treatment required was very different,
owing to the peculiar features which the malady assumed.

In the discussion which ensued, Dr. Eouth, Dr. Camps, Dr.
Webster, Dr. Cotton, Dr. Chowne, and Dr. Stocker took part.
The debate elicited nothing very striking or novel ; but it was
remarkable that none of the speakers spoke in favour of the
stimulating plan of treatment in inflammatory diseases of the
chest.

Dr. Semple, in reply, feared that the nature of his remarks
had been misunderstood by some of the speakers. So far from
advocating the indiscriminate use of bloodletting, his paper had
just the contrary tendency ; and he believed that a medical man
was bound to dispossess himself of all dogmatic opinions, and
to treat his patients in such a manner as would most rapidly
restore them to health. This could only be done by studying
the peculiarities of every case, and paying strict attention to all
modifying circumstances. However valuable statistics might be,
he thought that they did not throw much light upon practice ;
and as to the number of cases which, it was said, recovered from
pneumonia in the Vienna hospital without any treatment at all,
it was not stated what the peculiar forms of the disease were, or
what were their complications, and the results might be quoted
to support any doctrine whatever. He thought that the subject
of the modern treatment of the inflammatory diseases of the res-
piratory organs, and of innaVnmatory diseases generally, was a
very proper one for debate in medical societies; and as the ar-
guments were not by any means yet exhausted, he hoped that
others would continue the discussion upon some future occa-
sion. [Amer. Jour, of the Med. Sciences.

Foreign Body retained upwards of Tiuenty Years in the Nasal
Passage.

Dr. Hays states that the interesting case communicated to the
College at its previous meeting by the president, in which a
foreign body had remained four years in the lungs, recalled to
his mind a case in which a foreign body had remained in the

1858.] Treatment of Plturo- Pneumonia. 475

nose for, probably, upwards of twenty years, and a brief notice
of which might interest the Fellows.

Some years since I was consulted by a lady of between twenty-
five and thirty years of age on account of oza?na, with which
she had been troubled ever since childhood. The disease resist-
ed various means of treatment, and I discontinued my visits and
lost sight of the case.

About four years subsequently, a Fellow of the College, Dr.
Wm. Darrach, inquired of me if I recollected the case, and stated
that the patient had afterwards fallen under his care, and that
finding it very intractable, he had determined to examine into
the condition of the bones of the nose. With this object he in-
troduced a probe through the nose into the nasal fossae, and
while moving this instrument about there, he accidentally dis-
lodged a mass which dropped into the opening of the nostril,
and by an effort on the part of the patient was expelled. On
examination, it proved to be an old-fashioned glass button with
a brass wire eye.

The mother of the lady stated she remembered distinctly that
one of her sons, when a child, had had a coat with similar but-
tons.

Dr. D. supposed that the lady, when a child, had been play-
ing with one of these buttons, had placed it in her mouth, whence
it had slipped into her throat and produced strangling, and that
in the effort to expel the button it had been forced up through
the posterior nares and lodged in the nose. Here as a foreign
body it had become a source of irritation, and produced the dis-
ease for which we had been consulted. [Transactions of the
College of Physicians.

Treatment of Pie uro- Pneumonia.

Dr. S. 0. Habershon, Ass. Phys. to Guy's Hospital, draws the
following inferences from certain cases he has observed and re-
corded.

1. That active mercurial, antimonial and opiate medicines are
not necessary in many cases of pneumonia, even without de-
pression, and when seen at an early stage.

2. That convalescence rapidly takes place in many instances
under the saline plan of treatment, as bicarbonate of potash, as
shown by Dr. Hughes Bennett and others.

3. That while some cases of pleuro-pneumonia, especially in
young subjects, as several af the cases related were, may recov-
er, even without any medical treatment, that salines appear to
be of some value, perhaps by increasing the action of the secret-
ing organs, modifying the character of the blood, and hastening
the absorption of the effused product.

476 Principles of Treatment in Chronic Rheumatism. [July,

4. That in other instances, mercury appears to be of consid-
erable value, as in cases where there is considerable pleuritic
effusion.

5. That, in some, especially where there is much bronchitis,
with great febrile excitement, without prostration or struma,
antimony also is of much service; but that the indiscriminate
use of calomel and antimony in very many cases retards conva-
lescence, interferes with the return to healthy nutritive action,
and should be avoided.

6. That opium alone, or as its alkaloid morphia, is also a val-
uable remedy in pneumonia, either combined with ipecacuanha,
as in Dover's powder, or with antimony, when that is admissi-
ble; that it acts possibly by diminishing the frequency of the
respiratory act, by its action on the nervous system, increasing
diaphoresis, when combined as just mentioned; quieting the
nervous system, relieving pain, and diminishing the excitability
of the nervous system, and diminishing the excitability of the
bronchial tubes.

7. That while, in some cases, general or local bleeding may be
called for, such are exceptional cases now ; and that many in-
stances, on the contrarjr, require the liberal administration of
nourishing diet, and in some cases stimulants.

8. That each case must be judged by its own peculiarities;
and whilst many, from their age and other circumstances, will
probably recover under most varied treatment, other cases, of
which I might adduce many instances, almost invariably die,
as those arising in very intemperate habits, or where it follows
in the course of pyasmia and allied conditions. We have
thus sought by these instances to show that, whilst calomel and
antimony are sometimes of value, much more frequently they
may be dispensed with altogether in cases of pleuro-pneumonia,
rapidly advancing to consolidation of the lung, where a com-
paratively short time ago these remedies would have been pre-
scribed. [Med. Times and Gazette.

Principles of Treatment in Chronic Rheumatism.

Dr. Inman read an instructive paper on this subject, before
the Liverpool Medical Society. He adverted to the frequency
of the occurrence of chronic rheumatism, and the multiplicity
of the plans of treatment employed for it ; remarking that they
all, however, possessed something in common. Difficulty as to
diagnosis, and confusion as to treatment, he thought had arisen
from the practice of classing all sorts of aching pains under one
head, as rheumatic. The uneasy sensation experienced before
the access of eruptive fevers, and during the course of malignant
disease, or felt by those exposed to the action of mercury or

1858.] Principles of Treatment in Chronic Rheumatism. ' 17T

lead, and by those suffering from gout, gonorrhoea, or syphilis,
and in cases where it was evident that bile or urea was mixed
with the blood, and by children affected with struma had all
been set down as rheumatic, though due to most varied causes.
The term "Chronic rheumatism," he believed strictly applica-
ble to cases in which there is dull pain, usually coming on during
the night, referred to the tendinous expansions of the muscles,
the pulse not quickened, the skin warm, excepting over the seat
of pain, where the temperature is usually low ; the pain remit-
ting about 4 P. M., and not recurring till some time during the
night. There is usually no error of secretion, nothing visible at
the seat of pain. The duration may be from one or two days
to six weeks. Deposits in the joints rarely take place ; and that
form which causes gradual contraction of joints, and crippling
of limbs is rare. The rheumatic pain is usually symmetrical ; its
chief seats those parts least protected by fat and integuments.
Loss of motor power accompanies the pain, which, is increased
by action, and relieved by relaxation of the affected parts.
Rheumatism is not occasioned by dry and intense cold, but by
the more moderate degrees of cold, especially if the air be moist.
The experience of Arctic navigators, and of the army before
Sebastopol, as well as the comparative rarity of rheumatism
among carmen, carters, and bricklayers, confirm this point.
Firemen of ocean-going steamers appear particularly liable to
it. Persons of feeble constitution and languid circulation are
more obnoxious to it, than those with good circulation. It is
not common in women, except at advanced ages. The vigor-
ous action of the heart helps to remove the pain, as is evidenced
by the improvement which generally occurs after dinner. In a
case where there was great pain and stiffness in the arms, hands
and deltoid muscles, the immersion of the arms in very warm
water removed the pain for the time. Many rheumatic patients
feel quite well in a warm bath ; though often worse after it,
from increased susceptibility. The influence of temperature on
the local circulation has much power over rheumatism. Patients
take cold often through sitting near cold walls, &c The cause
of the pain is probably, primarily, the contraction of the pale
muscular fibres of the skin, the stagnation of blood in their
capillaries; the hot aching pain which succeeds^ being due to
reaction and dilatation of the vessels: the one efficient cause of
rheumatic pain in general, being deficient flow of blood through
the affected parts. With regard to treatment, the author thought
that no satisfactory results could be ascribed to colchicum, in
large or small doses. "Warm baths are useful in some cases.
Nitrate of potash had proved useful in the hands of some, but
he thought the iodide of potassium had a stronger claim to effi-
ciency. Guaiacum, aconite, opium, steel, and cod-liver oil, all

478 Lactate of Zinc in Epilepsy. [July,

prove useful in some cases ; and the local application of heat by
packing in wet sheets, blisters, sinapisms, heated irons, red flan-
nel, and red merino, also. The indication appears to be, to
restore the strength of the individual, and the vigour of his cir-
culation. In the most troublesome form, pain in the plantar
fascia, was removed by perfect rest and galvanism. [Liverpool
Medico- Chirurgical Journal.

Lactate of Zinc in Epilepsy.

Dr. Herpin's name is familiar to the medical profession on
account of his urgent advocacy of the employment of oxide of
zinc in the treatment of epilepsy. He now abandons this pre-
paration entirely in favor of the lactate of zinc. The greater
solubility and digestibility of the latter would a priori engage
our sympathies in its favour. The following is one of the cases
which have decided the author's preference, and deserves to be
recorded on account of the success obtained in fcpite of the un-
favourable prognosis which the case would have justified in the
first instance.

Miss E., aged eleven and a half, consulted Dr. Herpin, Februa-
ry 1st, 1854. She was well made, intelligent and pleasing. Her
paternal grandfather had died epileptic at forty-nine years of age ;
her maternal grandfather at seventy-six, after being insane for
six years, and in a state of melancholy for forty years. No pre-
disposing or exciting cause was traceable in the patient, except-
ing perhaps the fright caused by a fire two months previous to
the first attack. She enjoyed excellent health till six years of
age, when she had typhoid fever, having on the right side a
tendency to slight and evanescent deafness. Three months be-
fore the first seizure she was attacked with frequent headache,
generally commencing in the morning, and lasting till evening.
The headache ceased in December, 1853. The first fit occurred
on August 15, 1853, the second on September 5, the third on
September 26 ; six then followed at variable intervals, making
altogether nine in less than five months ; they always took place
during the first hour of sleep, and the evening before the attack
she was observed to be somewhat excited. The symptoms,
which, are detailed, leave no doubt as to the attacks having been
those of genuine epilepsy. The oxide of zinc had been pre-
scribed for the patient from September to the following July,
but she was unable to bear the doses which Dr. Herpin thinks
necessary in order to make a proper impression upon the patient.
He was once able to reach a dose of six grammes (ninety grains)
per week, but he was obliged to diminish it. Still the attacks
ceased, from January the 8th to July the 18th; but a return on
that day, brought on by a tepid bath, induced M. Herpin to have

1858.] Observations on Diabetes Mellitus. 479

recourse to the lactate of zinc, which he gave for above six
month, during which time the patient swallowed 306 grammes
(4600 grains). The tolerance of the remedy was complete, and
when she left off taking it, she was in perfect health. There
was one recurrence of epilepsy two months after commencing
the lactate. Three years have since elapsed, and the lady's
health continues sound. [& Union Medicate, and British and
Foreign Med. Chir. Rev.

Observations on Diabetes Mellitus, especially with regard to Hie
Changes of Temperature occurring in this Disease. By Dr.
Lo^initz.

On twenty-one successive days, 24th October to 13th Novem-
ber, 1856, Dr. Lomnitz carefully examined the temperature of
three diabetic patients in the hospital at Gottingen, by introdu-
cing the bulb of a thermometer into the arm-pit and into the
mouth. The observations were taken morning and evening,
and each time the frequency of the pulse and respiration, as
well as the amount of urine passed in twenty-four hours, and its
specific gravity, were noted. Two of the patients were females,
and respectively thirty and thirty-six years of age ; the third, a
young man, was nineteen years old. On comparing the aver-
age of his results with the temperature of healthy individuals as
determined by Barensprung, he finds that the diabetic patients
suffer an average reduction of 1'07 Reaumur (2*4 Fahrenheit)
in the arm-pit, and of 0'39 Reaumur (0;8 Fahrenheit) in the
mouth. The author sums up his observations thus: 1. The
temperature of a person suffering from diabetes mellitus is lower
than that of a healthy individual. 2. The diminution of tem-
perature is not progressive, but persists at a definite point, acqui-
red at a stage of the disease which has not yet been determined.
3. There is no relation between the loss of temperature and the
alterations in the pulse. [Henle und Pfeuffer's Zeitschrift, and
Brit, and For. Med. Chir. Review.

On the Treatment of Menorrhagia with Ergot. By J. McF.
G-astox, M. D., Columbia.

The author of this paper, after giving to Dr. Churchill the
merit of having first pointed out the 'value of ergot in menor-
rhagia, relates his own experience upon the subject. He tried
it at first (1846) in the case of a young lady who had suffered
from profuse flow of the menses for a considerable period, and
under the use of the remedy she completely recovered, married,
and had a family. The ergot was given with carbonate of iron,
in doses of five grains of each, three times a day. Dr. Gaston

480 Sulph. Acid and Sulphate of Zinc as a Caustic Agent. [ July,

has found the use of the ergot followed by beneficial results in
every subsequent case of menorrhagia in which he has prescri-
bed it. He has latterly given it in infusion, combined with the
tincture of the sesquichloride of iron, which he thinks a prefera-
ble form of administration. When much nervousness was ex-
cited valerian was combined with the ergot ; and when there
was great pain, opium was added with advantage. A discharge
somewhat similar to menorrhagia occasionally occurs within
the second month after delivery, which, if continued, may en-
feeble the patient ; and in such cases Dr. Gaston has employed
the ergot and iron with excellent effect. The ergot is of course
contra-indicated in pregnancy, unless it should be desirable to
dislodge the foetus. In a case of haemorrhage, about the fifth
month of pregnane}7, which threatened to prostrate the patient,
Dr. Gaston gave the ergot in doses of five grains, with one grain
of opium, every two hours, and only three doses were taken
when the child was expelled and the hemorrhage ceased.

[Charleston Med. Jour, and Review.

Sulphuric Acid and Sulphate of Zinc as a Caustic Agent.

There is an important chemical principle involved in the ap-
plication of sulphuric acid for the destruction of living tissues,
which is that the acid mainly acts upon organized matters, by
its powerfuj tendency to combine with the elements of water
contained in them, so that the carbon is left free, forming the
black charcoal-like mass with which we are familiar as the result
of its action upon all such tissues. Now, the more concentrated
is the acid, in its liquid form, the greater is its power to decom-
pose animal or vegetable tissues by abstracting the elements of
water. It is desirable, therefore, in adding material to the acid
for the purpose of giving it the form of paste, that the substance
employed should not be an organized matter capable of furnish-
ing water to the acid, and so weakening its caustic power, but a
substance which should add fresh caustic power, so as to pro-
duce a combination possessing the greatest possible degree of
caustic force. The dried sulphate of zinc suggested itself to Mr.
Henry Thompson as such a material ; and upon trial it has fully
answered his expectations. He prepares it as follows :

" The ordinary sulphate of zinc is to be dried in an oven or
sand-bath, so that the water of crystallization is driven off, and
a whitish powder remains. Enough of this is to be added to
some strong sulphuric acid, in order to make a semi-fluid mass
of consistence sufficient to prevent its running beyond the spot
on which it is placed. The mixture should be kept in a stopper-
ed bottle, and be applied with a small glass spatula or rod. Be-
fore using it, the surrounding parts should be protected by a

1858.] On Obstinate Vomiting. 48 L

thick layer of cerate or firm ointment, so as to form an embank-
ment limiting the surface to be destroyed, and a layer of the
caustic may be made upon this of about the eighth or tenth of an
inch in thickness. This is allowed to remain. As in the case
of other caustics, I believe, the pain is less in the superficial than
in the deeper diseased tissues."

One advantage of this combination consists in the ease with
which it is prepared, and the facility with which its constituents
may be obtained. [Lancet

On Obstinate Vomiting.

Various means have been proposed against vomiting during
pregnancy, in hysteria and other circumstances. Several French
physicians have lately tried with success, in many cases, some
remedies either too neglected or quite new. During pregnancy
vomiting has been stopped by the use of a portion of tincture of
iodine (10 drops), iodide of potassium (10 grains), and 120 gram-
mes (4 ounces) of water and syrup. This prescription has been
employed by M. Becquerel. A physician of the south of France,
M. Bacarisse, has made use of iodide of potassium alone, which
he thinks to be more successful than tincture of iodine. Profes-
sor Buisson, of Montpelier, has tried three remedies : tincture of
iodine with alcohol (a remedy much spoken of in Germany) ;
iodide of potassium alone, and with tincture of iodine. With
the first of these three medicines he has seen an increase of the
vomiting; with the second, vomiting has hardly diminished;
with the third it has completely ceased. He has made this trial
three times. Dr. Martin Magron, of Paris, has employed suc-
cessfully dry cupping on the spine, and in a case of obstinate
hysterical vomiting, he has succeeded at every fit in stopping
the vomiting by this mode of treatment. In a case of paraple-
gia, with convulsive fits and vomiting, he has succeeded a great
many times, in stopping at the same time the vomiting and the
fit, by cupping applied on the spine and slight bleeding. [Vir-
ginia Med. Journal.

On the Use of Chloroform in Certain forms of Paralysis. By M.
Laxdry.

M. Landry terminates a long series of papers with the follow-
ing conclusions : 1. There exists a group of paralyses of the
motor powers, offering the following general characters. There
is preservation of muscular irritability and of the excitability of
the nervous trunks, integrity of muscular nutrition, and absence
of reflex motion, of spontaneous convulsive movements, of con-
tractions, of fibrillary contractions, and of trembling in parts
actually deprived of voluntary motion. 2. In this group may

482 lite Doctrine of Elimination. [July,

especially be ranged hysterical paralysis and sympathetic par-
alysis, generally confounded together under the common de-
nomination hysterical. 3. Some of these paralyses disappear
during sleep, and immediately yield to the action of chloroform
(probably also of ether) and narcotics. Others undergo no modi-
fication under such influences. 4. The former appear to belong
to the category of sympathetic paralyses ; the latter to that of
hysterical paralysis, properly so called. 5. These phenomena
constitute a means of diagnosis of true hysterical paralysis. 6.
They serve to distinguish in all cases the paralyses in which
they are observed from those which are dependent upon organic,
nervous or muscular lesion. 7. Narcotic and anaesthetic agents
may be employed in the treatment of paralysis, whether as cura-
tive agents, palliatives, or simple auxiliaries. \_Mon, des Hop.,
and Med. Times and Gaz.

The Doctrine of Elimination, as propounded bg recent Authors.

Dr. Thomas Inman has published {Liverpool Medico- Chirurgi-
cal Journal, July, 1857), a very interesting paper on this subject,
in which he inquires : 1st. What the doctrine of elimination is.
2nd. The arguments in its favour. 3rd. The plan of treatment
it leads to. And he endeavours to show

" 1. That the processes by which poisons are expelled from
the body are passive, rather than active.

"2. That evacuations, emanations, or eliminations, are not to
be considered as ' salutary efforts of nature to cure,' but as symp-
toms of the normal nutrition being modified by a new force.

"3. That it is dangerous in diseases of a humoral origin, to
act upon an eliminant plan of treatment principally.

"4. That the mode of treating diseases, depending on the
presence of poison, is to enable the system in general, or any
organ in particular, to resist its action or tolerate its presence.

"5. That anything which depresses the vital powers, makes
an individual more susceptible of foreign influences.

"It is not simply a pure condition of the blood that is neces-
sary to health ; for man may have the most healthy blood pos-
sible, and yet die of cold ; while those whose blood is vitiated
by tuberculosis, cancer, the paludal or gouty poison, may appear
to enjoy perfect health, for a lengthened period, if not for the
ordinary duration of life. No medicine, therefore, whose sole
aim is to purify the blood, and no plan of treatment simply
eliminative, can be expected to have more than temporary, or
accidental success.

" There is, however, one plan for the elimination of all poi-
sons, with which we feel bound to concur. It is that which

1858.] Perchloride of Iron in Erysipelas. 483

places the patient in the midst of pure air and lovely scenery;
which takes him from the turmoil and wearing activity of busi-
ness, and gives him mental repose ; which supplies him with
nutritious diet, and abundance of the finest water; which pro-
cures sound rest at night, without any other opiate than health-
ful exercise ; and which does not scour out the bowels by a daily
purge.

"In this way, we believe health maybe regained, and poison
be expelled ; for there is in every living being a necessity for a
constant renovation; old materials are daily being replaced by
new; and when the increments are all healthy, and all old ma-
terials are being expelled, it is a necessary consequence that the
body should have as sound a constitution as it is possible to at-
tain." [American Jour, of die Med. Sciences.

Perchloride of Iron in the Treatment of Erysipelas.

The use of perchloride of iron in the treatment of erysipelas
has lately been brought again into notice by the publication of
a thesis by M. Louis Mathey, and by some observations made
by M. Aran, physician of the Hopital St. Antoine in Paris. M.
Mathey relates ten cases of erysipelas treated with this medicine,
and his conclusions are contained in the following remarks:

The action of perchloride of iron on erysipelas is evident, and
the course of the disease is modified a short time after its admin-
istration. In fact, on the second day, and sometimes even on
the first, M. Mathey has seen the disease become limited and
circumscribed, and its further progress arrested. As to the du-
ration of the disease, the effect of the perchloride is still very
remarkable : not only is the progress of the erysipelas sensibly
modified from the first few hours which follow the administra-
tion of the medicine, but it is completely arrested ; the radical
cure of the disease is obtained in a very short time. It was
observed that in ten rather severe cases of erysipelas treated by
the internal use of perchloride of iron, three were cured in two
days, three were cured in three days, two were cured in four
days, one in five days, and one in seven days. It cannot there-
fore be denied that erysipelas is advantageously modified by the
internal use of chloride of iron ; that the cessation of the symp-
toms proper to erysipelas is sometimes very rapid after the ad-
ministration of this medicine ; that in a series often observations
made upon varied cases, this treatment never failed; that even
where its efficacy may be doubted it has never given rise to any
bad symptom ; and that when administered in the dose of 30 drops
to a healthy subject, it has never given rise to any painful sensa-
tion, and has never produced any notable functional disturbance.

M. Aran agrees with M. Mathey in never having observed

k. s. vol. xiv. jro. vn. 24

484 Perchloride of Iron in Erysipelas. [July*

any unfortunate result from the administration of the perchloride
of iron in larger doses than those employed by M. Mathey
namely, thirty, fifty, sixty, and one hundred drops a day, in
certain exceptional cases. But a wider and more extensive
experience of the employment of the perchloride has shown him
that there are particular circumstances which favour the action
of the medicine. M. Aran believes that it would be vain to
expect advantageous results from the administration of per-
chloride of iron in all cases of erysipelas. He is convinced that
some cases of erysipelas will not yield to this remedy ; as, for
instance, the cases which occur in young, strong, and robust
subjects of a sanguine temperament, and which are accompa-
nied by a well-marked imflammatory action. On the other
hand, the cases of erysipelas which are developed in feeble, deli-
cate subjects, of a well-marked lymphatic or scrofulous tempera-
ment; in individuals already weakened by previous disease;
the cases especially which exhibit with well-marked tendency
to spread, the cedematous form ; and in which, even with a
marked acceleration of the pulse, the arterial throbs are weak
and easily depressed, or when fever is completely wanting, as
happens sometimes in old persons; these cases are remarkably
modified and often arrested in twenty-four, thirty-six, or forty-
eighth hours, by the administration of the perchloride. The
erysipelas, which is still more atonic, and which supervenes in
the course of serious diseases, around punctures, abrasions, or
lacerations of the skin, at other times even without appreciable
causes, are amenable to the perchloride of iron. Lastly, the cases
which, even when they show themselves in strong and robust
subjects, after having been reduced by various and appropriate
treatment, still linger on and pass from one part to another,
throwing out unexpectedly its eruptions in places where the
disease appeared to have been long extinguished; such cases
are often terminated in 24 hours by the perchloride of iron.

Another point connected with this subject is the propriety of
administering the perchloride as a prophylactic. " There are
certain epochs and years," says M. Mathey, "when cases of
erysipelas of a traumatic origin are multiplied to infinity, and
show themselves in such great number, that the disease is truly
epidemic. The application of a seton, a moxa, or a blister, is
followed by erysipelatous inflammation ; and a fortiori, the great
wounds united by sutures and bandages of diachylon are almost
infallibly attacked with the disease. The surgeon who operates
under these circumstances is pretty sure to see erysipelas among
his patients. It would perhaps be proper to postpone the opera-
tion, but sometimes the case is urgent, and the surgeon would
think himself fortunate and could act with more confidence if
he could hope to put his patient beyond the reach of a trouble-

1858.] Antidote to the Poison of the Rattlesnake. 485

some complication ; might we not, for the first few days which
follow a delicate operation, and during which inflammation is
to be feared, unite with soothing beverages some drops of per-
chloride of iron, because it is fully established that its use in
moderate doses is not followed by any bad effect?" [Bull. Gen.
de Therap. and Brit, and For. Med. Chirurg. Rev.

Experiments with Bibron's Antidote to the Poison of the Rattle-
snake, &c. By William A. Hammond, M. D., Assistant
Surgeon U. S. Army.

Some four years since, Prince Paul, of Wurtemberg, the cele-
brated naturalist, communicated to my friend, Mr. De Vesey,
the results of some experiments performed before the French
Academy of Sciences, by Professor Bibron, relative to an anti-
dote to the poison of the rattlesnake. According to Prince Paul,
Professor Bibron allowed a rattlesnake to bite him in the lips,
cheeks, etc., and by taking the antidote discovered by him, pre-
vented ail alarming symptoms, and in fact suffered no incon-
venience therefrom.

The antidote in question, as stated by Prince Paul, is prepar-
ed according to the following recipe:

ty. Potassi iodidi, gr. iv. ; hydrarg. chloridi corros., gr. ij.;
bromini, 3 v. M. Ten drops of this mixture, diluted with a
tablespoonful or two of wine or brandy, constitutes a dose, to
be repeated if necessary. It must be kept in glass-stoppered
vials, well secured.

Prince Paul forwarded a small quantity of the above mixture
to Mr. De Yesey, who used it successfully in the cases of two
men bitten by rattlesnakes near his residence in Iowa.

During a recent expedition to the Eocky Mountains, I had
several opportunities of testing its efficacy, and, since my return,
have performed additional experiments with it. The results
have been, upon the whole, exceedingly satisfactory, and I think
that, when taken in time, it may be entirely depended upon in
the poisonous wounds of the rattlesnake, and perhaps also in
those of other venomous serpents.

First Experiment Heinrich Brandt, acting hospital steward,
was bitten on the 2nd of July, 1857, in the index finger of the
right hand by a large rattlesnake (crotalus confluentus), which
he was in the act of putting into a jar for preservation. The
snake inflicted a very deep wound, and hung by his fangs to the
finger for a second or two before it could be detached. About
four minutes after the bite, and before much pain or swelling
had ensued, I administered one dose of Bibron's antidote. The
symptoms almost immediately disappeared. Forty minutes after
giving the first dose the pain and swelling returned, attended

486 Influence of Atmospherical Changes, &c. [July,

with considerable throbbing. I repeated the medicine, and in
less than five minutes the finger had regained its natural ap-
pearance, and all pain and swelling had vanished. He remain-
ed perfectly well, and resumed his duties in an hour from the
reception of the injury. [American Jour. Med. Sciences.

Influence of Atmospherical Changes in Determining the Recurrence
of Paroxysms of Asthma.

Dr. A. W. Nichols has presented, in a tabular form, the suc-
cessive paroxysms of asthma occurring in a case under observa-
tion at the Buffalo Hospital of the Sisters of Charity, in the
service of Dr. Flint, from December 3rd to February 17th.
During this period seventeen paroxysms occurred. The date of
each paroxysm the time of the day when it took place the
degree of severity, duration, remedies employed, and the appa-
rent effect, as well as the state of the weather, are noted in the
table referred to. The paroxysms generally came on during
the night or early in the morning. They did not observe any
rule of periodicity. They were variable as regards intensity,
and were usually much more severe after any decided change in
the atmosphere. Almost all of the variations in the weather
were from a cold and dry to a warmer and moister atmosphere.
It is also to be noticed that no paroxysms occurred after or
during certain decided atmospheric changes, as great as those
which, at other times, were followed or aocompanied by asthma-
tic attacks. The paroxysms, even when most severe, and when
not influenced by remedial agents, did not continue longer than
twenty hours. The inhalation of chloroform produced more
marked relief than any other measure employed. The parox-
ysms were apparently abridged by it; the difficulty of breathing
was diminished ; the patient was able to assume the recumbent
posture, and natural sleep soon succeeded. This was the result
in six paroxysms in which it was tried. The dry bronchial rales
were diminished in a few minutes after breathing chloroform.
[Buffalo Med. Jour, and North American Med. Chir Rev.

Rules Respecting the Treatment of Primary Syphilis.

It seems to be now pretty generally acknwledged, in hospital
practice, that mercury should be given only in those cases in
which the chancre presents marked induration, and that in all
others secondary symptoms should be waited for before having
recourse to specific treatment. In a large majority of sores not
attended by induration, no constitutional phenomena will fol-
low ; and to discriminate between those likely to be so followed

1858.] Influence of Pregnancg on Development of Tubercles. 487

and the harmless class is admitted to be impossible. There is,
therefore, no alternative, except we would give mercury very
often unnecessarily, but to wait in these cases until the real na-
ture of the affection shall have been made manifest. In the
non-indurated class local stimulants, as sulphate of copper, lunar
caustic, or the acid nitrate of mercury, are the old and still fa-
vorite remedies. If the chancre be seen within a week of its
origin, whether induration have already commenced or not, we
believe most surgeons would destroy it freely either by nitric
acid or some other caustic. [Omodei Annali Universal^ and
Med. Times and Gazette.

Influence of Pregnancy on the Development of Tubercles. By
Edward Warrex, M. D., of Edenton, North Carolina.

This subject is discussed by Dr. Warren in an essay to which
was awarded the Fiske fund prize, June, 1856. The essay was
published by request of the Khode Island Medical Society.
The author divides the investigation into three heads, thus 1.
A consideration of the tubercular diathesis. 2. An inquiry
into the nature of the tubercle. 3. An application of rules res-
pecting disease already established. In view of the length of
the essay, and the limits to which this review must be restrict-
ed, we can only present a summary of the several points of the
argument by which the author endeavors to prove that pregnan-
cy prevents the progress of phthisis even when fully developed.

"(1.) There is an inequality in the relations which men and
women sustain to phthisis; the former being less liable to it
than the latter.

"(2.) This inequality depends upon certain differences of
conformation, etc., which are plain, palpable, and conspicuous.

''(3.) An examination of phthisical statistics should show that
more women fall victims than men, and that the difference in
the relative mortality of the two is as plain, payable, and con-
spicuous, as their original dissimilarity of constitution and pre-
disposition.

"(4.) An examination of statistics proves, that it is not a set-
tled fact that more females are destroyed by this malady, and
that there is a positive approximation toward equality in the
effects of phthisis upon the two sexes.

"(5.) This 'approximation toward equality' shows the opera-
tion of some great equalizing cause, by which a certain amount
of protection is secured to the female system that makes up for
its greater original susceptibility, and affects the general result
in the manner alluded to above.

u (6.) Pregnancy complies with all the conditions which this

488 After Treatment of Surgical Operations. [July,

cause demands for its operation, and it is fair to attribute this
protecting, preventing, and equalizing effect to its influence
upon the female system." [American Jour, of Med. Sciences, and
North American Med. Ghir. Review.

After Treatment of Surgical Operations.

Dr. Broadbent, in a paper read before the Liverpool Medical
Society, session 1855-56, referred to the object sought that of
union by the first intention. He believed one most common
obstacle to this union to be the occurrence of hemorrhage, one
or two hours after the operation ; not to such an extent as to
require the removal of the dressings, but sufficiently to form a
coagulum of such a size as to seriously interfere with the union
of the wound acting, in fact, as a foreign body. The cause of
this appeared to be, that in amputations, &c, when the surfaces
were brought together immediately after the completion of the
operation, the vessels were tied while the patient was still suffer-
ing from the shock of the operation, or it might be, was some-
what depressed by the after-effect of chloroform, whilst the more
minute vessels were prevented from oozing, by their exposure
to the air, and that when reaction took place, the hemorrhage
came on. The author thought that those cases in which this
occurred to such an extent as to necessitate the re-opening of
the wound, usually terminate more favorably than others. He
therefore advocated the plan of postponing the dressing until all
oozing had ceased, and the cut surfaces had glazed over. The
unnecessary removal of dressings, he believed to be another
frequent cause of non-union. He thought that the sutures hav-
ing been removed, the bandages, &c, should remain untouched
till the third or fourth day, and should then be carefully cut off.
The inability of the patieut to maintain the required position,
acted in the same way, and to obviate this, it was suggested
that the patient should, before the operation, be habituated to
the position in which he would have to lie after it. In the
maintenance of the position of the parts, by means of pressure,
the author believed that small air-cushions might be advantage-
ously used, instead of pads of lint. [Liverpool Medico- Chirurg.
Journal.

Diagnosis between Cancer and Condylomata.

A young married woman is now under Mr. Lloyd's treatment
in St. Bartholomew's, whose case well exemplifies the need for
great care in expressing opinions as to the nature of growths
which have the slightest resemblance to cancer. She was

1858.] Editorial 489

originally admitted about nine months ago for some small in-
durated tubercles on one labium, not at all dissimilar from con-
dylomata, of more than usual hardness. There were three, and
they were quite distinct from each other. This fact together
with the patients age and good state of health, induced many to
believe them of syphilitic origin. Mr. Lloyd, however, held a
contrary opinion, and determined to excise them. This was
done, and on microscopic inspection the elements of epithelial
cancer was detected in abundance. The woman left the hospi-
well, but she has now returned, with a recurrence of undoubted
cancerous ulceration in the same site. The glands in the groin,
being enlarged, have been excised. [Med. Times and Gazette.

EDITORIAL AND MISCELLANEOUS.

Professional Correspondence. We are sometimes called upon to
write letters of advice, and to present our views in relation to certain
diseases, where an amount of reflection and consideration is required,
almost equal to that which would be necessary to prepare a regular
essay upon the subject in question. As these letters often occupy the
time which should be appropriated to our Editorial department, we
have deemed it but fair to answer some of them editorially. As they
generally refer to subjects of immediate and daily interest to the practi-
tioner, their occasional appearance in these pages may be found accept-
able to the profession, more especially to our friends, the younger
members, notwithstanding the informal and often imperfect manner in
which the views and suggestions may be presented. Most of these letters
will be written in answer to queries propounded by recent graduates of
the Medical College of Georgia ; if, therefore, they sometimes assume a
didactic tone, other readers will remember that they are then, but the
words of the teacher to those who were but recently his esteemed and
attentive pupils. [Edts.

Dr. R. Campbell,

Dear Sir, You remember sometime last winter, I requested you to
give me your treatment for Typhoid Fever, I suppose it has escaped
your memory. \Yhen I subscribed for the Medical Journal, I mentioned
it to your brother (Prof. Henry Campbell) ; he said I would find it in the
Journal, but I have failed to do so, unless it was in the April number,
which I did not receive.

This is undoubtedly the worst country for typhoid fever I ever heard

490 Editorial [July,

of. Every case of sickness I hear of, the doctors pronounce it typhoid
fever. Hoping that you will comply as soon as you conveniently can,
I remain, your obedient servant, * * *

Augusta, Ga., June 15th, 1858.

Dear Sir, Your request for my Treatment of Typhoid Fever, is
before me. The requirements of the case will not permit me to be very
brief; yet, on the other hand, there being some limit to an epistolary
communication, space may not allow me to particularize with absolute
definiteness, so that what I may hereinafter say, you will please regard
as a basis of hints, rather than a complete and thorough detail of man-
agement for this disease.

First : you must understand that this disease is of long continuance,
and is also self-limited in duration. That is start out to deal with it,
under the firm and full conviction, that you cannot cure it ; and this
conviction, if honestly maintained, will save the life of many a patient.
Let the patient and the disease alone, so long as they appear to agree
together very well, without the latter taking advantage of the former by
attacking him at any particular vital point, and you will find that
generally, the patient will outlive the fever, unless he started out to die.

Secondly : should the disease attack with violence a vital organ, as
brain, lungs or bowels ; or to speak more properly, should these organs
not possess sufficient force of vitality to resist the enervating and disor-
ganizing influence of this condition, it will become necessary to fortify
them by remedial means directed thereto, also by supporting the gene-
ral strength, and thus assist the recuperative powers of the system.

Then, should the brain become the seat of congestion, you may drive
it out, and keep it out, at the same time giving tone to the vessels, by
the frequent, though not too severe, application of the cold douche to the
head. Should the parenchyma of the lungs be the seat of engorgement,
sufficient to embarrass their function, as manifested by partial or com-
plete occupation of the air passages with mucus as shown by ausculta-
tion and percussion, as well as by the extreme frequency of the respira-
tion treat the case according to Behier's plan, (see March No. of South-
ern Med. and Surg. Journal,) viz., with extensive and repeated dry cupping
to the chest, and use turpentine to give tone to the mucous tissue of the
lungs, and prevent or suppress inordinate secretion or exudation. Should
the mucous membrane of the small intestines give way, at, or in the
vicinity of Peyer's glands, which sometimes happens, though not invari-
ably (as is supposed by some), give turpentine as the best known means
of arresting the disorganization of this tissue, and to stimulate its recu-

1858.] Editorial 491

perative energy. This can be materially assisted by keeping a small
blister the size of the hand open, upon the right iliac region.

But if you have not the forbearance and firmness to stand by a case
of typhoid fever, which is running its course harmlessly, without inter-
fering to diminish the patient's strength, and with it, his chance of
recovery, you had better forego all the reputation you may expect to
gain by your professional enterprise in this quarter.

Is typhoid fever, then, a disease not requiring the regular attendance
of the physician ? Far from it. It is one above most of diseases, de-
manding his especial supervision and untiring watchfulness.

1st. He must guard the patient, that he does nothing himself, and
that nothing be done for him or with him, by others, to jeopard his
chance of recovery.

2nd. He must see that he is placed and kept in the most favorable
circumstances as regards bodily comfort, temperature, ventilation, <fec;
bodily wants as diet properly and judiciously ordered, limited and
adapted to the stages of the disease ; also, as regards the application of
stimulants and when to be used.

3rd. He is to watch and listen with a sentinel's eye and ear the distant
approach of those insidious complications, to which we have referred,
and which are sometimes the result of this disease, in one or more of
the vital organs ; and begin early to assist the patient's constitution to
withstand or overcome them.

The patient with typhoid fever seems to me to be poised with fearful
precision between life and death. If he maintains his ticklish position
through this protracted crisis, he is safe ; but how awful it is, to see
what a little influence may jostle him from it. He may not drop off
suddenly, but that little influence, even one injudicious dose of active
medicine, in the beginning of the attack, may prove the source of his
gradual, but inevitable decline and final fall.

Therefore, beware of treating this disease actively, even in the begin-
ning. Especially exclude purgative medicines, which are detrimental in
various ways.

One of the first and the most prominent symptom throughout the
disease, is weakness, or loss of vital energy. The vitality of the fluids,
as well as of the solids, is below par. Depletion increases the impover-
ishment of the fluids and the approach to necraeinia ; and from this
condition of the blood, probably, results the extreme loss of nervous
power in this disease. The patient seems completely enervated : very
slight muscular effort seems, often, entirely to overcome him, so that
rising up in bed quickens the pulse, and if frequently repeated, will
often seriously damage the prospects of the case. Therefore, the mere

492 Editorial [July,

effort to get up to stool, frequently, should be avoided, and purgatives
withheld for this reason, if other more valid objections did not obtain.
I have seen a convalescent relapse for two weeks, from walking across
the floor to change his bed.

Purgatives given early in typhoid fever are apt to determine to the
bowels, in the latter stages, by deranging them and rendering them en-
feebled and more susceptible to the influences which manifest themselves
in this portion of the organism, as the most common form of complica-
tion or organic implication, occurring in this disease. And who can
say, but that the bowel affection is in many instances determined by
this treatment in the incipiency of the attack. If the alimentary canal
requires clearing out, a simple dose of castor oil would probably accom-
plish it without irritation or depletion. But I would express here, my
unfeigned disapprobation of the abominable plan of purging every pa-
tient, in every disease, as a necessary preliminary to any other treatment.
In typhoid fever, it is productive of positive mischief, by precipitating the
result of an existing predisposition, viz. to intestinal disease : whereas,
in paroxysmal fever, often, valuable time is lost in waiting for the opera-
tion of active medicines, to the delaying, or entire exclusion of the only
important element of treatment.

Thus, you perceive, that as for the treatment of typhoid fever, it is a
disease that requires more watching than active interference. But if
there is one remedy in the catalogue of the Materia Medica, which
seems to be adapted to this condition more than another if there is
anything which seems calculated to relieve the complications which
generally arise in this disease, or to prevent them ere they make their
appearance it does seem that that agent is Turpentine.

Dr. Thomas Smith, of London, wrote ninety pages upon the good
effects of turpentine, and some were disposed to smile at his credulity ;
but I rather think he was right.

The turpentine treatment of typhoid fever has been long in vogue.
The name of Professor Wood, of Philadelphia, is particularly associated
with this treatment, inasmuch as he recommends it highly, and advo-
cates strongly its advantages above all others in certain stages.

I have used this treatment for six or eight years, and whether from
its positive advantages, or from the benefit derived from the exclusion of
all other medication, there has certainly been the greatest improvement
in the success of my practice upon this disease during that period.

It sometimes happens that typhoid fever, in its incipiency, is mixed
up with paroxysmal fever. These cases require quinine to rid them of
this paroxysmal complication which it does leaving the continued
fever to pursue the even tenor of its way. I sometimes give quinine in

1858.] Editorial. 493

moderate doses, three times a day, and continue its use for a length of
time, varying the quantity with the degree of necessity for its continu-
ance in those cases which have a tendency to congestion, or to passive
hemorrhages because I believe that quinine acts upon the vascular
tissue, to give it tone or contractility ; and I have seen many good re-
sults from the continued administration of considerable doses of quinine
under such circumstances.

The mode in which I have found it convenient to administer turpen-
tine in typhoid fever, is by the following emulsion :

Be Turpentine, ss.

Loaf Sugar,

Gum Arabic,

Com p. Spts. Lavender, . .

Bi Carb. Soda,

Camphor Water, . q. s.

To make an 8 ounce Emulsion.

aa I).

Dose For an adult, 1 tablespoonful three times a day (well shaken),
and so continue.

To begin with the turpentine early in the attack, seems to lessen the
danger to the bowels, and also to the lungs.

I have often seen the bowels, discharging large watery stools before
the use of this emulsion, become even constipated under its use, by re-
lieving the local affection. I have continued the emulsion in many
cases from my first visit to a patient, until he was discharged.

If there should be much diarrhcea, and the emulsion does not check
it, I give 5 grains sub. nit. bismuth in a spoonful of water, after each
passage. The most convenient mode of administering the bismuth, I
find is in an aqueous mixture, viz :

R Sub Nit Bismuth, .... grs. 80

Water, gij.

Mix in two ounce phial.

Shake until well mixed at each dose, and give one teaspoonful after
each passage.

If this does not have the desired effect, I add a small quantity of
laudanum from 10 to 20 drops. I dislike the too free use of opiates
in typhoid fever : I think" they are calculated to bring about coma or
delirium in the latter stages.

The bismuth, in connection with the turpentine treatment, will gene-
rally check the bowels as promptly, or even more speedily than opiates.
When there is diarrhcea, I invariably put a small blister over the right
iliac region, and keep it open if possible, until this symptom disappears.
I always examine this region, whether there is diarrhoea or not, and if I

494 Editorial [July,

find tenderness upon deep pressure with the hand, or meteorism, I take
it for granted that the diarrhoea is not far off, and apply the blister and
put the patient upon the treatment above mentioned.

You will generally find that the comp. spts. lavender, in the emulsion,
will prevent subsultus tendinum in a great measure ; but if this pheno-
menon should appear, add to the course, a teaspoonful of the tincture of
valerian (for an adult,) every three or four hours, until relieved, and re-
peat pro re nata.

I give this tincture also, to quiet restlessness, sleeplessness, and slight
delirium, in these cases. Sometimes a Dover's powder (10 grains,) at
night is necessary to induce sleep.

In the earlier stages, when the skin is very dry and hot, great benefit
may be derived from the thorough application of lard ("bacon-rind")
to the surface of the patient's body and limbs. It has a very cooling
and soothing effect. This valuable fact I gained from my friend, Dr. P.
D'L. Baker of Alabama. The patient may be greased all over, once or
twice a day ; or, whenever his skin becomes very hot and dry, or he
seems very restless ; that is, if it can be done without giving him the
least fatigue, or causing the least muscular effort : for, recollect, that
nothing should be done that requires the patient to rise up or to move.
I have a patient now, who got his pulse up very high the other day, by
simply fanning the flies off of himself, for a little while. I mention this
forcible example to show you, how little muscular effort it would take,
either by getting up to stool often, or otherwise, to kill a patient with
this disease. Thus, a patient with typhoid fever, should never be allow-
ed even to get up to stool, if it could be avoided ; and there exist the
best of reasons for this, but time and space forbid my entering upon the
pathology here. I will, therefore, cite you to my brother's contributions
upon this subject, in his volume entitled "Essays on the Secretory and
Excito-Secretory System," article, " Typhoid Fever."

If the bowels should remain constipated for too long a time, they
should be relieved by warm-water enemata.

At a variable length of time from the beginning of the attack, some-
times ten days, or two or three weeks, the skin will become cool, or
even sometimes alarmingly cold. It is sometimes proper to give stimu-
lants before this stage comes on, when, for instance, the adynamic char-
acter of the disease is very apparent in the first stage, or if accompanied
with passive hemorrhage i.e. brandy with quinine : but stimulants are
generally imperatively demanded, when the cold stage has set in. Some
cases only require port wine, with which I often combine comp. tincture
of cinchona, three times a day, in doses of from one to two ounces of
the former, to two to four drachms of the latter for an adult, diminishing

1858.] Editorial 495

in proportion to the age of younger subjects. Other extreme cases re-
quire brandy almost without limit. It is astonishing sometimes to see
what immense quantities of brandy may be poured down a patient in
this very low condition, without his system appearing to recognize that
it is a stimulant.

The dietetic and regi menial conduct of a case of typhoid fever Lb
important, and I believe, even more so, than the medicinal course. In
the earlier stages the patient does not desire much nourishment does
not require much ; and probably it would do him an injury to force him
with much. Some light food, such as very fresh milk, well boiled with
rice or arrow-root ; grated cracker and hyson tea, <fec, is as much as he
will generally require ; and care should be taken that he does not take
too much even of these at a time.

In the latter stages, it is necessary not only to use stimulants, but a
nourishing diet is demanded, both by the patient's improved appetite,
and by his debilitated general condition. Sometimes the appetite is
ravenous, and craving the most indigestible and injurious articles, the
patient being often difficult to control, and this is a dangerous season on
that account. The best form of nourishment under these circumstances
is beef essence, and in the absence of this, chicken soup made with rice,
seasoned with pepper. The patient should be allowed the free use of
cold water ice water, if practicable but not to take too large a
draught at a time. Sponging the body with cold water in the earlier
stages, often affords great relief and improves the condition of the pa-
tient. He should never be allowed to lie upon the floor, or in an ob-
scure corner of the room, inconvenient to be got at; but should always
be supplied with a bedstead, placed in the most accessible part of the
room that he may be examined critically, in a good light, at pleasure,
and without the disadvantages of a constrained position, or other embar-
rassments to the physician. He should be on a comfortable, soft bed,
and should be turned over occasionally, or else he will have bed-sores
one of the most serious inconveniences attendant upon this protracted
disease.

Above all things, he should be in a well ventilated room, and not
near a fire, either in winter or summer. I believe many negroes die of
this disease, from being kept in too close quarters, and exposed to the
heat and smoke of a cooking-fire. The temperature of their apartments
should be uniform and moderate.

When the patient is convalescent, do not allow him to indulge in any-
excess of diet, or exercise, for some time after his attack. I have been
thus particular in dwelling upon these minutiw, because in attention to

496 Editorial. [July,

these things, which are ordinarily considered minor points, the treat-
ment of typhoid fever principally consists.

Hoping that the hints which I have thus, so hastily and unsystemati-
cally, thrown together here, may be of convenience to yourself and ben-
efit to your patients, I have the pleasure to remain,
Very truly, your friend,

ROBERT CAMPBELL.

Oglethorpe Medical and Surgical Journal. In a recent number,
we called attention to the prospectus of the Savannah Journal of Medi-
cine ; we have since received this new work, and find that it fully answers
our expectations, both in the character of its productions, and the style
of its typographical execution. We have now to acknowledge the
receipt of the first number of the Oglethorpe Medical and Surgical
Journal, which is to be published bi-monthly, in Savannah, under the
editorship of Drs. H. L. Byrd and Holmes Steele, Professors in the Ogle-
thorpe .Medical College. The number before us presents a handsome
appearance, both in the variety of its contents, and typographically. It
contains 64 pages, and will be published every two months. We take
pleasure in placing both the above journals upon our exchange list.

Medical College of the State of South Carolina. Resignations
and Appointments. " It is with extreme regret that we find ourselves
compelled to announce the resignation of Prof. Geddings from the chair
of Surgery, in the Medical College of the State of South Carolina. We
understand, however, that the resignation has been proffered, and that
the Faculty will, with whatever reluctance, feel themselves constrained
to accept it.

" For twenty-one years Dr. Geddings has been associated with the
above mentioned institution ; a College which numbered him amongst
the very first of its graduates, which showed its high estimate of his
worth and abilities by unanimously offering him one of its earliest va-
cant chairs, and which has since owed a large measure of its popularity
and influence to his labors and name."

In the words of the Charleston Medical Journal and Review, " we
heartily wish him in his voluntary retirement from the labors of the
desk, length of years, which cannot fail to bring with them coequal use-
fulness and honor."

The simultaneous retirement of Prof. S. H. Dickson, from the chair of
Practice, constitutes a double loss to the College of two most able and
popular teachers. Prof. Dickson has accepted the appointment to the
chair of Principles and Practice of Medicine in the Jefferson Medical

1858.] Editorial and Miscellaneous. 497

College at Philadelphia, vacated by the death of the lamented Dr. J. K.
Mitchell. This is the second time that Dr. Dickson has been called to
and accepted a chair in a Northern school ; we cordially wish hira even
more satisfaction and success in Philadelphia than he found in New York.
Appointments. The Charleston Mercury reports, that at a meeting
of the Trustees and Faculty of the Medical College of the State of South
Carolina, held on the 19th of May, Dr. P. C. Gaillard was elected to the
chair of the Institutes and Practice of Medicine in this institution, ren-
dered vacant by the resignation of Prof. Dickson ; and Dr. J. J. Chisolm
to the chair of Surgery, made vacant by the resignation of Prof. Ged-
dings. Both these gentlemen are favorably known to the profession.

University of Louisiana : Professorial change. Professor J. C.
Nott has resigned the Chair of Anatomy in this Institution, and Dr. T.
G. Richardson, recently Professor of Anatomy in the Medical Depart-
ment of Pennsylvania College, has accepted the chair thus made vacant.
Professor Richardson is well known to the profession, as one of the able
editors of the North American Medico-Chirurgical Renew, and also as
the author of a valuable work entitled "Elements of Human Anatomy ;
General, Descriptive and Practical." We wish our confrere every hap-
ness in his Southern home, and should we miss him from the North
American, we hope he may greet us some where else, still our prized
and valued co-laborer in medical journalism.

Books received. We have received the following works for review :

From Blanchard & Lea, Philadelphia

Graham's Elements of Inorganic Chemisiry.

Miller's System of Obstetrics.

Peaslee's Human Histology.

Plates to Wilson on the Skin.

From Lindsay and Blakiston, Philadelphia

Meigs on Diseases of Children.

Carnochan's Contributions to Operative Surgery and Surgical Pa-
thology.

From the author

Paine's Institutes of Medicine.

Paine's Medical and Physiological Commentaries.

Dr. Paine's Essays on Vitality and Remedial Agents.

From S. G. Courtenay <fe Co., Charleston

Geddings' Lectures on Surgery, by Drs. Logan and Waring.

Besides many valuable pamphlets and minor communications, all of
which shall receive due attention.

498 Editorial and Miscellaneous. [July,

Dr. Eve's Address. We have already expressed our high apprecia-
tion of the following address, in our summary of the proceedings of the
last meeting of the Association ; we now vindicate that opinion by pre-
senting it entire thus prominently to our readers. We here copy from
the Nashville Journal of Medicine and Surgery :

Gentlemen of the American Medical Association :

We meet under most auspicious circumstances, and have been
welcomed to the most favorable position ever occupied by our profession
on this continent. The very ground on which we stand may be con-
sidered sacred ; has been set apart from a common to a special purpose,
and is national. Invited as we have been to this magnificent temple,
furnished and dedicated by a generous foreigner to science ; in the
presence of that towering monument, designed to commemorate the
worth of him ever enshrined first in the hearts of his countrymen ; sur-
rounded by the glorious recollections constantly associated with this
government ; and before the great men and assembled wisdom of the
nation ; it becomes us to discharge the important duties which have
called us together, with honor to ourselves and benefit to our profession.
Inspired by its benevolent spirit, and invoking the aid of an ever present
and omnipotent God to preside over our deliberations ; we may here
renew our professional obligations, learn to love each other better, and
resolve henceforth to be more faithful to our high vocation, that its
dignity may be maintained and its usefulness extended.

Knowing as I do full well the value of time in our short sessions, and
how much is expected from this meeting, the half hour set apart for
this customary address will be restricted to subjects appropriate to the
occasion. From this stand-point in the history of our meetings, it is
proper to recall what has already been achieved, that we may be better
prepared profitably to engage in the labor now awaiting our deliberations.
This summary of our transactions is the more necessary, since by a
disastrous fire in 1851, the first four volumes of our proceedings have
been destroyed, and are of course inaccessable to all new members : the
last report of the committee on publication having announced the fact
that not one complete set of them was now on sale.

The grand object of a convention of the physicians of the United
States, held the previous year in the city of New York, was carried into
effect in Philadelphia, May 184 7, by organizing this Association; and
just ten years ago, the first general assembly met in Baltimore. Since
then annual meetings have been convened in our large cities for the
transaction of business and the proceedings regularly published each
year. Ten large octavo volumes now comprise the Transactions of the
American Medical Association, being the contributions of its two thous-
and members delegated to represent the medical institutions of thirty
States and Territories.

As set forth in convention, the ultimate purposes of this body are to
cultivate and advance medical knowledge ; to elevate the standard of
medical education ; to promote the usefulness, honor, and interests of the

1858.] Miscellaneous. 499

medical profession ; and collaterally to enlighten and direct public opin-
ion in regard to the duties, responsibilities and requirements of medical
men ; to excite and encourage emulation and concert of action in the
profession and to facilitate and foster friendly intercourse between those
engaged in it.

In carrying forward these desirable changes, embracing as they do
medical science, medical education, and medical ethies, no one believes
that we have done every thing demanded for the good of the profession
or that all our great designs could have been attained in the brief space
often years. The work assumed by the Association, it was well known,
would take time, labor, and united efforts. It comprehended higher
requisitions for admission into a learned profession ; prescribed the course
of instruction ; demanded a separation in the teaching and licensing
power ; proposed a code to regulate the intercourse between physicians,
their patients and the public ; and claimed that every one within its
pale should assiduously cultivate the science of medicine and promote its
best #terests. And however extensive or radical may have been these,
contemplated plans, still on the whole it can safely be assumed that the
American Medical Association has been no failure.

It has advanced medical knowledge, and promoted the usefulness of
the medical profession. There will be found in the ten volumes of its
printed transactions, the results of the meetings held in Baltimore, Boston,
Cincinnati, Charleston, Richmond, New York, St. Louis, Philadelphia,
Detroit and Xashville, that no less than three hundred pages are devo-
ted to medical education; over five hundred to hygiene, including the
sanitary condition of many of our large cities ; six hundred to botany and
indigenous plants ; one hundred and fifty to obstetrics ; four hundred to
medical literature ; seven hundred and fifty to medical science proper ;
more than a thousand to surgery ; and two thousand to practical medi-
cine, including the epidemics and prevalent diseases of nearly every
State in the Union.

Special reports have been made from committees appointed for the
purpose, on the effects of anesthetic agents, ether and chloroform ; on
the influence of tea and coffee on the diet of children and the laboring
classes ; on the supposed influence of the cerebellum over the sexual pro-
pensities ; the results of operations for the cure of cancer ; the introduc-
tion oi water and gas into cities ; two reports on the blending and con-
version of types of fever ; the action of water on lead pipes and the
diseases proceeding from it ; reflection of the uterus ; a nomenclature of
diseases adapted to the United States, having reference to a general
registration of deaths ; the sources of typhus fever and the means for
their extinction ; the permanent cure of reducible hernia ; the topical
use of water in surgery ; the agency of refrigeration by radiation of heat
as a cause of disease ; the results of surgical operations in malignant
diseases ; the acute and chronic diseases of the neck of the uterus ; the
nature of typhoid fever ; coxalgia or hip-joint disease ; the treatment of
morbid growths within the larynx ; the sympathetic nerve in reflex
phenomena ; the medical and toxicological properties of the cryptoga-
mic plants of the United States ; erysipelas ; the influence of the hy-
grometrical state of the atmosphere on health ; the diet of the sick ;
pathology, causes, symptoms and treatment of scrofula ; the preservation

N.S. VOL. XIV. KO. VII. 25

500 Miscellaneous. [July,

of milk ; tlie effects of alcoholic liquors in health and diseases ; hydro-
phobia ; the changes in milk produced by menstruation and pregnancy ;
the sanitary police of cities; treatment of cholera infantum; use and
effects of nitrate of silver applied to the throat ; strychnine; infant mor-
tality in large cities, the sources of its increase and means of its diminu-
tion ; medico-legal duties of coroners ; new principle of diagnosis in dis-
location at the shoulder-joint ; the flora, fauna and medical topography
of Washington Territory; the nervous system in febrile diseases ; etc.,
etc.

Prizes have been awarded by the Association to the authors of the fol-
lowing essays, viz : On the Corpus Luteum of menstruation and pregnan-
cy, for 1851.

On the variation of Pitch in percussion and respiratory sounds in
physical diagnosis, for 1852.

On the Cell, its physiology, pathology and philosophy.

And on the Surgical Treatment of certain fibrous tumors of the uterus,
heretofore considered beyond the resources of art, for ] 853. *

On a new method of treating ununited Fractures and certain Deformi-
ties of the osseous system, for 1854.

On the Statistics of Placenta Prsevia, for 1858.

On the Physiology and chief Pathological Relations of the ArteriaJ
Circulation, for 1856.

On the Excito-secretory System of Nerves, in relations to physiology
and pathology.

And on Experimental Researches in relation to the nutritive value and
physiological effects of Albumen, Starch and Gum, when singly and ex-
clusively used as food, for 1857.

Carefully prepared reports have been published by the Association of
the various epidemics and diseases which have prevailed during the past
ten years throughout our widely extended country, and the mortuary
statististics and public health of our large cities minutely ascertained.
Charts, maps, diagrams, tables and plates have been freely employed to
illustrate these subjects, so important to the general welfare of the people.
Every State and Territory, every large city and sick community, with
scarcely an exception, has had its hygienic condition explored by this
body; and dysentery and cholera, typhoid and yellow fevers have
specially claimed the attention of our members. The communications
on deformities after fractures, found in our eighth, ninth and ' tenth
volumes, constitute the basis of the best monograph ever issued from the
press. This work it may be predicted, will do more than all others to
check the reckless and speculative spirit of suits for mal practice against
medical men ; for in addition to teaching a useful lessen to the profes-
sion in the prognosis of fractures, its testimony is so conclusive in refer-
ence to the usual results of these accidents, that judicial decisions must
hereafter be regulated by it.

Besides these contributions to medical knowledge, this Association has
taken action to prevent the importation into our country " of worthless,
adulterated and misnamed drugs, medicines and chemical preparations,"
for which a member of the United States Senate has publicly declared
that if we had accomplished nothing else, this alone should have entitled
us to the gratitude of the nation ; it recommended to the different States

1858.] Miscellaneous. 501

the adoption of a regular system of registration of births, marriages and
deaths; memoralized Congress to secure steerage passengers in our
emigrant vessels medical attention, and due amount of space between
decks ; appointed a committee to ascertain the best means of preventing
the introduction of disease by emigrants into our large cities ; and con-
sidered many interesting individual ca- .

This is a mere index to what the American Medical Association has
done for medicine during the first ten years of its existence. A simple
reference to the professional facts spread out upon its pages, is abundant
and satisfactory proof how extensive, varied and valuable are its contribu-
tions to medical science, and its ten volumes an overwhelming and con-
gratulatory answer to the taunting proclamation of the Edingurgh
Review of 1820, "What does the world yet owe to American physi-
cians and surgeons?" In September, 1854, the editors of the Associa-
tion Medical Journal of Great Britian published our code, and declared
that this body of physicians was the most enlightened representatives of
the greatest medical constituency in the world, of which it would be
presumptuous in them to speak in terms of praise. They said of the
volumes of the Transactions already published, that the duties of the
standing committees have been ably and thoroughly performed ; that
the progress of medical science as a whole, its prominent divisions into
practical medicine, surgery and obstertics, carefully and accurately traced
in a series of reports worthy of the highest praise, had been reported in
a clear, concise and comprehensive manner, reflecting the highest credit
upon the committees, and also upon the Asssciation in selecting them
for their respective duties : and in regard to what has been done in the
laborious investigation of the indigenous medical flora of the Union ;
examination into and reports upon the adulteration of drugs ; the sanita-
ry condition of the various States, and difference between them in the
public health ; the study of epidemies and of special scientific subjects ;
the committees, continue these European medical authors, have collected
and published a vast amount of highly valuable information. They
moreover assert their belief that our success, especially in ethical reform,
depends solely in the moral power inseparable from a constitution based
upon the principle of equal representation, which they affirm they not
only greatly admire, but can scarcely refrain from envying.

Here, then, is a reply to the above invective pronounced against the
medical profession of America, voluntarily called forth from the country-
men of its authors, and before he had been in his grave ten years, * by
the contributions of this body to medical science within seven years of
its organization. Upon such disinterested evidence, such full, free and
candid confessions, and from such a source, may rest the claims of the
American Medical Association for proof of the benefits it has conferred
on medicine. A most active and poweiful agent in dissemminating
useful medical knowledge on this continent, it is highly probable that no
similar institution has ever been more successful in carrying out its chief
object the promotion of science than the one now assembled in this
hall.

It has done something, perhaps all it could under the circumstances,

*Sidoev Smith died in 1S54.

502 Miscellaneous. [July,

to elevate the standard of medical education. An influential motive
calling forth this organisation, was the proposed attempt to correct the
defects in the plan of instruction and conferring the degree then gen-
erally adopted in our medical colleges ; and one of the first resolutions
passed, even when the profession had assembled in convention, was the
creation of a committee to report at an early day on these exciting sub-
jects. Improvement in the system of teaching medicine, and a change
in the power granting the diploma, if not reformation in the schools,
have ever since agitated the profession, and consumed a considerable
portion of the time of our sessions. The only power to control the
economy of the colleges which this body possesses is exclusively moral,
advisory or recommendatory, and not legislative or legal ; and while it
may be true that no set of resolutions presented by the several commit-
tees have been fully carried into effect, still it cannot be denied that im-
portant changes calculated to advance medical education have neverthe-
less been made. At least seven professors now compose the Faculty in
all our schools, the one or two exceptions to this being in those in which
the science is taught nine consecutive months. Xot less than a period of
four full months' instruction now constitute a course of lectures, and
even this is exceeded in most of the institutions. But one annual course
is now delivered with scarce an exception, and an interval is thus allowed
for reading or private instruction. The Association has clearly defined
what shall be taught. It has inquired into the practical operations of
all the colleges in the land; scrutinized the general condition of medical
teaching in every State ; compared it with that of the most enlightened
nations ; called attention to preliminary education and declared what it
ought to be ; advised higher requisitions and a more rigid examination
for obtaining the degree ; and has, by its free discussions and oft reitera-
ted expressions in regard to the business of teaching and regulating the
schools, undoubtedly prevented greater abuses. It has never ceased to
urge at every meeting the pressing necessity for a more thorough prepar-
ation and greater attainments in candidates for the honors of the profes-
sion.

This subject, gentlemen, is one upon which you will be called to take
action. A committee chosen at Nashville is to report here on medical
education. It is composed of gentlemen from different sections, who,
while familiar with the systems of teaching medicine in our country, are
yet disconnected from all the colleges. It would seem to be a desirable
object to settle at this meeting the future relation of the schools to this
Association. Our sessions then might become less educational in charac-
ter, and hereafter more scientific. And at the present stagje of our pro-
ceedings, after all that has been said and done on this subject, the time
has surely arrived for a decision.^ I cannot believe the colleges have any
interested motives before this body; they of all others should be the last
to oppose a more thorough cultivation of medicine, and ought by such a
course to become unworthy of their trust, and unwelcome members of a
great national congress of physicians, whose grand design is to promote
medical science. We have now reached a period in our history when
this voluntary Association is to determine what medical organizations,
be they State, county or city societies ; hospitals, boards or schools, are
entitled to be represented in its meetings. It alone, can, of course, pre-

1858.] Miscellaneous. 503

scribe the requisitions for its own delegates. If created to improve and
advance medical education, (and this is in accordance with its own ex-
pressed declarations,) then it is quite certain the schools must be con-
trolled. It has but to speak on this point and it will be obeyed : for it
is now too late for any physician to oppose, or any medical college to set
at defiance the moral power of this body.

As to the first object of an ethical nature over which the Association
designed to exert its influence, that of enlightening and directing public
opinion in respect to the duties, responsibilities and requirements of
medical men, we are free to confess little or nothing has been done.
Nor is there much probability that any great change will soon if ever,
be effected. The work itself, in the very nature of things, is Utopian.
How is it possible to enlighten or direct the public mind on the economy
of a science which it practically denies to exist I We ought to recollect
that the time has not long passed since grave professors in our colleges
signed certificates recommending nostrums; or what was done even last-
year in London at Middlesex Hospital, by its regular surgical staff: these
rerainiscenses, however unpleasant, may serve somewhat to moderate
our indignation against those who would insult the profession, or who
entertain a very low estimate of the scientific acquirements of physicians
even at the present day. The profession must first fully comprehend
its duties and responsibilities, and the proper and special qualifications
for the practice of medicine, before any attempt can succeed to get the
public to appreciate what these are, or acknowledge the ethical impro-
priety of employing secret remedies. If we make no distinction between
the regular and irregular practitioner, between the physician and the
proprietor of a nostrum, we are alone censurable that two such opposite
characters are so generally confounded by the community. Until we
are more honest, more united, truer to ourselves and our calling, and
cultivate a proper esprit du corps, in vain is it to expect a change in pub-
lic opinion regarding medical science. To prevent disease or relieve the
sick is a^nost benevolent and honorable vocation, and when one con-
ceals for selfish ends a valuable medicine, he ceases to be honest and is
void of philanthropy ; for by attempting to place a monied valuation
upon pain and life, he becomes a trader in human physical sufferings ;
he estimates in dollars and cents the groans and tears of his fellow-
creatures. He may profess what he pleases, but his piety is not of the
Bible, and has not a jot or tittle of Christianity about it, for that teaches
us to love our neighbors as ourselves. Eschewing politics, and seeking
no aid from State or Church, we should become a law unto ourselves,
or rather act above all law save the Dfvine, since it is quite certain we
alone must protect the honor of the medical profession. And thank
God, standing this day, the proudest of my life, before this good:
sembly, and at the capital of our common country, I can announce that
here, to the American >. it may with a

confided. By its recent acts, proclaimed throughout the length and
breadth of this wide domain, this body has denounced all fellowship
with irregular pra I erected a barrier impassable to honor and

.ct ability.
Having learned wisdom from a more careful examination of the statis-

50-1 Miscellaneous. [July,

tics and results of deformities after fractures, the question occurs if we
have not ourselves unwittingly made patients expect too much from
remedical agents. Disease in itself is a destructive process, which we
can only prevent or relieve, and as of course, we can not create or restore,
should we not therefore be more chary of the little word, " cure ?" The
monument erected to Ambrose Pare, the father of surgery, bears the
modest inscription, in reference to the wounds he treated, * " Je les pan-
sey et Dieu les guarit." Empirics may boast that they cure, and doctors
of divinity may sustain them ; but the physician knows it is God who
healeth all our diseases.

On that branch of ethics which relates to ourselves, that of encour-
aging emulation and concert of action among physicians, and fostering
friendly intercourse in the profession, the Association has been eminent-
ly successful. It has far exceeded the most sanguine expectations in
overcoming all opposition ; in creating an admirable code now adopted
everywhere ; in organizing State, county and city societies ; in bringing
together physicians from the remotest parts of our immense territory ; in
awaking the whole profession to its true interests; and in blending
us into a common harmonious fraternity. Without law or authority,
but by moral suasion have we been united as one man, and possess this
day the power to be felt over this entire continent. There never has
been a more propitious period for medicine in America ; never greater
evidence of vitality and extended usefulness in our ancient and benevo-
lent calling ; never better feeling or more confidence of success than now,
by our united effort to do good in the great cause of suffering humanity.

We have seen, gentlemen, how much this Association has achieved in
its infancy to elevate honorable medicine. A wide field for scientific in-
vestigation is before us ; much territory still remains to be redeemed ;
the wilderness is yet to blossom as the rose ; and the leaves to be gath-
ered for the healing of nations. The hygienic condition of the nation,
of such immense interest to our people ; that first, all-important ques-
tion, ever before the profession the prevention of disease isjto be im-
proved. We are to search after truth, and when found it is to be gener-
ously applied for the good of mankind. The work is a self-sacrificing
and benevolent one, but it is grand and sublime, even God-like; for it
has to do with pain and disease, life and death. And we rejoice to know
that whenever or wherever called upon, the members of our profession
and of this Association have never failed in any duty, and have been
faithful to the end. Yea, many of them have stood alone between the
living and the dead, and cheerfully laid down their lives to stay the pes-
tilence and destroyer.

The very waters at our feet, as they sweep onward to the ocean, pass
in sight of a city where three years ago no less than four-fifths of our
profession in that community, swelled too as their ranks had been by
volunteers from this body, fell manfully contending with disease and
death : and on a late occasion, when one of our steam-packets having
been injured by a collision, went down in an instant, carrying every soul

* Ancient French,

1858.] Miscellaneous. 505

onboard into the depths of the ocean, among the passengers was a mem-
ber of this Association. To the inquiry where was be during the heart-
rending scenes of a sinking ship, freighted with human lives, promptly
came the affecting and sublime eulogy from one who knew him well, that
so long as a woman or child remained unprovided for. he* never left the
ill-fated Arctic. How near akin was his gallant spirit to that of him,
who during a subsequent and similar occurrence, after seeing every
woman and child committed to his care safely rescued from his founder-
ing bark, after sending the last parting message to his family, and dis-
charging every duty without one lingering ray of hope, calmly assumed
his commanding position on the deck of his vessel, and as she glided from
under him into the yawning billows, instinctively uncovered to meet his
fate and his God. While the wild waves are sighing a requiem over
the unseen burying places of these illustrious dead, the benedictions of a
grateful people are continually ascending over the forty graves of the
martyred heroes of Xorfolk. These were our companions, who died in
the noble service of that calling, to promote the best interests of which
has assembled us together.

Gentlemen of the American Medical Association, we have convened
for important purposes ; great events ai _ before us ; the interests of
humanity are here ; the hopes of the profession are in this meeting;
the eyes of the medical world are upon us. May we then so act in view
of surrounding circumstances, that "The skill of the physician shall lift
up his head ; and in the sight of great men he shall be in admiration."

Puerperal Convulsions. Dr. James M. Xewman presented a report
on this subject to the Buffalo Medical Association, at a late meeting,
which is published in full in the Buffalo Medical Journal, comprising
some accounts of 33 cases collected from various sources. Of these 17
were priimparae, 9 multiparas, 7 not stated. Recovered, 24 ; died, 9.
Described as anasarcous, 7. The urine was albuminous in 12 cases; not
albuminous in 2 ; dark colored in 2 ; no secretion of urine in 2 ; and
condition not noted in 19. Ether or chloroform was employed after
bloodletting in 19 cases and of these, 16 recovered and 3 died; em-
ployed without bloodletting, 9 and of these, 6 recovered and 3 died. Con-
vulsive movements modified and controlled by anesthetics, in 23 cases ;
convulsions not diminished by them, in 6 cases. Two cases proved fatal
in which chloroform was administered without previous treatment being
indicated. [Boston Med. and Surg. Journal.

Platinized Charcoal. The power of charcoal in inducing chemical
combination is greatly increased by combination with minutely divided
platinum. In this manner a combination may be produced possessing
the absorbent power of charcoal (which is much greater than that of
spongy platinum,) and nearly equal, as a promoter of chemical combi-
nation, to spongy platinum itself. In order to platinize charcoal, nothing
more is necessary than to boil it, either in coarse powder or in large
pieces, in a solution of bichloride of platinum, and, when thoroughly
impregnated, which seldom requires more than ten minutes, or a quar-

* Pro Carter P. Johnson, of Richmond, Ya.

506 Miscellaneous.

ter of an hour, to heat it to redness in a close vessel, a capacious platinum
crucible being well adapted for the purpose. ****** Platinized
charcoal seems likely to admit of various useful applications; one of the
most obvious of these is its excellent adaptability to air-filters and respi-
rators. From its powerful oxidizing properties, it may also prove a
highly useful application to malignant ulcers and similar sores, on which
it will act as a mild but effective caustic. [Ibid.

On the Discrimination of Albumen. The detection of albumen in
urine is very simple. A small quantity of the urine is to be heated until
it boils, in a test-tube, over the flame of a spirit-lamp. As soon as the
temperature of the liquid becomes raised over 170 Fahr., the albumen
will become coagulated ; and if the test-tube be set aside for a time, it
will become deposited, when it may be collected, dried, affd weighed.
The precipitate albumen is soluble in solution of potash, but insoluble
in nitric acid. [Dr. HasseVs Lectures. Ibid.

Increase of Insanity in England. It would appear, by the following
statement from the London Lancet, that the United States is not the
only country in which insanity has been on the increase during the last
few years.

"There are 1000 patients in Hanwell Asylum ; the house is to be en-
larged so as to accommodate 2000. There are 1200 pauper lunatics in
the house at Colney Hatch. Yet there are still 1100 pauper lunatics in
Middlesex unprovided for. 'A few years ago lunatics were in the pro-
portion of one to rather more than 800 of the population, while now
they are in the rate of one to 700 an increase of one eighth to an in-
creased population.' " [Ibid.

Death of Dr. Hare. We find in the American Medical Gazette, the
following notice of the departure of a distinguished man : indeed, one of
the fathers of American science. Let us remember him, not as the star
whose brightness was dimmed, as it sank, behind the horizon, but ra-
ther as when in the ascendant, or at his meridian, he shed a glory and
a resplendence upon American Medicine.

Died, in Philadelphia, May 16th, 1858, Dr. Robert Hare, in the
seventy-seventh year of his age. He was for a series of years Professor
of Chemistry in the University of Pennsylvania, and by his discoveries
and improvements acquired high distinction at home and abroad, rank-
ing justly among the first chemists of the age. The latter years of his
life have been beclouded by mental infirmities, terminating in senile im-
becility, under the influence of which he was ensnared by the vagaries
t>f clairvoyance, and thus led into the mysticism of the modern spiritual-
ists, endorsing by his high name the wildest of their speculations. Hu-
manum est errare.

SOUTHERN

MEDICAL AND SURGICAL JOURNAL.

(NEW SERIES.)

Vol. XIV.] AUGUSTA, GEORGIA, AUGUST, 1858. [No. 8.

ORIGINAL AXD ECLECTIC.

AKTICLEJ.VIIL

Observations on Malarial Fever. By Joseph Jones, A.M., MD.,
Professor of Physics and Natural Theology in the University
of Georgia, Athens ; Professor of Chemistry and Pharmacy in
the Medical College of Georgia, Augusta ; formerly Professor
of Medical Chemistry in the Medical College of Savannah.

[Continued from p. 449 of July Xo., 1858.]

Case XV. Irishman, age 18 ; brown hair, brown eyes ;
height 5 feet 6 inches ; weight 125 lbs. ; well developed chest.
Occupation bar-keeper in a sailor's boarding-house on the bay.
Five days ago, attended a boat race at Thunderbolt, and slept
for two nights in an open boat. The second morning, after
waking, felt very badly, and vomited.

Sept. 11th, 8 o'clock P.M. Tongue slightly furred, not redder
than normal. No tenderness upon pressure of epigastrium.

( Temperature of Atmosphere, .... 80 F.
Pulse 116. Respiration, 30 thoracic. -j " "Hand, 1025'

( " under Tongue, 103

#. Calomel, grs. xii. Castor oil in four hours, ty. Soda powders, Flaxseed
tea. Diet, grueL fy. As soon as fever remits, give sulphate of quinia grs. v.
every three hours, up to grs, xx.

Sept. 12th, 12 o'clock M. Says that he feels much better;
medicine acted four times. Skin cool; tongue very slightly
coated with white fur; papillae not enlarged; pulse 84, soft and
regular ; respiration 24, gentle. Says that the fever went off
about 1 o'clock this morning.

n.s. VOL. XIV. NO. VIII. 26

508

Jones, on Malarial Fever.

[August,

Temperature of Atmosphere, 83 F. (-,-,, , . ,. ,, n i e

" " Hand 985' ) s ta^en ten grains * t"e sulphate of

under Tongue,'.'.'.'. 99 ( <luinia- & Continue up to grs. xx.
Amount of Urine collected during the last 16 hours,. . . . grains 7,126

" " " calculated for 24 hours, " 10,689

" " " collected during each hour, " 445

Without doubt, some urine was lost during the action of the medicine.
Specific gravity 1018. High colored. Reaction decidedly acid. After stand-
48 hours, there was only a slight deposit of vegetable cells.

Calculated am't of urine|
for 24 hours, grs. 10689
contained grs.

ANALYSIS XVII.

Water,

Solid Matters,

Urea,

Uric Acid,

Extractive <fe col. matters.
Fix'd Saline Constituents.

Urine collected dur-
ing 16 hrs., grs. 7126
contained grs.

6766-102

359-898

203-700

A trace.

110-397

45-801

10149153
539-847
305-550

A trace.
165-596
68-701

1000 pts-
of urine*
contain'd

949-495
50-505
28-585

A trace.

15-512

6-408

The disappearance of the uric acid could not have been due
to the action of the sulphate of quinia, for the greatest portion
of the urine had been passed before the administration of the
sulphate of quinia. 8 J o'clolk P. M. Pulse 100, fuller. Inspi-
ration 24.

Temperature of Atmosphere, 82 F. ) Tongue slightly furred. Urine clear,

" " Hand, 102 12' > high colored a shade lighter than that

" under Tongue 103 9' ) passed this morning. Sp. Gr. 1022.

Amount of urine excreted during the last 8 hours, .... grains 6138

" " " calculated for 24 hours, " 18414

" " " excreted hourly, 767

Sept. 13th, 11 o'clock A. M. Did not rest well during the
night. Tongue moist and slightly coated with fur. Pulse 98.
Eespiration 26. Eespiration irregular, every half minute draws
a long, full inspiration.

Temperature of Atmosphere, 82 F. ) fy Citrate of Potassa, - - gss.

"Hand, 102 25' [ Water, f^xvi.

" under Tongue,. . . . 103 ) Dose, wineglassful every three hours.
# As soon as fever remits, give sulph. of quinia grs. xx.

Amount of urine excreted during the last 15 hours, grains 7154.

" " calculated for 24 hours, " 1 1446.

Amount of urine excreted hourly, " 477.

High colored, clear. Specific Gravity 1020.

5 o'clock, P. M. Pulse 90. Eespiration 28. Urine high
colored.

( Temperature of Atmosphere, 85 F.

Specific Gravity 1022. \ " " Hand, 101

( " under Tongue, 1029'

Amount of Urine passed during the last 7 hours, . . . .grains 4092

Calculated amount of Urine for 24 hours, " 14029

Amount excreted hourly " 584*5

September 14th, 1 o'clock, P.M. Tongue slightly coated with
white fur, moist and natural in appearance. Skin moist and
cool. Pulse 65} regular and soft. Eespiration 24, regular.
Color of urine much lighter.

1858.]

Joxes, on Malarial Fever.

509

{Temperature of Atmosphere, 85 F.
" Hand, 96
" under Tongue, 98

Amount of Urine passed during the last 20 hours, grains 10210

10210 )

12252 [

510-5 )

Jfc Quassia
and soda.

Calculated amount for 24 hour;
Amount of Urine excreted hourly,

September loth, 10 o'clock, A.M. Much better; dressed and
walking about the Hospital grounds. Pulse, skin, respiration,
and tongue, normal. Urine orange colored, much lighter than
the former specimens passed subsequent to the first stage of fe-
brile action. Specific Gravity 1019-7. Eeaction after twelve
hours, alkaline. Heavy light yellow deposit of urate of soda,
and prismatic crytals of triple phosphate. The crystal of triple
phosphate numerous and beautiful. Up to the present time, the
reaction of the urine has been very acidr and it has remained
without deposit for many hours.

Amount of urine collected during last 20 hours, grains 11726
Calculated amount of urine for 24 hours, " 14071

Amount of urine excreted hourly, - - - " 586*3

ANALYSIS XYIII.

Grs. 11726 of urine 1 Grs. 14071.8 of urine
excreted during 20 calculated for 24 hrs
hrs., contain'd grs. | contained, grains,

1000 parts of
urine contain-
ed,

Water,

11291*844

435-206

161-047

8-624

204-291

60-644

13550-613
521-247
200-016

10-350
237.109

72-772

962-887

Solid Matters,

37-113

Urea,

13-792

Uric Acid,

0-735

Extractive and coloring matters.
Fixed Saline Constituents,

17-332
5154

The patient left the Hospital a few hours after these observa-
tions. He entered the Hospital again on the 18th of October,
with a severe attack of remittent fever.

Case XVI. Irish seaman : black hair, black eyes, and florid
complexion ; height 5 feet 11 inches ; weight 175 lbs. Has been
staying on board the light ship and running up and down the
Savannah River, at all hours of the day and night. Says that
he resided six years at Panama, but was never sick. Was
taken with chill and fever two days ago, and the captain of the
light ship gave him several doses of drastic medicine.

September 5th, 7 o'clock, P.M. Has fever. $ James' pow-
der, grs. xviij., nitrate of potassa, grs. xxx. Mix and divide
into six powders, one powder every three hours.

September 6th, 1 o'clock, P.M. Has just had a chill, which
in fact is not yet entirely off. He is still shaking. Tongue
coated with light yellow fur, pale at its edges. Complains of
pain in his head. "Epigastrium tender upon pressure ; extremi-
ties cool ; head and trunk warm. Pulse 118. Respiration va-
ries from 20 to 32.

510

Jones, on Malarial Fever.

[August,

ft Three cut cups to epi- i Temperature of Atmosphere, 85 F.

gastrium. ft Spts. Mindere- < " " Hand, 96

rus grs. ss. every half hour. ( " under Tongue, 1015'

6 o'clock, P.M. Cupping relieved the tendency to vomit.
Skin hot, although moist. Pulse 120. $ Soda powders. $
Sulph. of Quinia, grs. xv.

September 7th, 10 o'clock, A.M. Did not rest well; "bow-
els are quite loose." Has taken ten grains of sulph. of quinia.
Pulse 98. Eespiration 28. Urine clear, high colored. Speci-
fic Gravity 1021.

Temperature of Atmosphere .. 80F. ) ft Opium, gr. 1.

" Hand 100 V

" under Tongue. . . 104 ) Diet, arrowroot and flaxseed tea.

The whole amount of urine passed was not collected, on ac-
count of the affection of his bowels. After standing 36 hours,
there was a small deposit of crystals of triple phosphate and
urate of soda.

1000 parts of Urine contained

Water, 936'047

Soliid Matters, 63-953

\ Urea, 34-995

Uric Acid, 0-705

Extractive and Coloring Matters, 21 277

Fixed Saline Constituents, 6 976

Sept. 7th, 7 o'clock P. M. Skin warm and moist ; tongue
slightly coated ; no pain upon pressure of epigastrium. Has ta-
ken 15 grs. of quinine and 2 grs. of opium this morning. Bowels
have not been moved since this morning. Pulse 108 ; respira-
tion 24.

Temperature of Atmosphere. ... 82 F. } Urine clear, high colored. After

" " Hand 1037 5' > standing 39 hours, there was a small

" under Tongue 105 ) deposit of the urate of soda. Spe-
cific Gravity 1020'8.

Amount of urine passed during the last 9 hours grs. 2552*

Calculated amount of urine for 24 hours, " 6803*

Amount of urine excreted hourly, " 283'6

ANALYSIS XIX.

ANALYSIS XX.

Urine excreted in
9 hours, grs. 2552
contained grains

Calculated amount of
urine for 24 hours, grs.
6803 contained grains

1000 parts
of urine con-
tained

"Water,

2402-683

149-317

81-660

1-000

54422

12-235

6405-664

397-968

217-705

2-666

144-986

32-611

941-490

Solid Matters,

58*510

Urea,

31-976

0391

Ext. and coloring matters,
Fixed Saline Constituents,

21-356
4-787

Sept. 8th, 9 o'clock A. M. Says that he feels much better.
Rested well during the night. Bowels have been moved twice.
Tongue clean at tip and edges, superior portion slightly coated
with fur ; color of tongue paler than normal ; skin cool, moist
and relaxed. Pulse 78 ; respiration 18.

1858.]

Jones, on Malarial Fever.

511

Temperature of Atmosphere ... . 75 V.) Urine high colored- Sp. Gravity

" Hand 985' V 1C18-7. After standing 26 hours,

" under Tongue 1005' ) urate of soda and prismatic crystals

of triple phosphate were deposited.

Amount of urine passed during the last 14 hours, grs. 12224

hourly " " " " " 873

Calculated amount of urine for 24 hours, " 20903

Actual amount of urine excreted during the last 24 hours, " 14776
" " hourly, " " u M " 615

ANALYSIS XXI.

Water,

Solid Matters,

Urea

Uric Acid,

Extractive and co-
loring matters,

Fixed Saline Con-
stituents,

Grs. 12224 of
Urine passed
during last 14
hrs., contain-
ed grains

11613-180

616-220

279-360

3-240

272-388
56-232

Grs. 20903 of U-
rine, calculated
for 24 hrs., con-
tained graius

19856-093

1047-631

477*705

5-540

466-885
96-157

Grs. 14776 ofU-
rine, actual am't
excreted in 24
hours, contained

grains

14015-863

760-537

361-020

4-240

326-810
68.467

1000 pts. of
Urine con-
tained

950-000

50-000

22-852

0*265

22*283
4-600

12 o'clock, M. Has just exhibited a rising upon the buttock
When lanced, f sii, of fetid black matter flowed. # Sulph. of
quinia, grs. v. Diet, beef soup and tea.

6 o'clock, P.M. Complains of great weakness. Pulse 88.
Eespiration 18. Extremities are much colder than the head
and trunk. The phenomena resemble those of chill. He does
not, however, complain on any chilly sensation.

Temperature of Atmosphere. .. .76 F. ) Urine high colored. After twenty-

" " Hand 93 > four hours, a heavy deposit of urate

" under Tongue 1045' ) of soda and triple phosphate.

Amount of urine excreted during the last 9 hours, grs 6127

" " " hourly " 680.7

" " " " during the last 24 hours, " 18351

" " " hourly " " " " 764.4

Calculated amount of urine for " " " 16335

Hourly " 680

Specific Gravity 1021 -2.

ANALYSIS XXIL

Water

Solid Matters,

Urea,

Uric Acid,

Extractive and co- )

loriLg matters, j
"Fixed Saline Con- )

stituents, f

Grs, 6127 of
Urine, passed
during last 9
hrs., contain-
ed grains

5830-238

286962

113-490

4320

126-498
42-654

Grains 16335 ofj
Urine calculat'd 1000 parts of'U
for 24 hrs., con- urine contain
tained grains ed

15570-075

765-040

302-564

11-517

337-244
113-715

953165

46-835

18-521

0-705

20-647
6-962

Gre. 18351 of
rineexcret'd
during last 24
hrs., contain-
ed grains

17453-472

898128

392-850

7-560

398-886
98-886

512

Jones, on Malarial Fever.

[August,

September 9th, 10 o'clock, A.M. Continues to improve, but
complains of great weakness. Pulse 76. Eespiration 20. Skin
cool and moist; bowels regular; urine high colored; deposit of
urate of soda and triple phosphate, after standing a few hours,
and acid reaction changed to the alkaline.

C Temperature of Atmosphere. .75 F.

Specific Gravity 1018' 2 { " "Hand 9775'

( " under Tongue 99 5'

Amount of Urine passed during the last 16 hours, grains 9163

" " " hourly, " 572.6

Calculated amount of urine for 24 hours " 13745

Actual " " " " " 15291

hourly " " 628.7

ANALYSIS XXIII.

Grs. 9163 of
Urine passed
during iast 16
hrs., contain-
ed grains

Grs. 13745 of
Urine calcula-
ted for 24 hrs.
contained
grains

1000 parts
of Urine con-
tained

Grs. 15291 of U-
rine, actual am't
excreted in 24
hours, contained

grains

Water,

8677-223

486-567

237-456

0-720

215*955
32-436

13015-850

729-850

356-084

1-080

324-032
4S-654

946-903

53-097

25-912

0-078

23-568
3-539

14517-471

Solid Matters,

Urea,

773-529
351-946

Uric Acid,

5-040

Extractive and co- )
loring matters, )

Fixed Saline Con- )
stituents, )

341-453
75-090

September 9th, 6 o'clock, P. M. Tongue and skin normal.
Pulse 76. Eespiration 22. Urine orange colored. Specific
Gravity 1022. Slight deposit in 15 hours of urate of soda and
triple phosphate.

Temperature of Atmosphere 87 F.

"Hand 975'

" underTongue 998'

Amount of urine passed during the last 8 hours, grains 6135

" hourly " " " 766' 8

Calculated amount of urine for 24 hours " 18405

Actual amount passed during the last 24 hours. . " 15298

Hourly amount of urine passed during the last 24 hours, grs 637.4

ANALYSIS XXIV.

Grs. 6135 of
Urine excret-
ed during last
8 hrs. contain-
ed grains

Grs. 1S405 of
Urine calcula-
ted for 24 hrs.
contained grs.

1000 parts
of Urine con-
tained

Grs. 15298 of
Urine, excreted
during last 24
hrs., contained,
grains

Urea,

113.490
4.440

340 470
13-320

18.498
0-723

350*948

Uric Acid,

5-160

September 10th, 10| o'clock, A. M. Pulse 68. Eespiration
19. Color of urine only a shade higher than normal. After
twelve hours a slight deposit of urate of soda and triple phos-
phate.

1858.]

JOXES, on Malarial Fever.

513

( Temperature of Atmosphere 79 F.

Specific Gravity 1021'5-j " "Hand 965'

( " under Tongue 98

Amount of urine passed during the last 16 hours, grains 5107

" hourly " * " " 319

Calculated amount for 24 hours " 7661

Actual amount of urine passed during last 24 hours, " 11242

Amount passed hourly " 468*4

ANALYSIS XXV.

Grs. 5107 of
Urine passed
during last 16
hrs., contain-
ed grains

Grs. 7661 of
Urine calcula-
ted for 24 hrs.
contained grs.

1000 parts
of Urine con-
tained

Grs, 11240 of
Urine excreted
during last 24
hours, grains

Urea,

63-050
1-000

94-575
1-500

12-362
0.196

176540

Uric Acid,

5-400

The diminution of the frequency of the action of the respira-
tory and circulatory systems, and the reduction of the tempera-
ture, have been attended by a diminution in the amount of
urine excreted, and also of its constituents.

7 o'clock, P.M. Dressed himself and walked in the Hospital
yard. Still feels weak ; is now in a profuse perspiration. Pulse
68. Inspiration 20.

Temperature of Atmosphere, . .80 F. ) Sp. Gr. of urine 10204. Deposit in

" " Hand 97 > 12 hours of urate of soda and prismatic

" under Tongue 989' ) crystals of triple phosphate. When

held in the sun, the whole mass sparkled with the crystals of triple phosphate.

Amount of Urine passed during the last 24 hours, grains 10209

" " hourly " " " 425 '3

during " 9 " " 5102

' " " hourly " " " 566.8

Calculated amount for 24 hours " 13601

ANALYSIS XXYL

Urea

Uric Acid- .

Grs. 5102 of|
Urine passed
during last 9
hrs. contained
grains

63-040
2 300

Grs. 13601 of
Urine calcula-
ted for 24 hrs.
contained grs.

169-091
6131

1000 parts
of Urine con-
tained

12-352
0-450

Grs. 10209 of
Urine excreted
during last 24
hours contained
grains

126100
3-300

"Sept. 11th, 11 o'clock A. M. Pulse 74 ; respiration 18.

Temperature of Atmosphere, 82 F. 1 Color of urine a shade higher than nor-
" Hand, 97 >mal. Specific Gravity 1021-2. In 12 hrs.

" under Tongue, 98 2' ) a small deposit of urate of soda and triple
phosphate.

Amount of Urine passed during the last 16 hours, grs. 7148.

i hourly " " " " 446.7

Calculated amount of Urine for 24 hours, "10722.

Amount of Urine passed during the last 24 hours, " 12250.

u u hourly " " " " ' 510.4

514

Jones, on Malarial Fever.

[August,

ANALYSIS XXVII

Urea,

Uric Acid,

Fixed Saline Constit.

Grs. 7148 of U-|
rine passsd du
ring the last 16
hours contained
grains

137-095

4200

41195

Grs. 10722 cal-
culated for 24
hours, contain-
ed grains

205-642

6 300

61-792

1000 parts
Urine con-
tained

19 490
0 587
5037

Grs. 12250 pas-
sed in 24 hours
contained grs.

200145
6500

6J o'clock P. M. Has been walking in the Hospital yard.
Pulse 67 ; respiration 22. Urine normal in color. Sp. Gravity
1026*5. Fermentation proceeded so rapidly, that in the course
of 24 hours, the whole of the urea was converted into the car-
bonate of ammonia. Deposit consisted of prismatic, stellated
and plumose crystals of triple phosphate, and globular and aci-
cular crystals of urate of soda.

Temperature of Atmosphere, 7875' F.

" " Hand, 97 83

" under Tongue, 99

Amount of Urine passed during the last 1\ hours, grs. 4106

hourly, " " " " " 534

Calculated amount of Urine for 24 hours, " 13139

Amount of Urine passed during the last 24 hours, M 11254

" hourly, " " " " " 4689

Uric acid in grains 41 06 of Urine. (7 hours) grs. 4-720

" " " " 13139" " calculated for 24 hours, " 15.104

" " " 1000 parts of Urine, 1149

" " " grs. 11254 " " excreted in 24 hours, 8-920

Sept. 12th, 12 o'clock M. Pulse 60', respiration 20. Sp.
Gravity of urine 1022*15. Heavy deposit of urate of soda, and
prismatic and plumose crystals of triple phosphate.

Temperature of Atmosphere, 83 F.

" " Hand, 97

" under Tongue, 988'

Amount of Urine passed during the last 17 hours, grs. 4088.

i k hourly, " " " " 2405

Calculated amount for 24 hours. " 5768.

Amount of Urine passed during the last 24 hours, . . .grs. 8194,
" " hourly, " " " " " 341.4

Uric acid in grs. 4088 of Urine passed during 1 7 hours, grs. 5.400

n u 5768" " calculated for 24 " " 7.619

" " " 1000 parts of Urine, " 1.320

" " 8194 " " passed during 24 hours, "10.120

Fixed Saline Constituents in grs. 4088 of Urine, (17 hours) grs. 40.880

" M 5768 " u (collected in 29 hrs.) " 57.688

" m * " 1000 parts of Urine, " 10.000

"grs. 8194 " " (24 hours) ' 10.120

Sept. 13th, 11 o'clock A. M.

Amount of Urine passed during the last 24 hours, grs. 16.962. Sp. Gr. 1025.
k (. hourly " * " " 706.7

1858.]

Jones, on Malarial Fever.

515

Sept. 14th, 4 o'clock P. M.

Amount of Urine passed during the last 30 hours, grs. 31.669. Sp. Gr. 1021-6

ii u n K u u it 24 " " 25.335

it ii hourly, " " " " M 1.055

, ANALYSIS XXVIII.

Water,

Solid Matters.

Urea,

Extractive, Col'g Mat- )

ters, and Uric Acid, )

Fixed Saline Constituents

Grs. 31669 of Urine,
passed during 30hrs.
contained grs.

Grs. 25335 ot Urine,
passed duri ng 24 hrs.
contained grs.

10U0 parts
of Urine,
contained

29965 178

1703-822

630 470

690 510

382-842

23971 943

1363 057

504-376

552-406

306 275

945 455
54-545
19 940

22-484

12121

In this case the uric acid was diminished during the active
stages of the malarial fever, and increased during convalescence.
The temperature of the body was slightly depressed below the
normal standard, during convalescence, and this depression was
attended by a corresponding diminution of all the urinary con-
stituents, except the uric acid.

The phenomena, during the cold stage, resembled in all res-
pects, those previously described. The consideration of many
other points of interest is deferred until we institute a general
comparison of all the various forms of malarial fever.

The annexed Table No. IV. (on pages 516-17), will present
a view of the foregoing results.

Case XVIII. Frenchman: age 45; weight 130 lbs.; thin
and spare ; nervous temperament; complexion pale. Has been
in Savannah three weeks. Has been acting as nurse in the
Hospital for the last two weeks. Occupation, nurse in an in-
sane asylum.

September 15th, 12 o'clock, M. Was taken with a chill this
morning, at 8 o'clock, A.M., which was attended with vomiting
and followed by high fever. Urine passed during the height
and decline of the fever, orange colored, and diminished in
amount.

September 16th, 12 o'clock, M. Apyrexia. Amount of urine
passed during the last 24 hours, grains 4086. Sp. Gr. 1021*5.
Amount of uric acid passed during the height and commence-
ment of the intermission of the fever (24 hours), grains 0'400.

1000 parts of urine contained

Urea, 20-425

Uric Acid, 0097

516

Jones, on Malarial Fever.

[August,

TABLE IV.

3ept'r,

1 P.M.

6 "

10 A.M.

7 P.M
9 A.M.
6 P.M.

10 A.M.

6 P.M.
lO.^A.M.

7 P.M.

11 A. M.
61 P.M.

12" M.
13ill A.M.

14 4 p.m.

US

80

82

75

76

75

87

79

80

82

7875'

100
10375
98-5'
93

97J75
97^5'
96u5
97
97

97-~83
97

101c5'

104
105
100 5:
104^5'

99-5'

99c8'

98

989'

9802'

99

9S8'

14776
18351
15291
15298
11240
10209
12250
11254
8194

637

341
706
(885-1055

14015
17453
14517

23971

1363

4.24
7.56
5.04
350 5.160
176 5.400

200

504

6.500
8.920
10.120

o a

GRS. GRS.

326 6S.0
398 98.8
341 75.0

552

2552
12224 14
6I27i 9
916316
6135 8
510716
5102 9
714816
41067*
408S|17

1020.8

1018.7

1021.2

1018.2

1022

1021.5

1020.4

1021.2

1026.5

1022.15

1021.6

ANALYSIS XXIX.
Sept. 17th.

Urea, - - - - -

Uric Acid, - - - -
Specific Gravity, - -
Ara't excreted hourly,

Grs. 6641 of Urine, excreted
during 24 hours, contained

252-200

2-275

1021-700

276-800

1000 parts of Urine
contained

38-001
0-342

ANALYSIS XXX.

Sept. 18th.

Urea,

Uric Acid, - - - -
Specific Gravity, - -
Am't excreted hourly,

Grs. 6640 of Urine passed
during 24 hrs. contained

136-188
13-845

1023-000
277-000

1000 parts of Urine
contained

20-470
2-082

Sept. 18th. Temperature of Atmosphere, 88. Temp, of Hand, 935'.
Temp, under Tongue, 99.

Sept. 19th. Amount of Urine in 24 hours, grs. 7530. Amounnt hour-
ly, grs. 314. Temp, of Atmosphere, 895'. Temp, of Hand, 965'.
Temp, under Tongue,98.

Continued to improve, and was discharged from the hospital
Sept. 23rd.

October 7th, 3| o'clock P. M. Has returned. Says he has
been "keeping bar" on the bay, and was taken with a "dumb

1858.]

JoXES, on Malarial Fever.

517

TABLE IV.

c

a

P

<

>
>

13
X

3 p
2 g

r "

Q

-
M

g

Q

c
=

X

O
p.
o

? &
-> p

- -

8 |

x a

: e

0
- ^

rl

3 c
E

0

p

[ ^

? J

* c

O

p_

g S

- -

f e
? I

o
> =

-. &

5

"~ e

Calculated amount
Saline Constltue

houra

Calculated amount <
tive and Color
ters for 21 hour

4
p

6

cc

0

; 0
. "-

\ s

: 1

d

0

p

5

0

G

>
0

0
0

M
H

= 1
1 s

?
2 =

-

7 0

0 1

i *
s i

cc

5

0

B

= =
O *
E c

fd

: 5"
;

n

: x

E"

C

ST

o

c O

o

:x c

= ~- B o

o

:

d

? ff

: e

'. <*

- ?

j C
E"

cc

: c
s

c

r.

: - - : *
79 : =.

d

"5

. OB

; c

5

S

0

d

'. O.

GRS.

GRS.

GRS.

GRS.

GRS.

GRS.

GRS.

GRS.

GRS.

GRS. 1 GRS.

s

GRS.

!".**!!

"""""!

'936 63 '9
941 5S.5

*34.9
31.9

0.705
0.391

21/27'
21.35

*6!976

4.78

81 6

1.00

54.4 12.235

6S03

6405 397.9

217.7

2.666

144.9 32.61

2S3

279 3

3.24

272.3 50.2

20903 19S56

1047.

477.

5.54

466. 96.15

950

50.

0.265 22.2$

4.600

566

113 4

4.32

126.4 42. 6

163:351 15570

765.

302.5

11.507

837. 113.7

953

46. S

I8.fi

0.705 20.6

6.962

6^0

887 4

0.72

215.9 32.4

13745

13015

729.

306.

1.05

324. 48. 6

946

53.0

25.9

0.078 23.5

3.539

572

113.4
63.0
63.0

137.0

4.440
1.000
2.300
4.200

1S405

7661

13601

10722

340.

13.32

18.4

12.3
12.3
19.49

0.723
0.196

766
468
566
446

94.5 1.50

169.0
205.6

6.131
6.300

0.450

0.5>7

41.19

61.792

5.087

4.720
5.400

13139

15.104
7.619

1.149
1.320

534
240
706
1055

576S

680.

690.0

945

54.5

19.9

22.4

12.1

ague'' on the 5th inst., which lasted two hours. The "dumb
ague:' has returned at the same hour, 11 o'clock A.M., on the
succeeding and this day. Now has fever, with pain in all his
limbs, and vomiting. Calomel, grs. xii., sulph. of quinia, grs. v.
were administered, and followed by castor oil. 20 grs. of the
sulphate of quinia were also administered. This delayed the
chill until Oct. 9th, 3^ o'clock, (27j hours.)

The following tables will present the most important phe-
nomena observed:

October 9th, 31 o'clock P. M. Phenomena of Cold Stage.

Pulse 92, very feeble, resembles
the vibration of a fine thread with
difficulty counted. Respiration ac-
celerated and irregular.

Lips and fingers blue.

Temp, of Atmosphere, . . 75 F.

u " Hand, 83

" under Tongue, . . . 101 5'
R. Mustard to extremities. Bran-

dv & snake-root tea, until reaction.

61 o'clock P. M

. Hot Stage.

Pulse 96 ; much fuller than dur-
ing the chill. Respiration fuller.
Pulse not so full as in milder cas-
es.

Temp, of Atmosphere, . . 70 F.

" Hand, 101 8'

" under Tongue, . . . 102 8'
R. Citrate of Potassa mixture.

Oct. 10th, 11 A. M. Febrile excitement has almost entirely subsided.
BL. Sulph of quinia, grs. xxv.

518

Jones, on Malarial Fever.

[August,

5 o'clock P. M. Apyrexia.

Pulse and respiration near the
normal standard.

Temp, of Atmosphere,
" " Hand, . . .
" under Tongue, ... 98
Oct. 12th, 3 P.M. Pulse, respiration, skin and tongue, normal.

70 F.
9V 5'
at

ANALYSIS XXXI.
Oct. 10th, 11 AM.

Urea, - - - -
Uric Acid, - - -
Fixed Saline Contit'

Am't of Urine excreted dur-
ing 15 hours of febrile ex-
citement, grs. 8687. Sp. Gr.
1022. Am't excreted hour-
ly, grs. 579. Grains

342*167

5-950

28-050

Grs. 13899 calcu-
lated for twenty-
four hours, con-
tained grains

547-388

9-520

44-880

1000 pts. of
Urine con-
tained

39-388

0-684

43-228

ANALYSIS XXXII.
Oct, 12th, 3 o'c. P.M.

Urea, - - - -

Uric Acid, - - -
Fixed Saline Conslit'*

Amount of Urine passed during the last 24
hours of Apyrexia, grs. 15330. Sp. Gravity
1022. Am't passed hourly, grs. 638. Grs.

349-200
11-250
76-500

1000 pts. of
Urine con-
tained

22-678
0-733
4-990

Urine was high colored, like new Madeira wine. The appro-
priate tests exhibit the presence of iron in abnormal amount.
The coloring matters were in such abundance that hydrochloric
acid changed the color of the urine into a purplish black. When
evaporated to the consistence of a syrup, the urine assumed a
dark brown, almost black color. After standing 50 hours, pris-
matic crystals of triple phosphate, vegetable cells, urate of soda,
and carbonate of lime were deposited.

This patient had no return of fever, but suffered for some time
with great weakness, and exhibited in his pale lips, pale gums,
and sallow complexion, the effects of the malarial poison on the
colored blood corpuscles.

In this case the uric acid was not diminished during the hot
stage.

If we compare the first with the second attack, it is evident
that the urea was more abundant in the second, than the first.
The first attack of intermittent fever was slight, while the se-
cond was severe. When we consider the weight and condition
of rest, and almost complete starvation of this patient, it is evi-
dent that the urea was greatly increased.

Case XIX.-

-English

seaman

age 25; weight 160 lbs.;
height 5 feet 6 inches ; black hair ; florid complexion ; muscu-
lar system well developed ; powerful chest ; short stout neck.
Has just returned from Jacksonville, Fla. Has been sick one
week.

1858.] Joxes, on Malarial Fever. 519

August 18th, 11 o'clock, A.M. Skin hot and dry ; face very
red ; pulse 106 ; respiration thoracic ; temperature of atmosphere
88 ; temperature of hand 105. Complains of pain in his head.
Urine high colored. Specific gravity 1021. $ Bloodletting in
the standing posture to produce relaxation of the system.

2 o'clock, P.M. Preparations were made for blood-letting.
The patient appeared to be alarmed by the preparations ; and
when I appeared with the specific gravity bottles, beaker glasses
and capsules, to receive the blood, he fell back into the arms of
the assistant, and in a few moments before the lancet was ap-
plied, the perspiration stood in large drops upon his face and
hands. During the bleeding, he perspired freely, and fainted
before f $ x, were abstracted. The pulse and respiration were
diminished in frequency and force, and the patient fell into a
profound slumber, during which his clothes were completely
saturated with a profuse perspiration.

Examination of Blood. Blood of a dark, almost black color,
commenced to coagulate in about ten minutes. After remain-
ing for two hours exposed to the atmosphere, the surface of the
blood exposed, changed to a bright red arterial hue.

Specific gravity of blood, 1042 ; Specific gravity of serum, 1018.
Serum of a light golden color. The color was not so deep as
in severer cases of malarial fever.

ANALYSIS OF BLOOD, I.

Water,

In 1000 parts of Blood, 830-509

" " Serum, - 929-287

(1) " " Liq. Sang. 927-194

(2) " " Liq. Sang. 887-328

Solid Matters,

In 1000 parts of Blood, 169*491

" " Serum, - 70-713

(1) " " Liq. Sang. 72-806

(2) " " _ Liq. Sang. 112-672
Sol. Matters in Serum of

1000 parts of Blood, 64*158

Fixed Saline Constituents.

In 1000 parts of Blood, 7-532

" " Serum, - 5*000

(1) " " Liq. SaDguinis, 5*332

(2) " " Liq. Sanguinis, 8'245

" " Solid Matters of Blood, .... 44.439

" " " " " Serum, .... 77*931

" " " " " Liq. Sanguinis, - - - 73*345

" " Blood Corpuscles, - - 28*500

" " Moist Blood Corpucles, - 7*258

In Blood Corpuscles of 1000 parts of Blood, ... 3.002

In Serum of 1000 parts of Blood, 4.530

o20 Jones, on Malarial Fever. [August,

1000 parts of Blood contained,

Water, 830-509

tv a x>\ j n i 1no ,oo ) Organic Matters, 100-431

Dried Blood Corpuscles, - - 103-433 J- Meral ' 3.002

Fibrin, - 1-900

Albumen - ^4-1 86 1 0rSanic Matters, 54-426

Albumen, 4 186 [ Mineral " 2*760

Extractive and Coloring Matters, 8972 [ jg M^> *

1000 parts of Blood contained,

J Water, - - - 310-219

Moist Blood Corpuscles, 413-732 V Organic Matters, - - 100-431

) Mineral " - - 3-002

Water, ... - 520-210

A11 ) Organic Matters, 51*426

Albumen, Kt*Li 0.7An

Liquor Sanguinis, 586-268

Mineral " 2-760

Extractive

j * n i > f Organic Matters, r6-902
and Colore V ,rb , n^n

Matters, gj Mineral 2-070

Fibrin, .... 1-900

1000 parts of Moist Blood Corpuscles contained,

Water, ---------- 749-996

Organic Matters, - - - - . - - - - 242*746

Mineral Matters, 7.258

(1) 1000 parts Liquor Sanguinis contained,

Water, 927-194

A1, e_ onn ) Organic Matters, 56-762

Albumen, .... 59*809^^ u 3.Q47

Fibrin, 2-093

Extractive and Coloring Matters, 10*904 ! .= , u ' 0.005

(2) 1000 parts of Liquor Sanguinis contained,

Water, 887*328

. nn AnA ) Organic Matters, 87*717

Albumen, .... 92*424^^ u ^

Fibrin, 3*242

Extractive and Coloring Matters, 15*310 ! . , u ' 3.538

8 o'clock, P. M. Much better; pain in his head has disap-
peared ; in a profuse perspiration ; skin much cooler. Pulse 96
to the minute, soft and natural. Kespiration regular and nor-
mal.

August 19th, 10 o'clock, P.M. Skin moist; urine high co-
lored ; Pulse 82 ; Kespiration 2-i. Temperature of Atmosphere

1858.]] JONES, on Malarial Fever. 521

89F. Temperature of Hand 100. Temperature under Tongue
10225'.

August 20th, 12 o'clock, M. Skin and tongue normal;
urine high colored. Specific gravity, 1015. Pulse 80; Respira-
tion 21. Temperature of Atmosphere 85F. Temperature
under Tongue 101.

August 21st. Pulse 80 ; Respiration 20. Temperature of
Atmosphere 80 Temperature under Tongue 988/.

This case yielded readily to the action of sulphate of quinia,
and the patient was discharged on the 23d. This has been a mild
attack of malarial fever, and the blood corpuscles were but
slightly diminished.

At first sight this case would seem to prove the efficacy of
blood-letting in malarial fever. The fact that the mere prepar-
ations for bleeding, caused the patient " to break out into a
profuse perspiration," demonstrated that the sweating stage was
nigh at hand and the bleeding was the occasion and not the
cause of its appearance.

It is probable that this patient would have done just as well,
without, as with this bleeding. The next patient suffering with
malarial fever, which I bled, was a stout German, with high
fever, scarlet face, and M distracting pain in his head," presenting
similar only severer symptoms. This case terminated fatally.
I have used local blood-letting (cut cups) in scores of cases of
malarial fever, and always with apparent benefit. Over the
epigastrium it often arrests obstinate vomiting, and over the
temples and back of neck, and over the spine, it often relieves
distressing pain. Local differs from general blood-letting, in two
essential degrees. First, the quantity of blood abstracted is much
less, and second, the number of colored blood corpuscles is less
in proportion to the amount of blood abstracted, in local than
in general blood-letting. The colored blood corpuscles rush
along principally in the centre of the streams, and in general
blood-letting they are lost, more rapidly than the other elements
of the blood. The malarial poison, whatever it be, destroys
rapidly the colored blood corpuscles. Whatever therefore
diminishes the colored blood corpuscles acts in concert with the
malarial poison. The malarial poison reduces rapidly the forces.
General blood-letting reduces rapidly the forces. The two, in
this particular, again act in concert. These views will be sub-
stantiated by facts, and more fully discussed hereafter.

Case XX. Frenchman, laborer;' height 5 feet 8 inches;
weight, 110 lbs., in health, 140 lbs. Has been in America, ten
years, and in Savannah, six months. Has been living and
working in a low miasmatic situation on Thunderboldt road,

522 Jones, on Malarial Fever. [August,

one mile from Savannah. Has been sick with chill and fever
five weeks, and has had no medical attendance. He is much
reduced in flesh and strength. Complexion sallow, anaemic.
Lips and gums pale the effects of miasmatic fever are well
marked.

August 19th. Pulse 72 ; Eespiration 24. .Temp, of Atmos-
phere, 90F. ; Temp, under Tongue, 98. Complains of great
weakness, and constant pain in his head.

August 22nd. Examination of Blood. The blood coagulated
in the usual time, and the clot was firm. After standing four
days in a stoppered bottle, in the heat of summer, the clot ap-
peared firm, un decomposed, and the serum was clear. The
blood of a patient who was suffering from the effects of remit-
tent fever, and severe salivation, placed by the side of this, in
the same time, and under the same circumstances, had its clot
completely disintegrated, and commenced to putrefy.

ANALYSIS OF BLOOD II.
Specific gravity of Blood, - - - 1034

"Water,
In 1000 parts of Blood, 850.888
" " Serum, 920-820

(1) " " Liq. Sang., 918-072

(2) " " Liq. Sang., 892-859

Solid Matters,
In 1000 parts of Blood, 149-112
" " Serum, 79-180

(1) " " Liq. Sang., 81-928

(2) " " Liq. Sang.,1 07-424
In Serum of 1000 parts of

Blood,- - - 73.167

Fixed Saline Constituents,

In 1000 parts of Blood, 7*692

" Serum, - 5-119

(1) " " Liquor Sanguinis, 5-120

(2) " " Liquor Sanguinis, 6'696

" " Solid Matters of Blood, - - - - 51-586

" " " " Serum, - 64-648

" " " " " Liquor Sanguinis, - - 62-493

" " " " Blood Corpuscles, - - 40-351

" " Moist Blood Corpuscles, - - - - 10-087

In Blood Corpuscles of 1000 parts of Blood, - - - 2-962

In Serum of 1000 parts of Blood, 4-730

1000 parts of Blood contained,

Water, 850-888

Dried Blood Corpuscles,- - 73-405 [ gSJ Mat|T' 7*

Fibrin, : 2-540

Albumen, Extractive and Coloring ) Organic Matters, 68-405

Matters, - 73-167 f Mineral " 4-730

1858.] Jones, on Malarial Fever. 528

1000 parts of Blood contained,

) Water, - - 220-215

Moist Blood Corpuscles, - - 2 9 3*G 2 0 V Organic Matters, 70-411

) Mineral " 2-962

Water, - - 630-705

T. c . . h~Q OOA Organic Matters, 68'405

Liquor Sanguinis, - - - Y6,380 f Mineral 4-730

Fibrin, - - 2540

(1) 1000 parts of Liquor Sanguinis contained,

Water, 918-072

Albumen and Extractive Matters, - 74*050

Mineral Matters, 5'120

Fibrin, 2'748

(2) 1000 parts of Liquor Sanguinis contained,

Water, 892*859

Albumen and Extractive Matters, 96-838

Mineral Matters, 6-696

Fibrin, 3-890

1000 parts of Moist Blood Corpuscles contained,

Water, 750-000

Organic Residue, 239-803

Fixed Saline Constituents, 10-087

This analysis confirms the statement, that the malarial poison
(either directly or indirectly) destroys the colored blood corpus-
cles. They are diminished one half, the dried corpuscles being
only 73*405, and the moist corpuscles 293*620, whilst in health
the dried corpuscles generally average 135'000, and the moist
corpuscles 540*000.

This patient improved very slowly under the action of sul-
phate of quinia, chalybeates, and alteratives, and on the 2nd of
September had a return of chill and fever.

September 3rd, 12| o'clock, P.M. Chill has just commenced;
he is shaking violently. Pulse 96, very feeble, can scarcely be
felt. Eespiration 82^0, irregular, spasmodic. Extremities
cold; trunk warm. Temp, of atmosphere 83; temp, of hand
9375' ; temp, under tongue 1005'.

3 o'clock, P.M. Skin hot and dry; pulse 108; respiration
28 ; temp, of atmosphere 85F.; temp, of hand 104 ; temp, un-
der tongue 105.

7 o'clock, P.M. Fever is subsiding; pulse 90; respiration
26; temp, of atmosphere 78F.; temp, of hand 1015' ; temp,
under tongue 103.

September 4th. Apyrexia.

September 5th. No return of fever.

y. s. you xiv. no. vhi. 27

524

Jones, on Malarial Fever.

[August,

September 6th. Pulse 76 ; respiration 20 ; temp, of atmos-
phere 80F.; temp, of hand 98 ; temp, under tongue 100.

Examination of Urine passed during the febrile excitement
and the intermission, Sept. 3rd.

ANALYSIS XXXIII.

Urea, - -
Uric Acid, -

Grs. 7084 of Urine passed j
during 16 hrs. Sp. Crav.
1012-4. Am't pass'd hour-
ly, grs. 442 7. Grains

151-077
2-243

Grs. 10613, calculated
for 24 hours, contain
ed grains

226-616
3-365

1000 parts
of Urine,
contained

21-08&
0-326

Case XXI. Irish laborer ; light brown hair, brown eyes ;
has been in America seven years, and in Savannah three years ;
age 22, medium height. Has been living and making bricks in
a low miasmatic situation. Says that he has suffered with chill
and fever for six weeks. Complexion sallow and anaemic; lips,
gums, and tongue pale. He is exhausted by slight exertions,
and complains of great weakness.

Sept. 16th, 12| o'clock P.M. Pulse 88, respiration 24. Tem-
perature of atmosphere, 875'F. ; Temp, of hand, 1005' ; Temp,
under tongue, 10125'.

Sept. 17th, Hi o'clock P. M. Pulse 72, respiration 20. Has
just awoke from sleep, in a profuse perspiration. Temperature
of atmosphere, 86 F. ; Temp, of hand, 90 ; Temp, under
tongue, 98

ANALYSIS XXXIV.

Water,

Solid Matters, '* - -

Urea,

Uric Acid, - - - -
Extractive and Color- )
ing Matters, j

Fix'd Saline Constituents

Grs. 16027 ot Urine excreted in 24 hours.
Sp. Gr. 1001-7. Clear, limpid. Amount
excreted hourly 667-7. Grains

15958-568

68432

42'680

1-280

18-776

5696

1000 parts
of Urine,
contained

995-730
4-270
2-664
0-079

1-171

0-356

The reduction of the nervous and physical forces was attend-
ed by a reduction in the amounts of the solid constituents of the
urine. $. Snake-root tea, 1 pint; brandy, flvi. ; sulph. of
quinia, grs. xv. Mix. Take a wine-glassful six times a day.
$. Citrate of Iron, grs. iv. three times a day.

Sept. 17th, 12 M. Pulse 72, respiration 20. Temp, of atmos-
phere. 88 F.; Temp, of hand, 985'; Temp, under tougue, 995'.
Amount of urine excreted during last 24 hours, grs. 14645. A-
mount excreted hourly, grs. 610. Sp. Gr. 1010. Urea in grs.
146459 of urine, 196.910; Uric acid in grs. 146459 of urine,

1858.]

Jones, on Malarial Fever,

525

7.975; Urea in 1000 parts of urine, 12.445; Uric acid in 1000
parts of urine, 0.544

The snake-root tea and sulph. of quinia and citrate of iron,
have produced an increase of the solid constituents of the urine.

Sept. 19th, 2 o'clock P. M. Pulse 76, respiration 24. Temp,
of atmosphere, 89 F. ; Temp, of hand, 98 ; Temp, under tongue,
99. Sp. Gr. of urine, 1012 ; Urea in 1000 parts, 10.270 ; Uric
acid in 1000 parts, 0.247.

Sept. 20th. Pulse 96, respiration 24. Temp, of atmosphere,
83 F.; Temp, of hand, 100; Temp, under tongue, 102. A-
mount of urine passed during last 24 hours, grs. 20400. Specific
Gravity 1010.

Examination of Blood, No. II Blood watery in appearance,
and coagulated slowly. Reaction decidedly alkaline. After
standing twenty hours, the clot contracted but little, and it was
soft, possessing but little consistency.

In the specific gravity bottle, the colored blood corpuscles
gravitated towards the bottom, and left above a light yellow,
transparent clot. Serum of a light yellow color. Specific gra-
vity of blood 10305 ; specific gravity of serum 1021*3

Water
In 1000 parts of Blood, 877-553
" " Serum, 927-757

(1) " " Liq. Sang. 925725

(2) " Liq. Sang. 911-124

Solid Matters.

In 1000 parts of Blood, 122-447
" " Serum, - 72-243

(1) " " Liq. Sang. 74-275

(2) " " Liq. Sang. 88-876
Serum of 1000 pts. Blood, 68-435

Fixed Saline Constituents.
In 1000 parts of Blood,
" " Serum -

(1) " " Liquor Sanguinis,

(2) " " Liquor Sanguinis, -
In Serum of 1000 parts of Blood,
" 1000 parts of the Solid Matters of Blood,
u u a n . Serum

<< u a ( 4< u (<

" " t" Liquor Sanguinis,
u " " " '" Blood Corpuscles,
Blood Corpuscles of 1000 parts of Blood, -
1000 parts of Moist Blood Corpuscles,

3316

3-326

3-328

3 965

3141

27083

45-901

44-790

3-240

0175

0 841

1000 Parts of Blood Contained,

Water, -------.. 877-553

t^ j m j m i ci no7 ) Dried Organic Residue, 51812

Dried Blood Coipuscles, 51-987 > r. , ^ & .. [ _ ,**

^ ) Fixed Saline Constituents, 0175

Fibrin, ......... 1-925

Albumen, Extractive and Color- ) Dried Organic Residue, 65*194

ing Matters, - - 68-335 \ Fixed Saline Constituents, 3-141

52ft Jones, on Malarial Fever. [August,

1000 Parts of Blood Contained,

) Water, - - - 155861
Morgt Blood Corpuscles, 207*948 V Organic Residue, - 51-812

3 Fixed Saline Constituents, 0175

Water, .... 721-692

Albumen, Extractive & Co* > 65-194

loring Matters, $

Fixed Saline Constituents, 3*141

Fibrin, - 1-925

Liquor Sanguinis, 792*052

J000 Parts of Moist Blood Corpuscles Contained,
Water, --......- 749*519

Dried Organic Matters, ...... 249*154

Fixed Saline Constitueuts, ...... 0-841

(1) 1000 Parts of Liquor Sanguinis Contained,
Water, ......... 925*725

Albumen, Extractive and Coloring Matters, - - . 68*817

Fibrin, -...-.... 2*032

Fixed Saline Constituents, - - - - 3 326

(2) 1000 Parts of Liquor Sanguinis Contained,
Water, ......... 911*167

Albumen, Extractive and Coloring Matters, - - - 823 1 2

Fibrin, ......... 3 965

Fixed Saline Constituents, 2*430

This analysis shows that the continued action of the malarial
poison has reduced the colored blood corpuscles to 51.987 dried,
or 207.948 moist, which is a little more than one-third of the
normal standard.

The fixed saline constituents of the colored blood corpuscles
are also, not only correspondingly, but absolutely diminished
in amount. I have derived much benefit in the treatment of
the effects of malarial fever, from the phosphates of iron, lime,
soda, and potassa. It is probable that they act beneficially by
supplying those salts which are deficient. If the hypophos-
phites of lime, soda, potassa and ammonia, act with as much
power and in the manner asserted by Dr. Churchill,* they will

?rove valuable remedies in the latter stages of malarial fever,
have employed them upon myself, this winter, after an attack
of intermittent fever, with apparent benefit.

* " On the Proximate Cause and Specific Remedy of Tuberculosis," by Dr.
John Francis Churchill. Dublin Hospital Gazette, Aug. 15th, 1857. Ranking's
Abstract, No. 26, July to Dec, 1857, p. 47. Dr. Churchill has employed the
hypophosphites, in the treatment of tuberculosis, with success, and asserts that
they increase nervous force, and are infinitely superior to all other medicines as
bsematogens.

1858.]

Jones, on Malarial Fever.

527

Case XXII. German laborer, age 30 ; height 5 feet 5 inches ;
weight, in health, 112 lbs.; light hair, blue eyes; small, delicate
man. Has been in the United States three years and in Savan-
nah three months. Has been "keeping store" on the river,
near the rice mill. Was taken sick with chill and fever two
months ago. Complexion anaemic. Complains of great weak-
ness. Lips, gums and tongue pale ; tongue coated with white
fur.

Sept. 10th, 11 o'clock A. M. Says that he had his chill yes-
terday. $. Sulph. of quinia grs. v. every three hours, up to
grs. xv.

Sept. 11th, 12 o'clock, M. Skin cool; in a profuse perspira*
tion. Pulse 76 ; respiration 19.

Temperature of Atmosphere, 85 F.

" Hand, 94

" under Tongue, 98

Amount of Urine excreted during last 17 hours, grs. 5072

u .. u u hourly " " " " 298-9

Calculated amount for 24 hours, " 7157

Specific gravity 1014*5. Color a shade higher than normaL

Grs. 5072 ot Urine,

Grs. 7157 calculated

1000 parts of

ANALYSIS XXXV.

excreted in 17 brs.,

for 24 hours, con-

Urine contain-

contained grains,

tained grains,"-

ed,

Water, - - - -

4886-160

6895-783

963-462

Solid Matters, - -

185-340

261-514

36538

Urea,

65-475

92-385

12-907

Uric Acid, - - -

2-750

3-880

0-552

Extractive & Color- )
ing Matters, j

102-485

144-607

20-225

Fixed Saline Constit's,

14-631

20-642

2-884

In this case, as in the preceding, we see that the depressed
state of the forces, consequent upon the continued action of the
malarial poison, was attended by a marked diminution of the
solid constituents of the urine.

Sept. 12th, 12i o'clock, P.M. Pulse 72; respiration 19.
Skin cool.

Temperature of Atmosphere, . . . 64 F.
44 " Hand, . . . . 97 25'

" under Tongue, .... 99 9

Amount of Urine excreted during the last 24 hours, . grs. 13652

" " " " hourly " " " " . . 568-8

Specific gravity 1011-3. After 16 hours, a copious deposit of urate ef
eoda and triple phosphate.

528 Jones, on Malarial Fever. [August,

ANALYSIS XXXVI.

Grs. 13652 ot Urine, excre-
ted in 24 hours, contained
grains,

1000 parts of Urine
contained,

Water,

Solid Matters,

Urea,

Uric Acid,

Extractive and Col'g Matters,
Fixed Saline Constituents, -

13242-437
409-563
209-520

19-710
158-485

20-265

970-000
30-000
15-316

1-443
11-676

1-567

Under the action of the sulphate of quinia, the urea, uric acid
and extractive and coloring matters, have been increased in
amount.

Sept. 13th, 12 M. Much better. Amount of urine passed
in last 24 hours, grs. 10,100. Amount of urine passed hourly,
grs. 420*8. Sp. Grav. 1010. fy. Quassia and soda, and snake-
root tea.

Sept. 14th. Amount of urine passed in 24 hours, grs. 14084.
Amount of urine passed hourly, grs. 587. Sp. Gr. 1006.

Sept. 15th. Pulse 64 ; respiration 18. Temp, of atmosphere,
85 F.; Temp, of hand, 98; Temp, under tongue, 99. Spe-
cific gravity of urine 1007*1. Grs. 13631 of urine contained, urea
96*400; uric acid 6*151. 1000 parts of urine contained, urea
6*003; uric acid 0*446. Urine excreted in 24 hours, grs. 13631 ;
urine excreted hourly, grs. 568.

Case XXIII. Irishman ; height 6 ft ; black hair, black eyes.
This patient had been in the Savannah Poor House for three
months, suffering with phthisis pulmonalis in its advanced stages.
For the last two months he had been confined to the ward and
recently he had been confined to his bed.

August 23d. During the night, was taken with chill, follow-
ed by fever. Had chill and fever four nights in succession, until
the paroxysm yielded to the action of the sulphate of quinia.
The chill and fever returned several times after this. Under
the combined actions of pulmonary consumption and intermit-
tent fever, the patient lost strength rapidly, and died Sept. 4th.

(1.) Autopsy 12 houks after death.

Exterior. Body much emaciated, universal sallow color,
marked cadaverous rigidity.

Head. "When the skull cap was removed, about f iss. of
serum and blood escaped from the base of the brain. Dura-
mater normal. Arachnoid membrane slightly opalescent in
several spots, especially in the neighborhood of the larger blood
vessels. The greatest part of this membrane, however, was trans-
parent and normal.in appearance. Subarachnoid fluid appeared
to be more abundant than usual. Bloodvessels of pia mater
filled with blood. The venticles of the brain contained small

1858.] JONES, on Malarial Fever. 529

quantities of serum. The cortical and medullary substances,
the cerebellum, pons varolii, the medulla oblongata, and the
spinal marrow, appeared natural to the naked eye.

Chest. Tubercles of various sizes, in various stages of devel-
opment and disintegration, were deposited throughout the sub-
stance of both lungs. Many of the largest were broken down
into a pus-like matter, mingled with portions of the cheesy tuber-
culous substance.

Heart normal in size; weight grains, 6557. Portions of the
right heart showed the commencement of fatty degeneration.
The right auricle was filled by a large light yellow clot, which
was attached to the tricuspid valves and cordae tendinae, and
sent a large cylindrical branch down the vena cava. The surface
and whole structure of this clot was of a light yellow color and
appeared to be entirely free from colored blood corpuscles. In
the right auricle and venticle were several other smaller clots,
which resembled ordinary coagulated blood, and must have been
formed posterior to the light yellow fibrinous clot. The lower
portion of the vena cava contained coagulated blood. No clots
were found in the left auricle and ventricle. The carotid arte-
ries contained flattened cylindroid, light yellow clots, which
sent off branches to the smaller arteries. These clots appear to
have been formed before death, when the circulation was greatly
diminished in force.

Abdomen. Stomach small, contracted; small intestines and
colon inflated with air. Mucous membrane of stomach of a pur-
plish red color, in spots, presenting a mottled appearance. Blood-
vessels upon the exterior filled with blood. The small intestines
contained fecal matters colored by bile. Internal surface of a
dark purplish and reddish yellow hue. Blood vessels upon the
exterior and through the structures of the intestines were filled
with dark blood. Glands of Peyer, normal, not enlarged.
Brunner's glands did not attract attention.

Liver. The form of the liver was abnormal; it had no left
lobe, and in its general shape resembled a spleen. The color
was purplish red. The structure was unusually firm. It required
considerable force to tear it asunder. It cut toughly under the
knife, and the lobules started out from the cut surface, as if they
had been bound down. The fibrous capsule surrounding the
exterior of the liver, forming a sheath for the large vessels lying
in the portal canals, was thickened. The individual lobules of
the liver were surrounded with fibrous tissue. The lobules of
the liver have been described by Malpighi, (') Kiernan, (2) Mul-

(1) Malpighi. De Yiscerum Structura Bologna. London: 1699.

(2) The Anatomy and Physiology of the Liver, by Francis Kiernan. Philoso-
phical Transactions of the Royal Society of London. 1833. P. 714.

630 Jones, on Malarial Fever. [August,

ler, (3) Leidy, (4) and others as isolated from each other, and
each invested with a layer of areolar or fibrous tissue. In the
pig, in which these lobules were first noticed, and in the Polar
bear according to Muller, and in the octodon cummingii, accor-
ding to Hyrtl, (5) the lobules are invested by fibrous tissue, but
in the liver of the human subject, and in that of vertebrate ani-
mals generally, the lobules are not separated from each other
by a fibrous partition, and there is no areolar or fibrous tissue
or prolongation of Glisson's capsule between them or in their
interior. Yogel, Henle, (6) Bowman, (7) and Beale, (8) have
failed to detect any fibrous tissue in the interlobular fissures of
the normal human liver.

In cirrhosis of the liver, on the other hand, there is a remark-
able development of fibrous tissue in the parenchyma of the
liver, and the individual secreting segments become prominent,
or even form isolated lobules. The increase of fibrous tissue in
the liver of this subject, was manifest to the eye, and especially
when the liver was subjected to the action of a stream of water,
and gently mashed between the fingers. The softer parts were
washed out, and the fibrous tissue remained. The character of
this was determined by microscopical examination. The portions
of the liver surrounded by the indurated fibrous tissue appeared
to be but little altered and could be readily scraped away.

The cirrhosed condition of the liver was not the result of
malarial fever, for the microscopical examination showed that
the fibrous tissue was abundant and well formed. The whole
structure of the liver could not have been pervaded by fibrous
tissue in the course of a few days. It is reasonable to conclude
with Dr. Budd, (9) that the remarkable changes in cirrhosis, are
mainly the consequence of adhesive inflammation in the areolar
tissue about the small twigs of the portal vein, and in the areolar
tissue of the portal canals, by which serous fluid and coagulable
lymph are poured out. In this stage/the liver may be enlarged.
The serous part of the effusion is next absorbed, the lymph
contracts, becomes converted into dense fibrous tissue, which
divides the lobular substance of the liver into well-defined
masses, and gives great density and toughness to the organ.

(3) Muller. De Glandularum Seceinent Struct. Penit, Berlin. 1830. Ele-
ments of Physiology, by J. Muller, M.D. Translated by Wm. Baly, M.D. Lond.,
1840. Vol. 1, p. 493.

(4.) Researches into the Comparative Structure of the Liver, by Joseph Leidy,
M.D. American Journal of the Medical Sciences, new series, vol. xv., 1848, p. 18.

(5) Hyrtl. Lehrbuch der Anatomie des Menchen. 1850.

(6) Huf eland's Journal. 1838. P. 8.

(7) Article, " Mucous Membrane," in Todd's Cyclopaedia of Anatomy and Physi-
ology, by W. Bowman. Vol. iii., p. 497. The Physiological Anatomy and
Physiology of Man, by Todd <fe Bowman. Philadelphia: 1857, p. 773.

(8) On Some Points in the Anatomy of the Liver of Man and Vertebrated Ani-
mals, by Lionels. Beale, M.D. London: 1856, pp. 13, 16, 19, 72.

(9) On the Diseases of the Liver, by George Budd, M.D. London: 1857, p. 143.

1858.] Jones, on Malarial Fever. 531

Finally, this fibrous tissue, compresses the small twigs of the
portal vein and the small gall ducts, and thus impeding the es-
cape of the bile and the flow of blood, induces great atrophy of
the original hepatic tissue, and causes by a deprivation of blood
and the admixture of this dirty white fibrous tissue, marked
changes in the color of the liver. If these views of Dr. Budd be
correct, it is evident that this condition of the liver could not
have resulted from an attack of malarial fever, which had com-
menced only twelve days before death. The weight of this liver
was 22968, troy grains, or 52^ ounces avoirdupois. According
to the researches of Dr. John Keid, (l ) the liver weighed in 43
cases, out of 82, between 48 and 58 ounces in the adult male;
and in 17 cases, out of 36, its weight in the adult female ranged
between 40 and 50 ounces. It may then, in general terms be
stated that the weight of %lq liver in health varies from 3 to 4
pounds, according to the quantity of blood which it may contain
at the time it is examined. The weight of this liver therefore,
was normal. It was however far more engorged with blood than
is usual in cirrhosis. If this patient had died from tuberculosis
and not from malarial fever, it is probable that the liver would
have weighed less than in health.

This patient was an Irish laborer. This class are addicted to
the free use of ardent spirits, and the true cause of this cirrhos-
ed condition of the liver, was the action of the alcohol in the
portal blood, absorbed directly from the stomach and intestines,
upon the bloodvessels and secreting apparatus of the liver. We
know that this form of disease is most frequent in large manu-
factoring towns, among the poorer classes who drink large quan-
tities of ardent spirits. All the cirrhosed livers which I have
had an opportunity of examining, have been taken from the
bodies of those who have been accustomed to the free use of
spirits. So common, and well known is this cause, that cirrho-
sis is familiarly termed by the English practitioners, gin-drink-
ers' liver.

The color of the liver of this patient was very different from
that generally presented in cirrhosis. Upon the inferior surface
of the liver, there was a small portion of a dark slate inclining
to bronze color, resembling the color of the malarial fever liver,
and forming a striking contrast with the surrounding purplish
red color. In cirrhosis, owing to the admixture of fibrous tissue
and the impediment to the circulation of the blood, and the pas-
sage of the bile, and the compression of the capillaries and secre-
ting apparatus, the normal dull-reddish brown color of the liver

(10) London and Edinburgh Monthly Journal of Med. Science, April, 1843,
See also Comparative Weights of the Liver of Animals, by Joseph Jones, M.D.
Smithsonian Contributions to Knowledge. 1856, p. 113.

532 Jones, on Malarial Fever. [August,

is altered sometimes to a bright canary yellow, sometimes to a
brownish or greenish, and occasionally to a reddish color. A
section of the liver upon a general view presents the greyish
and yellow color of impure bees- wax.

The researches of Dr. Thomas Stewardson, (l !) in the Phila-
delphia Hospitals, confirmed by those of Dr. Wm. T. How-
ard, (12) in the Baltimore Alms House, of Dr. Swett, (J 3) in
the New York Hospital, ofDrs. Anderson, (1 4) and Frickin the
Baltimore Almshouse and Infirmary, and of Dr. Kichard D.
Arnold, (* 5) in the Savannah Marine Hospital and Poor House,
have shown that the color of the liver in malarial fever, is
changed from the normal reddish brown, to a slaty or bronze, or
mixture of bronze and olive. The observations of the author,
which we hope to present in subsequent numbers of this journal,
confirm the statements of these observers.

In this case, owing to the pathological conditions of cirrhosis,
the admixture of fibrous tissue, impediment of the circulation
of the blood, and flow of bile and the compression of the
capillaries and secretory apparatus, the color of the liver was
not so marked as in those cases of malarial fever, in which the
liver was normal before the introduction of the malarial poison.
Allowing due weight to the pathological changes of cirrhosis, it
is evident that the change in the color of the liver, was similar
in all respects to the slate or bronze color of livers which were
normal before the onset of the malarial fever. This change in
the color of the liver in malarial fever is due to changes in the
amount, and physical and chemical constitution of the blood in
the capillaries of the liver, and to physical and chemical changes
in the bile and the contents of the secretory apparatus. The
blood which issued from the cut surface of the liver, remained
of a dark purplish color, and did not change to the arterial hue
upon exposure to the oxygen of the atmosphere. The loss of
this power to change from the venous to the arterial hue is sig-
nificant of profound changes in the constitution of the colored
blood corpuscles.

In this, and many other cases of malarial fever, I have obser-
ved the bile to be of high specific gravity thick, concentrated,
and of a greenish black color when seen in mass, and of a gam-
boge yellow, when spread in thin layers. I have always found

(11) Stewardson, on Remittent Fever. American Jour. Med. Sciences, April,
1841, new series, vol. i., p. 289. Elliotson's and Stewardson's Practice of Medi-
cine, p. 338.

(12) Communicated by Dr. Stewardson. Am. Jour. Med. Sciences, Jan. 1845.

(13) Swett, on Pathol, of Remit. Fever.

(14) Published by Dr. Alfred Stille. " " " " April, 1846.

(15) " An Essay upon the Relation of Bilious and Yellow Fever, prepared at
the request of, and read before the Medical Society of -Georgia, April, 1856," by
RJphard D. Arnold, M.D. Southern Med. and Surg. Journal, vol. xii., p. 515.

1858.] Jones, on Malarial Fever. 533

the filtered decoction of malarial fever livers, to be of a brownish
yellow color, whilst the decoction of normal livers is of a light
yellow, whilst that of yellow fever livers is of a bright golden
yellow. The color alone, would seem to point to pathological
changes in malarial and yellow fevers, differing in each disease.
The amount of blood contained in the capillaries of the malarial
liver has always appeared to be greater than normal. The
combination of these three causes will account for the peculiar
color of the liver in malarial fever.

The liver of yellow fever on the other hand, as far as my obser-
vations extend, is of a bright yellow color, (readily extracted
by water and alcohol,) firm texture, and contains much less blood
than the malarial liver. The yellow fever, liver although resem-
bling fatty degeneration in color, as far as my observations ex-
tend, gives no evidence of such a change under the action of
chemical re-agents. A solution of liquor potassa readily dis-
solves the liver of malarial fever, but acts very slowly upon the
3Tcllow fever liver.

These facts are sufficient to show that the patholigical changes
are widely different in the two diseases. The liver of this patient
who had died with phthisis pulmonalis and intermittent fever, was
carefully tested for grape sugar, with Moore's and Trommer's tests.
Not a trace of grape sugar was obtained. The absence of the
grape sugar was not due to the cirrhosed condition of the organ,
for I have detected grape sugar in the cirrhosed livers of patients
who had died from other causes than malarial fever. Diabetes
mellitus, has existed when much of the lobular substance of the
liver had been destroyed by cirrhosis, and the secretion of the
bile defective and the passage of the blood through the liver
much impeded. Such a case occurred in King's College Hospi-
tal, under the care of Dr. George Budd.(16) From numerous
chemical examinations of the livers of patients who had died
with the different forms of malarial fever, I am convinced that
the absence of grape sugar is due to the action of the malarial
poison upon the special ferment of the blood.

When tested for glycogenic hepatic matter (animal starch),
after the method of Bernard, an abundant precipitate was
obtained. When the fibrous capsule of the liver was torn off,
spread upon a glass slide, partially dried and treated with tinc-
ture of iodine, the cellular tissue was not altered by the tincture
of Iodine, but wherever a particle of liver adhered to the fi-
brous tissue, there a purple and blue color was produced. Under
the microscope the fibrous tissue of the liver generally, and of
the portal canals, were found to be completely infiltrated with
this animal starch. Under the microscope the liver cells appear-

(16) "On the Diseases of the Liver," by George Budd.M.D. London: 1857.

534: Jones, on Malarial Fever. [August^

ed to be paler and have fewer oil globules and granules than
usual, but otherwise, they were normal. When single cells
were treated with tincture of iodine under the microscope, I was
not able to demonstrate satisfactorily whether they contained
animal starch. When, however, a number of them, in mass, were
treated with tincture of iodine, the characteristic blue color was
produced.

In this case of intermittent fever, the special ferment in the
blood which transforms animal starch into glucose, had been
destroyed, whilst the power to manufacture starch from both
nitrogen ized and non-nitrogenized materials, was exercised by
the liver, and hence the absence of glucose and the accumulation
of glycogene. From chemical examinations of the livers of the
different forms of malarial fever, from the summer of 1856 to the
present time. I have obtained similar results an abundance
of animal starch, without a trace of grape sugar. Livers were
set aside and examined after intervals of 12 hours. The last
examination was made 36 hours after the first. At every exami-
nation the result was the same an abundance of animal starch,
without a trace of grape sugar.

The mere presence of starch in the liver is not peculiar to
malarial fever it is not a pathological condition. In the month
of September 1856, I had an opportunity of examining chemi-
cally the liver of a patient who had been under the care of my
friend and former colleague Dr. J. B. Kead. This patient had
black vomit, and all the symptoms of yellow fever, and the
liver presented the yellow box-wood color peculiar to this dis-
ease. Drs. Eead and Arnold, who have had extensive expe-
rience in the treatment of yellow fever, pronounced it a genuine
case of yellow fever. (17) Chemical examination gave decided
evidence of the presence of animal starch in the structure of the
liver. The liver of a yellow fever patient brought from Nor-
folk by Dr. J. B. Kead, (* 8) presented a similar appearance, and
also yielded animal starch.

I have detected this substance in the human liver, in normal
condition after sudden death, from diseases of the circulatory
apparatus, and appoplexy, and phthisis, and in abnormal states,
as cirrhosis, fatty degeneration, and cirrhosis and fatty degener-
ation combined. I have examined the livers of numerous ver-
tebrate and invertebrate animals, injected and uninfected, and
in every instance animal starch has been found. Whether the
elaboration of this product is confined specially to any one of

(17) For report of this case, see Addendum to Dr. Richard D. Arnold's Essay-
on Bilious and Yellow Fever, p. 3.

(18) Chief Physician of the Savannah Volunteers, who went on to Norfolk in
1866, and rendered medical service during the terrible epidemic of yellow lever.

1858.] JoNES, on Malarial Fever. 535

the anatomical elements of the liver, I have not as yet been able
to determine with certainty, for it has been found in the fibrous
tissue of the portal canals, in the hepatic ducts and in the secre-
ting cells. ~\Ve would naturally infer that it was formed in and
by the secreting cells of the liver, and was deposited in other
positions by endosmosis. The exact point at which it is conver-
ted into grape sugar, is also unknown. Bernard has shown that
this change is due to the action of a special ferment contained
in the blood. Experiments have shown that the liver cells con-
tain grape sugar as well as the hepatic veins. If the starch is
formed in the secreting cells, and grape sugar is formed in them
also, then the special ferment of the blood must be absorbed by
the secreting cells. A portion of the animal starch may be ab-
sorbed by the hepatic veins, and be acted upon by the ferment,
partially, if in large quantities, and finally be deposited in the
organs and tissues. This view is sustained by the fact that this
substance is not confined to the liver. I have found it in con-
siderable abundance in the malarial fever spleens, and in normal
spleens taken from patients who had died from cirrhosis and
fatty degeneration of the liver combined, and in one case where
the patient (an aged negro man) had died suddenly from apo-
plexy.

A carbo-hydrate, similar in its composition and properties to
vegetable cellulose, has been found in some of the lower classes
of animals. C. Schmidt, (* 9) discovered cellulose in the mantle
of phallusia mammillaris (one of the mollusca,) and Lowig (2 )
and Kolliker, have discovered it in the outer tube of salpae, in
the leathery mantle of the cynthiae, and in the cartilaginous cap-
sule of the simple ascidiae. The researches of Odier, (21) Las-
saigne, (aa) Payen, a 3) Children, (2 4) and Danniel, and especial-
ly of C. Schmidt, (25) have shown that a body closely resemb-
ling cellulose, (vegetable fibre, which C. Schmidt, regards as
composed of a carbo-hydrate and of a nitrogenous body having
the composition of the muscular fibre of insects,) forms the true
skeleton of all insects and Crustacea. This substance, called
chitin, constitutes not only the external skeleton, the scales and
hairs of insects, but it also forms their trachae, and even one of
the layers of the intestinal canal. Cellulose or animal starch

(19)Zu Vergl. Physiol, der Wirbellosen Thiere. 1845, S. 62. See also
"Contributions to the Comparative Physiology of the Invertebrate Animals, be-
ing a Physiologieo-Chemical Investigation," by Dr. Carl Schmidt. Taylor's
Scientific Memoirs, vol. v., part xviii. 1852, p. 34.

(20) Ann. de Scienc. Nat., 3d series, T. 5, pp. 193-232.

(21) Memoire de la Societe d'Historie Naturelle, torn. 1, p. 29, et. sq.

(22) Comptes Rendus, torn, xvi., p. 1087 Journ. de Chim. Med. 19. p. 379.

(23) Comptes Rendns, torn, xvii., p 227.

(24) Todv's Cyclopaedia of Anatomy and Physiology, vol. ii., p. 882.

(25) Zur Vergleichend, Physiol, der Wirbellosen. Thiere. 1845. S. 3269.
Trans, in Taylor's Sci. Memoirs, vol. v. 1852. pp. 14-28.

636 Jones, on Malarial Fever. [August,

has been discovered by Kudolph Virchow, (2 6) in the brain
and in some of the higher nerves of sense. These observations
were subsequently confirmed by those of George Busk. (2 7)
In 1853, Yirchow(28) announced the discovery of corpuscles
presenting the same reaction as the corpora amylacea of the brain,
in the malpighian corpuscles of diseased human spleens in the
condition termed waxy spleen. Virchow, Bennet and Carter
have also pointed out the existence of a peculiar amyloid sub-
stance in the liver, in some chronic forms of disease, as waxy
or fatty degeneration.

Notwithstanding that much time and labor were expended
upon the microscopical and chemical examinations of the liver
in this case, and in many others which we hope to record in
future, and notwithstanding that several facts of value to pathol-
ogy have been discovered, still the whole subject is open for
investigation and presents an inviting and untrodden field to
the investigator. These imperfect results are presented with
the hope that others may be excited to enter the same field, and
not only prove their truth or falsity; but also remove the uncer-
tainty and obscurity, and establish a clear knowledge of the
pathology of malarial and yellow fevers. Those who enter upon
this field of investigation will soon be convinced, that chemical
and microscopical examinations of the liver are tedious, and to
a great extent uncertain and vague, on account of the complex-
ity and delicacy of the structures, and secretions.

The accuracy and value of pathological investigations, depend
upon the state of anatomy and physiology. If anatomists and
physiologists are not agreed with reference to the minute anato-
my of the liver, and the mode of formation, and offices of its
secretions, how can the pathologist arrive at accurate and defi-
nite conclusions, when he has to investigate not only the com-
plex anatomical structures and secretions, but also examine the
morbid physical and chemical alterations, and if possible, dis-
cover the character and mode of action of the morbific agent or
agents ? The difficulty of correct microscopical examination of
the liver is strikingly shown by the differences of opinion
amongst the most distinguished anatomists, with reference to
the connexion of the liver cells, with the hepatic ducts. Kier-
man, (29) Schroder Vander Kolk, (30) Krukenberg, (31) We-

(26) Virchow's Archiv. b. vii., h. 1, p. 135.

(27) Journal of Microscopical Science, No. vi , p. 101.

(28) Comptes Rendus, No. 23. December 2, 1853.

(29) The Anatomy and Physiology of the Liver, by Francis Kiernan. Philo-
sophical Transactions. 1833.

(30) In Backer's Essay. De Structura Subtilori Hepatis Sani et Morbose.

(31) Untersuchungen ueber den feineren Bau der Menschichen Leber, in
Mull. Archiv., St. 3l8.

1858.] Jones, on Malarial Fever. 537

ber, (33) Retzius, (33) Theile, (34) Backer, (35) Leidy, (36)and
Beale, (37) have advocated the existence of a tubular basement
membrane, continuous with the ducts, within which lie the
liver cells. Kolliker, (3 8) describes the hepatic cells as so arran-
ged in the lobules, as to form a net work, by the simple apposi-
tion of their flat surfaces, Avithout the assistance of any foreign
connecting intermediate or investing coat. Not a trace of bilia-
ry ducts is to be observed in this net-work, and it is impossible
to make out any connection between the biliary ducts and he-
patic cell net-work, which is undoubtedly the secreting portion
of the liver. Dr. Handheld Jones, (39) asserts that the ducts
terminate in blind extremities, on reaching the lobule, instead of
forming a plexus within it, and that the chief agents in the secre-
tion of bile, and the cells lining these ducts, and not the cells in
the lobular substance. These facts, show the necessity for care-
ful and laborious research, and the importance of having a large
number of careful investigators engaged in this field. (4 )

Spleen. Color of spleen, dark slate, resembling in all respects
that common to the severer forms of malarial fever. Weight,
grains, 6343. According to the observations of Dr. John Eeid,
the weight of normal spleens ranges from 2187 to 3062 grains.
This organ then was enlarged. It was partially disorganized;
its fibrous capsule was torn upon the slightest pressure, and the
cellular framework was readily ruptured when the substance of
the spleen was pressed between the fingers. The pulp (mud) of
the splen was of a dark reddish brown color, and changed very
slowly and slightly, when exposed to the atmosphere. After 12
hours exposure to the atmosphere, although the color became a

(32) Annot. Anat. et Physiolog., Prol. vi., vii., viii. Lips. Zusatze zu seineD
Untersuchungen uber den Ban der Leber, in Berichte der K. Sachs. Ger. (L
Wissench, zu Leipzig, St. 151. Programmatar Collecta, Fasc. 11. Lips.

(33) Uber den Bau der Leber, Mull. Archiv. It. p. 141.

(34) Art. Leber, in R. Wagner's Handw. der Phys. 11, St. 308.

(35) De Structura Subtiliori Hepatis Sani et Morbose, Diss Inaug. Trajecti ad
Rhenum.

(36) Researches into the Comparative Structure of the Liver. American Jour,
of the Medtcal Sciences, Jannary 1848, p. 18.

(37) "On some points in the Anatomy of the Liver of Man and Vertebrate
Animals," by Lionel S. Beale, M.D. London : 1856.

(33) Manual of Human Microscopical Anatomy, bv A. Kolliker. Translated
by G. Busk and T. Huxley. Philadelphia: 1854, p. 532, el. seq.

(39) C. Hanfield Jones, on the Secretory Apparatus of the Liver. Philosophi-
cal Transactions, 1846, p. 473. On the Structure and Development of the Liver.

Phil. Trans. 1849. 1. p. 109. Further inquiries as to the Structure, Development
is of the Liver. Phil. Trans. 1853, Part i. p. 1-29.
(40) Of all anatomists, Dr. Lionel S. Beale appears to have examined the liver

with the greatest care, and to have arrived at the most accurate results, and I
would recommend his recent work "On some points in the Anatomy of the Liver
of Man and Vertebrated Animals. Lopdon : 1856," to the young members of
the medical profession who may enter upon similar investigations. This work
contains minute and valuable directions for the injection and preparation of the
liver for microscopical examination.

538 Batty, on Emulsions, [August,

little lighter and redder, still it by no means assumed an arterial
hue, as is usual with normal spleens. This spleen was not how-
ever as much enlarged and disorganized, as in severer cases of
malarial fever. When the fibrous capsule was torn off, spread
upon a glass slide, and treated with tincture of iodic e, the fibrous
tissue was simply colored red by the iodine, whilst in the meshes
of the fibres were seen irregular blue and purple masses, resem-
bling in all respects the animal starch of the liver. When the
spleen was subjected to a stream of water, and the pulp washed
out of the cells, and the cellular frame-work and bloodvessels
thus cleansed, spread upon a glass slide, and treated with a solu-
tion of iodine, numerous small irregular blue and purple masses
were seen in the meshes of the fibrous tissue of the frame-work,
and also of the blood-vessels.

Kidneys normal in appearance. Bloodvessel filled with
blood. Weight, grains 4156.

Bladder contracted, contained no urine.

(To be continued.)

ARTICLE XIX.

Emulsions. By Robert Batty, M. D., of Rome, Georgia.

[The following excellent suggestions on Emulsions, received
some months since, have not appeared hitherto, for the want of
space. We gladly find a place for them in the present number.

The writer, it seems, has paid considerable attention to
pharmaceutical combinations, and lays great stress upon the
neatness and beauty which those compounds should present.
He gives some good hints as to the mode of preparation by
which these desirable qualities may be secured.

As regards his reference to our Formula for Dysentery, pub-
lished some months ago, we would simply say, that we gave it
to the Profession in the exact form in which it occurred to us,
and in which it gained our confidence by its marked effects, and
just as it has been used ever since, not only by ourselves, but
by many others, with the most gratifying results. We would
prefer, therefore, to retain the amount of each ingredient intact,
rather than to sacrifice, in any degree, the success of the treat-
ment to pharmaceutical neatness, or agreeableness of taste.

We see that The London Lancet, a most critical and fastidi-

1558.] Batty, on Emulsions. 539

ous Journal, in transferring this formula to its pages, did not see
fit to suggest an alteration. Edts.]

There is, perhaps, no class of preparations in the dispensing
practice of country physicians, so badly done up as emulsions.
A few practical suggestions, from one who has spent some years
in the drudgery of a dispensing shop, will, I trust, not be devoid
of interest to those who desire to furnish their patients with
nauseous remedies in this most eligible form.

An emulsion may be defined to be a combination of oil, fat,
or resin, with water, through the intervention of an alkali, gum,
albumen, or casein. It is, in other words, an artificial milk, of
which nature has given us a perfect type in the milk of animals,
the juices of the garden lettuce, the poppy, the asclepias syriaca,
the ferula assafcetida, and a large number of both indigenous
and foreign plants, are samples or copies furnished us for our
study and imitation.

In attempting to arrive at the points of a good emulsion, we
cannot do better, perhaps, than take cow's milk as our standard
of comparison; and first, we notice that it is, when fresh, an
opaque, homogeneous liquid such should be the character of
the well-formed emulsion. The milk, upon standing for a time,
throws up its cream to the surface the emulsion, by age, will
do the same; but as we do not find masses. of butter upon the
milk, neither should we have globules of free oil on the top of
he emulsion the latter, like the former, should admit of free
dilution with water, without any separation or decomposition.
Like milk, while it should not be too thin and watery, it is by
no means thick and viscid; in color, pure white, if possible
if tinted, let it be cleanly and agreeable to the eye; in odor and
taste, as little repugnant as the nature of the remedy will per-
mit.

Let us now inquire how these indications are to be carried
out in practice. We will take, for illustration, the recipe upon
page 163 of this Journal a recipe medicinally admirable, but
pharmaceutical!}7 bad. We have here, of oils 2^ ounces, solid
materials 3 ounces, tincture 1 ounce, and water 3 ounces a
preparation entirely too concentrated, thick and viscid a tea-
spoonful of which forms a more nauseating dose than four times
v.b. vol. rrv. vo. vin. 28

5i0 Batty, on Emulsions. [August,

the quantity of a well made milky emulsion. When diluted
with an equal bulk of water, it separates into three distinct lay-
ers a dirty looking fluid, with a curdled precipitate at the
bottom and an oily fayer upon the top : in both respects, then,
most unlike its prototype milk. In this case, the quantity of
water has been insufficient to prevent the curdling action of the
lavender upon the mucilage; it should therefore be increased ;
and this may best be done by using a portion of aqua menth.
pip. as a corrigent, and also to conceal the flavor of the turpen-
tine. The quantity of soda, upon the other hand, is excessive,
its saponifying properties being tin-necessary so much only
should be used as is medicinally requisite.

Salts should enter into emulsions only when clearly indicated
in the case, and then in small quantity; for, with the exception
of the alkaline salts, they impair the permanence of the prepa-
ration while the alkaline salts, themselves, in large quantity,,
offend the palate and stomach. The use of ordinary spts. tur-
pentine should be avoided if possible fresh camphine or pine
oil is preferable; and when this cannot be obtained, the spts.
turpentine may be put in a retort or flask, writh a little water,
and one half of it distilled off for medicinal purposes: as pre-
pared in this manner, it is so nearly free of taste and odor, as to
be scarcely recognizable in the emulsion. The castor oil should
be clear and limpid, and wholly soluble in alcohol ; and the
powdered gum arabic, when rubbed upon a pill tile, with a little
water, should form a bright and clear mucilage, free of color.

Upon remodeling the formula, in accordance with the views
above indicated, we have a handsome preparation, as little re-
pugnant to the taste as the remedies will admit, and the recipe
will read somewhat as follows :

01. Ricini Opt.

Terebinth, Recentis. . . f Sss.

Sodas Bi Carb. . . . 3ij.
Pal. Acacia Opt. .

" Sacch. Alb. . . . aa l'\.

Sps. Lavendul Comp. . . fi.
Aquae Camph.

" Menthar Pip. . . aaf^vj.

M. Ft. Emulsio, Sig. a tablespoonful to be taken every two
hours.

fiij.

1858. J Batty, on Emulsions. 5-il

It is not sufficient, however, that we have a well devised for-
mula : skillful manipulation in combining the ingredients is also
of prime importance, if we would have a handsome product.
The simple mixture of the materials in a bottle, gives us a hete-
rogeneous mass, utterly devoid of form and comeliness; and
even when well begun, a single false step in the process will
often wholly defeat the end proposed. Yet the process, when
once understood, is by no means a complicated or difficult one.
In compounding the above formula, the first step is to weigh
the dry materials soda, gum and sugar and combine them in
a suitable mortar, capable of containing a pint then add of the
camphor water sufficient to form a thick mucilage, which gives
a crackling sound under the pestle. Mix well the turpentine
and oil in a graduate, and add it in successive portions of 5 or
10 drops, triturating thoroughly after each addition, until about
one-fourth has been thus combined with the mucilage, which
will be found to have thickened in the process. It will now be
necessary to add a few drams of the camphor water to attenuate
the mixture to its former consistence, when it will be proper to
add the remainder of the oils, slowly, as before, and with con-
stant trituration. The camphor water may now go in, dram by
dram, followed by the mint water; and lastly, the sps. laven-
der, which should be added cautiously, drop by drop, continu-
ing the trituration constantly throughout the process.

I have been accustomed in past years to compound an emul-
sion of Copaiba, extensively and favorably known to the Pro-
fession here as "No. 310." The recipe, obtained from Prof.
Miller, of the Augusta College, is as follows:

$. Copaibae,

Tinct, Cubeba?,
*Syr. Uva Ursi, . . aa f!ij.
Pul. Acacice Opt. . . lij.
Aquas Cinnam. . . . fsxvj.
M. Ft. Emulsio. Sig. Dose, a tablespoonful three times daily.

I use, in my own practice, a formula, as I think it somewhat
more elegant than the above

* Syrup Uva Ursi contains the active matter of four ounces of the leaves in
each pint of ayrujx

642 Batty, on Emulsions. [August,

$. Copaibae, . . . . fgss.

fExt, Dios. Fl. Comp. . f 3iv.

01. Menth. Yir. . . gtt. viij

Pul. Acaciae Opt. . . I ss.

Aquae Font. . . . f I v.

M. Ft. Emulsio. Sig. Tablespoonful three times daily.

In comparing the two recipes, three points are worthy of no-
tice : First, the use of mentha virida to couch the taste and odor
of the copaiba, as being much better fitted for this purpose than
the cinnamon ; secondly, the use of ol. menth virida, in place
of aq. menth vir., saving the unnecessary trouble of preparing
the latter for the purpose ; thirdly, the use of fluid ext. of buchu,
in place of the tr. cubebs and syrup uva ursi. The buchu con-
tains a notable quantity of sp. nitre, oil cubebs and oil juniper,
and is altogether a more eligible preparation for this use.

In typhoid fever, and indeed all febrile cases where I have a
dry, parched tongue to contend with, I use the following for-
mula:

3. 01. Terebinth Eecini,

f3ij.
3J.

Sodas Bi Carb.
Pul. Acaciae Opt.

" Sacch. Alb aa 5ss.

Sp. Lavendul. Comp. . . . f 5ss.

Aquae Camph f!iv.

" Menth. Pip. . . . fjiij.

M. Ft. Emulsio. Sig. Tablespoonful every two hours.

To this, tinct. opii. or tinct. verat. viride may be added, if
indicated.

In digesting a formula the following suggestions will be found
useful :

1st. The quantity of the active ingredient must, of course, be
governed by the case. For one pint of emulsion, two to four
ounces of castor oil one half to one ounce of oil turpentine, and
one to two ounces of copaiba, will usually be found desirable
limits.

2nd. The quantity of gum used may be one ounce for four
of castor oil, two of copaiba, and one of oil turpentine unless
it should be desirable, as in the case of copaiba, to render the

\ Each pint represents, of Buchu 2 ounces ; Sp. Nit Ether 2 ounees ; Oil Cu-
beba and Oil Juniper, of each, 21 drops.

1858.] Clinical Lecture on Dyspepsia. 543

preparation more mucilaginous. When sugar is used, the gum
may be a little curtailed, if desired.

3rd. Syrups may be added freely, if iudicated ; but with tinc-
tures and spirits it is advisable that the quantity do not exceed
an ounce in the pint

4th. No insoluble powders should be added to an emulsion ;
nor should soluble salts be used in large quantity.

The rules for the preparation of emulsions may be briefly
summed up in the order in which the materials are to be used.

1st All dry materials.

2nd. Watery menstruum to a crackling mucilage.

3rd. The oils, until the mucilage thickens.

4th. Watery menstruum to attenuate.

5th. Eemainder of the oils.

6th. u " watery menstruum.

7th. Simple or fluid extracts, if any.

8th. Tinctures, or spirits.

Clinical Lecture on Dyspepsia. Delivered at the Hotel Dieu, by
M. Trousseau.

Of the patients at present in the wards of our service, you may
every day see some who complain of disordered digestion. You
have seen me give trial to various therapeutic means, and per-
haps an accusation of empiricism has planted its germ in your
minds- but do not deceive yourselves. I have, it is true, been
groping my way; but if to some I have prescribed bicarbo-
nate of soda, carbonate of magnesia, carbonate of lime, and selt-
zer water; to others cinchona wine, infusion of quassia, or of
nux" vomica; and to others again, opium or hydrochloric acid,
it is because I would ascertain in what cases one or other of
these medicines is more particularly indicated, and more espe-
cially useful. This premised, let me now enter into some details,
for dyspepsia is a question on which it will be worth while to
bestow some pains.

There are circumstances in which the physician, furnished
with therapeutic agents, may bring his patients into particular
conditions of adjustment, and impress, for instance, on the
stomach a co-adaptation necessary to the regularity of its actions.
The organism readily accommodates itself to a new impression.
Man certainly was not born under the 50th degree of latitude ;

544 Clinical Lecture on Dyspepsia. [August,

his body which is protected neither by hair nor by feathers,
unlike the bodies of other animals, shows clearly that it was
placed at first by its Creator under a sky so mild as to render
unnecessary that clothing which, in oar climate, is indispensable
to the preservation of life. When the earth became too narrow
for him, man directed his steps towards other regions, and thanks
to the wonderful aptitude he possesses, after turning his back
on equatorial countries, he now lives under the pole. As with
these climatic variations, so it has been with his food ; from a
regimen the most elementary, consisting with the Hindoos of
scanty rations of rice, milk, and water, man has at last arrived
at the copious table of the nations of the north. Now, what we
have said of individuals is just as applicable to the organs.

What is seen occurring in the animal on which there has been
practised stomachic fistula ? It is only necessary, you know,
to introduce into the stomach a glass tube in order to excite the
mucous membrane of that bag, and produce an abundant flow
of gastric juice. Under the influence of such irritation of this
impression, which the nerves transmit to the ganglionic nervous
centres there is produced an extra physiological secretion of a
perfectly normal fl uid. Carry the excitement to a higher degree,
produce inflammation, and there is no longer any flow of gas-
tric juice: the fistula now gives exit only to mucus. But such
perturbations manifest themselves independently of mechanical
irritation. Let a man have fever, and let the fibrile state be
accompanied with a certain modification of the innervation, and
you have suspension of the gastric secretion. M. CI. Bernard
has repeated the experiment a thousand times, by exciting, in
his way, fever in animals. Let the stomach be no longer in con-
cert with the cerebral nerves and brain, let the pneumograstric
nerve be divided, and the same instant the glands of Lieberkuhn
become powerless and inert. If, on the other hand, you touch
the ganglia of the trisplanchnicsj^stem, that furnish nervous fila-
ments to the stomach, a phenomenon of another order arises:
the gastric secretion becomes more abundant. The results, there-
fore, are thus essentially different as the disturbance produced in
the nervous system has its seat in the encephalorachidian system,
or in the ganglionic system.

We see eveiy day exemplified in man the influence which
moral emotions have, if considerable, after a repast; indigestion
supervenes just as it would do had the pneumogastric nerve been
divided. Long continued mental affections may greatly change
the functions of the stomach; hence dyspepsia is frequently oc-
casioned by sadness. Keep these etiological details in remem-
brance : they may be singularly useful to you in the treatment
of an affection sometimes so obstinate, and which will form the
subject of several of our conferences.

1858.] Clinical Lecture on Dyspepsia. 545

The stomach secretion is modified also by local pain and neu-
ralgia. As neuralgia of the eye augments, ophthalmic conges-
tion increases the temperature of the organ, and causes an over-
flow of tears, so neuralgia of the stomach brings with it analog-
ous effects, and exaggerates the acid secretions to such a degree
that they occur not only during digestion, but also when diges-
tion is at an end.

Dyspepsia is observed in rsons who experience difficul-

ty in evacuating the bowels. Is constipation a cause or an ef-
fect of dyspepsia? This question to me does not seem of easy
determination ; for you may just as readily suppose an individu-
al may become constipated because his food is too sparing, as
that he is constipated because he is dyspeptic

When you irritate the lower extremity of the large intestine
you bring on a diarrhoea that has its source in the ileum. The
anal impression thus communicates itself to the small inte--
A very evident proof of the sympathy which connects the rec-
tum with the other parts of the intestinal tube may be seen in
fact that an enema administered after a meal gives rise to indiges-
tion. A suppository, which is never introduced beyond four
or five centimetres, very often produces results identical with
those caused by the enema. This at least is sufficient to provoke
alvine evacuation, at first of the form of the large intestine, then
demi-liquid, and containing matters in part from the ccecum or
last portions of the small gut. There is then a participation of
action, a synergia, by which the whole muscular apparatus of
the alimentary canal is preserved in harmony with the large
intestine. These considerations conduct you to an explanation
of the fact that constipation may cause dyspepsia; the muscular
apparatus of the rectum, when this gut is indolent, contracts
feebly, the movements of the rest of the tube are weakened, and
digestion becomes more difficult. It is the reverse of what takes
place in diarrhoea; so much is this the course of things, that
with some patients it is only necessary to procure regular eva-
cuations, whether by enemeta or ascending douches, so as to
awaken harmonious intestinal action, in order to cure the dys-
pepsia.

There is a multitude of circumstances in which colic pains are
taken for stomachic. The transverse colon lies, in fact, in the
epigastric region, and is found in contiguous relation with the
stomach. To that organ the patient invariably refers the pains
he feels in this situation an error into which the physician too,
it must be remarked, often falls. Of pains in the hypochondria
the same thing may be said ; whether they affect the ascending
or the descending colon, on account of their proximity to the
liver and spleen, they are confounded with hepatic and splenic
mptoms,

546 Clinical Lecture on Dyspepsia. [August,

In constipated individuals, accumulation of fecal matters
occurs in the transverse colon, giving rise to a feeling in that
part, of fullness and distension, which the patient never fails to
refer to the stomach, though innocent of the evil. It will not
be long ere voa are convinced, if you interrogate carefully, that
the pains complained of are not coincident with the first diges-
tion, but rather with the time when it is all but accomplished.
When you pursue your examination actively, you discover that
such individuals are liable to obstinate constipation, followed
often by diarrhoea, with a more or less abundant excretion of
mucus, to be recognized by small whitish bands, sometimes
mistaken for fragments of tape-worm. Such persons, in the
end, have attaeks of colitis, and of intestinal neuralgia, and are
yet supposed to suffer from affections of the stomach dyspep-
sia but, in its more general sense, dyspepsia in such has no
existence. Nevertheless, the attacks of colitis may give rise
consecutively to that affection.

Morbid states of the liver occasion painful dyspepsia. The
hepatic gland has with the stomach a relation so intimate, and
the physiological part it plays is of so great importance to diges-
tion, ihat it is easy to see how disease of the liver may influence
the gastric apparatus, and disturb the course of its action. He-
patic pains, on the other hand, are sometimes mistaken for gas-
tralgic phenomena; but the diagnosis is not difficult. The
Patient refers all his sufferings to the region of the stomach, but
medical investigations show that they extend to the entire right
hypochondrium.

The uterus exerts on the stomach an influence not less remark-
able; and you know what perturbations are often excited in
the stomach by pregnancy, an ordinary symptom of which is
vomit ng, in some cases quite incorrigible. If you admit the
action of the uterus, physiologically modified, on the alimenta-
ry canal, you must also admit that the organ of gestation may
act in the same manner when it is the subject of pathological
lesions; hence the dyspepsias that arise in the course of leucor-
rhcea and the leading diseases of the generative system. The
same, moreover, may be said of diseases of the kidneys, and of
other organs.

I thought it would be interesting to speak to you of those dys-
peptic states that depend upon distinct functional disorders, and
organic lesions. These dyspeptic difficulties always recur with
increased or diminished activity of the movements and secretions
of the stomach ; and it is essential to establish the differential
characters that distinguish symptomatic or sympathetic affections
from such as are idiopathic. For the latter, address yourselves
to the stomach; for the former, }^ou will be obliged to have re-
course, not only to the distant cause, but also to the momentary

1858.] Clinical Lecture on Dyspepsia. 547

morbid phenomena, and the organic lesions. Unless you do
this, you will find therapeutics impossible.

At the beginning of the present century gastritis came to
overturn all our received notions in pathology. The celebrated
chief of physiological medicine, exaggerating the facts he had
observed, and in his march retrogading back to Van Helmont,
whose archeeus sat enthroned in the centre of the epigastrium,
pretended to establish an etiological relation between the mucous
membrane of the stomach and diseases the most dissimilar and
discrepant, and would have inflammation of that tunic to be the
source of almost all the phlegmasia?. You have no doubt heard
of the scientific combats that were carried on at that time, and
the struggles which that doctrine had to sustain. Broussais,
doubtless, went too far ; but it must be said, also, that physicians
of the present day allow themselves to be led away by a contra-
ry exaggeration when they deny to the mucous membrane of
the stomach a capability 01 becoming inflamed. "Why, then, do
they admit that inflammation may attack the mucous linings
of the nostrils, pharynx, trachea, bronchi, uterus, vagina, and
even that of the intestines? Why, because Broussais abused
the subject of gastritis. Would they have the internal coat of the
stomach alone exempt? This is just, in fact, what we always
do; from one evil we fall into a greater.

In vitiura dacit culpae fuga si caret arte.

Gastrits, then, has an existence, and there are satisfactory-
reasons why it should. As the chronic states is that in which
it is most frequently seen, so also is it sometimes masked: but
still it is there, and excites serious disturbance in the process of
digestion. Under the influence of this inflammation, the move-
ments of the muscular fibres of the stomach become irregular,
and the secretions no longer take place, but in an abnormal
manner. Hence you see dyspepsia accompanied by inappe-
tency, and the tongue covered with a salivarial coating; the
patient finds his food taste bitter, nausea occurs after meals,
and so do inodorous eructations, retchings, and vomiting. Com-
mence your inquiries into the etiology of this form of dyspep-
sia, and it will not be long ere you discover that the origin of the
disease, its symptoms, and physical signs, are all referable to
some permanent irritation; to chronic grastritis. There is a
variety of dyspepsia, in which. bulimia takes the place of inap-
petency. The patient experiences in his stomach a constant
feeling of emptiness. Scarcely has he finished eating ere appe-
tite returns with imperious craving, compelling attention to its
factitious wants : eructation, flatulence, and constipation are, in
such cases, exceptional phenomena ; but diarrhoea is frequent.
The reason of this you will soon comprehend. In order that

5-iS Clinical Lecture on Dyspepsia* [August,

digestion take place physiologically, each of its phases must be
accomplished in a given time; but should the stomach contract
with too much energy, the alimentary mass is protruded with
undue celerity into the duodenum, and before it has acquired a
state of elaboration sufficient for fitting it for the second digestion.
The intestine thus brought into contact with a foreign body if
I may use the expression hastens its expulsion, exciting an
abnormal state of activity, both in its secretion and contractions.
Hence the diarrhoea, and often, also, dysentery.

Let us go on to another form of dyspepsia. You will often
be consulted by individuals whose stomach, after meals, become
distended with air to such an extent that the patient has to undo
his clothes. You are told that this phenomenon is due to the
rapid fermentation of amylaceous food, or else to an abundant
production of carbonic acid, the result of fermentation going on
in the stomachic bag, analogous to that of wine in a vat. But
sucli is not the way the thing occurs. As Graves has well re-
marked, if you substitute meat for amylaceous food, the patient
taking animal food almost exclusively, gas nevertheless appears,
and with the same importunity. Now, would you say in this
case, that the gas is a product of fermentation? There is here
a peculiar secretion that has nothing to do with digestion of the
food. In hysterical women, tympanitis sometimes shows itself
in less than ten minutes; the abdomen may be felt enlarging
under the hand. Assuredly fermentation will not suffice for the
explanation of such a phenomenon. Under the influence of
nervous disorders there occurs an exaggerated gaseous secretion,
which recalls those other secretions, the lachrymal, salivary,
renal, &c, the quantity of which is often extraordinary.

These facts are not without their importance. In fact, if you
reason as the chemists do, and consider the stomach a sort of
crucible, the excess of carbonic acid which comes from the pre-
tended fermentation you must combat by every sort of means
that chemistry affords. Well, I can tell you beforehand, that,
if you thus proceed, you will accomplish nothing to the purpose.
But, on the other hand, if you pursue the path of the true prac-
titioner, if you prescribe baths, effusions, a few drops of ether,
or any other means in which experience has taught you to con-
fide, you will succeed in mastering the symptoms. But on this
we shall say more when we come to the treatment.

In certain cases the acids of the stomach are in quantity enor-
mous, and the patient has scarcely finished a meal before he is
assailed by eructations in great number, and so acid as to set the
teeth on edge. There was lately in the Salle St. Bernard, ISTo.
27, a young woman, a prey to sufferings of this kind. When
taken with vomiting it was frequent and using a copper
basin, as they do in all the hospitals, lactate of copper was im-

1858.] Clinical Lecture on Dyspepsia. 549

mediately produced, easily recognized by its green color. The
chemists" have not been behind hand in endeavoring to find out
the cause of this acidity. Ii is a transformation, say they , of
glyclose into alcohol, and of alcohol into vinegar. Unfortu-
nately, the explanation falls to the ground before the fact that
the production of acid is often more abundant when animal
food is exclusively used. The contrary, no doubt, takes place
in many case3, but can this weaken in any measure, the former
results? No; the acids of the stomach are not produced by a
chymic operation, but are due to a particular secretion. Graves
said in 1823, and Berzelius repeated in 1830, that this acidity
consists principally of lactic acid, which may be formed in no
inconsiderable quantities under the influence of nervous action
and excitation peculiar to the mucous membrane of the stomach.

I have now passed in review with you various forms of dys-
pepsia. But can it be said that in practice you will be able,
with as much precision, to seize on all the various shades of the
disease? That is often impossible. In order to convey my
thoughts I am obliged to reassemble facts, give form to state-
ments, and describe genera and sub-genera, but I express nothing
that is absolute. Classification is in natural history a very sim-
ple thing, and to take only an example from botany, vegetable
spices are distinguished by well marked differential characters.
But the case is by no means the same in nosology. Diseases in
general, and the dyspepsias in particular, are far from being
always identical with themselves. In their manifestations there
is confusion ; they are crossed one with another, and rest on data
too shifting and unstable for one to attempt here to lay the foun-
dations of a sure classification. Take warning then ; and when,
in the treatment of some obstinate case, your minds are left to
their own resources, be not too ready to accuse therapeutics
should success not promptly follow* your efforts ; for so you
might soon be brought to deny medicine altogether, the worst
evil that could befall you in the practice of your art. If on the
contrary, you bear in mind this form of dyspepsia may usurp
the attributes of another, and that both may occur simultaneous-
ly, then you will not delay having recourse to the mixed treat-
ment I shall presently point out to you. Discouragement will
no longer then have any hold on you.

Dyspepsia causes its influence to be felt throughout the whole
system : a fact to which M. Bean was the first to direct the atten-
tion of practitioners. He has shown that there are very gener-
ally in dyspepsia anaesthetic conditions analogous to those seen
in many cases of hysteria, insensibility taking possession of an
arm, or a hand, or the face. Of our experiments in confirmation
of this you have yourselves been witnesses; and you have seen
me pinch, prick, and make holes with a needle in certain part3

550 Lecture on Pulmonary Hemorrhage. [August,

of the skiu, without the patient being at all aware of what had
been done, while the other parts of the body were perfectly sen-
sible. Nor do the moral and intellectual faculties escape its
influence. The difficulties of the stomach, moreover, become a
clog upon labor, interfere with the exercise of thought, and pre-
pare the way for hypochondriasis. The various influences which
dyspepsia exerts on the general health are attended with the
most serious consequences. Thus, disorders of digestion are a
cause of imperfect nutrition; and the almost perfect inanition,
which results from this state, changes the composition of the
blood, and plunges the patient into a state of physiological
wretchedness. [Medical Circular, American Med. Monthly.

Clinical Lecture on Pulmonary Hemorrhage. By Jame3 Alder-
son, M.D., Senior Physician to St. Mary's Hospital.

Gentlemen There are at this time a number of cases in the
wards, which form a group, displaying all the same formidable
symptom of hemorrhage from the lungs. Separately examined,
these cases will also afford so many subjects for tracing the vari-
ous causes whence that formidable symptom may arise. I shall
preface what I have to say by a few general remarks on medical
study which I conceive to bear especially on the interesting sub-
ject before us.

There are two methods by which we may study disease : one
to consider the pathological condition of the organ in fault, and
having fully understood it, then to observe the various symptoms
consequent on the pathological change ; the other is to bestow
your primary attention on the symptoms of the case, and after-
wards to investigate the several morbid conditions which may
give rise to them. The first is a safe course of study, in which,
as diligent pupils, you can scarcely lose your way. The second
is a course still more needed for perfect information, but many
students fail to gather the full reward of their industry by becom-
ing unduly absorbed in the contemplation of symptoms ; thus, by
neglecting to seek for the original causes, they will fail to learn
that there may be many for the same phenonenon. The danger
of falling into this error is increased by the mode of pursuing
medical science continually coming more in vogue viz., the sub-
division of medical labour, leading to what are called specialities.
It is obvious that the eye long exercised on given subjects may
perceive those points more clearly than a less diligent direct organ,
but it is a psychological fact, that the mind,- too much absorbed
in one limited field of investigation, becomes narrowed in per-
ception, and incapable of wider trains of reasoning. Now, we
know that natural science is linked together by primary laws,

1858.] Lecture on Pulmonary Hemorrhage. 551

some known, some yet to be discovered. It is plain, therefore,
that comprehensive views of phenomena and their causes are
needed in order to make any advance towards realizing truth.
In practice, I would not deprecate undivided close attention to
the nature and treatment of such organs as the eye and ear.
because their special knowledge and special manipulation are
required; but in the vast subject of internal disease, the habit of
taking a wide view of all the distinctive features, and reasoning
on them as a whole, cannot safely be surrendered to the narrower
course of choosing some essential but limited train of symptoms
for favourite contemplation. The progress of fashion is unfortu-
nately dividing every organ, and even some particular derange-
ment of the particular functions of every organ, into a separate
subject for exclusive study. By this process, secondary symptoms
are being continually exalted into primary diseases, tending in
many cases, to the neglect of vital phenomena, and in all to the
obscuration of much pathological truth. The practical result is,
the adoption and laudation of specifics.

The second course of study which I have alluded to, and which
has given rise to these remarks on specialities, is, however, that
which strictly belongs to clinical teaching. We will therefore
pursue it, endeavoring to avoid the error of classing diseases too
much by symptoms, and too little by the causes.

The popular view7 of hemorrhage from the lungs refers it to the
rupture of a bloodvessel ; it is also the common belief that such
hemorrhage is the beginning of consumption. Now, it is not
always the breaking of a bloodvessel ; and whether it is or is not
so, consumption does not always follow. It is not denied, as we
shall see hereafter, that hemorrage may take place from a ruptur-
ed or ulcerated vessel in the lungs, but this form of haemoptysis is
the exception to the general rule.

Hemorrhage from the lungs most frequently occurs by means
of exudation through membranes or the coats of vessels. Exuda-
tion of blood may also result from a constitutional derangement,
of which I shall presently describe an instance in one of the cases
before us. They are also exceptional cases, the cause of which I
shall presently refer to ; but by far the greater number are to be
referred to the existence of tuberculous deposit. It is not difficult
to understand how the presence of tuberculous matter will cause
blood to be exuded from the vessels. As all the blood of the
body has to pass through the lungs, for the purpose of purifica-
tion before being again transmitted to the system, it is plain that
the presence of any foreign body in the lungs must offer obstruc-
tion to the free transmission of the blood, and cause delay and
congestion. The greater the quantity of blood present in the
lungs, the greater must be the necessity of the presence of air to
purify it ; and the forced accumulation of both occasions the

552 Lecture on Pulmonary Hemorrhage. [August,

blood to exude from the surface of the membranes and vessels.
Hence we account, not only for the symptom before us, but also
for the dyspnoea, or difficulty of breathing. It must also be borne
in mind that the structures and vessels are altogether impaired
in tubercular constitutions, and therefore admit more easily of
transudation.

In the latter stages of pulmonary consumption, the hemorrhage
results not only from exudation, but from ulceration of smaller
vessels in the immediate neighborhood of softened tubercles. In
the progress of the disease this hemorrhage is small in quantity,
though frequently repeated; but in advance cases of a particular
class it is profuse and generally fatal, having resulted from the
ulceration of a large vessel. This lesion is still essentially differ-
ent from what is termed the breaking of a bloodvessel, as, for in-
stance, in the brain or its membranes, whether as in apoplexy, or
as the result of an injury.

If we now briefly review the general character of spitting of
blood, we shall find that it occurs under two forms the one
severe, the other slight. In the first, several ounces of blood will
be brought up at once six or seven or more ounces at a time.
In the other, only specks or streaks may be seen in the expecto-
ration ; both forms being referable to exudation from obstruction ;
and although it is only the larger quantity which terrifies the
patient, both forms equally reveal to the physician the existence
of a diseased condition of the lungs,

When profuse, the blood is usually of a florid colour, frothy
from the admixture of air, and clots of dark blood will be occa-
sionally spit up, or sometimes apparently vomited, when a sort of
convulsive action of the diaphragm accompanies the expectora-
tion of the blood. A difficulty of breathing almost universally at-
tends it, as well as pain, which is usually referred to the sternum,
though sometimes to the side affected.

You will now follow me through the case of J. F , in Albert

ward. He was received into the hospital having a severe attack
of spitting of blood, which had come on suddenly to such an ex-
tent, that in a few hours he had expectorated six or eight ounces.
He was not in the slightest degree emaciated, the arms and chest
being well covered with flesh ; though he admitted that he had
some slight difficulty of breathing, and a little cough, there had not
been sufficient distress before the hemorrhage began to warn him
that there was anything wrong within the chest.

The patient is twenty-one years of age, and by trade a boot-
maker ; and in the course of his employment he had to use strong
exertion, and whilst thus at work the spitting of blood came on.
His pulse was 100 in a minute, but he had no fever; his bowels
were confined. On examining the chest we perceived that he
did not expand the right side as well as the left ; on "percussion,

1358.] Lecture on Pulmonary Hemorrhage. 55o

at about a couple of inches below the clavicle, over the upper lobe
of the lung anteriorly, there was a decided dullness, very percepti-
ble when compared with the sound on percussion on the left side ;
some degree of dullness was also found posteriorly by percussion.
By the stethoscope the respiratory murmur over the left side was
clear and good ; over the right side, a crepitation or crackling
over the upper lobe, together with here and there increased re-
sonance of the voice. For treatment, he was immediately ordered
a dose of calomel and colocynth, followed by sulphate of mag-
nesia in infusion of senna; he was also ordered acetate of lead
with morphia, and diluted with acetic acid at intervals ; for drink,
lemonade; enjoined perfect rest; simple diet, to be taken cold.

The use of the dilute acetic acid is to keep the lead in the state
of superacetate. The aperient treatment had for its object to
divert the flow of blood to the bowels. When constipation
exists, the active treatment of this symptom is of great value, and
is often found of itself sufficient to stay hemorrhage.

I have the following notes of his state on the third day :
The pulse still 100 in a minute; the cough not troublesome,
but still existing. Great relief had followed the action of the
aperient. His expectoration clear and frothy, but free from blood.
On examining the chest by the stethoscope, the air was found to
enter freely and rapidly on the left side, but a hesitation or delay
occurred to the passage of air into the cells on the right side,
conveying an idea of some obstruction to its admission, as if re-
sisted by some foreign body, the expiratory murmur being longer
than the inspiratory. The pulse soon after this fell to 80, but in
a day or two again rose to 100, when the expectoration again
showed a few specks and streaks of blood. He complained of
pain and weight over the upper part of the right lung where the
breathing was a little tubular, indicating again some consolidation
from tubercular deposit. A few leeches and a cupping glass were
applied ; the aperient was repeated, and for the lead were substi-
tuted nitrate of potash and digitalis, with a view to act on the*
kidneys, and to control the heart's action ; and the opiate was
discontinued to avoid confining the bowels.

This appears to be a case of tubercular deposit in its earliest
stage, the deposit being confined to the right lung, and being at
present so limited in extent as not to have set up alarm in the con-
stitution, the processes of nutrition not having as yet been inter-
fered with. This man will be liable to returns of haemoptysis, the
severity of which would probably be heightened by any violent
or unusual exertion. He will, sooner or later be the subject of
pulmonary consumption. His intervals of troubled health will
be regulated by the favorable or unfavorable circumstances which
may attend his life, and in a great measure on the care and treat-
ment of symptoms as they arise.

o54 Lecture on Pulmonary Hemorrhage. [August,

A certain degree of relief for a time from his alarming symp-
toms may result from the equilibrium of the circulation through
the lungs being, in a measure, restored. It is possible that the
tubercular deposit has taken place rapidly, presenting a sudden
obstacle to the transmission of blood through the lungs. A large
withdrawal of the functional powers of a vital organ may be com-
patible with continued life, when the change takes place gradual-
ly, and the system has time and power to accommodate itself;
but sudden interferences of a much slighter character will destroy
life before the system has had time to accommodate itself to the
change.

I shall now direct your attention to a case in which haemopty-
sis occurred in a later stage of pulmonary consumption that of

S. B , in Carlisle ward. This young woman, aged nineteen,

has been received into the house more than once during the last
year, with symptoms of phthisis so obviously marked that "he
may run that readeth." On receiving partial relief she has been
discharged. During her former admissions there were some ap-
pearance of spitting of blood, and this symptom has now become
more grave and constant. The blood she spits is still only small
in quantity at a time. It appears in specks and streaks, mixed
with much purulent and offensive expectoration. The blood is
florid. Her cough is most distressing, loud, and frequent, and
she suffers from the constant effort to vomit during the paroxysms.
The case last considered was one of obstructed circulation through
the lungs, and consequent exudation of blood through the mem-
branes ; in this case the blood is not only obstructed by tubercu-
lar deposit, but also escapes from the vessels in the immediate
neighborhood of the tubercles, the vessels being perforated by
means of the ulceration which has taken place in the process of
the softening of the tubercles and the breaking up of the lung.
The chest in this young woman is nearly immovable, and to this
circumstance may, perhaps, be attributed the slow progress of the
disease. Adhesion of the lungs to the chest controls the move-
ment of the lungs during respiration, keeps the organ quieter, and
thus avoids irritation of diseased surfaces. The vomiting is a
usual and marked symptom of pulmonary consumption. This
may be referred partly to the expectoration dwelling about the
fauces, but arises chiefly through the medium of the association,
by nervous influence, of the throat, lungs, and stomach, which is
effected by the pneumogastric nerve, and is a reflex act.

In the treatment of this form of hemorrhage, palliatives are the
only resource. Opiates to allay the irritation, and occasional
local means to repress the attacks of pleuritic pain ; a single leech
to relieve the action set up at points where tubercular matter
reaches the pulmonary pleura, exciting and giving rise to adhe-
sion ; or a liniment of chloroform and opium may also be used to

1858.] Lecture on Arthritis. 555

subdue the pain till adhesion takes place. To restrain the hemor-
rhage, and to prevent as much as possible the offensive charac-
ter of the expectoration, alum is excellent. Creasote is also found
useful : it seems especially indicated in these cases. It is not only
a deodorizing agent, but stays sickness, and seems generally to
paliate symptoms. If one searches for a reason for this palliation,
I should give the following : The lung having lost its power from
want of space to throw off the carbon of the blood, the oxygen
present during respiration remains free to damage the structure ;
creasote. therefore, being chiefly carbon, is offered to the oxygen,
neutralizing the bad effects of the latter. Creasote is, in another
form, the old tar water of the last century, which had a fashion
without an explanation. Many remedies are taken up from good
experience, but laid down because they are not explained. I only
deprecate the present fashionable quackeries, as cod-liver oil, &c,
because they can be explained, and the reason has been found
insufficient. [Lancet.

Clinical Lecture on the Diagnosis of Idiopathic from Rheumatic
Arthritis, and the Pathology of these Diseases. By E. A. Lloyd,
Esq., F. R. C. S., Surgeon to St. Bartholomew's Hospital.

Gentlemen The subject on which I wish to treat to-day in a
" Clinical Lecture," so called, is one on which a good deal of
obscurity seems to hang, yet one on which you may be asked to
give an opinion very often.

The great object of clinical lectures I believe to be to teach
practical therapeutics and diagnosis ; some say to teach general
surgical principles ; but these you will receive in your lectures on
"Surgery," and the less of sameness and repetition we have in a
school like this the better. The subject of treatment that is the
corner-stone of all the edifice. I never knew a surgeon to get
on properly in after-life who was not aufait as to the little details
of therapeutics and good general treatment. The great secret
of success is to put yourself in the patient's place, and to treat all
cases well.

How often do I find old pupils of St. Bartholomew's regretting
that they neglected therapeutics ? Students are, by the present
Examination Boards, encouraged to go to "grinders;" encoura-
ged, indirectly, to make themselves u up" on fixed questions of
delicate anatomy or histology of no conceivable importance.
But therapeutics ! how to order the commonest mixture or lotion,
or what lotion or mixture is valuable in a specific surgical case,
is thought infra dig. It is when you have " passed" the College
you will find this. "Clinical" lectures are a step in the right
direction ; but, then, they are only another name for lectures on
v.s. vol. uv. no. vin. 29

556 Lecture on Arthritis, [August,

therapeutics and diagnosis. As such also you should not neglect
them if you wish to get on in practice.

The case I propose to speak of to-day is one of what was called
"Rheumatic Arthritis," but where we have now reason to see
the diagnosis was confused and uncertain for a long time at
least, out of hospital. The poor man told us the disease commen-
ced with a dull, heavy pain of the joint, which led his surgeon in
the country to pronounce it "rheumatic ;" a dull, heavy pain that
prevented him going about his work; he could tell us very little
else about it. About the end of August, you remember, I left
town, and the patient was then under Dr. McWhinnie's care.
The patient was sixty-eight years of age, and the disease had ex-
isted fifteen months prior to admission ; it was called rheumatism.
An abscess formed under the knee-joint, which was discharging
pus profusely, the joint was swollen, and some sinuses were observ-
ed around it ; on passing a probe, I found necrosis of the tibia
in fact, there was a hole in the tibia, with a piece of loose necros-
ed bone. It was, therefore, very clearly not rheumatic arthri-
tis, but a case, probably, of idiopathic disease of the tibia. The
patient's health was not suffering much, there was very little pain.
When I again saw him, pus had got into the cavity of the joint,
and very foetid matter was let out, which is always an indication
of loose or diseased bones. How the case was mistaken for
rheumatism before it came to us, I am not in a position to say.

Well, after this the knee-joint increased again in size, and now
severe pain also came on, with signs of a new attack of inflamma-
tion. I was obliged to allow exit to more matter ; the man then
rallied, the fever diminished, but subsequently he had tedious sup-
puration again, and he sunk. I dwell on this case to-day, as you
all had excellent opportunities of watching it from the time of its
admission. We often learn a good deal also that is retained in
the mind from errors of diagnosis rather than from plain sailing.

I now show you the diseased parts and this is what I call
practical diagnosis of cases. The man died a few days ago, and
we have the knee-joint here well preserved, and full of instruc-
tion. There is a cavity posteriorly communicating with that of
the knee-joint ; the cancellous structure of the head of the lower
bone is engaged, and even in the medullary cavity wTe see here
fragments of diseased bone ; there is a large cavity, in fact, in the
head of the tibia ; the articulating surfaces are destroyed, but the
condyles of the femur have escaped. Now this is a state, I need
not tell you, that we do not find in rheumatism ; it explains the
great tediousness and intractableness of the case. Some might
say, why not try resections, &c. ? But mind you. the man was
sixty-eight years of age, and worn down by suffering.

Now, the diagnosis of rheumatic diseases of joints is sometimes
very difficult. We have had some cases sent into our surgical

1858.] Lecture on Arthritis. 557

wards from medical wards over the way. The fever in these
cases was so great that they misled the physicians; but they were
cases of acute synovitis of the hip-joint, and immediate relief was
obtained by opening the joint Mr. Gay's method over a case of
a woman. She went out of hospital improved, and entirely
altered for the better after this operation. It is of course, a very
formidable proceeding, and not to be undertaken too lightly; but
in some cases the relief afforded is something wonderful

In a private case, not long ago, treated by one physician, and
then by another, for articular rheumatism for I do not know
how long I was sent for, and I found it common synovitis with
purulent deposit in the joint. This case took two years, but
ultimately got well with stiff joint, better perhaps than so-called
resections or amputations, and death. I saw at once it had
nothing, in fact, to do with rheumatism ; it puzzled ihe two
physicians exceedingly. If treated properly at first, all such cases
are rendered more amenable to professional skill ; this is what I
call proper diagnosis, for it is obvious to every one if we form a
wrong diagnosis, and use wrong therapeutical agents early, we
only confuse the case; and many of these cases, as they reach us
in hospital, are sadly confused. In a case at present in " Colston"
ward, sent to me also as rheumatism, the disease was thickened
periosteum over the os calcis. I divided this, and the patient has
gone on well. Now the treatment of the two diseases is not at
all the same ; so you will do well to take a note of the differences.

The question you are all this while asking yourselves is, how
is rheumatic to be diagnosed from common or idiopathic disease
of articulations? In rheumatism it is very rare to find pain in
one single joint; there is also some history, more or less obscure,
of previous rheumatism of various joints, pericaiditis, &c, or of
some affection probably yielding to rheumatism medicines.
Again rheumatism is very seldom, if ever, complicated with
suppuration in or about joints. Rheumatism is also a very com-
mon disease.

Now, the disease we are speaking of is a very rare and very
tedious disease. In diseased bone there is dull, heavy, protracted
pain, without effusion at first, but soon we get effusion of pus.
Now, I never saw suppuration in rheumatic disease ; on the con-
trary, the slightest amount of idiopathic synovitis leads very often
to suppuration. Again, in pyaemia you may find rapid suppuration
into joints and in internal parts, but you can scarcely call them
abscesses. In acute idiopathic inflammation, the cases are not
so tedious in their previous history, as this form of disease goes
through its stages more quickly than chronic rheumatism. If you
find " rigors" have set in, you may be almost sure there is sup-
puration going on, and that it is not rheumatism you have to deal
with. Anchylosis is very rare, or entirely unknown in rheuma-

558 Case of Hematuria. [August,

tism ; joints get stiff, but there is no true bony anchylosis. In
chronic rheumatism of joints, too, the fibrous and synovial tissues
are thickened, nay, the cartilage may be removed, but the ends
of the bones do not anchylose they become polished. How dif-
ferent all this is from strumous disease of joints with anchylosis,
so easily brought about, I need not to-day stop to describe.

I believe that opening a diseased knee-joint with pus in it, is not
at all the same thing, or so formidable as opening a healthy knee-
joint. I have now done it very often. I believe it a good opera-
tion. A great deal consists in a good diagnosis of^the case.

There are other forms of disease that may be confounded with
this "Rheumatic Arthritis;''" I mean malignant disease of joints.
Here we have the well known cachexia, attended with quick pulse
and pains at night, as well as other diagnostic points to lead us
which time will not permit me to enter into at any length. Nor
must we forget syphilitic and gonorrhoeal diseases of joints ; in
the former, mercury sometimes does good, but I think it does
harm in other forms of joint disease. You will merely make the
mistake of confounding these diseases with idiopathic forms of
inflammation; but you will do well to take care of "splitting on
the rock" in your way rheumatic as compared with idiopathic
'disease of bones and joints. [Medical Circular.

Case of Hematuria, Successful Treatment with Sulphate of Quinia.
Translated from the April Number of the Revista Medica de
lalsla deCuba. By J. F. Grall, M.D., Demonstrator of Anato-
my, NewT Orleans School of Medicine.

Being, in the month of September last, in the district of San
Anton de la Negada, a hurried call, to render professional assist-
ance to the wife of an old acquaintance, occasioned the following
observation, very important in a practical point of view, particu-
larly to physicians practising in a swampy locality; and since it
is a phenomenon only mentioned in a vague way by authors, even
the most modern, when they speak of local affections sustained
by a miasmatic, or better said, malaric cause, I shall try to give
a clear idea of the case.

The patient was a woman about thirty years of age, of bilious
temperament, and already mother of five children. She com-
plained of severe pains in the hypogastric, lumbar and inguinal
regions, and in the posterior part of the thighs. These pains
were not continuous, but observed, marked intermissions, which
circumstance, united with a cessation of her menstruation for two
months, made me suspect a commencing abortion ; but I was not
able to verify my suspicion by a vaginal examination, on account
of the repugnance, sometimes invincible, which most women

1858.] Case of Hoematuria. 659

evince against that kind of exploration. This hypothesis estab-
lished, my remedial means were naturally directed towards an
arrestation of the abortion. I recommended, therefore, absolute
rest in the horizontal position, evacuated the rectum by an emol-
lient injection, followed by a demilavement with ten drops of
laudanum, and give her a u portion calmente," consisting of aqua
laurocerasi, aqua florum aurant, and infusum tilia?. Jn conse-
quence of this treatment the pains were somewhat relieved ; some-
times they returned with the same intensity as before, to disappear
after the administration of the medicine. She remained in this
state for about four days, when, the urine which up to this time
had been clear and normal, began to have a turbid aspect, and I
noticed floating in it particles of mucus, and a few drops of blood,
which latter gradually increased, so that three days afterwards she
discharged almost as much blood as urine. Under such alarming
symptoms, I considered a rigorous examination of the bladder uf
absolute necessity, to which the patient readily submitted, com-
prehending the critical state in which she found herself. A ca-
theter introduced found no obstacle, either in the urethra, neck
of the bladder, nor the bladder itself. Although I endeavored to
arrest this hemorrhage by employing the different local and gen-
eral remedies recommended by the majority of authors, I produced
only a palliative effect; from time to time the urine presented a
sanguinolent aspect, accompanied by the inseparable sequitus of
pains above mentioned.

Twenty days had already passed, and my patient remained in
the same state, with more or less prolonged interruptions, when
I decided to call in consultation Ldo. D. Jose Manuel Xunez,
who has already practiced twelve years, with excellent success,
in that neighborhood. I related to him the past and what I had
done, to which he answered, that in his long practice, which
brought him in contact particularly with diseases of an intermit-
tent character, and their larved (masked) types, he had observed
four cases altogether similar to the one I presented to him ; that,
full of doubts at the beginning of his career, he could not fail to
recognize the miasmatic element, after he had observed, that all
the patients, who presented themselves with this affliction, lived
in swampy localities, and that consequently he had recourse to
quinine, always with very satisfactory results.

I, in consequence, determined to administer to my patient the
sulphate of quinia, not with full confidence, although I relied on
the good faith, and the great knowledge of the medical topogra-
phy of the county of Guamutas, which my colleague possesses ; and
not only for these reasons was I determined to give the quinine a
trial, but also, because I considered the administration of some
tonic necessary, to reanimate the failing strength of a patient who
had suffered from a disease of a haemorrhagic nature during twenty

5 GO Case of Hhematuria. [August,

days. I confess openly, that I did not hope for the result I
obtained with a scruple of sulphate of quinia, associated with
the extract ol absynthium, divided in twelve pills, which were
taken in twenty-four hours. I took good care not to divulge to
my patient the conposition of these pills, because, in spite of my
short practice, particularly in this island, I am not ignorant of
the repugnance, the horror, they have in the country of this salt
of the Peruvian bark; because to it they attribute generally the
effect or consecutive lesions of swamp fevers, which terror some-
times goes to such an extent, that they refuse to take it even in
the most urgent cases, as they consider it as a fire (un fuego) to
use their own expression. Unhappy error, that has conducted
more than one victim to the grave!

Two days after the administration of the quinine, I saw my
patient, and what was my surprise, when she told me that the
sanguineous fluid had ceased from the moment she began to take
the pills ; and it did not return afterwards, at least not until the
month of December, at which period I left that neighborhood.

When we consider on the one hand, the habitation of our
patient, which was situated close to a swamp, fed by the over-
flow of a ditch, which does not empty itself where it ought to, in
consequence of the embankment of the railroad of Jucaro, causing
continuous miasmatic emanations to such a degree that few per-
sons inhabit that part of San Anton de la Negada, without suffer-
ing from some form of intermittent fever; and, on the other hand,
the immediate good result from the antiperiodic, par excellence,
the quinine if we consider these facts, there remains not the
least doubt that the haemorrhage, which might have carried our
patient to the grave, was caused and sustained by the malaric or
swampy miasmata, which she constantly respired.

We believe that our readers will find this observation really
and trulyv interesting, because, far from being very common, I
have not seen this occurrence mentioned by any author, nor even
in the very modern work of Dr. Wanderlich, (Handbuck der
Pathologie und Therapie, Vierter Band ziveite Eadfte. Stuttgart,
1856.) which is perhaps, the most complete treatise on pathology
now existing in the field of science. When treating of haemor-
rhages caused by intermittent affections, he confines himself to the
following words : " Haemorrhages are very frequent in malaric
diseases. In more than half the cases of recent intermittent
fevers, more or .less abundant, epistaxis presents itself, and is
sometimes repeated. But it is when already a prolonged cachexia
exists, that with more certainty these haemorrhages and other san-
guineous extravasations present themselves." [N. 0. Med. News.

Dr. Juan C. Oxamendi.

1558.] Remarks upon Rheumatism. 561

Remarks upon Rheumatism. By O. C. Gibbs, M. D.

In the Peninsular and Independent, for April, Dr. DuBois pub-
lishes an interesting and able Report upon Rheumatism, which
we have read with pleasure. Its reading has suggested a few
thoughts, which we wish to express, and that too in no spirit of
criticism, influenced only by the consciousness that it is every
man's duty, who is engaged in the noble work of mitigating pain
and disease, to contribute his mite to enhance the efficiency of his
art.

In regard to the difference to be noticed between rheumatic
and ordinary inflammation, Dr. DuBois says :

' Throughout all this febrile disturbance, there is no coma, no
marked trouble of the stomach or of the bowels, no vomiting, no
diarrhoea," &c. : " which it is fortunate to remember in some
masked cases of difficult diagnosis."

To our apprehension, the above quotation contains an error, to
which we are the more anxious to call attention, as Dr. DuBois
is not the first to have given it expression. Vomiting is not com-
mon in rheumatic inflammation, but we have certainly seen un-
mistakeable cases, in which vomiting was the most distressing
symptom. We have seen vomiting commence almost simultane-
ously with the arthritic inflammation, before any remedies had
been administered, and have seen this symptom persist, in spite
of treatment for many days.

Rheumatism is a disease of such frequent occurrence, so dis-
tressing in its symptoms, so protracted in its course, and so often
fatal in its consequences, that any practical remarks in regard to
its treatment cannot be deemed ill-timed or out of place.

In regard to treatment in this disease, we have never bled,
have never given emetics, or antimony as an antiphlogistic, and
in no inconsiderable experience, have never had reason to regret
this neglect. Purging with neutral salts is an important therapeu-
tic measure, but, as an antiphlogistic in this peculiar form of in-
flammation, we know of no compound to be compared with calo-
mel, opium, and colchicum ; the first in rather small, the other
two in full doses. These of course, are to be used conjointly
with, or succeeded by, such other means as the peculiar circum-
stances of the case may demand. Contrary to the teachings of
some of our highest authorities, we have no hesitation in saying
that the earlier the calomel is used in this combination the sooner
will the cure be effected, and the less will be the liability to heart
complications. In our own practice, we are confident that endo-
and pericardic complications have not averaged one in fifty.

Rheumatic inflammation occurs in such a diversity of con-
stitutions, and of such varying grades of intensity, that no uniform
plan of treatment can be adopted. We have certainly seen cases,

562 On Urethral Intermittent Fever. [August,

to the cure of which quinine and opium was better adapted, in
our judgment, than any other known combination. In Rheuma-
tism, as in all other diseases, for their successful treatment, a
goodly share of common sense, and a thorough and appreciative
knowledge of the principles of medicine are more indispensible to
the practitioner than the best set formula that was ever devised.

There is one article of medicine that Dr. DuBois has not seen
fit to mention, that in some forms of Rheumatism is certainly
worthy of consideration. In chronic forms of this disease, or even
in the acute forms when convalescence has commenced, the tinc-
ture of cimicifuga, combined with the iodide of potassium (the
former in teaspoonful, the latter in from four to six grain doses) is
certainly a remedy of great efficacy. The good effect of this
combination will be materially enhanced by the conjoint action
of quinine in the debilitated, and the veratrum viride in the ple-
thoric. Dr. Davis, of Chicago, Dr. Johnson of New York, and
others, have recommended the tincture of cimicifuga even in the
early stages of Acute Rheumatism : we have but little acquaint-
ance with the remedy as recommended by them, but, in circum-
stances as above, we speak from a reasonable amount of experi-
ence.

In that troublesome form of rheumatic disease, denominated
Sciatica, we have succeeded in effecting a cure with strychnine,
after the failure of almost every other known means.

For a fuller expression of our views of the pathology and treat-
ment of inflammatory Rheumatism, we beg leave to refer the
reader to the American Medical Monthly, for 1854, Vol. II., page
412. [Peninsular Med. Jour.

On Urethral Intermittent Fever. By M. Chassaignac

This is the name M. de Chassaignac attaches to the febrile
attack which all surgeons have observed as a consequence of
catheterism, and which, if it were desired to indicate the cause
giving rise to it, might be termed cathartic fever. It is a curious
point to determine, whether the contact of the instrument with
the entire length of the urethra is necessary for the production
of the paroxysmal attacks, or whether it is sufficient for one
portion of the canal to have undergone such contact, and in that
case, which portion. Judging from the facts known to him
before the case which gave rise to these observations came under
his notice, M. Chassaignac was disposed to believe that neither
the membranous nor the prostatic portion of the urethra was in
the portion in question. Thus he never met with an instance of
such febrile paroxysm being produced after catheterism in the
female, nor is he aware of any one who has ever met with one.

1858.] Case of Mole, or False Conception. 563

A natural inference would be that it is not observed in woman,
because the paroxysm arises from the contact of the instrument
with a portion of the urethra which does not exist in her. An
opportunity offered itself for confirming this conjecture, by the
counter-proof of the induction of the paroxysm by the exclusive
catheterism of the portion of the uretha which is proper to man.
This occurred in the case of a patient suffering from multiple
urinary fistula?. The catheter being passed from one of these to
the meatus, and back again from the meatus to the fistula, no
difficulty or pain occurring, an intense intermittent paroxysm was
produced. The patient had had the catheter passed before, and
had borne one fixed in the urethra without such effects having
been produced. It was quite certain that on this occasion the
instrument had not come in contact with either the membranous or
prostatic portion of the urethra, or with the neck of the bladder;
and until further information upon the subject, M. Chassaignac
feels justified in localizing in the bulbous or anterior portion of the
urethra the physiologico-pathological process which gives rise to
the production of the paroxysm in these cases. [Moniteur des
Hopitaux. New Orleans Med. News.

Case of a Mole, or False Conception retained in Utero. By Samuel
B. Clark, M.D., of Brothersville, Geo.

[As cases of false conception are very rare in this region of
country, we select the following case from the Nashville Journal
of Medicine and Surgery. The subject is an- interesting one and
should elicit more attention from the profession as a more
thorough inquisition into the nature of these abnormal bodies
would in time, doubtless lead to a detection of their cause. -
Edts.] t

I delivered Mrs. J. B., of a female child on the 18th of October,
1857, with nothing peculiar about the labor, except perhaps a
little more difficulty in delivering the placenta than usual.
Some ten days afterwards I was called to see her, and learned
that the lochial discharge had become pale, as usually happens,
but that without any appreciable cause she had a return of
hemorrhage again, with very little pain. Gave ergot and other
astringents, which nearly checked the hemorrhage, but in a few
days she complained of heat low down in the abdomen. I then
made an examination per vag., and found a substance engaged
in the os uteri. Introducing the fingers still higher up, I found
the attachment to the inside of the uterus so slight that I easily
separated it and brought it away. On examination I found it
jr. s. vol. nv. ko. viii. 80

564 Treatment of Aphonia by Electricity. [August,

to be a mole or false conception, of a conical or pyriform shape,
about three inches long and two in thickness. It was smaller
at the neck, where it was attached to the uterus, and rather more
consistent than a placenta, with no regular organization. The
hemorrhage stopped, and she got well under the use of quinine,
iron, etc.

How long do these substances remain in utero usually ? This
must have remained nine months or more, unless it was a case
of superfcetation. According to my experience they usually
remain from two to four months. It may not be amiss to remark
that this lady had twins at her first confinement, and that all of
her sisters who have had children have had twins, so far as I
have been informed. In my limited library I cannot find a
very full history of these substances. In the 8th volume and
467th page of the Nashville Journal of Medicine and Surgery,
Br. T. Lipscomb gives an account of two cases, and requests-
other physicians to make inquiries respecting them. His
theory is that the continuance of lactation after conception has
taken place, will blight the conception by abstracting the neces-
sary stimuli from it to the mammary glands, and thereby pro-
duce a false conception. In the case of Mrs. B., I do not think
she nursed her former infant until after conception took place,,
as it was eighteen months old when conception took place.

Treatment of Aphonia hy Electricity. A case of aphonia was observ-
ed at the Samaritan Hospital, under the care of Dr. Savage. A woman,
aged 21, lost her voice a month ago ; she thought it was brought on by
her having caught a cold. The movements of the tongue were not in
the least impaired. There were no signs of inflammation nor of ulcera-
tion of the larynx ; very little cough, and some little pain in the larynx,
as well as in the chest. No tubercular deposits in the lungs. She has
always been regular. Purposely^o medicine was given, but Dr. Savage
asked Dr. Althaus to try what Faradization might do for her. Dr. Al-
thaus applied the current of the first order of his apparatus of induction
by means of solid metallic excitors covered with wet fingers of gloves,
localizing the electric stimulus in the inferior laryngeal nerve, which
animates all the muscles of the larynx concurring to the formation of the
voice. The day after the first sitting, which only lasted two minutes,
the speech seemed to be not materially improvd ; but in the course of
whispering, sometimes the normal sound of voice returned. After the
second sitting of the same duration as above, the improvement was
striking ; the day after the third seance the patient spoke almost quite
naturally, and the treatment was discontinued after another sitting, as
now the speech is going on perfectly well. We know of no other case
of aphonia in which the effect of the electric treatment was so quick and
manifest, without having been connected with any inconvenience what-
ever. Professor Sedillot applied electricity in a ease of aphonia, one pole

1858.] Editorial 565

being placed alternately on different parts of the tongue, and the other
one on the mastoid bone, the posterior and superior part of the neck and
various points of the face. The application was useful, but could not be
repeated until one week afterwards, owing to severe headache, which had
followed the application of electricity. By localizing the electric stimu-
lus in the inferior laryngeal nerve no such inconveniences were produc-
ed. [Med. Times and Gaz.

EDITORIAL AND MISCELLANEOUS.

The Principles and Practice of Obstetrics. Including the Treatment of
Chronic Inflammation of the Uterus, considered as a frequent cause of
Abortion. By Henry Miller, M.D., Professor of Obstetric Medicine
in the Medical Department of the University of Louisville. With Il-
lustrations on wood. Philadelphia : Blanchard & Lea. 1858. 8vo.
pp. 624.

A systematic book on Obstetrics, or any department of medicine,
must necessarily be, to a considerable extent, a republication of matter
already in print, but the present work is less obnoxious to this objection
than any that has appeared for a long time. Dr. Miller has very properly,
not deemed it incumbent on him to relate every thing his predecessors
have thought, done or written. He quotes when requisite, for illustra-
tion and elucidation, and no more. He tells what he has seen and done
himself what others will meet in practice the services they will be
required to render the operations they will be called on to perform.
He records his own experience and practice.

Some treatises are more extensive and comprehensive, consequently
in some respects preferable as books of reference, perhaps as text books
for students ; but as a practical work very few are equal to it, and none
possess higher claims to originality. The author is an original and in-
dependent thinker a bold and able practitioner.

We would not be over-fastidious or severe, but we must acknowledge,
we admire his sound logic, his plain common-sense instruction, more
than his occasional sallies of wit and humor. His style would be suffi-
ciently interesting, were he in another edition, which we predict will
soon be demanded, to expunge everything like a jest, pun, or other wit-
ticism : his subject is too serious, too delicate, and too important to ad-
mit of anything ludicrous, such as the serio-comic delivery of an unfor-
tunate half-born baby, by three persons holding on to each other and
the feet of the infant, and " taking a long pull, a strong pull, and a pull
altogether."

566 Editorial [August,

He asks us to excuse a pun on his own name ; we have to much re-
spect for that name to have it treated so lightly : for, besides the honor
which his own well earned fame has cast about it, there are too many-
tender recollections embalming it, for it, ever, to form the element of a
jest ; the word is dear to us, as the name of a loved and respected col-
league ; with us also, it is hallowed, nay almost sacred, because it calls
up in solemn remembrance the lamented image of one of Georgia's most
cherished sons, " The Woman's Friend" in the councils of our State ;
and with all the world, it must forever waken painful and loving remem-
brances, as it reminds us of the melancholy fate of one of Scotland's
brightest jewels, her mechanic-philosopher, the gifted " Stone-mason of
Cromarty," who

" Quarried truth all rough-hewn from the earth
And chiselled it into a perfect gem."

If time would permit, it would afford us much pleasure to analyze the
entire work, and give the author's views on many subjects which, with
very rare exceptions, we most cordially approve. His highest claims to
originality are based on his 5th and 6th chapters, in which he treats of
abortion and haemorrhage ; each of which published alone would con-
stitute a valuable monograph.

Dr. Miller's method of treating the subject of abortion is novel and
interesting, and founded on the most rational and scientific principles.
We would not assert that his opinions and views are all original : they
have generally been entertained and expressed by others, but to him the
credit is due of having collated them in such a manner, from various
sources, as to constitute an original and valuable treatise.

Dr. Miller considers the principal cause of abortion to be disease of
the cervix, which he believes extends from the cervical canal into the
cavity of the body, much more frequently than Dr. Bennett supposes,
which opinion we have long since entertained and expressed. In his
preface he says :

"lam not aware that modern improvements in uterine pathology,
resulting chiefly from the employment of the speculum uteri, and the
more rational and successful treatment of uterine diseases, which have
followed in their train, have hitherto received the full recognition which
they deserve, by any author of a treatise on obstetrics. Appreciating
so highly as I do these advances in the right direction, and having en-
joyed such abundant opportunities of testing their value, I have thought
it incumbent on me to give them their rightful place in this volume, and
this was found in discussing the subject of abortion. There is no fact in
pathology, of which I am more thoroughly convinced, than the frequen-
cy of inflammation and ulceration of the neck and body of the uterus
during pregnancy, and I am as well persuaded that such a morbid con-

1858.] Editorial 567

dition of the gestative organ is among the most frequent causes of abor-
tion. I could not, therefore, hesitate to give to specular treatment of
the disease a prominent place in the prophylaxis of abortion."

Dr. Miller makes the following very judicious and practical division
of the treatment of abortion :

"The treatment of abortion may be divided into the resistive, ike pal-
liative, and the prophylactic meaning by the first such measures as
may be taken to avert the disaster when it is threatened ; by the second,
the conducting of it to as favorable an issue as possible, when miscarriage
is inevitable ; and by the latter, the prevention of it by the cure of any
diseased state, which would be likely to occasion it or has already pro-
duced it in the previous pregnancies of the patient."

Professor Miller considers that the prophylactic is the most import-
ant part of the treatment, and that this consists principally in treating
the uterine disease, which is the most frequent cause. Under this head
he gives the appropriate treatment of inflammation of the cervix, and
its extension into the cavity of the body. His favorite remedy is nitrate
of silver, although he does not by any means neglect or ignore others,
either general or topical.

In the treatment of chronic endo-uteritis, in place of injections, of the
danger of which he entertains very just apprehensions, he proposes to
insert a strip of lint, wet with a saturated solution of nitrate of silver,
through the cervical canal into the cavity of the body. In reference to
the alarming symptoms that frequently follow uterine injections, Dr.
Miller remarks :

" Considering the subject in all its bearings, it occurred to me that such
sudden and violent symptoms must be owing more to the mode in which
the remedies were applied than to actual intolerance of the internal sur-
face of the uterus. Acting upon this view, instead of abandoning the
use of topical remedies altogether, I began to introduce them upon strips
of lint, pushed into the uterine cavity with a probe or sound. I first
applied the nitrate of silver in this way, notwithstanding that experience
had taught me that a weak solution of it two grains to the ounce of
water injected into the uterus, might be followed by the alarming
symptoms that have been detailed. I used it, commencing a very weak
solution, carefully prepared by the apothecary^and finding that it caused
no more pain than an ordinary cauterization %i the os uteri, 1 was em-
boldened to make it stronger and stronger, until I ceased to have it pre-
pared by weight and measure, but took a strip of lint, wet it thoroughly
with water, and passed the stick of caustic overit till it was imbued with,
as I judged, a saturated solution. I have cauterized the internal surface
of the womb in this manner, in quite a considerable number of cases,
without any of the alarming consequences incident to intra-uterine in-
jection. No practitioner hesitates, in cervicitis, to push the nitrate
crayon into the neck to cauterize the whole extent of its internal surface.

668 Editorial. [August,

Experience warrants me to declare that we may, with as little hesitation,
treat the internal surface of the body in the same manner, only a satura-
ted solution is preferable to the stick, on account of its liability to break
and be retained in the cavity -an accident which sometimes happens in
the neck."

This is a valuable suggestion : it will doubtless be found an excellent
practice when that patulous state of the os and cervix, which always
obtains to some extent in cases of endo-uteritis, is very much exagger-
ated ; but I cannot conceive that it can possess any advantage over the
introduction of the solid nitrate through the os internum into the cavity
of the body, where it may be held long enough for some of the caustic
to dissolve and diffuse itself.

Our experience differs a little from that of Dr. Miller : first, in that
no practitioner hesitates to thrust the nitrate crayon into the cervical
canal in cervicitis : we have met with a number of cases in which the
external cervical inflammation had been successfully treated, while its
extension into the cervical canal had been altogether neglected, from
the physician, formerly in attendance, hesitating to introduce the caustic
freely into that canal. Secondly, according to my observation, the
caustic crayon when sufficiently large is not liable to break in the cer-
vical canal, and when it does, from the contractile powers of that canal
it is promptly expelled.

Dr. Miller's remarks on haemorrhage in general are excellent ; but he
proposes a new method of treating the unavoidable, which if found on
fair experiment by other practitioners to be as successful, as it has
proved hitherto in his own practice, will be one of thcgreatest improve-
ments in modern midwifery, and ought to render his name illustrious.
At present we regard it very favorably, as every proposed improvement
ought to be, in a practice, to say the least, heretofore very unsatisfactory,
but we are not prepared to adopt it to the full extent advised by Dr.
Miller.

Properly executed it might perhaps answer admirably in every case,
if the practitioner had charge of it from the commencement; but cases
occasionally occur in which the labor is far advanced and the patient in
extreme exhaustion, wheAfirst seen by the practitioner, in which I do
not think anything can prove a substitute for version ; therefore, I can
not yet confine turning exclusively to the correction of malformations ;
although I fully concur with Dr. Miller that as an obstetric operation it
has been grossly abused, and ought to be very much limited in practice.

Dr. Miller describes his new method in the following extracts :

"The substitute for turning, which I will venture to propose, is a
modification of the method of M. Puzos, and consists in originating ex-

1858.] Editorial 569

pulsive contraction of the uterus by the tampon or plug and then punc-
turing the membranes, relying on the tampon to control the flooding until
the liquor amnii is evacuated. This is the only method of treatment, of
which I have any experience, and I have employed it with uniform suc-
cess, so far as the mother is concerned. This is strong testimony, but it
must be mollified by the confession that my experience, in placenta
pra?via cases, has not been large : yet I have encountered them sufficient-
ly often to have acquired some acquaintanceship.

' To expound this method of treatment and at the same time vindicate
it, it must be observed that the tampon is preferable to manual dilatation,
as an oxytocic, in placental presentations, because forced dilation could
not be practised without necessarily siill furthur detaching the placenta,
giving rise to additional hemorrhage, all the more profuse on account of
the non-parturient state of the uterus. Then, again, such manipulations
would be objectionable because of the greatly more vascular and sensi-
tive condition of the portion of the uterus contiguous to the os, which has
already been mentioned as a reason why delivery by turning ought to
be refrained from.

u In arousing the uterus to expulsive contraction, the tampon acts, I sup-
pose, through the channel that has been more than once indicated in the
previous pages of this work, viz : irritation of the incident nerves of the
cervix, leading to reflex action of the fibres of the fundus and body. Ex-
plain as we will, however, the fact is generally admitted that the tampon
is competent to excite uterine contraction and being on labor. Should
it fail (and what may not \ ) it may be reinforced by the puncture of the
placenta, as recommended by If. Gendrin, which, considered merely as
a means of bringing on labor, is excellent and wholly unexceptionable,
and it will be observed that I am not, just now. speaking of the restrain-
ment of hemorrhage but of the excitement of labor. No case can occur,
I think, in which the tampon, aided, if necessary, by puncture of the
placenta, will fail to bring on labor, in a longer or shorter time, and
where the tampon alone is sufficient, and labor is regularly established by
its instrumentality, either the placenta must be punctured to evacuate
the liquor amnii, or the finger must be pushed up beyond its margin to
rupture the membranes during a uterine pain. I have myself usually
practised the latter alternative, and always felt that my patient was safe,
when advanced thus far on the ft>ad to recovery.

'The supervention of labor the evacuation of the liquor amnii these,
in their order, are the great bulwarks of a flooding woman, no matter
where the placenta is implanted. It is a maxim in obsteterics that a con-
tracted uterus cannot bleed ; it might, I think, be amended and enlarg-
ed, by adding that neither can a contracting uterus bleed when it is
emptied of its waters, or at any rate, if it bleed, the hemorrhage is no
longer dangerous."

In conclusion, we can only express our regret that we cannot do full
justice to this excellent book, by presenting larger extracts, in an ex-
tended review. We can only now say that, we have derived much
pleasure and benefit from its perusal, and that we cordially recommend
it to the profession, both to practitioners and to pupils. J. A. E.

570 Editorial [August,

The Institutes of Medicine. By Martyn Paine, A.M., M. D., L. L. D.,
Professor of Institutes of Medicine and Materia Medica in the Univer-
sity of the City of New York, &c, &c. 4th Edition, pp. 1095. Harper
& Brothers: New York, 1858.

The above work, together with the volumes of the Medical and Physio-
logical Commentaries, and a pamphlet of Essays on Vitality and Remedial
Agents, was acknowledged in the last number of this Journal, as sent us
by their distinguished author. We wish to notice briefly, at present,
the " Institutes of Medicine," regretting, that in our monthly journal
space is allowed only for a bibliographical notice, rather than for a re-
view, which the character of the work richly merits.

Of all American writers, no one has been more indefatigable and
laborious than Professor Paine, and the works of but few, either in this
country or in Europe, display a greater amount of learning than we find
enriching both the Institutes and Commentaries of this perhaps most
recondite of American authors. On opening any of his works, we may
be said to be, at once " lost in a sea of erudition," and his copious refer-
ences to the authors of every country and every language, attest his
familiarity with the general literature of the science to an extent rarely
evinced by cis-Atlantic writers. Although, in the beginning, we must
affirm our thorough dissent from both the tenor and the tendency of
Professor Paine's peculiar physiological tenets, we cannot justly withhold
our cordial recommendation of the work before us, as one presenting a
most valuable collection of physiological and medical facts, accompanied,
in many instances, with very just commentaries upon the phenomena of
life ; but we must say, that his reflections have not always led their author
to such principles of practice, as we can wholly approve : for instance
he quotes, with approval, a number of authors who strongly recommend
profuse bloodletting in typhoid diseases, and endorses Dr. Parry as hav-
ing "introduced the only successful or philosophical treatment, that of
bloodletting, in purpura hemorrhagica* This treatment may have been
applicable in some particular form of purpura, and in some peculiar
epidemic ; but our own experience, and that of most practitioners of the
present day, will attest the virtue of an opposite course, and the extreme
hazard of depletion.

From our examination of the work, we receive the impression that its
pervading spirit will be found expressed in the first line of the initial
page ; " Solidism and vitalism will form the basis of these Institutes,"
says our author, and we find, upon every page, that it is most uncompro-
misingly carried out. Vitalism is for Dr. Paine, the Procrustean bed
upon which every fact, every phenomenon, and every medical theory are
placed, and with his determined hand laid upon them, they are length-

1858.] Editorial DTI

ened or shortened into a consistency which is often almost unanswerable.
For this vitalism, he contends with the most unyielding pertinacity, and
the chief objects of his horror, appear to be, the chemical and humoral
doctrines, in whatever form they may be presented. To the humoral
pathology he specially devotes but a small number of pages (about 35)
of the present work, but he maintains a sharp skirmishing warfare with
this class of medical philosophers, from his very first to his very last
page.

This vitalism, which in earlier times, and even as late as the days of
Boerhaave and Cullen, was a wonderful advance upon the unsettled no-
tions about physiological action, has become, in these later days, when
all our discussions of the phenomena of organic action are conditioned,
by a definite understanding of the nature of the elements with which we
deal, too vague a principle to "form the basis" of our physiological and
pathological reasonings. Vitalism, in its technical sense, has ever ap-
peared to us, to sustain the same relation to medicine, that the searchings
after the nature of the soul do to theology. The existence of both is
evident indeed undeniable, and must be admitted as being in close rela-
tion, the one with all our moral and intellectual, and the other with all
our physiological and organic acts, but still neither of them, when we
attempt to seize upon and define it, can be made the basis of satisfactory
and conclusive argument. As in theology, it has scarcely ever yielded
a"hy thing to investigate the ultimate nature of the soul, so in medicine,
beyond the full admission of the vital principle and its acceptance as a
dominant influence in all our organic acts, nothing has been gained by
the most elaborate investigation into the exact nature of the force by
which these organic acts are accomplished.

Physiology, like all the other inductive sciences, has for its basis, a bun-
dle of facts indeed, in the present day, it has become an ocean of facts.
These facts, are of no one kind : many, it is true', relate to the nervous
system, and indicate its sway over all our vital acts, but then others as
fully shew that humoral, chemical and atmospheric influences are at
work in modifying, supplying and controlling the power exercised by the
nervous system, and so intimately blended here, are cause and effect,
that when we would attempt to say of any one of them, " here is the
beginning," we become involved in labyrinths interminable, and are
forced to look back, to that Beginning of all beginnings, that source of
all power, the Creator of man and the universe.

Notwithstanding we have thus candidly considered those parts of
Prof. Paine's work which have appeared, to ws, objectionable, we repeat,
that we can still cordially recommend it as a valuable addition to the
medical literature of our country. In an age when Humoralism and

572 Editorial [August,

Organic Chemistry are threatening to displace all other views of physiolo-
gical and pathological action, this work, because it is ultra in its vitalism
and solidism, must exert a most salutary influence upon the history of the
medical opinion of the present, and the rising generation. It requires no
half-way assertion of the power of nervous action to gain its admission ;
but he who would advocate its unmodified sway, as Dr. Paine does,
must be as firm and as uncompromising even as he has been, throughout
the comprehensive work before us.

The present edition has been prepared, apparently with great care,
and, with a few marring exceptions, the typographical execution very
well sustains the reputation of the Harpers. A most copious analytical
index much enhances the value of the volume, and attests well, the per-
severance and industry of the author.

In regard to what may be called, par excellence, the controversial por-
tion of this work, viz., "The Rights of Authors" in the appendix, we do
not intend to make any extended remark : For although some of Dr.
Paine's reclamations, strangely enough, appear to refer pointedly to the
labors of one of the editors of this journal, still, printed beside them on
the same page, is the unanswerable decision of Dr. Marshall Hall, the
acknowledged Father of the great principle of Reflex action, awarding
the merit on the other side, and declaring that ." the field is indisputably
His Own." With his originality thus asserted, he may well be content
to add, not even a single word, for himself, no matter from what source
the denial may come.

Under these circumstances, we do not feel called upon to select this
one, from the thirty-nine ! distinct claims recorded in this appendix, in or-
der to make it the subject of particular discussion.

PROFESSORIAL CHANGES, HOSPITALS, COLLEGES, &c.
In our last number, we recorded several changes in various Faculties
of Medical Colleges throughout the United States. Our exchanges sup-
ply us with the following in addition :

Professor Daniel F. Wright, the former able Professor of Physi-
ology and Pathology in the Memphis Medical College, has been elected
to the same Chair in the Shelby Medical College. Professor W. is also
editor of the Memphis Medical Recorder, one of our ablest and most
valuable exchanges. We sincerely hope that his change of residence
will not deprive us of our valued confrere.

Dr. J. H. B. McClellan of this city, (Philadelphia,) has been elected
to fill the vacancy in the Medical Department of Pennsylvania College,

1558.] Editorial 573

caused by the removal of Dr. T. G. Richardson to New Orleans. Medi-
cal and Surgical Reporter.

Dr. Richardson held the Chair of Anatomy in the above College.

"Professor S. G. Armor," says the K. 0. Med. News and Hos-pital
Gazette, u requests us to announce his resignation of the chair of Path-
ology and Clinical Medicine in the Missouri Medical College of St.
Louis. Dr. B. L. Jones lias been appointed to the vacant chair of Che-
mistry in the Oglethorpe Medical College."

The New Orleans Medical News and Hospital Gazette, thus re-
gretfully refers to the resignation of Dr. Thomas Peniston from the chair
of Clinical Medicine in the X. 0. School of Medicine : " We are record-
ing an event which only gives us pain, and we shall do it in as few words
as possible. Impaired health has forced our worthy and most highly
esteemed colleague to tender his resignation, and he has gone across
the water to seek repose from his labors, and that restoration for which
he shall have our heartfelt prayers."

Professor Austin Flint, the distinguished author of Clinical Reports
on Typhoid Fever, the most accurate and reliable since those of Louis,
has been elected to fill the chair vacated by the resignation of Dr. Penis-
ton.. As Philadelphia has recently been making inroads into a Southern
Faculty by calling Prof. Dickson from Charleston, it seems but fair that
New Orleans should make reprisals on the North ; this has been done
by the New Orleans School of Medicine securing Dr. Flint from Buffalo,
and the University, Dr. Richardson from Philadelphia. Also, Dr. J. F.
Grail has been appointed Demonstrator of Anatomy in the New Orleans
School of Medicine.

L'niyersity of Louisville. This excellent Institution which a year
ago had the misfortune to lose its edifice by fire, with an energy truly
surprising and highly commendable in its Faculty, was able to gather
the same season, quite a large class. The following changes have oc-
curred in its Faculty : Prof. Benjamin R. Palmer has been transferred
from the chair of Anatomy, so long and so ably filled by him, to that of
the Principles and Practice of Surgery ; and Prof. J. B. Flint, the form-
er Professor of Surgery, occupies the newly created chair of Clinical
Surgery, while the chair of Anatomy thus vacated is filled by the elec-
tion of Dr. J. W. Benson. Prof. Henry Miller having resigned the chair
of Obstetrics, his place has been judiciously supplied by the election of
Dr. Llewellen Powell.

Dr. S. M. Bemis, favorably known to the profession by his contribu-

574 Editorial [August,

tions to the American Medical Association, has been elected to the chair
of Clinical Medicine.

The other members of the Faculty occupy their old positions, viz.,
Prof. T. S. Bell, Theory and Practice; Prof. L. P. Yandell, Physiology
and Pathological Anatomy ; Prof. Robert J. Breckenridge, Therapeutics
and Materia Medica; and Prof. J. L. Smith, Chemistry and Toxicology.
With the above excellent organization, the University may reasonably
expect the same distinguished success in her new edifice, which marked
her progress in the old.

Shelby Medical College. The unprecedented success of the Uni-
versity of Nashville, has encouraged others to establish a second Medical
Institution at this point. The following gentlemen have been elected to
fill the respective Chairs :

J. F. May, M. D., Principles and Operations of Surgery ; E. B.
Haskins, M. D., Theory and Practice of Medicine ; J. P. Ford, M. D.,
Obstetrics and Diseases of Women and Children ; T. L. Maddin, M. D.,
Descriptive, Histological and Surgical Anatomy ; J. H. Chandler, M. D.,
Materia Medica and Therapeutics ; R. 0. Currey, M. D., Chemistry and
Medical Jurisprudence ; Daniel F. Wright, M. D., Physiology and Pa-
thology ; H. M. Compton, M. D., Demonstrator.

The circular of the new college evinces a conciliatory spirit, and de-
precates strongly any suspicion of unworthy rivalry or desire to cripple
the valuable organization already existing in Nashville. " Its success is
a source of gratification to all who take pride in the public institutions
of the city and the state, and, without affectation, they desire it to con-
tinue."

Recognizing the names of several of our valued friends in the above
Faculty, we can cordially wish them success; but with friends equally
prized by us, in the University, that success could be no longer gratifying
to us, should it be secured at the expense of that noble and liberal Insti-
tution.

Nashville Medical Society. The Physicians of Nashville, Teun.,
have recently organised themselves into a society, adopted a constitu-
tion and chosen officers for the current year. Meetings are appointed
to be held monthly. Dr. A. H. Buchanan is President, Dr. S. S. May-
field, Vice-President, and Dr. G. S. Blackie, Secretary and Treasurer.
[Boston Med. and Surg. Journal.

Ohio Medical and Surgical Journal. Professor J. M. Hamilton has
become associated with Prof. John Dawson as joint editor and proprie-

1858.] Editorial 575

tor of the Ohio Medical and Surgical Journal, published at Columbus in
that State. [Ibid.

" We have room merely to announce," says the Medical and Surgical
Reporter, " that Dr. R. K. Smith has been re-elected Chief Resident
Physician to the Philadelphia Hospital, Blockley thus effectually re-
deeming that Institution from the disgraceful position which it has for
some time occupied." We learn also from the Reporter, that a new-
college hospital has been established at Brooklin.

NEW JOURNALS.

Journal de Physiologie de l'Homme et des Animaux. We have
the pleasure of acknowledging the first number of this valuable Journal
whose existence is due to the energy and zeal of the distinguished ex-
perimental physiologist, Dr. E. Brown-Sequard, so well known in this
country, as well as in Europe. We believe that this is the first, and at
present the only periodical exclusively devoted to that most interesting
and progressive branch of Medical Science Physiology. The " Annals
of Anatomy and Physiology," published in Edinburgh, by John Goodsir,
was of a different character, and so far as we know, did not reach its
third number. Dr. Brown-Sequard is assisted in his editorial labors by
Drs. Ch. Robin, Ch. Rouget, and Tholozan, and he has the promise of
original communications from many distinguished contributors in
America, England and Germany.

Besides Physiology proper, the journal will treat of

"1. Organic Chemistry, hygiene, toxicology, and legal medicine, in
their relations to physiology.

u 2. Descriptive anatomy, comparative anatomy, teratology, and nor-
mal and pathological histology, so far as they may be connected with
physiology.

" 3. The application of physiology to the practice of medicine, surgery,
and obstetrics.

"The numbers will be issued four times a year on the first day of
January, April, July, and October each number containing about 200
pages.

"The contents will be classified in the following manner :

"1. Original communications, forming more than one-half of each
number.

" 2. Articles published abroad, entire or in part.

" 3. Critical analyses of books published in France and other countries.

" 4. Accounts of the progress of physiology in France and other coun-
tries.

"The subscription price in this eountry'will be twenty-five francs, or
$5 per year."

576 Editoriul and Miscellaneous. [AugustT

American correspondents will please address, post paid, Mons. J. B.
Baillaire, et fils, or Dr. Brown-Sequard, Rue de Dragon, 16 a Paris.

We place the above journal, with pleasure, on our exchange list, and
hope to make it valuable both to ourselves and to our readers.

The Maine Medical and Surgical Reporter. We have received
both the first and second numbers of the above promising new journal.
It is edited by W. R. Richardson, M. D. and R. W. Cummings, M. D.,
who are also the proprietors. It is published monthly, at Portland, by
Sanborn & Carter. Both numbers are filled with valuable matter, ori-
ginal and selected, and the typographical execution and style of the
journal does credit to both the editors and the publishers. We welcome
the new comer to our sanctum, and with pleasure place it among our
exchanges.

Symmetrical Morbid Action. We copy the following from the Buf-
falo Medical Journal. The fact is certainly worthy of record, however
darkly hidden may be the explanation.

Lockport, May 31st, 1856.
Prof. Hamilton :

Dear Sir, I send you the following report of a case that occurred in
my practice, and which may possess interest enough to entitle it to a
more extended publicity. You are at liberty to do with it as you see fit :

In the summer of 1853, Mr. Monroe Levally, wagon-maker, age 46,
called at my office and requested me to examine his arm. I did so, and
found immediately over the point of the olecoron process an encysted
tumor of the size of a robin's egg, and which made its appearance a few
days previous. I made a few incisions in the sack with an abscess lancet,
and obtained about 3iii. of a thick fluid. Introduced into the sack a
pledgit of lint, and in a few days a perfect cure was effected.

But the next week I was not a little surprised, when he returned, with
another tumor on the other arm, an exact counterpart of the previous
one in every particular. It made its appearance in the same manner ;
in locality it was the same, (except on the other arm,) of the same size
and form. I treated in the same manner, and the result was the same.

How far this goes to prove the existence of a sympathetic action be-
tween the corresponding points of the human system, we leave for others
to decide ; but it does certainly go far to prove that, under certain cir-
cumstances, one elbow at least has some sympathy with the other.

Yours, ever, A. M. Leonard.

Dr. Elint, "Symmetrical diseases" are known to occur often in
eruptive affections, and occasionally in rheumatic and syphilitic affections,
but this is the only example which I have known where an encysted
tumor, or a true tumor of any kind, has illustrated this curious law of
affinities between opposite portions of the body.

Yours, F. H. Hamilton.

1858.] Miscellaneous. 577

Pertussal Glucosuria. In the }Tear 1855, the fact was first pointed
out by Dr. Gibb, that the urine in almost every case of hooping-cough is
saccharine, the quantity of sugar varying, generally but small, and some-
times a trace only being present. A considerable quantity he has, how-
ever, found on several occasions, the specific gravity being at the same
time high, and in general characters the urine has been similar to that
of diabetes. A case of pertussis, with urine in this last condition, was
recently under Dr. Gibb's care, at the St. Pancras Royal Dispensary, in
a child of six years, who had reached the spasmodic stage of the com-
plaint, without any complication, unless the glucosuria be considered as
such. The remarkable feature of this case was the rapidity with which
the quantity of sugar diminished under the usual plan of treatment re-
commended by Dr. Gibb in this disease namely, nitric acid in large
doses. The specific gravity of the urine became lower, the quantity of
sugar diminished, and, as a cure was established within three weeks, not
a trace of it was to be found. It is an interesting fact, that nitric acid
should so rapidly diminish the glucosuria. This may be effected in one
of two ways either by its curing the purtussis, and a condition with it,
which must hereafter be looked upon as symptomatic of it; or else the
assimilation of the acid prevents the formation of the sugar. To the last
view Dr. Gibb inclines, but he says large doses only will produce this,
as experience has proved in his hands. This condition of the urine in
hooping-cough is well worthy of record. We shall refer at a future time
to the explanation given of its appearance, but we take this opportunity of
throwing out the suggestions of a trial of the influence of nitric acid in
cases of diabetes mellitus. [Lancet.

New Method of Amputation. M. Maisonneuve read lately a paper
before the Academy of Sciences of Paris, on a new method of amputa-
tion, which he calls the diaclastic method. It consists of a contrivance
for fracturing the bone at the precise point required ; after which the
muscles are strongly compressed by mechanical means, so as to reduce
them to small diameter. They are divided, and the member separated
from the trunk. In consequence of the compression, all hemorrhage is
effectually prevented. M. Maisonneuve quoted six cases of amputation
by this astonishing procedure five of the leg, and one of the arm ; in
all of which complete cures were effected. No unsuccessful cases, he
says, have occurred to him. [Lancet.

"The Sands of Life11 "Played Out." Under this caption the New
York Times gives an account of the legal means lately adopted in that
city to put a stop to the disgraceful system of quackery for some years
carried on by a reckless swindler representing himself, in his advertise-
ments, as a physician " whose sands of life have nearly run out." It
seems that he, with other quacks of the same sort, have been arrested,
and the letters which are daily flowing into them by mail are sent on to
the Dead Letter Office at Washington, whence the money contained in
them will be returned to the deluded victims of this last and boldest of
the medical humbugs. [Boston Med. and Surg. Journal.

578 Miscellaneous.

Glycerine with Alum and White Precipitate. Dr. Anciaux recom-
mends the following formula in the local treatment of erysipelas, obstinate
eczemas and atonic ulcers : alum, in impalpable powder, 30 parts; white
precipitate, 1 part. Triturate them well together, put them in a phial
and add glycerine, 90 to 100 parts. Shake the phial, until the mixture
assumes the consistence of cream, each time it is applied. [Ibid.

Painless Caustic. M. Piedagnel, after various trials, has succeeded in
producing a caustic that may be employed, causing little or no pain. It
is formed of three parts of the Vienna caustic in powder and one part of
hydrochlorate of morphia, intimately mixed together, and then made
into a thick paste by means of chloroform, alcohol, or water. It is ap-
plied to the skin on diachylon. A black eschar is produced in fifteen
minutes, increasing in thickness with the duration of the application.
The morphia mixed in the same proportion with powdered cantharides,
prevents pain during the rising of a blister. M. Piedagnel, who at present
has only used this means for the production of issue and blisters, states
that the action of the morphia is merely local. [Druggists'' Circular.

A Specific for Scabies. At the last meeting of the Academy of Scien-
ces, Paris, M. Bonnet ofEpinal, sent in a paper announcing that benzine
is a specific for the itch. The author of the paper states that if benzine
be rubbed on the parts affected, and also very slightly on the other parts
of the body, a cure will be effected in the course of five minutes, after
which time the patient may take a warm bath for half an hour. Never-
theless, in cases where the itch is accompanied with a secondary eruption,
the latter will require a separate treatment. [Ibid.

Hydrocele treated by Electricity. Rodolfi of Milan, has applied elec-
tricity for the cure of hydrocele in four cases, and reports very favorably
concerning its effects, not only the fluid disappearing in all, but its re-
production being prevented in three of the cases. Bunsen's or better
still, Daniel's* pile should be employed. [Ibid.

New local application in Erysipelas. M. Anciaux speaks in high
terms of the following application for erysipelas and some other cutane-
ous affections. Alum reduced to impalpable powder, 30 parts ; white
precipitate, 1 part. Rub up well together, and place the powder in a
bottle, and then add from 90 to 100 parts of glycerine. Shake the bottle
until the mixture assumes a creamy consistence, and repeat the shaking
whenever the application is about to be employed. [Ibid.

Infants found dead in bed, are not generally killed by being laid on
by their mothers, but by being suffocated under the bedclothes, with
carbonic acid gas exhaled from their own lungs and re-inspired. They
die without pain, in a profound sleep. Mothers, give your babes more
air. Let them sleep with their heads uncovered. Do not let them go to
sleep on or under your arm, for when you cover yourselves, in the half
unconciousness of partial sleep, you will cover your darlings' heads also,
and in the morning may find them still in sleep a sleep from which
your caresses cannot awake them. [Pacific Med. and Surg. Journal.

SOUTHERN

MEDICAL AND SURGICAL JOURNAL

(NEW SERIES.)

Vol. XIV.] AUGUSTA, GEORGIA, SEPTEMBER, 1858. [No. 9.

ORIGINAL AND ECLECTIC.

ARTICLE XXX.

Observations on Malarial Fever. By Joseph Jones, A.M., M.D.,
Professor of Physics and Natural Theology in the University
of Georgia, Athens; Professor of Chemistry and Pharmacy in
the Medical College of Georgia, Augusta ; formerly Professor
of Medical Chemistry in the Medical College of Savannah.

[Continued from page 538 of August No. 1858.]

Section II. Remittent Fever.

In the preceding articles upon Intermittent fever, but few
comparisons were made but few conclusions drawn. A simple
statement of the phenomena was made, and they were placed
in a situation for future analysis and comparison.

A similar course will be pursued, with Remittent and Con-
gestive fevers.

When we have examined the phenomena of the varieties of
Malarial fever, then analysis and comparison will be instituted:
then the similar will be combined, and the dissimilar separated;
and thus we will endeavor to establish the relations, or laws, of
the phenomena of Malarial fever.

Our knowledge of Malarial fever, and in fact, of all fevers, is
imperfect*. Many phenomena have never been analyzed, and
it is probable that there are many which have escaped observa-
tion entirely. It is necessary, therefore, that we should proceed
upon the strict principles of induction.

We must establish a true knowledge of Malarial fever, in the

X. 8. VOL. XIV. NO. IX. 31

580 Jones, on Malarial Fever. [September,

same manner that all sciences have been constructed. By ob-
servation, experiment and reason, facts must be observed, re-
corded, accumulated, compared : complex phenomena observed,
recorded, analyzed, decomposed, and their component elements,
arranged and compared: the errors of the senses corrected,
and thus fundamental laws or relations established.

By analyzing phenomena, and connecting them by the natural
relations of succession and resemblance, fixed laws or relations
are discovered.

The end of knowledge is fore-sight, fore-knowledge; and
when perfected, it will enable us to predict with absolute cer-
tainty the future course of events.

Thus the great object of the Astronomer is to determine the
fixed relations or laws of the universe, so that the precise condi-
tion of the heavenly bodies, at any future time, may be deter- .,
mined with absolute certainty.

The great object of the Physician, should be to determine the
fixed relations or laws of the animal economy, and the definite
action, constitution, and relations of morbific and remedial
agents, so that he may be able to predict the results of the ac-
tions of these agents, and also to control and direct their action.

This is our object and this our method. But our instruments
and means of investigation have been imperfect. The pheno-
mena themselves were obscure, and it is probable that many, of
great importance, entirely escaped our observation.

Imperfections of the senses, imperfections of the mental facul-
ties, imperfections in our materials and instruments, of experi-
ment and analysis, will necessarily render the results imperfect.

My object is to assist in the establishment of the truth, and it
is my fervent hope, that whatever results, relations, or laws, I
may deduce from these observations, will be tested, and weighed
by careful, conscientious observers. Thus, we hope, that in
time, the errors will be eliminated, the imperfections removed,
the results enlarged, and the truth established.

Case XXIII. English seaman : age 25, weight 140, height
5 feet 6 inches ; black hair ; florid complexion. Sailed from New
York to Darien, Georgia. Eemained in Darien five days ; dur-
ing which time, he slept on board the vessel, lying in the Alta-
maha river. Sailed from Darien, and arrived in Savannah

1858.]

Jones, on Malarial Fever.

581

twelve days ago. During the day has been running on a steam
tug, up and down the Savannah river, from its mouth to the
city, and has slept, during the night, on the bay. Was taken
with a chill, September 6th, 10 o'clock A. M.

September 10th, 7 o'clock P. M. Took salts and senna, this
morning. This operated five times. Has taken no other medi-
cine. Pulse 90, full; respiration 48, panting, thoracic. Tem-
perature of atmosphere, 80 F. ; Temp, of hand, 103 ; Temp,
under tongue, 105. Tongue pointed and red at tip and edges,
superior portion coated with black fur; skin dry. Complains
of great thirst and pain in his head. Face flushed.

September 11th, 11 o'clock A. M. Pulse 88;' respiration la-
bored, thoracic, panting, irregular, varying from 34 to 40. Tem-
perature of atmosphere, 82 F. ; Temp, of hand, 10325'; Temp,
under tongue, 105. Says that he did not rest well last night,
and complains of great pain in his head. Intellect clear. Has
been vomiting yellow and green matters. Bowels have not been
moved during the night. Skin dry and harsh to the feeling.
Tongue red, dry and glazed. To the finger the tongue feels as
dry as the skin. The state of the tongue would lead us to sus-
pect tenderness of the epigastrium, but there is none. Complains
of great thirst ; says that he felt very cold and weak this morn-
ing at 5 o'clock. The nurse states that at this time his pulse
was 65, and his skin cool. $. Sulphate of quinia, grs. v. every
three hours, up to grs. xxxv.

If the stomach rejects the sulphate of quinia, administer the
following injection: $. Sulphate of quinia, grs. xx.; Starch,
f^ij.; Tincture of opium, n\ x. Mix. Eepeat in three hours.
$. 5 cut cups to epigastrium. $. Soda powders. Diet, gruel
and flax seed tea.

grams,

8160

12240

510

Amount of Urine passed during the last 16 hours,
" " " calculated for 24 "

" " " excreted hourly, -

Urine clear, high colored, like new Madeira wine. Specific
gravity 1020. Reaction decidedly acid. After standing 40
hours, threw down a small deposit of regular prismatic crystals
of triple phosphate and vegetable cells.

Calculated am't of Urine
for 24 hours, grs. 12240,
contained grains,

ANALYSIS XXXVII.

Water

Solid matters,

Urea,

Uric Acid,

Extractive <fe coloring

matters,
Fixed saline constituents

Urine excreted in
16 brs., grs. 8160,
contained erains,

7618-696

54U3C4

349*200

3-200

168-533

20-160

11428-044

811-956

523-800

4-800

252-805

30-240

1000 pta.
contained

933-664

66-336

42-593

0-393

20-673

2 475

582

Jones, on Malarial Fever.

[September,

Sept. 11th, 7 o'clock P. M. Patient is not so restless has an
inclination to sleep, and his intellect acts more slowly than nor-
mal. Tongue moister than this morning, but still much dryer
than normal ; free extremity of the tongue clean for one inch
from the tip ; this portion is as red as scarlet; the remainder of
the tongue is coated with dark fur. The nurse states thatr
" after the application of the cut cups, his skin began to moist-
en he became much more quiet, and went to sleep." Skin
moist, but hot; slight tenderness upon pressure of epigastrium;
lips dry, and coated at the edges with yellow matter. Pulse 90;
respiration 40 to 44, panting, thoracic, irregular every 15 or 20
respirations, he draws a long sigh, inflating his chest to its ut-
most capacity. Temperature of atmosphere, 81 F. ; Temp, of
hand, 104 ; Temp, under tongue, 104 8'.

Bowels have not been moved. Has taken 20 grains of the
sulphate of quinia.

ty. Stop sulphate of quinia, and give soda powders,
as fever remits, commence with sulph. of quinia, grs
three hours, up to grs. xv.

Urine high colored, clear; reaction decidedly acid,
gravity 1019*6. After standing 30 hours, let fall a small depos-
it of vegetable cells, and prismatic crystals of triple phosphate
and globulo-acicular crystals of urate of soda.

Amount of Urine excreted in 8 hours, - - grains,
Calculated amount, " " 24 " - "

Amount " " hourly, - "

Amount of Urine excreted in the last 24 hours, "

" " " " hourly, " " " - "

As soon
v. every

Specific

5098.
15294.

637.2
13258.

552.4

ANALYSIS XXXVIII.

Urine excret-
ed in 8 hours
grs. 5098 con-
tained, grains

Calculated
am't Urine for
24 hours, grs.
15294 cont'nd
grains

1000 parts
of Urine
contained

Urine excret"
ed in the last
24 hours, grs.
13258 cont'nd
grains

Water

4764-865

333*135

223-000

1-450

90210

18*325

14294-595

999*405

669-000

4-350

270-630

54*975

934-652

65-348

43-722

0-284

17-707

3-595

12383-561

Solid Matters

874*439

Urea ,

572-30O

Uric Acid

4-650

Ext. and Col'ing Matters.
Fixed Saline Constituents

258-743
38-485

A comparison of this analysis with the preceding one, shows
that the uric acid was below the standard of health, when the
patient was entirely free from medicine, and that under the ac-
tion of the sulphate of quinia (grs. xxv.), the uric acid was very
slightly diminished in amount, only T\\ of a grain during 24
hours.

If we compare these analyses (xxxvii. and xxxviii.) with the
analyses of the urine in intermittent fever, (see pages 386-391

1858.]

Joxes, on Malarial Fever.

583

and 438-450 of this journal,) it is evident that the urea has
.greatly increased in amount. The increase has been propor-
tional to the increase of the severity of the disease. When we
consider the state of rest, and the almost complete starvation of
the patient, it is evident that the urea has increased to more than
double the normal quantity. These facts will be noticed more
fully hereafter.

September 12th, 12 o'clock M. Complains of weakness and
headache. Was not so restless last night as on the previous
nights. Fever commenced to remit at 10 A- M., this morning.
Bowels have not been moved since his entrance into the hospi-
tal. Some tenderness upon pressure of epigastrium. Tongue
not so red, cleaner and moister the dark fur about the root has,
in a great measure, cleaned off tip and edges still much redder
than normal. Pulse 70; respiration 26-36, thoracic, irregular,
varying with each quarter every 12 or 15 respirations, draws
a long sigh, inflating his thorax to its utmost capacity. After
this, his respiration ceases for a few moments. The respiration
is indicative of oppression. Temperature of atmosphere, 83 F. ;
Temp, of hand, 100 75' ; Temp, under tongue, 102 50'. Has
taken 10 grs. sulphate of quinia during the night.

$. Continue sulphate of quinia, grs. v. every three hours, up
to grs. xl. Complains of uneasiness in his bowels. Has a dis-
position to visit the stool, frequently, without the ability to
evacuate the bowels. #. Calomel, grs. xii., followed by castor
oil in four hours. Continue the sulphate of quinia, regardless of
the action of the medicine. Urine, high colored, brownish-red,
limpid, without deposit. Sp. gr. 1019 ; reaction decidedly acid.
After 40 hours, a small deposit of vegetable cells, urate of soda
and triple phosphate.

ANALYSIS XXXIX.

Urine excret-
ed in 17 hours
grains 15285,
contained grs.

Calculated
ara't Urine for
24 hrs., grains
21567 cont'nd
grains

1000 parts
Urine con-
tained

Urine excret-
ed during the
last 24 hours,
grs. 20383 con-
tained grains

Water

14476*810

809-190
567-450

s-ooo

95-050
140-280

20435*283
1181*767

800-671

8-466

134-115

197-935

947 059

52-941

37-124

0-392

5*182

9-243

19240-675

Solid Matters

1142-325

Urea

790-450

7'450

Ext and Col'ing Matters,
fixed Saline Constituents,

185*260
158-605

Amount of Urine excreted during the last 17 hours, grains, 15285

u u u a hourly, " ' tt " " 899

Calculated amount of Urine for 24 hours, - 215G7

Actual amount of Urine excreted during last 24 hrs., "

hourly,

20383
849

9 o'clock, P. ^L Complains of some pain in his head, and

584 Jones, on Malarial Fever. [September,

in the region of the liver; intellect is clear and he is not so rest-
less; tongue moist, still redder than normal ; skin moist and re-
laxed. Pulse 70, regular and soft ; respiration 53, irregular and
thoracic. Temp, of atmosphere, 83F. ; Temp, of hand, 9916;
Temp, under tongue, 1015. Urine high colored, reaction de-
cidedly acid. Sp. gr. 1020. Medicine has operated several
times, and much urine was passed during the operations. 3.
Sulphate of Quinia, grs. xv. ; Snake-root tea, f xvi. Table-
spoonful every four hours.

Sept. 13th, 11 o'clock A. M. Eested well during the night,
feels better, but very weak ; bowels moved three times during
the night; tongue moist, rather pointed, red at tip and edges ;
tip clean, base coated with light yellow fur, slight tenderness
upon pressure of epigastrium. Pulse 52 regular, respiration
48, more regular and gentle than on the previous day. Temp,
of atmosphere, 85F.; Temp, of hand, 97 ; Temp, under tongue,
100. The calomel has evidently been productive of good.
The patient however appears to be very weak. The urine has
changed greatly in color since }^esterday. It is now orange
colored and turbid. Sp. gr. 1024; reaction after 15 hours
alkaline, ty. Sulphate of Quinia, grs. xv. ; Snake-root tea,
f I viij. ; brandy, f 5 viij. Mix. Dose, a tablespoonful every two
hours. If the pulse rises and the heat increases, discontinue the
brandy.

6 o'clock P. M. Tongue moist, not so red at tip and edges,
slightly coated with white fur. Pulse 60, respiration 26 to 32,
more regular, and not so thoracic as formerly, but still irregular,
varying with each quarter of a minute ; at one quarter indicating
45 to the minute, and perhaps at the next quarter it will indi-
cate only 20. $. Continue Sulphate of Quinia, Brandy, and
Snake-root tea; tablespoonful every three hours ; urine orange
colored. Sp. gr. 1022 ; reaction alkaline after standing 15
hours.

Sept. 14th, 1 o'clock, P. M. Much better. Bowels were
moved three times during the night. Pulse 58, respiration 28 ;
no tenderness upon pressure of epigastrium ; tongue normal, no
tenderness upon pressure of the epigastrium. Temp, of atmos-
phere, 87F. ; Temp, of hand, 99. ; Temp, under tongue, 102 ;
urine orange colored ; reaction alkaline in 12 hours ; in 24 hours
bad thrown down a copious deposit of crystals of triple phos-
phate, and urate of soda. The deposit of urate of soda, greatly
exceeded in amount that of the triple phosphate. Sp. gr. 1025.

Amount of Urine excreted during the last 19 hours, grains, 15375

" u a u hourly, " " " " " 809

Calculated amount of Urine for 24 hours, " 19418

1858.]

Jones, on Malarial Fever.

585

ANALYSIS XL.

Grs. 15375 Urine ex-
creted during 19 hrs.
contained grains

Grs. 19418 calculat'd
for 24 hours contain-
ed grains

1000 parts
Urine con-
tained

Urea

Uric Acid

538-350

8-550

35-840

679-926
10-798
45-288

35-054
0-556

Fixed Saline Constituents

2-390

September loth, 10 o'clock A. M. Continues to improve;
tongue moist, and normal in appearance; skin cool, relaxed and
moist. Pulse 50, full and regular; respiration 24, regular and
gentle. Temperature of atmosphere, 84 F. ; Temp of hand,
94 5'; Temp, under tongue, 99. 3. Quassia and soda. Con-
tinue snake-root tea and sulph. of quinia, table-spoonful every
four hours. Urine, deep orange color after standing 20 hours,
let fall a deposit of urate of soda and triple phosphate. Specitic
gravity 101 6*5.

Amount of Urine passed during the last 20 hours, grains, 6607
u u u u hourly, " " " " " 330

Calculated amount of Urine for 24 hours, " 8038

ANALYSIS XXL

Grs. 6607 Urine ex-
creted during 20 hrs.
contained grains

Grs, 8038 Urine cal-
culated for 24 hours,
contained grains

1000 parts
Urine con-
tained

Water

Solid Matters

6230*091

376-909

222-658

4-225

123-322

26 504

8585.710

452-290

267-189

5-070

147-986

31-805

942-953
57*047

Urea

38*169

Uric Acid

0*639

Ext. and Col'ing Matters.
Fixed Saline Constituents,

14-100
4-027

When this analysis is compared with the former analyses, it
is evident that the reduction of the force and frequency of the
circulation aud respiration, the reduction of the temperature,
and the relaxation of the skin, was attended by a diminution of
the urea.

7 o'clock P. M. Pulse 47 ; respiration 27. Temperature of
atmosphere, 87 F. ; Temp, of hand, 96 ; Temp, under tongue,
99. Skin moist, relaxed, cool, perspiration. Urine, orange
colored ; sp. gr. 1018-2 ; after standing 15 hours, let fall a heavy
light-yellow deposit of urate of soda and ammonia, and numer-
ous well formed prismatic crystals of triple phosphate-
Amount of Urine passed during the last 9 hours, grains, 5121
" ' " hourly, - " 569

Calculated amount for 24 hours, - " 13652

ANALYSIS XLIL

Grs. 5121 Urine ex-
creted during 9 hrs.,
containedgrains

Grs. 13652 Urine cal-
culate for 24 hours,
contained grains

1C00 part*
Urine con-
tained

Water

4946*350

174650

52-622

6-250

94-750

20-815

13186-384
465-616
140-291

16*662
252-035

55 492

965*854

Solid Matters.

34146

Urea

10-277

Uric Acid

1-220

Ext. and Col'ing Matters .
Fixed Saline Constituents,

18-484
4-065

586

Jones, on Malarial Fever,

[September,

September 16th, 12 o'clock M. Pulse 46 ; respiration 20 to
26, irregular. Urine, orange colored ; specific gravity 1022#2.
Temperature of atmosphere, 87 F. ; Temp, of hand, 97 ; Temp.

under tongue,

After standing 12 hours, let fall a light-

yellow deposit of octohedral crystals of the oxalate of lime,
globular crystals of the urate of soda, and a few prismatic crys-
tals of triple phosphate.

Amount of Urine excreted during the last 17 hours, grains, 4599

" <. u a hourly, " " " " 270

Calculated amount of Urine for 24 hours, " 6490

Actual amount of Urine excreted during the last 24 hrs. 9720

u u hourly 405

ANALYSIS XLIIL

Water

Solid Matters

Urea

Uric Acid

Ext. and Col'ing Matters,
Fixed Saline Constituents,

Grs. 4599 of
Urine excret-
ed during 17
hrs. contained
grains

4292-402

306*598

150-592

2-700

120-000

32-994

Grs. 6490 of
Urine calcula-
ted for 24 hrs.
contained grs.

6057-391

432-609

212-4S6

3-798

169-200

46-554

1000

parts

Urine

con-

tained

933

334

66

666

32-744

0-537

26-075

7

160

Grs. 9720 of
Urioe excret-
ed during last
24 hours con-
tained grains
9238-752
481-248
203-214
8-950
214-750
53-809

8 o'clock P. M. Pulse 47 ; respiration 28. Temperature of

atmosphere, 87 5' F.; Temp, of hand, 95 9'; Temp, under

tongue, 99.

Amount of Urine passed during last 8 hours, - grains, 4080
u u hourly u u u . 510

Calculated amount of Urine for 24 hours, - " 12240

After standing 12. hours, the urine threw down a heavy light-
yellow deposit of urate of soda and triple phosphate.

September 17th, 11 o'clock A. M. Pulse 44; respiration 24.
Temperature of atmosphere, 84 5' F. ; Temp, of hand, 96 ;
Temp, under tongue, 99. Color of urine, a shade higher than
normal. Sp. gr. 1018. Eeaction alkaline in 10 hours. Light
yellow deposit of urate of soda and triple phosphate.

Amount of Urine excreted in the last 15 hours, grains, 8712

" u u u hourly, " " " " 514

Calculated amount of Urine for 15 hours, " 13940

Grs. 8712 Urine ex-
creted during 15 hrs.
contained grains

ANALYSIS XLIY.

Water

Solid Matters

Urea

Uric Acid

Ext. and Col'ing Matters,
Fixed Saline Constituents,

8139-466
572-534
123-675
5-695
281-067
161-797

Grs. 13940 Urine cal-
culated for 24 hours,
contained grains

13023-945
916*055
197-880
9-112
449-707
258-876

1000 parts
Urine con-
tained

934-286
65-714
14-200
0-653
32-224
18-571

1858.]

Jones, on Malarial Fever.

587

September 18th, 12 o'clock M. Pulse 44; respiration 24.
Temperature of atmosphere, 86 F. ; Temp, of hand, 96 25' ;
Temp, under tongue, 99.

Amount of Urine passed during the last 24 hours, grains, 15903
u .. .. u hourly," M " " " " u 662

Uric acid in grs. 15903 of Urine of 24 hours, grains, 35*650
Uric acid in 1000 parts of Urine, u 2-241

Urine, normal in color. After standing 8 hours, reaction
alkaline, with a heavy deposit of urate of soda and triple phos-
phate. The increase of the uric acid has attended the conva-
lescence. This fact proves that the action of the sulphate of
quinia, in arresting intermittent fever, is not due to its power of
diminishing the amount of uric acid.

September 19th, 12 o'clock M. Pulse 44 ; respiration 24.
Urine, normal in color; deposit, after standing, triple phosphate.
Temperature of atmosphere, 88 5' F.; Temp, of hand, 97;
Temp, under tongue, 99.

Amount of Urine excreted duriDg the last 24 hours, grains, 24240
" " " " hourly, ... 1010

September 20th, 12 M. Specific gravity 1010.

Amount of Urine passed during the last 24 hours, grains, 32320
" " " " hourly " " " " " 1346

September 22nd. Specific gravity 1008.

grains, 23300
" 929

Amount of Urine passed during the last 24 hours,

U u u U hourly^ U U U U

Pulse 44 ; Eespiration 22. Temperature of atmosphere, 84F. ;
Temp, of hand, 97 8' ; Temp, under tongue, 99 12'.

This patient is now able to walk about the hospital yard, but
is pale, anaemic, and very weak.

Examination of Blood, No. IY. Blood coagulated slowly ;
clot firm. During coagulation the blood-corpuscles settled, and
left above a transparent clot, about l-8th of an inch in depth,
and of a light-yellow color. Color of the serum, light yellow.
Sp. gr. of blood 1042. Sp. gr. of serum 1022-5.

Water,

In 1000 parts of Blood, 831-294

" " Serum, 927-853

(1) " " Liq. Sang. 924664

(2) * * * * 887-265

Solid Matters.
In 1000 parts of Blood,
M Serum,

(1) " Liq. Sang.

(2) " u " "
Serum of 1000 pts. Blood,

168-706
72-147
75-336

112-735
64-464

588 Jones, on Malarial Fever. [September,

Fixed Saline Constituents.

In 1000 parts of Blood, 4-370

" " Serum, 3*288

(1) " " Liquor Sanguinis, 3-299

(2) " " " " 4-885

" " Solid Matters of Blood, 25-906

" " " " " Serum, 45*576

(2) " " " " " Liq. Sanguinis, - - - 37-390

" " " " " Blood Corpuscles, - - - 14-047

" " Moist Blood Corpuscles, 3-511

In Blood Corpuscles of 1000 parts of Blood, - - - 1*432

" Serum of 1000 parts of Blood, 2-938

1000 Parts of Blood Contained,

Water, - - - - 831*294

Dried Blood Cornuscles 101*941 1 Dlied 0rganic Residue, 100*409
uned tflooa Corpuscles, lUl 941 | Fked galine ConstituentS) VV62

Fibrin, 2*301

Albumen, Extractive and Coloring ) Dried Organic Residue, 61*500
Matters, - - 64-464 ( Fixed Saline Constituents, 2-938

1000 Parts of Blood Contained,

) Water, - - - 306-823

Moist Blood Corpuscles, 407.764 V Dried Organic Residue, 100-409

) Fixed Saline Constituents, 1-432

1 Water, - - - 525*471

Dried Organic Residue, 61*500

Fixed Saline Constituents, 2*301

Fibrin, - - - 2-938

1000 Parts of Moist Blood Corpuscles Contained,

Water, r 750-000

Dried Organic Residue, 246*468

Fixed Saline Constituents, - ~ - - - - 3*511

(1) 1000 Parts of Liquor Sanguinis Contained,

Water, 924;664

Albumen, Extractive and Coloring Matters, - 68*858

Fixed Saline Constituents, -- - -. - - 3-289

Fibrin, - - - 3*189

(2") 1000 Parts of Liquor Sanguinis Contained,

Water, 887-265

Albumen, Extractive and Coloring Matters, - v - 103880

Fixed Saline Constituents, 3-885

Fibrin, - 4-945

This analysis shows that the dried organic residue, and
especially the fixed saline constituents, of the colored blood
corpuscles, have diminished. The moist blood corpuscles are
less than normal by 100 parts in the 1000 parts of blood. The
fixed saline constituents are less than one-half the normal
amount.

1858.] Joxes, on Malarial Fever. 589

The patient recovered sufficient strength to walk about the
hospital grounds. His complexion continued anaemic and his
forces were feeble and did not increase, notwithstanding the
administration of tonics and iron. He complained continually
of a severe pain in his head. Cut cups over the temples and
back of the neck ; cold applications and internal remedies failed
to afford any relief.

On the 4th of October, he was taken with a chill followed by
high fever. The chill came on at 1 o'clock M., and has returned
daily at this hour.

October 6th, 12 o'clock M. The chill has been on one hour,
and the circulation of the capillaries is becoming equalized and
the temperature of the extremities is rising. Pulse 110, feebler
than after complete reaction, but stronger than during the lowest
depression of the cold stage. Respiration rapid, thoracic pan-
ting, 45-50 ; muscles trembling violently. It was with the
greatest difficulty that the bulb of the thermometer could be held
under the tongue with the lips closed around, on account of the
violence of the inspirations and expirations. The air was drawn
into the lungs and expelled with great violence.

The patient resembled an over-heated man after violent exer-
tion in hot weather, panting for breath. Temp, of atmosphere,
70F.; Temp, of hand, 97.; Temp, under tongue, 104. The
bulb of the thermometer under the tongue excited vomiting.
After vomiting the shaking of the muscles ceased, and the
violent respiration became calmer and more regular. This at-
tack yielded to sulphate of quinia, and the recurrence of the
chill was prevented by the administration of arsenic.

The occurrence of intermittent fever after an attack of remit-
tent fever, was due in this case to one or both of two causes.
The malarial poison may not have been completely broken up
and removed during the attack of remittent fever, or a fresh
dose of the malarial poison may have been received subsequent-
ly to the complete elimination of the disturbing element.

Both these causes may have acted simultaneously. The hos-
pital is situated in a malarious district, and a dose of the poison
might have been received at any time.

The annexed table will give a condensed view of the most
important phenomena. (See next page.)

A comparison of the phenomena of this case of remittent fever,
with those of health and intermittent fever, establish the follow-
ing conclusions:

(1). The secretions of the mouth are more completely checked,
and the tongue is dryer, redder, and rougher to the feeling in
remittent, than in intermittent fever.

(2). The glowing tongue of remittent fever, is not an index of
iifflammation. It indicates a want of circulation in the capilla-

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1858.] Jones, on Malarial Fever. 591

ries of the superficial parts of the tongue. The secretions of the
mucous membrane have been^checked ; the moisture is evapora-
ted by the elevated temperature; the circulation in the superfi-
cial capillaries, is thus retarded, and they become filled with
colored blood corpuscles, which give the bright color to the
tongue.

The question arises, what checked the secretions of the mucous
membrane of the mouth ?

The consideration of the chemical alterations of many elements
and secretions enter into the solution of this question. We will
mention only five and acknowledge that this is nothing but a
statement of the manner in which the changes may take place,
and not a direct absolute answer to the question.

1. Theftells of the mucous membrane. 2. The capilliaries of
the mucous membrane. 8. The serum of the blood. 4. The
blood corpuscles. 5. The nervous system presiding over the
elaboration of the blood, the circulation of the blood in the
capillaries, and the formation of the secretions.

We have before demonstrated that the malarial poison, pro-
duces profound chemical and physical alterations in the colored
blood corpuscles, destroying many, and in all inducing chemical
changes which result in a great diminution of the fixed saline
constituents.

The blood corpuscles, collectively form an immense gland,
which elaborates the materials of the serum into compounds for
the nervous and muscular system, and probably for the various
secretions. Whatever therefore destroys or alters the chemical
changes of the colored blood corpuscles, must produce corres-
ponding changes, in the secretions and excretions, and in the
structure and action of the nervous system.

There is a portion of the nervous system which presides over
the circulation and chemical changes in the capillaries and thus
over the secretions. The malarial poison may act upon the
nervous system directly, or indirectly, by the changes induced in
the blood corpuscles and the constituents of the serum, or it may
act upon the nervous system in both ways combined at the same
time. Whatever acts directly or indirectly upon the nervous
system, will produce corresponding changes in the secretions,
excretions and nutrition.

3. In this case we cast aside the advice of many of the older
writers and administered the sulphate of quinia freely in the
outset of the disease, regardless of the glowing parched tongue,
tenderness upon presure of the epigastrium, and severe headache
and high fever, and rapid bounding pulse, thoracic respiration,
and hot dry skin. Under the action of the sulphate of quinia,
the dry red tongue became moist, clear and pale ; the circulation
and respiration abated in force and frequency, the dry harsh

692 Jones, on Malarial Fever. [September,

skin was covered with perspiration, and all the symptoms sub-
sided. The advantage of this mode of treatment will be illus-
trated subsequently.

4. The increase of the action of the pulse and respiration was
attended by an elevation of the temperature. The elevation of
the temperature corresponded more accurately with the increas-
ed action of the circulatory and respiratory systems in intermit-
tent fever, than in this case of remittent fever. That is., the
pulse and respiration were more accelerated in remittent fever,
whilst the temperature did not rise higher than that of intermit-
tent fever.

5. The urea was increased during the active stages of the fever,
not only above the normal standard during rest and a depriva-
tion of food, but also above the standard of intermittent fever.

6. The increased temperature and correspondiugly increased
chemical changes, were attended by an increase of the urea.
When the temperature fell below the normal standard, in both
intermittent and remittent fever, the urea was decreased in
amount.

7. The uric acid was diminished in the active stages of inter-
mittent and remittent fevers,and increased as the diseases subsi-
ded.

8. The changes in the acidity of the urine in this case, resem-
bled in all respects, those during intermittent fever.

9. The coloring and extractive matters, were diminished
during the active stages, and increased during the subsidence of
the fever.

Case XXV. Irish seaman : aged 21; height 5 feet 4 inches;
weight 125 lbs; brown hair, brown eyes, sallow complexion.
Has been in Savannah three weeks, and has been sick three days.
This is his first trip to Savannah, during the summer season.

October 12th, 12 M. Complains of great weakness and pain
in his back and bones ; says that he has had no chill and no fever
during the three days of indisposition, previous to his entrance
into the hospital. Pulse 80, full. ty. Sulph. of quinia grs. v.,
every three hours, up to grs. xv.

October 13tb, 12 M. Did not rest well last night; complains
of pain in his head and bones. Had a chill two hours ago.
Tongue clean, red, dry, and rough ; papillae enlarged. Some
tenderness of epigastrium. Skin hot and dry. Pulse 118 ; res-
piration 24-26, irregular, thoracic. $. Calomel, grs. x., castor
oil in four hours. $. Soda powders during fever, ty. After
fever remits, give sulphate of quinia, grs. v., every three hours,
up to grs. xx.

October 14th, 12 M. Medicine acted twice; tongue clean and
very red ; patient is not so restless ; complains of great weakness.

1858.]

Jones, on Malarial Fever.

593

Has taken xx grs. of sulphate of quinia ; temperature of skin
normal. $. Brandy, Oviij.; sulph. of quinia, grs. xv.; snake-
root tea, f^viij. Mix. Tablespoonful every four hours.

October 15th, 12 M. Had an increase of fever yesterday after-
noon, which was accompanied with severe pain in his head and
bones. Now he is restless and nervous; countenance uneasyy
anxious. All his motions are indicative of restless, uneasy,
anxious, feeling; complains of great thirst; tongue as red as
scarlet. At 9 o'clock A. M., this morning, it was dry and
glazed; at the present time, (three hours afterwards), it is a little
moister and softer ; lips dry, red and rough. Epigastrium very
tender upon pressure; trunk and head very hot, extremities only
moderately warm. Complains of pain in the small of the back,
and in the knees and bones of his legs. Pulse 106, feeble; res-
piration 30-40, irregular, labored, thoracic, panting. Temp, of
atmosphere, 74 F ; Temp, of hand 101 ; Temp, in axilla, 105.
The temperature under the tongue could not be taken on account
of his restlessness. Eeaction of saliva acid. There is a great
want of co-ordination between the circulation, respiration, and
temperature of the extremities. The capillary circulation and
chemical changes are impeded. ^, 4 cut cups to epigastrium;
4 cut cups over the lumbar regions and spine. $. Mustard to
extremities. $. Soda powders. Urine high colored, of a deep
brownish red color. Sp. Gr. 1028 ; reaction decidedly acid.

Amount of Urine passed during the last 30 hours, grains, 15430
u a u u u l u u 94 u " 12344

u u u u hourly, " " " " " 514

ANALYSIS XLV.

Grs. 15430 of Urine
passed during 30 hrs.
contained grains

Grs- 12344 of Urine
passed during 24 hrs.
contained grains

1000 parts-
Urine con-
tained

Urea

727-500

9-300

75-000

582-000

7-440

60-000

47*178

Uric Acid

0-60&

Fixed Saline Constituents,

4-863

7^ o'clock, P. M. Lies in a stupor, muttering to himself, and
is with great difficulty aroused. When aroused, answers inco-
herently, and says that he feels very well. Temperature of ex-
tremities below the normal standard cool ; temperature of head
and trunk normal; tongue of a bright red color ; great tender-
ness of epigastrium, pressure here arouses him more quickly
than violent shaking; pulse 100, feeble; respiration 32. ty.
Two cut cups to each temple. $. Apply a blister over the
epigastrium 6 inches by 4 inches, and another to the back of the
neck 4 inches by 5. R. Apply mustard to extremities. #,
brandy and snake-root tea, and spirits of mindererus, f 5ss. of
each alternately every half hour, until reaction is established.
$. Sulphate of quinia, grs. v., every three hours up to grs. xly.

594

Jones, on Malarial Fever.

[September,

Amount of Urine passed during the last 7 J hours, grains, 4072
u u hourly, ' " " " 543

Calculated amount of Urine for 24 hours, " 13030

Urine high colored and strongly acid in reaction. After stand-
ing 50 hours there was no deposit, and the reaction was still
decidedly acid. Sp. gr. 1018.

ANALYSIS XLVI.

Grs. 4072 of Urine
passed during 7 -J- hrs.
contained grains

Grs. 13030 Urine cal-
culated for 24 hours,
contained grains

1000 parts
Urine con-
tained

Urea

151*320
1-888

483-224
6-036

37-161

Uric Acid

0*461

October 16th, 9 A. M. Much better, intellect clear. The
cups, blisters, and stimulants, and sulphate of quinia have re-
stored the capilliary circulation to its normal state.

12 1 o'clock P. M. Continues to improve. Urine high colored,
of a deep orange red ; reaction strongly acid, after standing 15
hours, a slight deposit of mucous corpuscles, and after 100 hours
a small light yellow deposit of mucous corpuscles, urate of am-
monia and vegetable cells. The presence of the mucous corpus-
cles in the urine is due to the absorption and action of the can-
tharidin upon the mucous membrane of the genito-urinary
apparatus. In several severe cases of remittent fever, I have
discovered after the action of blisters, numerous spermatozoa in
the urine. Sp. gr. of urine, 1021.

Grs. 11231 of

Grs. 16746 of

Grs. 15303 of

Urine passed

Urine calcula-

1000 parts

Urine excret-

ANALYSIS XLVIL

during last 16

ted for 24 hrs.

Urine con-

ed during 24

hrs. containedj contained grs.

tained

hrs. contain-

grains

ed grains

Urea

357-445

5-500

53-900

535 667

8-250

80-850

31-826
0*489
4-799

508*760

Uric Acid.

7*380

Fixed Saline Constituents,

64-680

Amount of Urine passed during the last 16 hours, grains, 11231

" " " " hourly, " " " " " 702

Calculated amount of Urine for 24 hours, " 16746

Actual am't of Urine excreted during the last 24 hrs., " 15303

" " " " " hourly, " " " " " 637

3 o'clock, P. M. Skin dry but soft. Has taken xlv grs. of
sulphate of quinia. This has not as yet exerted its character-
istic effects upon the skin ; tongue red, but moist and soft; blis-
ters have drawn well serum from blistered surfaces of a golden
color ; patient complains of difficulty in passing his urine. This
is due to the absorption and action upon the mucous membrane
of the bladder and urethra, of the cantharadin absorbed from
the blistered surfaces. Pulse 84 ; respiration 16 ; Temp, of at-
mosphere, 695'F. ; Temp, of hand, 99 ; Temp, under tongue,

1858.] Jones, on Malarial Fever. 595

995'. $. Sulphate of quinia, grs. v., every three hours up to
grs. xv. fy. Continue spirit of mindererus and brandy, and
snake-root tea, f I ss of each alternately, every two hours. Diet,
mutton soup and arrow root.

October 17th, 12 ML Continues to improve; tongue red, but
clean and soft. Pulse 70 ; respiration 16. Temperature of atmos-
phere, 67F.; Temp, of hand, 9733; Temp, under tongue, 985.
Color of urine deep red, reaction decidedly acid. Sp. gr. 1022.
Eeaction of saliva strongly acid.

Amount of Urine passed during the last 24 hours, grains, 8176
" " " " hourly, - " 382

ANALYSIS XLYIIL

Urea

Uric Acid

Fixed Saline Constituents

Grs. 8176 of Urine excreted
during 24 hrs. cont'nd grs.

185-240

4*400

40*000

1000 parts of Urine con-
tained

22-578
0*538
4-892

The reduction of the temperature and of the action of the res-
piratory and circulatory system, has been attended by a corres-
ponding diminution of the constituents of the urine.

October 18th. Continues to improve, "feels quite well, with
the exception of great weakness". His appetite has returned;
tongue clean, moist and soft, and not so red. Pulse 72 ; respira-
tion 18. $. Continue brandy and snake-root tea. Color of
urine orange, much lighter; reaction in 20 hours decidedly al-
kaline. Sp. gr. 1020. Heavy light yellow deposit after stand-
ing 20 hours.

Amount of Urine passed during the last 24 hours, grains, 20400
" " " " hourly, " " " " " 850

Diet, soft boiled eggs, milk punch, arrow-root, and mutton soup.

October 19th, 12 M. Skin, pulse and respiration normal.
Urine orange colored. Sp. gr. 1020 ; reaction alkaline in 12
hours ; heavy light yellow deposit in 20 hours.

Amount of Urine excreted during the last 24 hours, grains, 15300
u u u u hourly, " " " " " 637

October 20th.

Amount of Urine passed during the last 24 hours, grains, 17374
" " excreted hourly, - " 724

1000 parts of Urine con-

ANALYSIS XLIX.

Grs. 17374 of Urine passed
during 24 hrs. cont'nd grs.

Uric Acid

Fixed Saline Constituents,

11-730
93-500

tained

0-675
5-381

Specific gravity of urine 1022 ; reaction alkaline in 12 hours
orange color. After standing 24 hours, a light yellow deposit
of triple phosphate and urate of soda was thrown down.

N.8. vol. xrv. no. ix. 32

596

Jones, on Malarial Fever.

[September,

October 21st, 9 A. M. The patient is dressed and has been
walking about the hospital grounds. His pale sallow complex-
ion and feeble gait, show the effects of malarial fever. Urine of
a light orange color, only a shade darker than normal. Sp. gr.
1024. Keaction just after its deposition, acid in 10 hours after-
wards alkaline. This change gave evidence of the formation
of ammonia, and was attended by the formation of crystals,
presenting, when the urine was held in the sun, a sparkling
appearance, like particles of silver. Under the microscope,
these crystals were found to be well formed prismatic crystals
of triple phosphate. The microscope also revealed a few crys-
tals of the urates of soda and ammonia.

ANALYSIS L.

Grs, 9234 Urine ex-
creted during 12 hrs.
contained grains

Grs. 18468 Urine cal-
culated for 24 hours,
contained grains

1000 parts
Urine con-
tained

Urea

229-599

7-740

91-800

458-198

15*480

183-600

25-128

Uric Acid

0'935

Fixed Saline Constituents,

9-941

AmouDt of Urine passed during 12 hours, - - grains, 9234

" " " " hourly, 769

Calculated amount of Urine for 24 hours, " 18468

This case confirms all the conclusions which were drawn from
the preceding case of remittent fever.

Case XXVI. Irish seaman, aged 38 ; weight 160 lbs ; height
5 feet 6 inches ; stout muscular man : first trip to Savannah, Has
been in Savannah 10 days, during which time he has worked
on a ship lying along the shore of the river, and has slept on
Bay-street at night.

October 14th, 2 P. M. Was taken sick four days ago with
pain in his head and in all his bones, accompanied with fever,
which has continued unabated up to the present time. Has had
no chill. Took a dose of calomel three days ago, which acted
freely. Now his face is much flushed ; skin hot and dry ; head
very hot ; complains greatly of pain in his head ; eyes look heavy
and stupid; tongue bright-red and dry; voice hoarse and gut-
teral ; says that he has been vomiting, and can retain nothing
upon his stomach. $. Cut cups to each temple, and two to
back of neck, and four over the region of the stomach.

If the cut cups do not relieve the vomiting, administer a table-
spoonful of equal parts of milk, lime water, and the aqueous
solution of the acetate of morphia.

October loth, 11 A. M. Says that he feels better; the cut
cups over the temples and back of neck relieved the pain in his
head, and the cut cups over the region of the stomach checked
the vomiting. Face is not so much flushed ; tongue still very

1858.] Jones, on Malarial Fever. 597

red, dry and rough; no tenderness upon pressure of epigastrium,
although the state of his tongue would lead us to look for it ;
skin soft and not so hot. This morning at 3 A. M., the fever
remitted with a perspiration. Pulse 76 ; respiration 20. Has
taken xxvi grs. of sulphate of quinia. $. Neutral mixture;
drink ad-Ubitum.

8 o'clock P. M. Has been vomiting this evening. This was
arrested by milk and lime-water, and acetate of morphia. Tip
of tongue for three-fourths of an inch, clean, dry, glazed, and of
a brilliant red color the remainder of the tongue is coated with
brownish-yellow fur, which is dr\r and harsh to the feeling;
face flushed and hot ; skin, upon all parts of the body, hot, pun-
gent and dry; no tenderness upon pressure of epigastrium.
The calomel has acted several times, and is still acting. Pulse
94; respiration 26. $. Soda powders. Urine, high colored,
like new Madeira wine.

October 16th, 1 o'clock P. M. Did not rest during the night;
was tossing about, and getting up out of the bed every few mo-
ments, and was and is now tormented by unquenchable thirst;
appears to be completely exhausted. Tip of tongue clean, dry,
scarlet-colored, glazed, shining posterior portion (base) of
tongue coated with brown and black fur, dry, harsh, and as
rough as sand-paper. The under surface of the tongue is dry,
glazed and shining. There is no more moisture in his tongue,
and in the walls of the mouth, than if they were made of glass.
Skin hot, dry, and harsh to the feeling.

The temperature under the tongue, cannot be taken, on ac-
count of the dry condition of the lips and tongue. Bowels are
loose stools watery and yellow ; no pain upon pressure of epi-
gastrium. Complains of no pain anywhere. There is a great
tendency to stupor.

Although his tongue is glowing red, and his face is flushed,
and there is an inclination to stupor, still I will administer sul-
phate of quinia and stimulants, because he is exhausted, and the
appearance of the mucous membrane of his mouth and tongue
is indicative, not of inflammation, but of derangement of the
capillary circulation, and of alterations in the structure of the
nervous system and blood.

$. Brandy, f 3 viij.; Snake-root tea, f 3 viij.; Sulphate of qui-
nia, grs. xv. Mix. f 5J. every hour. $. Spirit of mindererus,
f 3 j. every hour. 3. Mustards to extremities. $. Sulphate of
quinia, grs. v.; Camphor, grs. ij. Mix. Every three hours.
%. Soda powders.

Amount of Urine passed during the last IV hours, grains, 10210
" k- hourly, " 600

Calculated amount of Urine for 24 hours, - - u 14406

Sp. gr. 1020 ; reaction decidedly acid ; urine high colored, like

598

Jones, on Malarial Fever.

[September,

new Madeira wine. No deposit after 30 hours ; after 60 hours,
a slight deposit of mucous corpuscles and triple phosphate.
Crystals of nitrate of urea, silvery and well formed. Hydro-
chloric acid showed the presence of coloring matters in large
amount

ANALYSIS LI.

Grs. 10210 Urine ex-
creted during 17 hrs.
contained grains

Grs. 14406 Urine cal-
culated for 24 hours,
contained grains

10C0 parts
Urine con-
tained

Urea

320-980
0-200

30-000

452-581

0-382

40-330

32*305

Uric Acid

0-019

Fixed Saline Constituents,

2-938

Oct. 17th, 11 o'clock A. M. Much better. Tip of tongue
clean superior portion coated with fur; tongue moister, softer,
and not so red as on yesterday ; face much less flushed ; the
burning thirst has almost entirely disappeared; has no pain
anywhere, and says that he has an appetite ; no tenderness of
epigastrium. Has taken grs. xxx. of the sulphate of quinia
since 1 o'clock P. M., October 16th. Pulse 68; respiration 18.
.Pulse much fuller respiration more regular and soft. Tem-
perature of atmosphere, 68 F. ; Temp, of hand, 98 ; Temp, un-
der tongue, 99 5'.

Here we see, that under the action of the sulphate of quinia
and stimulants, his respiration has become regular ; his pulse
slower and fuller ; his burning thirst diminished; his glowing
tongue and flushed face, paler ; his parched mouth, moister ;
his intellect brighter ; his exhausted forces more active ; and all
the secretions and functions more regular. Urine, high color-
ed. Decided acid reaction. Sp. gr. 1022. No deposit after
standing 30 hours. After 80 hours, a small light-yellow depo-
sit of triple phosphate and urate of soda.

Amount of Urine excreted during the last 24 hours, grains, 12264
" " " " hourly, " " " " " .511

ANALYSIS LII.

Grs. 12264 Urine passed
during 24 hrs. cont'nd grs.

1000 parts of Urine con-
tained

Urea

315 250

5 200

34-800

30 846

Uric Acid

0-440

Fixed Saline Constituents.

2-84G

$. Continue camphor and sulphate of quinia, and brandy and
snake-root tea. Diet, milk punch, wine whey, arrow-root, and
mutton soup.

October 18th, 12 o'clock M. Eested well during the night
had no fever, and his skin was in a good perspiration. The
great thirst has entirely disappeared. Tongue still redder than
normal, but moist and soft, and the yellow fur coating the pos-
terior portion is breaking up and cleaning off; skin moist, and
normal in temperature and feeling. Pulse and respiration nor-

1868.] Joxes, on Malarial Fever. 599

mal. Dressed himself, and has been walking in the ward.
Urine of a deep orange color, several shades lighter than that
voided yesterday. Sp. gr. 1019. Reaction slightly acid.
Amount of Urine passed during the last 24 hours, grains, 12737
" " hourly, " " u u " 614

R. Continue brandy and snake-root tea, table-spoonful every
three hours. Diet, soft boiled eggs, milk punch, mutton soup,
arrow-root and rice.

October 19th. Dressed, and walked about the ward.

October 20th. Walked about one mile into town, says that
he feels well; urine orange color. Sp. gr. 1020. After stand-
ing 12 hours, a heavy light yellow deposit of triple phosphate
and urate of soda. 1000 parts of urine contained uric acid,0-607.
Fixed saline constituents, 3*529.

October 2 1st. Says that he took a slight cold yesterday
during the walk into the city ; urine orange color. Sp. gr. 1019.

Amount of Urine passed during the last 17 hours, grains, 13247

M u u u hourly, " " u u " 770

Calculated amount of Urine for 24 hours, * 19495

ANALYSIS LIU.

Grs 13247 Urine ex-
creted during 17 hrs.
contained grs.

Grs. 19595 Urine cal-
culated lor 24 hours,
contained grains

1000 parts
of Uri ne
contained

Urea

181 5GS

6 110

96 900

290-5H8

9 770

154 040

12 992

Uric Acid

0461

Fixed Saline Constituents.

7- 199

This patient had no return of fever and was discharged a few
days subsequently. This case sustains not only the conclusions,
but also the treatment of the two preceding cases of remittent
fever.

Case XXVII. Seaman, native of Scotland; age 21; height
5 feet, 5 inches ; weight lo4 lbs. This is his first trip to Savan-
nah. Has been in this port three weeks, and during this time,
has slept on board ship in the river. Two of the crew from the
same ship are now in the hospital with remittent fever.

October 13th, 12 M. Was taken three days ago with a chill
and pain in his back, head and all the bones. This was followed
by fever. Has fever now. Skin hot and dry ; pulse 108 full ;
respiration 38, thoracic; tongue pointed, red at tip and edges;
coated with brownish yellow fur dry and harsh, rough to the
feeling; no tenderness of epigastrium. $. Calomel grs. x.;
sulphate of quinia, grs. v. Mix. Administer, and follow by
castor oil in four hours. The patient must be closely watched
during the action of the medicine, and if he appears to be undu-
ly exhausted, apply sinapism and administer stimulants.

9 P. M. Appears stupid, is aroused with difficulty. Tongue

600 Jones, on Malarial Fever. [September,

dry and rough; face flushed; skin hot and dry ; pulse 100. R.
Brandy and snake-root tea, tablespoonful every hour. R. Sul-
phate of quinia, grs. v. every three hours, up to grs. xxx.

October 14th, 12 M. Much better ; medicine operated freely ;
tongue soft and moist; pulse not so frequent; skin soft and
much cooler; no tenderness upon pressure of epigastrium. Com-
plains of pain in back, in the region of the lumbar vertebrae and
cannot bear the slightest touch over the seat of the pain. R.
Four cut cups over the region of the pain in the back. R. Con-
tinue brandy and snake-root tea, and sulphate of quinia, table-
spoonful every four hours.

October 15th, 12 M. Cut cups relieved the pain in the back.
Apex of tongue, for about half of an inch, clean, red and dry;
the remainder of the tongue is coated with rough, dry, brown-
ish black and yellow fur. No tenderness of epigastrium ; skin
hot, dry and pungent ; pulse 90 ; respiration 30. Temperature
of atmosphere 74 F. ; Temp, of hand, 105 ; Temp, under
tongue, 106. Eeaction of saliva decidedly acid.

8 o'clock P.M. Face still flushed, and expression of coun-
tenance stupid ; intellect dull and heavy ; skin in a slight moist-
ure ; tongue presents the same appearance, only a little moister.
The head and trunk are hot, but not pungent. Temperature of
extremities above the normal standard, but cooler and not so
pungent as at 12 o'clock. Pulse 90 ; respiration 22-26, irregular.
R. Sulphate of quinia, grs. v., every three hours, up to grs. xx.
Soda powders.

Amount of Urine excreted during the last 8 hours,

" " " hourly, " " " "

Calculated amount of Urine for 24 hours, - ' -

grains,
U

5610
101

u

16830

ANALYSIS LIV.

Grs. 5610 Urine ex-
creted during 8 hours
contained grains

Grs. 16830 Urine cal-
culated for 24 hours,
contained grains

1000 parts
of Urine
contained

Urea

125-372

4 675

29-150

376 047
14 025
87-450

22 147

Uric Acid

Fixed Saline Constituents.

0 833
5-196

This urine, which was excreted during fever, and under the
action of sulphate of quinia, differs from the former specimens,
excreted under similar circumstances, in that the uric acid was
greatly increased. Sp. gr. of urine 1020. Orange colored nitrate
of urea, silky, silvery. No deposit after 30 hours ; at the expi-
ration of this time the reaction was still acid.

October 16th, 12 o'clock M. Toogue dry and rough ; com-
plains of pain in his legs and left side. Countenance is more
easy. Urine, high colored, red. Sp. gr. 1020. Eeaction acid.
After standing 15 hours, a light yellow deposit of triple phos-
phate, and urates of soda and ammonia.

1858.]

Jones, on Malarial Fever.

601

Amount of Urine passed during the last 16 hours, grains, 11220

u u u u hourly " " " " " 101

Calculated amount of Urine for 24 hours, " 1G830

Actual amount of Urine passed during the last 24 hrs. " 16830

" " " " hourly, " " " " u 701

ANALYSIS LV.

Grs. 11220 ot
Urine excret-
ed during 1G
hrs contained
grains

Grs. 16830 or
Urine calcu-
lated for 21
hrs., contain-
ed grains

Grs. 16830 ol
Urine excret-
ed during 24
hrs., contain-
ed grains

1000 parts
Urine con-
tained

Urea

341440
4-400

512- 160
6-600

466 812
9 070

30 906

Uric Acid

0 392

ft. Brandy and snake-root tea, and spirit of raindererus, f 5j. of
each, alternately, every two hours, ft. Sulph. of quinia, grs. v.,
every three hours, up to grs. xxxv.

3 o'clock P. M. Tongue moister and softer, tip and edges not
so red posterior portion still coated with brownish-yellow fur.
Slight tenderness upon pressure of epigastrium. Pulse 75;
respiration 20. Temperature of atmosphere, 70 F. ; Temp, of
hand, 10133'; Temp, under tongue, 1015\ R. Continue
brandy and snake-root tea, spirit of mindererus and sulph. of
quinia.

October 17th, 12 M. Much better ; has been dressed and
about the ward this morning ; tongue soft, moist ; the yellow
fur is soft and rapidly disappearing ; reaction of saliva decided-
ly acid; pulse 54; respiration 18; Temp, of atmosphere, 68F.;
Temp, of hand, 96 ; Temp, under tongue, 99. Urine much
lighter in color, only a shade higher than normal. Sp. gr. 1020.

1000 parts of Urine contained,

Urea, - - - - 20783

Uric Acid, - - - A trace a few small crystals.

Fixed Saline Constituents, - 2156

The disappearance of the uric acid is, without doubt, due to the
action of the sulphate of quinia. This patient continued to
improve and was discharged on the following day. This case
illustrates, in a striking manner, the beneficial effects of stimu-
lants and large doses of sulphate of quinia in remittent fever.
The prompt administration of sulphate of quinia and stimulants,
not only cuts short the disease, but also supports the strength
of the patient, and he comes through a severe attack with com-
paratively unimpaired forces.

(To be continued.)

602 Doughty. Report of Hospital Cases. [September,

ARTICLE XXI.

Report of Cases in the City Hospital. By W. H. Doughty, M.D.,
Augusta, Ga.

INTERMITTENT FEVER, ATTENDED WITH A SWELLING OF THE

TESTICLES.

J. 0., was admitted March 10th, for injuries (fractured ribs)
which he had received by a fall upon the deck of a steamboat.
When examined, it was found that he also suffered from a
swelling of the testicles. He was not sensible of any injury
having been inflicted upon them, but thinks that no violence
has been done them by the fall, since he is subject, upon expo-
sure, to this peculiar malady. The ordinary mode of manage-
ment of fractured ribs was pursued, attention being also paid to
the swollen organs. In due time, these latter were restored to
their natural size, and his condition, otherwise, so much im-
proved that he was permitted to leave the hospital for a short
time. He became intoxicated soon after his departure, and lay
out that night in the street, exposed to a very damp atmosphere
and an exceedingly heavy dew.

April 6th. Keturned at 7 o'clock A. M. Was taken with a
chill at 10 A. M., which lasted about four hours, and during the
continuance of which his testicles became enormously swollen.
Having been interrogated concerning his liability to intermit-
tent fever, and whether or not this glandular swelling was a
common attendant, he replied, that whenever he had a chill or
was much exposed to cold and damp, his testicles almost invari-
ably swelled, the engorgement, at such times, producing excru-
ciating pain. He was visited during the chill; and being struck
with this unusual feature in ague and fever, the testicular en-
gorgement was closely watched, in order to ascertain whether
or not it would subside with the termination of the paroxysm.

Treatment. ty. Spts. camphor gtt. xxv. ; Chloric ether 3j.;
Tr. opii. gtt. x. to be given occasionally during the cold stage ;
also, mustard to spine and extremities.

April 7th. Patient in a profuse perspiration ; bowels confined ;
testicles swollen and painful ; tongue furred, yellow.

1858.] Intermittent Fever, &c. 603

Treatment. Mercurial cathartic immediately ; quinine, 3 grs.
every three hours ; cold applications to testicles.

April 8th. Patient better ; no chill ; swelling of the testicles
diminished.

Treatment Same as yesterday.

April 9th. Swelling of the testicles disappeared ; patient up,
moving about. Discharged 10th.

Eemarks. Perhaps no principle in pathology is more univer-
sally received by the practical part of the profession, than that
of a congestion of the organs, which repose in the three great
splanchnic cavities of the body, during the cold stage of an inter-
mittent. Indeed, whilst they differ widely among themselves,
as to its determining cause or causes some attributing it to a
state of poisoning of the blood, and others to primary lesion of
the nervous system, yet they agree, that this cold stage is
the result of a sudden retreat of the blood from the surface to
the internal organs and structures. No exception to this fact is
recognized, for we never read or hear of a congestive deter-
mination, to either of the four extremities, unless we regard
as such, the rare instances upon record of a concomitant con-
gestion of the genital organs. How far the occasional, perhaps
accidental, determination of the vital fluid to these organs,
constitutes it an example of an external or peripheral ten-
dency, we are not prepared to say, since, like the arms and
legs, in the language of Hunter, they "are not necessary for
the existence or support of the individual, but have a reference
to something else." The exceeding great rarity of these cases,
entitles them to peculiar interest, if for no other reason, than
the opportunity which they present of beholding an organ
under the congestive influence of an intermittent. The penis,
in this case, was unaffected, being entirely relaxed, notwith-
standing the violent congestive determination in its immedi-
ate vicinity. All of the cases, affecting the genital apparatus,
that have come within the scope of ray study, have been
confined entirely to the penis. The, following is from Dr. Dick-
son * of Charleston. " We had in our museum, a long while,
sthough now lost, the preparation of a penis, which suffered

* Dickson's Elements of Medicine, page 214.
K. 8. VOL. XIV. SO. IX. .33

604: Doughty. Report of Hospital Cases. [September,

during a protracted attack of intermittent, the same, or analo-
gous, engorgement, enlargement and induration which usually
derange the spleen in ague, being obviously the seat of the
congestive determination, familiarly taking place in that vis-
cus. They possess an erectile structure in common. The case
occurred in our almshouse, and was witnessed by a large
number of physicians, none of whom, I belive, entertained any
doubt of its nature." Further on, he states, that a similar case
had been reported to him, as having occurred in the state of
New York, "in which the same organ was attacked with con-
gestive or vascular turgescence, during the paroxysms." No-
thing is said concerning the adjoining organs (testicles) in these
cases, but we are justified in the belief, that the determination
was confined entirely to the penis. In the case reported, it will
be observed, that the patient had just recovered from an attack
of orchitis, f and doubtless the predisposition to a recurrence still
remained. The history of this case might justify us in laying
stress upon secondary influences, in producing such a deter-
mination ; but in regard to those quoted, we cannot say, since
nothing is mentioned as to their previous condition, whether
diseased or not. A point of dissimilarity between the reported
case and those quoted, exists in the fact, that the state of
priapism of the latter, is said to have existed, "during the
paroxysm," whilst the testicles in the former, remained swollen
for several days, and were subjected to treatment. This dis-
similarity becomes reconciled at once, we conceive, by a refer-
ence to the difference in the anatomical structure of the two
organs and their physiological functions.

PHTHISIS PULMONALIS.

R N., has been an inmate of this institution since Feb. 8
is about 45 years of age has been subjected to great hardships,
and undergone the numerous privations of poverty : is also ad-
dicted to drunkenness and its associate vices. Has been labor-
ing under this disease since 1854. During this time, has had
numerous hemorrhages, not, however, very profuse. At present,
she evinces all the common symptoms of consumption viz.,
cough, purulent expectoration, hectic fever, diarrhoea, etc. The

f There was no venereal infection.

1858.] Phthisis Puhnonalis. 605

most distressing symptom seems to be a difficulty of breathing,
apparently asthmatic in character and referred to the right side.

Physical Examination of the Chest. Heart. The action and
sounds of this organ are natural in their evolutions.

Auscultation of Right Lung. Broncho- vesicular respiration
established throughout the king is everywhere prominent, but
most so in the infra- scapular and scapular regions. Inspiration
high in pitch tubular and blowing in quality intense and
shortened in duration ; also, a sound, as of dry crackling, dis-
covered at the end of inspiration in the scapular region and at
its apex. Expiration high in pitch, being remarkably loud,
bronchial in quality, and longer than the act of inspiration.
The natural rhythm of the respiratory acts destroyed, being
very irregular.

Left Lung. A modified (broncho-vesicular) respiration exists
only in the apex of this lung: the vesicular respiration in the
middle and lower lobes seems to be simply exaggerated, without
noted deviations as to quality.

Auscultation of the Voice. Right Lung. Bronchophony very
prominent at the point of the scapula, and radiating in a more
or less marked degree, all over the right side, even to the apex.

Auscultation of the Voice. Left Lung. The normal vocal re-
sonance slightly modified in the apex.

Auscultation of the Speech. Right Lung. Perfect pectoriloquy
at the point of the scapula not discoverable at any other por-
tion.

Auscultation of the Speech. Left Lung. No departure appre-
ciable.

Percussion of Right Lung. Marked dulness over the entire
lung more tympanitic than otherwise, in quality, about the
point of the scapula, denoting, with its correlative signs, the
presence of a cavity.

Percussion of Left Lung. Appreciable dulness over the apex
ofthe left, with tenderness.

Treatment. Blisters, from time to time ; syrup superphosphate
ferri, 3iij. three times daily.

Remarks. The principal treatment of the above case con-
sisted in the use of the syrup superphosp. ferri. Indeed, having
noticed at that time, frequent allusions, in the various medical

606 Doughty. Report of Hospital Cases. [September

journals, to the treatment of consumption with phosphorus, this
course was adopted with an experimental view. It was given
in such a manner, that from 5 to 10 grs. of the salt (superphos-
phate ferri) were taken daily it was continued up to the time
of the death of the patient (May 12th). She would frequently
express herself benefitted by it, but no beneficial effect could be
perceived by myself. The only good which it possibly accom-
plished, was an exhilaration of the system, which but increased
the fatal delusion of the sufferer, that she was better physically.
The preparations of phosphorus recommended by Dr. Churchill,
the hypo-phosphites of soda or lime, could not be obtained, and
this being at hand was substituted. Of courser no inference
would be safe, much less conclusive, in regard to the use of this
therapeutical agent, from a single case of phthisis,, but, as far as
this case goes, it at least serves to negative, to some degree, that
recent special pathology of consumption, which ascribes it to a
deficiency of phosphorus in the system. It would be considered,
neither unwise nor unnatural to suppose, that a deficiency of
this chemical element did exist, amidst the outspread and almost
illimitable devastations of this disease ; but such a conditition,
if it exists, should be regarded in the light of a consequence or
coincidence, rather than the cause. I am not aware, that this
ideal pathology is supported by the chemical proof of a material
diminution, not to say absence, of this element of the numerous
salts, excreted by the various emunctories of the body.. Molli-
ties ossium is a disease, attributed to a deficiency of a salt, one
element of which is phosphorus. Would not persons, subjects
of this disease oftentimes for years, present more or less of this
condition, as an ultimate symptom, if this pathology be true?
More than this : organic chemistry teaches, that the brain and
osseous system contain the greater part of the phosphorus of the
system. Physiologists also state, that "the quantity of phos-
phorus which may be found in the nervous matter varies con-
siderably at different periods of life, and is very small in idiocy-."
" The minimum of this element is found in infancy, in old age
and idiocy." Now, this being true, intellectual development
would seem to keep pace with it, increasing with its increase,
and declining with its decline. Should we not, with consistency
look for a decided failure of the intellectual man, coextensive
with the diminution of this substance in the .progress .of _the dis-

1858.] Bronchial Phthisis, &c, ' 607

ease ? Does the practical history of the consumptive teach this ?
There is no evidence upon record, to the end, that consumption
produces greater prostration of the mental energies, than any
other cachectic disease. On the contrary, examples are not
wanting in history, showing the highest mental abilities, in con-
sumptives, some of whom have distinguished themselves and
left their mark upon the age in which they lived. To deny any
benefit to alkaline phosphates or those tonic in their combina-
tion, in phthisis, would bespeak ignorance ; but we think, that
time and experience will prove that they are not curative, and
will determine the circumstances under which they are to be
used. In the above case, it produced no effect, other than an
increased buoyancy of spirits, with a commensurate cheerful-
ness. Seasoning from its physiological importance to the sys-
tem and its therapeutical action, as far as is understood, it is
perhaps better adapted to the condition of certain dyspeptics.

BRONCHIAL PHTHISIS, WITH DISEASE OF THE HEART.

Edward M. was admitted March 14th, for cough: is about 26
years of age ; dark hair and eyes states that he has had a cough
for five months ; has never spit blood ; is not hereditarily pre-
disposed to consumption, but thinks that a brother of his died
with disease of the heart.

Symptoms. A violent, convulsive cough ; scanty and frothy
expectoration during the day, but consists, early in the morning,
of pus and hardened mucus; shortness of breath, confined to the
left side of the chest ; frequent palpitation of the heart; the least
exercise readily excites the attacks of palpitation ; cannot lie
upon the left side, from the violence of the cough, which is ex-
cited thereby; no pain in the chest; is not subject to headache;
left cheek flushed; pulse natural in frequency, but rather full;
bowels regular, and appetite and digestion good.

Physical Examination of the Lungs. The respiratory murmur
on the right side, normal in its various features ; on the left, the
vesicular murmur is somewhat exaggerated in the upper lobe,
whilst a broncho- vesicular respiration is observed in the other
lobe an expiratory murmur, however, only occasionally per-
ceptible.

Auscultatum-of Voice and Speech.No variation.

608 Doughty. Report of Hospital Cases, [September,

Percussion. Normal vesicular resonance observed throughout
the chest.

Physical Examination of the Heart In the supine posture, its
impulse is. very strong, being felt and heard everywhere on the
lower part of the left side, in front, and in the infra-clavicular
region of the right; in the erect, in the supra-scapular region of
the left, also. The sounds appear to have a muffled quality or
tone, and with the impulse, are distinctly audible in the supra-
scapular and tapper inter-scapular region of the left side. In no
other part of the superficies of the chest, can the sounds be heard,
than in the immediate vicinity of the heart and in this particu-
lar region.

Percussion shows a larger area ef dulness over the cardiac
region, than is usually found in healthy persons.

Treatment. Blister 2 by 6 inches to chest, (leftside), running
obliquely towards the spine; alkaline cough mixture.

March 19th. Patient somewhat improved ; cough less fre-
quent and violent since the drawing of the blister, has lost its
convulsive character; expectoration more loose. Treatment
continued.

March 23rd. His condition the same, except that the cough
has regained its convulsive character, since the drying up of the
vesication.

Treatment. Blister renewed ; ext. belladonna?, in suitable
doses, added to the alkaline cough mixture.

March 29th. Cough less frequent expectoration still contains
pus early in the morning.

Treatment. Cod-liver oil, Iss. three times daily, in conjunc-
tion with the above remedies.

March 30th. Physical Examination of the Chest. Broncho-
vesicular respiration more general in the left lung sonorous
rkonchus sometimes observed in the same ; the other characters,
the same as were noted at the first examination.

Percussion over the left lung shows an appreciable dulness in
the infra-scapular region.

A close examination of the heart was prevented by the recent
vesication : so far as was observed, the result confirmed the pre-
vious one.

April 20th. Patient is decidedly better coughs but little, and
only when he first awakes ; general health improved can walk

1858.] Bronchial Phthisis, &c. 609

up and down stairs, without being distressed by palpitation; is
gaining flesh; still expectorates pus. Treatment, same.

May 10th. This patient was so much improved, that he left
the hospital for New York.

We regret, not having had another opportunity of examining
him physically, which was prevented by his sudden determina-
tion to return to the north.

Remarks. In the differential diagnosis of diseases of the
chest, from a frequent association of disease of the different or-
gans, contained in the cavity, it is exceedingly difficult, if not
impossible, always to distinguish the one primarily affected ; for
they all present such a community of symptoms as to require
the nicest tact and the most accurate judgment to determine, une-
quivocally, the order of the diseased actions. In the case above
the patient had entered the institution to be treated for a cough
which, as is usual among the unprofessional, when protracted
he considered as an evidence of consumption. Happily, physi
cal exploration, by the absence of certain landmarks, when associ
ated with the history of the individual, as to predisposition and
the previous occurrence of haemoptysis, was sufficient to decide
in favor of a bronchial affection, without tubercular complica-
tion. Having determined this point, another presented itself,
viz: With the heart and the bronchiae, both diseased which is
the primary lesion? This, to the patient, became a question of
great moment; for, if the lung be primarily diseased, with its
cure, which might reasonably be expected, the sympathetic af-
fection of the heart, now assuming an organic nature, might
also be expected to retire. But if the heart be the primarily
diseased organ, notwithstanding the bronchial affection yield to
treatment, yet, to say the least, recovery would be more than
doubtful, such condition of the organ, as we suppose this
to have been, seldom, or never, proving amenable to treat-
ment. Without mentioning, in detail, the reasons which im-
pelled us to the conclusion, we are satisfied, that the heart was
primarily diseased, and that the bronchial affection was second-
ary, being kept up by its proximity to the former, its increased
action and the want of proper treatment. What the particular
diseased condition was, we have not stated, and is still a matter
of doubt, but we suppose it to have been, one of hypertrophy,

610 Doughty. Report of Hospital Cases. [September,

with, perhaps, dilatation of its cavities its various signs and
symptoms pointing more particularly to this. The most remark-
able feature presented by the case, and the one which induced
its publication, was that of a distinct appreciation of the impulse
and sounds of the organ, without solidification of the pulmonary
tissue, at the supra-scapular and upper part of the inter-scapular
region of the left side of the chest. In healthy persons, this
latter phenomenon is not observable at any point on the poste-
rior aspect of the chest, but is confined to an extent of surface
between the right infraclavicular region and the anterior aspect
of the left side of the chest. The only conditions of the thoracic
viscera which have been proposed for the interpretation of this
phenomenon, are an increased conducting capacity of the pul-
monary structure from solidification, as in pneumonia, carcino-
ma, pulmonary apoplexy, compressions of pleuritic effusions,
and tuberculous deposits ; also, in cases of emphysema, where
the conduction of sounds seems to be abnormal in one lung
from the diminished capacity of the other. In this case, no
evidence of a consolidated condition of the lung was observed ;
on the contrary, the normal vesicular resonance was unmodified
beyond that which occurs in ordinary cases of bronchial disease.
No materially increased conductibility of sound could be attri-
buted to this organ under this condition of things. It could not
have been produced by emphysema of the right, since no evi-
dence to this effect existed, and, moreover, the left was the dis-
eased one. How, then, are we to explain its production? We
have no satisfactory answer to the query, unless it be, that under
the increased action of the heart, the enlarged extent of its sur-
face, which came in contact with the chest, the thoracic parietes
became the instruments of this greater transmission of its sounds.
On the other hand, if this be so, would not every case of hyper-
trophy, with dilatation, even unassociated with diseased lungs,
be characterized by the same observation ?

In connection with the production of this phenomenon, it
may not be amiss, to present the following quotation :*

" Dr. Walshe states, that in a case of intense emphysema of
the left lung in which the disease was limited, and especially
marked at the posterior aspect of the chest, he found the heart

* See Flint, on the Respiratary Organs, p. 291.

1858.] Bronchial Phthisis, &c. 611

sounds considerably more distinct posteriorly on the right, than
on the left side, there being no evidence of induration of the
right lung to intensify the sounds on that side. The disparity
here was attributed to an abnormal diminution of the transmis-
sion of the sound to the posterior surface of the left chest, the
right remaining in a normal condition in this respect. AVithout
knowledge of the fact that the transmission may thus be abnor-
mally diminished, a normal intensity may be mistaken for a
marked sign."

An obvious inference from this quotation is, that this trans-
mission of the sounds of the heart to the posterior of the chest,
may take place even in health ; but so far as our reading and
observation extend, it is at variance with other authors, for the
vesicular structure of the lungs produces such a diffusion of the
sonorous vibrations, as effectually to prevent such a perfect
transmission, as will be appreciated by audition. Being analo-
gous to the production of the physical sign, pectoroloquy, it
necessarily requires a more solid conducting medium, than the
porous, vesicular tissue of the lungs. It will be remarked, that
the phenomenon was only distinguishable at a particular part
(the supra-scapular and upper inter-scapular region of the left
side): if it had been owing to a natural transmissibility by the
lung, it would not have been so circumscribed.

The only alternative, to which we may resort, by which to
account for the morbid sign, viz., transmission by the thoracic
walls, is, when we examine strictly the circumstances of the case,
perhaps ful]y adequate to its accomplishment. In health, dur-
ing the alternate contraction and dilatation of the heart, no part
of the organ touches the thoracic walls, except its apex, and
that only during the contraction of the ventricles. The im-
pulse, the result of this action, is most distintly felt between the
5th and 6th ribs. Again, those parts, the various valves, which
are the agents in the production of the two sounds, occupy a
position in this organ higher up, being situated beneath the 3rd
'and 4th ribs, whose spinal attachments are in the supra-scapular
and upper inter-scapular regions. Now, when the heart is of
its natural size, it is entirely separate from these ribs (3 and 4),
therefore, whatever of sound is transmitted by them, must be
derived indirectly from the impulse below, through the muscu-
lar septum of the intercostal spaces. Now, if the heart be en-

612 On Headache. [September,

larged, and at the same time dilated, it has a greater extent of
surface in contact with the parietes of the chest, increasing the
space over which the impulse may be felt, and favoring a more
direct transmission of the valvular sounds by the same, to dis-
tant parts. Bearing in mind the spinal attachments of the 3rd
and 4th ribs, and their relation at their sternal extremities to
that portion of the heart which contains the valves in conjunc-
tion with the increased action of this organ, producing greater
intensity of sound, may we not find in their direction the key
to the solution of the problem under discussion. Their firm,
dense structure, receiving direct impressions, render them better
conductors of sounds, and perhaps point to a reason why the
sounds were not heard in other directions of the same side.

Perhaps the worthy editors of this journal can give some
additional reflections, valuable to its readers, upon the point
involved.

On Headache. By John Addington Symonds, M. D., F.R.S.E.,
Consulting Physician to the Bristol General Hospital, etc.

It is an interesting but a difficult investigation to ascertain the
mode of production of some of these sympathetic pains in the
head. Here, for instance, is a question. What is the cause of a
so-called bilious or sick headache in a person who suffers such
an attack once in a year or so? In him there cannot be any
great susceptibility on the part of the cerebral nerves, or it would
occur oftener. But what is the course of events when it does
occur? We need not stop to ask whether it is some imperfectly
chymified substance in the duodenum, or some depraved secretion
which begins the mischief. We will assume it to be some dis-
turbing impression on the nerves of the alimentary tube.

This impression may or may not. produce a sensation of indi-
gestion before the headache. If it does, we might suppose that
the impression has passed by extension from the parts of the sen-
sorium in relation with the nerves of the stomach to that which
is in relation with the nerves of the head, and that the pain is, so
to speak, reflected on the latter nerves. If this is the course, I
think it must be presumed that there must have been some pre-
vious disposition in the centres related with the nerves of the
brain to be so affected.

I doubt if this hypothesis is so tenable as the supposition that
the impression is communicated along the sympathetic chain to
the nerves of the brain, and there excites the disturbance.

1858.] On Headache. G13

Whatever may be the function of the sympathetic nerves as to
sensation, motion, and reflex action, it is impossible to observe
their intricate nexus, as well as their distribution, without suspect-
ing that one part of their duty must be internuncial between the
viscera, and that they must be the agents of that consentaneous
operation without which the functions of organic life could not
long continue.

Order in time must be as necessary in the human microcosm
as in the macrocosm of the universe. Were the processes of
digestion, sanguifaction, respiration and circulation, to go on in-
dependently, the vital machinery would soon come to a stop.
The heart beats at definite intervals, the respiration keeps a pro-
portionate time, food should enter, and its residue leaves the sys-
tem at regular periods. But the rates are perpetually changing,
from the variations of daily or even hourly life, and the changes
must be announced from one part to another, in order that the
requisite adjustments may take place. Without entering, however,
more minutely into speculations as to the final cause of the inti-
mate nervous connexions of the viscera, we may content our-
selves with pursuing the way of exclusion. The cerebro-spinal
nerves mixed up with the ganglionic nerves account for as much
of sensation and emotional influence and reflex action, as we
meet with in the viscera. The contractions of the muscular
fibres of organic life, probably have special relations with true
ganglionic fibres and ganglionic centres, uni-pular, bi-polar, etc.
Still there are a large number of plexuses and nerves, entering
and departing from those plexuses, whose function is scarcely
accounted for, unless we infer that their office is to keep up a con-
nexion of some sort between the viscera.

A general survey of the ganglionic system and the connecting
nerves, impresses us with the unity of the whole system. But
without the a priori assumption that organs so connected must
work together, we have strong a 'posteriori evidence of the con-
nexion in the events of disease. One organ, the variations of
whose actions may be considered typical of the rest, is more easily
observed than the others. I need not say that J allude to the
heart. Much has of late years been done to prove the dependence
of its rhythmical action on ganglionic centres. Since these re-
searches, I think we can no more definitely understand than ever
we could understand before, the readiness with which the rate of
the cardiac pulsations is affected by disorders of anv organs within
the ganglionic chain. The intermittent pulse of indigestion, the
alarming rapidity of the heart's action from inflammation of the
peritonaeum, or the depression of its action from injuries without
loss of blood or severe pain show that this regulating central
power of the circulation, not only receives tidings of distant
organs with great quickness, but also that it is seriously perturbed

614 On Headache. [September,

by them. There is every reason from analogy to infer, that,
although we have not such ready means of noting the influence
of other ganglionically connected organs on each other as in the
case of the heart and the other viscera, yet that communications
are continually going on in health, and that the same links of com-
munication produce the association of morbid phenomena. That
the connexion in health is quite irrespective of sensation is obvious,
from the fact that in perfect health individuals may live for long
periods of time unconcious of internal viscera, and, therefore, that
their harmonious action had not been indebted to sensation. The
sensory nerves of the viscera seems to have no other function
than that of denoting unusual states of the organs. But if this
be the function, the question arises, What possible good can
accrue from the transference of the sensation from the sick organ
to one that is well, or comparatively so? a common enough
occurrence in sympathetic disorders. The good would certainly
appear to be beyond our discovery ; but we may endeavor to
learn the course of transmission. Do the sensory fibres convey
the impression direct to the sensorium ? and, before its conver-
sion into a sensation, is the impression transferred to another part
of the sensorium, related with sensory ganglial fibres from some
other viscus ? Is the impression which has been made on the
gastric nerves by a lump of ice, allowed to pass over the ence-
phalic cells related with those nerves without being converted into
a sensation, while on reaching the cells related with the sensory
fibres of the first branch of the fifth nerve, it causes a state which
is felt in this nerve as neuralgia? Is this the, probable route? or
is there not another equally probable ? If we admit that impres-
sions are exchanged between the different ganglia, may we not
conjecture that the impression made by the ice on the gastric
nerves, instead of running along the nearest rami communicantes
to the spinal ganglia, and thence up the sensory tracks (whatever
they are) to the sensorium, or, if you please, by the more direct
course of the vagus; instead of either of these courses ; I say,
may we not conjecture that the impression takes its route up the
chain of sympathetic ganglia, making no disturbance till it reaches
the ophthalmic ganglion, which being in a susceptible state, un-
dergoes a certain change, which change, on being imparted to its
sensory nerves, excites a sensation of pain referred to the parts
over which the sensory nerves of that ganglion are disturbed ?
In this hypothesis I assume the ophthalmic ganglion to be predis-
posed to disorder, because an organ sympathetically affected with
disease, implies a readiness for disease in some part of its struc-
ture. A sympathetic disorder is. so to speak, not forced on the
sympathizing organ it is invited by the readiness of the latter to
take offence.

Let us endeavor to apply some of these considerations to

1858.] On Headache. 615

another particular instance bearing on our immediate subject.
A gentleman had for many years been liable to attacks of head-
ache on the slightest provocation. Long-continued intellectual
exertion, the excitement of an agreeable party, a journey, any
erro* of diet, would inevitably lead to an attack of headache.
During the same period he suffered at different times from pain
in his teeth, which decayed rapidly, and at last were removed,
and replaced by false ones. This change happened more than a
year ago, and since that time he has been almost exempt from
pain of the head. In other respects, his health and mode of life
have been unaltered. What was the connexion between the
diseased teeth and the headache ? The morbid impressions on
the ganglionic fibres of the fifth pair might, without any stretch
of hypothesis, be reasonably presumed to induce a morbid state of
the Gasserian ganglion, whether the impressions on the senory
fibres did or did not reach the sensorium, and induce a painful
sensation referred to the teeth. The Gasserian ganglion is con-
nected by marked fibres with the cephaiic ganglion, from which a
large number of nerves pass to the cerebral arteries. The cepha-
lic ganglion probably partook of the morbid condition of the Gas-
serian, and hence might have arisen so susceptible a state of the
ganglionic nerves of the brain, that they may have become dispo-
sed to ache under the influence of impressions which, without the
predisposition in the nerves, produced in the manner I have des-
cribed, would have had no effect. It seems to me that if this ex-
planation cannot be accepted, there is no alternate but the sup-
position that morbid impressions on the dental nerves (not crea-
ting pain in those parts) arriving at the central extremities of the
nerves, are passed on to that part of the sensorium which is rela-
ted with the sensory fibres of the ganglionic nerves of the brain,
and maintain in that part of the sensorium a morbidly susceptible
condition ; and that this condition is brought into such action as
constitutes pain, whenever the said part ot the sensorium receives
impressions transmitted from nerves which have been offended
by causes acting directly upon them in the brain itself, (as in over-
study or anxiety,) or when it has received like disturbing impres-
sions from the nerves of other parts of the ganglionic system.

I confess that the first of these views, which I have ventured to
propound, is the one that seems to me more admissible. The
course of communication traced in that survey is more direct,
and involves less complexity of causation.

I should feel myself to be taking an unwarrantable liberty,
were I to occupy the time and attention of such an audience as
that which I have the honor of addressing, with hypothetical sug-
gestions if the case would admit of a theory. We have not the
means of subjecting ganglia and their nerves to satisfactory exper-
imental observations in reference to sensation. When the

616 On Headache. [September,

vivisector has made his way to the base of the cranium, external-
ly and internally, though he might obtain satisfactory information
as to the conduits of motor influence, I know not how it would
be possible, in the midst of such tearing and severing of tissues,
to determine degrees of sensation, which can only be demonstra-
ted by cries or quiverings.

Allow me to try the hypothesis by another example. A gen-
tleman, after playing at bowls one evening, awoke in the night
with slight haemoptysis. The source was referred by his own
feelings and his physician's examination to the upper lobe of the
right lung. Whether or not a tuberculous nodule was the nucleus
of the disease, there was evidence for a short time of a portion of
the lung in the right infra-clavicular region, and in the same part
pain was felt for a long time afterwards, when the patient laughed
vehemently, or made any strong muscular exertion. But after
awhile he observed that pain would occasionally come on in the
same part whenever his stomach was at all deranged, and that it
would subside after a slight eructation of wind. What was the
chain of events in the production of this obviously sympathetic
pain ? Was the morbid impression, which had been made by
gas in the stomach on the gastric nerves, transmitted by sensory
nerves to the sensorium, and instead of being transformed into a
sensation in the part of the sensorium related with the gastric
nerves, passed on to the central cells related with the sensory
nerves belonging to that portion of lung which was formerly dis-
eased? Or is it not more probable that the gastric impression
was transmitted by ganglionic nerves to the pulmonary plexus
belonging to the spot of lung in question, and that the impression,
acting on the morbid susceptibility left in that plexus by old
disease, excited in it another impression, which, having been
transmitted to the sensorium, produced a sensation referred to the
lung ?

There is, however, another element to be considered in that
curious process, by which, when impressions are being made on
many sensory nerves, some in particular will be converted into
sensations, and which may easily lead to a fallacy. It is a famil-
iar fact that, amid the din of confused sounds in a street, or at a
dinner party, the only auditory impression which become sensa-
tions, that is, which are presented to the consciousness, may be
the words of a friend in colloquy. The cause of this appears to
be simply the predominance given to one cluster of impressions
by the desire, or the compulsion of the will, in other words, the
expectant attention. If of two impressions, starting severally
from the gastric ganglionic centre, and its related pulmonary
centre, one is more intense than the other, it will become the sen-
sation perceived in the sensorium. Or supposing the intensity to
be equal, the prevalence may be determined by the expectant

1858.] On Headache. 617

attention. If. for example, the pulmonary impression has been
linked with apprehensions as to the nature of the illness, or with
previous suffering, it will be perceived to the exclusion of the
gastric.

This subject of morbid sympathy as to sensation may, perhaps,
be still further elucidated, if we consider the sympathy between
the tegumentary surface and the internal organs. What, for in-
stance, is the order of events in catching cold, in the common
occurrence of a catarrh? A person, liable to such attacks, may
have been standing at a corner of a street, or at an open window,,
conversing with a friend. According to the degree of interest
in the conversation, he may or may not feel chilly ; but in twelve
or twenty-four hours he has the symptoms of incipient catarrh.
What has happened during that period of incubation? What
did the current of cold air do to him? It may be said that the
insensible perspiration was interfered with, and that matters were
thereby retained in the blood which ought to have been elimina-
ted ; and that the blood, thus contaminated, excites disease in any
predisposed organ the Schneiderian membrane, for instance.
This may be the case ; but another view might present itself.
It might be inferred that, an impression has been made on the
nerves belonging to the cutaneous blood vessels, reaches the gan-
glionic centres, and in its further diffusion, extends to the grey
ganglionic nerves belonging to the blood-vessels of the Schneider-
ian membrane, and, through them, so alters the circulation and
secretion of the membrane, as to produce what is called catarrh.
The one view seems at least as likely as the other. But suppose
the cold to have operated on some limited portion of the body, say
the scalp ; or suppose the outward cause to have been damp ground
operating only on the feet. It is not easy to presume, in this case,
a general defect of elimination. The more probable presumption
is, that an impression is made on the nerves belonging to the
blood-vessels in the skin, and that they transmit the impression to
the visceral ganglia, and disturb such parts as are most prone to
disorder.

Or we may take another case for investigation. I have a
patient who frequently suffers from severe attacks of headache,
and who tells me that one of the most frequent causes is driving
in an open carriage in a cold wind. She has no general chill, for
she is well clothed, but some morbific impression must be made
on the face. In a few hours, the headache comes on. There is
here no general interference with elimination, but an impression
is made on the skin of the face, which mav be transmitted to the
Gasserian ganglion, and thence to the cephalic ; or it may travel
by the route of the arteries to the nerves of the brain. But the
road which the sympathy travels may be traced in the reverse
direction. Thus a patient is the subject of headache, attended

618 On Headache. [September,

with heat of the scalp, dilated and with throbbing temporal arteries.
Cold is applied to the forehead and scalp, and the pain is lessened
or removed. How is it thus sedative to the nerves of the cerebral
vessels? Its operation on the vessels of the scalp is to cause their
contraction ; and I presume that this is effected by its operation
on the vascular nerves. The impression on them, transmitted to
their ganglion and plexus, must reach the nerves of the brain. We
cannot think that the cold penetrates the bony case, and so redu-
ces the vascular disturbance within it; or, should any one think
that this is not impossible, let us suppose that instead of cold lotions,
leeches have been applied. No influence is in this way transmit-
ted through the cranium ; the quantity of blood lost is too small to
affect the heart or the general circulation, and it is a clear case of
sympathy. The relief is afforded here unequivocally through the
blood-vessels and their nerves, the latter nerves being the only
media of communication between the vessels of the scalp and the
vessels of the brain and pia mater, whatever communication may
be traced between those of the scalp and the cranium and dura
mater. An analogous train of argument might be pursued, as to
the action of anodynes applied to the surface.

The phenomena of a coup de soleil also illustrate the principle ;
for, unless it be thought that the sudden elevation of temperature
in the scalp is extended to the cranium, and thus directly irri-
tates the vessels of the membranes and the surface of the hemis-
pheres, there seems no other way of tracking the influence than
that which I have already pursued, along the nerves of the exter-
nal blood-vessels to those of the corotidal plexus.

Cerebral Circulation. Having thus far considered the relation
which painful affections of the head bear to impressions on dis-
tant nerves, let us turn our attention to their connexion with the
cerebral circulation.

The intimate connexion of the nerves of the brain with its
blood-vessels, enables one to account for the difficulty which is
often presented to our diagnosis that of distinguishing the pain
which is purely nervous, from that which is the effect of vascular
disorder. The peculiarity of the intracranial circulation enhan-
ces the difficulty; for though the researches of Dr. Burrows have
settled the question as to whether the qnantity of blood in the ves-
sels can vary, having proved that it is variable, yet the nature of
the outward barrier indicates plainly that the compression of the
vessels, and consequently of the nerves, must at times be very con-
siderable. Suppose the nerves be in a normal state, the pressure
of distended vessels may occasion pain, as in the inflammation of
the pulp of the tooth. Or suppose the nerves to be hyper-aesthe-
tic, very slight changes in the force and the volume of the circu-
lation will distress them. The aggravation of a nervous headache
by palpitation, by interruption to the venous circulation, in cough-

1858.] On Headache. 619

ing, straining, or other muscular exertion, must be familiar to
most persons. I have just supposed the case of the nerves being
in a normal state, and then distressed by the hydrostatic pressure ;
but, on consideration, I doubt whether pain is ever due to simple
vascular distension, unless the latter has been extreme and long-
continued.

It is difficult to find a combination of circumstances exactly
like that of the vessels and nerves of the brain. Some resemblance
may be found in a limb compressed by an article of dress, as a foot
by a tight shoe, which in the evening, under the influence of heat
and long dependence, begins to swell. The pressure of the shoe
makes the swelling painful; but here, again, there is a want of
strict similarity. For the pain comes from the superficial nerves
of the skin, which are directly compressed. The pain is not like
that which ensues when the vascular nerves only are affected.
That mere compression of healthy nerves by their distended ves-
sels should occasion pain, is rather negatived by the freedom from
pain during violent muscular exertions and strains, which put the
vessels of the head under the highest degree of pressure. And
again when the accumulation of blood takes place in the other
direction, whether attracted into the capillaries by unusual func-
tional exercise, or injected into them by emotional excitation of
the heart, or by the more composite influence of alcohol, there is
often an entire exemption from pain, and in the latter instance a
feeling of great enjoyment. I think it may be inferred that when
fulness of the vessels gives rise to pain, there must be an accom-
panying or preceding unhealthy state of the nerves of the part,
or that the congestion must have been long continued enough to
beget such textural disorder as the nerves will necessarily partake
of. In inflammation the nerves are for the time injured by the
changes in which the process consists, as well as by the first action
of the exciting cause.

The headache which follows an epileptic paroxysm, and that
which attends or ensues on prolonged dyspnoea, or violent fits of
coughing, might seem to be examples of pain occasioned by
simple disturbance of the brain-circulation; but the latter cases
are exceptional; that is, it so often happens that both long-contin-
ued dyspnoea and cough occur without producing headache,
that we cannot but infer that some nervous element must be in-
troduced into those cases in which pain attends upon difficult
breathing and cough. As to epilepsy, though we have much to
learn respecting its pathology, yet a paroxysm presents unambigu-
ous evidence that the vessels are enormously strained ; and the
pain after the attack and the functional disturbance of the brain
bear a direct ratio to the severity and frequency of the attacks.

It was while I was considering the relation of headache to altered
states of the circulation in the brain, and speculating on the pos-

n.s. VOL. XIV. NO. ix. 34

620 On Headache. [September,

sibility that the duration of a fit of headache might be connected
with the time requisite for the adjustment of the disturbed balance,
and especially for change in the distribution of the cerebrospinal
fluid, which has been supposed to play an important part in such
adjustments it was with the view of confirming or correcting
this supposition that I determined to make some experiments on
animals. In the performance of these I had the valuable assist-
ance of my friend, Mr. Michell Clarke, a gentleman well versed
in anatomy, and expert in operating.

If the cerebro-spinal fluid replaces blood withdrawn from the
intracranial vessels by gravitation, or if, conversely, the recession
of the fluid makes room for congestion of those vessels, it appeared
to me that were an animal kept some time in a certain position,
the cerebro-spinal fluid ought to be found accumulated either in
the cranial or in the vertebral cavities; if erect, in the ventricles
and subarachnoid space of the brain ; if inverted, in the theca
vertebralis.

Three rabbits were selected. One was suspended by its ears
and fore-legs, another by its hind-legs, a third was kept for com-
parison.

The two suspended rabbits were poisoned with prussic acid after
about half an hour, their position having been strictly maintained.
The post mortem examination was made immediataly, and with
the bodies kept steadily in the same position.

In the rabbit inverted during suspension the eyes were very
prominent, and the membrana nictitans was congested (but there
had been no manifestation of distress during life). The vertebral
canal was first laid open. All the tissues in the lumbar and dor-
sal regions were bloodless; those of the neck and cranium were
gorged with blood; the membranes and the substance of the
spinal cord in the lumbar and dorsal regions were quite pallid. In
the cervical portion of the theca there appeared a slight accumu-
lation of sanguinolent serum. On opening the cranium, the bony
tissue was full of blood ; the meninges were highly congested,
and the puncta sanguinea in the cerebral substance were numer-
ous and strongly marked. There was no serous fluid in the ven-
tricles, and none external to the convolutions.

The rabbit which had been suspended by its ears and forelegs
was of course examined in an erect posture. The tissues of the
head, neck, and back were exsanguine ; but those of the lumbar
region were in an opposite condition. When the cavities were
laid open, the membranes of the spinal cord in the same region
were found injected, while those of the brain and the vessels of
the brain substance were extremely pallid. Serous fluid was
anxiously and carefully looked for in the ventricles and between
the convolutions, and at their base, but none was found.

The third rabbit was poisoned with prussic acid, and examined

1858.] On Headache. 621

immediately in the horizontal position. There was a pretty equal
distribution of blood, and nothing remarkable was observed, ex-
cepting the absence of anything like cerebro-spinal fluid, either
in the cranial or in the vertebral cavity.

These experiments, while they entirely confirmed the observa-
tions and conclusions of Dr. Burrows, as to the production of an
increased or lessened quantity of blood in the brain by gravitation,
were negative as to any adjustment affected by cerebro-spinal
fluid.

I thought it well therefore to repeat the experiment on two full-
grown and very strong rabbits. They were suspended for an
hour. The rabbit which hung by the ears and forelegs was
found dead. The other, quite vigorous, was poisoned with prus-
sic acid. They were examined with the same results, excepting
that in the inverted animal there was not the same appearance
of sanguinolent exudation in the cervical portion of the theca
vertebralis which had been found in the first case. The rabbit
which had died suspended by his ears and fore-legs was examined
with particular care and interest. No serous fluid was discover-
able in the ventricles, and none beneath the pia mater none in
any part of the cranial cavity. But the membranes and brain-
substances were absolutely blanched. The appearances corres-
ponded with the plate in Dr. Burrows' work, representing those
of a rabbit bled to death.

As this observation was interesting in proof of the fatal effects
of a posture which diverted blood from the brain, it was repeated
on two other rabbits. One was suspended by the ears and fore-
legs, the other by the ears only. Death occurred a few minutes
earlier in the former than in the latter case. The appearances
within the cranium were similar to those described in the former
instance.

In order to meet the supposition that the animals might have
been distressed by the weight of the body, and the strain on the
ligaments of the neck, the weight had been taken offby a support
applied to the haunches.

Thinking it desirable to ascertain whether the inverted position
would occasion death, if continued longer than in the cases of
the animals suspended in that posture, a strong middle-sized rab-
bit was hung up by his hind-legs and kept in that situation for
more than four hours. After being cut down, he looked for a
moment astounded, then gave his head a shake, and seemed to
have recovered his self-possession. He was in fact quite well,
and began to feed quite heartily.

Rabbits are known to hold their lives on a slighter tenure than
do many animals. We thought it right therefore to try the effect
of the erect posture in one of another order. A cat, being pro-
verbially tenacious of life, was selected. 'Mr. Clarke found it

622 On Headache. [September,

difficult to keep her head constantly upright. She died in three
hours and a half. The brain and its membranes were perfectly
bloodless, but there was no fluid in the ventricles, nor under the
pia mater, nor in any part of the cranial cavity. Neither could
more than a very few drops be discovered in the vertebral cavity,

Whatever may be the physical agency by which the brain
deprived of its blood is still capable of filling its bony case, the
proof given by the experiment of the degree to which blood may
be drained from the cerebral vessels by posture only, has, it seems
to me, some considerable value. We see that, independently ol
the neutritive relation between blood and neurine for the perform-
ances of brain function, one of the conditions under which this
function is performed is a certain amount of pressure, a greatei
or less amount of which may produce distressing or even fatal re-
sults. In the rabbit the circulation is not so arranged as to main-
tain even for a short time an adequate supply to the brain undei
the disadvantageous circumstances of erect posture. While the
egress of blood is helped by gravitation, the afflux is to be kepi
up by the exertion of a heart not vigorous enough to overcome
the difficulty presented by gravitation. The heart soon becomes
further weakened by the reflected influence of that very state ol
the brain which its own incapacity has engendered, and fata)
syncope is the result.

The fact teaches us also how important to man, with his "os sub-
lime" is a sufficiency of strength in his left cardiac ventricle. Il
may be that in him there is a larger amount of cerebro-spinal fluid
normally existent, and that he is furnished with adjustments for
his greater variety of postures. But still nothing is more to be
apprehended than the result of diminished afflux and pressure,
from a failure of the cardiac impulse. And the observation is, ]
think, confirmed by all clinical and pathological experience.

I need scarcely say that in these experiments it was a surprise
to Mr. Clarke and myself that no appreciable quantity of fluid
should have been found corresponding to the cerebro-spinal fluid,
though it was carefully looked for. Mr. Clarke was at the pains
of examining under every precaution the vertebral and cranial
cavities in a cat, and in dogs poisoned with prussic acid, but with
the same negative results. The examination of a dog was made
in the presence of Mr. Henry Clark, an accomplished anatomist,
and myself. The whole quantity of fluid collected on bibulous
paper from the theca vertebralis, the ventricles of the brain, and
the cranial cavity, amounted at the most liberal computation to
no more than seven drops.

It is not difficult to reconcile these negative results with the
fact that one finds more or less serous fluid in the cranial and
spinal cavities of the human subject, because the latter is always
examined several hours after death, and when there has been

1858.] Conical Cornea and its Treatment, &c. 623

abundance of time for the transudation of fluid in these as well
as in other serous cavities. And, a priori, a large proportion
might be expected from the exceeding vascularity of the pia mater,
which represents sub-serous cellular tissue. But it is more diffi-
cult to explain the absence of the fluid in the animals examined
by us, when we consider it in relation to the experiments of
Magendie, Cruveilhier, Ecker, and others, on the living animal.
It would be presumptuous, as it is unnecessary to question the ac-
curacy of such practised observers. And without other evidence
I shall come to the conclusion that the presence of true cerebro-
spinal fluid is confined to the living animal, and that when the
quantity of blood in the vessels is diminished by death, the fluid
passes into them by endosmotic action.

But I have before me the note of an experiment made by Mr.
Clarke on a living dog, previously rendered anaesthetic by chloro-
form, which fully corroborated those of Magendie and Cruveilhier.
The dog was of smaller size than that which was examined after
death, yet nearly sixty drops escaped from the puncture through
the occipito-atloid ligament, though from a dead animal of the
same size the sum total of serous fluid obtained from venticles,
cranium, and theca vertebralis amounted at the outside to seven
drops only.

I have already said that it also remains to be explained how the
brain all but emptied of blood, still fills the cranial cavity. Two
cats were killed, especially with a view to this point The brain
was drained either by posture, or by division of the cervical ves-
sels, but on opening the cranium the dura mater was found as
tense as if the vessels had been full of blood, and yet no serous
fluid was discoverable. As there is no ground for attributing
resilience to the cerebral substance, we are forced to speculate
upon the possibility of some interstitial fluid or serous halitus. As
the experiments have proved that the cerebro-spinal fluid of the
living animal is not to be found, after death, can it be that this
fluid instead of being extra-membranous becomes interstitial ? Or
is there some aeriform substance in the vessels, such as prevents
the coats of many of the arteries from collapsing after death,
though they no longer contain blood ? I have already suggested
some experiments to Mr. Clarke in elucidation of this subject,
some of which he has already performed, while others are still in
progress. [Xew Orleans Med. News and Hosp. Gaz.

Clinical Lecture on Conical Cornea and its Treatment, and on
Gonorrheal Iritis. By W. Lawrence, F.R.S., F.R.C.S., &c,
Senior Surgeon to St. Bartholomew's Hospital.

Gentlemen, We have had, since Summer Session, commen-
ced various instructive " eye" cases in the hospital, to which I

624 Conical Cornea and its Treatment, &c. [September,

wish to direct your attention to-day. Several severe cases of
syphilitic iritis, with, and, I may say, without complications, as
also a most unique case of that very singular disease "conical
cornea." Iritis is a very ordinary disease in practice, so that your
attention cannot be drawn to it too early in the session ; it is also
01V3 seen under unexpected circumstances. The first case of
which I may speak is that patient suffering under

INFLAMMATION OF THE EYE WITH GONOERHCEA.

You will remark, I say, inflammation of the eye attended
with gonorhcea not gonorrhoea! ophthalmia; the diseases, in
fact, are quite different, as well in their pathological seat and
import as in their mode of treatment, constitutional or otherwise.

In cases of gonorrhoeal ophthalmia, of which I speak hereafter,
it seems as if a patient laboring under gonorrhoea conveyed much
of the puriform discharge immediately to the conjunctivitis, of
which, no doubt, you have all read in your books; but in this
patient now under our notice, with a gonorrhoeal history of a
somewhat like kind, the infection from some constitutional cause
or peculiarity, probably of a rheumatic character, extended from
the conjunctiva to the sclerotic coats of the eye: from thence
even to the iris, causing great intolerance of light, with remark-
able dullness of colour in the iris itself. To these signs of this
affection were added profuse lachrymation, and what I consider
almost as pathognomonic of this class of cases, most severe supra-
orbital pain pain of a most remarkable kind, extending round
the orbit, and, no doubt, in some measure engaging all the
fibrous tissues of that part. Now I wish you to remark that
both these diseases arise under similar circumstances ; yet this is,
you see, quite a different thing from gonorrhoeal conjunctivitis,
or a conjunctivitis of any kind, properly so called.

The supra-orbital pain of sclerotitis is absent in the disease oi
the conjunctiva. The appearance of the patient himself is also
peculiar; you can, in fact, scarcely mistake these cases when
once you have studied them. Fortunately, this serious thing
gonorrhoeal ophthalmia is not very often seen in this hospital ;
but if any cases do offer themselves I shall take the opportunity
of showing them to you.*

The treatment of these cases differs, also, so that a propel
diagnosis is not a matter of idle curiosity or ingenuity, but oi
necessity. In this patient we had to combat the inflammatory
symptoms in the sclerotic coat with much vigour. Depletion
and cupping on the temple were ordered and mercury used
night and morning: calomel and opium, not for any specific

* Mr. Wilde, of Dublin, as previously stated in the Circular, has recently discov-
ered that simple leucorrhoea in a married female produced as marked infection in
the conjunctiva a& gonorrhoea.

1858.] Conical Cornea and its Treatment, d*c. 625

action, so much as to stop inflammation. To these remedies we
added a blister on the nape of the neck ; yet all did not answer,
and we were obliged to have recourse to the wine of colchicum
( 3 ss., sex tis horis). This affected his stomach a little, as col-
chicum very often does, so that it is a drug requiring much
caution in its administration. In my experience, however, I
find that when the pain and sickness are induced, the action of
the medicine is more certain and specific ; still great caution is
also necessary, for very serious results have followed overdoses
of this powerful agent.

If the colchicum* be used without due caution, even fatal
results might arise, so that it will be necessary to watch its action
with great care. I am not going now to enter into the minute
diagnosis of sclerotidis, we shall see it as we go through the
wards during the summer, and it will be better to point it out
to you in the wards.

the next case I wish to speak more in detail about, is a patient
suffering under what is termed,

(TOXICAL CORNEA.

The patient is E. TV , a poor woman, it seems, who

has been led about the streets quite blind. She is a comparative-
ly young woman, only aged thirty six years; she has occasion-
al flashes of light, she says, but with that sole exception she has
been now thirteen years totally without vision of any kind.

This is a most singular disease, one of the pathology or nature
of which we know absolutely nothing. As far as I have seen
it during fifty years' experience (if possible to add to its anoma-
lous character) it usually takes place in young and healthy sub-
jects who have not suffered in any manner irom excessive use
of the eye, like watchmakers, needlewomen, printers, &c. This
young woman, our present patient, you see, is perfectly healthy ;
she tells us nothing of any previous disease of her eyes ; in fact,
it is a gradual change occurring over a long space of time in a
cornea otherwise healthy. I have seen the cornea in this state
become in shape quite like a cone; the rays of light, too, present
a most unusual appearance in conical cornea; the patient does
not present the vacant, dull eye of the amaurotic patient, who
holds his head towards the sky whene'er he may chance to catch
a glimmer everything dark, dark,

" Amid the blaze of noon
Irrecoverably dark, total eclipse."

* It may be prudent to observe that very few surgeons share Mr. Lawrence's
4read of the use of colchicum, at least in Hospitals. Mr. Hancock, uses tiuct of
aconite in such cases, which is nearly the same medieine, and probably aconite,
and atropine will, ere long, supersede all the routine plans of calomel and opium,
belladonna, <fec, <fcc

626 Conical Cornea and its Treatment, &c. [September,

There is nothing of this dulness or opacity of the eye in conical
cornea, but no doubt you have observed it in this woman ; the
eyes here have an unusual bright appearance, sparkling like
diamonds or those bits of cut glass that sometimes represent
diamonds! The rays of light passing into the eye in conical
cornea are, I think, reflected (not refracted, mind you) before
they fall on the retina, and are thus thrown into those singular
glittering or diamond-like reflections in the vitreous humour
and lens of the eye. I think that even on physical principles
the blindness of the eye in conical cornea is to be explained;
her eyes are like a telescope that has been pulled out in a wrong
manner, or fixed at half cock. But neither a gun or a telescope
will answer if fixed firmly at half the measure of its capacity.
In the eye it must also very seriously impair the focus of vision,
as you see it does in this poor woman. She says, over and over
again, that for years she has been totally blind, led about like
a child !

Well, on examining the eye with some care, I found that,
though the cornea in each eye is in a very marked manner,
bulged into a cone- from what cause I never could meet any
surgeon who could exactly say yet that the immediate circum-
ference of the cornea, situated next the sclerotic, remained un-
changed ; indeed, few persons not familiar with the different
varieties of blindness would detect that this healthy young
woman, with what the story-books would call " brilliant eyes,"
was a poor creature almost totally blind. Any one accustomed
to eye cases will at once distinguish these cases, however, from
cases of photophobia, amaurosis, &c*

Now, on the admission of this woman with conical cornea to hos-
pital, having seen some similar cases, benefitted by the only
remedy I know of in these patients, I was anxious to give that

* In these times, when sanitary science shows the value of light, it is very in-
teresting, with the additional knowledge imparted by modern science, to study
the early observations of Milton, who, " in the latter years of his life suffered
severely from rheumatic gout, which, attacking his eyes, left him totally blind"
so severe this " dim suffusion" which veiled his sight ! Speaking of light he
exclaims

" Thee I revisit safe,
And feel thy sovereign vital lamp ; but thou
Revisit'st not these eyes that roll in vain
To find thj- piercing ray."
And again he makes the blind Sampson say
" Since light so necessary is to life
And almost life itself

Why was the sight
To such a tender ball as the eye confined."
"Almost life itself is a very beautiful idea! Marshall Hall has shown that
perhaps the first link in the long chain of actions ending in assimilation, diges-
tion, &c, is a reflex action in the lenticular ganglion, and eighth pair from light
exciting the retina.

1858.] Conical Cornea and its Treatment, &c. 627

remedy, which is belladonna, a fall trial. I will now read some
of the notes of the case :

May 5, " The patient has had the belladonna applied," (I
read in the notes furnished by the House-Surgeon,) "since when,
greatly to our astonishment, she begins to see objects all around
her, and on bringing a book close to her face she sees the type
and recognises the larger letters." Exactly so. Now, the reason
of that is at once obvious : 1 have already remarked that the
immediate circumference of the cornea, next to the sclerotic,
remained unchanged ; very well, now comes the belladonna or
atropine, and dilates the pupil ; more light is thus permitted to
pass, and through a healthy portion of cornea a mere line or so
of pupil is left, and on bringing a book up to the face she can
read very respectably indeed. It is remarkable and curious
that the retina retains its sensibility for a very long period.
Now, the conical cornea in these cases is subject to friction, and
becomes roughened; you must be prepared also for that, but I
am of opinion that in young and healthy subjects it will not
give much trouble.

An elderly gentleman, a clergyman, quite blind, consulted
me some time ago ; he was perfectly well in all other respects,
but he was totally blind, and had this singular disease of the
cornea. A change had occurred, unfortunately, in this case, in
the apex of the cone due to friction, it appeared quite opaque.
The old gentleman was very far advanced in life, perhaps about
eighty an age, of which one is not fond of new experiments
or new theories. It has been suggested now by the new
Ophthalmological School, if I mistake not to make an artificial
pupil in such cases. I simply ordered the atropine drops, from
which he obtained a very fair amount of comfort ; indeed, he
went to church, he rode about in his carriage, took exercise, and,
much to his delight, renewed his acquaintanceship with an old
friend, the 'Times' newspaper! which he read, holding it up
close to his nose and forehead. I cannot say that I am favora-
ble to cutting operations in these cases; the palliative plan of
atropine answers every purpose.

We next pass on to a different order of cases, but one which
must attract, as it deserves your serious attention. The next is
a case of

SYPHILITIC IRITIS.

I may say, in the beginning, this has been a patient a little
out of the ordinary hospital routine of such cases a respectable
young person coming to us in perfect health, but attacked with
iritis! If we put the question of syphilitic or non-syphilitic to
herself out of book, I should be disappointed if she answered it
exactly as it might be wished. She comes to us from the coun-

628 Conical Cornea and its Treatment, &c. [September,

try ; she looks something like a quiet governess in a private
family. Now governesses may go wrong, I dare- say, for all
that you know, as well as those over whom they may be said
to govern. It is very probable that we are favored with this
lady's society because she has kept the thing a profound secret
up to the present. All this has a bearing on the case, however,
and if we make any hand of it, it will be by going slowly, as
there is such a thing as idiopathic iritis, rheumatic iritis, &c.

She admitted that she had taken some medicine, but it was all
Epsom salts, certainly nothing else. Well, not knowing much
of what are now termed, in the phraseology of the day, this
lady's "antecedents," or the amount of moral control she may
or may not have practiced as a governess on herself by way of

example to her pupils, Mr. , my House Surgeon, commenced

what the newspapers call a "delicate investigation." She, of
course, denied point blank all syphilitic taint, but on untying
the strings of her bonnet which she was requested to do, as
you saw on the day of her admission there were some copper-
coloured spots under the ribbons, not as inviting as one would
like; yet this was not sufficient for our purposes of a diagnosis,
though it left no doubt on my own mind of the true nature of
the disease ; but we further- made out : this is the month of May,
but about last Christmas she had a discharge, attended by swel-
lings in each groin, but she merely took small doses of Epsom
salts, and did nothing else. She would not for the world have
told the family surgeon. You will see the bearing of this
'delicate investigation' presently: she took her salts, and rested
contented that it would all blow over. Now let us retrace our
steps with this new light. About five months ago, you perceive,
she had primary syphilis: it may have been very slight; she
had a discharge probably from an abrasion in the passage. Two
months after she noticed the marks under the ribbons of her
bonnet viz., a scaly eruption, and now more of a copper colour,
yet she very probably knew of no bearing of one of these things
on the other.

May 4. Together with the previous history, we find the left
eye of this governess has been bad for ten days. She was
ordered strong poppy fomentation and gray powder, ter in die
eight leeches to the temple. When I first saw the muddy
colour of the iris, and perceived that she complained of dimness
of vision, that the pupil was contracted, and did not seem to
answer to the stimulus of light, I had no doubt in my own mind
of its being syphilitic iritis.

13. I need not go over the notes of treatment; they do not
present anything worthy of stopping to remark on, as you have
seen the case to-day; but here, on the 13th, she is reported as
"nearly well;" the leeches and gray powder have answered

1858.] Effect upon the Mother of Poisoning the Foetus. 629

their purpose; the iris is again safe; and she will probably
leave the hospital, thus rescued from further temporising mis-
chief.

Now, gentlemen, this history interests us all as surgeons.
You see it is made up of quiet, confidential demeanour towards
even the poorest patient; and when this is adopted you seldom
fail to come down on the truth; the educated surgeon will not
go astray, and then, also, it teaches you a great tact, as I take
it to be, in the natural history of syphilis, to be arrived at in the
same manner, that you may most undoubtedly have all the
phenomena ofsj'philis, even in syphilitic iritis, without one
grain of mercury having been previously administered. Iritis
is said especially to be a "mercurial symptom." Some of my
colleagues and many other surgeons express themselves strong-
ly on this point of doctrine a doctrine I do not hold at all.
This young woman, as Horace says, was striving to drive out
Nature, but still ii would ever keep returning

"]N~aturani expellas furca," <fec.

She took no mercury; she dosed herself soberly with salts; but
still we have the usual course of natural symptoms an abrasion
or an ulcer, probably getting Avell by cleanliness, and not using
any irritating washes ; then muco-purulent discharge, next bu-
boes, all cured. for the time by salts ; then the inexorable spots
under her ribbons, as completely copper coloured as ever I saw,
and now iritis; but all, I am firmly satisfied, generated without
mercury !

You probably know that the surgical world is divided into
two opposing, if not hostile, camps: the mercurial and non-
mercurial plan of treatment having each its ensign flying, and
some battle some Knights arrayed with their hosts on one
side or the other; but of the natural progression of syphilitic
symptoms, even as far as iritis, without the agency of mercury,
I have had no doubt whatever ; indeed, this single case every
bit of which is now coherent and simple proves it. Do not be
misled, then, by the supposition that diseases of the iris or
periosteum are due to mercury more than to syphilis, for disease
of the iris brook no delay if you wish to preserve the integrity
of vision in the organ. [Medical Chronicle.

An Experimental Inquiry into the Effect upon the Mother of Pois-
oning the Foetus. By W. S. Savory, Demonstrator of Anato-
my and of Operative Surgery at St. Bartholomew's Hospital ;
Surgeon to the great Northern Hospital.

The structure of the placenta and the character of its circula-
tion the close and intimate relation which exists there between
the fcetal and maternal blood is naturally appealed to in ex-

630 Effect upon the Mother of Poisoning the Fcetus. [September,

planation of the well-known effects produced in the child by
various morbid and other peculiar conditions of the maternal
system occurring during pregnancy. This intimate relation
between the two circulations at the placenta is looked to for an
explanation, not only of the transmission of obvious and fully
developed disease from the mother to the foetus, as variola
and syphilis, but also of those more subtile and obscure changes
which are likewise understood to be capable of affecting the
child.

Although the influence thus exercised by the mother upon
the foetus has been known to every one for ages past, and is con-
tinually illustrated by striking examples, it is only compara-
tively recently that the converse relation the influence of the
foetus upon the mother has received any attention.

The subject has been most ably brought before the profession,
by Dr. Alexander Harvey, in a very interesting series of phil-
osophical papers "On the Foetus in Utero, as inoculating the
Maternal with the Peculiarities of the Paternal Organism."*" In
these well-known essays, he advances some excellent observa-
tions, and cites many cases to show " that an explanation offered
by Mr. M'Gillivray, of Huntly, is the true one viz., that while,
as all allow, a portion of the mother's blood is continually pas-
sing by absorption (and assimilation) into the body of the foetus,
in order to its nutrition and development, a portion of the blood
of the foetus is as constantly passing, in like manner, into the
body of the mother ; that as this commingles there with the gene-
ral mass of the mother's own blood, it inoculates her system with
the constitutional qualities of the foetus; and that as these quali-
ties are in part derived to the foetus from its male progenitor,
the peculiarities of the latter are thereby so engrafted on the sys-
tem of the female as to be communicable by her to any offspring
she may subsequently have by other males."

Now, although we are in possession of absolute facts, which
furnish clear and convincing evidence of the direct transmission
of what may be termed accidental matter from the mother to the
foetus, not only of certain diseases, but also of foreign substan-
ces as camphor and oil in the experiments of Magendie and D.
Williams yet we have no such conclusive facts in support of
the converse proposition. However strong the argument from
analogy may be, supported as it is by the record of cases of ex-
treme interest, yet demonstrative evidence is wanting of the
direct absorption of foreign matter from the foetus by the mother.
Indeed, the only experiments in reference to this point with
which I am acquainted was attended by a negative result.

In his " Compendium of Physiology," Magendie briefly says,

* Monthly Journal of Medical Science, for Oct 1849, and Sept. 1850,

1858.] Effect upon the Mother of Poisoning the Foztus. 631

"I have often injected very active poisons into the vessels of the
cord, directing them towards the placenta; but I have^never
seen the mother suffer from the effects of them."

And this negative result may be supposed to depend upon
the fact that after all the communication between the maternal
and foetal blood is only an indirect one, and is therefore limited.
It may reasonably be believed to be one office of the cells which
intervene between the fcetal and maternal vessels to regulate
or control such transmission, to exercise a selecting influence
on the materials absorbed, as some other cells in all probability
do. It is commouly supposed that the office of these cells is
solely connected with the transmission of materials from the
mother to the foetus, one set selecting and separating, and the
other elaborating and absorbing them.* Therefore, even if an
interchange to the certain' extent be admitted, there is still no
proof that poisons or other morbid materials, whether arising
from within or without, must necessarily pass from the foetus
to the mother.

But in whatever way the argument may be supported, it is
certain that two very opposite opinions are expressed by phys-
iologists on the subject. Dr. Harvey, after quoting this sentence
from Mr. M'Gillivray, "I am quite aware that many physiolo-
gists maintain that, in the highest species of animals, the blood
cannot be returned by the foetus to the mother during utero-
gestation," endorses it with the following statement: "That
this opinion is very generally held by physiologists in this
country is quite certain. Dr. Alison, for instance, after obser-
ving (on the authority of Magendie and of Dr. David Williams,
of Liverpool) that camphor and oil injected into the blood of
pregnant animals are soon detected in the blood of the foetus ;
but that poison injected into the umbilical arteries, although
mixing with the blood on its way from the foetus to the placenta,
does not affect the mother; and that fatal haemorrhage in the
mother does not apparently diminish the fulness of the vessels
of the foetus adds ' so that it would seem that the transmission
of fluids is almost entirely from the mother to the foetus.7
Again, Dr. Kirkes, referring to Professor Goodsir's observations
as to the intervention of two distinct layers of cells between the
fcetal and the maternal portions of the placenta, speaks of the
one being, ( probably designed to separate from the blood of the
parent the materials destined for the blood of the foetus,' while
the other 'probably serves for the absorption of the material
secreted by the other set of cells, and for its conveyance into
the bloodvessels of the foetus' no idea, seemingly being enter-

* Kirkes' Physiology, 3rd edition, p. 681. Carpenter's Manual of Physiology,
3rd edition, pp. 154-5 and 526.

632 Effects upon the Mother of Poisoning the Foetus. [September,

tained of a converse process.* Moreover, the view taken by
most physiologists of the destination of that portion of the foetal
blood which is transmitted to the placenta appears to be exclu-
sively that of renovation or aeration, by coming into relation with
the oxygenated blood of the mother, nothing being said as to
re-absorption into the maternal system." In a note he adds, " In
his 'History of Medicine,' Dr. Alison expresses himself even
more strongly on the subject: 'The experiments of Magendie
and others have proved that any substance which may be circu-
lating in the blood of the mother finds ready access to that of
the foetus, but that there is little or no transference of fluids in
the opposite direction.' " Those authors who express a contra-
ry opinion, cannot refer to any facts in support of it.

As the question at present stands, then, the only demonstra-
tive evidence is that yielded by the experiments of Magendie,
and these gave a negative answer. All the rest of the evidence
which has been adduced on either side is devoid of proof, is in-
direct and inconclusive.

This subject was brought before the notice of the Hunterian
Society by Mr. Jonathan Hutchinson, in a paper on the "Com-
munication of Syphilis from the Foetus to the Mother," read there
in the latter part of 1856.f Jt was followed by a very interest-
ing discussion, and it then occurred to me that it should be
brought to the test of experiment. I could find no such evidence
on record, excepting the experiments of Magendie already re-
ferred to, and these had yielded a negative result. But the
nature of these experiments appeared to me objectionable; for
it seems almost impossible to open the vessels of the cord and
inject directly into them, without interfering to a fatal extent
with the foetal circulation.

This was the general plan of my experiments:

By opening the abdomen and uterus to expose and isolate a
living foetus. Then to inject into it, with the least possible
amount of violence, some substance capable of ready absorption,

* It is however, only fair to add that in the latter editions of his work, Dr.
Kirkes in a note expresses the following strong opinion : " Although in the text
mention is made only of the passage of materials from the blood of the mother
into that of the foetus, yet there can be no doubt of the existence of a mutual in-
terchange of materials between the blood of both foetus and parent, the latter
supplying the former with nutriment, and in turn abstracting from it materials
which require to be removed." The most recent expression of Dr. Carpenter's
opinion is to this effect. After giving the common account of the function of the
placenta as furnishing materials for the nutrition of the embryo and as a respira-
tory organ, he adds, " And it is probable, too, that the placenta is to be regarded
as an excreting organ, serving for the removal, through the maternal blood, of
excrementitions matter, whose continued circulation in the blood of the foetus
would be prejudicial to it."

f This question in relation to the transmission of syphilis had previously been
often suggested by various authors, but it is much more fully discussed by Mr.
Hutchinson.

1858.] Effects upon the Mother of Poisoning the Foetus. 633

and the operation of which is marked by obvious and unmis-
takable effects. To be sure that no trace of the substance came
into direct contact with the maternal tissues. To place the
foetus thus injected in a condition most favorable for the con-
tinuance of the circulation, and then to watch for symptoms of
the operation of the poison upon the mother.

The poison I selected from some others was strychnia, for
these reasons :

It is extremely active in very minute doses.

It is easily dissolved, and therefore readily absorbed.

Its absorption is rapidly followed by its operation on the sys-
tem.

The symptoms of its operation are striking and characteristic.

Its effects are not materially counteracted, nor its symptoms
marked, by the influence of chloroform.

After some experiments with strychnia dissolved in various
menstrua, as alcohol, benzole, &c., I preferred as the most eligible
a solution of strychnia in diluted acetic acid. In this way I
obtained a very convenient solution of the acetate of strychnia,
of sufficient strength.

Twenty-four grains of strychnia were dissolved in seven
drachms of distilled water by the addition of one drachm of
acetic acid. Twenty minims of this solution, therefore, contained
one grain of strychnia.

A certain quantity of this solution was introduced, usually,
into the abdominal cavity, through the parietes, by means of
AneFs syringe. This little instrument is very convenient for
the purpose. The abdominal wall can be easily pierced with
its fine point without any violence. The quantity of fluid in-
jected can be accurately calculated, and when withdrawn, the
minute puncture is so closed by the natural elasticity of the tis-
sues, when the foetus is far advanced in development, as to pre-
vent the escape of any portion of the solution.

The subjects of my experiments were dogs, cats and rabbits.
Dogs, from their size, are the most convenient, and furnish the
most satisfactory results.

From a considerable number of experiments, I select the fol-
lowing ones as fair examples:

Experiment 1. A pregnant bitch, a common smooth -haired
terrier, weighing about twelve pounds, was rendered insensible
by chloroform. The abdomen was opened in the median line,
and the uterus was partially drawn out. It was carefully divi-
ded over a foetus. The amnion was punctured, and the foetus,
ly and vigorous, was allowed to escape. It was received
upon a napkin, and remained connected with the mother only
by the cord. The foetus was carefully supported, so as to avoid

634 Effects upon the Mother of Poisoning the Foetus. [September,

stretching the cord. The abdominal wall was cautiously punctur-
ed with the point of the syringe, and ten minims of the solution
(half a grain of strychnia) were injected into the cavity. When
the syringe was withdrawn, no fluid escaped. The puncture
was so minute that nothing exuded even upon pressure. The
foetus, which struggled slightly after the operation, and then
became tetanic, was suffered to remain where it lay, not in con-
tact with the mother.

An incision was then made in another part of the uterus over
a second foetus, which was only partially exposed, and not drawn
out. The side of the chest was wiped dry, the point of the
syringe was inserted between the lower ribs, and about the same
quantity of the solution was injected into the thorax. The pis-
ton was slightly retracted before the pipe was withdrawn, and
not the least trace of moisture appeared. The part where the
puncture was made was carefully watched for some seconds by
Mr. Crowfoot and myself, and we both were fully satisfied on
that point. That portion of the uterus which had only partially
extruded, was now carefully replaced, without any protrusion
of the foetus, then the rest of the uterus, and lastly the foetus
first operated on was returned into the abdomen, and the wound
was closed by sutures.

The bitch lay on her side motionless, and breathing tran-
quilly for eight minutes from the time of the first operation. In
about nine minutes slight spasms appeared. These gradually
increased in intensity, and continued, with scarcely any inter-
mission, for eighteen minutes. In twenty-eight minutes from
the time of the injection the dog was dead.

Five minutes after her death, the abdomen was re-opened.
There were two other foetuses besides those two which had been,
injected four in all. While the two which had received the
strychnia revealed no signs of life, the other two were still alive
and vigorous. They lived some time after separation from the
mother, and one which was suffered to escape from its mem-
branes respired and otherwise displayed such evident signs of
full development, such as crying, that any doubt of the near
approach of natural labour which could have been entertained
after a mere inspection of the foetuses were completely set at
rest. The parts were found in the abdomen as they had been
replaced, and the foetus which was operated on in the uterus
still remained there.

Now, I am satisfied that in these experiments none of the
solution escaped from the foetus through the puncture, because
I ascertained that, if proper precaution had been adopted in the
injection, none escaped upon pressure. Moreover, I had learned,
from another set of experiments, that when the solution is allow
ed to come into direct contact with the maternal tissues, as

1858.] Effect upon the Mother of Poisoning the Foetus. 635

when injected into the uterine or peritoneal cavity, or when
allowed to escape from the foetus, its symptoms are never delay-
ed for a period at all approaching the length of time which elaps-
ed between the closure of the abdomen and their manifestation
in these experiments. The usual period is two minutes, and
this is rarely extended to five. The animal is in most instances
dead before that period.

But that this source of fallacy did not arise, I have more than
once unintentionally obtained still better evidence in another
way. Some of my experiments, the earlier ones more especial-
ly, were attended with a negative result. Foetuses were inject-
ed and returned into the mother, but no visible effects on her
of the poison followed. Prolonged exposure and rough mani-
pulation when the foetuses were small and feeble, had been fatal
to their circulation. But I now see the importance of the nega-
tive results which these experiments yielded. The solution
could not have escaped from them, or in any way have come
into contact with the maternal tissues.

More recently I have performed the following experiment:

Experiment 2. I removed two foetuses, within a day or two
of their full term, from the uterus of a cat, immediately after its
death from chloroform, having previously placed ligatures on
the foetal portion of the cords. They both were lively. I in-
jected ten minims of the solution into the abdominal cavity of
each by perforating the walls with the point of the syringe in the
usual manner. When the syringe was withdrawn, the punc-
tures remained dry, and the spots were scarcely .visible. Xo
fluid exuded upon pressure. Then, without in any way se-
curing those punctures, I introduced the two foetuses alive and
tetanic into the abdominal cavity of another cat under chloro-
form, and allowed them to remain there for more than twenty
minutes. Not the slightest symptom of strychnia was produced
in the cat.

We are naturally reminded by the negative result of these
experiments of the impunity with which a mother may carry a
dead and decomposing foetus. In neither case is there any
Onger a circulation.

In the following experiment the possibility of the fallacy
occurring, which has just been alluded to, was prevented:

Experimerit 3. A cat, far advanced in pregnancy, was render-
3d insensible by chloroform. The abdomen wasopened and the
iterus exposed. It was carefully divided at a part to which a
Dlacenta was not attached, and a vigorous foetus extracted in its
nembranes, which were removed from it. It was carefullv
supported on a napkin, and into the abdominal cavity about ten
ninims of the solution were ejected. The portion of integu-
nent around the puncture was then carefully pinched up and

N.8. VOL. XIV. so. IX. 35

636 Effect upon the Mother of Poisoning the Foetus. [September,

secured by a ligature, so as to prevent the possibility of any
escape of the solution. A second foetus was then extractedy
and treated exactly in the same manner. Both, with the por-
tion of the uterus, were then returned into the abdomen, which
was closed with sutures.

For ten minutes from the period of the first injection, the cat,
lay on her side breathing tranquilly. Then slight spasms en-
sued in the hinder extremities; these gradually increased, and
at length passed into violent and general ones. In seven
minutes more the cat was dead.

The abdomen was then re-opened, and the ligatures placed
upon the punctures in the foetuses were found still perfectly
secure. Both the injected foetuses were yet alive. Within a
few minutes after they were injected, they exhibited decided
spasms, and these continued for a long period after the death of
the mother frequently to recur. The other fcetues were not
affected.

In the next experiment the foetuses, after being injected, were
not returned into the abdomen.

Experiment 4. A pregnant rabbit, within a day or two of
her full term, was rendered insensible by chloroform, and the
uterus was exposed by the usual longitudinal incision, and pro-
truded considerably. It was carefully divided over a foetus,
which was immediately expelled, and received on a napkin,
remaining connected with the mother only by the cord. The
point of the syringe was inserted through the abdominal wall,
and about five minims of the solution were injected. None es-
caped. Five other foetuses all but one were removed and
injected in a similar way; from five to ten minims of the solu-
tion being thrown into each. The punctures remained dry. In
one case the cord gave way. The foetuses were all fully develop-
ed, and very vigorous. Almost immediately after the injection,
decided tetanic spasms appeared in all, but each survived and
moved actively for some time after. None of the foetuses were
replaced after injection ; indeed, it would have been impossible
to do so owing to their size. They were allowed to lie outside
the mother, and remained connected with her only by the um-
bilical cords.

At the end of fifteen minutes from the time of the first injec-
tion decided tetanic spasms appeared in the mother, and aftei
repeated attacks she died rigid in three or four minutes more,
During the spasms of the mother two or three of the placenta:
became detached.

The following experiment is a still more striking one :

Experiment^. A large bitch, far advanced in pregnancy, was
rendered insensible by chloroform. The uterus was exposed
and opened to a small extent, at a spot as far as possible front

1858.] Effect upon the Mother of Poisoning t)ie Foetus. 637

the attachment of a placenta. Through this, by means of very
gentle pressure, a foetus enclosed in its membranes was readily
expelled. The membranes were carefully divided, and the foetus
now only connected by the cord, was placed in a large, but
shallow, vessel of water, conveniently arranged, the temperature
of which was about 100 that is as nearly as possible, the tem-
perature of the fluid in which it is naturally immersed. Into the
abdominal cavity of the foetus, which was kept distant from the
mother the entire length of the cord, some two or three inches,
twenty minims of the solution (one grain of strychnia) were in-
jected, the foetus being raised from the water for that purpose.
In about two minutes the foetus, which was vigorous and lively,
exhibited decided spasms, and these continued to recur at fre-
quent intervals.

Another foetus removed in the same manner, and placed in
the same water, was similarly treated and similarly affected. In
about five or six minutes, a ligature was placed on each cord,
and the foetuses were separated, by dividing the cords on the foetal
side of the ligature. Little or no blood escaped from them.
Three other foetuses were subjected to the same process, and
after a fq|f minutes likewise removed. The quantity of the so-
lution injected into each varied from twenty to twenty five or
thirty minims. Into one nearly forty minims were thrown.
They all exhibited tetanic spasms which, in the majority, con-
tinued, though feebly, after division of the cord. The protrud-
ed portion of the uterus, which still contained three or four
foetuses, and such portions of the intestines as had escaped,
could be only partially replaced, owing to the contracted state
of the abdominal muscles.

The mother continued to breathe placidly under the influence
of chloroform for thirty minutes from the period of the first in-
jection, and for fifteen minutes after the last foetus had been
removed. At the end of that time very slight twitchings were
visible; these became more and more marked, and passed at
length into a decided spasm. The spasms, preceded by twitch-
ings, gradually increased in intensity, occurring at intervals of
about two minutes. For fifteen minutes I watched some six or
seven, to remove any doubt of their character, and then as the
effects of the chloroform were rapidly subsiding, I did not choose
to prolong the experiment further, and the dog was killed.

In this experiment, all direct contact between the injected
foetuses and the mother was prevented. No communication
whatever existed between the injected foetus and its mother ex-
cept through the cord, and placenta. It cannot be doubted that
the poison passed from the blood of the foetus to the blood of the
mother at the placenta.

These experiments, more especially the latter, are very deli-

638 Effect upon the Mother of Poisoning the Foetus. [September,

cate ones, and unless certain conditions concur they are very
likely to fail. When foetuses are removed from the uterus and
exposed, they soon become feeble; the circulation very rapidly
declines; and of course they perish the more quickly in propor-
tion as they are young and small. Therefore, in order to ensure
success, it is most important that the foetuses be well developed,
near their full term, large and vigorous. It is more difficult,
but, nevertheless, quite possible, to succeed when the foetuses are
much younger. For the same reason, and to facilitate the neces-
sary manipulation, the larger the mother is the better. In di-
viding the uterus, care must be taken not to wound the placen-
ta. This may be avoided by gently raising up the uterine wall
between the thumb and forefinger, before cutting it; in this
way the absence of placenta can be ascertained. It is also as
we'll to avoid, if possible, dividing the larger veins. For this
and for other reasons, the most convenient part of the uterus
for division is towards the constricted portion between two ad-
jacent foetuses (as the placentas are circularly attached around
the dilated portions in which the foetuses are contained), and at
a point most distant from its attachment. In operating on the
foetus, traction of the cord must be most rigidly avdWed, for,
besides interfering with its circulation, it is very likely to tear a
portion of the placenta from the uterus.

All these remarks apply with increased force to the last ex-
periments, where the foetuses remained exposed, for when they
are returned in a feeble condition to the abdominal cavity the
warmth of the mother often greatly restores them. In the latter
experiments the more foetuses that can be injected the better,
and in a few minutes after the injection of each, it is as well to
detach it, for its circulation has then probably almost ceased,
and b}' retaining it the experiment is complicated and the risk
of accidental contact of the foetus with some part of the mother
or separation of the placenta is increased. But this more deli-
cate and difficult experiment is doubtless most obviously free
from objection.

One or two points in these experiments appear worthy of
notice. The great length of time the foetus survives after the
injection of strychnia is remarkable. I think this may be thus
explained : When the strychnia kills rapidly, it produces death
principally by aifecting the muscles of inspiration, thus fixing
the chest and so suspending respiration. When strychnia kills
quickly it kills by apncea. This kind of death the foetus in utero
of course escapes, and in it death is probabty produced by ex-
haustion, as in ordinary cases, when strychnia kills more slowly.

Again in my experiments after the mother has died from the
effects of strychnia, I have carefully watched for any appearance
of tetanus in those foetuses which still remain untouched in the

1858.] Reminiscences of the Treatment of Disease, &c. 639

uterus: and although the effect of strychnia is so striking in the
fcetus when directly injected, I have never observed any of its
symptoms in those which I had not poisoned. This fact is most
interesting in relation to the present inquiry, and may proba-
bly be explained by the short time the mother survives the
effects.

A similar remark applies to chloroform. Although in my
experiments the mother was invariably reduced to a state of
profound insensibility, yet the foetuses, when exposed, were
always active and lively.

I submit, then, that proof is no longer wanting of the direct and
rapid transmission of matter from the fcetus to the mother
through the blood in the placenta.

Although it has hitherto been the custom, when considering
the close and intimate relation between the fcetal and maternal
blood, to speak only, or especially, of the effect produced on the
fcetus by morbid materials present in, or other unnatural con-
ditions of, the blood of the mother, to say the least, it must be
admitted that there is an equally free and direct transmission of
matter, though for many reasons a less obvious one, from the
fcetal to the maternal blood.

When the influence which the foetus in utero thus exercises
upon the mother shall be fully recognised, it will soon become
more clearly understood. At present, it is impossible to esti-
mate the importance of the subject. While stauding only on
the very threshold of the inquiry, enough is visible to tempt
any one beyond. Why should not the investigation of this
question lead toresults which, although moredfficult to obtain,
are perhaps not less worthy of research than those useful and ex-
tensive ones which have already been disclosed by the study of
hereditary transmission of disease ? [London Lancet.

Reminiscences of the Treatment of Disease without the use of Alco-
holic Stimulants. By John Higgln'BOTTOM, Esq., F.E.S.,
Nottingham.

Ox Uterine Hemorrhage.

For the first twenty-five or thirty years of my professional
life, I had a very extensive midwifery practice, consequently
many cases of uterine haemorrhage, and some of them which
caused me intense anxiety of mind for the safety of the patient
The first seventeen years of my practice, I was in the habit of
Ifollowing the example of my medical brethren in giving, as a
medicine, alcohol in the form of port wine and brandy, and the
: ;ure of opium. The tincture of opium a valuable remedy
was given in proper doses; but the wine and brandy were

640 Reminiscences of the Treatment of Disease, &c. [September,

administered according to the degree of haemorrhage and con-
sequent depression, often with little attention, to either the qual-
ity or quantity of the intoxicating fluid, depending on the law
of tolerance for safety in such cases.

In these terrific cases, along with the stimulants, were used
every local application, as cold water, ice, pressure on the ute-
rus, &c, to cause contraction of the organ. Under such treat-
ment the patient would rally a little ; but very soon the sinking
pulse, the blanched face and white lips, would indicate the ne-
cessity of more wine or brandy, which was immediately given,
very soon to be followed by an increased flooding and conse-
quent lowness. This alternate state of reviving and sinking
has continued for several hours, when the stomach has become
so much distended and irritated by the stimulants and other
fluids given as to produce a full vomiting of the contents of the
stomach ; after this the haemorrhage has ceased, the patient has
gradually recovered, and required nothing more than a little
gruel or tea. This happy termination by vomiting does not
always take place, but the wine and brandy have been given
in such quantities as thoroughly to narcotize the patient; she
becomes insensible and comatose, and cannot be roused, and
death takes place. Alcohol has caused her death ; not the hae-
morrhage. The following is a case in point :

In June, 1823, I attended Mrs. M in labour; she was

of a stout, plethoric habit of body ; she had after delivery a
very profuse flooding. The usual stimulants of wine and bran-
dy, and also opium, were given her, and the customary local
applications were resorted to with very little effect. Her friends
became alarmed for her safety, and called in an old physician,
without my knowledge, who immediately was dissatisfied with
the brandy. He said it was not strong enough, it having been
procured from a neighboring public-house. More brandy, sup-
posed to be of a better quality, was procured and given to the
patient. The quantity administered was thought quite requisite
to keep up the sinking powers of the patient; insensibility and
coma ensued, breathing became heavy and laborious, and in
about two hours after her delivery she died. The stomach in
this instance unfortunately retained its contents ; her only safe-
ty would have been a full vomiting of the contents of the sto-
mach. In this instance I have always been of opinion that she
died from alcoholic poisoning, and not from the haemorrhage.

The following case will show the value of vomiting in a simi-
lar case, and which led me to the disuse of alcoholic stimulants
in cases of flooding:

Mrs. C , a delicate female, about thirty years of age. ]

had attended her twice in labour in the years 1821 and 1823 :
each time she had severe flooding directly after the separatior

1858.] Reminiscences of the Treatment of Disease, &c. 641

of the placenta. I employed the usual local applications, and
administered wine and brandy and tincture of opium. These
cases were attended with great anxiety, and I had to remain
with my patient several hours before I could leave her with
safety.

On her third labour, in the year 1826, 1 was afraid she would
die, after having used all my remedies, and having given her a
pint of port wine, and half a pint of brandy, during the three
hours after the birth of the child, which proved of no avail: it
occurred to me that in both former times in which I attended
her, when I had used similar means to check the haemorrhage,
that there was no amendment until she had ejected the con-
tents of the stomach. I was then most anxious that vomiting
might take place in hope of relief, as she was rapidly sinking.
I thought as vomiting had been so beneficial to her in the form-
er instances, that I was in this case justified in procuring it by
giving an emetic. I directly gave her an emetic dose of ipecac-
uanha; a full vomiting soon succeeded, and a large quantity of
fluid was ejected. I was much, struck with an expression of
my patient, which I had several times before heard in similar
cases after vomiting " Oh, I'm better; I'm better now !" The
haemorrhage ceased directly, and did not return, the symptoms
of sinking abated, and the patient appeared soon in her usual
state of body, but very feeble ; a little plain gruel was all the
nutriment given her, and she recovered gradually from the
weak state.

I attended the same patient three times afterwards, in the
years 1827, 1829, and 1831, and, what is very satisfactory in
favor of the secale cornutum, which was about that time com-
ing into use in this locality, I gave her in every case half a
drachm of the powder before the birth of the child, a second
dose before the separation of the placenta. This remedy had
the desired effect of preventing the haemorrhage, so that I had
no further need of the ipecacuanha, or indeed any other remedy.

I have attended patients since that time, when the secale had
no effect in checking the flooding, both in my own practice and
in consultation ; and I have resorted to the ipecacuanha emetic,
when other means have failed, and with immediate success.

For more than thirty years I have lost all confidence in the
diffusible stimulants, such as wine, brandy, &c, in uterine
haemorrhage, from & conviction that they increase the arterial
circulation, and consequently the haemorrhage. The common
practice of giving the patient a little cold water, or vinegar and
water, to drink, and keeping the body in a cool state by means
of a well-ventilated, cool room, are more likely to restrain the
haemorrhage, and thus preserve the strength of the patient.

The ipecacuanha emetic, in half-drachm doses, I consider a

642 Valuable JRemedyfor Dysmenorrhoea, &c. [September,

perfectly safe remedy, which may be used in any case of severe
flooding, but I have hitherto given it as a dernier resort. I have
found the secale cornutum, if good, to answer in most cases. In
other cases, I have given a drachm of the tincture of opium
with decided benefit; if not fully relieved in hajf an hour, half
a drachm more, but I have had very rarely to repeat the reme-
dy a third time; the tincture of opium has the effect of check-
ing the haemorrhage, and also of relieving the pain. [Ibid.

Valuable Remedy for Dysmenorrhoea and consequent Sterility.

Professor E. D. Fenner presents some valuable considerations
on the subject of Dysmenorrhoea, and offers his experience with
a new formula. ' We select the following from the Medical News
and Hospital Gazette:

"Soon after I commenced the practice of medicine, I received
from my brother, Dr. Kobert Fenner, of Jackson, Tenn., a recipe
for an emeuagogue which, he said, was not to be found in any
medical book of the day, but had been given to him by our fa-
ther, a practitioner of forty years experience, and he had gotten
it out of an old English work, then extinct, written by a Dr.
Falk, of London. 1 was told that it was an excellent emena-
gogue, more especially in that painful form of obstructed men-
struation called dysmenorrhea, and that it was remarkable for
almost invariably causing fruitfulness in the cases of young
married women.

The following is the original recipe and directions:
^. Gum guiac, l'\.

Balsam canadens, I i.

01. sassafras, 3 ii.

Merc, corrosiv. sublimat., 9i.

Eect. spt. vini (alcohol), 1 viii.
'Dissolve the guiac and balsam in one half the spirit, and the
corrosive sublimate in the other. Let the guiac and balsam
digest for several days ; then pour off the clear liquor, mix with
the sublimate and add the oil. Dose Ten or twenty drops night
and morning in a glass of wine or water, pro re nataJ
This was called by Dr. Falk, ' Tinctura Antacrida.1
I have continued to use this prescription . for dysmenorrhoea
ever since I first received it, and with the most satisfactory re-
sults. I have given it to my brother practitioners wherever I
have lived, and they have all pronounced it the best remedy
they ever used for this complaint. It is only very recently that
I accidentally discovered in the tenth edition of Ellis' Medical
Formulary, the same recipe, though not exactly the same direc-

1858.] Valuable Remedy for Dysmenorrhea, &c. 613

tionsfor preparing it (See page 189 of that work). It is there
placed amongst his alteratives, with the commendation of Dr.
Emerson and other practitioners of Philadelphia, in lues venera,
etc., but no allusion whatever is made to its admirable virtues
'as an emenagogue. Dr. Falk also used it in lues, and I myself
have had some interesting experience of its virtues in that dis-
ease, but I shall confine my remarks at present to its effects in
dysmenorrhoea and sterility.

Directions. I usually direct the patient to begin a da}' or two
before the expected period and take twenty -five drops in an in-
fusion of sage or sweetened water, night and morning, until the
discharge is freely established ; then cease till the next period.
In obstinate and severe cases, the medicine should be com-
menced a week or ten days before the period ; and if the pain
appears, the medicine should be taken every four or six hours
till relieved. The pain usually disappears as soon as the dis-
charge becomes free ; but in most cases the discharge comes on
without pain after taking a few doses. I have known immedi-
ate relief to be given by a single dose taken in the paroxysm;
but I have seen cases in which the pain was excruciating, caus-
ing shrieks and even violent convulsions. In such I have had
to resort to a more prompt and efficient anaesthetic, as the inha-
lation of chloroform, or the following, which I have often known
to act like a charm :

#. Spirit Camphor, 3 iii.

Chloroform, 3ii.

Tinct. opii., 3i. M.
S. A teaspoonful in sweetened water once an hour till relieved.
In violent hysterical spasms there is nothing comparable to
to the inhalation of chloroform. In the treatment of d}-smen-
orrhcea, it is important to obviate costiveness by the use of
aloetic pills. When dysmenorrhea is relieved by this treat-
ment, conception almost invariably soon occurs in married wo-
men."

After giving many cases illustrative of the value of the reme-
dy, he closes with the following incidents, which are striking,
both for their significance and the quiet drollery with which
they are related:

"I might give numerous cases of newly married ladies in
which I was consulted for dysmenorrhcea. This tincture hardly
ever fails to restore the healthy function of the uterus, and 'send
them on their way,' but not always 'rejoicing,' as the following
incident will show. A gay, sprightly and robust married lady,
mother of three or four children, and without the least (Jesire
for more, after indulging too freely in the fashionable dissipa-
tions of the ' gay season ' in Xew Orleans, began to have symp-

61-i Valuable Remedy for Dysmenorrhoea, &c. [September,

toms of engorgement of the uterus, and more than ordinary pain
at her monthly period. I was consulted, and gave the ordinary
advice in such cases ; urging upon her the necessity of abstain-
ing from late hours, too much dancing, and rich suppers. She
disregarded my advice, got worse, and sent for me again. She'
was now a plain case of dysmenorrhoea, and I knew what would
soon cure her; but I also knew that if aware of the probable
consequence, she would not take the medicine. So I took trie
liberty of judging for her what was best to be done under the
circumstances, and gave her the tincture. Her next period
passed free and easy ; but it was not long afterwards that she
found, to her horror, that she was pregnant. She has since borne
two fine children, but I have never ventured to reveal to her
the trick that was played on this occasion.

In several instances where the ladies had learned from experi-
ence the only danger of the medicine, after putting it off until
they could see no other prospect of relief, have taken the medi-
cine again, and were soon in the condition they expected.

Only a few months since I was consulted byayoung married
man about the case of his wife, who was suffering greatly with
dysmenorrhoea. They had been married about twelve months.
The young wife had been afflicted with this complaint during
the whole time, and was now very pale and feeble. Getting no
relief from the prescriptions of the family physician, they had
been induced to consult a Medical Spiritualist, one of the vari-
ous charlatans who practice on the credulity of the people in
this city, with great profit to themselves alone. He said the spir-
itualist told him ' his wife would get better and then worse again,
and thus go on for a long time, but finally recover her health;
and that there was no medicine that would do her much good.'
The gentleman permitted her to go on this way for several
months, but finding his young wife continually declining, and
her monthly pains increasing in violence, he resolved to seek
further medical advice. About this time he happened to men-
tion the case to a friend whose wife had suffered in a similar way,
and been relieved by medicine obtained from me. Upon this
he came to consult me. I prescribed this tincture, with aloetic
pills, to obviate costiveness, and at the same time foretold what
would be the probable consequence, which did not seem to terrify
either of them. The very next period passed off free and easy,
and she has had no return. Her health is greatly improved,
and they are now rejoicing in prospect of an heir.

In the dysmenorrhoea of virgins, a complaint by no means
uncommon among our delicate young ladies of the South, I
have known this tincture to produce the happiest effects. I
have prescribed it in numerous instances, and never knew it fail
to give relief when directions were properly attended to. Some

1858.] The Amaurosis of Laziness. 645

of the most severe and obstinate cases I ever met with were in
young girls from the age of fifteen to twenty years. As in mar-
ried women, these unfortunates sometimes suffer excruciating
agony, and even go into spasms. In this emergency I usually
prescribe the compound tincture of chloroform mentioned in the
preceding portion of this paper."

The Amaurosis of Laziness. (Under the care of Mr. Ernest
Hart.)

Xo other affection of the eye comes more frequently under
care, whether in private or in hospital practice, than scrofulous
ophthalmia attacking all the various tissues of the eye in turn.
Its most frequent, and usually its earliest, seat is the palpebral
and ocular conjunctiva. Out of the total number of cases treat-
ed by him at this Infirmary, we are informed by Mr. Hart that
at least two-thirds are either confined to the mucous membrane,
or initiate there and pass on to the other structures. The cornea
is the most frequently attacked after the conjunctiva, and the
ulceration which so commonly occurs here due to the softness
of the tissue is frequently followed by opacity. This varies
from dense leucoma to a slight want of polish only. It is stated
by Mr. Hart to be due to the deposit of a granular lymph be-
tween the lamellae in the former instance, and to the formation
of a freshly and irregularly developed epithelial layer in the
latter. He has two cases of amaurosis now under treatment a
result of leucoma which is not perhaps so unfrequent as it may
be thought to be, and to which little attention is commonly di-
rected, perhaps because its origin and character are not always
clearly perceived. The frequent result of leucoma is amaurosis,
as in these cases ; but an amaurosis of a peculiar character the
amaurosis of laziness. The opacity of the cornea renders vision
difficult with the eye affected, and hence the effort necessary is
constantly evaded. The whole burden of vision is thrown upon
the other eye, and hence it is overworked. From this two evils
result : a confirmation of inefficiency and increased amaurosis in
the eye which is dimmed by the veil of opacity, and fatigue,
weakness, and inflammation of the overtaxed organ. Under
these circumstances, the attention of the surgeon is not to be led
astray and fixed upon the inflammatory condition^ of the other-
wise sound eye. Remedies applied to this are perhaps some-
what worse than useless. The cure is to be effected by the treat-
ment he adopted that of compelling its leucomatous fellow to
assume a share of work, and so relieve the overstrain. The
sound eye should be bandaged, and the necessary effort for vis-
ion with the other should thus be made compulsory. Vision
rapidly improves, the retina adapting itself to the necessary ef-
fort with considerable facility. [London Lancet.

64:6 Editorial and Miscellaneous. [September,

EDITORIAL AND MISCELLANEOUS.

Practice per capita. We withhold our editorial and much of our
miscellany in order to give place to the following judicious remarks upon
what appears to be, as we learn from many sources, a great evil in our
profession, in certain parts of the country. Although we may not be
prepared to adopt the severity of tone used by our correspondent, we can
yet heartily endorse his sentiments, and feel very much like commending
even his indignation :

Messrs Editors :

As one of the objects of a medical journal, is, to expose the abuses of
the Profession, and thereby purge it of all corruption, so as to secure a
steady course of improvement, as well as maintain its dignity and honor,
we propose, at this time, to furnish you for publication an exposition of
one evil, to which many men, calling themselves Doctors, and pretending
to practice the " healing art," have resorted. We allude to the taking
of families per capita, or by the head.

We regard this as being unprofessional, unjust, mean, and venal.
There is such a practice as a mule or a hog-drover paying toll over a
ferry or bridge for so much a head. Circus companies may sometimes
let a man with his family, or his negroes, enter for so much a head.
Chicken wagoners may sell fowls to a Hotel-keeper for so much a head.
Stock-raisers may furnish the flesh market for so much a head. These
are all right and proper, and in keeping with the business. But for a
man to practice medicine that most responsible, time-honored, and
noblest of all professions which has for its high object the preservation
of the body during life's temporal existence upon which so much is
relied in the hour of physical suffering and despair and which has been
distinguished in almost all ages for its wise, learned, and great advocates,
'for so much a head, cannot be too severely censured, and ought to re-
ceive the condemnation of every philanthropist.

We say it is unprofessional, because its tendency is to bring the Pro-
fession into disrepute. It is illegal, because, nowhere in all the past his-
tory of the Science of Medicine, can there be found the least semblance
of authority for it neither is it tolerated by any of the regular schools
of the present day nor is it authorized by the medical board of the
State : hence it is a usurpation of privilege. It is unjust, because it robs
many of patronage which. their superior qualifications and honest merits
entitle them to. It is mean, because it is beneath the dignity of the Pro-
fession. It is venal, because a man hires himself by the year, as he would
his own servant, and in that way enslaves himself.

1858.] Epitorial and Miscellaneous. 617

The practice has been inaugurated, and is still pursued by a few Char-
latans, who care nothing for the dignity and honor of the Profession, and
*are forced to it for want of due qualifications. "We have come to this
conclusion, because we have never seen a man that was really qualified
and learned in the science, that would deign to do such a thing,
generally true is this, that whenever we hear of a man guilty of it, we
mark him as a quack, and as one who has not medical learning and in-
trinsic merit enough to commend him to the favor and patronage of the
people. We know men engaged in this kind of practice, who are just
beginning business, and we must confess it is a very low and niggardly
claim for a young man to set up. Our advice to all such, is, to quit
physic, and do something for which they are qualified. Adopt the motto,
that if you can be of no honor to a profession, be sure that you are of no
disgrace to it. We know of others, who have been practicing for years, and
have amassed wealth by a combination of extraneous influences, and
now, that young, scientific, and skillful physicians have set up in opposi-
tion to them, relying entirely upon their capacity, and contending for a
just and full remuneration for their services their avarice and the devil
have seduced them into the same ignoble practice of taking families
so much a head, seeming to care nothing for the interest of the Profession
after they have made a " speculation " out of it, and contending with the
poor young physician, upon a dishonorable principle, for the very last
dollar.

We further deuounce it as a system of bribery. For it is a voluntary
inducement offered, to obtain that which rightly belongs to another, by
virtue of his superior skill and qualifications. Our doctrine is, that
every thing should stand upon its own merits, for good or for evil for
weal or for woe. It is the same glorious doctrine inculcated in Scripture,
in the passage, " according to thy works shalt thou be judged " evi-
dently implying the just reward of merit. Every man, with ordinary
faculties of mind, has a talent for something, and if he will but culti-
vate it, he may safely calculate on success. We are sorry to assert, that
there are many persons who have so meagre an opinion of the Science of
M .icine, and depreciate its responsibilities and duties so far as to ima-
gine that any ordinary mind may grasp it and practice it successfullv.
This is enough to verify the fallacy and incompetency of all such, when
it is well known that the Science of Medicine is one of the most exten-
sive and recondite in all nature. It is not only difficult to comprehend,
and a thorough knowledge acquired by a course of hard and lengthened
study and application, but demands research and attention at every step
in a man's life. A physician should be a student of medicine as long as
he continues to practice it.

648 Editorial and Miscellaneous. [September,

We come now to the causes that have engendered this evil. They
are two : one exists in the so-called Physician, as has been sufficiently
indicated in the above remarks; and the other in his patrons. This is
considered a fast age one of improvement of enterprise and of pro-
gress, which would naturally suggest the idea of liberality. But such,
in the main, is not the fact. For as the people grow richer, their hearts
grow more callous, contracted, and fixed upon the idol mammon.
When a man wants to buy an article of merchandize, he goes to the
cheapest store, it matters not whether it be Dutch, Jew or American.
He consults his purse, and nothing else. So, when he wants a physi-
cian, he employs the cheapest it does'nt matter whether he has ever
heard a course of lectures or not he may be of the same or a different
creed. He will employ him by the year, at a small sum, and if he loses
half his family, it is better than to pay a learned physician double the
amount, or the usual rates, and save all his family. Well, experience
and observation have taught us, that cheap things are of little value.
Hence we conclude that cheap Doctors, like cheap goods, are of little
use.

Many people are ready to cry out against the Profession, as failing to
accomplish the object of its institution, and impute to it many hard and
unkind things. But we ask, in all candor, how can they expect any bet-
ter, when they throw all their patronage and influence into the hands of
the cheap and illiterate Doctor, while the educated, intelligent, and skill-
ful physician, who has devoted time, money and labor, for the acquire-
ment of a thorough knowledge of his profession, and upholds its dignity
by contending for even customary rates, and refusing to condescend to
anything uncourteous and unprofessional is forced to abandon his pro-
fession, and seek other means of support or plod along through life with
a mere pittance as his share of public favor and patronage.

This is certainly a deplorable state of things, and is tending to a de-
generacy of the Science of Medicine, at a time when it is thought to be
in a high state of improvement and progression. Let this evil only con-
tinue a few years longer, and we predict for the science a state of obscu-
rity and bigotry exemplified in the dark ages of the world. The succes-
sive teachings of Hippocrates, Stahl, Boerhaave, Cullen, Brown, Brous-
sais, Sydenham, Harvey, Jenner, Rush, Chapman, and many other great
and shining lights in Medicine, will be lost, and there will be none to
succeed and revive them. Then, instead of having a beautiful Science,
as we now have, which harmonizes with the laws of Chemistry and Na-
tural Philosophy, and is so efficient in counteracting and subduing the
pathological conditions of human organism, we shall have a mere nom-
inal system an insignificant wrecked skeleton of the existing mighty

1858.] Editorial and Miscellaneous. 649

and magnificent ship. What a great calamity it would be to deprive
the world of the immense amount of learning, skill, and usefulness that
characterize the ranks of the Medical Profession, when it can be so easi-
ly maintained by a just and manly reward of the arduous and merito-
rious labors of the qualified physician.

Patron, we exhort you to reflect upon this subject : for the evil and
its remedy are both in your hands. If the science ever does foil, which
seems to us inevitable, in view of the evil which we have been dia
ing, the dreadful curse of the sacrifice must rest upon your own heads.
, For, as long as you continue to reward medical merit, so long will it as-
sume a high and honorable standard. But whenever you disregard and
ignore it, by casting all your influence and patronage into the hands of
the illiterate, and the quack, on account of his cheapness, as many are
now doing, you at once consign it to ruin, decay, and oblivion.

There is another consideration to which we would call the attention of
the patron. Suppose one of your family gets sick are you not bound,
as Father or Master, as the case may be, to employ the best medical
skill and learning, without regard to price, to combat the disease, and, if
possible, restore health ] But suppose, instead of doing this, you employ
one of those cheap, illiterate, yearly Doctors, and the patient dies, as is
frequently the result, then, we ask, upon whose skirts does the blood of
the sacrifice rest \ Certainly upon yours. Then, if you want good,
skillful, and intelligent physicians such as are worthy of the appella-
tion, and such as you can repose confidence in, in the hour of physical
affliction and trial when all your earthly hopes are at stake bestow
your patronage upon those who merit it, (even if your bill is a little
larger,) and you will be vastly benefitted, in the. saving of life, and in the
discharge of you duty to your family, and the satisfaction that will
accrue in the just reward of merit. But when you wilfully pursue any
other course than this, you risk life, which is dearer than all things upon
earth subordinate it to money, barter it away as you would hides and
tallow, and thus perpetrate one of the most heinous and unpardonable
offences against the law of God and man.

We also call upon the Profession, everywhere, to assist in expunging
this evil, now in its incipiency, for it is a monstrous one, and a few years
will develope it, when it cannot be eradicated. If there be found any in
the Profession so devoid of respect for its dignity and honor, as to resort
to this abuse, let them receive the condemnation of all men, both in and
out of the Profession. Let us have and sustain those in our ranks who
are worthy and well-qualified. Let us contend for just and remunerating
prices, and maintain all other considerations in keeping with the cause.
Then may the hopes and wants of the afflicted be realized in the timely,

650 Editorial and Miscellaneous.

skillful, and effectual ministrations of the genuine, true, and enlightened
physician. Justitia.

Sulphur and Nux Vomica in Hemorrhoids. M. Van Holsbeck recom-
mends the following formula as being rapidly beneficial : ft. Sulphur
loti. sacchar. alb. aa, gj. ; extr. strych. nuc. vomic. gr. vj. ; mucil. gum.
tragacanth. sufficient to form twenty-four lozenges. The patient is to
take two the first day, increasing the dose by one daily until six a-day
are taken. He now rests a few days, and then diminishes the dose in
the same proportion, until he gets to the two again. If the cure is not
complete, he must begin again; but it is rare to find the treatment re-
quired for more than a week. During its continuance alcoholic drinks
and a too stimulating diet are interdicted. The treatment is applicable
to all stages of uncomplicated haemorrhoids. [Druggist's Circular.

Wind of a Shot. The following extract from an Indian letter con-
firms the doubts entertained as to deaths attributed to the " wind of a
shot:" "Brigadier Russell is also about to leave the army, under the
advice of a medical board. Never, perhaps, in all the chances of war
has there been such an escape as his. A cannon ball cut the gold watch
chain at the back of his neck as cleanly as if it had been a pair of nip-
pers, and did him no further injury, except inflicting a shock to his
nervous system. [Med. Times and Gaz.

Pennsylvania Medical College. Dr. T. G. Richardson has resigned the
Professorship of Anatomy in the Medical Department of Pennsylvania
College, and Dr. J. H. B. McClellan has been elected to the vacant
chair. [Med. News and Library.

Augusta, Ga. the Healthiest City in the Union. We are pleased
to record the following from the Constitutionalist of this city :

"The editor of the Charleston Mercury, in a recent article on the mor-
tality of cities, says : ' Looking at the returns of Augusta, Ga., we find it"
to be, at the present time, the healthiest city in the Union, and having
less deaths.' "

Sir Philip Crampton's Coffin As any thing which relates to this
great Surgeon must be interesting, we insert the following :

"By the singular directions of Sir Philip Crampton, made just prior
to his death, the body was placed in a solid Irish oak coffin without any
lid ; around this was placed a thick concrete of Roman cement, which
was made to fill up al! the spaces in the interior of the coffin not occu-
pied by the body, which was covered over, and entirely imbedded in the
cement, of which nearly five hundred weight was used. The heavy mass
was placed wTithin another Irish oak coffin of great strength, which was
covered with fine black cloth, on the lid of which was a shield bearing
the following inscription : 'Sir Philip Crampton, Bart., died June 10th,
1858, aged eighty-one years.'" [London paper.

SOUTHERN

MEDICAL KM) SURGICAL JOURNAL.

(NEW SERIES.)

Vol. XIV.] AUGUSTA, GEORGIA, OCTOBER, 1838. [No. 10.

ORIGINAL AXD ECLECTIC.

ARTICLE XXII.

Observations on Malarial Fever. By Joseph Joxes, A.M., M.D.,
Professor of Physics and Natural Theology in the University
of Georgia, Athens; Professor of Chemistry and Pharmacy in
the Medical College of Georgia, Augusta; formerly Professor
of Medical Chemistry in the Medical College of Savannah.

[Continued from page 601 of September Xo. 1858.]

Case XXVIII. Scotch seaman ; age 14 ; light hair, blue
eyes, florid complexion; height 5 feet 2 inches; weight 95 lbs.
From light ship, lying at the mouth of Savannah river. Was
taken sick three days ago.

September 16th, 7 o'clock P. M. Face as red as scarlet; skin
in a profuse perspiration, which has saturated his thick flannel
shirt and wet the bed-clothes. Pulse 100. Eespiration 24 : does
not correspond with the flushed appearance of his face. Tem-
perature of atmosphere, 88 F. ; temp, of hand, 102 ; temp, un-
der tongue, 103.25. Tip and middle of tongue clean and of a
bright red color; posterior portion (root) of tongue, coated with
yellow fur; tongue rough and perfectly dry. When the finger
is passed over the tongue, it feels as dry and harsh as a rough
board. Lies in a stupor it is almost impossible to arouse him.
Great tenderness upon pressure of epigastrium : pressure here
causes him to cry out.

$. Blister, 6 by 6 inches, over the epigastric region. Mus-
tards to extremities. $. Calomel, grs. x. ; Sulphate of quinia,
grs. vij. Mix. Administer immediately, and follow with castor
oil in four hours. #. As soon as the blister and mustards have
:aroused the patient, administer sulphate of quinia grs. v. every
three hours, up to grs. xv.

k;s. vol. xiv. ko. x. 36

652

Jones, on Malarial Fever.

[October,

Sept. 17th, It o'clock A. M. Restored to the exercise of his
intellectual faculties, and says that he is much better. Mustards
and blister acted promptly, and aroused the patient. The calo-
mel and castor oil acted six times. Rested very well during
the night. Skin was in a perspiration during the night. Tongue
moist. The bright red color and dry rough state, have disap-
peared. It is now slightly coated with yellow fur. Pulse 86;
respiration 18, regular and gentle. Skin moist and relaxed.
Temperature of atmosphere. 87 F. ; temp, of hand, 100 2 3 ;
temp, under tougue, I0ia. lias taken xxij. grains of sulphate
of quinia.

$. Sulphate of quinia, grs. xx.; infusion of Virginia snake-
root, f I xvi. Tablespoonful every three hours. Diet, gruel and
flaxseed tea. Urine of a light orange color, a shade higher than
normal. Sp. gr. 1008'2. Amount, of urine collected during the
last 16 hoursr grains 8065. It is probable that much urine was
lost during the action of the purgative.

Grs. 8065 Urine pass-

Grs. 1 2098 Urfne cal-

If,00 parts

ANALYSIS LYL

ed during 16 hotirsr

culated for 24 hours,

Urine con-

contained grains

contained grains-

tained

Water

7880-128

11745-892

970-874

Solid Matters, .....

234-872

352-108

29-126

Urea ,.

83-100

124-600*

1C290

Uric Acid ,.

01 60

0-240

0-019

Ext. and Col'ing Matters.

118-216

177-224

4-077

Fixed Saline Constituents,

32-880

49-200

14-038

Sept. 18th, 12 o'clock M. Took a change for tbe worse this
morning now lies in a stupor. Tongue coated with yellow
fur, much drj^er than normal;: reaction of saliva acid. Pulse
9-3, feeble; respiration 32. Temperature of atmosphere, 87 5;
temp, of hand, 103; temp, under tongue, 104. Has taken xxxv.
grains of sulphate of quinia during the last 30 hours.

B. A cut cup to each temple, and two to back of neck. Mus-
tards to extremities. As soon as fever remits, give sulphate of
quinia, grs. v., every three hours, up to grs. xv. Urine, light
straw colored, resembles the urine of Diabetes Mellitus.. Sp.
gravity 1010. Amount of urea in 1000 parts of urine,. 7.970;
Amount of uric acid in 1000 parts of urine, 0.029^

8 o'clock P. M. The cut cups and mustards aroused him, and
he asked for something to eat. The change, however, was only
temporary, and he relapsed again into a state of stupor. Kow
can be aroused only by violent shaking, and then goes into a
profound sleep in a few moments. Tongue, bright red at tip
and edges, dry and harsh to the" touch, and coated at. the supe-
rior portion with light yellow fur. Pulse 90 ; respiration 26.
Temperature of atmosphere, 85 F.; temp, of hand, 102 25;

1858.] Joxes, on Malarial Fever. 653

temp, under tongue, 103 25. Has taken x grs. of the sulphate
of quinia during the last eight hours.

H. Blister to back of neck; mustards to extremities. Calo-
mel, grs. vi.; castor oil in four hours. Neutral mixture.

Sept. 19th, 11 o'clock A. M. Appears to be better. Intel-
lect more active than last night, but still inclined to stupor. Face
still much flushed; tongue moist, red at tip and edges and coat-
ed with white fur; papi Ike enlarged. Blister upon the back of
the neck has drawn. Cathartics acted ten times. Skin moist
and relaxed.

R. Brandy, f 5 viij.; Infusion of Virginia snake-root, f I viij.;
-Sulphate of quinia, grs. xv. Mix. Tablespoonful every hour.
Continue neutral mixture.

Has just passed 5020 grains of light orange colored urine.
Sp. gr. lOOi. After standing 50 hours, a very slight deposit of
triple phosphate and urate of soda.

ANALYSIS LYII.

Grains 5020 of Urine con-
taiund grains

1000 parts of Urine con-
tained

Water -

4923*468

96-537
38*482

0-200

51-112

6 435

880*770

Solid Matters

19*230

Urea

8-480

Uric Acid

0-049

Ext. and Coloring Matters
Fixed Saline Constituents,

9-317
1*282

Sept. 20th, 12 o'clock M. Says that he is much better. The
"brandy, in conjunction with the infusion of snake-root, and sul-
phate of quinia, appears to have exerted decided beneficial effects.
Face still flushed; tongue relaxed, moist, and slightly coated
with white fur; papillas enlarged, and prominent over the
whole surface of the tongue. Surface of blister looks health v.
Amount of urine passed during the last 24 hours, grains 3030 ;
sp. gr> 100 L ; reaction slightly acid ; color, very light yellow, like
diabetic urine.

$. Continue brandy, infusion of snake- root and sulphate of
quinia.

Sept. 21st, 1 o'clock P.M. Continues to improve. Countenance
and intellect bright. Tongue has altered greatly in appearance
it is moist and pale, and very slightly coated with white fur; pa-
pillae slightly enlarged; face not so flushed. Pulse66; respiration
18. Temperature of atmosphere, 83 F. ; temp, of hand, 98;
temp, under tongue, 100. Skin cool and relaxed. Amount of
urine passed from Sept. 20th, 1 o'clock P.M., up to 11 o'clock,
(hours 10,) grs. 13013 ; light yellow color; sp. gr. 1001 ; reaction
alkaline after standing 15 hours. Amount of urine passed from
Sept. 20th, 11 o'clock P.M., up to the present time, grs. 5030:
sp. gr. 1006. Deep orange color. Amount of uric acid in grs.

654 Jones, on Malarial Fever. [October,

5030 of urine, grs. 1.050; amount of uric acid in 1000 parts of
urine, grs. 0.200.

Sept. 22nd, 12 o'clock M. Tongue moist and normal in ap-
pearance; skin cool; face of natural color. Pulse 65; respira-
tion, 18. Temperature of atmosphere, 845F. ; temp, of hand,
93; temp, under tongue, 99a5.

$. Quassia and soda; continue infusion of Virginia snake-
root and sulpli. of quinia, tablespoon ful every six hours. Ain't
of urine passed during the last 24 hoursy grs. 20.800 ; normal in
color ; sp. or. 1001.

7 o'clock P. M. Pulse 57; respiration 16. Temperature of
atmosphere, 8i; temp, of hand, 98; temp, under tongue, 99-5.
Amount of urine passed during the last 8 hours, grains 7021;
sp. gr. 1003 ; light colored.

Sept. 23rd. Examination of Blood No. V. Clot appeared to-
be softer than normal. Serum of a light yellow color. Specific
gravity of blood 1042.4; sp. gr. of serum 1021.3.

Water

In 1000 parts of Blood, 827-901

" " " " Serum, 928-370

(1) " " " Liq.Sanjr., 926937

(2) " " " u " 887-034

Solid Matters

In 1000 parts of Blood, 172-099

" " " " Serum, 71-630

(1) " " "Liq.Sang., 73-297

(2) " " " " " 112-965

Solid Matters in Serum of 1000 parts of Blood, 62*789.

Ftxed Saline Constituents,

In 1000 parts of Blood, 4-041

" " Serum, 4-035

(1) " " Liquor Sanguinis, ------ 4-045

(2) " " " " 6-246

" " Solid Matters of Blood, ----- 23-202

" " " " " Serum, 56-338

" " " " " Blood Corpuscles, - - - 4-584

" " Moist Blood Corpuscles, - - 1-119

In Blood Corpuscles of 1000 parts of Blood, - - - 0-490

" Serum of 1000 parts of Blood, 3-551

1000 Parts of Blood Contained,

Water, - 827-901

Dried Blood Corpuscles, 107-877 } Sj Maers* J 10*>

Fibrin, 1-433

Albumen, Extractive and Coloring ) Organic Matters, - 59*210

Matters, - - 62-789 [ Mineral " - 3*551

1000 Parts of Blood Contained,

) Water, - - - 323*631

Moist Blood Corpuscles, 431.508 [ Organic Matters, - - 107*320

) Mineral " - - 0*490

1858.] Jones, on Malarial Fever. 655

Liquor Sanguinis, - 568*492

Water, - - - 504-270

Organic Matters, - - 592 10

^Mineral " - - 3-551

Fibrin, - - T433

1000 Parts of Moist Blood Corpuscles Contained,

Water, 750-000

Organic Matters, - 248-709

Mineral Matters, -------- 1-119

(1) 1000 Parts of Liquor Sanguinis Contained,

Water, 926-703

Organic Matters, 67-380

Mineral Matters, -------- 4-035

Fibrin, - 1-667

(2) 1000 Parts of Liquor Sanguinis Contained,

Water, 887-034

Albumen, Extractive and Coloring Matters, - 104 000

Mineral Matters, - - - 6-246

Fibrin, 2-520

A few days after this observation, numerous small boils ap-
peared over all parts of the body of this patient. These were
productive of nothing but pain and uneasiness, and disappeared
in the course of two weeks. The patient continued to improve,
and was discharged from the hospital.

This case exhibits the following points of interest:

1. The cerebral symptoms were strongly marked. There was
a constant tendency, in the active stages of the disease, to pro-
found stupor. The flushed face and hot head and torpid intel-
lect, indicated congestion of the brain. Sinapisms, blisters, cut
cups and purgatives, diminished the apparent congestion of the
brain, and relieved the intellectual faculties temporarily, but not
permanently. Stimulants and sulphate of quinia, so far from
increasing the apparent congestion of the brain, diminished it
permanently, and relieved the intellectual faculiies. Under
their action, the red, dry, rough tongue, became pale, moist and
soft under their action, the circulation and respiration were
equalized, and diminished in frequency; the temperature was
diminished and the intellect restored to its normal exercise.

As the sinapisms, blisters, cut cups and purgatives, were
used in conjunction with the stimulants and sulphate of quinia,
we cannot assert that the restoration of the functions were due
solely to the action of the stimulants and sulphate of quinia. It
is evident, however, from the history of the case, that the action
of the former was temporary, whilst that of the latter was per-
manent. It is probable that the recovery of this patient would
have been doubtful in the extreme, if cither of these modes of
i treatment had been omitted.

656 Jones, on Malarial Fever. [October,

During the height of the disease I had no hopes whatever of
his recovery. The brain was more affected than all the other
organs. Long after the pulse and respiration, skin and digestive
functions were restored to their normal actions, the patient was
scarcely able to stand or walk on account of the condition of the
brain. His first efforts at walking resembled those of an infant
just learning to stand and walk alone. This was not due to the
loss of muscular power, for there had been but a slight reduc-
tion of the size of the muscles. It was due rather to the dis-
ordered state of the cerebro-spinal system.

2. The urine was abundant of low specific gravity and light
color. In these particulars this excretion presented a marked
difference from the urine of the cases recorded in previous num-
bers of this journal.

8. The uric acid was diminished during the active stages of
the fever, and under the action of sulphate of quinia.

4. The analysis of the blood shows that the organic matters
of the blood corpuscles were diminished slightly, whilst the min-
eral matters were greatly diminished. The fibrin was dimin-
ished in amount, and appeared to be softer than normal. The
albumen and extractive matters of the serum were somewhat
below the normal standard.

When we consider that this patient was in a state of almost
complete starvation, during the height of the disease, it is evi-
dent that the malarial poison acted but slightly upon the con-
stituents of the blood. The malarial poison appeared to act
almost entirely upon the brain and nervous system. This ac-
tion may have been greatly increased by circumstances as
peculiarities of constitution, irregularities of habit, and continu-
ed exposure to the hot sun on the light-ship.

I was afterwards informed that this boy was in the habit of
using ardent spirits freely.

It is probable that one or all of these causes may have pre-
disposed the brain to congestion, and converted a light attaek
into a severe and dangerous disease, It is probable that the
dose of malaria was small, and, aside from these circumstances,
would have produced only a mild disease, We are led to this
conclusion by the fact, that its effects upon the blood and excre-
tions were comparatively slight,

Case XXIX. American seaman, native of Philadelphia:
age 30 ; weight 150; heights feet 8 inches; brown hair; brown
eyes; dark complexion.

August 7th, XL o'clock A.M, Has entered the hospital in a
stupid, torpid condition. It is difficult to arouse him, and then
his answers are incoherent.

His companion states that " he has been running up and

1858.] Jones, on Malarial Fever. 657

down the Savannah river in a steam-tug. One week ago, was
attacked with chill and fever^ which was treated with sulphate
of quinia, by one of his companions. Two days ago took blue
piil and castor oil. He is of intemperate habits, passing much
of his time in a state of intoxication." Skin hot, but in a pro-
fuse perspiration ; tongue coated with light yellow fur; pulse
112, moderately full; respiration 38, hurried, thoracic chest
heaving. Temperature of atmosphere, &1F. ; temp, of hand,
103; temp, under tongue, 104. The patient breathed through
his mouth, was restless and stupid, and hence it was difficult to
determine accurately the temperature under the tongue. Has
just passed a considerable quantity of clear, limpid, high-colored
urine. #. Castor oil, f I ss. Diet, gruel.

August 8th, 9 o'clock A.M. Skin hot and dry; pulse 120.
Continues stupid. Urine passed during the night arid this
morning, clear, high colored, (reddish orange). Sp. gr. 1013.
Nitrate of urea well formed silvery white crystals.

ANALYSIS LVIIL 1000 Parts of Urine Contained,

Water, 957-282

Solid Matters, 42 618

Urea, 7-108

Uric Acid, 0*394

Extractive and Coloring Matters, - -, - - - 32-570

Fixed Saline Constituents, - ' 2-621

11 o'clock A.M. Skin moist; pulse 112. During the last
three hours the pulse has lost 8 beats to the minute. Respira-
tion 36. Temperature of atmosphere, 80 F. ; temp, of hand,
103. Temperature under the tongue could not be ascertained,
on account of the stupid condition of the patient. Castor oil
acted six times stools very offensive; breath offensive acid.
His body has a peculiar, disagreeable smell. Epigastric region
.somewhat tender upon pressure.

$. Blister to epigastric region ; soda powders. Diet, gruel.

Aug. 9th, 11 o'clock A. M. Worse: stupid. When aroused
by shaking, cannot converse intelligently attempts to pro-
nounce words and fails. Passes his urine and feces in bed.
Skin hot and dry. Has a pustular eruption over the surface of
trunk and limbs most abundant over the chest and abdomen.
Pulse 112; respiration 40. Temperature of atmosphere, 80;
temp, of hand, 10oo. Stools dark colored and fetid. Blister
has drawn, and he has torn off the cuticle with his hand sur-
face red and raw. Urine of a bright reddish brown color
cloudy, with epithelial cells from the mucous membrane of the
.kidneys, ureters, and bladder and urethra, and with mucous
corpuscles and spermatozoa.

The deposit at the bottom of the vessel consisted of spermato-

G58 JONES, on Malarial Fever. [October,

zoa, epithelial cells, mucous corpuscles, prismatic crystals of
triple phosphate, and small acicular crystals, soluble in hydro-
chloric acid.

The acicular crystals were in such small numbers that I was
unable to determine accurately their chemical constitution.

The presence of the epithelial cells, mucous, corpuscles, and
spermatozoa in the urine, were due to the action of the canthara-
din, absorbed from the blistered surface.

ty. Calomel, grs. xij. ; James's powder, (pulvis antimonii
cornpositus,) grs. xxij. Mix, and divide into six powders. Ad-
minister one every three hours. Diet, gum-water and gruel.
$. Apply blisters to the calves of his legs.

6 o'clock P. M. No improvement of symptoms. Yery rest-
less. Intellect wandering. Bowels are loose has several stools
daily. Passes his urine and feces in bed. Pulse 104, weaker
than this morning; skin not so warm; tongue dry ; blistered
surface of the epigastric region red, and without any discharge
of serous fluid. The blisters upon the legs are very slow in
their action.

#, Camphor water, f^viij.; Oil of turpentine, f 3 i j . ; Sugar,
3 ij. ; Powdered gum-arabic, 3ij.; Carbonate of magnesia, 3j.
Mix. Administer a tablespoon ful every three hours. Stop the
calomel and James's powders. Diet, arrow-root and a small
quantity of brandy.

August 10th, 9 o'clock A. M. No improvement of symptoms.
Passes his urine and feces involuntarily. Urine of a bright red
color; sp.gr. 1012*6; reaction decidedly acid contains small
quantities of albumen. It has been carefully tested for grape-
sugar, without the discovery of a trace. Amount of uric acid
in 1000 parts of urine, 0-296.

11 o'clock A. M. Countenance has a peculiar look of stupidi-
ty and anxiety, or rather horror. These two apparently incom-
patible expressions are combined. Has had two stools this
morning. Pulse 120, feeble ; respiration, 40 ; blistered surfaces
red and dry ; complexion pale, sallow.

$. Continue the mixture. Administer brandy and arrow-
root every hour.

Urine a shade lighter in color than that passed during the
night after standing a few hours, gave off numerous small
bubbles, which coated the sides of the glass vessel. After stand-
ing 12 hours, a heavy deposit of crystals of triple phosphate, of
mucous corpuscles, and of spermatozoa fell.

August 11th, 10 o'clock, A.M. Stupid, almost insensible;
expression of countenance, vacant. When aroused, mutters
lomething, inarticulately, for a few seconds, and then relapses
into his former state of stupor. ...,.,,

The eruption, alluded to before^ is oat, quite thickly, on the

1858.] Jones, on Malarial Fever. 659

back, and is distinctly pustular. Some of the pustules are com-
mencing to slough. His elbows and shoulders, and hips, upon
which the weight of his body has rested, are or a dark purplish
color, and the skin is commencing to slough at those parts most
exposed. This patient has a peculiar disagreeable smell.

Tongue dry and rough ; teeth coated with sordes. Pulse 132 ;
respiration 47. Temp, of atmosphere, 80 F.; Temp, of hand,
104; Temp, under the tongue could not be taken with abso-
lute accuracy ; it was about 105.

$ Continue mixture. Diet, milk-punch and egg-nog.

After leaving the ward, the nurse raised the patient and
placed him upon the night stool. Immediately his respiration
became hurried, he gasped for breath, his head fell upon his
breast, and the nurse called out that he was dying. He was
immediately placed in bed. It is probable, that if he had re-
mained in the sitting posture a few moments longer, death
would have resulted from the exhaustion.

12 o'clock, M. Examination of Blood No. VI. Color of the
venous blood when first abstracted, dark purple, almost black.
After exposoure to the atmosphere, the surface of the clot
changed to a cherry-red color, and not to the bright-red color
assumed by the surface of healthy venous blood, when exposed
to the atmosphere. Coagulation took place in the course of ten
minutes, and the clot was moderately firm. Under the micro-
scope, the colored blood corpuscles were found united together,
forming rolls as in inflammation, and in the blood of the horse.
Many of the colored corpuscles appeared to be altered in form
and appearance. The colorless corpuscles appeared to be more
numerous than normal. Serum, of a golden color, like that
which escaped from the blistered surfaces. Specific gravity of
blood, 1035; specific gravity of serum, 1021.

Water

In 1000 parts of Blood, 860*976

u u u u Serum, 923-786

(1) " " "Liq. Saner., 921-233

(2) " " " M " 900-473

Solid Matters

In 1000 parts of Blood, 139-024

u u u u serun]? 76-214

(1) " " "Liq.Sang., 78767

(2) " " " " " 99527

k Solid Matters in Serum of 1000 parts of Blood, 71-032.
Fixed Saline Constituents,

In 1000 parts of Blood, 7*317

" " " " Serum, 5-480

(2) " " " " Liquor Sanguinis, .... 6-489

u " Solid Matters of Blood, - - - 52-631

" " " " u " " Serum, - - - 71-902

" " " " " " " Blood Corpuscles, - 42-751

u " " " " " " Moist Blood Corpuscles, 10-649

" Blood Corpuscles of 1000 parts of Blood, - - - 2-795

" Serum of 1000 parts of Blood, .... 4*522

660 Jones, on Malarial Fever. [October,

1000 Parts of Blood Contained,

Water, ---_.. 860*976

Dried Blood Corpuscles, - 65-612 i ?rrganif Matters, - 62-703

r j Mineral " - 2*795

Fibrin, ---.-_ 2-380

Albumen, - - 60-105 I ?/Sani? Ma*ters> " 67'985

, WU LVO | MlneI.al U m g-OlO

ExtractiveandColor'g Matters, 10-927 i ^f Mf erS' " ?"?}S

to ) Mineral " - 2'ol2

1000 Parts of Blood Contained,

) Water, - - 196*836

Moist Blood Corpuscles, 262-448 > Organic Matters, - 62-703

J Mineral " - 2-795

Water, - 664-140
Albumen, j Organic Matters, 57*985

60-105 \ Mineral u 2-010
Liq. Sanguinis, 737-552 y

Ext. and Color'g j Organic Matters, 8-415

Matters, 10-927 ( Mineral " 2-512

J Fibrin, 2-380

1000 Parts of Moist Blood Corpuscles.

Water, 750*000

Organic Matters, 239-296

Mineral Matters, --- 10l64&

(1) 1000 Parts of Liquor Sanguinis Contained,

Water, 918-57&

Albumen, - - - 64.632 i ^ani? Mfers' " *?"

9 ) Mineral u - 2-010

Fibrin, - 2-553

Ext and Coloring Matters, 14-236 [ ^ Maers- ; "Jg

(2) 1000 Parts of Liquor Sanguinis Contained,
Water, 900-473

*>- - - 81M^ : 'SE

Fibrin, 3-206

Ext. and Coloring Matters, 14*815 I ^iferlf ^^% '

11-409
3-405

Examination of Urine passed just after the Abstraction of the
Blood. Urine a shade higher than normal ; reaction acid ; spe-
cific gravity 1013'2 slightly cloudy from mucous corpuscles
and spermatozoa. After standing 12 hours, the urine threw
down alight yellow, almost white, deposit of triple phosphate,
urate of soda, epithelial cells, mucous corpuscles, and sperma-
tozoa.

1858.] JONES, on Malarial Fever. 661

ANALYSIS LIX. 1000 Parts of Urine Contained,

Water, ------ 961-112

Solid Matters, ------ 38888

Urea, ------- 12304

Uric Acid, ------ 0-592

Extractive and Coloring Matters, Mucus, &c. - - 22-259

Fixed Saline Constituents, - 3333

August 12th, 7 o'clock A. M. Kespiration hurried. Patient
is entirely insensible, and is evidently dying. Urine passed at
this time, normal in color; reaction acid ; sp. gr. 1011*5. When
treated with nitric and hydrochloric acids, there was considera-
ble efferescence. Crystals of nitrate of urea, well formed and of
a white, silvery appearance.

ANALYSIS LX. 1000 Parts of Urine Coxtained,
Water, ------ 972-728

Solid Matters, ------ 27-272

Urea, ------- 5-228

Uric Acid, - - - - - - 0-158

Extractive and Coloring Matters, - 18543

Fixed Saline Constituents, - - - - 3 030

This patient died one hour and a half after this observation, at
S J o'clock A. M.

(2) Autopsy four hours after Death.

Exterior. Muscles full, well developed. Body appears to have
2ost but little flesh during sickness. Universal sallow color.

Head. Dura mater perfectly natural ; arachnoid membrane
opalescent (pearl colored) in most parts. There were different
degrees of this opalescency, from almost perfect transparency to
semi-translucency. This change was especially evident in the
neighborhood of the large blood-vessels, and in those portions
of the arachnoid which covered the depressions between the
convolutions.

Blood-vessels of pia mater somewhat more distended with
blood than usual, but not so much, however, as to account for
the cerebral symptoms during life.

Substance of brain firm, and not more congested with blood than
normal. Weight of brain without membranes, grs. 21000, which
equals ozs. -18 : equals lbs. 3, avoirdupois. The appearance of
the structure and condition of the brain, and its blood-vessels and
membranes, do not correspond to the condition of congestion,
effusion or softening, which the cerebral symptoms led us to ex-
pect. The brain was not examined microscopically, and there
may have been minute changes in the delicate structures, chemi-
cal or physical, which escaped the observation of the naked eye.
This is possible, but not probable. It is hardly probable, or
possible, that profound alterations could take place in so deli-

662 Jones, on Malarial Fever. [October,

cate an organ as the brain, without some changes in its color or
consistence, palpable to the naked eye.

Chest. Lungs normal in appearance and structure; lower
portions more congested with blood than the superior. Old ad-
hesion of the pleura in several places. Weight of lungs 10,320
grains.

Heart. Normal in size. Eight auricle and ventricle present-
ed the appearance of incipient fatty degeneration. Columnoe
carneaeof left ventricle remarkably well developed. Weight of
heart, 4440 grains.

Abdomen. Liver externally of a slate color. When cut, the
surface of the incision was of a dark bronze color, and appeared
to contain more blood and bile than normal. The liver pre-
sented the true malarial color.

Gall bladder filled with bile of a greenish, black opaque color,
when seen in mass, and of a gamboge yellow color, when
spread out in thin layers.

Structure of liver, with reference to firmness, appeared to be
normal. I did not discover any softening. Liver cells appear-
ed to be normal in structure, under the microscope. Their color
appeared to be a shade darker than usual, inclining to a light
green. Blood of liver dark, and did not change to the arterial
hue when exposed to the atmosphere.

Filtered decoction of the liver of a bright golden color, and
resembled, in this respect, the serum of the blood. After this
yellow colored decoction of the liver had remained twenty -four
hours, it changed to a dark brown color. When the liver was
boiled with a strong solution of potassa, it dissolved rapidly and
completely, and the solution resembled in color venous blood,
when viewed in mass. In thin layers, the color was of a bright
purplish pink.

The liver also dissolved completely and rapidly when boiled
with concentrated nitric acid. The same complete dissolution
took place, but more slowly, when the liver was allowed to re-
main in cold solutions of potassa and nitric acid, without boil-
ing. The decoction of the liver was carefully tested for grape
sugar not a trace was discovered.

Weight of the liver, 25,642 grains, equals 3 lbs. 11 J ozs.

Spleen. Externally of a dark slate color, two shades darker
than the liver. Enlarged, lobulated. There was a small addi-
tional spleen of the size of a rifle ball. This presented the same
slate color, as the large spleen.

Structure of the principal spleen, soft. When pressed gently
between the ringers, the tissues appeared to give way.

The contents of the cells of the spleen (pulp or mud) was of a
dark reddish brown. When exposed to the atmosphere, this
oolor was not altered. Under the microscope, the pulp was

1858.] JONES, on Malarial Fever. 663

found to consist of numerous colored and colorless corpuscles
and granules. Weight of spleen, 7,920 grs., equals 1 lb. 2 ozs.

The lymphatic glands in the region of the liver and spleen,
were larger and darker and more congested with blood, than
normal.

Judaeys. Normal. Weight, 5,760 grains, equals 13 ozs.

Alimentary Canal. Stomach. Internal surface of stomach,
colored yellow with bile. As far as the unaided eye could as-
certain, the mucous membrane was continuous and unaltered in
structure.

The blood-vessels of the mucous membrane were filled with
blood, and several spots were more engorged with blood than
the rest of the surface, presenting an ecchymosed appearance.

The mere stagnation of the blood in the vessels and capilla-
ries of the mucous membrane is not a pathological condition.
To the naked eye, there were no pathological alterations in the
structures of the stomach.

Intestines. The color of the intestines, externally and inter-
nally, was darker than usual. The small intestines contained
fecal matters, epithelial cells, mucous corpuscles, and mucus,
colored yellow with bile.

Blood-vessels of the mucous membrane of the small and large
intestines injected with blood. The mucous membrane was
most injected with blood, and presented a purplish color, in the
last eight feet of the inferior portion of the ileum. This engorg-
ment of the blood-vessels was greatest in the immediate region
of the ilio-caecal valve.

The solitary glands were numerous, enlarged, elevated and
distinct, and of a brown color.

When the intestines were held up to the light, blood-vessels,
engorged with blood, were seen passing to each gland. The
blood-vessels supplying the solitary and Peyer's glands, were
more engorged with blood than those supplying the mucous
membrane generally. These solitary glands were most numer-
ous in the neighborhood of the ilio-caecal valve, and were found
scattered over the superior portion of the colon, and over the
caecum, and over eight feet of the inferior portion of the ileum.

Peyer's glands were enlarged and elevated. These glands
were of various sizes, from one quarter of an inch to three
inches in length, and from a quarter of an inch to half an inch
in breadth. They occurred at intervals of from one to two
inches from each other, and extended from the ilio-caecal valve,
along the mucous membrane of the ileum, for about nine feet.
The blood-vessels around these glands were engorged with
blood. This part of the mucous membrane of the ileum, studied
with the solitary and Peyer's glands, was far more injected with
blood than the stomach, jejunum, or superior portion of the

66$: Jones, on Malarial Fever. [October,

ileum. Although these glands were enlarged, elevated, and
injected with blood, still they could not by any means be com-
pared to the condition of these glands, in an advanced stage of
typhoid fever.

It is however interesting that a small dose of castor oil caused
an unusual action upon the bowels, and also that the fever re-
sembled, in the continued elevation of the temperature, and
pulse, and respiration, typhoid fever.

We will now state the points of interest presented by this
case:

The Pulse was feeble, and varied from 104 to 132 beats in the
minute.

The Respiration was hurried, thoracic, and varied from 36 to
-47 in the minute.

The Temperature under the Tongue varied from 101 F. to 105.

The Temperature in the Hand varied from 103F. to 104.
'The temperature of both the trunk and extremities was remark-
ably uniform. When we compare the rapidity of the circula-
tion and respiration, and the temperature of this case, with these
phenomena manifested in the cases of intermittent fever, report-
ed in former numbers of this journal, (see pp. 377, 393, 436,
449) it is evident that the elevation of the temperature corres-
ponded more accurately with the increased action of the circu-
latory and respiratory systems in the latter, than in the former.

The pulse and respiration were more accelerated in this case,
whilst the temperature did not rise higher than that of inter-
mittent fever.

The state of the Skin varied : sometimes dry, and at others,
bathed in perspiration.

Tongue dry and coated with fur; and towards the termination
of the disease, the tongue and teeth were coated with sordes.
It is evident from these facts that there was no distinct remis-
sion of the febrile excitement.

The Urine was copious : of low specific gravity : of higher
color than normal in the earlier stages of the disease. Twenty
hours before death the urine changed to its normal yellow color.
The urine contained small quantities of albumen. The urea
was diminished relatively to the extractive matters. We can-
not say absolutely, because the whole amount of urine excreted
was not determined. The extractive matters were increased
relatively to the other constituents of the urine. The uric acid
was normal in amount.

The Blood exhibited profound alterations. The dried colored
corpuscles were only 65*612, and the moist colored corpuscles,
262*448 in the the " thousand parts. They were, therefore, di-
minished more than one half. Many of the colored corpuscles-
were altered in shape and appearance, and had in a great meas-

1858.] JONES, on Malarial Fever. 665

ure lost the power of changing from the venous to the arterial
color. Many of them united together and formed rolls, as in
the blood of inflammation!. The fibrin was not diminished.
The serum was of a golden color, and low specific gravity. The
albumen was diminished, whilst the extractive matters of the
serum were increased.

The mineral matters of both the blood corpuscles and liquor
sanguinis were diminished relatively, but not absolutely. That
is, their diminution corresponded with, but did not exceed the
diminution of the other elements of the blood the diminution
of the mineral matters appeared to be due solely to the diminu-
tion of the solid elements of the blood the remaining elements
of the blood possessed the usual amount of mineral matter.

The pustular eruption, the offensive smell, the stasis of the
blood in the parts of the body exposed to pressure, and the ten-
dency of these parts to slough all indicated alterations in the
constitution of the blood, and derangement of the capillary
circulation.

The loss of muscular power, exhaustion, stupidity, coma,
low muttering delirium, insensibility to pain all indicated de-
rangement of the cerebro-spinal system.

The alterations in the actions of the capillary and general
circulations, and of the respiration the profound alterations in
the blood the alterations of the secretions and excretions, and
of the structures of the liver and spleen, and of Peyer's and the
solitary glands of the intestine, were all indicative of derange-
ments of the sympathetic system of nerves.

Our knowledge of the early symptoms, and pathological
changes of this case, do not permit an arbitrary decision as to
which system of nerves was affected primarily. The fact that
the post mortem examination revealed (to the naked eye) no
prominent lesions of these two systems of nerves, would seem
to indicate that the poison or poisons acted primarily upon the
blood, destroying and altering the blood corpuscles, the active
agents in the elaboration of the elements of the secretions, and
of the muscular and nervous systems.

When the proper chemical changes in the blood were altered,
when the compounds for the secretions, and nutrition, of the
nervous system were altered, or not elaborated, then both, the
cerebro-spinal and sympathetic systems, manifested aberrated
action. As the circulation and respiration, and the secretions
and excretions, and the action and integrity of the organs de-
pend, in great measure, upon the integrity of the nervous sys-
tem, it is evident that the derangement of the cerebro-spinal
and sympathetic systems, through the derangement of the blood
and secretions and excretions, would in turn act in concert with
the disturbing agent or agents, and thus still greater derange-
ments of the solids and fluids would be produced.

666 Jones, on Malarial Fever. [October,

Another theory may account for the changes, and that is,
that the poison or poisons acted primarily upon one or both
the grand portions of the nervous systems, and the cerebro-
spinal and sympathetic systems, singly or combined, in turn al-
tered the actions of the organs and apparatus, and the secretions
and excretions, and chemical and physical actions, over which
they presided.

In the present state of Medical science, we are not able to de-
cide positively upon the truth of these theories, because the
ultimate facts are wanting. What is the poison or poisons
which we have assumed to exist and act upon the organs and
tissues, solids and fluids? What is the relation of these substan-
ces, physically, chemically, physiologically and pathologically, to
the cerebro-spinal and sympathetic systems, to the blood cor-
puscles and elements of the blood, organic and mineral, and to
the organs, tissues, and secretions and excretions?

In other words, what physical, chemical, physiological and
pathological changes are they capable of producing on the solids
and fluids of the human body, and what effects would these
changes have upon the development and action of the vital and
nervous forces?

These questions have not as yet been answered. Until they
are answered, we will broach our hypotheses as hypotheses, and
not as truth.*

The destruction of the colored corpuscles the golden color of
the serum the slate color of the liver upon the exterior, and
bronze color in the interior the color of the bile the absence
of grape sugar from the structures of the liver the slate color
of the spleen and the disorganized state of its tissues, and the
inability of its pulp to change from the dark reddish-brown to
the arterial color, gave decided evidence that this was a case of
malarial fever.

There were, however, other symptoms and other lesions,
which indicated that there was something besides malarial fever.

The cerebral and nervous symptoms the continued febrile
excitement without intermission the loose state of the bowels
the unusual action of a small dose of castor oil the enlarged
and congested glands of Peyer, and solitary glands of the intes-
tines indicated the presence of typhoid fever.

The history of the case, (the recent attack of intermittent fe-
ver,) and the fact that the glands of Peyer showed the marks of
recent, only partially developed, inflammation and pathological

* These relations of the Nervous System to Febrile Phenomena have been dis-
cussed, at length, in an Essay, (now in type for the 11th volume of the Transac-
tions,) read before the American Medical Association, at Washington, D. C, May
5th, 1858, by Henry F. Campbell, M. D.[Edts. Southern Medical and Surgical
Journal.

1858.] Jones, on Malarial Fever. 667

changes, and not the changes produced by typhoid fever of only
moderate standing, lead us to the conclusion that the remittent
fever preceded, or was at least simultaneous with the appearance
of the typhoid fever.

The treatment of this case was radically different from that of
all the cases of intermittent and remittent fevers, which we have
as yet recorded.

The typhoid symptoms, masked to a great extent those of
remittent fever, and our diagnosis was partially, but not wholly
incorrect. The plan of treatment was correspondingly partial
and incorrect. We considered; and treated the disease as un-
complicated typhoid fever, when we should have considered and
treated it as typhoid and remittent fevers combined. The ma-
larial fever was left entirely out of view, and marched on speed-
ily and unchecked to a fatal issue.

The true mode of treatment would have been the free admin-
istration of sulphate of quinia, stimulants (brandy, carbonate of
ammonia, and oil of turpentine,) and nutritious, stimulating
diet (wine-whey, milk-punch and beef and mutton soups, and
arrow-root), and the application of revulsives. Purgatives
should have been rigidly avoided.

If this mode of treatment had been pursued, it is probable
that the patient would have had a chance of recovery.

We will now proceed to consider several cases, which illus-
trate in a forcible manner, the fact which we have stated, and
demonstrated in several previous articles in this journal, that in
malarial fever the blood undergoes profound alterations.

Case XXX. Irishman age 26: height 5 feet 11 inches;
weight 170 lbs. ; black hair; black eyes; full, dark-brown beard
and mustache. Has been in America (New York) nine years,
and in Savannah three months. During this time, he has fol-
lowed, steadily, the occupation of a baker.

Sept. 11th, 12 o'clock M. Has just entered the hospital with
remittent fever. His pulse is accelerated, but feeble, and his
complexion shows the effects of malarial fever. Says that he
has been sick for one week: has been living near the Albany
and Gulf railroad, in a low, malarious situation.

Under the action of sulphate of quinia and stimulants, the
febrile excitement disappeared in the course of four days. The
patient, however, was left in a very feeble condition complain-
ed of great weakness; his pulse was feeble, the action of the
brain slow, and he had a peculiarly disagreeable smell, which
was not permanently removed, either by water or by a change
of clothing. Under the action of tonics, he recovered sufficient-
ly to walk about the ward ; but continued, however, weak, low
. spirited, and indisposed to action.

y.i. vol. nv. vo. x. 37

663 Jones, on Malarial Fever. [October,

Sept. 27th. Complained of a want of action upon his bowels.
A mild cathartic was administered.

Sept. 28th. lias a cough. The wind has been from the North-
east for some time, and the weather has been cool and damp,
and epidemic catarrh is prevailing. About two-thirds of the
patients in the hospital are suffering with the influenza. This
patient was up, and about the wards, assisting and nursing the
patients, all this day. He was up and about, when I went the
rounds of the wards, at 9 o'clock P. M. Shortly after this he
complained of oppression, difficulty of breathing, and loss of
muscular power.

Sept. 29th, 9 o'clock A. M. During the night, took a sudden
and remarkable change for the worse. Respiration spasmodic,
and sounds as if the air-cells, bronchial tubes and trachea, con-
tained lar^e quantities of fluid loud rattling sound in the
throat. The churning, rattling, gurgling, crackling sounds of
the lungs and trachea, are very loud, audcan be distinctly heard
over the upper wards of the hospital. Muscular power com-
pletely exhausted, lies upon his back, and is unable to turn upon
either side. Surface of extremities cold ; surface of trunk cool,
several degrees below the normal standard. The temperature
of the extremities does not differ essentially from that of the sur-
rounding medium. The expression of his eyes and counten-
ance, and his efforts to converse, show that he is intelligent.
He is, however, entirely unable to articulate or expectorate.

Sinapisms were applied to the extremities, epigastric region
and chest, and stimulants were administered freely. These did
not produce any beneficial effects did not arouse the circula-
tion, and did notincreasc the animal temperature, because the
supply of oxygen, necesrary for the chemical changes which
generated the pl^sical, muscular and nervous forces, was cut
off. The mustards scarcely reddened the skin.

The patient continued in this state, with a gradual diminu-
tion of power, until 1 o'clock A. M. the next morning when
the painful respiratory sounds were hushed in death.

(3). Autopsy 8 hours after death
Exterior. Body in good condition, not emaciated limbs full
and round ; muscles of trunk and extremities covered by a thick
layer of fat; face and hands sallow and sun-burnt; surface of
the skin which had been covered by the clothes was fair.

Head. Dura-mater presented the usual appearance. Arach-
noid membrane transparent; blood vessels of pia-mater filled
with blood. When the dura-mater was removed, an ulcer in
the substance of the brain was discovered, occupying a position
near the centre of the superior surface of the left hemisphere of
the cerebrum. This ulcer was three-fourths of an inch in length,

1858.] Joras, on Malaria! Fever. 669

half of an incli in breadth, and about one-eighth of an inch in
depth. The walls were thickened and much harder than the
surrounding brain. The blood-vessels of the surrounding pia-
mater and brain were congested with blood, and there was an
effusion of a small quantity of bloody serum betweeu the arach-
noid and pia-mater, in the immediate neighborhood of the ulcer,
but nowhere else. The appearance of the ulcer, and the conges-
tion of the blood-vessels around, by no means accounted for the
death of the patient. The ulcer appeared to be of long stand-
ing. Tne thickened walls, the absence of pus, and the sound
state of the structures of the brain around, show, not only that
the ulcer was of long standing, but also that it was rapidly
healing.

The existence of this ulcer will account, in part, for the dull,
lethargic state of the intellectual faculties, but not for the death
of the patient.

The ventricles of the brain contained a small quantity of clear
serum. The structures of the brain presented the usual consist-
ence and appearance.

C/iest. Heart, normal in size: the left ventricle contained a
large, light yellow fibrinous clot, attached to the chordae ten-
dineoe and earn eae column a?, and extending through the ariculo-
ventricular opening into the auricle. This clot was firm in
texture, and weighed one ounce.

The left ventricle contained a small light yellow clot. The
aorta also contained a small flattened, riband-like, light yel-
low clot. These clots were evidently formed previously to
death, when the circulation was exceedingly feeble.

Lungs. The lungs were greatly inflated, and did not collapse
in the slightest degree when the air was admitted into the pleura.
They were congested with blood, and resembled liver. When
handled, they were fouud to be remarkably heavy, and felt
more like liver than lungs. When cut, the air-cells, and large
and small bronchial tubes, were found to be filled with serous
fluid and numerous fine bubbles of air. When the lungs were
squeezed, pints of this serous fluid flowed out. In many por-
tions of the lungs the serous fluid was clear in others it was
reddish. The fluid resembled serum in all respects, and was
not mucus.

Here, then, we have the cause of the death of this patient. He
was drowned.

Abdominal Cavity. Stomach, pale and perfectly healthy in
appearance. Intestinal canal, from the stomach to the anus,
pale and healthy in appearance.

Liver. The normal reddish-brown color of the liver was
changed in most parts to a mixture of light bronze and light
olive. In several places the color of the liver resembled the

670 Jones, on Malarial Fever. [October,

normal color. In two circular spots, about three inches in di-
ameter, the liver was of a dark-bluish, slated color, like that of a
recent case of malarial fever. The cut surface of the liver ap-
proached more nearly to the normal celor than the exterior.
The blood of the liver, after exposure to the atmosphere, assum-
ed a red, arterial color.

It is evident, from this examination, that the structures of the
liver were recovering from the effects of the malarial fever, and
the organ was regaining its normal color.

Spleen slate colored, enlarged and softened. The pulp of
the spleen dark purplish brown. It did not change to the red
arterial color, so rapidly as the pulp of healthy spleens. The
change of color, however, was much greater than that of the
pulp of the spleen in a recent case of malarial fever.

This organ, like the liver, appeared to be recovering from the
effects of malarial fever.

Kidneys healthy.

We believe that we have now all the facts necessary for a
rational explanation of the phenomena presented by this case.

The malarious poison and its effects had produced profound
alterations in the blood and capillaries, and liver and spleen,
and secondarily affected the nervous system. The patient, al-
though weak and lethargic on account of these pathological
alterations, and the ulcer upon the brain, was nevertheless in a
fair way of recovery. The alimentary canal had resumed its
healthy actions, the liver and spleen were fast recovering, and
he was gaining strength daily.

We can safely assert that, if no other disease had occurred,
the lesion of the left hemisphere of the brain, and the effects of
the malarial poison, would not have proved fatal.

In this state of slow convalescence, the patient was suddenly
seized with the prevailing influenza. The mucous membrane
of the bronchial tubes and air-cells was irritated. The irritation
of the mucous membrane was followed by congestion of the
blood-vessels and capillaries of the lungs. The capillaries were
in an enfeebled state, and the blood in a watery, altered condi-
tion. Healthy limited inflammation was impossible. Diffused
inflammation of all the structures of the lungs resulted. The
serous portion of the blood poured into the air-cells, bronchial
tubes and trachea the supply of oxj-gen was in a great measure
cut off the chemical changes of the solids and fluids, in a cor-
responding degree, checked the physical forces, heat and elec-
tricity, and the nervous force, developed by these chemical
changes, were, as a necessary consequence, correspondingly di-
minished.

The immediate cause of the death of this patient was a depri-
vation of oxygen, and perhaps the partial retention of the

1S58.] JONKS, Oil Malarial / 071

carbonic acid gas. We may Bay with truth that he was drown-
ed.
The attack of malaria] fever appeared at the time to be mild,

and it is highly probable that all its effects were aggravated, and
a fetal issue determined bv the injurious effects upon the con-
stitution of this patient, of his occupation and previous habits.
He was a baker. As a general rule, this elass are unhealthy,
and easily succumb to disease. This will be illustrated at a fu-
ture time, by another fatal case of remittent I'cxvr, occurring in
this cl

The only two bakers which entered the hospital whilst it was
in my charge, died from the effects of malarial fever, and their
occupation.

The following remarks of C. Turner Thackrah, have an inter-
esting bearing on this case:

''Bakers are generally pale and unhealthy. The temperoture
in which they are placed is seldom below 80, and often as high
as 100. The heat of the oven is rarely lower than 180.

"Bakers are subject to disorders of the stomach, to cough and
rheumatism.* The two former of these two affections arise, I
conceive, from the dust which is largely inhaled.

"In the Plague of Venice, we find, from Mercurialis, that the
bakers, and other persons in similar employments, suffered most.
In the Diet, des Sciences Medicales, it is stated that during the
Plague at Marseilles, in 1720, all the bakers died. The debility
produced by great heat, probably induces this susceptibility to
disease.

"Bakers work by night; and from this change in the time of
sleep, they have been supposed to suffer as much as from the
dust of employ. Observation, however, on the health of watch-
men, and others, does not support the opinion." {TJte Effects of
Arts, Trades and Professions, on Health and Longevity, by 0.
:r Thackrah, Esq. London, 1832, pp. 133-134.

Cask XXXI. Irishman laborer and boatman: age 30;
height 6 feet; weight 150 lbs.; tall, spare frame, light hair, blue
i\ pale, sallow complexion. Has been running on (lat-boats
and rafts, up anddownthe Savannah river, between Savannah
and Augusta, for the last twelve months. Habits irregular
addicted to the use of ardent spirits. Says that his constitution
has suffered much from the exposure to the hot sun and night air
on the river, and also from the intemperate use of ardent spirits.

* In a report ofa Huml. . IOD, it aj[).-:i!s that rlu-umat '< t

I the boken l one-fourteenth of the c&binet*makere, and one-

f the tailors, Raadicei graredii morbi, at plearitidet,

imonue JUmazzim.
MenU says a great number of bakers ai -j.itaU."

672 Jones, on Malarial Fever. [October,

Sept. 20th. ."A flat, laden with wood, which he was bringiug
to the city, was sunk in shoal water." He was all day in the
water, up to his waist, fishing out the wood. This night had a
chill, followed by fever. The fever went off before morn-
ing, and on the next day was employed again in the water.
The chill returned at night, and was followed by fever. Has
been sick, without any medical attendance, until the present
time, September 27th. Pulse 106 ; respiration accelerated, la-
bored; skin hot and dry; countenance distressed has a hag-
gard, anxious look; complains of great thirst, of pains in his
back and bones, and of great exhaustion. His pulse, although
rapid, is feeble, and his forces appear to be completely exhaust-
ed. His fever remitted slightly on the next day, but returned
on the 29th inst. Under the action of large doses of sulphate
of quinia, stimulants, sinapisms, snake-root tea, and milk punch
and wrine whey, and brandy and arrow-root, the febrile excite-
ment subsided, the urine regained its normal hue, and on the
4th inst. his pulse was 70, and respiration 18 temperature nor-
mal, and function of skin normal ; and although apparently very
feeble, was able to be up and about the ward.

During tnis attack, the saliva was acid, and the urine copious:
from 20,000 to 25,000 grains were exereted daily. The specific
gravity was correspondingly low, from 1012 to 1014. The
abundant discharge of urine was due to the large quantities of
water which his thirst led him to take, and also to the diuretic
action of the infusion of snake-root.

Throughout the attack his pulse was feeble and his forces
greatly exhausted, and he required close attention and the free
administration of stimulants.

October 5th. This morning absconded, clandestinely, from the
hospital.

Oct. 8th. Has returned. Pulse 120; skin hot and dry; res-
piration accelerated, labored; complains of great pain in the
back of his head and neck these parts are swollen, and painful
upon pressure.

As the 5th inst., on which he left the hospital, was the day of
election of the city officers, it seems probable that he may have
received a blow upon the head. This, however, he stoutly de-
nies. $. Cold-water dressing to back of head and neck.

Oct. 9th. His head has been shaved, and the tissues above the
occipital bone, and above the left temporal and parietal bones,
are swollen, and the skin looks black and is ulcerated in several
places. The swelling extends down along the neck, and reach-
es the superior portion of the left shoulder. To the finger, the
swollen parts feel as if there was a collection of fluid beneath
the skin. Says that he is suffering intense pain. Countenance
distressed and haggard; pulse 128; skin hot and dry; respira-
tion thoracic, labored, accelerated.

1858.] JoXES, on Malarial Fever. 673

Oct. 10th. Pulse 160, feeble; skin hot; respiration spasmodic
and labored. In addition to the intense pain in the back of his
neck and left side of the head, he complains of intense pain in
his chest. The pain in the chest cuts short the respiration and
renders it spasmodic. His countenance is expressive of great
agony and terror.

Oct. 11th. Pulse 140, rapid and very feeble; respiration 24r
labored, thoracic, spasmodic. The pain in his chest is intense:
lie groans and cries out at every breath. The expression of his
countenance is indicative of great agony, terror and horror.
AVas restless and delirious during the night, and during his de-
lirious visions spoke and acted as if he was engaged in mortal
combat. Has no hope of himself, and refuses all medicine. The
back of neck and back and side of head is much swollen, and
when pressed with the hand there is a distinct fluctuation.

Hoping that a discharge of the pus, or fluid, would afford re-
lief a free crucial incision was made at the most prominent part
of the swelling. Nothing but blood issued. The hemorrhage
was so great, that it was necessary to check it, by the applica-
tion to the wound, of a compress, saturated with the tincture of
muriate of iron.

Oct. 12th. During the night was delirious would rip out the
most terrible oaths, and cry out that the devils were after him
had beaten him severely, and were endeavoring to throw him
out of the windows. At other times, he would speak and act as
if he had been in mortal combat, and was wreaking vengeance
upon an imaginary antagonist. These actions excited the sus-
picion, that the injury on the back and side of the head was
received from a blow.

The patient died at 1 o'clock A. M., this morning.

(4). Autopsy 9 hours after Death.

Exterior. Body much emaciated; back and left side of neck
much swollen. The inferior surface of the trunk and neck pre-
sented a mottled appearance, from the settling of the blood by-
gravitation, in the most dependent parts of the body. On the
left buttock, just below the position of the glenoid cavity, was
a black, gangrenous spot, about one inch in diameter. An in-
cision showed that the change of color was confined entirely to
the skin. On the right leg, there were the marks of an exten-
sive ulcer, upon the skin covering the tibia.

The cicatrix presented a purplish, angry color.

When incisions were made into the swollen pans of his neck,
* and back and side of head, the spaces between the muscles, the
meshes of the fibrous tissue surrounding and connecting togeth-
er the muscles and the fibrous tissue of the skin, were found to
be completely filled and distended with golden-colored serum.

674 Jones, on Malarial Fever. [October,

Head. Dura mater healthy. Arachnoid membrane transpar-
ent throughout its extent over the hemispheres of the brain.
At the base of the brain, it was slightly opalescent.

Blood-vessels of pia mater not\ more filled with blood than
usual. The cortical and medullar^ substances of the cerebrum,
and of the cerebellum, the pons variolii, the medulla oblongata,
and superior portion of the spinal marrow, appeared natural in
consistence and color.

Ventricles of brain contained f3iv. of golden colored serum.

The superior longitudinal sinus of the dura mater contained
a golden yellow elongated clot, the diameter of which was about
one half that of the longitudinal sinus.

Chest. Heart somewhat enlarged. Pericardium contained
f li, of golden serum. All the cavities of the heart contained
golden colored clots. The right auricle had a large golden
colored clot, which was attached to the carneae column ae of the
ventricle, and the chordae tendineae of the tricuspid valves, and
extended through the auriculo-ventricular opening into the
right auricle. The left ventricle and auricle also contained a
large golden colored clot, which was in like manner attached to
the carneae columnar and chordae tendineae of the auriculo-ven-
tricular valves. The aorta, carotids and pulmonary arteries
contained elongated golden -colored clots, having diameters
nearly equal to those of the arteries. All these clots were firm,
and appeared to be almost organised.

Lungs. The lungs did not collapse when the cavity of the
thorax was opened. Exterior surface of the pleura, covering
the lungs and lining the walls of the thorax, covered with co-
agulable lymph of a golden color. Adhesions were numerous,
but as yet not strong on account of the soft, fresh condition of the
coagulable lymph, which was evidently but recently effused,
probably within the last 70 hours. This inflammation of the
pleura accounts for the severe pain in the chest during life.

The lungs were much congested with blood, and when cut
they resembled liver. The bronchial tubes and air-cells contain-
ed much serum. The amount of serum was much less, however,
than in the previous Case XXX. The anterior surface of the
middle lobule of the right lung had a dark blackish red spot,
about one inch in diameter, which resembled at first sight the
wound from a sharp instrument.

The examination of the exterior of the chest, and interior
surface of the ribs, showed neither wound nor fracture of the
ribs. When closely examined, this portion of the lung was
found to be more congested and solidified than the surrounding
portions, and would in all probability, if the patient had sur-
vived, been the seat of an abscess.

Liver, Liver of a light bronze color. The color is lighter

1858.] Jones, on Malarial Fever. 675

than that of a recent attack of remittent fever, but resembles
the color of a liver which was recovering from the effects of re-
mittent fever. Cut surface of a light bronze color, and of not
such a deep and decided bronze as the liver of a patient who
had died from a recent attack of malarial fever.

The right lobe of the liver had upon its under surface a slate
colored spot three inches in diameter, which resembled in all
respects the liver of a recent case of malarial fever. "When an
incision was made across this spot, the cut surface presented for
one-sixth of an inch, the true malarial hue, below this it ap-
proached more nearly the normal hue. The liver appeared to
be somewhat enlarged. The weight, however, was not ascer-
tained. Its structure did not appear to be materially altered.

Spleen. Much enlarged, and of a dark slate color. Although
much softer than a normal spleen, it was much harder than a
spleen of a recent case of malarial fever. This organ, like the
liver, appeared to be just recovering from the effects of malarial
fever. Weight of the spleen, grains 13562, equals ozs. 31.

Kidneys appeared to be somewhat enlarged. The calices,
infundibula and pelvis of the kidney, contained a fluid resem-
bling (to the naked eye), in all respects, pus.

Alimentary Canal. Stomach enormously distended with gas.
Mucous membrane pale and healthy in appearance. Small in-
testines and colon healthy in appearance to the naked eye.

The following appears to be the cause and history of this last
attack :

The patient left the hospital when he was in an exceedingly
feeble condition, after a severe attack of remittent fever. It is
probable that upon election day he indulged his taste for ardent
spirits. The wind was from the northeast, and the weather
damp and cool, with occasional scuds of rain and mist. Expo-
sure to this cool damp wind, fresh from the ocean, and the low
grounds and swamps of Georgia and South Carolina, not only
during the day, but probably during the night also, in a state
of intoxication, induced a severe attack of pleura-pneumonia.

The swelling on the back of his head, was due, either to a
blow, or to inflammation in the cellular tissue and muscles, an-
alogous to the inflammation of the lungs, and probably arising
from the same cause. The large amount of golden -colored se-
rum which was effused into the cellular tissue of the neck and
head, indicated the altered condition of the blood. The deter-
mination of the true mode of treating this case was exceedingly
difficult.

Here was a patient whose blood had been depraved, organs
impaired, and forces exhausted, by dissipation, intemperance,
and exposure, and by a severe attack of malarial fever, sud-
denly attacked with pleuro-pneumonia of both lungs, and a

N. 6. VOL. XIV. NO. X. 38

676 Harrison. Case of Extra- Uterine Pregnancy. [October,

painful inflammation of the cellular tissue and muscles of
the neck and head. The usual treatment for pleurisy and pneu-
monia was impossible. A single bleeding would have taken
life immediately, or at all evenis hastened the fatal issue.

He could bear neither purgation, starvation, nor tartar emetic.
The only rational plan of treatment was to support the consti-
tution and strengthen and relieve, if possible, the congestion of
the internal organs, by revulsives. The only hope was that
nature would work her own cure.

This was the plan of treatment which we adopted.

Many other points of interest in this case might be noticed,
but we defer them until a future time, when we hope to gener-
alize all the facts and phenomena observed.

(To be continued.)

ARTICLE XXIII.

Medical and Medico-legal Notes of a Case of Extra- Uterine Preg-
nancy. By G. Harrison, M. D., of Macon, Ga.

On the 10th of June last, I was called to see a servant girl, of
one of my patrons, who was suffering from abdominal or uterine
pains, at intervals of six or eight minutes, indicating that she
was threatened with a miscarriage. I judged from her size, in
a lying position, that she was near the full period of utero-gesta-
tion ; but on investigation I found that she was (according to
her and her mistress' statements) only about the fifth month.
Learning these facts, I immediately gave a teaspoonful of lauda-
num, which soon arrested the pains.

After leaving,. I heard nothing more from her until the month
of August, two months after I was first called to the case ; when
I was sent for again about three o'clock in the morning, to see
the girl, with a request, that I would be in great haste, that she
was thought to be dying. On my arrival, I found her dead,
A report was soon put in circulation that she had been killed
as there had been a difficulty the day before between her and
her mistress, who had stricken her several blows. This gave
rise to a post-mortem examination. After the necessary pre-
parations, the abdomen was opened, by a crucial incision through
its walls, exposing to view a great quantity of blood, which was
carefully removed by the sponge, when a foetus was seen, sepa-

1858.] HARRI30X. Case of Extra- Uterine Pregnancy. 677

rated from the cord, lying loosely with the other contents of
the abdomen. The foetus was removed and examined; no
marks of injury could be detected on it, and it was concluded,
judging from its size and general appearance, that it could not
be more than a five-month child. The examination was con-
tinued, and it was found to be an extra-uterine fcetation of the
ovarian class. The uterus, with its entire appendages, were re-
moved, and we now have them together with the foetus in a
state of preservation. The uterus presents no unnatural appear-
ance possibly a little enlarged.

Two facts connected with this case deserve notice, which I
will give, before proceeding to remark upon the general interest
of the case. Attached to the placenta were two ligaments, in-
dependent of the cord, one about six inches long, connecting
with the transverse colon; the other about four, connecting
with the body, just above the point of the ilium. How these
attachments happened to be made at such remote distances is a
matter of some little astonishment, while other parts were so
much more convenient, as might have served the same purpose
is left as a matter of speculation for the curious.

In a medico-legal point of view, this case has become one of
some interest from the fact, that Rogers, the owner of the wo-
man, refused to pay five hundred dollars, a balance due for the
purchase of the woman and her two children, alleging that he
had bought her and paid a high price for her, because of her
pregnancy, and the future prospects of raising children from
her. Rogers alleged in his plea that the woman was warranted
to him sound, and produced a warrantee of soundness, a fact
which defendant did not pretend to den}-. Yet the seeds of
death had been sown anterior to the purchase, and of right he
ought not to pay any more. The reason for the plea was not
based on the unsoundness of the woman, but upon the fact that
she had in her system at the time of sale that which would in-
evitably produce death. To prevent a suit the parties agreed to
eave it to arbitration, under the late law, known particularly as
"Judge Cone's arbitration law." A jury of three very intelli-
gent gentlemen was selected, the witnesses were summoned and
sworn, and their testimony taken. After which, Thomas P.
Stubbs, Esq., attorney for Rogers, proceeded to the investiga-
tion of the facts as proved. It was proved by several witnesses

678 Harrison. Case of Extra- Uterine Pregnancy. [October,

that the woman was represented by Mrs. JefYers, her former
owner, as being pregnant at the time of sale, which induced her'
to ask more for her than she otherwise would have done. In
addition to the testimony there present, Mr. Stubbs introduced
the sayings of the woman to her physician when called to visit
her professionally, to show that she was pregnant at the time of
sale, judging from the ordinary symptoms usually taken as the
best evidence in such casesr viz : suppression of the menstrual
flux, which had ceased on her two months before the sale
morning sickness, etc.

He next proved by Dr. Fitzgerald, who assisted in the post
mortem examination, and myself, that the woman was pregnant
and of the class above specified, and under such circumstances
death was inevitable.

Judge Nisbet, the counsel for Mrs. Jeffers, admitted the war-
rantee of soundness, but insisted that the negro was sound at
the time of sale, and that all the facts taken together showed no
breach of warrantee. He showed that the kind of pregnancy
was no evidence that she was not sound, but rather good evi-
dence that she was a healthy woman. He also proved that a
suppression of the menstrual flux was not always an infallible
sign of pregnancy, and that most or all of the symptoms men-
tioned in this case, might have arisen from a suppression, pro-
duced from other causes. He insisted upon the rejection in
toto, of all the sayings of the woman, and showed from the sta-
tute laws of Georgia, that her testimony was inadmissible and
could not be relied on, even in this case. He, therefore, con-
tended that the plea was not sustained ; putting it upon its own
merits, assuming that the woman was pregnant at the time of
sale, a fact which they had failed to establish, insisting that the
suppression had been produced from another cause.

The examination of the witnesses being through, Mr. Stubbs
proceeded briefly to argue the case before the jury: he com
mented upon the testimony, showing that he considered that it
made out his case, and thought that he ought certainly to be
entitled to a verdict, saying nothing about the sayings of the
woman, which he contended should be taken by all means in
this case. He urged this fact forcibly on the minds of the jury,
and in support of his argument, produced cases which had beer
decided by the Supreme Courts of Kentucky and Tennessee

&

1858.] Harrison. Case of Extra- Uterine Pregnancy. 679

and a case by the Supreme Court of this State, where the say-
ings of negroes were admitted to prove the existence of long
standing disease the doctors who testified being allowed to use
the statements of the negroes when called to visit them, to com-
plete their testimony. He concluded his argument by pleading
the justness of his cause, and asked the jury to release him from
the farther payment of the purchase money, as he thought he
had clearly shown that the seeds of death had been sown prior
to the sale of the negro.

Judge Nisbet commenced his argument by admitting, that if
Mr. Stubbs could prove positively that the seeds of death had
been sown, in this case, prior to the sale, it would be good
grounds for the release of defendant from all liability, but in
this he had failed. He said, that he had not proven this fact
by any witness, for all had testified according to the sayings of
the negro and Mrs. Jeffers, which, as to the negro, was not
good, as he would proceed to show. He insisted upon rejection
of the sayings of the negro entirely, and would now show from
the best authority that the woman could not have been preg-
nant at the time Rogers bought her. He read from Ramsboth-
am's Midwifery to show that ovarian pregnancies seldom if ever
passed the second or third month, rarely reaching the fifth, and
never exceeding the sixth. He read a number of extracts from
different authors, showing the strength of his position, and con-
cluded his argument by a few extracts from Beck's Medical Ju-
risprudence and a short comment on the statute laws of Georgia,
against the propriety of negro testimony as against white per-
sons, as rebutal to the decisions of the courts, read by the oppo-
site side ; that the facts set forth in the plea were not sustained ;
that Rogers ought to comply with his contract, and pay the
balance of the purchase money.

I have the opinion of two distinguished gentlemen, both
teachers of medicine, one saying that he believed the woman
was pregnant at the time of sale; circumstances and appearan-
ces, and the woman's statement (which is " good evidence in
medicine if not in law,") give sufficient ground for the belief;
but think that the arbitrators did right in requiring Rogers to
pay, putting it to his charge as a bad and unfortunate specula-
tion. The other gives no opinion relative to the pregnancy,
but believes that the verdict ought to have been different ; be-

680 La Taste. Remarks on Effects of Honey. October,

a

cause of the high price paid for the property, and that in justice
a division of the loss would have been equitable, since the whole
would have fallen on the other party, had she not been fortun-
ate in selling.

Had the case to be tried again, I would give it as my opinion
positively, that it was a seven months' pregnancy, taking all
the circumstances into view, notwithstanding most of the author-
ities indeed, all which I have consulted, take the opposite
grounds and say that ovarian pregnancies rarely, if ever, pass
the fifth month.

ARTICLE XXIV.

Remarks on ike Alleged Deleterious Effects of Honey. By YlCTOR
La Taste, Pharmaceutist, Augusta Ga.

Gentlemen :

I have been making various observations, enquiries, &c, with
a view of solving the question, whether honey is, within itself,
a poisonous substance, but must acknowledge a total failure up
to the present time. I know that there is a prevailing opinion
in favor of the affirmative of the question ; but, then, is that
sufficient to establish the fact, any more than that turnips will
grow better, or soap more successfully made, if the seed of the
one are planted, or the ingredients of the other" mixed in parti-
cular reference to certain stages of the moon? I hope, in this
enlightened age, such superstitious notions are confined to the
illiterate. In the progress of my investigations, I addressed a
note to the Editor of the " Druggist's Circular," and asked to
append his answer, which may be found in the last number oi
that excellent journal.

"You may be correct in your opinion, that the notion that
honey is sometimes poisonous is one of the popular errors of the
times. It is perhaps difficult to prove it to ]oe so ; but common
opinions have generally some foundation in fact. It is known
to most persons that the quality and flavor of honey is modinec
by the sources from which it is gathered. It may therefore be
logically inferred that the change in quality and flavor may be
so great as to render it pernicious to human health, when it it
used as food. What the changes are that take place in the or
gans of the bee, we cannot know; but that changes do tak<
place is extremely probable, as the saccharine matter of the

1858.] Epithelial Cancer of the Anus and Rectum. 681

nectaries of flowers are not exactly identical with the character-
istic properties of honey. Yet the change effected in the elabo-
ration of honey, is not sufficient to eliminate all the peculiarities
of the flowers from which the materials are obtained.

"Several cases of poisoning, from eating honey, are recorded
in the New Jersey Medical Reporter, for Nov. 1852. A few
cases of this kind are not sufficient, certain ly, to establish the
fact, but they lead to strong suspicions. The argument, that
honey may sometimes be poisonous, is one of the post hoc, ergo
propter hoc kind."

All that the learned Editor has said may be strictly true ;
still I am of the same opinion that honey is quite harmless ;
and I tli ink so, because my experience with the bee teaches me
that this insect has too much sagacity not to know the difference
between those flowers having noxious properties and those that
have not. It is also true, that naturalists differ as to whether
honey is a secretion of the bee, or whether it exists already
formed in plants. I believe that it does exist already formed,
and deposited by the bee just as it was gathered. If this were
not so, the honey gathered from the buckwheat, and that from
the white clover, would have the same appearance whereas,
that from the latter is much whiter: proving, also, that whate-
ver chemical change may take place in the stomach of the bee,
if any, that the quality of the honey does not partake of the
change. But leaving all theory out of the question, does it not
appear that if honey is poisonous, cases of poisoning ought to be
more frequent, taking into account the quantity that is used?
And again, when you physicians prescribe the use of honey, do
you do it with the same understanding as when arsenic is pre-
scribed, or do you recommend it as an innocent adjunct? I
would be glad to have your opinion in full.

Epithelial Cancer of the Anus and Rectum. By T. B. Curlixg,
Esq., F.R.S., Surgeon to the London Hospital.

The parts of the body most prone to epithelial cancer are
those in which a junction takes place between the skin and mu-
cous membrane. We see this in the lips, and in the extrem-
ity of the penis, and in the prepuce. The anus, though less
frequently attacked than these parts, is nevertheless liable to
this form of cancer. Its occurrence, however, at the ver^e of
the rectum, and within the bowel, has been scarcely noticed by

682 Epithelial Cancer of the Anus and Rectum. [October,

writers, and there are no satisfactory accounts of the results of
operations performed for its removal from this situation. This
may be owing, in part, to the dise^le being somewhat rare, but
is more probably due to the circumstance that epithelial cancer
has been distinctly recognised only in recent years. The fol-
lowing cases in which growths of this character were successful-
ly excised seem deserving of record, as a contribution to our
knowledge of this disease :

Case 3. Epithelial Cancer of the Rectum cured by Excision

after repeated Failures of Treatment. Mrs. M , aged forty, an

English lady married to a German, but without having borne
children, consulted me in April, 1855, on account of an obsti-
nate disease of the rectum. On examination, I found a large,
elevated and slightly indurated sore, occupying the whole of
the right side and part of the back part of the rectum, just with-
in the sphincter muscle, and extending up the bowel the distance
of about an inch and a half. The sore was somewhat larger than
a crown -piece. There was slight bleeding from the surface after
the removal of the finger. The chief symptom she complained
of was a frequent smarting pain, which became more severe
after an evacuation. At this time there was usually a slight
discharge of blood. There was no obstruction in the passage.
The lady looked pale and anxious, but in other respects seemed
free from disease. It appeared that the complaint of the rectum
was first noticed two years before. At that time she was resid-
ing in Germany, and she consulted the late Professor Siebold,
of Jena (Saxe- Weimar), who excised the diseased part in Sep-
tember, 1853, whilst she was under the influence of chloroform.
She recovered slowly from the operation, and remained appar-
ently well until July, 1854, when a return of the disease was
noticed, and the complaint shortly became as painful as before.
She subsequently went to Paris, and in August placed herself
under the care of a German surgeon practising there. He made
repeated applications of a caustic nature to the sore, and finding
them unsuccessful, at length proposed the actual cautery, which
was used in February, 1855, the patient being placed under the
influence of chloroform. She remained under the care of this
gentleman, altogether six months, but according to her account,
she derived no benefit from his treatment, and was not free from
the shooting-pains any part of the time. She was induced,
therefore, to come to London for further advice, and at the re-
commendation of Swayne of Clifton, consulted me.

By getting the patient to strain, and by introducing my fin-
ger into the vagina, and pressing in a direction to evert the
sore, I managed to get a tolerably good view of the part. It
was an irregular, spongy-looking ulcer, of a deep-red colour.

1858.] Epithelial Cancer of the Anus and Rectum. 683

Judging from the characters of the sore, I had little doubt that
this was a case of epithelial cancer of the rectum, and that the
disease had been only imperfectly removed in the various pro-
ceedings for its extirpation. After careful consideration, I pro-
posed the operation of excision, but considering the failure of
the treatment previously adopted, I advised her husband to
take another opinion. Mr. Hilton, a few days afterwards, met
me in consultation, and fully agreed with me that the disease
could be entirely removed with the knife. The disappointment
which they had experienced naturally led both the patient and
her husband to distrust a repetition of excision. I consequent-
ly saw nothing more of them for a month, during which period
they sought other advice, and also communicated my proposal
to Professor Siebold, who wrote and recommended her to sub-
mit to the operation, when they again applied to me.

May 30th, 1855. The bowels having been well relieved by
castor oil, the patient took chloroform, and I then excised the
growth, taking care to cut wide of the disease so as to extirpate
all the morbid parts. In doing so, I removed nearly the whole
of the sphincter muscle on the right side. By carrying the
point of the forefinger of the left hand beyond the upper margin
of the ulcer, and cutting over it, I made sure of excising com-
pletely the portion of the disease which was deeply seated in
the rectum. Several large arteries which bled freely were at
once secured. This was attended with a little difficulty, owing
to their depth in the pelvis consequent on the retraction of the
levator ani muscle. The wound was afterwards plugged with
sponge. My friend, Mr. Hamilton, of the Richmond Hospital,
Dublin, being in London, accompanied me to the operation,
and gave me his valuable assistance. No unfavorable symp-
tom followed. The wound healed very slowly, but steadily;
and by August 9th, had quite closed. For some weeks after
the operation, the patient lost the power of retaining the faeces;
but it was regained by the time the wound closed, except when
the bowels were much relaxed. The contraction at the anus
was less than might be expected considering the amount of sub-
stance, and of the sphincter musele removed. The aperture
admitted the passage of the forefinger without difficulty.

Nearly three years have elapsed since the operation ; and
during this period I have repeatedly examined this lad}', who
has naturally remained anxious respecting a recurrence of her
disease. In February this year, the parts were quite sound.
There was no warty growth, nor any appearance of a return of
the disease. She experiences no pain in the part, and the pas-
sage is free and ample.

The diseased part, when examined in the microscope, exhib-
ited the characters of epithelial cancer.

684 Epithelial Cancer of the Anus and Rectum. [October,

Case 4. Epithelial Cancer of the Anus and Rectum removed
by Excision. E. C , a stout, married woman, aged forty-
nine, the mother of several children, of pale complexion, but in
tolerable health, was admitted into the London Hospital, Janu-
ary 11th, 1855, in consequence of a disease of the rectum. It
appeared that she had suifered from what she believed to be
piles for about sixteen years, and had been subject to bleedings.
About three months before her admission, her surgeon, the late
Mr. Aitkin, of Kiugsland, excised a tumour from the anus,
which she described as being the size of a hen's egg. The part
healed, but ofterwards ulcerated, giving rise to the present dis-
ease. Since its formation, she had suffered sharp irregular
pains in the part, and soreness during the passage of stools.
None of her family had suffered from cancer. On examination
I found an ulcerated sore occupying the right side of the anus,
and extending some distance into the rectum. It was about the
size of a crown -piece, and not very hard. Its edges were raised,
ragged, and slightly overlapping; its surface irregular. A
small piece detached from the sore, and examined in the mi-
croscope, exhibited the characters of epithelial cancer. There
were also some warty growths in the vicinity of the large sore,
and on the opposite side of the bowel, but they were neither
hard nor ulcerated; and I did not regard them as cancerous.

On the day after her admission, the bowels having been well
relieved, I excised the cancerous growth, taking away a consid-
erable portion of the sptjincter muscle on the right side. There
was smart haemorrhage from several vessels, their orifices being
retracted and deeply seated. With some trouble they were
secured, and the wound was afterwards plugged. She bore the
operation very well without chloroform, which she objected to
take. An astringent draught with opium was given after the
operation, the bowels remaining unrelieved until the fifth day
after the operation, when they were acted on by castor oil. She
quite lost the sharp pains, and the wound soon began to heal.
The soft warts about the anus were touched with potassa fusa,
under which application, repeated three or four times, they gra-
dually disappeared. She was discharged from the hospital on
the 14th of April, the wound being quite healed. The anus
was contracted, but it readily allowed the passage of the fore-
finger, and no difficulty was experienced in defecation. She
was also able to retain her motions as before. There was still
a strong disposition to warty growths about the anus; and after
her discharge from the hospital, she returned occasionally to
have the potassa fusa applied to them. A lotion of the nitrate
of silver was also kept to the part. After a time she ceased to
attend; and in January, 1856, she was again admitted in con-
sequence of a mass of soft warts having sprung up close to the

1858.] dhelial Cancer of Ote Anus and Rectum.

cicatrix at the anus. They were not ulcerated, and caused no
pain ; but being apprehensive that they might undergo cancer-
ous degeneration, 1 thought it desirable to remove them. Chlo-
roform was given, and they were excised on the 23th. The
tumour, on minute examination, proved to be simple epithelial
growths, or hypertrophy of the normal elements of the part.
The wound healed favourably, and she was discharged in the
beginning of February, and recommended to keep a rather
strong nitrate of silver lotion to the part. The tendency to
warty productions in the skin above the anus, though partially
restrained by the lotion, was, however, quite remarkable, and
in September of the same }*ear she was admitted into the hospi-
tal a third time, on account of fresh growths having arisen.
They were slightly prominent, and exactly similar in character
to those removed in January, and free from ulceration ; but she
complained of their being painful. Allowance, however, must
be made for their repeated recurrence having made her anxious
and apprehensive of a return of the cancerous disease. The
warts were removed this time by the repeated application of a
caustic composed of muriate of antimony, one part; chloride of
zinc, one part, and plaster of Paris, three parts. This composi-
tion formed a sort of paste very convenient for use, but it
caused a good deal of pain, which lasted some hours, and had
to be alleviated by full doses of opium. She remained in the
hospital until the middle of November. The warts had not
entirely disappeared, but' she was anxious on account of her
family, to return home.

In February, 1657, I again admitted her on account of large
flattened warty growths around the anus, in two considerable
masses, and one small one. There was ulceration on the sur-
face of one of the former, with some amount of induration, and
this was the seat of a good deal of pain.

On the 12th, I examined these growths, and at one spot near
the verge of the anus, applied some strong nitric acid. The
patient was under the influence of chloroform during the opera-
tion.

In a few days the nitrate of silver lotion was applied to the
wound, which healed favourably, without further contraction of
the orifice, and all pain ceased. There was afterwards some
indication of a rising of fresh warty growths, but it was check-
ed by the application of strong nitric acid. I should now have
discharged my patient cured, but for some weeks a glandular
swelling had been forming in the neck, on the left side, just
beneath the lower jaw, and it ended in an a: . hich was

opened on March 26th.

About a week afterwards she was seized with erysipelas of
the face, which unfortunately had a fatal termination on the

686 Epithelial Cancer of the Anus and Rectum. [October,

8tli of April. The body was examined, but there were no en-
larged glands, indeed no internal organic disease.

About thirty years ago, M. Lisfranc performed, in Paris, some
bold operations for the removal of cancerous rectums. Those
who witnessed these formidable excisions gave sad accounts of
the results, such as death from haemorrhage or from peritonitis,
and subsequent obliteration of the passage, but they reported
no permanent successes. The operation was generally con-
demned by British surgeons, and I know no instance of its
repetition in this country. The objections justly made to the
excision of cancers of the rectum do not apply, however, to
cases of epithelial cancer at the extremity of the bowel, and the
cases just related show that a considerable portion, not only of
the anus, but even of the rectum itself, may be removed with a
satisfactory result. Excision is, indeed, the treatment best
adapted to the entire removal of an epithelial cancerous growth
of any great size in this part. Powerful caustics, even the actu-
al cautery, failed to obtain a cure in Case 3. There is this great
advantage in the recourse to the knife, that the surgeon can
make pretty sure of thoroughly removing all existing disease;
whereas the extent of the operation of a caustic is somewhat
uncertain ; it may destroy too much or too little. It may be
objected that in Case 3, the first operation of excision was not
successful, the disease having returned; but it seems highly
probable that Professor Siebold was not then aware of the real
nature of the lesion, and regarding it as an innocent growth,
was not so careful to excise freely all the morbid parts. We
h%ve some ground for this conclusion, not only from the rarity
of the disease, but also from the circumstance that the distin-
guished surgeon when appealed to, twenty months afterwards,
for his opinion respecting a repetition of the operation which I
then proposed, advised its performance. The length of time
nearly three years in Case 3, and upwards of two years in Case
4 which elapsed after the operations, without a recurrence of
the cancerous disease, is sufficient to show that in each instance
the growth was entirely removed.

Case 4 is remarkable also for the strong tendency which ex-
isted to the formation of warty growths a tendency which was
limited to the skin in the immediate vicinity of the contracted
anus, and which did not implicate the rectum. Dr. Andrew
Clark, who. examined the mass removed by operation in Janu-
ary, 1856, a year after the excision of the epithelial cancer, had
no hesitation in determining the simple character of the growths.
They consisted of areolar tissue, hypertrophied papillae, and
enormously accumulated epithelial cells of the cutis. From the
fact that these elements had preserved their normal relations ;
that the cells had not invaded the subjacent tissues; that there

1858.] Diseases of the Coecum. 687

were no nest, or granule cells, and no heterogeneous forms of
any kind, it was inferred that the growth was innocent. The
warts which sprang up afterwards were removed by escharotics,
which caused considerable pain, and my experience of the action
of caustic on morbid growths connected with the skin, convinc-
es me that they produce, as in this instance, more suffering than
the knife. It was very necessar}7 to get rid of these warty
growths as they were renewed, not only on account of the irri-
tation they produced, but also because of their liability to de-
generate into cancerous disease.

These cases show that a large portion of the sphincter muscle
may be excised without seriously weakening the retentive pow-
er of the anus, or contracting the orifice so as to produce any
important impediment to the passage of stools.

I am not acquainted with any recorded case in which a
growth ascertained to be an epithelial cancer of the anus or
rectum has been excised. It is very probable, however, that
operations have, in some few instances, been performed for this
disease. Thus, Mr. Herbert Mayo mentions having removed
from a woman, forty years of age, a painful indurated ulcer,
which extended round the rectum, half an inch within the anus.
She died two years afterwards of abdominal inflammation,
when the cicatrix had begun anew to ulcerate.* Dr. Bushe
also states that he also excised a cancerous transformation which
commenced, apparently at the verge of the anus, and was con-
fined to an inch and a half of the intestine. The wound healed
rapidly, and the patient's health afterwards improved, f In a
future communication I shall adduce some more cases of epithe-
lial cancer of the rectum, but which were unfit for operation.
They will serve to illustrate further the character and progress
of the disease. [London Lancet.

On some of the Inflammatory and Obstructive Diseases of the Cozcxim ;
with Remarks on the Abuse of Violent Purgatives. By W. R.
Rogers, M. D.

The author commences by alluding to the slight and cursory
notices of these diseases in sjrstematic treatises on medicine, and
how frequently they are confounded with essentially different
diseases of the intestinal canal. They are of frequent occur-
rence, are dangerous, and often fatal, and are characterized by
a train of symptoms which render their recognition certain. He
believes that the caecum may be the seat of fatal diseases without
any other part of the digestive tube being implicated; and that

Observations on Injuries and Diseases of the Rectum, 1833, p. 212.
\ Treatise on the Anus and Rectum, p. 294.

688 Diseases of the Ccecum. [October,

it often is first in the chain of causation of other disorders, with
which it has been generally believed to be only accidentally re-
lated, these evincing the most marked disturbance, while the
caecum apparently exhibits but little disorder. Thus its diseases
are not unfrequently mistaken for hysteritis, cystitis, enteritis,
peritonitis, puerperal fever, and pelvic abscess. The author
quotes Tiedemann and Graelin, Drs. Copland, Carpenter, and
others, to prove the importance of the caecum in the animal
economy, partaking of the nature of a stomach in the gramniv-
orous and ruminating animals, and that it is the viscus in which
the last act of digestion is performed, secreting an acid, albumin-
ous, and solvent fluid, and also pouring out of its numerous
follicles an unctuous and oily material, with hydro-sulphuretted
gases, to be eliminated from the economy. Thus, like the lungs,
kidney and skin, it is a depurating organ, so that when costive-
ness exists there is danger of these excretions being reabsorbed
and contaminating the blood. He states that he had within the
last twenty years met with not a few cases of these diseases,
some of which he would class as "acute," others "chronic,"
inflammation of the caecum tuphlo-enteritis ; they had not ap-
peared to arise from the ordinary causes of inflammation viz.,
exposure to the vicissitudes of the weather, or alternations of
temperature, but seemed to be produced by some mechanical,
exciting and irritating cause, the lodgement of impacted, hard-
ened feces, undigested food, fruit-skins, and stones of fruit, and
concretions of varied and different kinds, and often arise while
the person is in good health. The, symptoms may begin mildly,
and gradually proceed to greatnr intensity ; or they may, in
excitable subjects, be violent from the onset. There is but little
febrile disturbance compared with the local pain and suffering;
less anxiety of countenance than in enteritis; pulse not small,
or much quickened at the commencement ; there is great tension
and tenderness over the caecum, so that the least pressure cannot
be borne; there are no rigors; the pain is constant, does not
intermit, and its area goes on extending till the whole abdomen
is involved; but the right ileo-inguinal region is ever the most
tender part. There is obstinate costiveness; nausea and^violent
vomiting may set in, especially when drastic purgatives have
been persevered in; the position is characteristic the patient
lies on the right side, body bent, and thigh drawn up ; the
countenanc has not the anxious aspect of enteritis. If neglect-
ed or wrongly treated, the abdomen becomes tense and tympani-
tic, and general enteritis or, peritonitis may supervene. Should
the appendix be inflamed or ulcerated, all the symptoms are
more acute, and likely to terminate fatally by peritonitis or fecal
abscess. In the progress of these diseases, adhesions are often
formed in its interior, or to other parts ; the areolar tissue around

1858.] Diseases of the Ccecum. 689

may inflame, suppurate, and give rise to abscess, which may
tend upwards and downwards, and require to be opened; they
may either open externally, or find their way into other part3
of the intestinal canal, the patient recovering, or may die worn
out by the discharge. Should the ulceration open into the peri-
toneum, peritonitis of a diffused and fatal character will be set
up, as in one of the cases related by the author. This termina-
tion is fortunately most rare, though not uncommon in typhoid
and dysenteric fevers. When resolution takes place, it is pre-
ceded by action of the bowels and gradual subsidence of the
pain, tenderness, sickness and fever, about the fourth, sixth, or
even the eighth day. This result can only be obtained by most
judicious treatmeut; but when mistaken, and treated too ac-
tively by large and repeated bleedings, or violent and continued
purgatives, there is much danger of a fatal termination, or of a
long and protracted convalescence. If fecal abscess forms, the
drain on the system is long and exhausting. The author coin-
cides very much with Doctor Burne, whose papers in the " Medi-
co-Chirurgical Transactions" he refers to. In these acute cases,
leeching, fomentations, soft poultices, mild effervescing aperients,
and large bland enemata, will often resolve the inflammation;
if not, calomel and opium, or opium alone, should be given, but
violent purgatives are to be avoided. Dr. Kogers places great
reliance on bland mucillaginous enemata, passed into the bowels
with a long O'Beirne's tube, with which he has often relieved
and cured cases of simple obstruction and constipation that had
resisted other treatment; he thinks the use of this instrument is
much neglected. The author lays great stress on cautious diet-
ing, which should be, for a long time, of the simplest and bland-
est form arrowroot, rice, milk, eggs, and subsequently beef tea
and jellies. In those forms of acute inflammation that have
supervened on some subacute chronic form, long perseverance
in this cautious regimen is even of more importance. In chronic
inflammation, careful regimen and regulated action of the bow-
els are essential ; the symptoms now are all more or less subdu-
ed and indistinct: irregular action with colicky pains ; diarrhoea
alternating with costiveness and fetid dejections ; hardness and
fulness over the caecum, with tenderness on pressure. The au-
thor relies on blisters, iodine and liniments, mild saline aperients,
and strict attention to dietetic rules : from neglect of these, he
has had occasionally to regret the loss of a patient. In simple
obstruction, he relies on a large enemata and mild saline aperi-
ents, with a sedative, as hyoscyamus, belladonna, &c. ; he quotes
cases from different authors on the frequency of these obstruc-
tions and the mistakes often committed by the reckless abuse of
violent purgatives, which, even in cases of hernia, have been
given till death removed the sufferer from his tortures. In the

690 Autopsy of a Woman, &c. [October,

more obstinate cases, electricity, dashing cold water, tobacco
fomentations over the abdomen, and inflation with bellows,
have each been successful. Should all means fail, operative
surgery comes to our aid. [British Med. Journal, and Ranking^ "s
Abstract.

Autopsy of a Woman whose Uterus had been removed thirty years
previously. By Dr. G. S. Goddard.

In the anatomical collection at Rotterdam a remarkable spe-
cimen is preserved: it is the uterus of a woman, in whom inver-
sion of that organ had occurred in the year 1821, probably in
consequence of forcible separation and removal of the placenta.
After repeated but fruitless efforts to reduce the uterus, and
when the symptoms had assumed a more and more threatening
aspect, the part was tied by Surgeon Nortier thirteen days after
delivery; and eight days subsequently the tumor below the lig-
ature was removed with a pair of scissors ; in the evening of the
following day the ligature lay loose in the vagina, and exhibited
the small opening through which the pedicle had passed. A
month later the woman had quite recovered, menstruation did
not recur, and the sexual passion was wholly extinguished. In
the preparation the uterus is seen, of the size of the head of a
child at full term, with an internal rough, nocculent surface,
which, at the right side, in the neighborhood of the fundus uteri
(where the placenta was attached), has an opening with uneven
edges, of about an inch and a fifth in circumference. Less ex-
tensive on the under side, this sacciform body ends with an
opening of about two and a third inches. On the left side of
the fundus portions of the Fallopian tube and of the round liga-
ment, both, as well as the uterus, still enlarged, are seen ; while
on the right side the round ligament appears to be partly destroy-
ed, and a much larger portion of the Fallopian tube is evidently
also destroyed in its whole length. The woman died in 1850, in
consequence of an acute disease, in which the genital organs were
not involved. On opening the body the internal genitals, on a
superficial inspection, presented a tolerably natural appearance,
except that the right broad ligament was rather tense, giving
rise to a degree of obliquity ; there was a great accumulation of
fat in the connective tissue around the vagina and between the
laminae of the broad ligaments, in which no cicatrices, but only
modified plaiting, were to be seen. The folds of the mucous
membrane of the vagina were very strong and irregular; the
vagina itself was much shorter than usual. Of the uterus only
the cervix remained ; the cavity of the latter was scarcely large
enough to contain a lemon pippin, was very pointed, and was
about three inches in length; the palmae plicatae were very

1858.] Fatty Degeneration of the Heart. 691

strongly marked; the walls, which were thicker than usual, ter-
minated as cut off; on the surface looking towards the cavity,
was a white, firm, cellular, intervening substance, a couple of
lines in length, and particularly dense on the right side, which
as the cicatrix had filled the space left open in the operation,
as well as the truncated substance of the uterus, had become
covered with peritoneum. The free extremities of the Fallopian
tubes were normal; each terminated in a cul de sac, the right
was shorter than the left, and with the ovary was drawn strong-
ly downward by a fold of peritoneum. The round ligaments
were in great part deficient on both sides ; the right was the
shorter, and was surrounded with much connective tissue. The
left could be followed a little further. The ovaries were more
atrophied than even the woman's time of life should lead one to
expect; the ligament of the right ovary was very small ; that
of the left still in a great measure existed. On either side there
was one of those pediculated hydatid-shaped bodies, which Ko*
belt and Follin regard as remnants of the ductis Mulleri in the
corpus Wolrianum; the right possessed a short and broad, and
the left, on the contrary, a long pedicle. [Nederlandsch Lancet,
and Dublin Medical Press.

Fatty Degeneration of the Heart Death from the Inhalation of the
Tincture of Chloroform. By William A. Hammond, M. D.,
Assist. Surg. U. S. Army. (Read before the Biological De-
partment of the Academy of Natural Sciences of Philadelphia,
April 19th, 1858.)

Private S , of Company "C," 2d U. S. Dragoons, was ad-
mitted into the hospital at Fort Riley, Kansas Territory, on the
23d day of November, 1856, with an injury of the left elbow-joint,
caused by his falling from his horse whilst intoxicated on the af-
ternoon of the previous day. I did not see him till eighteen hours
after the accident, when, owing to the swelling and inflammation
of the part, I was unable to determine the exact nature of the
injury. Erysipelatous inflammation immediately ensued, and
lasted for ten days, requiring absolute rest, and the ordinary reme-
dies for its removal. At the end of this period there was still a
good deal of swelling, and the motions of the joint were very much
impaired. Dr. Coolidge (who in the mean time had joined the
post) and myself were unable still to make out the exact condi-
tion of the parts; and after repeated examinations, we decided to
induce anaesthesia with the view of obviating the great pain
caused by the necessary manipulations, and thus to make a more
satisfactory examination than had yet been accomplished.

A sponge wet with two or three drachms of the tincture of
chloroform was placed in a tubulated bell-glass and held to the
n. s. VOL. XIV. no. x. 39

692 Fatty Degeneration of the Heart. [October,

mouth of the patient, he having previously removed his coat and
stock, unbuttoned the neck band of his shirt, and laid down on a
bed. He continued to breathe the vapor for five minutes with-
out any appreciable result. The pulse, which at the commence-
ment of the inhalation was 100 per minute, remained about the
the same. The sponge was again moistened with the tincture of
chloroiorm, then placed in a towel, and again held close to the
mouth. Full, deep breathing was directed, and in two or three
minutes some excitement was produced. During this period the
face became red and flushed, but not to an unusual extent; the
respiration was not affected in any remarkable degree, nor was
there any notable variation in the pulse. In an instant, however,
all was changed; the eyes were turned up, the face became tur-
gid, the muscles became relaxed, and vomiting ensued. My hand
was upon his pulse, which, from beating at the rate of 100 per
minute, stopped as if he had been struck with lightning. Dr.
Coolidge immediately discontinued the inhalation, and judging
from the character of the vumited matters, thought at first that'
some substance was closing the larynx. Introducing his finger
into the posterior fauces, he removed a large piece of cabbage.
Subsequent to the vomiting the patient breathed two or three
times, but it is probable the heart ceased to act before respiration
was entirely suspended.

Every means proper in such cases was used to re-excite respi-
ration, Marshall Hall's method among others, but without the
least success. Stimulants were thrown into the rectum, the body
rubbed sedulously, &c, but no evidence of life was perceived,
and after persevering for nearly two hours, we abandoned all
hopes of resuscitation.

Autopsy twenty two hours after death. Body well developed, no-
superabundance of fat. Great muscular rigidity, and considera-
ble hypostatic congestion of the back of the head, neck and body.
The brain and appendages were healthy. The stomach was
large but not distended with gas, and contained about three ounces
of pultaceous matter, and several large pieces of unmasticated
and undigested beef. The spleen was about three times its natu-
ral size. The liver presented no unusual appearance ; it was not
minutely examined. The thoracic cavity was free from effusion
and pleuritic adhesions. The lungs, especially their inferior and
posterior portions, were intensely congested, and of a deep purple
hue. On opening the pericardium, the heart appeared of unusual
size. The right auricle and ventricle were distended with blood
and covered with fat. On removing the heart in the usual man
ner by dividing the great vessels at their origin, about two quarts
of dark, thin, uncoagulated blood escaped. No coagula were
found in the heart or large vessels ; the left ventricle was empty,
The heart weighed within a fraction of fourteen ounces, ami

1858.] Fatty Degeneration of the Heart. 693

measured in its longitudinal diameter full six inches, and in cir-
cumference, at ils base, eleven and a half inches. The wall of
the left ventricle at its base was f of an inch in thickness, at the
middle f of an inch, and at the apex f of an inch. The extreme
thickness was one inch. The thickness of the right ventricle
ranged from \ to of an inch, exclusive of its fatty covering,
which, near the auricle, was quite thick. The walls of the right
auricle were extremely thin, and were loaded with fat. The sub-
stance of the heart was of a very pale red or dirty pink color,
comparatively soft and flabby, less resisting in the right than in
the left ventricle, but easily penetrated in both with the finger or
handle of the scalpel.

In order to form a more definite conclusion as to the exact pa-
thological condition of the heart, I submitted several sections to
microscopical examination ; many portions of the right ventricle
were thus found to consist almost entirely of fat-cells and oil-glo-
bules ; in others, muscular fibres were visible. In the left ventricle
both fibres and striae were to be seen, with many fat cells and oil-
globules. The more precise results of the examination are as
follows :

1st. A piece of the right ventricle taken from the central por-
tion of its wall, t. e., midway between its external and internal
surfaces, and in which no fat was visible to the naked eye, exhib-
ited under the microscope numerous fat-cells and oii-globules.
One hundred grains of this character of tissue, when subjected to
the action of ether, yielded 32.75 grains of ether extract.

2nd. A section of the right ventricle extending through its en-
tire thickness, and in which fatty deposit was visible to the naked
eye, yielded 69.92 percent, of ether extract.

3rd. A portion of the left ventricle, in which no fat was visible
to the naked eye. was perceived by the microscope to contain a
few fat cells, and yielded 9.89 per cent, of ether extract.

It is evident, therefore, from tins record, that the heart, besides
being loaded with fat. was in a state of fatty degeneration. It is
worthy of note that there was no arcus senilis observed in this
case,

A few words in relation to the anaesthetic employed, will not,
I think, prove uninteresting.

The anaesthetic issued to the medical officers ofthearmyis
(or was at that time), the tincture of chloroform, or chloric ether
of Dr. J. C. Warren and others. When properly prepared, it
consists of one part of chloroform, and two parts of absolute alco-
hol, and such was the preparation intended to be furnished. The
contents of the same bottle used in this case had been a short time
previously used in six cases; one of amputation of both legs ; one
of Chopart's operation on right foot, and Hey's on left foot; one
case of delirium tremens following fracture of arm, and complica-

694 Fatty Degeneration of the Heart [October,.

ted with severe convulsions; one amputation of great toe; and
one excision of a portion of the fibula. In all these cases the
anaesthetic had acted unpleasantly, and in that of amputation of
the great toe great prostration was produced, and the pulse fell
from 60 to 40 per minute. By the use of stimulants, &c, further
ill effects were obviated.

It did not, however, occur to Dr. Coolidgeor myself, that these
consequences were due to the peculiar character of the anaesthetic,
but after the death of S I submitted it to a chemical exam-
ination with the following result:

The specific gravity was 980. The reaction was strongly acid.

A solution of nitrate of silver caused a flaky precipitate, solu-
ble in ammonia, and precipitable from this solution by nitric acid,
showing, therefore, the presence of chlorohydric acid.

A portion was put into a glass tube graduated to tenths of a
cubic centimetre, and an excess of water added so as to destroy
the solvent property of the alcohol. The chloroform thus precipi-
tated amounted to but one -sixth of the whole.

The alcohol entering into its composition, instead of being ab-
solute, was the common diluted alcohol of the Pharmacopoeia.

The tincture of chloroform was thus shown to be very impure,
and not the article contemplated by the medical department. It
had been carefully preserved whilst under my charge and that of
Dr. Coolidge, in closely stopped bottles carefully kept from the
light, so that it is probable the chlorohydric acid had been present
from the time of its manufacture.

How far this impure character of the anaesthetic may have
tended to cause death in the case related, is difficult to say. I
believe, however, that it was not without influence. The condi-
of the heart was doubtless, however, the chief cause of death.
Persons suffering under fatty degeneration of this organ are pecu- ft
liarly liable to sudden death, and it is also true that there are no f\
certain signs from which its presence can be determined during J
life. Of fifty-eight cases cited by Dr. Eichard Quain,* death was f
sudden in fifty-four.

Two cases have recently been published of fatty degeneration ji
of the heart, in which death occurred from the inhalation of chlo- b
roform. In one of them, that of Mr. Erichsen,f it took place at fco
the time of inhalation. The other occurred in the practice oi ^
Dr. Macgibbon,J at the New Orleans Charity Hospital. In this '&:
latter case death ensued on the day following the administration
of the chloroform.

Private S was 23 years of age, 5 feet 6 inches high, o

ruddy complexion, gray eyes, and brown hair. He was exceed-

k

* Medico-Chirurgical Transactions, vol. xxxiii.

\ British and Foreign Medico-Chirurgical Review, January, 1855, p. 222.

\ American Journal of the Medical Sciences, Janury, 1856, p. 261.

L858.] Hernia of the Ovary, 695

ngly intemperate in his habits. He had never, as far as I am
iware, complained of any afFection of the heart, and never, to ray
knowledge, had any symptoms which would indicate disease of
this organ.

In the preparation of this paper I have freely availed myself of
;he notes of Dr. Coolidge, especially those relating to the post-
mortem appearances and measurements of the heart. [American
Journal of the Med. Sciences.

History of two cases of Hernia of the Ovary, in one of which there
was periodical Mnlargement of this Organ. By Dr. Oldham,
Obstetric Physician to Guy's Hospital.

These cases are examples of a rare conformation of the female
sexual organs, in which the ovaries had descended through the
nguinal canal, and become permanently lodged in the upper part
:>f the external labia. In both of them it was impossible to detect
sither uterus or vagina; and in the first there was a periodical
increase of one or other of the ovaria, followed by its gradual re-
duction a direct evidence of an ovarian menstrual act.

Case 1. The subject of tbis case applied to me in September,
L851, for advice on account of never having menstruated. She
was nineteen years of age, of a tall figure, symmetrical frame,
well-expanded pelvis, and womanly aspect, bearing all the marks
of a full completion of the physical changes of puberty ; and her
general health, though not robust, was fairly good. She was one
of a family of five children, and her sisters had menstruated be-
tween 15 and 16 years of age. The principal point which was
elicited from her history in connection with her complaint was,
that, eighteen months before, a swelling had somewhat suddenly
appeared on the right side of the external organs, which had
caused her some pain for a few days and had then disappeared.
In four or five months a similar swelling again appeared, but was
attended with so much suffering that a medical man was consult-
ed, who took it for an abscess and ordered it to be poulticed.
Again it passed away, again to recur at the end of two months;
and so it had gone on at irregular intervals until the time of her
seeing me, when the pain of a renewed attack of unusual severity
had occasioned her some alarm. On examination, a swelling the
size of a goose-egg was found to extend between the external ab-
dominal ring and the centre of the labium on the right side, which
was very tense and firm to the touch ; and the cellular tissue, skin,
and mucous membraue of the labium were cedematous and in-
flamed. It was painful, but by no means so painful as a labial
abscess, which in its general aspect it resembled ; and there was
but little febrile disturbance. A more critical examination de-

Hernia of the Ovary. [October,

tected the presence of a solid body of an oval shape within the
tissue of the labium, which proved to be the ovarium, whose en-
largement had so compressed the surrounding tissues as to swell
and inflame them. On the opposite side there was another oval
body, the size of a walnut, which passed just beyond the outer
ring, but readily slipped into the canal. This was the left ovary
in a quiescent state. The external sexual parts were normally
formed ; but the ostium vaginas was closed, a slight indentation in
the median line alone marking its position. Frequent careful
physical examinations failed to detect any trace of a vagina or
uterus, and the conclusion arrived at was that these central pelvic
organs had not been developed. The mammary glands were
fully formed.

1 have had repeated opportunities during the six years which
have intervened since first ihe case came before me, of examining
the organs both during the periods of ovarian excitement and
during the intervals. For nearly two years, however, I complete-
ly lost sight of her, when I learned, to my amazement, that in
spite of my strong admonition both to her mother and herself, that
she should lead a single life, she had married. For some time past
I have seen her more frequently, and have watched the recur-
rence of the ovarian swellings.

For the first three years the right ovarium was exclusively en-
larged, and the intervals were not so regularly marked, varying
between three and six weeks : excepting for the first year, when
thev were much longer, occasionally extending to three months.
For the last two years the left ovarium has been far more frequent-
ly affected, the right remaining quiescent ; occasionally both are
painful and tumid, but even then one more than the other. The
intervals are now pretty regularly three weeks. The acute in-
flammatory symptoms which accompanied the onset of these
swellings have long since ceased to recur, which is obviously due
to the loose state of the tissues from repeated stretching, so that
the swollen organ is no longer compressed.

The accession of a menstrual time is sometimes suddenly felt.
She will go to bed well, and in the morning the ovary will be
swollen : more commonly, however, it is very gradual, augment-
ino1 in volume for four days, then remaining stationary for three
days, and then gradually declining; the whole process, before the
ovary is reduced, generally lasting tenor twelve days. On sepa-
rating the ovary, when at its -height of swelling, from the tissues
surrounding it, it appears scarcely, if at all, less than double its usu-
al volume; its outline is clearly defined, and it is plain that the
whole, and not merely a part of the organ, is involved. There is
no suffering worthy of notice during the time; the swelling is
tender if pressed; and tender, too, in the act of sitting down or
rising up ; but she walks about as usual without distress, and

1858.] Poison of the Upas Antiar. 697

there is but little lumbar or hypogastric pain. Neither are there
any manifest sympathies excited, either of the mammary glands
or other organs. Nor is there any vicarious flux, either of blood
or any secretion, with the exception of an excess of saliva, but
this is not in any large flow. The ovary alone appeared to be
engaged in this periodical act, which it is not too much to sup-
pose, in accordance with modern physiological views, would have
been attended with a flux of blood, had not the organs which nor-
mally supply it been absent.

But while this may be said to represent the usual course of a
period, yet the volume of the ovary, and the length of time it re-
mains swollen, is subject to occasional variation ; sometimes
being much less tumid, and dying away in a shorter time.

The repeated attempts at sexual union have only had the effect
of somewhat loosening the tissues around the vulva, but the vagi-
na remains imperforate as before, and is beyond the reach of
surgical remedy. It may be added, that the subject of this histo-
ry recognizes an increase of sexual feeling at and soon after the
periods of enlargement of the ovary.

Case 2. This case was that of,a young woman who had at-
tained the age of twenty without having menstruated. She was
a tall, strumous-looking person, in weak health. There had not
been any well-marked efforts at menstruation, but she had suffered
slightly from lumbar pain. The mammae was well developed.
The pelvis was fairly formed. On examination I found the two
ovaviajust appearing beyond the external abdominal rings, and
readily returning by pressure into their respective inguinal ca-
nals. They were of equal size and similar shape, being ovoid
bodies about the size of small chestnuts. They were not tender
when touched, although organically sensitive, and she had never
experienced pain in them. The external sexual organs were
somewhat less perfectly developed than usual ; the vaginal orifice
was closed, and no trace of a canal or uterus could be detected
by exploration with a catheter in the bladder and the finger in the
rectum. These organs, as in the former case, were absent. Du-
ring the time I saw the patient, which was only for two months,
the ovaria did not enlarge, although her general health improv-
ed. [Proceedings of Royal Society, and Hanking1 s Abstract.

Observations on the Poison of the Upas Antiar. By Professor

KOLLIKER.

The results of Prof. Kolliker's investigations into the effects of
the antiar upon frogs, are the following:

" 1. The antiar is a paralyzing poison.

"2. It acts in the first instance and with great rapidity (in 5 to
10 minutes) upon the heart, and stops its action.

698 Puerperal Fever. [October,

" 3. The consequence of this paralysis of the heart are the ces-
sation of the voluntary and reflex movements in the first and
second hour after the introduction of the poison.

" 4. The antiar paralyzes, in the second place, the voluntary
muscles.

"5. In the third place, it causes the loss of excitability of the
groat nervous trunks.

"6. The heart and muscles of frogs poisoned with woorara may
be paralyzed by antiar.

11 7. From all thisit may be deduced that the antiar principally
acts upon the muscular fibre and causes paralysis of it.

" So much for this time. My experiments with the antiar upon
warm-blooded animals have only begun, and I am not yet able to
draw any conclusion from them. As soon as this will be possi-
ble, I shall take the liberty to submit them to the Roval Society,
together with the results of my experiments with the upas teinte,
which poison I had also the good fortune to obtain through the
kindness of Sir Benjamin Brodie and Dr. Horsefield. With re-
gard to the antiar, I may further add that experiments made inde-
pendently, and at the same time, by my friend Dr. Sharpey with
this poison, have conducted to the same results as my own."

[Proceedings of the Royal Society, and Ranking 's Abstract.

Puerperal Fever.

The Academy of Medicine in Paris has for some time been
occupied in a discussion on Puerperal fever, in which the leading
obstetricians of the French metropolis have given utterance at
length to their opinions. From among the numerous speeches,
we translate that of M. Cazeaux, as it gives a very good digest of
the different opinions entertained.

I think that it would be superfluous, after the speeches you have
heard, to revert to the symptomatology and anatomical charac-
ters of the disease or diseases collectively described under the
names of puerperal fever or puerperal peritonitis. These points
in the discussion appear to me to have been sufficiently studied
by M. Depaul and M. Cruveilhier. You are aware of the im-
portance given by the last named speaker to lymphangitis among
the alterations peculiar to puerperal fever; so much so, that he
considers it characteristic of that disease. But that opinion has
been vehemently disputed by M. Behier, who maintains, on the
contrary, that, in autopsies of women who have died of puer-
peral fever, he has found inflammation of the veins more frequent-
ly than of the lymphatics. This assertion of M. Behier's has
surprised me greatly. I have, for my own part, opened a good
number of bodies of women who have died of puerperal diseases,
and I declare that, like M. Cruveilhier, I have found pus much
more frequently in the uterine lymphatics than in the veins. Does

1858.] Puerperal Fever. 699

not M. Behier's error depend on an anatomical confusion ? For
it is remarkable that, although he describes the pus as being in
other vessels than M. Cruveilhier does, he still finds it in the same
parts of the uterus or its appendages ; that is to say, in those por-
tions which are particularly rich in lymphatic vessels. But there
is one question which has in an especial degree excited the speak-
ers ; it is that of knowing what is the nature of puerperal fever,
and what nosological rank it is proper to assign to the lesions
which it presents.

In this respect the speakers have been divided into two camps.
In the one, they admit the existence of an essential fever of a
pyrexia; in the other, they see only local phlegmasia?. Up to the
present moment, M. Beau is the only one who has formally de-
clared himself in favor of this latter doctrine. With regard to the
doctrine of essentiality, it has found supporters in M. Depaul, who
has the most boldly and the most clearly laid down the question ;
In M. Danyau, who has also spoken out resolutely enough ; in
M. Trousseau, who, after having formally rejected the puerperal
fever, has so well generalized it subsequently, that he has admit-
ted it not only for women in child-bed, but even for women not
in the puerperal state at all, for the foetus, for the new-born child,
and for all subjects attacked by any kind of traumatism. M. Du-
bois has equally announced himself an essentialist; but he has
produced no new arguments in favour of that opinion, and he has
enveloped his ideas in such thick clouds, that it is difficult through
such a veil to distinguish a pure essentialist. The question,
therefore, is solely and entirely between M. Depaul and M. Beau.

M. Beau appears to me to have replied victoriously to M. De-
paul, invoking the epidemic and contagious characters of the
disease as proofs of its essentiality. I will not revert to these
arguments; but I will add that one of the characters of pyrexia,
viz., the manifestations of the fever some days before the appear-
ance of the local symptoms, as is the case with typhus and small-
pox, is not what is observed in puerperal fever, in which the pain,
which is the sign of local phlegmasia?, shows itself almost at the
the same time as the shivering, which is the sign of the general
pathological state. I find also a very good argument against
i essentialism in the speech of M. Dubois, who nevertheless makes
profession of being an essentialist. Have we not heard that hon-
ourable professor tell us that the multiplicity, the variety of the
lesions in puerperal fever, would be consistent with placing it
among pyrexiae, the principal character of which is to present
anatomical alterations, constant and always identical.

With regard to the negative autopsies quoted by M. Depaul
as an argument in favour of essentiality, while I admit, as I do
willingly, that they have been well made, 1 can neither consider
them as convincing proofs, nor as motives for rejecting the doc-

700 Puerperal Fever. [October,

trine of local phlegmasias. In fact, do we not see peritoneal
inflammations, traumatic, or by perforation, kill so promptly, that
material alterations have not had time to be formed ? Do we not
see, also, burns in the first or second degree cause a rapid death
the effect assuredly, not of the lesion of the tissue, but solely of
the extent and violence of the inflammation ? On the other hand,
is it really necessary to find severe organic lesions to explain
functional disorders, and even death, in puerperal fever? I do
not think it is ; for, in my opinion, the blood in this disease has
undergone so profound an alteration as to acoount for all the
accidents, and for the usually fatal termination of the disease.

The mistake committed by those nosologists who have wished
to assign a place to puerperal fever, consists, in my opinion, in
their having studied it under its epidemic form. In order to form
a true and clear idea of the disease, we must look at it under its
sporadic form ; that is, in its condition of simplicity, disengaged
from the special elements of gravity necessarily given to it by the
epidemic character. Let us then imagine a physician who has
never seen a case of puerperal fever, and who has never read a
description of this malady. He is brought into the presence of a
woman recently confined, in whom a laborious parturition, a pro-
longed labour, has produced numerous bruises and lacerations,
speedily followed by violent shivering, by very severe abdominal
pains, and by a series of other severe general and local symptoms
which will rapidly terminate in death. At the autopsy, he finds
pus in the peritoneum, in the veins and lymphatics of the pelvis.
What idea can this physician form of the nature of the disease,
but that it is phlegmasia?

Now, must we admit that tbere exists a natural difference be-
tween the epidemic and sporadic forms of puerperal fever? By
no means any more than that there exists a difference between
epidemic and sporadic pneumonia. Nevertheless, M. Trousseau
has brought forward one difference which he describes as very
essential ; it is the existence of a specific cause, of a kind of virus
which would be the essence of the epidemic puerperal fever.
Well, a specific cause always produces a corresponding specific
disease, announcing itself by signs or lesions always identical;
thus, the virus of rabies always produces rabies ; the virus of
syphilis, syphilis; the smallpox virus, smallpox; while here we
have to do with a disease which presents itself with lesions the
most varied, sometimes a metritis, sometimes a peritonitis, some-
times a phlebitis, at other times a lymphangitis, a pneumonia, a
pleurisy, a suppurating arthritis, etc. We cannot, therefore, al-
lege a sole cause for effects so varied.

The difference which I admit, for my own part, is not where
M. Trousseau has placed it in the nature of the disease; I find
it in the very fact of the epidemic, which renders the disease

1858.] Puerperal Fever. 701

more severe, without changing anything of its essence. It is here
with puerperal phlegmasia as with cholera, angina, dysenler}-, and
a hundred other affections that I might name.

Do not think, however, that beyond the local inflammation I
see nothing whatever, and that I believe that in that resides the
whole gravity of the affection. If, indeed, 1 do not admit a puer-
peral fever, 1 do admit a puerperal state, which, in preparation
throughout the pregnancy, arrives at its maximum of intensity at
the time of the accouchement, and shortly afterwards. This pu-
erperal state consists in a notable alteration of the fluids, which
is present, in a greater or less degree, in all pregnant women. I
have heard M. Trousseau speak to us with some disdain of recent
haematological researches. For my part, I think they are destin-
ed to open to medicine a way of progress, and to enlighten us on
many questions which are still obscure. It is not my place here
to recall all the results already obtained ; but I cannot be silent
on the very special services rendered by haematology to obstetric
physiology and pathology. Thanks to that science, gentlemen., it
is now admitted that pregnancy, so far from constituting a condi-
tion of plethora, actually, on the contrary, engenders an anaemic
state. Thanks to haematologv, we now understand the etiological
analogies existing between eclampsia and the epileptiform con-
vulsions which terminate Bright's disease. It has been establish-
ed very clearly that in both cases the nervous phenomena depend
on an intoxication of the blood by urea on an uraemia.

It is also in the blood in the blood so profoundly modified in
pregnancy that we must seek the first cause and the point de
depart of puerperal diseases. Thus, diminution of globules, of
albumen, of iron, a notable augmentation of water and of fibrine
such are the modifications I ought to say, the alterations of the
blood in a woman about to lie in. If in such a condition there
supervene an extensive inflammation of an important organ, you
may conceive what development it must assume in invading an
organism so seriously altered. Who can foresee to what extent
these alterations of the blood may go, and what may be the con-
sequence of them ? For myself, I do not hesitate to say that, in
certain cases, they may be carried to a point at which they will
produce a transformation of blood-globules into pus globules; and
that without a wound, without phlebitis, without any lesion of the
solids.

And on this subject, let me recall a fact reported by M. Andral,
and which is very well adapted to impart a certain value to this
hypothesis. A man was brought in dying, in a most formidable
atixo-adynamic state; he died at the end oi three days. At the
autopsy, numerous abscesses were found in the brain, in the lungs,
in the spleen, in the kidneys; the blood everywhere was like very
loose currant-jelly. In the midst of the blood-globules, which

702 Puerperal Fever. [October,

were misshapen, strawberry-like (framboise's), a great number of
pus-globules were plainly distinguished. Nowhere was there the
slightest trace of phlebitis. Collections of pus in many of the
solids, and pus in the blood itself, were the only alterations de-
monstrable.

There is, therefore, in lying-in women, as M. Trousseau has
said, a great morbid aptitude, which I will at once call a. pyogenic
stale, which not only manifests itself in abdominal phlegmasias,
but makes its sad influence felt, whatever be the disease attacking
the puerperal female. It is thus that, according to M. Chomel
and M. Grisolle. the pneumonias which supervene during the pu-
erperal state acquire an extraordinary degree of virulence, which
renders them promptly mortal.

Be the puerperal fever sporadic or epidemic, it always consists
essentially in an alteration of the blood and a special aptitude of
certain organs to inflame, and to rapidly produce pus ; with this
sole difference, that with epidemics this aptitude finds itself sin-
gularly increased by this agent, unknown in its essence, but so
manifest in its effect, and to which has been given the vague de-
nomination of epidemic influence (genie epidemique) ; whence
also the gravity of the disease, and its termination more promptly
and more constantly deadly.

I will only say this regarding the contagious character of puer-
peral fever, that I adhere without p reserve to what MM. Depaul
and Danyau say about it. After a demonstration so clear, so
peremptory, as that furnished by those two speakers, it is impossi-
ble that there can remain any incredulous on the point. M.
Danyau has therefore, with good reason, insisted on the precau-
tions to be taken to avoid the dangers of contagion.

What shall I say of the treatment? The speakers who have
preceded me have superabundantly proved the uselessness of the
different methods of cure, and the vanity of certain remedies con-
sidered prophylactic.

For the curative treatment, I will confine myself to the decla-
ration that all the means I have tried have failed in my hands, as
in those of my colleagues, in cases of virulent or epidemic puer-
peral fever. I must, however, say that I have obtained good
effects from the employment of mercury. I have seen every case
get well in which powerful doses of mercury have produced an
abundant salivation ; a circumstance which induces me to think
that he who shall find an infallible means of bringing on a copious
salivation will have perhaps discovered a specific for puerperal
fever.

As for prophylactic measures, I see none better at present than
such as consist in diminishing the agglomeration of women in
lying-in; and on that point, I entirely agree with M. Danyau.
The measures he proposes appear to me the wisest, the best un-

1858.] Injection of Urea, <c, into the Blood. 70S

derstood, and the most conformable to the rules of a prudent
hygiene. [British Med. Journ., from Gaz. IIMomadaire.

On the Injection of Urea and other Substances into the Blood. By
Dr. VV. A. Hammond, Assistant Surgeon U. S. Army.

The principal object in undertaking the experiments detailed
in this paper, is that of deciding upon the correctness of the theory
advanced by Frerichs explanatory of uraemic intoxication. As
is well known, this distinguished author regards the symptoms of
blood-poisoning, so frequently present in Bright's disease, as not
directly depending upon the presence of urea in this fluid, but as
being caused by its conversion, through the agency of a ferment,
into carbonate of ammonia.

Frerichs performed two series of experiments, which he regards
as tending to sustain his hypothesis. In the first series, he inject-
ed a solution of urea into the blood of animals whose kidneys had
been previously removed. In from an hour and a quarter to
eight hours they became restless, and vomited. Ammonia was
detected in the expired air, and simultaneously convulsions ensu-
ed. Death occurred in from two hours and a half to ten hours
from the commencement of the experiment. Ammonia was found
in the blood, the contents of the stomach, and in the bile and oth-
er secretions.

In the second series, a solution of carbonate of ammonia was
injected. Convulsions ensued almost immediately, and were
' quickly followed by stupor. The respiration was labored, and
the expired air was loaded with ammonia. This substance, how-
ever, gradually disappeared, and the animals recovered their
senses.

Frerichs offers no explanation of the nature of the ferment
which he conceives to be necessary to produce uraemic poisoning,
nor does he even attempt to demonstrate its existence, except in-
directly, through the experiments above cited.

While admitting the facts set forth by these experiments, Dr.
Hammond differs with Frerichs in his theory. Ammonia has
often been met with as a constituent of the expired air of healthy
individuals. He has himself frequently detected it in such cases ;
it has been demonstrated to be constantly present in the blood;
and Frerichs' own experiments (those of the second series) show
that it was not capable of causing death even when injected di-
rectly into the circulation, and when its presence in the blood
was evidenced by its being exhaled in large quantity from the
lungs.

The fact that in the first series of investigations the kidneys
were extirpated, while in the second the animals were unmutila-
ted, while different substances were used in each, prevents our
drawing any comparative conclusions from the results obtained.

704 Menstruation during Pregnancy. [October,

The experiments to which the present paper relates consisted
of two series. In the first the suhstance was injected into the
blood of the sound animal; in the second the kidneys were pre-
viously extirpated. The two series were, as far as possible, alike
in every other respect. The substances injected in both series
were urea, urea and vesical mucus, carbonate of ammonia, nitrate
of potash, and sulphate of soda.

Dr. Hammond's conclusions are:

1st. That urea (simple and combined with vesical mucus), car-
bonate of ammonia and sulphate of potash, when injected into
the blood-vessels of sound animals, do not cause death.

2nd. That nitrate of potash, when thus introduced, is speedily
fatal.

3rd. That death ensues from the injection of any of the fore-
going named substances into the circulation of animals whose
kidneys have been previously extirpated.

4th. That in neither case does urea when introduced directly
into the circulation, undergo conversion into carbonate of am-
monia. \_N. A. Med. Chir, Bev.} and Banking's Abstract.

Menstruation during Pregnancy. By Dr. Elsasser.

This contribution to a disputed topic is founded upon 50 cases,
extracted from the journal of the Stuttgart Lying-in Hospital,
cases which are said to rest upon the most certain information.
The subjects were 15 primaparae and 36 pluriparee, who, with the
exception of two women (aged 36 and 41), were between 20 and
30 years of age. Of the 51 children born, 34 were boys and 17
girls, 36 being mature, and 15 immature. The menstruation du-
ring pregnancy occurred in 50 women, in the following manner;
Once in 8, twice in 10, three times in 12, four in 5, five in 6,
eight in 5. and nine in 2. In 13 cases the peculiarities of the
rhythm of the discharge were inquired into, and the rhythm was
found regular in 4, in 1 it occurred at the sixth* week, in 3 there
were pauses between the epochs, in 2 the menstruation first ap-
peared after the second month, in 2 after the fourth, and in 1 after
the fifth month. In one case the menstruation first appeared in
the middle of gestation, and henceforth came on every four weeks,
lasting three or four days. The child perceived but feebly at
first, was strongly felt during the last four or five weeks. Hem-
orrhage occurred twice within a week before delivery, but a ma-
ture, living infant was born. Indications as to the amount of
discharge were furnished in 26 cases, and in 18 of them it was
less than in the non-pregnant condition. The weight of the 35
mature infants varied from 5 lbs. to 9 lbs.

Dr. Elsasser observes that although he is unable to state the
proportion of cases in which menstruation occurs during preg-

1858.] Investigation of Epidemicsby Experiment. 705

nancy, it is by no means so exceptional an occurrence as suppos-
ed by some authors. It occurs more frequently in pluriparae than
in primiparae ; and it takes place much more frequently during
the first half of pregnancy, and especially in the earlier months of
this, than during the latter half. The amount of discharge too
is smaller than in the normal menstruation. The duration of the
pregnancy was normal in more than two-thirds of these cases (36),
while in nearly one-third (14) of the cases it was interrupted, in
4 during its first, and in 10 during its latter half. As regards the
development of the child, which by some authors has been sup-
posed to be impeded by the occurrence of menstruation, this was
found to be normal, or more than normal in three-fourths of the
cases [Afonatschrift fur Geburtekiinde, and American Journal of
the Med. Sciences.

The Investigation of Epidemics by Experiment. Read before the
Epidemiological Society. By Dr. Richardson.

He commenced by pointing out the weakness of the present
system of epidemiological study, which sought after results by
trying to descend from the general to the particular. This
method lets pass simple laws, which lie at the root of all inqui-
ries. It is painful to say, as a fact, yet a fact proper to be said,
that the researches at present so laboriously conducted do not
tend to such proofs of unanimity, or to such positiveness of
science, as might on a priori reasoning, be expected from them.
The present modes of research may bring out negatives they
may bring out partially-accepted positives, and a sufficient
amount of positive evidence to satisfy a section of men ; but
as yet they have failed to educe such demonstrations that
those who are educated to the same maik can read off the same
phenomena by the same process of thought and inductive learn-
ing. The author next proceeded to point out carefully such
experiments as might be reasonably instituted for the purpose
of investigating particular epidemic disorders, especially small-
pox, scarlet fever, and typhus, commenting also on the care which
should be taken in the section of the animal subjected to experi-
ment, and showing that in inquiries relating to the three special
diseases named above, the pig is the proper animal to be selected,
as one more susceptible of these diseases than other members of
the inferior animal kingdom. Thence, leaving propositions for
the history of experiment itself, as a means of investigation, the
author explained what had been done in recent times towards
the production of some diseases artificially, and the information
derivable from this form of investigation. He followed up this
argument with a minutely-revealed account of some experiments
performed by himself, in which all the characteristics of typhus,

706 Aconitum Napellus Aconite. [October,

symptomatological and pathological, were produced by the in-
troctuction of alkalies into the system. He showed further that
the typhous condition, which could be introduced by the injec-
tion of animal putrid matter, was coincident with, and depend-
ent on, the development of a superalkaline condition of the
blood; and he connected the pathology of putrid fever, so call-
ed, with the conditions analogous to those which had thus been
artificially produced. In a connected, simple mode of argument,
which peculiarly arrested the attention of the audience, the
question was next put, whether, when the virus of a disease is
introduced into a healthy animal so as to reproduce that disease,
the symptoms and the pathological changes are due to an abso-
lute reproduction of the virus itself, and to the actual presence
of such virus, or whether the virus acted by setting up such
new changes in the body that a product, generated secondarily
and differing in character from the original poison, was the cause
of the symptoms ? He (Dr. Richardson) was inclined to the
latter view, and gave some clear experimental evidence in sup-
port of his position. He admitted at the same time that further
experiment was required, and argued that until this point was
denned no sound progress could be made in the study of epidem-
ics.

It is impossible, in an abstract to give more than the briefest
outline of a communication written in so condensed a style, and
opening up for consideration so many subjects, each differing in
detail, yet having but one object; but the final propositions laid
before the Society were as follows:

1. That by experiment it might be ascertained in what excreta
the poisons of certain of the epidemic diseases are located.

2. By what surfaces of the body such poisons may be absorb-
ed so as to produce their specific effects.

3. When the virus of a disease, in reproducting its disease in
a healthy body, acts in the development of the phenomena by
which the disease is typified primarily or secondarily i. e. by
its own reproduction and presence, or by the evolution of anoth-
er principle or product.

4. Whether climate, season, or external influences modify
the course of epidemics, by producing modifications of the
epidemic poisons, or modifications in the system of persons ex-
posed to the poisons. [London Lancet

Aconitum Napellus Aconite.

Dr. Edward B. Stevens, of Cincinnati, reports {Cincinnati Med.
Observer, Oct. 1857) his success, confirmatory of the experience
of others, in the use of aconite, for the cure or relief of "almost
the entire range of neuralgic affections, and of those obscure

1858.] Cannabis Indica. 707

complications, of rheumatism and neuralgia, in which there is
freedom from local or constitutional trouble, independent of
nervous derangement."

In a case of neuralgia, "supposed to be a result of previous
attacks of miasmatic disease," and which was treated by the use
of quinine and other remedies with but temporary relief, Dr.
Stevens prescribed a mixture of the tincture of aconite and tinc-
ture of cimicifuga, which gave entire relief to the patient. The
proportion was $. Tinct. rad. aconit., 3i. ; Tinct. cimicifuga,
fij. M. Dose, a teaspoonful every four hours. Three doses
were sufficient to procure the desired relief. Ten months had
elapsed without a return of the disease.

A case of neuralgic rheumatism of the arm, of peculiar obsti-
nacy, after having been intractable to all remedies, yielded to
the aconite. In the above formula, each close should be equiva-
lent to about four drops of the tincture, although, in fact, this
latter gives somewhat more than sixty drops to the drachm. In
this dose of four drops, Dr. Stevens has ." never seen any effects
sufficiently marked or evident to occasion alarm."

Dr. S. has not used this article in acute rheumatism; but in
chronic rheumatic pains, particularly in old people, he has de-
rived excellent effects from it. In dysmenorrhcea, or neuralgia
associated with uterine derangement at or subsequent to the
catamenial period, entire relief, followed by refreshing sleep, has
been obtained by the administration of the aconite.

In the diminished and sometimes abolished sensibility and
voluntary motion to which aconite gives rise, we find similarity
of effects to those produced by veratrum virideand gelseminum.

[Xorth American Medico- Chir. Rev.

Cannabis Indica Haschisch Indian Hemp; called also Gungha,
Bung, etc.

Dr. John Bell, of Derry, New Hampshire, has a paper in the
Boston Med. and Surg. Journal, April, 1857, on the effects of this
plant, chiefly in a psychical point of view. He describes the
manner in which he was affected when he put himself under its
influence. Room is not allowed us to give even an analytical
notice of his opinions and observations on this interesting theme,
and we must be content to note a few passages. Among these,
is one on the resemblance between a state of mind produced by
the Haschisch and that occurring in Mania a resemblance no-
ticed both by M. Moreau and Dr. Bell: "In both states there
is the same excitement and abruptness of manner, the same ra-
pidity and incoherence of thought, the same false convictions
and lesions of the affective faculties." "There is no error of
judgment, no delusion or lesion of the will or moral faculties,

N. 8. VOL. XIV. NO. X. 40

708 Cannabis Indica. [October,

which is seen in the former state, [Mania,] but what might take
its rise in the latter." Dr. Bell describes the series of mental
phenomena which were produced on himself by this substance:
" Amid all the strange vagaries of the Haschisch, the mind pre-
serves the power of taking cognizance of its condition, and to a
certain extent, of analyzing its operations. The memory of eve-
rything said and done is nearly perfect; but of the multitude of
thoughts, only those making a more than commonly distinct
impression are observed." He thinks that considerable light
might be thrown on insanity, and especially delusions, by watch-
ing and analyzing the effects of the Indian hemp, which we may
take as a picture of the mind when under another and more
enduring series of morbid impressions.

Speaking of its operation on the brain, in reference to the
psychical phenomena produced in consequenceT Dr. Bell thinks
that^ive grains is the smallest quantity from which any percepti-
ble effects are to be expected, and generally more will be re-
quired. This opinion coincides with our own experience of the
drug (the extract of Cannabis) when we have administered itfor
the alleviation of pain, as in neuralgia, and to procure sleep in
delirium tremens.

Dr. A. Bryant Clarke, of Holyoke, {Boston Med.' and Surg,
Journal, MayT 1857,) tells us, in reference to Dr. Bell's statement
of the dose of the Cannabis Indica required to produce the de-
sired effect, that a pill of the English extract, in the quantity of
two grains and a half, given to a maniacal patient, who had pre-
viously taken the medicine in two-grain doses, produced very-
marked effects. On visiting his patient, two or three hours after
she had taken the pill, Dr. Clarke found her sitting up, and
more rational and quiet than she had been for weeks: "The
attendant described her as apparently fainting, with respiration
slow and regular, a blue and dusky state of the skin, blood set-
tled under the finger nails, and said they had with difficulty kept
her alive." Dr. Clarke being incredulous of the effects attribu-
ted to the medicine, swallowed one of the pills, soon after a
hearty dinner. Within an hour he began to feel its peculiar
effect's, such as are so well described by Dr. Bell. Dr. Clarke's
left arm was paralyzed, the skin looked blue, and there was a
blueness under the finger nails, as though the blood were im-
perfectly arterialized ; the pulse was natural. The effect of the
Cannabis was at its height in about three, and passed off in about
five hours. The arm was in a powerless condition for half an
hour, but friction would partially restore it

Dr. Merret, of Detroit, in a short article on this subject, (Medi-
cal Independent, Sept. 1857,) describes the Cannabis as a deliri-
ant which produces on many of the native population of the
East, who use it freely, a most undesirable, in fact, a dangerous

1858.] Treatment of Trismus and Tetanus. 709

frame of mind. These evils are, however, fortunately counter-
balanced by the antispasmodic effect of the drug. Dr. Merret
speaks from a personal observation, during three years in a
military hospital at Calcutta, of its administration in tetanus. In
idiopathic cases it was most generally successful, and even in
traumatic cases it showed its superiority overall other remedies.
He mentions two cases of its successful use in England. Its re-
laxent effect has been proved to be an aid to taxis, in the reduc-
tion of hernia.

For further details of the effect of doses of different degrees of
strength, and the descriptions of the manner in which haschisch
affects different individuals, we would refer the reader to an
article in the '"National Review," copied into LittelVs Living
Age, Feb. 20th, 1858. [Ibid.

Treatment of Trismus and Tetanus. By Dr. Molxar, of Nim-
burg, Bohemia. (Translated from the Allgemeine Wiener
Medizinische Zeitung, by Dr. B. Joy Jeffers.

The uncertainty of most of the recommended means of treat-
ing tetanus, fortunately a disease of rare occurrence, makes it
the duty of every consciencious physician to remedy this defi-
ciency in therapeutics by relating any single case in which the
adopted plan of treatment was successful.

Ours was the case of a mason, Vincenz Holub, of Nimburg, a
robust man, previously healthy, aet. 45. Sept. 22nd, his left
fore-finger was so crushed by a stone of three hundred weight,
that amputation with a flap was necessary, close above the head
of the first phalanx. The wound was healing regularly, without
pain, and had perfectly granulated "rose-red," when the patient
began, on the 5th of October, to complain of painful tension and
contraction of the muscles of mastication, and of difficulty of
deglutition. In spite of the exhibition of opium and tartar
emetic, in one grain doses, baths, followed by the desired dia-
phoresis, and of the greatest care, yet by the 9th of October the
highest degree of tatanus was developed.

The patient had complete consciousness; pulse normal ; pu-
pils, in a moderately darkened room, strongly contracted; the
teeth firmly set together, and not separable, either actively or
passively. All the muscles of the neck and trunk, and the ex-
tensors of the extremities, were hard as a board. The stiffened
body was thrown into various positions by painful electric-like
shocks, both spontaneously and at the slightest touch. The pa-
tient was sleepless. The urine was drawn off by the catheter.
Fluids (milk, soup and water) which were poured in, through
an opening left by the extraction, several years previously, of

710 Beneficial Effects of Pepsine, [Octoberr

two upper incisors, were mostly regurgitated, the remainder
flowing down as through a pipe.

Opium, in the form of clysters, gave no relief, as also the oth-
er means generally recommended. Baths could not now be
used; and without much hope of success, I resolved, on October
16th, to employ chloroform. After the first inhalation of two
drachms, the patient was greatly relieved. His consciousness
did not exhibit the slightest disturbance. The painful contrac-
tions and rigidity were lessened, and he slept for two hours.

On the day following, three drachms of chloroform were used;
on the third day, four; and on the fourth day, six, without pro-
ducing any narcotism. But I noticed that on the third day of
treatment, the patient could separate his teeth three lines.

The chloroform was now suspended for one day, and then
again inhaled for five days in doses of three drachms per diem.
All appearances of tetanus and trismus gradually disappeared,
so that the patient could have been considered well by the 8th
of November. His strength speedily returned. In all, he had
used about four ounces of chloroform.

In view of this case, I have no hesitation in enrolling myself
with those physicians who consider chloroform in this disease
as a " Unicum." [Boston Med. and Surg. Journal.

Observations on the Beneficial Effects of Pepsine in the obstinate
Vomiting of Pregnancy. By Dr. L. Geos.

In a great majority of cases the vomiting of pregnancy may
safely be left to the influence of time; but there are some cases
in which females are scarcely able to retain in their digestive
system a sufficient amount of nourishment to support their ex-
istence, and are therefore reduced to the last degree of emacia-
tion. In some, also, the shocks occasioned by this obstinate
and repeated vomiting become the source of abortions, which
might have been prevented by moderating the activity of the
morbid phenomenon. A very remarkable case was related in
1856, by M. Tessier, Professor of Clinical Medicine at Lyons,
showing the immediately beneficial effects of a dose of pepsine
in a case of vomiting during pregnancy. In this case the symp-
toms resisted all the ordinary methods which were employed,
and the patient was unable to retain in her stomach any sub-
stance whatever. Under these circumstances, the patient was
brought to M. Tessier, who found her in the following condition :
The vomiting had continued for two months, and she was at the
end of the fourth month of her pregnancy ; she presented the
appearance of a skeleton, having the aspect and cough of a
phthisical subject; the pulse was 140, and M. Tessier thought
at first that the case was one of pulmonary tubercle. Finding

1858.] Introduction of the Catheter in Stricture. 711

that all treatment had been hitherto inefficacious, and that the
lady was fast actually dying of inanition, he was seriously med-
itating upon the propriety of inducing abortion as a means of
saving her life; but as a last resource, before operating, he de-
termined to employ pepsine. He accordingly prescribed one
gramme, to be divided into two doses, and taken every day in
a spoonful of broth. At the very first dose the broth was re-
tained, and from that moment the vomiting never returned.
On the third day the lady ate some chicken, and then some
beef-steak. The treatment was continued in the same manner
for three weeks, and at the end of that time the cure was com-
plete ; the emaciation was replaced by embonpoint, the fever and
the cough ceased with the vomiting, and at the end of the nine
months the lady was safely deliverd.

Dr. Gros then relates six other cases in which the pepsine was
employed with the same success, and he thinks himself warrant-
ed in concluding that pepsine undoubtedly produces good effects
in the vomiting which attends pregnancy. He explains the re-
sults by supposing that, although in the first instance the vomit-
ing is due only to the sympathy existing between the uterus
and the stomach, yet subsequently the stomach itself becomes
affected, as is proved by the fact that in the beginning of preg-
nancy the vomiting occurs only in the morning or the evening;
but in aggravated cases it supervenes every meal, and all ali-
mentary matters are rejected. In such cases, therefore, when
the stomach has taken on a morbid habit, and exhibits an alter-
ation of secretion, the pepsine seems to be really indicated ;
although in a merely sympathetic action between the uterus
and stomach it would be difficult to explain the efficacy of its
action. [Bui. Gen. de llierap., and Brit, and For. Med. Cliir. Rev.

On the Introduction of the Catheter in Stricture. By Dr. Slade,
of Boston.

I prefer that the patient should be in bed, that he should be
warmly covered, and that be should be particularly protected
against any sudden chill. A bougie is then to be selected, of a
size corresponding to the size of the stream passed, as nearly as
mav be, or to the presumed diameter of the constricted passage ;
this is to be carefully lubricated with lard, cold cream, cerate,
or some other equally tenacious substance, which is greatly to
be preferred to the olive oil so commonly in use. Thus prepar-
ed, the instrument is to be carried carefully down to the seat of
the stricture, and, if possible, pushed on into it. the entrance of
its extremity being at once known by the peculiar manner in
which it is grasped. After a few moments' delay, the bougie,

712 Introduction of the Catheter in Stricture. October,

in a great majority of cases, may pe pushed on into the bladder.
This, however, it must be borne in mind, is not always neces-
sary ; the mere presence of the instrument at the seat of the
obstruction is generally sufficient to overcome the spasmodic
action upon which the retention depends. The only difficulty
in carrying these delicate instruments down to the stricture, is
from their becoming entangled in the various lacunae, which, as
is well known, are greatly enlarged in this disease.

Mr. Henry Thompson, of London, has recently suggested a
method of protecting the mucous membrane from injury, and of
rendering the introduction of small instruments more easy, par-
ticularly in these very cases of narrow stricture, which on trial
will be found very useful. It consists in the simple method of
applying the oil to the urethra itself, and very freely, rather
than to the instrument. In order to effect this, he says, the
nozzle of a common glass syringe, containing from four to six
drachms of pure olive oil, should be introduced into the urethra
as far as it will go, the external meatus being at the same time
closed upon the nozzle by the forefinger and thumb of the left
hand, so that none can esoape. Gentle pressure being now
made upon the piston-rod, the oil gradually finds its way down
to the stricture ; and if this be very narrow, the urethra in front
of it slowly fills and becomes slightly distended ; but as the pis-
ton continues to descend, the oil will gradually pass through the
stricture and onward into the bladder, thoroughly lubricating
every part of the canal. At the moment the oil passes through
the stricture, the operator may sometimes distinctly perceive a
slight, but very complete, sensation communicated to the hand,
of resistance overcome, and partial collapse of the previously
distended urethra in front. The syringe is then to be removed,
the finger and thumb still commanding the meatus of the ure
thra so that no oil escapes. The smallest catheter may now be
introduced, and made to traverse the urethra at all events as
far as the stricture with \ery little or none of that difficulty
arising from the catching of its point against the walls of the
passage, so often experienced with very small instruments, and
which renders so much care necessary in their employment.

Temporary dilatation is, without doubt, the safest and surest
method of treating organic stricture. Although slow, at the
same time it can be easily managed, and can be suspended at
any moment, according as circumstances require, and, above all,
does not prevent the patient from pursuing his usual avocation ;
and for the early treatment of narrow irritable stricture, the use
of gum elastic or wax bougies is far preferable to metallic instru-
ments. I have seen patients who have suffered so much from
the passage of small metallic instruments, that they have nol
been willing to allow their farther use, but have made rapid

1858.] Strychnine in Sciatica. 713

progress under the employment of flexible instruments. When,
however, the dilatation has proceeded so far that a No. 5 or b'
bougie passes with ease, then these may be laid aside and metal-
ic instruments substituted. [ Virginia Med. Journal.

Strychnia in Sciatica.

Dr. 0. C. Gibbs, of Frewsburg, Chatauque county, Xew York,
{American Medical Monthly, September, 1857, relates an obstin-
ate case of sciatica which had resisted colchicum, ammouiated
tincture of guiacum, quinine and morphia, oil of turpentine,
tincture of cimicifuga, iodide of potassium, Dover's powder, blis-
ters over the great trochanter, and the endermic application of
morphia, cups over the same part, and calomel to touch slightly
the gums. For some time the patient, despairing of relief, had
been in the habit of using opium, which was given at the dis-
cretion of his wife, as the only means of assuaging the pain.
Dr. Gibbs describes his mode of using the strychnia, and its suc-
cess in the following terms:

"We now took two grains of strychnia, in crystals, and put
it with two ounces of water, slightly acidulating the water with
sulphuric acid. We also took four grains of podophyllin and
five of sulphate of morphine, rubbing them up with sugar, and
dividing them into twent}r powders. We ordered thirty drops
of the solution of strychnia, also one of the powders, to be taken
three times a day. The patient had no severe paroxysm of pain
after this, and within three weeks from the time of commencing
the strychnia, he went down the Alleghany and Ohio rivers as
a pilot on a lumber raft, and up to the present time he remains
free from a return of the affection."

The author has omitted to say when the successful treatment
was begun, and at what date he wrote the account of the case.
He took charge of his patient March 6th, 1857. We are left to
gather from the narrative, that the trial of the long list of reme-
dies above mentioned lasted about three or four weeks before
recourse was had to strychnia. Each dose of the solution of this
substance, as directed by Dr. Gibbs, was equivalent to the six-
teenth of a grain. \_Xorth American Medico- L'hir. Rtv.

Tobacco in Erysipelas.
Dr. John G. Stephenson, of Terre Haute, Indiana, desires to
call the attention of the profession M rn Lancet, May, 1867)
to the treatment of erysipelas, which has proved so beneficial in
his practice, that the use of it has become, with him, a matter of
routine. " The treatment is simply the covering of the inflamed
surface with wet tobacco leaves, (such as are to be had in any
cigar shop.) which are permitted to remain until much nausea is

The Influence of Water- Drinking upon the Metamorphosis of the
System. By Dr. Mosler.

Mosler contributes a valuable essay " On the Influence of
Water on the Metamorphosis of Matter,'' which has gained the
first prize from the Verein fur Gemeinschaftlkhe Arbeiten. The
author divides his researches into those made on children, those
on adult females, and those on adult males; in all of them he
examined the phenomena of metamorphosis a, when the inges-
ta and the manner of living were as usual; b. when the water
taken with the fluid articles of food was withdrawn ; c, when
various quantities of water were added to the amount of food.
The water employed was pure, containing in sixteen ounces only
2.774 grains of solid substances, and 1.1036 grain carbonic acid.
Abstinence from taking water led to the diminution of the secre-
tions and excretions, principally those from the kidneys. Al-
though the specific gravity of the urine became much increased,

714 The Influences of Water- Drinking, &c. [October,

produced." Dr. Stephenson, while he admits that the excessive
and distressing nausea produced by the internal use of tobacco
prevents its administration by the stomach, is willing to believe
in its power and safety when cautiously applied to a cutaneous
surface, as a remedy for local inflammation.

We must, however, be aware of difficulty, not to say impossi-
bility, of determining, after no matter how many trials, the
extent of surface to be covered, and of absorption produced by
this application of the tobacco, so as to procure the desired
amount of sedative effect and accompanying nausea. The dif-
ference between the internal and external use of tobacco is only
one degree; and in both instances there is uncertainty and risk
of alarming, if not fatal results. Hence the great caution always
practiced in the administration of this plant as a therapeutic
agent a caution which is especially called for in cases of ery-
sipelas in old subjects with broken-down constitutions and slight
powers of reaction.

In one of the cases related by Dr. Stephenson, the patient was
pregnant about five months. She soon got well under treat-
ment. This consisted in the use of calomel, followed by saline
purgatives, Dover's powder, sulphate of cinchona, and the local
use of tobacco. In another case of a person aged 17 years,
slightly chlorotic, in which tincture of the chloride of iron inter-
nally and tincture of iodine externally failed to prevent the
extension of the inflammation of the leg from above the ankle
to above the knee, the application of the wet tobacco leaves soon
produced extreme nausea and prostration, followed, after sever-
al other renewals of the same topical treatment, by a complete
removal of the inflammation. [Ibid.

1858.] Editorial 715

yet not only the quantity of water, but also the total amount of
solids excreted within a certain period was considerably lessen-
ed, and most so that of the urea, after which ranks the chloride
of sodium, the phosphoric and sulphuric acids. Lesser was the
decrease in the excretion through the skin and lungs. The stools
were more bound, the tongue rather dry, the appetite defective.
Increased ingestion of water caused an acceleration of the total
metamorphosis of matter, which in some instances manifested
itself more through the skin than through the other organs of
excretion ; in most cases, however, principally through increased
flow of urine containing an increased amount of solid constitu-
ents ; the increase was largest as regards urea, after which follow
chloride of sodium, phosphoric acid, and sulphuric acid. These
phenomena were accompanied by loss of weight of the body.
On the days succeeding the increased ingestion of water the ex-
cretions were diminished, and the body gained weight. [Archiv
d. Vereins. f. gemeinsch. Arbeiten, and Medico- Cliirurg. Rev.

EDITORIAL AND MISCELLANEOUS.

The Question of Poisonous Honey. So extensively related are the
interests of the Medical Profession, that there is no subject, however
remotely connected with any branch of it, which is not worthy of our
diligent attention. So liable to change are many of our apparently best
established tenets, that, at the present day, no one is surprised to find
some of the most settled and long accepted doctrines, brought into ques-
tion, and subjected to the most rigorous re-examination. In the brief
communication appearing under our original head, our respected corres-
pondent has entered into an examination of an opinion wThich, for many
years, has maintained its hold upon the convictions, not only of the peo-
ple, but which has been scarcely ever doubted, so far as our knowledge
extends, by the Profession. That honey sometimes contains elements
which are deleterious to man, many facts, not only of occasional daily
occurrence, will corroborate, but the long chain of testimony will be
found even reaching back, far into the dim records of ancient history,
connecting the familiar occurrences of to-day with the mythic annals of
the past. The first account we have of an accident from the eating of
poisonous honey is that given by Xenophon, of the effect produced upon
the Grecian soldiers during the celebrated retreat of the ten thousand
after the death of the younger Cyrus, which, though it did not operate
fatally, "gave those soldiers who ate of it in small quantities, the ap-
pearance of being intoxicated, and such as partook of it freely, the

716 Editorial [October,

appearance of being mad or about to die numbers lying on the ground
as if after a defeat."*

In more modern times, we have well authenticated accounts of the
injurious effects of certain specimens of honey. The author just quoted
states that he once knew a lady upon whom the eating of honey, or the
drinking of mead, acted like poison, and that he had heard of instances
of death from the same cause. That bees sometimes extract their honey
from poisonous plants, there can be no doubt, and the results are not
confined to individuals of a particular habit of constitution or idiosyncra-
sy. In the fifth volume of The American Philosophical Transactions,
will be found an account by Dr. Barton, of an extensive mortality which
was produced amongst those who had partaken of the honey collected
in the neighborhood of Philadelphia, in the autumn and winter of the
year 1790. " The attention of the American government was excited
by the general distress, a minute inquiry into the cause of the mortality
ensued, and it was satisfactorily ascertained that the honey was chiefly
collected from the Kalmia latifolia.v It is also said that a specimen of
poisonous honey, which continued to retain its deleterions properties for
a very long time, was sent from Trebizond, on the Black Sea, to the
Zoological Society of London, in the year 1834, by Keith E. Abbott, Esq.

We might collect from various sources facts which clearly prove the
occasionally noxious properties of honey, but these are certainly not
sufficiently numerous to interdict its use, either as an article of diet, or
as an occasional ingredient in pharmaceutical preparations, but at the
same time these facts will serve to assist the practitioner, in accounting
for any phenomena indicating poisoning, which may be observed, after
partaking of this kind of food. %

The argument, used by our correspondent, that the sagacity of the
bee will be any protection against the sometimes poisonous nature
of their honey, is by no means unanswerable. The instinct which
directs and governs the actions of insects is truly remarkable, and, per-
haps, in no race more conspicuously so than in the bee ; but it must be
remembered that this " mimic of the reasoning faculty" is an endowment
to animals, which has direct reference, so far as we can see, to their own
preservation and to the propagation of their own species, and does not
refer in the least, except incidentally, to the welfare of man. The in-
stinct of the bee may, in most instances, preserve him and his race from
the toxic effects of the deleterious properties of flowers, and yet what
has served as his nutriment, may be for man, a most destructive poison.
The question, perhaps, cannot be definitely settled without further in-
vestigation, as to the frequency with which we are to find poisonous

* See Kirby <fe Spence.

1858.] Editorial 717

elements in honey, but so far as we have examined the subject, the
weight of historical record is greatly in favor of the opinion, that this de-
lightful natural product has been often, the medium by which the most
deleterious poisons have been introduced into the system. The ques-
tion at the present time is, however, of somewhat less importance to the
physician and pharmaceutist than formerly, when most of those prepa-
rations in which sugar is now used, honey was an important adjuvant.
In its relation to honey as an article of food, the question still retains
its pristine interest, and should our correspondent's communication in-
cite useful inquiry upon the subject, in this important relation, we feel
assured that he will be much gratified by the result, whether it corrobo-
rates or contradicts his own present convictions.

Vaccination for Hooping Cough. In presenting the following in-
teresting correspondence, we regret that time has not been allowed* to
make such references to the records, as doubtless there are, as would tend
to settle the question in dispute. The journals some years back, according
to our recollection, contained numerous references to the subject, but
we were not aware, till seeing the letter of Dr. Parkhurst, that the expe-
riment had been tried at so early a date after the discovery of Jenner.

Decatur, Ga., August 24th, 1858.
Editors of Southern Medical and Surgical Journal :

Gentlemen, The question, " Who originated the practice of vaccin-
ation for abating the symptoms of Hooping-cough ?" is sometimes asked,
and as it has been claimed to be of very recent origin, I beg to give you
the copy of a letter which I received from an old practitioner of medi-
cine. (

Petersham, Mass., 17th July, 1857.

Dear Sir, I received yours of the 6th instant: " You ask me what
success I have in treating Hooping-cough by vaccination with kine-pox
matter, and with whom did the idea originate ?" Forty -two years ago,
this autumn, I moved to Petersham, and hooping-cough was prevalent
at that time in this place. Dr. Jos. H. Flint, late of Springfield, was
my predecessor. He was using at that time vaccine virus as a remedy
in that complaint.

I have been in practice over fifty years, and whether it was in use at
the time I commenced the practice, I am not confident, but I have the
impression that it was.

Who originated the practice is beyond my power to tell. If vou wish
anything more definite, you can obtain it from Dr. James Jackson of
Boston, an aged physician, and a man of great medical learning and

718 Editorial [October,

long experience having been a Professor in the Medical College of
Boston for many years.

You ask me, u What success I have had in the use of this remedy in
the Hooping-cough ?" It is my opinion, when used early in this dis-
ease, it mitigates the severity of the complaint, and many times, seems
to cut short its career. Truly, yours,

WILLIAM PARKHURST.

If this is of the least importance, you are at liberty to use the facts,
or the letter, as you choose. Respectfully,

LEVI WILLARD.

Commendable to the Profession. The Newbern (N. C) Gazette,
a high-toned and spirited secular paper, gives the following rebuke to
everything which savours of Quackery: "The Howard Association is
informed that the price of admitting an advertisement of the length of
the size it sends us, would be about $40. But we would not insert it
under any consideration : Patent medicines, lottery, humbug and obscene
advertisements, will never appear in the columns of this paper."

We have never exactly understood what connection that highly be-
nevolent body, the Howard Association, constituted as it is, by the noblest,
the most self-sacrificing and the most intelligent of our countrymen, may
have with the advertisements found everywhere in the secular press, but
certain it is, that if they do not indicate a felonious misappropriation of
clarum et venerabile nomen, it is a most horrible prostitution of the spirit
of that beneficent Association.

The Health of Augusta. While we have to regret the prevalence
of Yellow Fever in our sister cities Charleston, Savannah, Mobile, and
New-Orleans we can but feel grateful for the unexampled health of
our own city. " The official report," says the Chronicle and Sentinel of
this city, " of the number of deaths in Charleston for the week, ending
Saturday 18th (inst), shows a total of 171 128 of which were from
Yellow Fever, an increase of 25 over the previous week. Of the deaths
by Yellow Fever, 99 were white adults, 23 white children, 3 coloured
adults, and 3 coloured children."

This almost entire exemption of the coloured population is indeed re-
markable, but yet not without precedent: in 1839, during the epidemic
in Augusta, very few negroes died of the disease, more mulattoes and a
large number of whites. So complete was the exemption of negroes,
that many of them considered the disease intended as a special affliction
to the whites.

1858.] Editorial 719

Our own city still maintains its character for health, and there is every
indication of the happy condition continuing. Some apprehension was
felt by a few citizens when the Yellow Fever appeared in Savannah, but
this was the only foundation for the uneasiness ; every other circum-
stance is opposed to the disease appearing here. The very cleanly
condition of our city, the prevalence of western winds, and the refresh-
ing and wholesome showers during last month, are all conditions which
did not obtain, immediately preceding either of the two epidemics here-
tofore in Augusta. In 1839, turnips were planted in the dry bed of the
Savannah River, and in 1854, the corn crops in our immediate neigh-
borhood were destroyed by drought.

We fervently hope, that an early frost may drive the destroyer from
all those cities, now mourning under his sway.

"Honey Catches more Flies than Vinegar." Let us Try Honey.
Notwithstanding the alleged noxious properties of honey, we have
concluded to initiate a series of experiments which will be calculated to
test its properties in a very important relation. Upon the result, we
are almost willing to stake our reputation for good judgment, at least, in
matters of this sort.

Did our readers have the opportunity we enjoy, of perusing the many
"calls upon subscribers," "gentle hints," " plain talks," <fec, in which
courteous but urgent duns are presented to the subscribers of many of
our exchanges, they would certainly come to one of two conclusions ;
either the readers of the Southern Medical and Surgical Journal are an
unusually prompt corps of subscribers, or the Editors are very remiss in
their calls for payment, as compared with those of other journals. The
former of these, we are happy to say, comes nearer the truth ; we have
indeed, as a general thing, an excellent list of subscribers, who by their
punctuality have afforded us but little excuse for showing our talents in
the financial department of the Journal office, and while we have fre-
quently had occasion to thank our patrons for our handsome list of
monthly payments, we have not once, taken occasion to make any call
editorially upon delinquents.

The Southern Medical and Surgical Journal has been, for years, a self-
supporting periodical, notwithstanding the heavy expense attending its
publication, and our liberal publisher, Mr. J. Morris, at the opening of
the present volume, has considerably enlarged the work, trusting confi-
dently to the high appreciation of our readers, and hoping that by their
punctuality he would be saved from any embarrassment in carrying out
the liberal arrangements he had contemplated for their benefit. These
expectations have not been always met as fully as they should have

720 Editorial [October,

been ; but on looking over the list of those in arrears, we are convinced
for many of them are our personal friends and familiar acquaintances
that a simple statement of their dues by us, reminding them that the
payment is now important, will be responded to promptly by them all.

Our publisher has considerable weekly payments to meet, and de-
pends mainly upon receipts of money from subscribers for their liquida-
tion. The small sum of three or six dollars is but little to each individ-
ual subscriber, but the delay in receiving it, in the aggregate, frequently
causes him much inconvenience. We know so well the business habits
of that species of the genus homo termed " Doctor," that we can well
account for any ordinary amount of delay attending their payments,
and yet we know too, that of all men, they are the most liberal, just,
and kind hearted all three of these admirable attributes must now be
put in requisition, for the money is in real demand. In closing this ra-
ther unusual editorial, we would say to each reader; "Before you leave
the chair, enclose your Three, or your Six, or your Fifteen dollars in an
envelope, with a short line, even in pencil-mark, with your name and
address, and direct to J. Morris, Publisher, Augusta, Ga. Your name
will then stand clear and unblemished upon our subscription list, and
what is alwa}-s gratifying to us as editors, we shall feel no fear of losing
an intelligent and appreciating reader. " Losing a reader," refers to a
certain surgical operation which Mr. Morris sometimes threatens to per-
form, which always proves fatal to the relation which we, as Editors,
sustain to our subscribers. But we are baiting now with honey and do
not intend that it shall even smell of vinegar. We wait in anxious but
confident expectation the result of our entomological experiment, which
perhaps would be better denominated, " An experimental inquiry into
the relative value of Honey and Vinegar in the apprehension of Flies.

Navy and Army Appointments. We are gratified to find that one
of the two out of twenty-seven applicants, receiving the recommendation
of the Medical Board for army appointments, was a Georgian :

Naval Appointments. The Board of Naval Surgeons recently con-
vened in this city, consisted of Surgeons Greene, President; Rusehen-
berger and Foltz, members; and Passed Assistant Surgeon Howell,
Recorder. Twenty-seven candidates presented themselves for examina-
tion, of whom the lollowing gentlemen were selected as qualified for the
post of Assistant Surgeons in the United States Navy : Drs. Bertolette,
of Pa. ; Leach, of N. H. ; Christian, of Va. ; Megee, of Pa. ; Gibbs, of N.
J. ; Burnett, of Pa. ; and King, of Pa.

Army Appointments. The Army Medical Board met at Richmond,
in April last, and selected but two of twenty-seven candidates who were
examined. Drs. J. H. Bill, of Pa., and J. H. Berrien, of Ga., were the
successful candidates. \N. Am. Med. Chir. Review.

1858.] Miscellaneous. 721

Professional Dignity. The following independence of bearing to-
wards those in high places, might well be expected from the physician,
who could say to his King's messenger "Tell his Majesty to wait :"

Abemethfs Figs. When Abernethy was canvassing for the office of
surgeon to St. Bartholomew's Hospital, he called upon a rich grocer.
The great man, addressing him, said: " I suppose, sir, you want my
vote and interest at this momentous epoch of your life Y* ,k Xo, I don't,
(said Abernethy.) I want a pennyworth of figs; come, look sharp and
wrap them up I want to be off."

Laceration of the Ferinceum, occurring during Labor in a Girl thir-
teen yiars old ; Conception having taken place at twelve years and three
months. Dr. H. Bigelow reported the case. The patient was a farm-
er's daughter, who was delivered of a child one year ago, being then 13
years and 11 days old. She was small, rather slender, and not particu-
larly developed. The rent extended nearly to the top of the sphincter,
from three-fourths of an inch to an inch up the anus, so that there was
a constant tendency to the passage of faeces, particularly when there
was looseness of the bowels. The skin had formed over the laceration
wrhen Dr. B. sa^v it, and he advised the operation to be deferred; the
patient recovered without it. She is now perfectly well, the upper part
of the sphincter having assumed the function of the whole muscle. The
child was of average size and perfectly healthy. [Boston Med. & S. Jl.

New Haemostatic. After prolonged experience, M. Lami strongly re-
commends the following haemostatic: R Decot. rhatanise, 300 parts;
alum, 60 parts. If given internally, 70 parts of syrup are to be added.
Internally, 10 drachms may be taken three times daily ; while for exter-
nal use it may be employed as injection or lotion. Boston Med. Jl.

Sir Benjamin Brodie. The Council of the Royal Society, London,
have recommended Sir Benjamin Brodie to the Fellows as president of
that most scientific body. As it is usual for those who are selected by
the Council to be elected, Sir Benjamin will, in all probability be placed
at the head of a society of which he has always been a distinguished
member. Not only is he the leading and most eminent surgeon of that
great metropolis, but he also holds a high rank as a philosopher and a
man of science, so that the Fellows of the society may feel proud of his
election. [JV. Amer. Med. Chir. Review.

Sound Common Sense and Quackery. There are few more danger-
ous men in society than he who prides himself upon his sound common
sense. Every one has met this man, and knows his characteristics well.
He has no book-learning, and is inclined to be thankful that he has not;
he is none of your recondite book-worms, full of cranks and nonsense;
he is a thoroughly common-sense man. And so, without any special
knowledge on any subject, he thinks himself qualified to decide upon all.
He makes his own will in a plain and straightforward way, which in-
volves his heirs in an endless chancery suit. He does everything in his
own private and sensible fashion, and being always " open to conviction,"

722 Miscellaneous.

ten to one but lie falls a victim to the first plausible quack whom he
meets. He eschews the mysteries of medicine, and laughs at the care-
fully-wrought theories of the treatment of disease. He trusts to the light
of common sense, and adventures by its aid to grope obscurely amongst
the complicated ropes and pulleys by which man's frame is guided, and
to tamper with the delicate machinery, with about as much success as
an ignorant land-lubber might have in adventuring to handle a ship's
ropes in a storm, reefing when he should furl, and hoisting sail when he
should scud with bare poles. Common-sense men delight in acting as
their own physician : and this to be sure, they have a right to do ; and,
if they choose, to poison themselves with lobelia, salivate themselves
with "vegetable" mercury, or line their intestines with antiseptic char-
coal. We should be very little inclined to dispute this, their undoubted
privilege. But they are commonly unwilling to confine the benefits of
their common sense to their own proper person, and in their anxiety to
extend them to other less sensible fellows they bring themselves within
the range of sharp criticism. It is thus that we find ourselves called upon
to concur in a vigorous rebuke inflicted by an inquest jury at Woolwich,
upon a Mr. Clark, a dissenting minister. This gentleman, considering
hydropathy to be based upon reasonable principles, and to be a more
44 sensible system" of medication than that recommended by the great
men who have devoted their lives to the study of medicine, proceeded
to apply his principles to the friendly treatment of an unfortunate man,
afflicted with pneumonia, pleurisy, and pericarditis. He immersed his
victim in cold water, and swathed him in wet bandages a^ the time that
he was undergoing treatment by calomel. Gross deception was prac-
ticed upon the qualified attendant. The patient sank rapidly, and Mr.
Clark, finding things look badly for him, beat a hasty but untimely re-
treat. It was too late to save the patient if at any time he could have
been saved. The jury included in the blame, Mr. Clark and the relatives ;
they greatly censured the blind assurance which could presume to med-
dle in a matter of life and death, the dangerous ignorance which could
so mischievously blunder, and the unworthy deception which could
counsel concealment from the attending surgeon. It is hard to say how
many lives are snuffed out by sheer ignorance and stupidity. We
chronicle but a tithe, and yet our gathering is abundant. Our sheaves
overflow with fulness, and the sprouting crop of quackery almost defies
the edge of the scythe. [London Loncet.

Death of Foreign eminent Medical Men. One of the most distinguish-
ed surgeons whom Ireland has produced, Sir Philip Crampton, lately
died in Dublin in the 82d year of his age. We also notice, in the Eng-
lish journals, the death of Dr. John Snow, an eminent physician of
London, well known for his researches on chloroform and other anaes-
thetics. Dr. Snow died from an attack of apoplexy, June 16th. [Boston
Med. and Surg. Journal.

SOUTHERN

MEDICAL AND STOGICAL JOUMAL.

(NEW SERIES.)

Vol. XIV.] AUGUSTA, GEORGIA, NOVEMBER, 1858. [No. 11.

ORIGINAL AND ECLECTIC.

ARTICLE XXV.

Observations on Malarial Fever. By Joseph Joxes, A.M., M.D.,
Professor of Chemistry and Pharmacy in the Medical College
of Georgia, Augusta.

[Continued from page 676 of October No. 1858.J

Case XXXII. Irish laborer, age 23 : has been in America
eighteen years the last three years has resided in Savannah.
This summer has been "running" on a coasting schooner, be-
tween Savannah and the rice plantations on the Ogeechee and
Savannah rivers.

July 17th, 12 o'clock M. Has entered the hospital with
oedema of the abdomen and lower extremities. Says that he
has had fever for three weeks, and that "it was broken by sul-
phate of quinia and five Quack pills.

Complains of debility and great irregularity in the action of
his bowels. Has had no stool for three days. Liver and kid-
neys appear to be torpid ; tongue clean; respiration 20; pulse
61. Under the action of alteratives and tonics, the action of the
kidneys, liver and bowels was restored, the oedema disappeared,
his appetite and strength returned, and he left the hospital July
30th.

August 18th. Has returned. After leaving the hospital,
commenced work in a brick yard, situated on theThunderboldt
road, in alow, damp, malarious district. The operatives at this
brick -yard have always suffered greatly with malarial fever.

His skin is now covered with an eruption, resembling the

severest form of lichen agrius. This eruption is thick upon his

jface, neck and chest. In these regions, and especially upon the

face, the papulae are very numerous prominent of a vivid red

\ color, and in many places closely aggregated into large clusters,

y.s. vol. xrv. no. xl 41

724 Jones, on Malarial Fever. [November,

of irregular form and size. Numerous vesicles and pustules,
containing sero-purulent fluid, are mingled with the papulae.
From the clusters of papulae, vesicles and pustules, an ichorous
or sero-purulent fluid issues which desiccates into yellow crusts.
In some places, from the thickening of the skin, the density of
the crust, and the depth of the fissures, the disease might be mis-
taken for psoriasis. On the legs the eruption is much thinner
and resembles lichen tropicus (prickly-heat). The vesicles and
pustules are so large and numerous that, across the ward, the
eruption resembles small-pox. Pulse 100; skin hotter than
normal.

$. Bitartrate of potassa, H ; Water, flxvi. Mix. To be
taken during the 24 hours. 3. Tepid salt-water bath.

August 19th. Pulse 100; tongue red at tip, and coated with
yellow fur; skin normal in temperature. Complains of great
weakness, dull pain in his head, and bad taste in the mouth.
Bowels torpid, have not been moved for two days.

#. Calomel, grs. x., followed with castor oil in four hours.

August 20th. The nurse states that, last night he appeared
to be out of his head. Respiration labored ; pulse 120, weak.
The acceleration of the pulse appears to be due, in part, to the
fact that he has just returned from the water-closet, at the oppo-
site end of the ward. Appears to be completely exhausted by
the effort, and complains of great weakness.

Ifr. Sulphate of quinia, grs. xv. ; Infusion of Virginia snake-
joot, fSxvi. Mix. Tablespoonful every three hours. Continue
the bitartrate of potassa.

August 21st. Complains of weakness. Pulse 88; tongue
much cleaner, very slightly coated with yellowish fur, tip and
sides of tongue redder than normal. Eruption appears to be
drying up in many places. Has a peculiar, disagreeable smellr
which was evident when he first entered the hospital on the 18th
inst., and was not dissipated by the salt-water bath.

#. Citrate of potassa, 3j.; Water, f^xij. Administer a wine-
glassful every three hours. Discontinue the bitartrate of potassa.
Continue the sulphate of quinia and infusion of Virginia snake-
root.

August 28th. Appears to be improving. The eruption is.
fast drying up and disappearing. The pustules are covered with
dried scales. Notwithstanding his apparent improvement, he is
very weak and low spirited. During his sickness there has been
an unusual depression and dullness in the action of his intellect.

$. Iodide pf potassium, grs. v.r three times a day.

$. Officinal infusion of quassia excelsa. f xvi. ; carbonate of
soda, 3j, Mix. Win eglassful three times a day.

$. Iodide of potassium, grs. v., three times a day.

August 30th, This morning, before taking his breakfast, was-

1858.] Jones, on Malarial Fever. 725

suddenly seized with a strong convulsion, which lasted about
ten minutes, and was succeeded by stupor. Now, four hours
after the convulsion, cannot be aroused by the loudest interro-
gations, or by violent shaking. Skin moist. The perspiration
stands in large beads upon his forehead. Pulse 80.

$. Four cui-cups to back of neck, mustards to extremities,
and blisters to calves of legs. Castor oil, f 3 j.

August 31st. Had another convulsion at 10 o'clock P. M.
last night, after which his left leg appeared to be paralyzed.
His left leg and foot continued to tremble from the time of the
convulsion, during the night, up to the present time. The left
arm is drawn up across the breast, and appears to be paralyzed.
It requires considerable force to straighten it, and when released
it flies back to its former position, like a steel spring. The left
leg also, in like manner, returns when removed from its posi-
tion.

The oil operated three times. Tongue moist and clean ; pulse
96. He is stupid, and it requires loud talking to arouse him,
and then he replies only by a low grunt. Although exceeding-
ly stupid his intellect is not entirely gone, for he put out his
tongue, after several requests in a loud voice. After having
protruded his tongue, he retained it in this posture, notwith-
standing loud requests to the contrary. When pressed upon
the epigasrtic region, he cries out. Pressure here appears to give
him great pain.

^. Apply blister to back of neck, and 4 cut cups over epigas-
tric region. Calomel, gr. i. every three hours.

Sept. 1st. This patient died this morning at 5J o'clock A. M.

(5). Autopsy five hours after death.

Exterior. Body much emaciated, complexion normal, erup-
tion quite dry, and the scales commencing to fall off.

Head. When the scull-cap was removed, about Ovj. of
blood flowed from the base of the brain. Dura-mater normal in
appearance. Arachnoid membrane slightly pearl-colored, opa-
lescent in several places. Blood-vessels of pia-mater, especially
at the base of the brain, filled with blood. Much blood, and
bloody serum was effused between the dura-mater and arachnoid
membrane. Cerebellum and pons-varolii, of a bloody red color
upon the exterior. The ventricles of the brain contained an
unusual amount of serum. Structure of the brain appeared to
be softer than normal, and the blood-vessels were filled with
blood, and distinct. Blood-vessels of meclulla-oblongata and su-
perior portion of spinal cord filled and distended with blood.
Much bloody serum was effused around the spinal cord. No
clots were found in the blood and serum effused upon the brain.
Weight of brain , grs. 21,655 equals lbs. 3, ozs. l.

726 Jones, on Malarial Fever. [November,

Chest. Lungs normal. Heart normal. Both ventricles con-
tained light yellow clots, which appear to have been formed
some time before death. Weight of heart, grs. 5031 equals
ozs. ll|.

Abdomen. Liver, color darker than normal. When cut, the
color was dark reddish- brown ; when squeezed, no bile could
be seen issuing from the hepatic ducts; when the cut surface
was exposed to the atmosphere its color became redder and
brighter, and the venous blood, flowing from the veins of the
liver, assumed the arterial hue upon the surface after exposure
to the oxygen of the atmosphere. The blood-corpuscles of the
blood of the liver presented, under the microscope, a normal ap-
pearance. Cells of the liver appeared normal they were a little
paler than usual. The oil globules were large, and in many
parts of the liver appeared to be as abundant, if not more abund-
ant, than in health. Trommers and Moor's test showed the pre-
sence of grape sugar in the liver. The process of Bernard gave
an abundant floculent deposit of animal starch. When the de-
posit, precipitated from the decoction of liver, by alcohol, was
treated with tincture of iodine, the nitrogenized matters were
colored (under the microscope) of a yellowish-red; whilst the
animal starch was changed to a beautiful blue ar.d purple color.
Weight of liver, grs. 36,312 equals lbs. 5, ozs. 3.

Spleen. Much enlarged and softened when pressed between
the fingers, feels as if the tissues were giving way. Color, light
slate, not so dark as malarial spleens generally, but resembling
them in the character of the color and the softening of the fibrous
frame- work. The anterior surface of the capsule of the spleen
was attached by coagulable Ivmph to the peritoneum, thickened
and of a white color, from the effusion of coagulable lvmph.
Pulp of spleen, of a purplish and reddish-brown color. After
exposure to the atmosphere, the pulp of the spleen upon its sur
face, assumed a bright arterial hue. Under the microscope, the
blood of the spleen presented the normal appearance the dark,
granular masses were almost entirely absent. Weight of spleen,
grs. 12J687 equals lbs. 1, ozs. 13.

Pancreas. Normal in size and appearance. Weight of pan-
creas, grs. 1,431 eqrjals ozs. 3}.

Kidneys. Enlarged, and greatly engorged with blood.
Weight of kidneys, grs. 7,218 equals lbs. 1, oz. J.

Alimentary Canal. Stomach. Blood-vessels upon the exterior
filled with black blood. Internal mucous membrane generally
of a reddish and pinkish color, and in many spots, where the
congestion was much greater, the color was much deeper. Brun-
ner's glands, in the duodenum, and Lieberkuhn's follicles, in the
pyloric extremity of the stomach, and in the pylorous and duo-
denum, appeared to be enlarged, and gave to the mucous mem-
brane a mammillated appearance.

1858.] JONES, on Malarial Fever. 727

Small Intestines. Mucous membrane of a reddish color, with
blood-vessels tilled with blood, especially at the superior portion.
The glandsof Peyer, in the interior poition ofthe iutestinep, were
distinct, but pale, and without any evidence of congestion. The
solitary glands of the inferior portion ofthe ileum, especially in
the region of the ileocecal valve, were enlarged. Solitary
glands in the superior portion of the colon, also enlarged. Mu-
cous membrane ofthe stomach and intestines was cjl<n\d yellow
by the bile. The small intestines contained much offensive gas,
tenaceous mucous, and fecal matters, colored yellow by the bile.
The colon was distended with offensive gas.

It is evident from this autopsy, that the effusion of blood upon
the brain was the cause of the death of this patient; fur the
eruption was fast disappearing the liver had almost regained
its normal hue, its blood possessed the power of changing, upon
exposure to the atmosphere, to the arterial color the elabora-
tion of the bile, animal starch and grape sugar, was performed
in a normal manner.

The spleen appeared to be fast recovering from the effects of
malarial iever. Although softened and enlarged, still its pulp
had regained the power of changing when exposed to the at-
mosphere, to the arterial hue, and the blood corpuscles appeared,
under the microscope, to be normal in form and color. The
effusion of blood upon the brain, and of serum into the ventri-
cles, and the softening of its structures, appear to have been the
results ol alterations of the nervous elements, capillaries and
blood.

Were these the results ofthe action of the malarial poison ?

The following cases have an interesting bearing upon this
question :

Case XXXIII. House painter native of Xew York: red
hair, blue eyes, florid complexion ; height 5 feet 9 inches; a^e
30 years; weight, in health, 160 lbs.

October 20th. Has entered the hospital, with a note from his
attending physician, stating that he had an attack of malarial
fever three weeks ago. This yielded, in the course of one week,
to the action of sulphate of quinia. Since that time, has re-
mained in a very feeble condition.

Lips, tongue, gums and complexion, pale, anaemic. He ap-
pears to be suffering from an impoverished condition of the
blood.

He was placed upon iron and tonics, and appeared to be do-
ng well, when, upon the night ofthe 22nd in.st., he was seized
with convulsions. Had iifteen successive convulsions in the
iourse of three hours, which left him in an insensible condi-
tion.

728 Jones, on Malarial Fever. [November,

Died comatose, seven hours after the termination of the convul-
sions.

(6). Autopsy five houks after death.

Exterior. Complexion pale, anaemic. Did not appear to have
lost a great amount of flesh.

Head. Not examined.

Chest. Lungs pale, anaemic. Structures appeared to be nor-
mal. Heart normal.

Abdominal Cavity. Liver. Upon a general view, it was of a
light slate color, with purplish and brownish reflections. Upon
nearer inspection, it presented a mottled appearance many of
the lobules presented the yellow color of cirrhosis. The cut sur-
face presented, upon a general view, alight bronze and purplish
yellow color. Upon close inspection, the yellow lobules were
distinctly visible. Structure of liver unusually firm it required
great force to tear it: it was enlarged. The yellow color of
many of the lobules, and the large admixture of dense fibrous
tissue, proves that this liver was in a cirrhosed condition previ-
ously to the attack of malarial fever. The yellow color of cir-
rhosis was masked very much by the characteristic effects of the
malarial poison. Bile, of a brownish-yellow color, in mass, and
of a gamboge-yellow color, in thin layers. It was tenaceous,
like mucus; in fact, it resembled closeiy colored mucus.

Specific gravity of bile 1022'5.

Spleen. Enlarged, and softer than normal, but much harder
than usual in the active stages of malarial fever. The cut sur-
face presented a compact, dark brown, almost black appearance.
Numerous small white bodies, about the size of a millet seed,
were found scattered through the pulp of the spleen. I have
never before seen the splenic corpuscles so numerous, large and
distinct. The exterior of the spleen was of a slate color. The
compact nature of the pulp of this organ shows that it was re-
covering from the effects of the malarial fever.

Kidneys. Normal.

Alimentary Canal. Stomach. Small and large intestines pre-
sented a healthy appearance.

The cirrhosed condition of the liver pointed to the previous
habits of this man. Although the malarial fever apparently
yielded to treatment, still its effects, combined with those of in-
temperance, produced a fatal issue.

Case XXXIV. Irish laborer, age 40 : height 5 feet 10 inch-
es; dark brown hair, brown eyes, dark complexion. In health,
weighs 200 lbs.; at the present time, his weight is not more
than 100 lbs.

August 13th. Has entered the hospital in an exceedingly
feeble condition says that he has had a severe attack of fever,

1858.] Jones, on Malarial Fever. 729

complicated with bilious diarrhoea. Appears to have been he-
roically medicated, and at the same time neglected during his
sickness. He is severely salivated, and his mouth, tongue and
fauces are covered with small ulcers. Xeglected sinapisms and
blisters have produced large ulcers upon the epigastric region
and upon the thighs and legs. The surface of the body has nu-
merous boils and ulcers, and has a disagreeable nauseous smell.
Complexion sallow anaemic. Says that he is "very weak, and
completely worn out with pain and loss of sleep."

Tonics and opiates were administered, and appropriate reme-
dies applied to the mouth and ulcers upon the skin.

August 22nd. Improves very slowly. Mouth still sore, and
the ulcers show no disposition to heal.

Examination of Blood No. YIL Blood coagulated slowly.
In the specific gravity bottle the colored corpuscles settled to the
bottom, leaving above a clear, transparent, yellow clot. In a
small shallow porcelain capsule the superior central portions of
the clot appeared transparent for several lines in depth.

A portion of blood was set aside in a glass bottle. In twelve
hours the clot commenced to disintegrate and liberate its colored
blood-corpuscles, and in twenty-four hours the blood gave forth
a putrid smell, and the serum was filled with the liberated co-
lored, corpuscles, presenting the appearance of blood.

A specimen of blood drawn at the same time from a patient
who had recovered from an attack of intermittent fever three
weeks before, was placed in the same room, in a similar bottle,
by the side of this specimen. The clot, serum and odor of this,
remained unaltered for fifty hours.

Specific gravity of blood 10424. Serum of a golden yellow
color.

Water

In 1000 parts of Blood, 839-589

u " " "Serum, 912779

<1) " " " Liq. Sang., 909-839

(2) " " " u " 879-S13

Solid Matters

In 1000 parts of Blood, 160-411

u u "Serum, 87-221

(1) " "Liq.Saug., 90-169

(2) " " " " " 120-187

Solid Matters in Serum of 1000 parts of Blood, 80-227.

Fixed Saline Constituents,

In 1000 parts of Blood, 7*500

" " Serum, 4-056

(1) " " Liquor Sanguinis, 4-066

(2) u a " 5-405

" " Solid Matters of Blood, 46-754

" " " " Serum, 46-387

" " " " " Blood Corpuscles, - - - 51-046

" " Moist Blood Corpuscles, 12-181

In Blood Corpuscles of 1000 parts of Blood, - . - 3-770

u Serum of 1000 parts of Blood, 3-730

Liquor Sanguinis, - 690-064

730 J ones, on Malarial Fever. [November,

1000 Parts of Blood Contained,
Water, 839-589

D,iedB.ood Corpuscles, "*" f85Sd "^ '- WW

Fibrin, 2.710

Albumen, Extractive and Coloring ) Organic Matters, - 76-88*7

Matters, - - 80-227 j Mineral " - 3-730

1000 Parts of Blood Contained,

Water, - - - 232-452

Moist Blood Corpuscles, 309.936 J- Organic Matters, - - 73-655

Mineral " 3-770

Water, - - - 607-124

Organic Matters, - - 76-387

'Mineral " - - 3-730

Fibrin, - - 2-710

1000 Parts of Moist Blood Corpuscles Contained,

Water, 750-224

Organic Matters, - - 237-645

Mineral Matters, - 12-131

(1) 1000 Parts of Liquor Sanguinis Contained,

Water, 909-839

Organic Matters, 83*075

Mineral Matters, 4-066

Fibrin, - 2-948

(2) 1000 Parts of Liquor Sanguinis Contained,

Water, 879813

Organic Matters, 110 695

Mineral Matters, 5*405

Fibrin, 3'927

August 26th. Left arm is swollen, and painful to the touch.
Ulcers upon the surface of the body appear slightly improved.
Still Ytry weak. Disagreeable odor continues.

$. Apply cold-water dressing to arm. Infusion of wild-
chery bark, wineglassful three times a day. Huxham's tincture
of bark, tablespoon ful three times a day.

Sept. 3rd, 12 o'clock M. Lies in a stupor. Has taken a sud-
den change for the worse. During the last week, has been able
to dress himself, and sit by his bed. Cannot now be aroused by
hallooing or shaking. This morning passed his urine and fe-
ces in bed.

The whole of the left arm, from the shoulder to the tip of the
fingers, is greatly swollen. Pulse 140; respiration 28. Tem-
perature of hand', 9dt5 F.

$. Administer stimulants freely, in conjunction with the
tincture of bark.

3 o'clock P. M, Lies with Ids mouth and eyes open, and ap-

1858.] Jones, on Malarial Fever. 731

pears to be insensible. Skin in a profuse perspiration, which
has saturated his shirt and the surrounding bed-clothes. Pulse
128; respiration 33. Temperature of hand, 101 F.

Sept. -ith, 12 o'clock M. Lies in a stupor, with his mouth
open.; teeth coated with sordes; passes his urine and feces in
bed. The odor from his body is nauseating and exceedingly
disagreeable. Surface of skin covered with a clammy sweat,
which resembles bloody serum. This sweat stains his shirt and
the bed-clothes, just as bloody serum would do. Pulse 106; res-
piration 26. Temperature of atmosphere, 81 F. ; temperature
of hand, 100.

Sept. 5th, 10 o'clock A. M. Lies in a stupor, with mouth and
eyes open. Every tendon and muscle of his body is twitching
and jumping violently. Kespiration 42, labored, thoracic, spas-
modic, like that of a irftin during a severe chill. The muscles of
the thorax and abdomen shake, and twitch, and jump violently,
as in a severe chill. At every inspiration and expiration he
emits a sound, like the hoarse bark of a thirsty and starved dog.
The muscles of the face contract and relax, and contort in every
possible manner, making the most awful grimaces. During
these contortions of the muscles of the face, every expression of
ridicule, sarcasm, joy, pain, agony, malice, revenge, hatred, are
depicted in rapid succession. The jerking of the muscles appear
to be paroxysmal they are very violent for a few minutes, and
then moderate for a few moments. The nurse states that it
commenced at 8 o'clock P. M., and was much more violent du-
ring the night than at the present time. The patients in this
ward state, that they were kept awake during the whole night,
by his barking and shaking. Pulse 144, feeble. It was very
difficult to count the beats of the pulse, on account of the vio-
lent twitching of the tendons of the fore-arm. Temperature of
hand, 103 F. Skin covered with the clammy sweat, resemb-
ling bloody serum. Odor of body intolerable.

7 o'clock P. M. Kespiration 40, thoracic, spasmodic ; pulse
140. Continues in the same jerking state; spasmodic bark is
much lower and hoarser; skin hot.

Sept. 6, 10 o'clock A. M. Lies in the same insensible state,
with his body covered with the clammy reddish sweat, and
emitting an awful stench. Twitching and jerking and contor-
tion of muscles have ceased. Eespiiation 38, spasmodic, gasp-
ing. Pulse 140. Temperature of hand, 105 F. ; Temperature
of atmosphere, 80. He is evidently near his end.

This patient died eight hours after this observation, at 6 o'clock
P. M.

His superstitious friends, who had neglected him during life,
prepared a coffin before his death, and placed him in it, and
drove off half an hour after his death.

732 Jones, on Malarial Fever. [November,

Although exceedingly anxious to perform a post-mortem
examination, could not resist their earnest entreaties to the con-
trary.

Case XXXV* German Butcher, age 23 : height 5 feet 10
inches ; light brown hair, brown eyes ; weight, in health, 180
lbs. his present weight cannot be more than 110 lbs.

Has been suffering with chill and fever for two months, and
has had no medical attendance until the 25th of September.
His physician administered calomel and opium, with a view to
salivation, and placed a large blister, 8 inches by 7, over the
epigastrium. This plan of treatment appeared to act in concert
with the malarial poison, and exhaust his small store of strength.

He came into my hands on the 28th of September, 7 o'clock
P. M., in an exceedingly feeble and critical condition. Com-
plexion sallow, anaemic ; flesh and strength greatly reduced ;
nervous and muscular forces very feeble. Pulse 120 ; respira-
tion 24, labored. Lies in a stupor cannot be aroused; tongue
dry and harsh to the feeling; skin dry and rough in all parts
of the body, except just around the nose, where there is a slight
moisture.

ty. Cut-cup to each temple, and sinapisms to extremities.
Sulphate of quinia, grs. v., every three hours, up to grs. xxxv.

$. Infusion of Virginia snake-root, Oxvi. ; Brandy, f^xvi.
Tablespoonful every half hour. Diet, milk-punch and arrow-
root.

Sept. 29th, 11 o'clock A. M. The mustards, stimulants and
sulphate of quinia, have aroused him, and he is brighter this
morning, but still not restored to the full exercise of the reason-
ing faculties. Pulse 112, fuller than at 7 o'clock P. M. ; respi-
ration 18. Temperature of atmosphere, 80 F.; temperature of
hand, 95 12. Temperature under tongue could not be deter-
mined, on account of his restlessness. Tongue slightly coated
with yellow fur, dry and harsh to the feeling.

ty. Apply sinapisms again to the extremities, and continue
brandy and infusion of Virginia snake-root, tablespoonful every
hour.

4 o'clock P. M. Examination of Blood No. VIII. Blood co-
agulated slowly. In one specimen the coagulation was remark-
ably slow, and the blood-corpuscles gravitated towards the
bottom of the vessel, and left above a clear golden colored clot.
This transparent portion of the clot was about one-fourth of an
inch in thickness. Serum of a deep golden color. Eeaction of
serum alkaline. Specific gravity of blood 1036*6 ; specific grav-
ity of serum 1023'6.

* The alterations of the blood in this case have been previously noticed, by the
author, in the May number of the Southern Med. and Surg. Journal

1858.] JotfES, on Malarial Fever. 733

Water

In 1000 parts of Blood, 840511

" u M M Serum, 913950

(1) " " "Liq.Sang., 912-605

(2) " " " " " 882723

Solid Matters

In 1000 parts of Blood, 159489

" " " u Serum, 80-050

(1) " " M Liq.Sang., 80-978

(2) " " u " u 117277

Solid Matters in Serum of 1000 parts of Blood, 79-135.

Fixed Saline Constituents,

In 1000 parts of Blood,

" " " u Serum,

(2) " " " " Liquor Sanguinis, -
u " " " Solid Matters of Blood,
" M " " " " " Serum,

" " " u " " " Blood Corpuscles,

" " " " " " - Moist Blood Corpuscles,

" Blood Corpuscles of 1000 parts of Blood, -
" Serum of 1000 parts of Blood, ... -

1000 Parts of Blood Contained,
Water, ------

Dried Blood Corpuscles, - 79-434 i ?jc ^teTS> '_
Fibrin, ------

Albumen Extractive and Color'g ) Organic Matters,
Matters, - - - 79-096 ] Mineral "

1000 Parts of Blood Contained,
) Water,
Moist Blood Corpuscles, 317*748 > Organic Matters, -

) Mineral "

Water, - - -
Organic Matters,
Mineral "
Fibrin, - - -

1

Liquor Sanguinis, - - 682*252

1000 Parts of Moist Blood Corpuscles Contained.

Water,

Organic Matters, --------

Mineral Matters, --

(1) 1000 Parts of Liquor Sanguinis Contained,

Water,

Albumen, Extractive and Coloring Matters, -

Mineral Matters, -

Fibrin, -

(2) 1000 Parts of Liquor Sanguinis Contained,

Water,

Albumen, Extractive and Coloring Matters, -

Mineral Matters,

Fibrin,

5-796

2-647

3-498

36-341

30-178

42-914

10-728

3-409

2-387

840-511

76-000

3-409

0-877

76-508

2-387

238-271

76-000

3-409

602-240

76-708

2-387

0-877

749-873

239-284

10k728

913022

83-303

2-647

0-928

882-723

112-433

3-498

1-285

734 Jones, on Malarial Fever. [November,

This examination reveals the following changes in the blood :

1. The fibrin is greatly deficient. The deficiency of fibrin in
the blood was farther demonstrated by the fact, that the blood
oozed from the cut-cups upon the temples, for 18 hours, and it
was finally necessary to check the flow by cold applications.

2. The colored corpuscles are greatly diminished, the dried
corpuscles being 79434, and the moist blood corpuscles 31 7'748.
The fixed saline constituents are correspondingly reduced in
amount.

3. The color of the serum is changed to a golden color, and
the albumen is diminished.

It is worthy of note, that the reaction of the blood is alkaline,
while that of the saliva and urine is strongly acid.

7 o'clock, P.M. Pulse very feeble ; feels like the vibration of
a delicate silver thread. Owing to its exceeding tenuity and
feebleness, cannot be counted with absolute accuracy. The
number of beats to the minute lies between 130 and 150.

Eespiration 34, thoracic, labored. Tongue dry and rough ;
feels to the touch like sand paper; skin of trunk and extremi-
ties much cooler than normal. Has been taking brandy and
the infusion of Virginia snake-root, and milk punch, during the
day. ty Apply sinapisms to extremities, and continue the sti-
mulants, milk and arrow- root.

September 30th, 2 o'clock, P.M. Sinapisms aroused him,
and he appears to be more intelligent. Skin warmer; Pulse
112, still feeble, but decidedly better than last night. Eespira-
tion 17, full, thoracic. Temperature of atmosphere, 73F.; temp,
of hand, 91. Tongue slightly coated with yellow fur, moister
and softer ; surface of blister raw and red ; urine of a bright red
color; specific gravity 1016. When carefully tested ior uric
acid, the urine was found to contain only a trace a few small
crystals. Eeaction of urine and saliva decidedly acid.

fy Sulphate of quinia, grs. v., every three hours, up to grs. xx.

ty Continue brandy and infusion of snake-root tea.

October 1st, 2 o'clock, P. M. Eestless and stupid. Pulse
100 ; respiration IB, full, thoracic. Temperature of atmosphere,
79F.; temp, of hand, 88 5; temp, under tongue, 945. The
temperature of the trunk is between 4 and 6 degrees below the
normal standard. The temperature of the extremities is 10 de-
grees below the normal standard. Tongue dry and rough ;
teeth coated with sordes; refuses to take nourishment.

October 2nd, 2 o'clock, P. M. Intellect more active, but still
very slow and dull. When aroused, says that he feels easy ;
has a disagreeable smell. Tongue of a brownish yellow color,
and as dry and rough as a fresh sawed board ; teeth coated with
sordes; pulse 124; respiration 18. The incision in the arm,
where he was bled, has not healed. It bled during the night,

1858.] Joxes, on Malarial Fever. 735

and drops of limpid serum are now oozing continually from it.
The left side of his head is swollen, and painful to the touch :
this compels him to lie upon the right side and arm in which he
was bled.

$ Tincture of chloride of iron. nix v. three times a day.

October 3rd, 2j o'clock, P.M. Pulse 120: respiration 24.
The state of his tongue presents a striking contrast with what it
was yesterday : it is now moist and soft. Reaction of saliva
decidedly acid. During the night his right arm has swollen
from the shoulder to the end of the fingers, to nearly twice its
natural size; the veins upon the surface are filled with blood;
the lancet wound is open and emits a serous fluid. The lancet
with which he was bled was carefully washed before its use.
The swelling of the arm appears to be due to the interference of
the circulation by the pressure of his body, rather than to a
poisoned lancet.

$ Continue tonics, stimulants, and nutritive diet. Paint the
whole arm, from shoulder to tip of fingers with the tincture of
iodine, and apply cold-water dressing.

October 4th, 2 o'clock, P. M. Says " that he feels badly ; has
pain all over." The swelling on the left side of the face, in the
region of the ear, and angle and joint of the jaw, continues
to increase: it is hard, tense, and painful to the touch. Boils
and ulcers are appearing upon various parts of his body. The
blister presents a purplish red, unhealthy, raw surface; tip of
tongue red and glazed; superior surface coated with brownish
yellow and black fur; tongue is so dry that it is protruded out
of the mouth with great difficulty; pulse 120; respiration 24.
Temperature of atmosphere, 76F.; temp, of hand, 1005. The
rise of the temperature in the extremities is probably due to in-
flammatory action.

October oth, 2 o'clock, P.M. Says that he is better. Face a
little flushed : up to the present time it, has been entirely with-
out color; swelling in arm stationary ;v swelling on side of face
continues to increase, and is very painful; pulse 118. Tempe-
rature of atmosphere, 73F.; temp, of hand, 100.

fy Paint arm and side of face with tincture of iodine.

October 6th, 4 o'clock, P.M. Skin hot and dry; has never
been moist since his entrance into the hospital. Complains
greatly of his head: carotid arteries are throbbing violently ;
pulse 104; respiration 24. Temperature of atmosphere, 72F.;
temp, of hand, 101; the temp, of the trunk is about 104F.
Since the commencement of the inflammation his pulse has be-
come fuller and stronger. Slight moisture about the tongue.

$ Chlorate of potassa, 3i.; water, Oviij. Dissolve. Ad-
minister during the 24 hours, and continue.

$ Compound tincture of gentian, f 3j.; comp. tine. Peruvian

736 Jones, on Malarial Fever. [November,

bark, f 3j. Mix. Administer three times a day in f lij. of the
infusion of Virginia snake-root.

October 7th, 4 o'clock, P.M. Arm greatly swollen, and when
bent much serous fluid issues from the lancet wound. Surface
of blister shows no disposition to heal; ulcers upon the body
are increasing; tongue moister and softer than it has been dur-
ing his sickness. Temperature of hand, 102F.; temp, of trunk
about 104.

$ Continue stimulants, alteratives, tonics and diuretics. Diet,
soft boiled eggs, milk punch, wine whey, arrow-root and mutton
soup.

October 9th, 4 o'clock, P.M. Appears brighter and stronger.
Abscess upon the side of his face has been lanced ; it discharg-
ed a large quantity of pus ; it had formed a communication into
the meatus auditorias externus from which much pus issued ;
pulse 163, probably excited by the lancing of the abscess one
hour ago.

October 10th, 4 o'clock, P.M. Skin hot and dry; tongue dry
and rough ; abscess in the region of the ear, and joint and angle
of the inferior maxillary bone, continues to discharge large
quantities of pus, and masses of cellular tissue. Arm looks
badly; the skin presents a greenish yellow, unhealthy appear-
ance; the cellular tissue appears to be completely infiltrated
with serum ; when it is flexed, and the tissues thus compressed,
considerable quantities of this fluid issue from the lancet cut,
which has never shown the least disposition to heal ; pulse 130,
full and strong; respiration 28. Temperature of atmosphere,
70F.; temp, of hand, 10375 ; temp, under tongue, 1045.

October 12th. The surface of the blister has commenced to
suppurate and discharge an unhealthy looking offensive fluid.
It has' never shown any disposition, either to healthy inflam-
mation or healing. The ulcers upon various parts of the body
have steadily increased in size, and like the blister, discharge an
unhealthy offensive fluid, and show no disposition to heal. .

October 13th. The arm looks dreadfully ; the skin over the
biceps muscle is black and gangrenous ; digestion bad and bow-
els loose.

October 17th. The skin over the entire region of the biceps,
and over a large portion of the triceps mucle, has sloughed en-
tirely away, and exposed the red quivering muscles. There
has been no hemorrhage, but a large discharge of the serous
fluid which had infiltrated the cellular tissue. The surface of
the blister and ulcers, and exposed muscles, emit a disgusting
stench. Bowels are moved frequently.

October 21st. The biceps muscle has sloughed entirely from
its lower attachment. It is impossible to give a correct idea of
his distressing and loathsome condition. He is completely ex-

1858.] JOXES, on Malarial Fever. 737

haustcd and worn out by diarrhoea, and by the discharge from
the numerous diseased surfaces.

This patient died October 22nd, Wo1 clock, P.M.

It is surprising, that although the patient has apparently had
the exercise of his intellect for the last three weeks, he has never
once been heard to utter a complaint. He has been either a
man of extraordinary resolution, or else the effects of the mala-
rial poison, in conjunction with the changes which it has pro-
duced in the nervous system and all the organs and tissues,
have tended to blunt the sensibilities and render the patient
callous alike to pain, disgusting odors, and the fear of death.
He has nothing in his face to denote an unusual amouut of
either intelligence or resolution, and the latter appears to be the
true supposition.

(7) Autopsy twelve hours after Death.

Exterior. Trunk and limbs greatly reduced in flesh a skel-
eton with the skin stretched over.

Head, not examined.

Chest. Lungs normal, but very pale and anaemic.

Heart, normal. The auricles of the heart contained a quan-
tity of fluid blood, which was carefully examined under the
microscope. Colored blood corpuscles appeared normal in color
and structure. When the blood was treated with acetic acid,
the colored corpuscles disappeared and the colorless corpuscles
remained behind. The colorless corpuscles appeared to be more
numerous than normal.

Abdominal Cavity. Liver, of a light slate color, approaching
ing in mauy places to purple and purplish-brown, as if it was
returning to its normal color. The cut surface was of a bronze
and purplish-bronze color, as if its substance also was returning
to its normal color. Structure of the liver unusually firm.
Blood-corpuscles of the blood of the liver appeared to be normal
under the microscope. The liver-cells were normal in shape
only a little paler than usual.

The Gall-Bladder, was filled with bile of a brownish-yellow
opaque color, when seen in mass, and of a gamboge-yellow in
thin layers; and with numerous, irregularly-shaped, yellow
masses, of various sizes, from an English pea to a grain of sand.
These yellow masses formed about two-fifths of the contents of
the gall-bladder. These masses were soft and readily crushed
between the fingers. Under the microscope, they were found
to consist of numerous cells from the mucous membrane of the
gall-bladder, and a yellow amorphous matter. The bile duct
appeared to be choked up with these cells and this yellow amor-
phous matter. Sp. gr. of bile, 1036.

/Spleen. Enlarged; surface covered with effused coagulable

738 Jokes, on Malarial Fever. [November,

lymph, and bound to the liver and diaphragm by bands of co-
agulable Ipmph. A large quantity of pus, of a greenish -yellow
color, issued from the anterior border of the spleen, which was
firmly attached to the liver. Whether the abscess had opened
and discharged this pus before death, or whether the abscess
was accidently ruptured during the opening of the chest and
abdomen, I was unable to determine.

The structure of the spleen felt firm, very unlike the soft,
yielding structure of the spleen of the active stages of malarial
fever. When cut, many portions of the spleen resembled a
dark bronzed and slate colored liver. The pulp of these por-
tions was not soft, and did not pour out, like the pulp of the
spleen of the active stages of malarial fever.

The liver-like substance of the spleen was found to consist,
under the microscope, of fibrous tissue, and numerous colored
corpuscles, and flakes, composed of granules resembling the
dark-colored flakes of the black vomit of yellow fever. These
flakes were, without doubt, composed of altered colored corpus-
cles. The colorless corpuscles of this portion of the spleen ap-
peared to be more numerous than normal.

This dark, liver-like substance appears to be nothing more
than the pulp (mud) of the malarial spleen, from which the se-
rum has been in a great measure removed, and in which altera-
tions of the blood-corpuscles have taken place, and fibrous tissue
formed.

After several hours exposure to the oxygen of the atmos-
phere, the color of this portion of the spleen was not altered.

In addition to the abscess, opening upon the surface of the
spleen attached to the liver, the substance of the spleen contained
numerous other smaller abscesses, of various sizes, (two or three
largest of the size of a bullet, and the smallest of the size of an
English pea,) filled with thick greenish-yellow pus. Portions of
the spleen, especially surrounding the abscesses, were altered
into a cheese-like substance. Under the microscope, these
cheese-like portions consisted almost entirely of pus corpuscles,
and large cells, containing granules and other smaller cells, thus
resembling cancer cells; and also black masses composed of
granules (probably altered colored corpuscles) like those from
the dark dense portions of the spleen ; and also numerous oil
globules. The bodies resembling cancer-cells were not numer-
ous. The pus issuing from the large abscess, resembled ordina-
ry pus, under the microscope, and contained a few of these
peculiar cancer-like cells.

Kidneys, normal in appearance. Bladder contained a small
quantity of urine, which was normal in color.

Alimentary Canal. The stomach and small and large intes-
tines were greatly contracted. Blood-vessels of mesentery,

1858.] Jones, on Malarial Fever, 739

omentum, and exterior surface of stomach, and small and large
intestines, engorged with black blood. The mucous membrane
of the stomach presented an appearance, resembling that of
chronic inflammation. The exterior of the large and small in-
testines was of a purplish color. The mucous membrane did
not appear to the naked eye to be altered in structure. Glands
of Peyer, enlarged and distinct; some of them were several inch-
es in length. The glands of Peyer, however, did not present
the appearance of active inflammation, as in typhoid fever.
They were even paler than usual. The solitary glands did not
attract attention. The lymphatics of the mesentery were much
enlarged.

Case XXXVI. This case is recorded, not as one of remit-
tent malarial fever, but for the purpose of illustrating the path-
ological changes of the spleen in malarial fever.

Native of South Carolina: age 37 years; height 6 feet 2
inches; weight 200 lbs.; large chest, full, round limbs. Has
been living on the river, several miles below the city, in a mi-
asmatic situation. Has suffered for some time with oedema of
the extremities, and difficulty of breathing, and great exhaustion
upon the least exertion. Complexion sallow, bilious; respira-
tion 3i to minute, laborious can be heard at a considerable
distance; circulation in the extremities very feeble; pulse can
scarcely be felt; temperature of extremities below the normal
standard. Auscultation reveals a labored, rapid, and strong
action of the heart ; the sounds are tumultuous and close to each
other; the impulse of the heart against the walls of the chest,
and the point at which it strikes is much below the usual point;
no abnormal sounds could be heard in the large blood-vessels;
dulness upon percussion over the region of the heart.

We conclude from this examination, that the heart of this
patient is greatly enlarged.

Complexion sallow, anaemic; conjunctiva yellow; tongue
clean and pale.

This patient was treated for hypertrophy of the heart, torpor
of the liver, and anaemia, with apparent benefit, from the time
that he entered the hospital, August 19th, until August 29th,
when he was taken suddenly at night, upon his bed, with op-
pression of breathing, followed in the course of half an hour by
profound stupor, accompanied by stertorous breathing. He
died in nine hours after the supervention of coma.

The day .previous to the Altai issue, he had been walking
about the hospital grounds, and said that he was decidedly bet-
ter. During the whole time that he has been an inmate of tl e
| hospital, has appeared dull, stupid, and indisposed to hold a con-
versation with any one, and has passed most of his time in sleep.

U.S. VOL. XIV. NO. XI. 42

740 Jones, on Malarial Fever. [November,

Bowels generally torpid, and when they were neglected for
several days, the difficulty of breathing increased, and his lower
extremities commenced to swell.

(8) Autopsy six hours after Death.

Exterior. Trunk and limbs round and plump. A close ex-
amination showed that this fulness was due to serous infiltration.
On making the first incisions through the skin and superficial
facia, serum mixed with blood flowed freely.

Head. When the skull cap was removed, a large quantity of
blody serum escaped. Dura-mater presented the usual appear-
ance. A fluctuation of a large quantity of fluid could be felt
between the dura-mater and the substance of the brain, and
when an incision was made through the dura-mater, a consider-
able quantity of serum escaped. A considerable quantity of
serum was also effused between the arachnoid membrane and
pia-mater. The arachnoid membrane presented a decidedly
opalescent (pearl-colored) appearance. Lateral ventricles of
brain contained an unusual amount of serous fluid. Brain much
softer than usual. This could not have been the result of
changes after death, for the time (6 hours) has been too short.

Chest Lungs congested with blood.

Heart. Pericardium adherent to the sternum for several inch-
es, and distended with golden -colored serum. The heart ap-
peared to the eye, when the pericardium was opened, to be as
large as the heart of a bullock. All the cavities of the heart
were dilated, and the walls thickened. The dilation and thick-
ening were greatest in the cavity and walls of the left ventricle.
In the right auricle and ventricle, there was a large, elongated,
light yellow clot, adherent at one extremity to the columnar
carneae of the ventricle, and chordae tendineae of the tricuspid
valve. In the left ventricle, there was a similar light yellow
clot, attached at one extremity to the columnas carneae, and
chordae tendineae and mitral valves, and extended full eight
inches up the aorta. That portion of the clot which extended
into the aorta, was divided into two flattened cylindrical por
tions, fimbriated at each extremity, as if they had been whipped
about for a long time in the current of the blood. The clots in
both cavities of the heart resembled, in all respects, fibrin from
which the red blood corpuscles had been carefully washed, and
were, without doubt, formed previously to death. Weight of
heart, grs. 10,500 equals ozs. 24 equals lb, 1, ozs. 8.

Abdominal Cavity. Liver. Color peculiar, and. difficult to
describe: mottled lilac and brownish yellow. Upon near in
spection of the lobules, they presented the color and appearance
of cirrhosis. The structure of the liver was firm, and cut like
soft cartilage. The liver contained such a large amount of

1858.] Jones, on Malarial Fever. 741

fibrous tissue, that after vigorous pounding of slices in a mortar
for one hour, they still retained, in a great measure, their con-
sistency. Microscopical examination showed that this tough,
resisting substance was cellular tissue. This liver, then, was in
a cirrhosed condition. Under the microscope, the cells of the
liver appeared paler and flatter than usual. The blood-vessels
of the liver were filled with blood, which ran in considerable
quantities from the cut surface into the dish. This blood readi-
ly absorbed oxygen, and changed to an arterial color. Under
the microscope, the blood-corpuscles presented the usual appear-
ance. They appeared to be diminished in number. The
structures of the liver were in tilt rated with animal starch and
cellulose. After thin slices had been pounded in a mortar, and
carefully washed under a strong stream of water, apparently for
a sufficient length of time to remove all the animal starch, and
then treated with sulphuric acid, or with liquor potassae, and
then treated with tincture of iodine, the large body of it was
turned to a blue and purple color, like the cellulose of wood.

As far as the examination extended, the cellulose appeared to
enter as a constituent of the cellular tissue of the cirrhosed liver.
When tested for grape-sugar, 24 hours after death, no evidence
was obtained of its existence. Weight of liver, grs. 80,396
equals ozs. 69 1 equals lbs. 4, ozs. o. The fibrous tissue of
the gall bladder was infiltrated with serum. The gall-bladder
contained f 3iij. of thin bile, presenting the color of tincture of
iodine, when seen in mass, and a gamboge yellow in thin layers.

Spletn Enlarged and indurated ; color of the exterior purp-
lish red. When pressed in the hand, feels dense and firm.
When cut or torn, the color and structure resembles that of a
healthy spleen, in all respects, except that it has a much larger
quantity of fibrous tissue. The pulp of the spleen absorbed oxy-
gen readily when exposed to the atmosphere, and changes to a
bright scarlet arterial color. The pulp of the spleen presented
nothing peculiar under the microscope. Did not discover those
black flakes and granules which were so abundant in the spleen
of the patient previously described (Case xxxv). The spleen
contained, like the liver, animal starch and cellulose. When
the fibrous tissue was washed, and treated in a manner similar
to that of the liver, it gave the same reaction, with tincture of
iodine. Weight of spJeen, grs. 13,343 equal ozs. 30| equal
lb. 1, ozs. 14{. Kidneys unusually small. Weight of both
kidneys, grs. 3937 equal ozs. 9.

Alimentary Canal. Stomach of enormous size: it appeared to
be capable of containing two gallons. The small quantity of
food which it contained was colored yellow by the bile. Mu-
cous membrane presented a healthy appearance. Small and
large intestines appeared healthy.

742 Jones, on Malarial Fever. [November,.

Passing over, for the present, the discussion of the character
of the disease, and immediate cause of death, and many other
points of interest, we will confine our attention to the patholo-
gical changes of the spleen.

A companion states, that this man resided two years ago on
the Ogeechee river, in a low, miasmatic situation, and was very
ill with fever during the summer season. He is unable to de-
scribe the exact nature of the fever.

From the situation, it is probable that the disease was malarial
fever, and it is probable that the pathological alterations of the
spleen were due to the action of the malarial poison during this
attack of fever. If it was malarial fever, the spleen during the
active stages was engorged with blood, softened, and the trabe-
cule in many places ruptured. When the action of the poison
ceased, the serum of the extravasated blood was removed, and
the ruptured trabecular repaired, and numerous bands of fibrous
tissue formed throughout its substance. These changes of spleen
during convalescence from malarial fever, were plainly demon-
strated in Cases xxxiii. and xxxv. Finally, the colored corpus-
cles of the extravasated blood were disintegrated and removed.

Case XXXVI. Irishman : pastry cook and baker age 44:
weight 150 lbs.; height 5 feet 9 inches; grey hair, blue eyes
has an old, feeble, decrepid look. Has followed the occupation
of pastry cook and baker for thirty years, and during this time
has worked the greater part of the night, and slept during
the day. In order to keep up his strength, has used ardent
spirits freely. The loss of sleep, combined with intemperate
habits, have completely broken down his constitution, and he
looks and talks and moves like an old man, 60 or 70 years of
age. Eight months ago, had a stroke of paralysis which affected
his tongue, right arm and lower extremities. Since this, he
walks with some difficulty, and has but little use of the right
arm. The temperature of the right paralyzed arm is generally
from one to three degrees below that of the left.

The following observation was taken on the 7th of July:
Temperature ol atmosphere, 82 5 F. ; temp, of hand, (paralyzed,)
965F; temp, of haud, (sound,) 99 F.; temp, under tongue,
100 25 F.

Under the action of strychnia and tonics, his condition was
greatly improved, and he left the hospital on the 20th of Sep-
tember.

He resumed, in a short time, his habits of intemperance, and
often lay drunk all night on the commons and in the Park. He
was taken up as a vagrant, and placed in confinement by the
police. It was soon discovered that he was suffering with re-
mittent fever.

1858.] JONES, on Malarial Fever. 743

Entered the hospital October 8th, in an exceedingly feeble
condition, and died in the coarse of 2-i hours.

(9.) Autopsy four hours after Death.

Exterior. Not much reduced in flesh. His constitution, en-
feebled by his occupation and intemperate habits, did not long
withstand the action of malarial fever.

Head. Dura-mater normal, f I j. of clear serous fluid escaped
from the space between the dura-mater and arachnoid membrane.
Blood vessels of brain did not appear to be more congested with
blood than usual.

Chest. Lungs normal. Heart normal in size. The auricles
showed incipient fatty degeneration. Weight of heart, grains
4:6 12 equal ozs. 11.

Abdominal Cavity. Liver, upon the exterior, of a dark slate
color. The cut surface presented a bronze and olive color. The
cells of the liver contained more oil globules than usual. With
this exception, the}' presented a normal appearance. The blood
of the liver did not change to the arterial hue when exposed to
the atmosphere. The liver contained animal starch, but no
grape sugar: it was set aside, and at the end of 15 hours, again
carefully tested for animal starch and hepatic su^ar. The result
was the same animal starch in apparent abundance, but no
grape sugar. The cellular tissue of the blood-vessels of the liver
appeared to be infiltrated by animal starch. Weight of the liv-
er, grains 29,312 equal ozs. 67 equal lbs. -i, ozs. 3.

Spleen. Of a dark slate color, enlarged and softened; when
pressed between, the fingers, the structures appear to give way.
Pulp of spleen of a dark purplish brown and reddish brown co-
lor. After exposure for 20 hours to the atmosphere, the pulp
of the spleen did not alter its reddish and purplish brown color.
The spleen contained animal starch in considerable abundance,
both in the pulp and also in the meshes of the fibrous tissue of
the trabeculae and blood-vessels. Weight of spleen, grs. 8093
equal ozs. 18^ equal lb. 1, ozs. 2^.

Kidneys Normal. Weight, grs. 5687 equals ozs. 13.

Alimentary Canal. Stomach. Mucous membrane presented
the usual healthy appearance.

Small Intestines. Mucous membrane appeared to be healthy.
Glands of Peyer, large and distinct, but pale, and without any
marks of congestion or inflammation. Several of these glands
were three inches in length. The solitar}- glands, especially in
the region of the ileo-caecal valve, were enlarged and prominent.
They were about the size of millet seed, and of a reddish brown
color.

(To be continued.)

744 Douglass. Disease of the Mucous Membrane. [November,

ARTICLE XXVI.

Cases of Disease of the Mucous Membrane. By TlLMAN DOUG-
LASS, M. D., of Alexander, Ga.

Case I. Mr. A. K. Moore, aged 45 ; stout, well formed, of
fair complexion, light hair a farmer, of excellent character:
was attacked, violently, with pneumonia, the 9th of March,
lfc>44. He had fever the preceding fall, and colds and general
ill health during the winter. I relied on tartar-emetic, quinine
and blisters, stimulating expectorants, &c, under the use of
which he was convalescent in a few days.

Some three months after this, Mr. Moore was able to ride
about his farm, his usual health nearly restored he came to see
me on account of a small tumor, the size of a cow-pea, on the
inside of the right angle of the lower lip, which had enlarged
and become very painful, within a day or two. I declined to do
any thing for it, and advised him to visit Augusta; which he pro-
mised to do, but deferred it from time to time, until he thought
the tumor ceased to. enlarge. Although it still annoyed him,
and sometimes excited his fears, he had very little done for it,
until the 13th of April, 1846, just two years and one month
after the first attack, when I was called to see him in another
attack of pneumonia. The cancer, and other symptoms of bad
health, had, by this time, so worn him down, that scarcely any
hope of his recovery was indulged. None but the mildest and
most supporting treatment could be resorted to. But on the
30th of the same month he was discharged apparently cured.

The novelty in this case was, that the very day the pain was
felt in the side, and other symptoms of pneumonia were devel-
oped, the cancer began to heal, and in a few days the ulcer in
the lip was entirely covered over by new cuticle. Nothing
could be seen of it except a small excavated cicatrix.

How much he and his friends rejoiced at the supposed happy
termination of pneumonia and cancer may be well imagined.
But how changed the scene, when in a few days, so soon as he
was able to ride, Mr. Moore visited me again on account of the
same sore ! It had broken out suddenly was swollen, red,
spreading, and intensely painful; the new tender cuticle destroy- I

1858.] Douglass. Disease of the Muccms Membrane, 745

ed, it was an open angry nicer. The same motives which caused
me to decline to touch the cancer, two years before, of course
urged me to the same course now.

After suffering all the horrors of this most awful malady, for
several months, under the cruel tortures inflicted by the officious
ignorance, usual in such cases, death kindly came to his relief.

Case II. Mrs. S. G-., aged 22 ; light hair, fair skin, blue eyes,
weighing about 150, of fine form, and general good health and
spirits the only child of Mr. Moore.

Before proceeding to the details of this case, it may be best to
state that Mr. G., the husband of this lady, a fine healthy young
lawyer, had his knee hurt in the spring of 1857, while driving
an unruly horse in his buggy : a very bad ulcer formed in the
wounded part, and subsequently not less than twenty almost
literally covered the leg, down to the ankle. As soon as one
would heal, leaving a deep, dark cicatrix, others would appear
near by.

The point of interest in this case is, that Mrs. G. had ulcers of
the same character, on her leg, last fall and winter, which healed
about the time of her confinement. Her child was born the 12th
of February of this year, and she had a severe attack of dysen-
tery, with discharges of bloody mucus, tormina and tenesmus,
on the 14th. Cream of tartar and some mild diuretics relieved
her very promptly, and she was soon up.

In a few days I was called again to see her, when I found the
tongue, mouth and throat red and intensely sore; deglutition
very difficult. The disease was confined to the mucous mem-
brane would spread over a considerable surface in a short
time, and subside as quickly. Fever, which abated in the morn-
ing and returned at three in the afternoon, caused an increase
of the burning pain. The next day, constant nausea, with oc-
casional colic and great prostration, fits of fainting, and lancina-
ting pains through the abdomen, made it but too evident that
the whole canal was involved. Quinine soon arrested the fever.
Solution of creasote as a gargle, and a very weak solution of
creasote into the stomach, followed by iodide of potassium, after
the fever was arrested, measurably restored her. But then the
returning appetite was tempted by a fine perch, which aggrava-
ted all the symptoms, and in two days more severe pain was

746 Douglass. Disease of the Mucous Menbrane. [November,

found passing down the rectum, followed by discharges of bloody
mucus, affording temporary relief. Two days later, the anus,
and the vagina and urethra, were invaded by the swollen, pain-
ful, burning disease. Emulsion of spirits turpentine and gum-
arabic was tried, but thought to be too exciting. She has been
taking balsam copaiba with gum arabic, for some time, with de-
cided advantage. Since the fever has given way, syrup iodide
of iron has improved her strength and appetite.
This lady is now, 6th of July, considered well.

Case III. Mrs. M. C, aged 25 : slender frame, tolerably tall,
sandy hair, fair skin, relaxed fibre and very little stamina;
about five years, married ; mother of two children. Her hus-
band, a man of feeble constitution, has a troublesome sore on his
leg. His lady had ulcers on her leg. She became pregnant the
first of last year, lived in a sickly neighborhood, and had two
or three attacks of intermittent fever the last, in Sepiember.
The bowels were very obstinately constipated, with tenesmus
and intolerable tormina. Was relieved by quinine, and an
emulsion of castor oil, balsam copaiba and gum-arabic, in small
doses. She was confined the 13th of December, just two months
after the attack in September. On the second day after the
birth of her child, dysentery, of the most violent grade, set in.
The tenesmus and tormina were as severe as in September; and
in addition to that, the stomach was very irritable, and she pass-
ed bloody mucus from the bowels. The stomach, not tolerating
the oil emulsion, she was relieved with small doses of cream of
tartar. This was the 18th January, one month and five days
after the birth of her child.

I heard nothing more of her until the 23rd of April, three
months from the attack of dysentery, when I was called to see
her on account of sore mouth. She said her mouth had been
sore almost ever since I saw her before. The soreness did not
confine itself to the mucous membrane, as it did in the case of
Mrs. G., but penetrated and formed ulcers which secreted pus.
They would heal and then come in other places. For several
weeks she declined in flesh and strength, until she became so
prostrate as to keep her bed constantly. The stomach was irri-
table, and the bowels either constipated or excessively loose.

The treatment consisted of an emulsion of balsam copaiba

1858.] Diphtheritic Affections. 747

with gum-arabic, quinine, iodide of potassium. Washes of va-
rious kinds were tried, but diluted tinct. mur. ferri. seemed to
afford her most comfort. The irritable stomach was relieved bj
a very weak solution of creasote. Animal broths were pre-
scribed as a nourishment. Her strength so improved that on
the 26th day of May she was carried to her mother's, out of my
neighborhood.

All treatment was abandoned, except laudanum given by an
old lady, and all rules of dieting laid aside, until the 5th June,
nine days from her removal ; when diarrhoea set in, and my
friend, Dr. David Perkins, was called, who called me in con-
sultation the next day.

We found her prostrated, so a noA to 1 e able to raise her head,
or even to be raised, without idintmg ; ghastly countenance, nnd
passing watery discharges constantly from the bowels with
cough and other evidences of the lungs having been invaded by
the same disease. The ulcers had left the mouth. The only
sore which had remained for any length of time, on the tip of
the tongue, had now entirely healed. She lingered on, almost
motionless and speechless, till the 30th of June, when she ex-
pired.

Diphtheritic Affections.

A late No. of the Archives Generales de Med. contains an in-
teresting paper by M. Isambert on diphtheritic affections and
on the malignant angina in Paris in 1855. The following are
the authors conclusions:

Diphtheritic affections sometimes appear sporadically; they
often seem to be endemic, and also epidemic and contagious.
Epidemic influences are often the principal causes. Contagion
does, however, really exist, as several medical men have been
infected.

Shall we agree with M. Bretonneau, and believe that diph-
theritic is not propagated by the air, but is always the result of
a kind of inoculation or actual contact of the morbid secretion
with a mucous membrane? The author thinks this opinion
too exclusive, as also does M. Trousseau.

Diphtheritic affections are generally preceded by initiatory
symptoms in the form of bronchitis, with more or less fever.
The general aspect of these affections, at an advanced period, is

x. s. vol. xrv. vo. xi. 43

748 Epidemic Diphtheritic Angina. [November,

of the adynamic kind, except when there is much agitation and
convulsive effort brought on by croupy exudation.

These ailments are of a decidedly specific nature ; the more
they are studied, the more we remain convinced that inflamma-
tion is of secondary importance, and is sometimes completely
absent.

Relapses are not rare in diphtheritis; this complaint therein
differs from other specific diseases ; as variola, rubeola, and scar-
latina.

The general treatment should be directed against the inflam-
mation, if it be present, which circumstance is, however, rare.
Abstraction of blood should be used cautiously in an affection
which so soon assumes a typhoid character. Cutaneous counter-
irritation should be completely avoided, as the irritated regions
soon become centres of new diphtheritic manifestations. Emetics
are extremely valuable; and alteratives, mercury, alkaline car-
bonates, and cholorate of potash, are often useful.

Local treatment is very important, and consists of an energet-
ic modification of the affected surfaces. Calomel, alum, hy-
drochloric acid, and especially solutions of nitrate of silver, are
always indicated.

The patient should, finally, be well sustained, besides taking
medicines, as there is a tendency to a typhoid state in this kind
of affection. He should also be given tonics, as bark, coffee, and
wine; the latter tonic is especially advisable during convales-
cence after severe diphtheritis. American Jour, of Med. Sciences.

Epidemic Diphtheritic Angina at Lima. By M. Odeiozola.

About the close of the month of July, 1851, an epidemic grippe
appeared, and suddenly attacked the whole population of
Lima, and was fatal, particularly to old people, in consequence
of grave pneumonias which were developed in its course. The
first cases were observed from the middle to the twenty-fourth
of July, and extended rapidly and simultaneously to all the in-
habitants of this city, so that, during the height of the epidemic,
the streets were deserted for ten or fifteen days. Since that
period, we have suffered two other epidemics, one ever memora-
ble on account of the great ravages it caused the yellow fever,x
the first invasion of which occurred in the summer of the year
18o2, in a benign form, to become grave and fatal in the years
'53 and '54; and the diphtheritic angina, which, though not so
general or fatal as the preceding, did not fail to secure some
victims, notwithstanding the small number of persons attacked.

To this last, which still prevails, we devote a few lines.

If we may rely upon the few and incomplete records left by

1858.] Epidemic Diphtheritic Angina. 749

our predecessors, relative to the epidemics which have afflicted
the inhabitants of Lima, the diphtheritic angina appeared here
for the tirst time in the year 1821, and then, as now, merited
the epithet epidemic, because it appeared simultaneously in a
large number of individuals. Since that date, we have no
notice, nor does there exist any document to show its reappear-
ance until the year 1850, when it attacked, sporadically, a small
number of persons, to whom it proved fatal. Four years passed,
and in 1855, it extirminated almost an entire family, without
extending beyond the house in which it caused such marked
ravages. And, in the mouth of April last, 1858, it appeared
again, and from that time to the present, there is scarcely a prac-
titioner who has not had at least two or three cases under his
care. It is worthy of remark that our estimable fellow-member.
Dr. Jose J. Bravo, prognosticated the invasion of this diseass in
February last, on the ground that it had appeared a year and a
half ago epidemically at Piura, passed to Trujillo, and thence
to Huacho, places where it had some victims, and that it was
rational to expect so fearful a guest, which, from its origin, was
propagated from north towards the south.

As the diphtheritic or pseudo-membranous angina now pre-
vailing does not differ in its symptoms or anatomical characters
from that described by authors under the same name, or from
that which we have mentioned as described by Dr. Valdes, we
believe ourselves to be excused from entering into details, con-
tenting ourselves, for the present, with merely indicating the
class of society in which the diphtheritic angina appeared more
especially, the proximate number of sufferers, and the treatment
resorted to in preference by a majority of the profession.

It was natural to expect that, once developed amongst us, th:s
disease would find its largest number of victims in the needy
class as happens in certain European populations, where it pre-
vails with some frequency ; but the contrary has happened, for
it has attacked, in preference, persons who enjoy all possible
comforts, and in so marked a manner that, in the hospital for
men, there has not been a single case, and in that of Santa Ana,
for women, there has been only two. The black race, up to this
time, has been as resistant to this angina as it was to the yellow
fever. It is to be regretted that no data on this point cau be
obtained from the history of the epidemic of 1821, above men-
tioned. For this and various other reasons, we have character-
ized the description by Dr. Valdes as incomplete.

We should have been pleased to present an exact statement
of the number attacked by the angiua; but it may be readily
perceived that such a labor is impracticable, inasmuch as it has
not yet ceased, and because it has not occurred in the hospitals,
where it might be accurately made.

750 Diphtheria, or Diphtherite. [November,

Notwithstanding the many impediments we have encountered,
we have succeeded in obtaining, from a majority of the most
respectable practitioners, the number of cases they have treated,
with the following results :

Of 70 cases of diphtheritic angina, 49 were females and 21
males; 55 were cured and 15 died. Of the 15 deaths, only two
were adults, the rest between 3 and 12 years of age, much the
largest number being between 3 and 5 years old. Of the 55
cured, only 5 were under, and the remaining 50 exceeded 12
years of age. The whole 70 patients belonged to the white race.
The total number attacked up to this time is between 80 and
90.

The majority of physicians have decided in favor of cauteriza-
tions with pure chlorohydric acid, practised two or three times
a day, according to the gravity of the case, and emetics of tartar
emetic or ipecacuanha, alternately employed. It is not our
object, nor is it possible, to decide upon the degree of curative
efficacy in diphtheritis which the cauterizations may possess;
but we ingenuously confess that this treatment, employed active-
ly from the beginning, has yielded happy results in the greater
number of cases, and it has been inefficacious in the most of
these cases in which it has been applied two or three days after
the developement of the disease.

We hope that time and experience will determine the true
value of this remedy, which is considered impotent by some of
our practitioners. We have employed emetics exclusively for
their mechanical effects on the pharynx, favoring the expulsion
of the false membranes; but it may be said, in passing, that
their abuse in children produces more hurt than advantage, and
they do not tolerate them as well as adults, in whom we have
observed no accident, although fear caused by the gravity of the
disease, may have induced us, perhaps, to carry them further
than we ought. As purely auxiliary, we have used opiate gar-
gles, and the liquor of Labarraque. We know thai some have
employed different therapeutic agents in this angina, such as
bark, internally, baths, gargles, and cataplasms of a concentra-
ted decoction of the same, sulphate of quinine, cauterizations
with a concentrated solution of nitrate of silver, or sulphate of
copper, &c, &c. ; but we are entirely ignorant of the opinion
which should be formed as to their utility. [Gaceta Medica de
Lima. Organo qficial de la Sociedad de Medicine, and lb.

Diphtheria, or Diphtherite. By David Thompson, Esq., of Lan-
caston.

About three years since, this neighborhood was visited by an
epidemic of this rare disease. The first cases occurred in the

1858.] Diphtheria, or Diphtfierite, 751

town, and no others then appeared for several months, when it
again broke out in the district north of this place, where it pre-
vailed for several months, whilst the south side was comparative-
ly free from it. From the north, it gradually spread, until the
whole line of country had been visited by it. There appeared
to be no difference in the geological nature of the country, the
level, or the aspect, in increasing the severity or granting an
immunity from the disease. The premonitory symptoms varied
somewhat A few retired to rest comparatively well, and awoke
in the morning with the throat sore, and covered with white
deposit. In the majority it was preceded by all the ordinary
symptoms of pyrexia, of which headache was one of the most
severe, followed in the course of a day or two by the usual
throat symptoms. An extreme feeling of depression, not to be
accounted tor, by the amount of mischief in the throat, was a
characteristic symptom in each case. An external examination
of the throat showed the tonsil generally to be swollen, hard,
and tender to the touch ; while sometimes the parotid gland
participated in the swelling. Internally the tonsil was swollen,
and either covered with the diphtheritic deposit, which frequent-
ly extended over the pharynx, and sometimes into the nares
and palate, or else it would be scooped out into an ulcer, with
raised violet-coloured edges; the floor exhibiting a dark ash-
coloured slough. In some instances there would be no deposit
or ulceration at first, but simply the tonsil painful and enlarged.
These cases generally changed for a state of ulceration, which
began in several distinct spots, and gradually spread over the
whole tonsil. In the most severe examples, the tonsils sometimes
sloughed en masse. I saw one instance in which this occurred,
in an early stage of the disease ; and where now (two years since
it occurred) a cavity remains, capable of containing a pigeon's
egg, across the surface of which extends a small band of mucous
membrane, which did not slough at the same time, and gives
great inconvenience, from retaining the food impacted in the
hollow during deglutition.

I have seen no case in which I could detect the extension of
the disease into the oesophagus; but in many it has entered into
the air-passages, this being the most frequent and most fatal
complication. Of 4b5 cases that came under my own observa-
tion, the instances in which the air-passages became involved
in the disease amounted to 15; and of this number II died, the
greater number within a few hours after the first symptoms of
croupy breathing began. The false membrane formed on the
tonsil and pharynx extended into the larynx, trachea, and fre-
quentlv far into the minute divisions of the bronchi. In one
..nee, a girl aged 17 expectorated, within twelve hours after
the first symptoms of croup made their appearance, a complete

752 Diphtheria, or Diphtherite. [November,

cast of the larynx, trachea, and bronchial tubes, extending to
the fifth division of the bronchi; in a few hours afterwards, a
fresh membrane formed, and she died from suffocation.

In many instances, I saw numbers of minute casts expectora-
ted from the lungs, whilst at the same time a stethoscopic exam-
ination gave all the symptoms of capillary bronchitis. A gen-
tleman aged 46, died from this condition of the lungs. His
throat was first affected. After a few days, the breathing became
impeded, with all the ordinary symptoms of capillary bronchi-
tis in the first stage, the throat continuing to improve. He
gradually sank, constantly expectorating casts of the small
tubes, precisely similar to the deposit in the trachea.

I kept accurate notes of 125 of the most severe cases, inclu-
ding all the deaths.

Cases. Deaths.

Males 55 9

Females 70 4

Totals 125 13

The deaths, with two exceptions, were all below fifteen years
of age; and, with two exceptions, were all from affections of the
air-passages. In the two who died from other causes than affec-
tions of the air-passages, death occurred in one from the slough-
ing of a blister, applied for three hours to the upper part of the
sternum; and in the other from extreme debility remaining after
recovery from croup. There was a very remarkable tendency
for blistered surfaces to take on unhealthy action ; and I fre-
quently saw the irritated surface covered with a deposit similar
to that on the throat.

A strong similarity appears to exist between this disease and
scarlet fever, so strong, as almost to lead one to hazard the opin-
ion that it may be a modification of that disease. The following
are the reasons for considering so :

1. Diphtherite prevailed in this neighborhood as a conta-
gious (?) epidemic at the same time as well-marked scarlet fever,
and chiefly among children.

2. In the same house, the father and mother had well-marked
scaflet fever severely without any ulceration or deposit on the
throat; while the three children had all the marked symptoms
of diphtherite, without much feverishness and no rash, though
attended by the same premonitory symptoms, the cases occur-
ring at the same time.

3. In many instances, cases of apparently pure diphtherite
were, after some days, attended by a rash, that seldom remained
more than a few hours.

4. The disease in most instances commenced with all the
symptoms of fever, its duration being similar to that of scarlet.

1858.] On the Prevailing Diphtheritic Affection. 753

5. In cases of apparently pure scarlet fever, the throat be-
came, after a few days, covered with diphtheritic deposit.

6. The sequela? of the two diseases nearly resembled each,
other; albuminous urine, with casts, being present in eight cases
of diphtherite, and anasarca pro viug fatal from convulsions in
one.

It would occupy too much space to give more than a mere
outline of the subject ; but future and more extended experience
than mine may prove whether there is any connection between
the two diseases. Deafness was a not unfrequent sequela of
diphtherite and temporary paralysis; in all instances these were
recovered from. 1 have only known one case of diphtheritic
ophthalmia to have occurred in the neighborhood. In that in-
stance, the deposit extended over the lower half of the conjunc-
tiva.

The treatment most successful was the early and thorough
application of lunar caustic to the throat, together with the use
ot a stimulating gargle of nitrate of potass, and capsicum, or so-
lution of chlorinated soda (Beaufoo's) diluted. When there was
much feverishuess in the early stage, an emetic appeared some-
times to benefit. Mild but continued counter-irritation over the
upper part of the chest appeared of great service. General treat-
ment, beyond keeping the secretions regular, was of little use,
and frequently injurious. Depletion of any sort did an infinite
deal of harm. Stimulants were often required in an early stage.
The chances of recovery when croup set in severely were but
small. The only chance seemed to be, in the rapid exhibition
of small doses of calomel- and ipecacuanha, with stimulants.
Under this treatment, four out of fifteen recovered who were
affected with this complication. Tracheotomy was tried, but of
no service, as the false membrane extended beyond the trachea.

In the number of the Lancet for, I think, the }-ear 1832, there
is a most characteristic case described by Dr. Alison, of Edin-
burgh, as having occurred in the Royal Infirmary, and which
.terminated, as the fatal cases here did, in croup.

A careful microscopic examination of the white deposit showed
nothing different from the usual appearances of exuded lymph.
British Med. Journal and lb.

On the lately prevailing DiphUieritic Affection. By Dr. William
Camps.

This affliction has been variously designated as croup,
croupy diseases of the throat, malignant sore throat or cynanche
maligna, diphtheritis or diphtherite, throat affection, prevalent
sore throat, &c Under one or other of these terms, there could
now no longer be any doubt that a disease lately prevailed, and

754 On the Prevailing Diphtheritic Affection. [November,

did still exist, with more or less intensity, in various parts of
the United Kingdom, including the metropolis. The public
health authorities had, in their periodical documents, of late
solicited information respecting it, uuder Jhe term diphtheria.
Dr. Camps states that his attention was directed thereto, in the
first instance, by noticing in one of the quarterly returns of the
Registrar- General an unusually large number of deaths from
croup, as having occurred in a rural district, with the popula-
tion and locality of which he was tolerably well acquainted.

It was well known that a form of pharyngeal inflammation
had been investigated and described some years ago by M. Bre-
ton neau, of Tours, and that to this disease he gave the name of
diphtherite. It was probably from the analogy observed between
the disease lately prevailing here and that described by M. Bre-
ton neau, that the former was now commonly spoken of as diph-
therite, diphtheritis, diphtheria, or diphtheritic disease. M.
Breton neau and some other French authorities appeared to have
regarded it as almost, if not absolutely, identical with the ordi-
nary inflammatory croup of this country; and Dr. Watson in
his lecture on croup, appeared to regard Dr. West as holding
the opinion that diphtherite is a variety of croup an opinion
in which Dr. Camps did not concur. Whether in this country
or in France, this disease had heretofore appeared rather as an
epidemic than as a sporadic affection ; and the author was of
opinion that many of the cases of throat disease which proved
so fatal not long since at Boulogne, might have been cases of
diphtherite. Here it assumed quite an epidemic character ; and
in all the severer and fatal instances of the disease in this country
that had come to the author's knowledge, such cases had occur-
red in tolerably rapid succession as to time, and in tolerably
close proximity as to place. He hesitated to commit himself
without reserve to the question of its contagiousness, although
he believed that practitioners in France entertained that opinion.

The type of the disease in its severest forms, he considered
to be essentially asthenic or adynamic; and, therefore, attended
with more or less languor, depression, and diminution or
impairment of vitality, thus indicating most clearly the appro-
priate mode of treatment. Of late, in many of the metropolian
dispensaries and hospitals, stomatitis had been very prevalent;
and in the judgement of the author, there existed between
stomatitis and the diphtheritic affection, now under considera-
tion, a very close analogy or resemblance. He regarded the
former as the standing off into a milder form of the latter, yet
both as the result of the same morbific general cause ; so that
the difference between the two should be considered as one of
degree, rather than of kind. The tendency to the production
of plastic, pseudo-membranous exudations, as observed in these

1858.] On the Prevailing Diphtheritic Affection. 755

diseases, was one mode of denoting the existence of an adyna-
mic or low form of inflammation ; and the correct appreciation
of this condition was of the highest importance in the treatment.

A description of the disease, as detailed by M. Bretonneau,
was then briefly adverted to by Dr. Camps, who then stated that
he was indebted to Dr. H. W. Fuller, of St. George's Hospital,
for having drawn his attention to a record of cases of diphtheri-
tis that had occurred in 1849 at Haverfordwest, in the practice
of Mr. Brown, of that place, and which that gentleman had
communicated to the " Medical Times and Gazette." Mr.
Brown in that year had had no fewer than two hundred cases,
forty of which had proved fatal ; and in some of these death had
ensued in a few hours from the seizure, others lingered on for
some days. In its course, Mr. Brown said that some of the
little sufferers appeared to get through it easily ; while others
lingered for weeks with slight but deceitful symptoms. The
treatment adopted by Mr. Brown was referred to by the author
at some length. He affirms that he did not lose a patient in
whom he succeeded in establishing ptyalism. That gentleman
advocated the topical application of solution of nitrate of silver;
in regard to constitutional treatment, he depended upon calomel
in combination with ipecacuanha, in doses varying from half a
grain of each, every four or eight hours. He found, moreover,
emetics of great service in the first stage of the disease ; they
then always relieved the distress in breathing, carrying away
large quantities of mucus. The only cases that proved fatal
under his care were those in whom the pharynx and the larynx
were simultaneously affected. The post-mortem examination
of all the fatal cases that had come within the author's knowledge,
showed the pharynx, tonsils, larynx, trachea, and upper part
of the bronchi, to be more or less coated with plastic, pseudo-
membranous exudation. Eeference was made by the author to
the occurrence of the disease in various parts of the country;
namely, in Essex, Norfolk, Lincolnshire, Staffordshire, Wor-
cestershire, Lancashire, Devonshire, and in the metropolis.

With reference to the cause or causes of this and similar
diseases assuming an epidemic character, it was usual to regard
such as the results of some specific epidemic influence or agency,
operating upon the human system through the blood. This
explanation, or attempted explanation, the author stated, was
by no means satisfactory to his own mind, however much so it
might be to the minds of others.

From all the facts or particulars which Dr. Camps had been
able to collect respecting this disease, he was disposed to draw
the following conclusions:

1. A disease very analogous to, if not identical with, that des-
cribed by M. Bretonneau as diphtherite, had existed in this

756 Some Obscure forms of Nervous Affection. [November,

country, and had prevailed with more or less intensity during
the iast few years.

2. This disease was mainly, if not essentially, of an asthenic,
adynamic type; and characterized in the severer cases by the
formation of plastic pseudo-membranous exudations.

3. This disease was primarily pharyngeal as to its seat, and
not laryngeal, except secondarily, and by complication; thus
differing anatomically from croup.

4. Its difference from stomatitis was a difference of degree or
intensity, rather than a difference of kind; and that one chief
point of difference from the malignant sore throat, consequent
upon scarlatina, consisted in the tendency to the formation of
plastic pseudo-membranous exudations.

5. In many instances this disease possessed the characters of
an epidemic disease.

6. Its low adynamic type clearly indicated the mode of treat-
ment to be adopted ; which in the author's judgement, should
be both topical and general. The topical consisting of free ap-
plications of a strong solution of nitrate of silver to the parts
affected, composed of from one scruple to two drachms of the
nitrate to one ounce of distilled water; or similar applications
of chlorine or hydrochloric acid ; the general treatment compris-
ing the repeated administration of chlorate of potassa, with
chlorine, or a combination of cinchona bark, or its alkaloid salts
with the mineral acids; and in the severer cases, calomel in
repeated doses, so as to produce ptyalism. Emetics in the early
stages of the disease have been given in some cases, and with
good result. In addition, the vital powers of the system must
be well sustained by liberal administration of wine, stout, beef-
tea, and other invigoratihg means. [British Med. Journal.

On some of the more Obscure Forms of Nervous Affections: their
Pathology and Treatment. With an Introduction on the Physi-
ology of Digestion and Assimilation, and the Generation and
Distribution of Nerve Force. By Harry William Lobb, L.
S. A. and M.R.C.S.E.

Mr. Lobb, in the first part of his work, advances opinions,
both in physics and physiology, which are diametrically oppo-
sed to those ordinarily received. One or two examples will
convey a notion of Mr. Lobb's matter and manner.

Adopting a system of molecular physics (which would seem
to have scarcely any other foundation than ingenuity) he makes
this the master-key with which to unlock several of the myste-
ries of physiolgy. He assumes that "the ultimate atoms of all
matter are spheroids in a state of vibration" (p. 6) ; vibration

1858.] Some Obscure forms of Xervous Affection. -*

gives rise to certain definite currents ; " currents in the spheroid
produce rotation; rotation will continue the currents; they,
therefore, contain within themselves the elements of their own
existence" (p. 8); the currents are electrical currents, and as a
consequence we have the conclusion liat, as no change
of an}" description can take place in matter without causing cur-
rents of electrical fluid, and as the combinations and disruptions
which take place during an act of growth, and which occur
through the agency of what is termed vital force, or as Mr. Lobb>
prefers to term it, cell force or cell electricity, are always accom-
panied by molecular changes, therefore, "Vital force is merely
a modification of that remarkable fluid pervading all matter and
space, always aiming at equilibrium and yet so easily disarrang-
ed" (p. 11).

Mr. Lobb's views will scarcely supersede the views of Mr.
Groves and Dr. Carpenter, the former of whom has dealt most
ably with the physical relations of electricity, and the latter
with the physiological. (On the mutual Eelations of the Vital
and Physical forces, " Phil. Trans." 1850, Part II.)

Mr. Lobb advances a theory of the formation of chyle-cells.
He states that the initial step in the formation of the cell is the
vibratory movements of certain minute crystals of phosphate of
lime. These crystals during vibration become coated with the
proteine and oily compounds of the chyle forming molecules.
44 When many of these molecules are formed, they, upon ap-
proaching one another, become attached in a line like a small
string of beads, vibration still continuing; when a certain num-
ber are thus joined, they double one upon another, forming a
nucleus, to which minute atoms are continually added until a
tolerable aggregation is the result ; this is a mass of molecules.
The external atoms now proceed to form a cell wall, which, in
this period of its existence is completely invisible : but it consists
of minute atoms, between which are still smaller interspaces,
which admit of the passage of fluids," &c. (p. 31). A sad short-
coming of this theory is the absence of all proof of the process
of formation here said to take place.

As another example of Mr. Lobb's mode of reasoning, the
following may be quoted : " Carbonic acid gas is constantly, day
and night, winter and summer, although in varying proportions
according to circumstances, being excreted by the blood in the
lungs ; the repair of tissue surely does not require this immense
waste of material. The most idle man the fat unwieldy inhab-
itant of the Eastern harem, who is afraid to move lest she should
lessen her value in the eyes of her lord by losing a portion of
her obesity, eats largely. Merely to throw off this waste from
the lungs? Surely not ; there must be a cause, and it is this.

11 The nutriment absorbed by the lacteals, converted into

758 Some Obscure forms of Kervous Affection. [November,

albumen, fibrine, and blood cells, is conveyed into the most
minute intensity of the organism by the capillaries; here the
oxygen brought by the blood seizes upon some hydrocarbon
with which to unite, giving rise to molecular change to currents
of electricity ; these currents are collected by the nerves always
accompanying the vessels, and serve lo feed the nervous system ;
at the same time, some portion correlates into animal heat, &c.
It is then to feed the nervous system that this tissue-change,
beyond that really required for repair, is constantly going
forward, and so much carbonic acid is excreted from the lungs.
It is not, then, a wilful waste, 4his apparent carbon ; on the
contrary, life could not last without it aervous energy would
lessen, the extremities and skin would get cold circulation
would become sluggish, and death eventually ensue" (p. 82).

It is certainly, a somewhat novel view to regard the cabonic
acid given off by the lungs as wasted material, seeing that that
gas is commonly regarded as a deleterious product of the decay
of some, and the metamorphosis of other tissues, and of the re-
duction of the carbon of the food, which reduction has especial
reference to the maintenance of animal heat. No question of
physiology has been more carefully and successfully investigated
than that of the sources of the carbonic acid given off from the
lungs, and its relationship to the amount and quality of food
taken, and of the degree of metamorphosis going on in the differ-
ent tissues of the body ; but Mr. Lobb appears to ignore
altogether the results of the researches on this question. Mr.
Lobb, moreover, does not seem to be aware that the electrical
conditions arising from changes going on in the intimate struc-
tures of the body, particularly in the nerves and muscles, have
been made the subject of most successful experimental research
by M. E. de Bois-Eaymond and others, and that, in consequence,
theories upon this subject which are not based upon experiment,
are neither necessary nor admissible. When Mr. Lobb makes
use of the expression " correlates into," e. g. " some portion {i. e.
of the electricity) correlates into animal heat" (p. 83) ; he betrays
a singular misapprehension of the signification of the term cor-
relation.

In the second part of his work, Mr. Lobb treats of "certain
affections of the nervous system, the symptoms of which are
obscure, and which, if not alleviated, would develop themselves
into organic degeneration, fatal disease, or insanity." He ex-
presses the opinion that the affections of which he treats depend
upon "partial paralysis of some portion of the sympathetic
system of nerves, either of their centres or their peripheric ter-
minations, thus upsetting the healthy process of digestion and
assimilation in some portion of its extended course, causing
functional derangements, nervous irritability, and frequently

1858.] Effect of Local Influences on Spasmodic Asthma. 759

sympathetic complication of the most important organs" (p. 124).
He discusses the nervous affections which accompany certain
morbid conditions of the urine, B right's disease, and diabetes.
He discusses, also, spermatorrhoea, stammering, hysteria, chorea,
and epilepsy; diet and regimen, certain medicinal preparations,
and the therapeutics of galvanism and electro-magnetism. He
adds nothing new to our knowledge of the affections of which
he treats, and his therapeutics are in great measurs derived from
the peculiar views which he entertains on the physiology of
digestion and assimilation.

That portion of Mr. Lobb's work which is devoted to sperma-
torrhoea would appear to be written rather for the public than
the profession. [Ranking* s Abstract.

The Effect of Local Influences on Spasmodic Asthma. By Dr.
Hyde Salter, Assistant Physician to Charing-cross Hospital.

The purport of this paper is to show that, in a very large
proportion of cases of asthma in which it has been fairly tried,
change of locality effects an instantaneous cure, which is perma-
nent as long as the asthmatic continues his residence in the place
that has cured him. The author remarks that, although the
subject of his paper is a single method of cure of a single disease,
yet that the efficacy and completeness of the cure, and the pain-
fulness and intractability of the complaint, vindicated it from
unimportance; and, indeed, that in so distressing and unman-
ageable a disease, any remedy that offered even a small percent-
age of cures might be considered the greatest possible boon.
The paper is illustrated by nearly thirty original cases, and the
points that the author considered to be established are as follows :

1. That residence in one locality will radically and perma-
nently cure asthma resisting all treatment in another locality.

2. That the localities which are the most beneficial to the
largest number of cases are large, populous, and smoky cities.

8. That this effect of locality depends, probably, on the air.

4. That the air that would be imagined to be the worst for the
general health is, as a rule, the best for asthma; thus the worst
parts of cities are the best, and conversely.

5. That this is not always the case, the very reverse being
sometimes so a city air not being tolerated, and an open, pure
air effecting a cure.

6. That there is no end of the apparent caprice of asthma in
this respect, the most varying and opposite airs unaccountably
curing.

7. That, consequently, it is impossible to predict what will be
the effect of any given air, but that probably the most opposite
to that in which the asthma seems worst will cure.

700 Influmce of Surgical Affections, Sec. [November,

8. That some of these differences, determining the presence
or cure of asthma, appeared to be of the slightest possible kind,
arbitrary, and inscrutable.

9-. That the mere conditions of locality appear to be adequate
to the production of asthma in a person whose disposition to it
was never before suspected, and who probably never would
have had it, had he not gone to such a locality.

10. That, consequently, probably many healthy persons who
never have had asthma, and never may, would have been asth-
matics if their lot had been cast in other localities.

1L That possibly there is no case of asthma that might not
be cured if the right air could only be found.

12. That the disposition is not eradicated, but merely suspend-
ed, and immediately shows itself on a recurrence to the original
injurious air.

13. That change of air, as change, is prejudicial.

14. That, from ^he caprice of asthma, the constancy of the
result in any given case is often deranged.

In reference to the frequency with which London air is bene-
ficial to asthma, the author remarked that he was in the habit
of putting to country asthmatics the two questions "Have you
ever been in London? have you ever had asthma there?" and
that, if an affirmative answer was given to the first question, a
negative one was pretty sure to be given to the second. In his
own experience he had found hardly any exception to this
rule. [Lancet.

On the Influence of some Surgical Affections upon Animal Heat.
By M. 1)emarquay.

M. Demarquay observes that although many observations
have been made upon the modifications of the temperature pro-
duced by internal diseases, with the exception of Hunter's upon
inflammation, and some researches upon the effects of ligatures
on large vessels, nothing has been done with respect to surgical
affections. He treated upon the subject in his inaugural disser-
tations in 1847, and since then has continued to pay attention to
it ; and the present memoir is an account of some of the results
of his observations.

The pyrexia following amputations and other operations is
accompanied by an elevation of temperature proportioned to
the amount of reaction ; but when the case becomes complicated
by other phenomena, as phlebitis or erysipelas, the temperature
may undergo notable variations. Thus, in a case of amputation,
of the thigh, followed by phlebitis and purulent affection, the
thermometer has risen from 97 or 99 to 104 Fahr.; and
although this increase may seem in itself but trifling, yet the

1858.] Influence of Surgical Affections, &c. 761

observations of Andral and others have noted but a few degrees
of elevation only, even in the intensest fevers. If, however, the
elevation of the general temperature is inconsiderable, that is
not the case with respect to the local temperature. Thus, in
phlegmon and erysipelas, comparing the condition of the afflict-
ed parts with that of the healthy ones, it has been found that
while the general temperature of the body may have undergone
a notable increase, exceeding that of the neighboring parts Dy
from 2 to 5 C. All serious wounds which produce febrile
action induce an elevation of general and local temperature, but
when the membrane covering the granulations has become well
organized, the temperature is then found to be like that of the
surrounding parts ; so that ice applied under such circumstances
would abstract normal, not morbid, caloric. Experimenting
upon dogs, too, the author has observed that the application of
ice leads to a considerable falling of the thermometer in the case
of subcutaneous wounds. The same experiments showed that
a wound that had undergone such diminution in its temperature,
quickly recovered this, and went beyond it, the temperature of
the wound thus undergoing a series of elevations and depres-
sions, according to the quantity of ice employed, and its degree
of fusion. It is evident that such a powerful modifier requires
great reserve in its employment ; and most of the Paris surgeons
reasonably prefer in the case of great breach of surface, tepid
irritations to these freezing applications. As to the temperature
in aneurisms, MM. Demarquay and Monneret have on several
occasions observed in arterioso-venous aneurisms of the lower
extremity, an elevation of from 1 to 2^ C. ; but they have
never observed a similar difference in the case of such aneurism
existing at the bend of the elbow. When in a limb, the subject
of aneurism, the circulation has undergone no considerable dis-
turbance, no important variation of the animal temperature is
observable; but when complications, such as phlegmon, are
present, an elevation of 2 may take place. After ligature of
the femoral and humeral arteries, the author has found a dimi-
nution of temperature to take place, and the experiments upon
animals which he had made with MM. Dumeril and Lecointe
demonstrate the accuracy of the assertion, that every ligature of
an important artery, performed so as to avoid all injury to the
veins and nerves, give rise to a diminution of the temperature
of the limb beyond the ligature. A priori, a considerable modi-
fication in the temperature of a limb might be expected in limbs
suffering from senial gangrene; and the author has been some-
what surprised to find only a difference of 1| or 2C. between
the two limbs, except in one case, when the difference amounted
to 5.

The following are the conclusions of the memoir : 1. Purulent

762 Absorption of Medicinal Substances. [November,

infection and erysipelas give rise to an elevation of 2 to 3 C.
2. Circumscribed inflammations, as phlegmon or local erysipe-
las, give rise to an increase varying from 1 to 5. Ice quickly
gives rise to a temporary diminution, but the parts afterwards
not only recover their former temperature, but exceed it. 3. A
true aneurism, if the limb is healthy, give rise to no change of
temperature, but arterioso-venous aneurism, and especially in
the lower extremity, increases it by 1 to 2\ C. 4. Hunter and
his school have examined into the effects of ligature of vessels
on the temperature, but have arrived at contradictory results.
From my observations it follows that ligature of the artery and
the vein in arterioso-venous aneurism of the lower extremity,
give rise to an elevation of temperature ; while when the princi-
pal artery of a limb is alone tied, there is always a diminution
of temperature. 5. In senile gangrene there is always a diminu-
tion of temperature of from 1 to 5 C. in the parts situated
above the mortification. \Comtes Rendus. and Ranking 's Ab-
stract.

On the Absorption of Medicinal Substances by the Large Intestine.
By M. Briquet.

The object of M. Briquet's two memoirs is the study of the ab-
sorption of medicinal substances introduced into the large intes-
tine by means of clysters. The following are the general conclu-
sions he has arrived at :

1. The fluid constituting the injection may easily reach as far
as the caecum, and consequently may be brought into contact
with a very large extent of absorbing surface. 2. The mucous
membrane and the fluids that bathe its surface do not exert any
chemical action upon the subslances so introduced into the large
intestine, where all that is absorbed is that which was previously
in a state of solution. 3. When a clyster of the soluble salts of
quinine, in doses less than 15 grains, is administered, rather more
than a third of the quantity so administered is eliminated, and has
consequently been absorbed. 4. When large doses are adminis-
tered, they are ill-supported, and only a fifth or a sixth of the
quantity is absorbed. 5. In whatever dose the the quinine
may have been given, it generally gives rise to cerebral symptoms
only very slowly and to a slight degree. 6. Traces of elimina-
tion and consequently of absorption are only met with an hour
after the administration of a clyster, and even then the elimina-
tion is incurable. 7. The duration of the elimination is usually
short two or three days at the utmost. 8. The greatest or less
dilution, within certain limits, the more or less viscous nature of
the liquid, or the addition of the salts of morphia to the cinchona
alkaloids do not exert any sensible modification on the absorption.

1858.] The Uses of Pain. 763

9. Absorption takes place more readily in the young than in the
adult; and is performed with difficulty in the aged of either sex.

10. The salts of quinine, administered in clysters in doses of less
than 15 grains, exert the same effect as when given in moderate
doses by the mouth, and may be very well substituted for these.

11. But this is not the case with large doses, which are never
absorbed in sufficient quantities to produce energetic effects.

12. The large intestine will rarely tolerate a larger dose than 30
grains of the sulphate. 13. These conclusions more or less exact-
ly apply to the various substances administered by clysters. 14.
The apyrexic is notably more favorable to the absorption of
medicinal substances than the pyrexic condition. 15. The
typhoid condition favours such absorption less than other states
of phlegmasia. Nevertheless it is more energetic than hitherto,
supposed, being only about a tenth inferior to the absorption
taking place in the pyrexic condition. 16. In diabetes, the ab-
sorption of medicinal substances appear to be very feeble in the
intestines. 17. In certain diseases, the tolerance or intolerance
of medicinal substances may depend upon a special susceptibility
rather than upon variations in absorption. Thus, in hysteria the
tolerance of opium nowise depends upon an absence of absorption
but results from a special susceptibility. 18. The rapidity with
which medicinal substances, such as the salts of quinine, are
eliminated, is in a direct ratio with the quantity of urine passed.
This rapidity is the exact measure of the time which the econo-
my takes to rid itself of the greater part of the fixed substances
taken medicinally. 19. The absorption of medicinal substances
analogous to the salts of quinine is far more rapid in the young.
20. It is less active in females than in males, in the proportion of
a sixth to an eighth. 21. Abstracting from a medicinal effect
the portion due to the quantity of the substance absorbed, the re-
mainder gives the measure of the susceptibility of being influen-
ced by the medicinal substance. [Bulletin de I 'Acad, and Ameri-
can Jour, of Med. Sciences.

The Uses of Pain.

Mankind are so accustomed to shrink from pain, and so eager
in seizing upon every means to lessen or annul it, that the facts
of our having been endowed with it, as with a sense, by a benifi-
cent Creator, and with the kindest intent, does not readily impress
us. Yet that this is strictly true, daily observation teaches.
Without pain to act as a sentinel, the body would almost moment-
ly be injured, perhaps hopelessly so, and Death would revel in
such wise as that the race would soon be extinct. This is hardly
an exaggerated statement ; and a little reflection will enable any

n. s. VOL. XIV. NO. xi. 44

764 The Uses of Pain. [November,

one to realize the immense amount of evil which would ensue to
us all, were the "sense of pain" abolished.

A very interesting and instructive article, in a late number of
the Quarterly Review, is transferred to the pages of the Living
Age of the 24th of April, 1858. It is a critique upon "An Essay
on the Beneficent Distribution of the Sense of Pain," written by
Mr. G. A. Kowell, Honorary Member of the Ashmolean Society,
and Assistant Underkeeper of the Ashmolean Museum. Most of
the details are familiar to medical men, but any reader will be
delighted with the pleasant style of the review, the entertaining
illustrations and the facts communicated. It is a paper calculated
to do good to the general reader in many ways ; and not the least
by the noble sentiments with which its last two or three pages
ieem. We allude to the remarks upon cruelty to animals. Many
seem now to believe, as did Malebranche, that dogs, horses, and
such like animals do not feel, and that, therefore, any amount of
abuse, by means of kicks, blows, goading and spurring is admis-
sible. We say many persons seem to suppose this, for although
they hear a dog howl if kicked, and know that a horse springs
forward under the spur, they do not realize, or do not think, how
much unnecessary pain is inflicted by them, in their gusts of tem-
per, upon animals almost always innocent of any fault.

To recur to our first topic the wonderful guardianship over
the bodily organs, so kindly established for us through the agency
of pain. How few think of the subject in this light. Accustomed
too much, to look upon pain as an unmitigated evil, we are apt
to concentrate our hatred upon it, rather than to recognize its
function ; and we strive only to remove it, without seeking for
its cause. The latter task is, it is true, mainly the province of
the followers of the healing art ; yet how much may others learn
by properly considering their own sensations.

Pain is an evil, then, but it is also a blessing. It is composite
in its essence ; and in this it resembles many medicinal agents,
which, whilst effecting a certain good, are exceedingly unpleasant
in their action. Of course it would be foolish to term pain a good
in itself, and therefore not seek to relieve and remove it. The
future Sir Humphrey Davy doubtless changed his opinion very
quickly and permanently, untler the strong personal application
of the argument implied in the story referred to by the Quarterly
Review, in the opening paragraph of the article we have cited.
" Sir Humphrey Davy, when a boy, with the defiant constancy
of youth which had as yet suffered nothing, held the opinion that
pain was no evil. He was refuted by a crab, who [which ?] bit
his toe when he was bathing, and made him roar loud enough to
be heard half a mile off. If he had maintained, instead, that pain
was a good, his doctrine would have been unimpeachable. Un-
less the whole constitution of the world were altered, our very

1858.] The Uses of Pain. 765

existence depends upon our sensibility to suffering." As the re-
viewersays, " without the warning voice of pain, * * * the crab
might have eaten off the future Sir Humphrey's foot while he
was swimming, without his entertaining the slightest suspicion
of the ravages which wTere going on." So he adds. " had he sur-
vived the injuries from the crab," he would have been destroyed
by continuing the inhalation of carburetted hydrogen, after it
had almost caused his death, and yet saved him by inducing
painful sensations.

The preservation of infancy is alluded to by the reviewer, as
often entirely due to physical pain. Of course, in the absence
of parents or nurses, thousands of children would perish from
mere lack of that experience which suffering gives them by de-
grees.

Another phase in the "beneficient distribution of pain" is the
undoubted total absence of it in what is termed the last struggle.
Dissolution is painless ; the agony has been distributed over
other hours of existence; the sunset of life, like those of many a
stormy natural day, are placid, most generally. The opinion,
however, is still commonly entertained that there must be pain
whilst the spirit is leaving the body, because of the occurrence of
convulsive movements remarked at such times. The suffering
is only apparent, not real. What a consolation to friends is this,
and what a source of comfort to all poor mortals, who know that
they must pass through the gate of death. Upon this point the
reviewer says : " In fact, though disease is often painful, the act
of dying is not. Bodily suffering would be no protection then,
and, consistently with the invariable method of Providence, we
are spared a useless anguish."

Anaesthetic agents, which have been so mercifully revealed to
us, and whose discovery is certainly the greatest boon to humani-
ty since that of vaccination, have been questioned in regard to
one of their applications, by eminent medical men. We refer to
their employment in obstetric cases. There are those who con-
tend that the pains of labor, being, in fact, natural and healthy
demonstrations, ought not to be interferred with ; that they have an
important part to play and that they have such uses as ought
not, even partially, to be lost to the parturient woman. Whilst
many decry this view as foolish and unfounded, we confess to
seeing much truth in it. There can be no dispute as to the bene-
fit of ether and chloroform in surgical operations, or their appli-
cation for the relief of any pathological condition ; but childbirth
is not a pathological state, but wholly a natural act. It may
well be questioned how far we ought to interfere with what are
termed its " pains." Of course, if the woman in labor begins to
sink under their mere endurance, or any morbid element mingles
with the process, our authority is at once established, to inter-

766 Analysis and Principles of Human Excrements. [November,

pose the state has become pathological. But often, anaesthetics
are used in short and easy labors, when the patient would have
done as well, or even better, without them. We can refer to
several instances in which labor has been undoubtedly retarded
by the action of ether on the uterine efforts ; and within a few
days, a case has been mentioned to us by a highly intelligent and
observing medical friend, where this was distinctly proved. The
labor was a first one, and the birth was delayed a long time without
any apparent reason. The suspension of the inhalation of
ether was advised by the gentlemen referred to, and on comply-
ing with the suggestion, the uterus immediately resumed its efforts,
which safely and speedily resulted in the expulsion of the child.

This aspect of the use of pain deserves closer attention, and it
may be well to sift obstetric cases more thoroughly ; using anaes-
thesia, only, or chiefly, in such instances as really demand it.

We have already extended our remarks beyond the limits we
had assigned to them. Pain, as an evil, has of late been placed
more than could ever have been hoped for, under the dominion
of scientific medicine. As a good, it still is vouchsafed to us in
the shape of a watchful guardian ; and it must be ever present
on the earth in many forms and with every shade of intensity. It
is only in the vision of the Revelation that we read, " and there
shall be no more death, neither sorrow, nor crying, neither shall
there he any more pain. [Boston Med. and Surg. Jour.

On the Analysis and Immediate Principles of Human Excrements
in Disease. By Dr. Marc^t, F. R. S.

The object of this communication is 1. To describe an easy
and very practical method of analisis to be applied to feces in
the diseased condition. 2. To show that the method of analysis
in question is essentially anatomical or mechanical, and as free
as possible from chemical reactions. 3. To show that in three
instances of disease where the bile was prevented from flowing
into the duodenum, the feces yielded a quantity of crystallizable
fatty acids, (margaric and stearic acids,) which immediate princi-
ples are known to be absent from healthy evacuations, except in
certain cases depending on a peculiar diet. A few words may
suffice for describing the analysis. The evacuations are exhaust-
ed with boiling alcohol, and the solution strained through muslin.
On cooling, a precipitate or deposite occurs in the fluid, which is
separated from the mother liquor by filtration. This deposite,
after it has been washed with boiling alcohol, is found in healthy
cases to consist of stearate and margarate, or soaps of lime and
magnesia, with or without earthy phosphates these compounds
existing in the evacuations under examination in the form of im-

1858.] Analysis and Principles of Human Excrements. 767

mediate principles. #The alcoholic washings or solution obtained
from the deposit yielded, in case of retention of bile ; considera-
ble quantities of free margaric and stearic acids The clear
original alcoholic extract being mixed with miik of lime, contain-
ing a considerable excess of water, is converted into muddy fluid,
when a distinct precipitate will be noticed. After having collect-
ed this precipitate in a filter, washed it with water, and dried it
on the water-bath, it is to be exhausted with a mixture of alcohol
and ether. The clear extract thus obtained deposits on standing,
in all healthy cases, impure crystals oi excretine ; a substance
easily purified and prepared, perfectly colorless, by repeated crys-
talizations in alcohol and filtration through animal charcoal. The
author had previously described the characters of excretine in
communications to the Royal Society, published in the " Philoso-
phical Transactions" for 1850 and 1S57. Diseased excrements
do not always contain excretine, as it was absent in those*cases
referred to in the present communication, where it was searched
for. The lime precipitate exhausted with alcohol and ether, is
now to be mixed with water, and decomposed by means of hvdro-
chloric acid ; chloride of calcium is formed, and an insoluble* sub-
stance remains floating in the liquid ; this he has found very
abundant in some diseased cases and also in a few exceptional
instances after a vegetable diet ; it consisted of margaric and
stearic acids mixed with a considerable portion of oleic acid.
Finally, by concentrating the filtrate from the lime precipitate on
the water-bath, and decomposing the residue with sulphuric acid,
certain organic acids soluble in water are obtained, possessed of
a very pungent odor, and whose properties have not vet been in-
vestigated ; the castings of carnivorous animals yield in this stage
of the analysis butyric acid, a substance not present in healthv
human evacuations. It must be remembered that the animal
body contains a number of organic acids forming known soluble
salts with lime, and consequently the examination of the filtrate
from the lime precipitate in diseased cases is not to be neglected.
The above description, although necessarily most incomplete,
gives a rough sketch of the processes recommended for the analy-
sis of feces ; it has been put to the test for the examination of a
very great number of human evacuations, and found to yield con-
stant results in health ; it is, therefore, perfectly adapted for the
investigation of the composition of diseased excrements. Dr.
Marcet now wishes to draw the attention to the circumstance
that chemical reagents have been used as seldom as possible in
these analyses, in order to avoid the decomposition of immediate
principles or of compounds, such as they exist in the body.
Alcohol and ether, with and without the application of heat, are
the principal means employed.* It is not impossible, however, to
determine immediate principles by chemical analysis ; and a

768 Statistics of Tracheotomy. [November,

remarkable instance of the aid obtained from chemistry in these
investigations, is the fact, that by the analysis of the mass deposi-
ted in the original alcoholic extract of feces on cooling, he has
been able to ascertain that it contains phosphoric acid, fatty acids,
lime and magnesia, exactly in such proportions as are required
for the substances to combine in the form of earthy phosphates
and earthy soaps. These compounds had, therefore, previously
existed in the intestines in the form of immediate principles. Dr.
Marcet then gives the detail of three cases in which he carried
out his exaninations. [Proceedings of the Royal Med. and Chir.
Society, and Banking's Abstract.

Statistics of Tracheotomy.

Tfce statistics of the operations of tracheotomy performed
during a number of years at the Hopital des Enfans at Paris,
where the effects can be observed upon an extended scale, must
always be interesting and valuable. In former years we have
frequently entered into practical details on the subject. We now
quote from the Journal of Practical Medicine and Surgery the fol-
lowing statistics relative to the operations of tracheotomy per-
formed during the eight years just elapsed.

The following is the list of these operations from 1850 through
1857, with the number of cures obtained:

1850 20 operations -

185131 " ...

185259 " ...

185361 " ...

185445 " ...

185548 " ...

185655 " ...

185771 . " ...

6

recoveries.

12

<<

11

7

(

11

<<

10

14

<(.

15

<

Total, 390 86

It will be seen by the above table, that the proportion of reco-
veries, although very unequal in the several years, presents a
very similar general average ; that is, from 1 in 4 to 1 in 5 of
the whole number operated on yearly. It should be mentioned
that the majority of the children operated on were in the last
stage of croup, and were consequently in imminent danger of
death.

M. Guersant, in whose wards this estimate was prepared, gives
the following summary of the indications for and against trache-
otomy, based upon the age of the children, the existing complica-
tions, &c.

Age is an important element to be considered. Amongst the

1858.] Statistics of Tracheotomy. 769

cases which compose the above table, there is one of a child 18
months old, who died with convulsions during tracheotomy. M.
Chaillon, the author of the article cited by us from the Journal
of Praitkal Medicine and Surgery, states that, he saw. on the 7th
of January last, a little girl of two and a half years die during the
operation, notwithstanding the well-known skill of the surgeon.
He had also seen a similar case in private practice the patient
being also a girl less than three years old.

Nevertheless, whilst the peculiar difficulties of tracheotomy in
subjects under the age of two years are admitted difficulties as-
cribable to the restricted relations and volume of the parts at that
age ; to the dangers of a minute, long and delicate dissection; and
especially to the small size and mobility of the trachea, which
often allow of the insertion of the tube only with extreme difficul-
ty M. Guersant does not consider the youth of the patient an
absolute contra-indication to tracheotomy.

The same is true as regards pneumonia, when it complicates
pseudo-membranous croup. For a long time, says M. Chaillon,
the existence of this complication was thought sufficient wholy to
contra-indicate tracheotomy. At present, M. Guersant adopts
the opposite opinion ; and he has become convinced that, in es-
tablishing respiration by an artificial track, he has favored the
resolution of the pneumonia. He admits but one decided contra-
indication to opening the trachea in croup and that is, diphthe-
ritic infection, or general diphtheritis. When a child whose
vocal chords have been invaded by false membranes, exhibits at
the same time similar morbid products in the nose, the ears, or
upon the skin ; when there are attacks of epistaxis and every
sign of extreme debility tracheotomy will be useless ; the child
will invariably die.

M. Guersant does not, moreover, consider the extremest degree
of asphyxia an insurmountable obstacle to the success of the ope-
ration, provided the condition is permanent, and has continued
for at least an hour, with a persistent character.

Slow and continued asphyxia is, indeed, the very state which is
the chief indication for tracheotomy, according to M. Guersant.
It is, then, the only thing to be done the restablishment of res-
piration being that alone which can keep the child alive.

There is a sort of asphyxia which does not so imperatively call
for the operation viz., the intermittent form. M. Guersant has
seen children making violent efforts to breathe and seemingly
about to die instantly ; false membrane having been discharged,
the nature of the disease was certain. Notwithstanding, the
friends having opposed the operation deemed necessary by the
surgeon, the usual means were employed such as eme^jcs, calo-
mel, alum, and chlorate of potash and the patients have recover-
ed. But with the exception of these rare instances and of the far

770 Watery Discharge from the Uterus. [November,

more common cases of general diphtheritis, M. Guersant thinks
that as a general principle, tracheotomy is distinctly indicated
whenever there is continued and increasing embarrassment of the
respiration. [Gazette des Hqpitaux, and Boston Med. and Surg.
Journal.

Watery Discharge from the Uterus During Pregnancy.

Dr. Harvey made the following remarks on this affection at
a meeting of the Cork Med. and Surg. Soc, Dec. 9, Vobl: "In
some books on Midwifery, watery discharge from the uterus is
noticed as amongst the diseases to which pregnant women are
liable. A clear, limpid, colourless fluid, oozing in quantity
from a few ounces to pints daily, flows away, sometimes stopping
for a short time, and recommencing; and in the majority of
cases it continues nearly, or full to the time of delivery. The
abdomen does not appear palpably reduced by these discharges,
and a living child is commonly born at or near the full time.
In the greater number of instances, also, there is evidence of the
usual quantity of liquor amnii being present on the supervention
of labor. Dr. Alexander's case, given in the third volume of
the Medical Commentaries, shows this very prominently. In a
case by Dr. Petel, also, in the Gazette de Bojjilaux of July, I808,
the liquor amnii is specially mentioned as normal in quantity.

"What is the source of this fluid, discharged as it is, to the
amount of hundreds of pints in the course of a few months ?
The supposition of its coming from the cervical glands of the
uterus, or from the vagina, both of which have been assumed as
sources of it by different authorities, appeared altogether unlike-
ly from the nature of the fluid, its quantity, and its mode of:
coming away in gushes of considerable quantity at a time.
That it could come from the. space between the decidua and
chorion, or between the chorion and amnion, we have no
pathological facts, so far as I am aware, to warrant our suppo-
sing such a source for the flow ; whilst in the natural condition
of parts such spaces do not exist; as, at a period of pregnancy
before these discharges commonly show themselves (say the
sixth month, or thereabouts), the cavity between the chorion
and amnion has disappeared ; and we know that the chorion
and decidua are in contact throughout.

" Under these circumstances we seem driven to the conclusion
that the amnion must be the source of this flow ; that there may
be occasional solution of continuity in this membrane, admitting
of discharges from time to time, which either close again,
or admit by the mechanical relations of the bag to the
neighboring parts of the amnion, refilling to a certain extent by

1858.] Watery Discharge from the Uterus. 771

a fresh secretion of its particular fluid. In confirmation of this
view may be mentioned cases recorded by Dr. Denman, Profes-
sor Burns, of Glasgow, and Dr. Pentland, of Dublin, in which
the amnion is said to have given way from fright or other
sudden shock, the water being discharged without labour coming
on. All these considerations tend rather to the view that the
escaping fluid may be liquor amnii than to any other which has
been propounded. In the case which I am going to relate the
symptoms were similar to those which were present in the cases
of watery discharge which I have been noticing, and in this in-
stance, as will be seen, the flow was undoubtedly amniotic.

"Mrs. , mother of several children, was for more than

a year, the subject of heavy sanguineous discharges, which were
so little influenced by the treatment adopted thai the existence
of polypus was thought possible. An examination revealed
considerable congestion of the os and cervix uteri, with superfi-
cial ulceration, which gave way to treatment generally and
locally applied. During last summer her health was considera-
bly improved, but occasionally menorrhagic attacks, which lat-
terly observed more or less closely the monthly periods, showed
themselves. Matters were going on thus when she suffered a
considerable shock by her eldest boy meeting with a severe acci-
dent, in which his arm was fractured. On that day, for the first
time (six weeks before deliver), she had a sudden gush of clear
watery fluid from the vagina, and since that time to the date of
these notes (5th November), she was scarcely free from it ; it
would diminish or nearty stop for a few days at a time, to come
on again in gushes, and in considerable quantity. The quantity
escaping in one of these was seldom less, and generally more,
than half a pint; and on the late occasion, when the flow was
accompauied by a heavy sanguineous discharge also, she thinks
the combined amount was fully a quart. It came on in the
horizontal position as well as in the erect, and apparently with-
out any cause. The size of the abdomen did not appear much
affected by these at any time.

"The occurrence of the watery discharge suggesting the
probability of pregnancy, notwithstanding the menstrual changes
which had been going on with some regularity, and that, if
pregnancy did exist, the ovum might have suffered hydatid de-
generation, I proposed an examination for the purpose of ascer-
taining the point. I found an abdominal tumour occupying
the hypogastri urn to above the umbilicus, and on laying my
hands over its surface, it gave a good example of the value of a
diagnostic indication lately suggested by Dr. Oldham ; it afford-
ed distinct evidence of its being uterine by gradually and
regularly hardening under my hand. The movements of the
' child were also felt, and foetal pulsation, distinctly heard by the
stethoscope, put an end to all doubts.

772 New Remedies in Yellow Fever. [November,

" I told the lady that she had passed some six or near seven
months of her pregnancy without being aware of it, and that
her labor would probably come on prematurely, all of which
she entirely disbelieved, and I could not induce her to make
the necessary preparations. Two days after, I was called to her
the first stage of labour having set in with unusual distress
and irritation ; the pains peculiarly sharp and unbearable ; the
os uteri was hard and unyielding, and the breech, presenting in
the second position, was felt in close contact. I immediately
put her on antimonial solution, notwithstanding which the os
uteri took over three hours to relax. After a first stage of about
four and a half hours, and a second of less than half an hour,
a male child, of scarcely seven months' growth, was born. The
presenting hip and buttock were perfectly black, evidently from
the direct pressure to which they had been subjected, in con-
sequence of the loss of the liquor amnii. None whatever
escaped with the child, and the sanguineous discharge was also
unusually scanty. I do not think I ever witnessed so dry a
labour. [Dublin Quart. Journ. Med. Sci., and Amer. Jour. Med.
Science.

New Remedies in Yellow Fever Chlorine and Veratrum Viride.
By E. D. Fenner, M. D.

Up to the present time, the treatment of yellow fever may be
said to have been almost entirely empirical or based on expe-
rience alone ; but empiricism may work on till doomsday and
in the hands of skillful practitioners, achieve great success, yet
fail to satisfy the demands of the inquiring -and philosophic
mind. Science alone can do this ; by which I mean a knowledge
of the morbific cause and an explanation of its modus operandi
in the production of all the phenomena of the disease, as well
when it terminates in recovery as in death. In ignorance of
these fundamental desiderata, the practice must necessarily be
empirical like one groping in the dark, who might stumble
upon a jewel, but at the same time be liable to fall into a pit a
thrust with a dangerous weapon by the looker-on of a personal
combat, equally liable to strike friend and foe. By observation,
much valuable knowledge has doubtless been attained, and
likewise, great skill in practice has been acquired from experi-
ence ; but all this is still unsatisfactory and incapable of being
taught or transmitted to those who are to come after us.

Various plans of treatment and all sorts of remedies have
been resorted to in yellow fever, but neither plan nor remedy
has ever yet attained universal approbation and acceptance.
Cases have been known to recover under every plan, and others

1858.] New Remedies in Yellow Fever. 773

to die in spite of every known remedy ; but the most important
fact of all is, that persons may recover from the disease without
any treatment at all a problem full of instruction, but as yet,
remaining unsolved.

Of all the remedies for this disease that have gained notoriety,
the following four are the only ones that have been supposed
to exert a special action on the morbific cause or materies morbi,
viz: mercury, quinine, salines and the tincture of the muriate of
iron. The virtues of all the rest, such as emetics, cathartics,
diaphoretics, diuretics, blood-letting, counter-irritants, etc., are
attributable to their generally known therapeutic action.

Of the four remedies just named, not a single one has suc-
ceeded in commanding general confidence in the powers claimed
for it. Mercurial ptyalism is no longer relied on as a protection
against the danger of yellow fever; the introduction of salines
into the system for the purpose of counteracting the morbid
changes of the blood, has been tried in vain ; the once vaunted
powers of quinine are fading away, and the tincture of iron has
fallen into probably unmerited neglect, after a brief but brilliant
career.

A correct theory is absolutely necessary to scientific and suc-
cessful practice; and the plrysician, if there be one, who has no
theory, is a mere empiric. In a case of yellow fever, we see a
contest between the inherent conservative powers of the body and a
lethific agent ; be it a poison, a ferment, animalcule or vegetable
cryptogam. In the course of this conflict, we may suppose that
one or more of the following occurrences will happen: The
morbific agent may be only capable of causing a perturbation
or disease which can be overcome by the conservative powrers
of the system, with or without medical aid ; or it may be so
powerful as to defy the conservative powers as well as any
known remedies, and prove inevitably fatal. 2. It may be neu-
tralized in the system by remedial agents, in the way that cer-
tain poisons are disarmed by certain known antidotes. 3. It
may be eliminated from the system by the emunctories, or secre-
ting and excreting organs. 4. By the disturbance of the func-
tions which it produces, it may cause the retention of elements
in the system which have fulfilled their legitimate purposes and
can no longer be retained with impunity ; thus adding fuel to
the destructive fire that is already raging.

The physician's theory of each individual case, based on its
history and sj^mptoms, will direct his practice towards the
accomplishment of one or more of the above objects. If nature
is doing all that is necessary, of course he will not interfere;
but when she appears to be unequal to the task, it becomes his
duty to render such assistance as the indications of the case
appear so clearly to point out.

774 New Remdies in Yellow Fever. [November,

Here we might pause and inquire, what, that is really beneficial,
has as yet been discovered ? and wherein, lie the principal de-
fects of our practice in this disease ? The answer to these
questions would require a critical review of all the various plans
and remedies that have been resorted to in the treatment, of
yellow fever ; a task which we have neither time nor space to
perform at present.

The foregoing remarks have been thought necessary as a pre-
lude to the introduction of two new remedies in the treatment
of yellow fever, which, so far as a limited experience can testify,
promise to fulfil in a most satisfactory manner, three of the most
important indications, viz : 1. The controlling of excessive
febrile excitement : 2. Maintaining the free and continued action
of the great eliminating organs, the skin, liver and kidneys:
3. And consequent thereon, the preservation of the integrity
of the blood and tissues. These remedies are chlorine, and Nor-
wood's iinclare of Ycrairum Viride.

I brought myself to the experiment of chlorine by reflecting
on the course and nature of this fever, and the want, long felt,
of something that is capable of neutralizing the action of the
morbific cause, or of assisting the efforts of nature to eliminate
it from the system. Secondly, by recollecting the happy effects
of the muriated tincture of iron which I witnessed in the
epidemics of 1854 and 1855. Thirdly, by the flattering testi-
mony in favor of chlorine in malignant scarlet fever, to be found
in Watson's Lectures; and lastly, by the therapeutic action of
chlorine and the chlorate of potass, as recorded in Pereira's great
work, and other late writers. I resolved on using the chlorine
mixture mentioned in Watson's Lectures, p. 1002, third Ameri-
can edition. The plan adopted was, first to purge the patient
moderately with castor oil or some other simple cathartic, and
bring on free perspiration by means of the hot mustard foot
bath, warm orange-leaf tea and covering with a blanket ; then
to give to an adult two table-spoonfuls of the chlorine mixture
every two hours.

My first experiments succeeded beyond my most sanguine
hopes, and every casein which it was timely applied, excepting
one, recovered in a most satisfactory manner. The medicine
sat well on the stomach, but occasionally caused griping, which
disappeared on omitting it for five or six hours or reducing the
dose to a single tablespoonful. Under its use the febrile excite-
ment soon declined, headache disappeared, and the kidneys and
liver acted freely. The dose was diminished or the interval
prolonged as the fever went down. In most cases, no other
medicine was given till the end of the third or critical day, when
the chlorine was stopped and I gave what is called here the

1858.] New Remedies in Yellow Fever. lib

Sydenham Mixture, composed of the phosphate of lime and gum
arabic suspended in equal parts of orange-flower water and dis-
tilled water. The bowels were kept open by enemata, as occa-
sion required, and the patient was allowed to drink orange-leaf
tea and barley water ad libitum.

In this manner, I had treated some eight or ten cases with
satisfactory success, and was applying it to all my cases, both in
private practice and the Charity Hospital, when I happened to
meet one of the most extensive practitioners of our cit}', who
stopped to relate to me a very extraordinary case he had just
been attending. He then asked me whether I had ever tried
Veratrum Yiride in yellow fever? I told him I had not, but
had long intended to do so. He begged me to try it in the
Hospital, as he did not like to experiment on patients in private
practice, yet felt the necessity of our endeavoring to find out
some more valuable remedies than any we now have. I promised
him to make the experiment very soon, and we parted. On the
same day, I learned through the newspapers, that Dr. White
and another physician of Charleston, had met with very extra-
ordinary success in the treatment of yellow fever with the Vera-
tum Viride. In the evening, I went to the Charity Hospital
for the purpose of commencing my experiments with this medi
cine. This was on the 20th instant.

In Ward 16, (under my charge), I selected three cases, two
of which had entered since my morning visit.

Case 1 Was a fine young Irish sailor, aged 16, who had ar-
rived here from Liverpool only five days previously, and was
attacked this morning; entered the Hospital at 5 P. M ; had
taken a mustard foot-bath and a dose of castor oil, which had
moved his bowels freely. He had headache, injected eyes, skin
very hot and sweating; great thirst; pulse 120. Ordered cold
applications to head, orange-leaf tea, and five drops of [Norwood's
tincture V. V. every three hours.

September 21st. Found patient sound asleep and sweating
freely, eyes less injected, headache much relieved, tongue moist;
less thirst, pulse 100. Continued the V. V. every four hours.

5 P. M. Very quiet, but pulse up to 112.

September 22d. Cool, quiet and moist, pulse 88. Found
the urine acid, but not coagulable. Continue treatment ; move
bowels by enema.

September 23d. Cool and quiet ; rested well and apparently
convalescent; pulse 70. Stopped the Y. V. and allowed chick-
en water. On testing the urine, found it albuminous.

On the 25th, the patient had slight exacerbation of fever in
the evening and took neutral mixture, tablespoonful once an
hour. Urine more albuminous.

September 26th. Patient does not improve ; has exacerba-

776 Neio Remedies in Yellow Fever. [Novsmbei,

lions in the evening; bowels open, sweats moderately ; urine
now highly albuminous and bilious ; threatened with haemor-
rhage from gums. Put him on my chlorine mixture, tablespoon-
ful every four hours.

27th. Has slight haemorrhage ; is improving.

28th. Kested well : is cool, quiet and hungry. Now fairly
convalescent.

Case 2. Young Irishman, aged 19, was attacked on the
morning of the 19th September, 'and went immediately to the
hospital. I saw him at my morning visit and prescribed hot
mustard foot-bath, and a dose of castor oil. After the bowels
are well purged, to take two tablespoon fuls of the chlorine mix-
ture every two hours. On the morning of the 20th he was
doing well, and ordered to continue the mixture.

At my evening visit I resolved to put him on the V. V.,
and found his condition as follows: Considerable fever; skin
hot and rather dry ; pulse 100 ; tongue white, with red edges,
and moist; considerable thirst; pain in the head and back;
bowels rather loose and uneasy. Ordered five drops of the V. V.
every three hours and the chlorine mixture immediately.

September 21st. Much better; face and eyes less injected;
skin cooler and sweating freely; pulse 72 ; headache relieved;
has some pain in the back ; thinks the chlorine gripes. Ordered
to prolong the interval of the Y. Y., and to take less of the
chlorine. His urine is acid but not coagulable.

September 22d. Completely relieved ; clear of fever and pain ;
pulse down to 72 ; is quite hungry ; urine acid but not yet
coagulable. He continued to improve steadily, and was dis-
charged at his own request on the morning of the 26th. His
urine was then beginning to show albumen.

Case 3. Was a German aged about 30. Entered hospital
this evening, September 20th, in the second stage of the disease,
(third day), having been vomiting and purging from the com-
mencement of the attack. He was very weak ; eyes much in-
jected; headache; sweating; tongue moist; still vomits; pulse
100 and feeble. Wishing to see the effects of the Y. Y. in a
desperate case, I prescribed five drops every three hours; sinap-
ism to epigast.

September 21st. Pulse 80; skin cool, moist and of deep red
color ; had no pain ; attempts to vomit ; very thirsty ; urine
abundant, acid and highly coagulable. At noon his pulse was
clown to 54 : has hiccup ; stop the Y. Y. 5, P. M., hiccup
checked. Contrary to orders he got out of bed and the hiccup
returned. He lingered till the 23d and died. He passed urine
to the last day, and it was highly albuminous.

In reflecting on these first cases, it appeared to me that case
one, had such a lingering convalescence from the want of some-

1858.] New Remedies in Yellow Fever. 777

thing besides the veratrum. This medicine had displayed its
wonderful power of subduing febrile excitement, but there was
something wanted to act upon the blood, liver and kidneys;
that the rapid convalescense of case two, was probably due
in some measure to the good effects of the chlorine mixture he
took for about thirty hours ; and that case three, could hardly
be expected to recover after removal to a considerable distance,
in the second stage of the disease.

From that time I have continued to use these two remediesin
nearly all cases that have come to my charge in the first stage,
and at the hospital in all stages while there was febrile excite-
ment. I directed the remedies to be taken alternate^, at inter-
vals of two hours, i. e., first the veratrum, and two hours
afterwards the chlorine ; and so on till the febrile excitement is
sufficiently reduced, the pulse of the adult brought down to 70
beats in the minute, when the former is stopped, but the latter
continued in small doses. Previous to giving these medicines,
the bowels should be well evacuated, but not severely purged.
Subsequently, they may be kept sufficiently open by enemata.
Sweating should be promoted by mustard foot baths, warm teas
and covering with one or two blankets. Yellow fever patients
are frequently sweated too severely, but I have hardly ever
mown one to do well without maintaining a good perspiration
for three days.

It is proper that I should mention some of the troubles that
may arise in the use of these remedies, for there is no medicine
that possesses great remedial powers without being likewise
capable of doing injury if improperly administered.

The Veratrum viride, as is well known, is a very powerful
medicine and liable, when taken in excess, to produce great
prostration of the vital powers. It should therefore be very
cautiously given, and its action watched with the utmost care.
There should be a considerable interval between the doses, so
as to allow time for the medicine to display its effects. It will
surely reduce the frequency of the pulse and febrile excitement
enerally ; but if carried too far, it produces alarming prostra-
tion, great restlessness and a peculiar wild delirium, all of which
will pass off in a few hours and may be relieved by a little pare-
goric and brandy. I have never heard of its producing fatal
affects, although it has recently come into very general use in
ill parts of the country as a remedy in pneumonia and typhoid
fever. The dose I have directed is of course intended for adults,
ind must be varied according to the age of the patient. It
should be stopped gradually after the pulse falls to 72; and the
-emainder of the cure left to the chlorine mixture, with such
idjuvants as the particular case may require.
In respect to the use of the chlorine mixture, I have as yet

778 Antagonism of Opium and Quinia. [November,

met with no other trouble than the occasional griping before
mentioned, which has never proved at all serious. This medi-
cine certainly acts finely on the liver and kidneys. My experi-
ence with this remedy as yet only covers some twenty-five or
thirty cases, an extent too limited to justify any farther remarks
at this time.

In offering these hasty observations to the profession, at the
present time, I beg leave to say that my only object is to call
attention to some new remedies which I have reason to hope
will prove to be highly beneficial in the treatment of this terri-
ble Southern pestilence, and to allow physicians residing at
places where yellow fever is now prevailing, the opportunity
to test their virtues at once. This, I hope, they will do at once,
and let us know the results of their observation at their earliest
convenience.

In conclusion, I must be permitted to say, that if the veratrum
viride should ultimately turn out to be as valuable a remedy in
yellow fever, as it unquestionably is in pneumonia and tj^phoid
fever, Dr. Norwood will be entitled to ihe meed of being ranked
among the greatest benefactors of mankind. [New Orleans
Med. News and Hospital Gazette.

The Antagonism of Opium and Quinia. By M. Gubler.
[Translated by J. P. Barrot, M. D.

M. Gubler read a paper before the Societe Medicale des Hopi-
timx de Paris, on the antagonism between Opium and Sulphate
of Qninia, of which the following is a synopsis condensed from
the summary published in UL> Union Medicale," of May 20,
1850. Being unwell himself, M. Gubler took sulph. quirria in
0.50 centigrammes doses only and was struck with the fact that
they produced humming in the left ear only, although his hear-
ing is equally good on both sides. This peculiar effect occurred
three days in succession. As at that time he suffered from a
head-ache which was most violent on the right side on which
side it is always greatest in M. G., he was led to suppose that
the evident congestion on the right side, neutralized the effect
of the quinia, which effect M. G. considered due to the privation
of the brain of blood, (anemier Vencephale decongeetionner le cer
veau) the removal of congestion of the brain. M. G. having re
covered his health, resumed his attendance in the wards of the
Hospital. He there saw a case of acute articular rheumatism
in which large doses of sulph. quinia and opium had beer
administered for several days without success. M. G. continued
the dose of sulph. quinia i. e., 1 gramme 50 centigrammes witl
0.25 centigrammes extract of opium. Finding that the particu

1858.] Antagonism of Opium and Quinia. 779

lar therapeutical effects of both remedies were entirely wanting,
he increased the dose of sulph. quinia and diminished that of
the opiate, without, however, any better success.

Lastly, he left out the opium altogether, and gave 1 gramme
50 centigrammes of sulph. quinia alone, which produced in a
marked manner, the peculiar remedial effects of that drug. And
from that time the rheumatism diminished rapidly and marked-
ly. This and other subsequent cases of the same nature, con-
firmed him in his belief that opium was antagonistical to sulph.
quinia, or, so to speak, its antidote.

M. Gubler enunciates his particular views of the modus operan-
di of opium and sulph. quinia. According to him, opium pro-
duces congestion and hyperemia, whilst its antagonist, sulph.
quinia, produces anaemia and dissipated congestion (anemie et
decongeslionne).

The following are the conclusions of M. Gubler : 1. Inverse-
ly to opium, which exalts organic action, producing sanguine-
ous congestion and caloricity, sulph. of quinine acts on the
nervous system by condensing the forces there, in such a way
as to arrest organic action, the source of waste, and to diminish
as much as possible the afflux of blood in inflamed parts. (Sic).

2. This modus operandi once admitted, we can readily under-
stand the innocuousness of sulphate of quinia in the cerebral
symptoms of rheumatism, which symptoms recent experiments
have already tended to show were not due to its use.

3. Moreover, the use of sulph. quinia is indicated in all the
inflammatory forms of cerebral rheumatism; opium being ser-
viceable in the nervous forms only, and in these only when not
complicated by fever.

4. Sulph. of quinine and opium, being antagonistic should
not be given together.

5. These two remedies may be used as antidotes to one another.
M. Guerard thought that sulph. Quinia did " decongestionner le

cerveau" and stated in support of his opinion, that its use produ-
ced imminent synchope. Some years previously, while suffer-
ing from intermittent fever, he had taken large quantities of
sulph of quinia, sometimes for a month at a time, in a single
dose daily. As long as he remained in the recumbent position
lie experienced no unpleasant sensation, but when sitting,
syncope was imminent. He had seen a second similar case.

With respect to the antagonism of opium to sulph. of quinia,
he was the more ready to believe it, inasmuch as in his tklse de
concours for the Chair of Therapeutics, he had shown that the
effects of medicines when isolated might be neutralized by com-
bination ; and had mentioned that M. Caventou had given
strychnia combined with morphia, each in large doses, and that
the effects of the combination had been greatly diminished.

H. S. VOL. XIV. NO. XI. 45

780 Subcutaneous Operation on Varicose Veins. [November,

Substances which are poisonous by themselves, cease to be so
when united.

Note by the Translator. The conclusions of M. Gubler, on the antagonism of
opium and sulph. of quinia, although endorsed in a measure by M. Guerard, fail
to convince us. Further trials on a more extended scale, would show the correct-
ness or incorrectness of his views. Should his opinions turn out to be correct,
quite a revolution would take place in the administration of sulph. of qunine in
this city, where either from fashion or e'onviction, it is most generally given in
combination with opium. The Haustus Quinice of the Charity Hospital, which
has done so much service, would then have seen her last day.

[New Orleans Med. and Surg. Jour.

The Subcutaneous Operaticnx on Varicose Veins. By Mr. Henry
Lee, Surgeon to King's College Hospital.

When blood is effused into the cellular tissue in the living
body, it undergoes changes varying in different cases. Some-
times it is simply absorbed, leaving the surrounding parts as
they were before ; sometimes the fibrin becomes separated from
the more fluid parts of the blood, and remains after these are
removed. Again, the effused blood may remain contained in a
kind of sac, of a dark grumous color, for weeks or months ; or
finally, it may undergo a process analogous to that of suppura-
tion, and be discharged, more or less deprived of its coloring
matter, as from an abscess. Blood that remains for any length-
ened period stagnant in veins undergoes somewhat similar
changes. It may be deprived of its serum, and its more solid
parts may remain, obstructing the veins for almost an unlimited
period, or it may become dark and grumous, undergoing a kind
of slow decomposition ; or again, in the fibrin previously separa-
ted from the other constituents of the blood, cell development
may take place, and an abscess will form in the vein.

In the various operations which have from time to time been
practised for the obliteration of varicose veins, the effused and
stagnant blood has eccasionally either undergone a kind of de-
composition, or has become involved in an abscess; and when
the products of these changes have become mixed with the
blood, it is now well known with what fatal certainty their
presence is manifested. The occasional, although rare occur-
rence of the symptoms, now recognized as those of blood-poison-
ing, after operations on the veins, had led surgeons from time to
time to seek for modes of operating which should be free from
the dangers previously experienced.

In 1815, Sir Benj. Brodie published a paper in the "Medico-
Chirurgical Transactions," in which he advocated the subcutane-
ous division of varicose veins. In that paper, the advantages of

1858.] Subcutaneous Operation on Varicose Veins. 781

the subcutaneons mode of operating are clearly pointed out. (A
description here followed of Sir B. Brodie's mode of performing
the operation.) In this mode of operating, no adequate provi-
sion is made against hemorrhage frbm the divided vessel on the
one hand, nor against the absorption through the open mouth of
the vein of the products of the effused or stagnant blood on the
other. If a vein be simpty divided, no one can tell exactly how
much blood will be effused ; and if effused in quantity, the
changes above mentioned will occasionally take place. These
changes may occur either in the blood outside the vein, or in
the stagnant blood still within the vessel, or the action may be
communicated from one of these to the other. The product of
these changes may be localized by the unassisted powers of
nature ; the vein may be closed, so that no absorption through
its canal can take place. In like manner, an artery, when divid-
ed, may spontaneously cease to bleed ; but nevertheless surgeons
are not fond of trusting to these unassisted powers of nature.
In one case, as in the other, that which may take place from
natural causes may be with tolerable certainty effected by arti-
ficial means. The vein, like the artery, may be safely and
efficiently closed. If this be carefully done before an enlarged
vein is divided, the effusion of blood is in the first instance pre-
vented, and there is proportionately less risk of any of the mor-
bid changes which have been referred to ; and secondly, even
should such changes take place, the products of such changes
are prevented from entering the circulation through the wounded
vein.

Such were the considerations which induced Mr. Lee in the
year 1853 to try a new mode of performing the operation of
subcutaneous division of varicose veins. The plan then adopted
was to place a needle under the vein both above and below the
part to be divided. A ligature was then placed over the needle
in each situation, and allowed to remain for a couple of days.
At the expiration of this time the blood was usually coagulated
in the vein, which would be felt as a round soft cord on either
side of and between the needles. The vein was now divided by
subcutaneous iucision, and two days later the needles were re-
moved. After three or four more days the parts usually had
the appearance of having united b}~ the first intention, and the
patient was allowed to go about his usual occupation. In his
first attempts to perform this operation, he could not say that
his success had been quite such as he could have wished, and
indeed expected. One case in particular had some severe local
and constitutional symptoms; and he had reason to believe that
an abscess had formed in the vein, where it had been traversed
by one of the needles. Eeflecting subsequently on the cause of
this, he became convinced that the origin of the mischief was,

782 Different Effects of Gaseous Injections. [November,

that the needle had pierced the vein instead of being made to
pass fairly under it. In subsequent operations this point was
attended to, and performed with due precaution, as it has now
been by Mr. Erichsen, and various other surgeons, a great num-
ber of times, and it has not, so far as Mr. Lee was aware, been
attended with danger. During the last twelve months a further
improvement, as he conceived, had been effected in regard to
this operation. The vein is divided as soon as the needles have
been placed under it. The subcutaneons incision heals in about
the same time as in the other operation, and the confinement of
two days previous to the section of the vein is avoided. In this
operation the blood which the vein contains between the two
needles is allowed to flow out of the incision ; and thus any ten-
dency that there might be for stagnant or effused blood to de-
compose is avoided. In performing the operation in the man-
ner now described, the blood contained in the veins between two
needles escapes ; the sides of the vein necessarily fall together,
and are maintained in apposition. The sides of the vein com-
pressed by the needles and ligature suffer no violence or injury.
The subcutaneous incision is pretty sure to heal by first inten-
tion, and even should it not, the vein being closed above and
below, no diseased secretion can find its way along its channel.
Various cases were given to illustrate the different modes of
producing obliteration of veins by subcutaneous division.

British Med. Jour., and Banking's Abstract

The different effects of Gaseous Injections into the cellular tissue and
into the peritoneal cavity. By J. C. Shapakd, M. D.

M. M. Laconte and Demarquay communicated a memoir to
the Academy of Sciences at its meeting of the 29th of March,
1858, on the pathological, physiological, and chemical phenom-
ena produced by the injections of air, azote, oxygen, carbonic
acid, and hydrogen into the cellular tissue and into the perito-
neal cavity.

From facts contained in this memoir, the authors conclude :

1. That air, azote, oxygen, carbonic acid, and hydrogen, do
not produce any hurtful effect when they are introduced into
the subcutaneous cellular tissue or into the peritoneal cavity.

2. That all these gases are absorbed after a longer or shorter
time, and with a rapidity which varies from forty-five minutes
(carbonic acid) to many weeks (azote). The rapidity of the
absorption is always presented in the following manner: carbo-
nic acid, oxygen, hydrogen, air and azote.

3. That the injection of any gas whatever into the cellular
tissue or into the peritoneum, constantly determines an exhala-
tion of the gases contained in the blood and the tissues.

1858.] Suture of the Exterior Tendons of the Fingers. 783

4. That after the injection of the gases, mixtures are formed
that are more easily absorbed than the least absorbable gas con-
tained in the injected part. So that the absorption of this last
does not commence only when it is already mixed in certain
proportions with the other gases.

5. That, in general, the exhalation of the gases of the blood
or of the tissues, has been more considerable in the the experi-
ments made during the digestion, than in those made during
fasting, and more in the peritoneum than in the cellular tissue.

6. The rapidity of the absorption has not seemed modified by
the state of fasting or digestion.

7. That of all the gases injected, hydrogen is the one which
determines the most considerable exhalation of the gases of the
blood when the hydrogen has already disappeared from the
mixture, the animal still preserves the volume that it presented
at the moment of injection, which would induce the belief of
nonabsorption of hydrogen, if a chemical analysis did not ex-
plain the phenomenon.

8. The rapidity of the absorption of the gases by the blood
is not always in proportion to their solubility in water (azote
and hydrogen).

9. If in the injections of air into the cellular tissue and into
the peritoneum there is a constant absorption of oxygen, and
exhalation of carbonic acid, which in this respect, resembles the
phenomenon of pulmonary respiration, the two physiological
facts should, nevertheless, not be considered as identical, for in
the case of the injections, the proportions between the carbonic
acid axhaled and the oxygen absorbed constantly vary.

[Nashville Jour, of Med. arid Surg.

Suture of the Extensor Tendons of the Fingers, with a Case of Cure
by this Treatment. By M. MouRGUE.

Suture of the small tendons, like the extensors and flexors of
the fingers, is a triumph of modern surgery ; and the happy
results which have followed its use have given it a place among
legitimate operations. The case of M. Mourgue adds another
instance of success to those already recorded.

Case. A maker of wooden shoes" received on the back of his
left hand, on the 10th of December, a blow of a hatchet, which
divided the extensor tendons of the fore and middle finger at
the metacarpo-phalangian joint. The lower ends presented at
the wound, but the upper were retracted tendons, allowed them
to be seized by forceps and pierced by a needle armed with a
waxed thread ; this needle was then passed through the corres-
ponding ends of the tendons below, and they were thus brought
into contact with those above, and tied. The external wound

784 Editorial. [November,

was also closed with sutures. The hand was extended on a
wide flat splint, and the wound covered with a linen bandage
spread with cerate, and compresses wet with cold water.

12th. There is considerable swelling of the wrist and great
redness ; it is necessary to remove the sutures from the wound.
In a few days the inflammation subsided.

20th. The wound, which is open, but free from redness and
inflammation, is in good condition. The edges were brought
together with sticking-plaster.

The ligatures of the tendons came away on the 24th and 26th ;
the external wounds cicatrized at once. On the 8th of January,
the splint was dispensed with.

Jan. 22d. The man has resumed his work, the Angers having
gradually recovered their strength and mobility, and having
complete power of extension and flexion. In a word, the
suture of the extensor tendons has been attended with all the
success which could be desired. [Gazette Medicate, and Boston
Med. and Sur. Journal.

EDITORIAL AND MISCELLANEOUS.

EDITORIAL REFERENCE TO OUR ECLECTIC DEPARTMENT.

Quinine and Alum in Diphtheritis. We have here* collected in a
body, a number of articles on a most interesting and sometimes fearfully
fatal form of disease. As we have seen, it most commonly prevails epi-
demically though sporadic cases are referred to. Our object in thus
bringing together, in the compass of a single number, various accounts of
both the character and treatment of membranous sore throat, is, that our
readers may have these accounts to refer to, when, in their practice, such
histories may become of particular interest. We are struck with the
remarkable uniformity in the character of the disease, in all the descrip-
tions presented from various sources and also, by the entire absence
of any mention of certain modes of treatment which, in our experience,
have been of the greatest practical value which, indeed, have proved
almost specific, in the latitude which bounds our practice.

Just ten years ago, (in the year 1848,) Augusta and its vicinity, toge-
ther wTith several other sections of the State of Georgia, were afflicted
sorely by the incursions of an Epidemic Diphtherite, the history of which
has never been written. It is not our design to write its history now,
but simply to refer to some of the peculiarities which the disease pre-

* See pp. 747-'? 56, present number.

1858.] Editorial 785

sented during its prevalence here at that time, and to give a summary of
the treatment pursued.

The year 1848, in its meteorological character, presented nothing
very unusual in this region. Late in the autumn, when intermittent
fever was prevailing perhaps to a greater extent than in the earlier
part of the year, we suddenly observed, among children, certain cases
of this unusual form of "sore throat." Our attention was not call-
ed to the first cases until the disease had advanced so far, that remedial
measures were unavailing. The fatal croup had supervened, and the two
or three first cases soon died without undergoing any modification from
the treatment applied. "We were thus early made painfully aware of the
serious nature of the affection with which we had to deal, and whenever
called early, treated the cases vigorously upon such a plan, as our little
personal acquaintance with the affection could devise. Notwithstanding
the opportunity afforded by early attendance, the disease rapidly pro-
gressed in most of these cases, and several of them died, on the super-
vention of the croup.

Our description of the cases which occurred in Augusta, will not, we
think, differ very widely from that found in several of the articles pre-
sented to our readers from the various journals. In a few cases the
attack was preceded by premonitory symptoms, as restlessness at night,
slight fever and loss of appetite, but seldom with any actual soreness of
the fauces which induced the child to complain. More frequently than
otherwise, the parent or physician would have the attention arrested by
a peculiar, offensive odor in the breath, even before the child had evinced
any symptom whatever of any ailment; when, on looking into the
mouth, the tonsils and larynx would often be found covered with the
white, curdy-looking deposit, peculiar to this form of disease. On
closer examination, the upper part of the larynx, the nares, even as far
forward as the opening of the nostrils, would be found covered with the
same matter, which spread itself in the form of a membrane* over the
whole surface of the mucous lining of these more external parts of the
air-passages. Often, at this first examination, a croupal hoarseness could
be detected, which too plainly indicated the extension of the disease into
the larynx. The cases in which the affection proved most fatal were, as
may be seen in most of the accounts given of it elsewhere, children
under twelve years of age, and death seldom transpired here, in any other
way than from the croup.

The condition of the subjacent mucous membrane was often the
6ubject of our careful inspection. Excellent opportunities were afford-
ed us to examine the state of both the false membrane and the
mucous membrane, during the life of the patient, by those cases in

786 Editorial. [November,

which the deposit existed in the nostril ; for in them, it often extended
forward to the very junction of the skin and mucous membrane, and we
could compare the appearance of the three surfaces as they lay in regular
order of super-position viz.,* skin, next mucous membrane, and lastly,
the false white deposit the skin, even immediately bordering upon the
two other membranes, seldom evinced any change, but the subjacent
mucous membrane was invariably red, to nearly its entire thickness, and
seemed to be the seat of a certain kind of inflammation while the false
membrane was perfectly white and seemed to have no vascular connec-
tion whatever with the mucous surface. In a few days the first layer of
the deposit would be elevated and loosened by the effusion of pus under
it and them it was easily separable from the mucous membrane. . In
the pharynx it would be often found hanging from the posterior wall,
and even from the velum, in the form of a white ragged curtain. While in
a certain fatal case which we examined, the child evidently died at the
moment of, and directly in consequence of, this kind of separation of the
false membrane from the walls of the larynx, the shreds blocking up the
rima and producing death by suffocation. The case appeared to us, to
die in getting well. Doubtless, many have died in exactly this stage, of
what may, in one sense, be called a natural process of recovery.

We had many cases among the adult population, but not a single fatal
case over twelve years of age indeed the nearer the child approached
to infancy, the more imminent, in our mind, was the peril from the croup.
From a close observation of many cases comparing the cases of the
younger children with those occurring in youths and adults, we came to
the conclusion that the greater fatality among young children was not
due so much, to any greater susceptibility to the disease, nor to a less
power of resistance on the part of the patients of this age ; for many of
our most violent cases occurred in children over twelve years of age,
whose constitutions were comparatively feeble, and yet they went through
even the -croup, and recovered. The circumstance which, in our opin-
ion, decided the fate of the patient, for death or for recovery, was of a
purely mechanical nature a question simply of space space to breathe.
The little advantage in the calibre of larynx which the older children
possessed over the younger ones, was certainly the determining accident
of their recovery. The deposit on the inner surface of the larynx varied
but little in its thickness : it occupied as much space, absolutely, in a
large windpipe, as in the smaller ones, but then the smaller ones could
not afford this space, and suffered complete, or at any rate, a fatal occlu-
sion. We are very confident that the above is the true explanation of
the marked influence which age appeared to exercise over the result of
the disease.

1858.] Editorial 787

In a recent communication to the American Medical Association,*
the nature of Diphtherite became incidentally the subject of discussion,
and although we cannot here, without inconveniently extending our
remarks, define our belief, or present arguments in its behalf, we yet
state that we regard diphtherite as a disease which is eminently
under the control of the nervous system, which underlies and governs
its phenomena in such a manner, that it is impossible to deny its
recognition in all our deliberations upon the nature of this affection.
We do not deny the ground which many, doubtless, will take, that the
disease is essentially, a peculiar vitiation of the blood, as is clearly mani-
fested in its observed phenomena; but from our own observation, which
has been ample, this blood affection, or toxaemia, specially affects the
pharyngeal plexus of nerves, aberrating the influence which they exer-
cise over the circulation and secretions of the pharynx, larynx and
trachea, and metamorphosing their normal mucous exhalation into an
effusion which forms the material of the false membrane of diphtherite.

In the earlier part of our epidemic, the disease was seldom marked
by fever, and only local remedies and such as would be rationally sug-
gested by the special symptoms presented, were applied ; but later, a
few cases were accompanied with decided fever. This fever was inter-
mittent, and was found to aggravate the local symptoms very decidedly.
Along with the local treatment previously applied, quinine was freely
administered to those patients, in order to control the fever, and to our
surprise, not only was the fever arrested, but the extension and progress
of the membranous deposit was promptly arrested with the breaking up
of the fever. From this marked influence of quinine upon the disease,
we were induced to apply it in every case, whether fever presented or not ;
our mode of giving it was the following: From 5 to 15 grains of quin-
ine, according to the age of the child, was given in divided doses, during
the earlier part of each day, for several days ; and no less in the apy-
rexic than in the few pyrexic cases, did the quinine appear completely
to control the progress of the affection. Seldom, after the free use of
quinine, in the earlier part of the attack, did we ever find the disease ex-
tending into the larynx and producing the croup. In addition to the
quinine, we frequently advised, in the beginning, a mild cathartic, con-
taining from 5 to 8 grains of calomel, but if called later to the cases, this
was omitted.

The local remedies applied here were numerous nitrate of silver,
both in weak and strong solution, was freely used by many : our own
experience with it was not such as to induce us to recommend it. Dr.

I* Report on the Nervous System in Febrile Diseases, WftshiDgtoD, D.C., May '58.

788 Editorial [November,

L, A. Dugas lias the record of many cases which illustrate the value of
strong hydrochloric acid, locally applied, in our epidemic. Pulverized
alum (sulphas aluminae) was the local application used by Dr. J. A. Eve,
and by several other of our practitioners, with much success. This last
was the only local remedy applied by us. The method of using the
remedy, was the following : The alum was first ground in a mortar to
an impalpable powder occasionally it was mixed with a small proportion
of sugar. This was blown against the posterior wall of the pharynx five
or six times a day, through a reed or glass tube. The most advantage-
ous mode of applying it, was to press the end of the tube upon the mass
of pulverized alum, so as to engage a considerable quantity of the pow-
der have the child properly held by an assistant, and then with a spoon
or speculum, press down the tongue, and directing the tube rather down-
wards, blow the powder strongly against the posterior wall of the pharynx.
If the tube were directed upwardly, the alum was liable to get into the
posterior nares and give the child much pain, and cause it to resist the
subsequent applications.

Time nor space does not allow us at present to dwell upon the advan-
tageous results of the above treatment of Diphtherite, nor upon the
peculiarities of the disease as it presented itself in Augusta.

In perusing the many accounts of epidemics, in various parts of the
world, which have recently appeared in journals, we have, with much
interest, sought for the results obtained from the use of quinine, applied
in the manner we have herein hastily described ; but we have found
quinine but rarely mentioned at all, and only in one of those accounts
but incidentally, and not much importance attached to the results of the
treatment. Having experienced such beneficial results from the treat-
ment, we are now induced to record our views, hoping that it may be
found valuable to those of our readers at least, who may have to con-
tend with an epidemic of this insidious but terrific affection in a South-
ern, or a malarial region.

Medical and Physiological Commentaries. By Martyn Payne, M, D.,
A. M., &c. Vols. 1 and 2, octavo, pp. V 16 and 816. 1840.

Essay on the Modus Operandi of Medicines. By the same author.

In a former notice, we called attention to the great value of this dis-
tinguished writer's contributions to the medical literature of our country.
No less now, are we impressed with Dr. Payne's commendable industry,
indefatigable labor, and also, with the value of their results, than when
we reviewed, a few months since, " The Institutes of Medicine," from
his distinguished and prolific pen. Leaving out of sight, that difference

.858.] Editorial 789

>f sentiment and belief, which must necessarily exist among medical
nen, of the present age, on such long contested questions as Humoral-
sm and Vitalism, no one can read the works of Dr. Payne, without
:onceding to him. the opinion that, in him, the one has met its most
myielding and able opponent, and the other, a most ardent, learned and
>owerful advocate.

His volumes all evince an amount of erudition and thorough aequaint-
mce with the history of medical science, which render his works valua-
)le, together with their other points of interest, as a rich repertory of
nedical facts and opinions, collected with much judgment and discussed
vith great acumen and fairness. But these are far from being the most
>rominent recommendations of the volumes before us. In an age when
lumoralism has become ultra, and the influence of the nervous system
s somewhat overshadowed and obscured by modern chemical doc-
xines which are doubtless, in great part, true in themselves, Dr. Payne's
jarnest advocacy of Vitalism, which we are free to admit, is itself ultra,
proved a valuable defence to the true and more conservative doctrines of
nedicine. His urgent appeals for this Vitalism and strong arguments
igainst Humoralism, catch the ear and arrest the attention of the pro-
fession: and it has begun to be admitted, that though Humoralism may
t>e true, as the majority has heretofore firmly believed, yet the nervous
system and its influence upon the animal economy, may also have at least
\ modicum of truth.

In the volumes before us, the authors considerations are embodied
under the following heads, to each of which it will be seen he has devo-
ted much thought and a goodly number of pages: 1st. "The Vital
Powers," 119 pages; 2nd. '-The Philosophy of Blood-letting," 264 pa-
ges; 3rd. u The Humoral Pathology," 332 pages which completes the
contents of the first volume. During those three extended essays, he
applies observation, research and able reasoning to each department of
his subjects, and examines them not only as they exist now, but as they
are found recorded from the earliest history of medicine to the time at
which the author's commentaries were written, 1840.

In volume 2, we have 78 pages devoted to " Animal Heat," 44 pages
on the " Philosophy of Digestion," with an Appendix of about 20 pages,
on "Spontaneous Generation," 74 pages on 4' The Theories of Inflamma-
tion" ; while the body of the volume, 426 pages, appears to be devoted
to the " Philosophy of Venous Congestion." A paper on the " Compara-
tive merits of the Hippocratic and Anatomical Schools," together with
a review of the writings of Louis, serve to complete the second volume
of the work.

The Pamphlet, mentioned at the head of this notice, is a series of

790 Editorial. [November,

"Essays on the Philosophy of Vitality as contradistinguished from
Chemical and Mechanical Philosophy ; and on the modus operandi of
Remedial Agents." This pamphlet constitutes a part of the third vol-
ume of the M Commentaries," and fully sustains the character of the two
volumes we have had the opportunity of examining.

A System af Human Anatomy : General and Special. By Erasmus
Wilson, F. R. S., author of " The Dissector's Manual," " A Treatise on
Diseases of the Skin," etc., etc. A new and improved American, from
an enlarged London edition. Edited by William H. Gobkecht, M.D.,
Professor of Anatomy in the Philadelphia College of Medicine, Fellow
of the College of Physicians of Philadelphia, etc. With 397 illustra-
tions on wood. Philadelphia: Blanchard k Lea. 1858. Pp.616
octavo. (Through H. D. Norrell, Augusta, Ga.)

The great practical value of Wilson's Anatomy, as a manual for the
student, the practitioner, and for all who may desire to become acquaint-
ed with the subject, is too well attested by the unprecedented success of
the work, and the universal verdict in its favor, to render recommenda-
tion necessary. The present edition is greatly enlarged, and its value
much enhanced by numerous new illustrations. "The extensive addi-
tions made by the hand of the author, in successive revisions, are indica-
ted by the fact, that it contains fully one-fourth more matter than the
previous American edition, rendering a smaller type, and an enlarged
page, necessary to keep the volume within a convenient size."

The work has heretofore been edited by Dr. P. B. Goddard, but the
present edition bears the name of Dr. William H. Gobrecht well
known, both as a teacher of Anatomy and as the Editor of works in
which he has creditably labored. His valuable initial chapter is an
introduction which early bespeaks the interest and attention of the read-
er for the balance of his labor upon his author's work. We have ever
commended Wilson's Anatomy, without hesitation or reserve, to stu-
dents of medicine, and the present edition only increases our approbation.

1

I-.

Lectures on the Principles and Practice of Physic. Delivered at King's
College, London, by Thomas Watson, M. D., Fellow of the Royal Col-
lege of Physicians, late Physician to the Middlesex Hospital, and for-
merly Fellow of St. John's College, Cambridge. A new American,
from the last revised and enlarged English edition. With additions
by D. Francis Condie, M. D., Fellow of the College of Physicians of
Philadelphia; member of the American Philosophical Society, etc., etc.
With 185 illustrations on wood. Philadelphia: Blanchard & Kea.
1858. 8vo., pp. 1224. (Through H. D. Norrell, Augusta, Ga.)

Although we have not room for even a full notice of the above work,
we yet call attention to it, and will dwell upon it more fully hereafter.
This is truly a splendid edition of a splendid work on the Practice off:

1858.] Editorial 791

Medicine. It comes to us just in time for the opening sessions in the
various Colleges. The English work costs eight or ten dollars. This
improved American copy only three or four. Dr. Condie has added
largely to its value, and has adapted it well, to the various diseases as
they prevail in all parts of our widely extended country. This notice is
intended particularly for the students in our own and other Colleges.
We shall review the work more fullv in our next issue.

The Nashville Record of Medical and Physical Science. The
face of a new acquaintance is ever agreeable and interesting to us ; but
with far more interest and pleasure do we contemplate the countenance
of old and familiar friends friends, too, concerning whose fate we had
felt somewhat uncertain. The breaking up of the offices of our two
valued exchanges, the Memphis Medical Recorder and The Southern
Journal of the Medical and Physical Sciences, by the removal of their
respective editors to Nashville, certainly, suggested the inquiry What
is to become of our interests ? The question has been promptly an-
swered the temporary silence of the two parties has been occupied, it
appears, in business-like, matter-of-fact courtship, which has resulted in
the happy marriage of the worthy couple, and the comely offspring
greets us in the Nashville Monthly Record. The name of Professor
Daniel F. Wright is familiar to our readers, and not less so is that of
Professor Richard 0. Curry. We wish them, in their congenial and
j well-assorted union, even more happiness and success than they enjoyed
as separate journalists.

Medical Journal of North Carolina. The two first numbers of
this valuable bi-monthly are before us. Its original, eclectic, editorial
rod miscellaneous contents fully assure us that the old North State has
?aked up in medical matters to some purpose, and suggest the idea,
hat it may, ere long, not only overtake, but outstrip some of her sisters,
nrho had taken a long start of her. The editor of this new comer to our
sanctum is Edward Warren, M. D., son of Dr. Edward C. Warren, one
>f the Vice-Presidents of the American Medical x\ssociation. Our new
jonfrere is well known to the Profession as the successful essayist in a
Recent contest for the Fiske fun*d prize. His subject was, we think,
The Influence of Pregnancy upon Tubercular Development."
It affords us pleasure to place the North Carolina Medical Journal
ipon our list of exchanges, and we will endeavor to enrich our own
_-s from its valuable fund. It is published bi-monthly, at Edenton,
{ tforth Carolina, under the auspices of the State Medical Society.

792 Editorial and Miscellaneous. [November,

American Dentists in Europe. There are, we believe, from twelve to
eighteen American dentists engaged in practice at the present time in
the different parts of Europe, and all, so far as we have been able to
learn, are receiving the most flattering encouragement. There are two
in London, one in Manchester, three or four in Paris, one in Berlin, one
in Rome and one in Madrid. There are also others whose places of resi-
dence we do not know, and every year adds to the number. We have
recently learned that Dr. F. Fuller, of Portsmouth, N. H., intends visit-
ing Europe in a few months, but whether he goes merely for purposes of
pleasure or with a view of practicing his profession abroad, we are not j
informed. A gentleman of his intelligence and professional capacity
will scarcely fail to meet with a kind receptiou from the members of his
j3i^ession on the other side of the Atlantic. We wish him a pleasant
trip and safe return. [American Journal of Dental Science.

We, too, have a friend among the American dentists in Europe. Dr.
J. W. Spear, formerly a practitioner in this place, but more recently of
New York, has, we understand, removed to England, where, we are
gratified to learn, he is much pleased with the encouragement he has
received. We sincerely wish him that full amount of success which his
urbane manners, gentlemanly bearing, and fine professional abilities are
so well calculated to secure him.

The Cauterization of Strictm-es of the JVasal Canal, by means of Cat-
guts impregnated with a solution of Nitrate of Silver. By Dr. Raw,
Professor of Medicine at Berne. Ten years ago I conceived the idea of I
employing this means for cauterizing contracted or indurated canals ; I
first made the experiment on the Eustachian tube, and afterwards on the
urethra, and on the nasal canal. Process: The cat-guts are cut into
pieces of convenient length, polished at one extremity which is smooth-
ed with a very fine file, then washed in a solution of potash to free them
from the oil which they contain. They are afterwards plunged into a
strong solution of nitrate of silver (1 part to 10 of distilled water), from
which they are taken at from four to eight hours, according to their
thickness ; they are then dried by suspension in the open air in a dark
place. If the cat-gut is left too long in the solution it will become twist-
ed and distorted. After drying, the surface and the interior are satura-
ted with crystalized nitrate of silver. Should there be any inequalities
they must be removed by the file. The pieces of cat-gut thus prepared,
are* preserved in blackened glass-tubes. In course of time the color oi
the cat-gut becomes darker, without the curative effect being weakened.

When we wish to use these cat-guts in strictures of the nasal canal,
they are flattened at the upper extremity so that they can be applied
and fixed to the fistulous orifice at its outlet. After performing some
abstergent injections the cat-gut is introduced, without the coat of oil
until it becomes strongly pressed in the contraction. At first thepatiem
experiences scarcely any pain, and that which he feels afterwards has
never been so great as to compel me to withdraw the cat-gut before th<
lapse of twenty-four hours. If the irritation is not too great, introduc<

1858.] Miscellaneous. 793

every day a new cord, after having previously injected with fresh water,
or what is better, a solution of sulphate of copper. After the second
trial we perceive that we may increase rapidly the diameter of the cords.
When the irritation becomes too great, which rarely occurs, we intro-
duce cat-guts, not nitrated, nntil the irritation ceases. "When the canal
is sufficiently dilated throughout its extent, and the secretion has lost its
purulent character, it is well to wear for some time a leaden nail, before
allowing the fistulous opening to close. The strictures of the nasal canal
not caused by an anomaly of the osseous duct, heal by this method in a
few weeks, while we know the other methods often require several
months. I have also in several cases successfully used the solution of
sulphate of copper. [Charleston Med. Jour, and Rev.

Facial Neuralgia Cauterization of the Helix. Our readers will per-
haps remember the singular treatment proposed in Sciatique which
consisted in cauterizing the helix with iron at a white heat. However
strange this process may appear there can be offered in its favor a certain
number of well established cures, and it is by no means abandoned by
practitioners, although in truth the failures have been thus far quite as
numerous as the successes. The same means have just been employed
in Facial Xeuralgia, by Dr. Texier, who has published in the Moniteur
des Hopitaux, a communication on the subject. Dr. T. had seen the
process applied in this affection by Professor Jobert de Lamballe, and he
resolved to repeat it on the first occasion. A youn<r woman had suffered
for six weeks with intolerable pains on the right side of the head and in
the lower jaw : she had had no rest, and at times experienced inordinate-
ly painful exacerbations. M. Texier effected with the instrument at a
white heat, the cauterization of the helix at the moment when the pain
was at its maximum. The patient uttered a cry and began to weep,
then shaking her head as if to see whether she had been dreaming, she
declared herself entirely free from pain. The cure was permanent.

Another yonng woman was for two months troubled with a trifacial
neuralgia on the left side, for the cure of which various expedients had
been tried in vain. The pain in the jaw was so severe as to render mas-
tication impossible, and she lived only upon soups and milk. The cau-
terization of the helix was quite as successful in this case as in the pre-
ceding.

A third observation gave precisely the same result. But M. Texier
informs us that this process does not always succeed; very far from it,
since with eight patients he effected only one cure. It seems that to
apply the method with any confidence of success the neuralgia should
be fixed and without complications. Cauterization, reserved for cases in
which the affection is, so to speak, idiopathic, without any particular
character but a violent, steady pain in the course of the trifacial, may
become a valuable resource, and we ought to be the better satisfied
thereat, because in general such cases are the most difficult to manage,
as science possesses little more than uncertain and too often inefficacious
beans of controlling them. [Jour.de Med. et de Chirurgie, and lb.

Convulsions of Children. Irrigating the head with cold water is con-
iridered by Dr. Lalesque an excellent remedy in convulsions of children.

794 Miscellaneous

Paralysis of the Facial Nerve. An interesting case of this disease
has been reported by Professor Hohl, of the Lying-in hospital, at Halle.
It occurred in a new-born child that had been removed from the mother
by the aid of forceps. The pressure of the left blade upon the side of
the head induced a paralysis of the facial nerve which resisted all treat-
ment. In consequenee of this, the child was prevented from drawing
the milk from the mother's breast, since all the fluid ran out of the cor-
ner of the mouth on the paralyzed side. Nothing could be swallowed
until it was placed within the grasp of the muscles of the pharynx. The
child died on the twelfth day of inanition. [American Journal of Dental
Science.

Treatment of Threatening Mammary Abscess. R. Linseed oil, one
oz., Honey, flour, do. To be stewed over a slow fire, at a moderate heat,
until the flour has become converted into a paste, and completely incor
porated with the honey and oil. While warm add to this one ounce
of camphor, ground into a fine powder, with a little sulphuric ether or
strong alcohol. Mix the camphor with the paste intimately, and spread
a plaster on a piece of cloth or cotton ; apply this to the inflamed breast,
and keep it on night and day until relief is obtained. It is well to take *
the plaster off every morning, and sprinkle about a drachm of finely pow-
dered comphor over it ; then re-apply as before.

(Dr. Wilkinson, of the parish of Plaquemine, speaks in high terms of
the above application in the early stages of milk abscess, or rather in
cases where the inflammation of the mammary gland threatens to termi-
nate in an abscess. If applied in the forming stage of the affection, he
assures us it will seldom fail, especially when assisted by suitable con- *{
stitutional treatment. [New Orleans Med, and Surg. Jour.

k
It
b;
A
it

Tetanus Dr. Winston in the Nashville Journal, speaks favorably of
heroic doses of opium in traumatic tetanus. He relates several cases in
which that agent was employed to advantage, by beginning with one
grain of morphia and increasing the quantity with each paroxysm.

Hemorrhage. Hemorrhage of the temporal artery may be arrested
easily, by using a common tailors' thimble and applying a compress over
it. Hemorrhage following the extraction of a tooth, may be relieved
by cutting a piece of dry sponge into the shape of a cone, and inserting
it into the cavity, making the patient close his jaws at the same time.
Hemorrhage from sloughing can be arrested by the local application of
ergotine.

Anus, Prolapsus of. Dr. Demarquay condemns Blandin's method of
excising a portion of the sphincter, and simply removes a portion of the
mucous membrane, using the galvano puncture in connection with it.

Mammary Abscess. The extract of Belladonna spread upon a linen
cloth in the form of a plaster, and applied to the breast, is highly recom-
mended in this disease.

[North, Carolina Med. and Surg. Journal.

SOUTHERN

MEDICAL AND SURGICAL JOURNAL

(NEW SERIES.)

Vol. XIV.] AUGUSTA, GEORGIA, DECEMBER, 1858. [No. 1!.

ORIGINAL AND ECLECTIC.

ARTICLE XXVII.

4.n Essay on the Physiology of Menstruation. By Eben Hillyer,
M.D., of Eome, Gra. (Read before the Medical Society of the
State of Georgia, at the annual meeting in Madison, April,
1858, and ordered to be printed.)

The function of menstruation has always been a subject of

Quch discussion among physiologists. Its nature, the causes

yhich bring it about, and the purposes which it subserves, in

he female, have never been clearly understood. There exists

auch difference of opinion, among scientific men, upon all these

i >oints, and there is no theory which has yet been advanced,

rhich has received the entire support and approbation of the

1 rofession ; so that it cannot be said that the physiology of

i lenstruation is established upon any definite theory.

Menstruation may be defined to be a sanguineous discharge
\ *om the uterus of the human female, accruing generally at
>f lonthly periods, and continuing from three to six days : it is
Dnsidered to be peculiar to woman. The females of other an-
il nals are supposed to be in an analogous condition during the
A eriod of heat, except that they do not have the discharge. We
re told that there is an exception in a certain species of ape ;
m some, this exception is not admitted they believe it to be a
3jmp]e flow of blood from the rupture of some small vessel of
Le vagina, or uterus, and that it is not true menstruation.

N.S. VOL. XIV. NO. XII. 46

796 Hillyer on the Physiology of Menstruation. [December,

From the accounts given us of the discharge in the ape, it is
very probable that this animal is an exception with the human
female, to the usual course of things, during the period of ovu-
lation. Its early, or late appearance, depends much upon the
climate, the constitution, the habits, and the hardness of living,
to which the girl may be subjected. Those accustomed to a
luxurious life, to an abundance of nutritious and stimulating
food, sleeping upon down-beds, and in warm rooms, etc., will
menstruate much sooner than one, who has endured hardships.
In the one, the female is hurried on to maturity, as in the hot-
house plant, under similar circumstances ; in the other, from
her mode of life, the privations she undergoes, etc., the discharge
is delayed, as are also other developments, which are signs oi
her near approach to womanhood. Her reading of exciting
books of romance, and an early association with the opposite
sex, will tend to cause her to be early in a condition to men-
struate. In warm climates, girls have this function to come or
much more early than in a temperate or more northern latitude
In Greece, we are told, that girls are subject to this evidence o
maturity at eight or ten years of age. As we proceed north
the more do we find the function postponed. In Lapland, it i
said, that it does not appear until a mature age, and that ii
some far northern latitudes, it only occurs in the summer, ano
then is very slight, and continues only for a little while. Oj to
the other hand, in a more southern region, it is much more pre
fuse, and lasts for a longer period. In this latitude, the age
which girls usually begin to menstruate, is between the ages o &
fourteen and fifteen.

At the first period of menstruation, there is a very decide
change in the constitution of the female. Her color is mucjtr
improved, her cheeks are flushed, her countenance more anin
ated and expressive. There is a decided change in the chara
ter of her conversation. She ceases to be amused with hcjie
dolls, and other childish playthings. Her sympathies are moi
easily aroused. Her affections more strongly exhibited. H
whole intellectual nature becomes peculiarly sensitive, and ir.
prcssible. Her form is more graceful, the contour of her liml
is more perfect; her breasts expand, her voice becomes mo
harmonious, clear and distinct. With some, the discharge tak

I

::

1858.] Hillyer, on the Physiology of Menstruation. 797

place without any premonitory symptoms, but generally, it is
indicated by a train of unpleasant feelings, which announce its
approach. For some time previous, the female is troubled with
a sense of weight, pain, a bearing-down in the pelvic region.
The vascular system is disturbed, and there is a determination
Df blood to the head, and to the mammae.

The quantity of the menstrual discharge is also governed
much by the habits, and station in life, of the individual. The
amotions and passions of the mind will affect it; stimulating
liets and drinks', or the use of a warm foot-bath, will increase it,
as will any cause which tends to produce a plethora of the ute-
rus. In this country, the quantity of the discharge is estimated
at from three to six ounces during each period. At the ap-
proach of old age, this peculiar function ceases ; the time of its
cessation varies in different persons. As a general rule it may
be assumed, that in those cases in which it commenced at an
3arly period, it will disappear sooner, while in those in which it
Dccurred after the usual age of puberty, it will continue longer
in action. When the time draws near for the menstrual dis-
charge to cease, it becomes more uncertain as to the periods of
its return ; also, as to the quantity eliminated. Sometimes it
will miss one or two periods, or be put off two or three weeks,
and then recur with increased violence, sometimes amounting
to a dangerous hemorrhage. Then, perhaps, there will be sev-
eral successive regular periods, during which it will conform to
the functional habit which has been established ; then, perhaps,
^mother hemorrhage, after which it leaves the woman forever,
rhis is a critical period in her life ; it is known as the " change
:>f life," the " turn of life," etc. In temperate latitudes, men-
struation commonly ceases at from forty to fifty years of age.

During the menstrual period, the system of the female is more
rritable than at other times. Any sudden or irregular check to
ihe transpiration should be avoided; also, every kind of mental
)r corporeal agitation, or the process may be impeded, or hys-
erical or other unpleasant affections be excited.

The appearance of the menses is an evidence of the capability
)f the woman to become impregnated, and their cessation the
oss of such capability ; but there are exceptions to this rule,
tforgagni cites instances of a mother and daughter, both of

798 Hillyer, on the Physiology of Menstruation. [December,

whom were mothers before they had menstruated. Sir Everard
Home mentions the case of a young woman, who was married
before she was seventeen, and having never menstruated, be-
came pregnant. At four months after her delivery, she became
pregnant again, without menstruating. The fact that, with the
cessation of menstruation, woman lose the power of bearing
children, has been long known to mankind. It was known to
the old patriarch Abraham, for when the angel appeared to him,
and told him that Sarah, his wife, should bear him a son, he
was loath to believe it, and gave as an evidence that it could
not be so, that " the ways of woman had ceased upon her."

There is usually no menstrual flow during pregnancy and
lactation ; in fact, the cessation of the discharge is one of the
evidences that conception has taken place ; though it is not un-
common for the discharge to occur once or twice after concep-
tion; and I have known one or two instances in which it has
continued, at regular intervals, throughout the period of gesta-
tion. Its absence during lactation is by no means constant, es
pecially should the period of lactation be prolonged : but when
it does recur, it is an evidence of an aptitude to conception.
There has been an opinion prevalent among mankind, which
probably had its origin among the Jews, that the menstruous
blood of the female had malignant properties. A woman whc
had her menses upon her was considered unclean, and anything
which she touched was polluted. In the time of Pliny, this no
tion was carried so far that her touch was believed to blight
corn, to arrest the growth of grafted trees, to corrode copper, tc
destroy hives of bees, to drive dogs mad, etc., etc.

We are informed by Dr. Elliotson, that many in England be
lieved, that meat would not take salt, if the process was con
ducted by a woman so circumstanced. There has been for som<
time past, much discussion among authors and teachers, as t<
the nature of the menstrual fluid ; some contend that it is a se
cretion from the internal surface of the uterus ; others insist it i
a hemorrhage. Hippocrates declares it to be pure blood. Ma
ny, since the days of Hippocrates, believe it to be a secretion
Haller, Border, and John Hunter, besides other eminent am
learned men of a later day, are of the same opinion. The doc
trine that it is a hemorrhage, is at the present time the mos

1858.] Hillyer, on the Physiology of Menstruation. 799

popular. The researches of Yon Baer, Purkinge, Pruchet, Ne-
grier, Bischoff and others, have rendered it clear to the minds
of many, that the catamenial fluid is blood. From a careful
investigation of the subject, I have no hesitation in saying that
I am in favor of the hemorrhagic theory. To my mind the
evidences of its truth are conclusive. I do not believe that
there is a single argument which is used to prove that the fluid
is a secretory product, but what can be refuted. Those who be-
lieve that menstruation is a hemorrhage, contend that the dis-
charge is co-existant with, and a part of, the function of ovula-
tion. The rupture of the Graaffean follicle, and the extrusion
of the ova, are periodical.

Dr. Meigs says : " That at this time the ovaries receive a much
larger supply of blood. That their vascular circulation and
nervous intensity is much augmented; this state of excitement
passing from the ovaries to the uterus and vagina, renders them
also the seat of sanguineous engorgement.

"Under such circumstances, the uterus increases in weight,
acquires a redder hue, is more sensitive, and sinks lower in the
pelvis. Probably the glandular tubular matter of its body be-
comes thickened. From such engorgement and affluxion it is
delivered by means of the mensual hemorrhage, which escapes
from the vessels on the interior of the womb, falls into the vagi-
na, and thence flows upon the outer surface of the external
genitalia, and is called 'Menses,' 'Catamenia,' * Show,' &c."

This doctrine is advocated and taught in many of our colleges.
[ts most successful advocates are Gendrin, Eacaborski, Lee,
Wharton Jones, Coste, and others.

That the menstrual fluid is a secretory product is contended
for most strenuously by Dr. Dewees. He says " I look upon
this discharge as a genuine secretion from the mucous membrane
of the uterus with which the cavity of that organ is lined."

The reasons which he assigns for his belief, are the same
which are generally brought forward by those supporting the
same views. He contends

"1st. That the color of the discharge is between arterial and
venous blood, being less brilliant than the former and more
brilliant than the latter.

" 2nd. It does not separate into its components.

800 Hillyer, on the Physiology of Menstruation. [December,

" 3rd. Does not coagulate, though kept for years, whilst other
blood does, when exposed to the air.

"4th. Its odour is remarkably distinct from that of the circu-
lating mass."

To his argument, that its color is between arterial and venous
blood, we would reply, that this change is clearly owing to its
admixture with the secretions of the cervix uteri and vagina.
To his second and third, that it never separates into parts, nor
coagulates when other blood does we answer, that the power
of coagulation is lost by the decomposition of the fibrin by the
vaginal secretions. To his fourth, that the odour is not the
same as blood we answer, that it is not reasonable that it
should be, passing, as it does, slowly through the vagina and
mixing with its secretion, which has a peculiar odour, distinct
enough to make the change, and to entirely neutralize the na-
tural odour of the blood, We ascribe all the differences which
he points out between the menstrual fluid and pure blood, to
the effect of the mixture with the vaginal mucous, &c.

He asserts, further, that it is from the mucous membrane, lin-
ing the uterus, that this discharge has its origin. If so, why
does this mucous membrane secrete blood globules ? Can this
be possible ? This is not all : there is fibrin found in the dis-
charge. Does it secrete fibrin? and all admit that the other
essential elements of blood are in the discharge. So now we
have all the constituents of pure blood, all that is claimed
to belong to it, and secreted from a mucous membrane. No
other mucous membrane in the whole body secretes any one,
much less all of these ingredients. If, then, this fluid be a
secretion, containing these elements, it must be regarded as
a perfect anomaly in physiology, forming a single exception
to all the laws of secretion throughout the entire system. The
uniformity of nature's laws forbid us to accept such a position.

The experiment of M. Brierre de Boismont proves that
when it first issues from the womb it has all the constituents o1
pure blood, and almost in the normal quantity. In conducting
his experiment, " he adjusted a speculum to the cylinder of the
cervix uteri during menstruation, A patient of his alio wee"
this to be done. He thus carefully collected the fluid, as ii
passed from the speculum. It contained fibrin, and by 'analysis

1858.] Hillyer, on the Physiology of Menstruation. 801

was shewn to have all the constituents of blood, and nearly in
the same proportion as blood drawn from the arm."

There can be no doubt but that the vaginal secretion will
decompose the fibrin, and thus prevent coagulation. Women
who have passive hemorrhages from the womb, rarely pass co-
agula, and when they do, it is when the hemorrhage has become
so excessive that the quantity of the vaginal mucus is not suffi-
cient to decompose the fibrin. Within the last twelve months,
I have made enquiries of many women upon this point, and
they all have told me that when they only had a slight hemor-
rhage they passed no clots. I know one woman who had a
constant hemorrhage for months, and she rarely .passed coagula.
What docs this prove? That lite discharge of blood, bting slight,
the secretions of the vagina were wholly adequate to produce
the changes alluded to by Dr. Dewees. These women do not
say that they bleed that they have a hemorrhage, but "they
are unwell all the time" that they have their courses constantly
upon them. Xo man will admit that this is so. All will agree
that, in such cases, the woman has a passive hemorrhage, un-
connected with ovulation. Will it not appear from this, that
the blood of a passive hemorrhage and the menstruous blood
are similar?

It is now generally believed, that the cause of menstruation
is from the excitement produced by the maturation and dis-
charge of the ovulum from the Graaffean follicle. This is sub-
stantiated from numerous cases collected by Negrier, Eobert
Lee, Eacoborski, and others, of females who die during men-
struation, in whom the Graaffean follicle was recently ruptured,
and the ovulum just escaped. It is universally admitted, that
3onception is more likely to take place just before or just after
menstruation. Hippocrates remarked this fact. Boerhaaveand
Haller were of opinion that ovulation and menstruation were
coincident. Both functions begin in the female at the same
time, and leave her at the same time.

From all these facts, I am forced to believe that menstruation
is caused by ovulation, and that it is a hemorrhage. There have
been numerous theories advanced as to the purposes of the
menses: none of them seem to have much weight with physi-
ologists. The true purpose which nature intended them to

802 Baker, on the Sources and Qualities of Honey. [December,

subserve in the female, is not yet clearly understood, and this
point is still open for investigation, by those who are interested
in studying this subject.

ARTICLE XXVIII.

Remarks on the Sources and Qualities of Honey. By Paul
De Lacy Baker, M. D., of Eufaula, Alabama.

Messrs. Editors:

In the October number of your valuable Journal I find dis-
cussed, " The question of Poisonous Honey ;" and the importance
attached to it by your interesting editorial, induces me to offer
to your pages a few brief, and matter-of-fact, observations in
reference- to the subject.

The chief object of this communication is to combat the erro-
neous, yet almost universal impression, that bees "extract"
honey from flowers, and that as some blooms possess poisonous
properties, the honey extracted from them must, of necessity, be
more or less deleteriously impregnated. This impression pre-
vails with all, I believe, who have written about bees and honey,
and it plainly exists in the minds of the three writers, whose
articles, in reference to this matter, were set forth in this Journal.
Now, I propose to show that honey is not the juice or nectary
of flowers, and that it is never extracted or collected from flowers,
but that like dew, it falls from the atmosphere, and is gathered
by the bees and deposited in the cells of the honey -comb in pre
cisely the same state in which it was collected, and that there
fore, in all probability, honey, "within itself," is ever a perfectly
innocuous substance.

The following experience forced me unavoidably to this con
elusion : About the middle of June, 1850, I was at an old
hunter's house, in South-Western Georgia, preparatory to start
ing with him on a deer drive. This man was a great lover and
minute observer of Nature; in his yard there was a great num
ber of bee-hives, and he sold the honey in large quantities to the
neighboring villagers. While at his house, I heard him com-
plaining that there was a honey famine that the hives were all
ready for its reception, but that they were utterly destitute of

1858.] Baker, on the Sources and Qualities of Honey. 803

honey, and that the bees would soon starve. I asked him, how
such could be the case, when it was then the middle of June,
and the country full of flowers, and why the bees did not collect
it ? To my great surprise, he replied, that bees did not get
honey from flowers, but that it "fell from the clouds." I was
amused at the idea, but, of course, wholly skeptical concerning
it. He, nevertheless, assured me of its correctness; and to my
question, why did we always find bees at work upon flowers ?
he answered that, they were gathering pollen, from which they
made bee bread for their young, and that they were also collect-
ing materials for forming the honey-comb and arranging the
cells, to convince me, he exhibited to me a hive, where, sure
enough, existed the comb, cells, and all else, perfectly prepared,
yet not a particle of new honey, and the old supply nearly ex-
hausted. There was prevailing at the time a severe and pro-
tracted drought. Of course I had to believe what I saw, but was
still an unbeliever as to the "honey falling from the clouds."

The evening of the same day we went fifteen miles into the
wild woods, where our hunting party camped, far away from
any dwelling. The Old Hunter and I slept under two beautiful
young hickory trees, and at dawn the next morning he roused
me up, exclaiming, with great enthusiasm, "the honey dew has
fallen ! get up, you unbelieving Thomas, and see for yourself."
Upon rising, the first thing that attracted my attention was the
buzzing of bees, and on looking up to the top of the hickory
trees, I saw myriads of them working, and coming and going ;
the limbs of the trees grew low to the ground, and upon its be-
ing pointed out, my astonished eyes beheld, for the first time, the
"honey dew," on the leaves, and occasionally actually roping
down and dropping from the pendant points of the smooth
leaves ; I tasted it frequently, and at once recognized the pecu-
liar flavor of the common honey. I saw, and felt, and tasted it,
and my mind was convinced by these means, which God had
given, to lead it to correct conclusions.

The only observable difference, between this substance found
on the trees, and honey obtained from hives, was, as to their re-
lative consistency the latter being somewhat more inspissated ;
but I have no doubt that the difference is produced by time alone,
and that if a portion found on the hickory leaves had been col-

804 Baker, on the Sources and Qualities of Honey. [December,

lected, and preserved in a test vial, its properties would ultimete-
ly have been identical with that found in the hives.

My companion remarked that, in ten days all his hives would
be ready for robbing, and that the next morning he would show
me the bees working at home, and collecting honey from the
leaves of the tall black gum trees that grew in his yard. He
said, bees only collected it from the smooth-leaved trees of the
forest. The same evening we returned to his house, and at day-
light the next morning we went out into the yard, and the
smooth-leaved black gums presented the same appearance as did
the hickories in the woods on the previous morning. The bees
filled the air, and I watched them fly from the trees straight to
the hives occasionally, those starting from the lower limbs
would come to the ground before reaching the hive, and be
compelled to take a second and sometimes, a third flight to gain
it, some of these we caught and killed and opened, and in
every instance were their stomachs filled with the honey. I tasted
it, and found it identical with what I saw the morning before.
Through a glass in the hive, I saw them storing the honey
they invariably backed into the cell and deposited their burden.

In less than two weeks I was at this man's house to see the
hives robbed. They were full to overflowing, with the most
beautiful and luscious honey. If I recollect correctly, there still
had been no rain.

I am aware that there are flowers, such as the common honey-
suckle and woodbine, that contain a sweetish juice, not visible
I think, but readily detected by the sense of taste, but the flavor
is not similar to that of honey. It is true, as the editor of the
" Druggists' Circular" remarked, that " the saccharineematter of
the nectaries of flowers is not exactly identical with the charac-
teristic properties of honey." I would also observe, that this
juice occupies a situation so far down, in the long tube of the
flowers, as to be out of reach of the bee, and only attainable by
the long delicate bill of the humming-bird, or the proboscis of
the butterfly ; and even could it be attained by the bee, it exists
in such minute quantities as to preclude the possibility of a
swarm's collecting from such a source, twenty or twenty-five
pounds of honey in the space of two or three weeks, as was evi-
dently done by the hunter's bees.

1858.] Baker, on the Sources and Qualities of Honey. 805

Such is the experience, and such the observations that have
taught me, that honey is not the "extract" or product of flow-
ers; nor is it the result of any elaborating function of the bee's
stomach, but, that it falls like dew, and is collected as ready-
made honey, and requires no more extracting or elaborating
process, than is necessary in collecting rain water in a cistern.

So much, then, as to " whether honey is, within itself, ever a
poisonous substance ;" but, what I have related, does not do
away with the fact that persons are sometimes injuriously, if
not poisonously, affected from or after eating honey ; nor does
it explain the why or wherefore of such accidents, but I think
it does establish the fact, that such occurrences depend upon ex-
traneous matters and accidental circumstances. If it could be
ascertained, I think it would be found to be the fact, that when-
ever deleterious consequences resulted from eating honey, the
honey -comb was masticated, and that no care was used in the
selection of it ; in this way, it would be quite possible to intro-
duce into the stomach poisonous materials; for it is a well
ascertained fact, that there is such a thing in the bee-hive, and
among the comb, as " bee-bread ;" that it is a brown, bitter sub-
stance collected from the pollen of flowers, as food for the young
bees. This might be collected from poisonous flowers, and to
it may pertain in full force your philosophic remark, that "the
instinct of the bee may, in most instances, preserve him and his
race from the toxic effects of the deleterious properties of flow-
ers, and yet, what has served as his nutriment may be, for man,
a most destructive poison."

I have no certain knowledge of the source from which are
collected the materials for forming the comb, nor what the na-
ture of those materials is ; but I would sooner look to them as
the cause of the mischief, than to the honey knowing as I do,
the source from which it is gathered. Again :* in considering
this matter, it might be well to remember, that it is common to
find in honey in the comb dead bees, and that to the sting
of each is attached a bag of poison, and should these be accident-
ly conveyed into the stomach, might not the circumstance have
some connection with the ill effects produced ? Nearly all the
cases of sickness or poisoning, /ever heard of, as occurring from
the use of honey, resulted from eating wild honey obtained from

806 Farell's Remarks on Formulae. [December,

an old hollow tree, and where it was consumed incautiously and
in large quantities, during the frolic of robbing the bee tree,
which is generally done at night; and it should not be forgotten,
that the cavities, of the trees containing the honey, are the
abodes of bugs and spiders of very poisonous natures, which by
the fall of the tree might possibly be crushed and mingled in
the honey, and in that way be conveyed into the stomach. In
addition to the suppositions already set forth, I would remark
that these old hollow trees are frequently covered with a vine
known as the "poison vine," and would suggest the possibility
that, cut and bruised as it would necessarily be, in the fall of the
tree, it might, in some way, be the cause of the mischief. The
frequency of these cases of poisoning is by no means so great
as to exclude the possibility of the agency of such circumstances
in producing it.

It is, however, true, that these accidental and isolated cases
afford no explanation of the effect produced upon large num-
bers, as for example, on the Grecian army, as related by Xeno-
phon. In reference to such examples, all I can say is, that if
such an effect should be produced among soldiery at the present
day, by the use of honey, there would exist in my mind, strong
suspicion, that there was mixed with it an undue portion of
" old peachy

The only way in which I can imagine that honey could, in
itself, possess toxic properties, is in the same manner that the
dews of certain latitudes and localities are rendered poisonous. .
This is said to be the case ; if so, the same causes and circum-
stances rendering the dew nocuous, might also deleteriously
impregnate the honey dew.

ARTICLE XXIX.

Remarks on Formulae. By William Farell, M.D., of Eome, Ga.

There is, perhaps, no duty of the physician so badly executed
as the writing of prescriptions. I trust, therefore, a few practi-
cal hints, from one who has had some experience in deciphering
and guessing at these important documents, will not be entirely
devoid of interest to those, who desire to furnish their apotheca-

1858.] Farell's Remarks on Formula. 807

ries, and the public, with formulae, creditably written and in an
intelligible form.

Since there is, probably, no better reason for writing prescrip-
tions in Latin, than a sort of veneration for antiquity, it is
greatly to be desired, that physicians would employ the English,
without contraction, leaving out no important words, nor add-
ing those that express nothing, and thus avoid the many glaring
errors, to say nothing of the occasional fatal mistakes, which
expose them to the just ridicule and contempt of the intelligent.
If, however, there are those, who insist on retaining the ancient
custom, let them make themselves sufficiently familiar with the
language to write their prescriptions correctly.

In many works, whose practical precepts are justly entitled
to high regard, we observe a jumble of English and bad Latin
in the formulae, disgraceful to the merest tyro. For illustration,
the following recipes are taken from the pages of most respecta-
ble practitioners and professional writers :

$. Hydrargys. praecip. alb. . . . 3ij.

Ess. lem.. ..... gwt. x.

Adeps praeparat 3ij. M.

$. 01. Eicini. opt fjij

" Terebinth Eecentis. . . f^ss

Sodoz Bi. Carb. . . . . 3 jj

Pulv. Acacia, opt.

" Sacch. Alb, . . . aa Ij

Sps. Lavendid. Comp. . . . f j
Aquae Camph

" Menth Pip . . . aa Hvj
M Ft Emulsio.

$. Copaibae.
Tinct. Cubebae

Syr. Uva Ursi . . . aa f5ij

Pulv Acaciae opt . . . . I ij

Aquae Cinnam .... f 3xvj
M Ft Emulsio

3. Pulv. Opii.

Pulv. ipecac . . . . aa 3j
Sulphate of potass .... 3 viij M

The above formulae are medicinally, and pharmaceutical^,
admirable, but gramatically, bad. In the first, the syntax would

808 Farell's Eemarks on Formulae. [December,

have been greatly improved by the use of lim., and Adipis in-
stead of "lem." and " Adeps."

In the second, the " Sodas Bi Carb," by the use of the capitals,
seems to consist of three distinct words. The word " Acacia,"
like "lem" and " Adeps," violates one of the simplest rules of
syntax. "Lavendul" is a new coinage, neither English nor
Latin, and must be guessed at, as no dictionary defines it. The
apothecary arrives at the meaning of such mongrel crosses by
the following sylogistical process of reasoning. The word lav-
ender, and its Latin equivalent, lavandula, both mean the arti-
cle we call lavender. The word "Lavendul" lacks nothing of
being the one, but what is contained in the other, ergo, it must
mean lavender also. The author has displayed his medical
latinity by the use of this new version of lavender throughout
his work.

In the third recipe, if "Syr. Uva Ursi" was intended for
English, it is in the wrong place; if Latin, it is in the wrong
case.

In the fourth, the simple recipe for Dover's powder is com-
menced in Latin and finished in English.

Much of our medical literature is spoiled with such formulas
as the above, to the discredit of the authors and the profession
generally. Until we reform in this particular, we shall never
hear the last of our dog-Latin. The evil is equally great
among a large class of physicians, who, in their practice, in en-
deavoring to make a little display of their classical lore, couch
their prescriptions in a jargon, neither English nor Latin, leav-
ing the apothecary to guess at their meaning, which he will
generally do, rather than ask an explanation, and incur abuse
for want of proper qualifications.

The gross errors of some of these learned gentry are quite
amusing. One, in prescribing the citrate of iron and quinia,
"comes the Latin" with a grand flourish, after this fashion
"Ferri Quinia et Citras." Another latinizes Dover's powders
thus: "Pulv. Dov. et Ipecac. Opii. Compos.", seeming much
pleased with the length and mystery of his recipes. There are
others, again, who pride themselves on the shortness and sim-
plicity of their prescriptions. It was one of these who drugged
his patients for a long time with saltpetre, by directing simply

1858.] The Medical Uses of Wines. 809

" Nitre," when sweet spirit of nitre was intended. On learning
the fact, he abused the apothecary, and made the matter worse
by ordering "spirit of nitre," which, the apothecary's apprentice
learned to mean nitric acid, and sent it out accordingly. This
was too much for the doctor's nerves : he stormed the dispens-
ing shop, and had the master of bottles arraigned for his grave
error(?), who proved that he had learned a thing or two, besides
the detergent qualities .of soap and water, by producing no less
authority than Wood & Bache, for what he had done. This
medicinal doctor would have done much better to have orna-
mented his prescription with "spts. nit. dulc. eth.", which would
have been within guessing distance of the true mark.

Now, all this confusion of tougues, errors and uncertainty,
might be easily avoided by the use of plain English, and thus
save the profession from a deal of wit, sarcasm and just blame,
which all ages have been disposed to direct against it. Being
no Latin scholar, and but little skilled in medical Latin, we in-
tend, in our own practice (should we have the occasion), to write
our prescriptions in English.

As above indicated, we do not seriously object to the Latin,
if correctly written, yet must think reform in this particular de-
sirable. We are glad to see that this reform has already been
commenced by some of ths most respectable professional writers
of the day, who are beginning to write their prescriptions either
in good Latin or good English.

The Medical Uses of Wines.

This is a subject thickly clouded with all sorts of prejudices
and pre-possessions, as is the discussion of most substances used
equally by the sick and the healthy. Persons argue that what
is good for themselves must be good for their patients. We
have known a plethoric dietician, who himself loved lobster-
salad and champagne in the small hours, advise a starveling
dyspeptic to follow his custom of taking no breakfast till noon.
So a hearty rough stomached doctor will declare one diluted
alcohol just as good as another; the ascetic, or the reformed
rake, will pronounce all equally bad; the gouty will dread all
that is thin and acid ; the aguish will have a predilection for
Port.

810 The Medical Uses of Wines. [December,

It is very possible that prime wines may be made of all kinds,
which may be equally and perfectly wholesome ;v but their rarity
will always put them out of the reach of our patients, and what
we have practically to think of in naming a wine for use, is at
best a second or third-rate article. We must also choose those
which are capable of being grown in quantity proportioned to
their popularity, or the chances of adulteration are exagerated.
When Madeira was on everybody's table, it could not be recom-
mended to patients, for in nine cases out of ten it was either an
inferier sort or a sour imitation. But now that it has gone out
of fashion, a wholesome and often a very perfect wine is to be
bought of that kind, and the adulterators expend their ingenui-
ty upon Sherry. What we want is a liquor which is either pro-
duced in very large quantities, or is not sufficiently known to
the million for it to be worth imitating.

The medical questions concerning the employment of wine
will be put in the clearest light for exhibiting our real know-
ledge and ignorance, by considering separately the physiologi-
cal effects on the human frame.

The effects may be practically included under the following
heads: Exhileration, Nutrition, Arrest of Destructive Metamor-
phosis, Inebriation, Degeneration of Tissue, Derangement of
Digestion. The three first are good the three last bad ; and
the object is to secure the former, while avoiding the latter.

Exhileration is not merely a minor degree of drunkness. It
may be produced by many things besides alcohol, and which do
not inebriate such as, for example, the essential oils, pepper-
mint, onions, valerian, assafoetida, tea, coffee. Even eating, and
the increased circulation of blood, produced the effect to some
extent. Alcoholic fluids truly do exhilerate with the greatest
certainty and rapidity, but not in direct proportion to the alcohol
they contain. A glass of wine will raise the spirits of a healthy
person as much as a glass of gin ; a glass of fine claret as much
as one of strong tavern port; and this is not merely from the
pleasure of taste or association, for the same may be observed in
fever patients, whose gustatory nerves are blunted by a thick
coating of sordes.

The distinction is not only a subjective one, evident to the
mind of the recipient, while it is incapable of demonstration to
others. There is a real physiological difference in the effects
which follow exhilarating and intoxicating doses a difference
which in its ultimate results, amounts to a complete contrast.
The former mcrease the amount of vital power rendered availa-
ble in a given period, and the latter decrease them. Can there
be a more perfect antithesis ?

This is too important a matter to rest solely on the unassisted

1858.] The Medical Uses of Wines. 811

ienses of patients or observer, and it does not do so, for the ad-
nirable experiments of Dr. Bocker having submitted it to the
>roof of chemical analysis. Though the whole series of his in-
vestigations into the action of alcoholic stimulants bear directly
m the present subject, they are too mutually dependent on one
mother, and too lengthy for quotation. The general results,
lowever, may be stated as follows :

1. The special action of alcoholic drinks is to arrest destruc-
ive assimilation to stop the over-active processes of life in their
jffects upon the organism ; so that, for a certain period during
he stay of the alcohol in the system, less urea, less phosphates,
ess water are excreted by the kidneys, less carbonic acid by the
ungs, and less digestion goes on in the alimentary canal,
ihowing that the muscles, bones, nerves, &c, are not getting rid
)f their effete tissue, but retaining it, and making use of it as far
is possible.

2. But at the same time they give rise in the body to a defen-
sive reaction, which is prominent, first immediately after taking
;he dose, then gives place to the special action, and on this ceasing
s again manifested to a greater extent.

3. So that if a suitable quantity be taken, and if both action
ind reaction are allowed to exhaust themselves before the dose
oe repeated, more manifestation of life, represented by more
excretion and more consequent renewal of the body, takes place
n a given time with the alcoholic drink than without. There
aas been a positive gain in vitality.

4. But if such a large quantity is taken at once that the re-
action is overpowered, or if it is arrested by a continuous repeti-
tion of the dose, the manifestation of life is kept down ; the body
is not renewed, because its effete particles are not removed, and
:he amount of vitality must certainly be reckoned at a loss.*

The first named state is Exhilaration, in which the alcohol
nay be fairly called a food or medicine, a medicinal food or
lietetic medicine, for body and mind. The second state is In-
ioxication, when it is a poison to both.

Now, the exhilarating effects of diluted alcohol are very much
ncreased by its admixture with sugar, extractive, vegetable
essential oils, ethers, and the allied substances which have been
lescribed as producing the aroma and bonquet of wines.
With a quantity of alcohol which taken alone would be ineffi-
iient, a delicate wine is able to produce a decided impression
lpon the nervous system. When, then, this is mainly sought,

*Beitrage zur HeiLkunde, von F. W. Bocker, vol. i., sect. 6. Weingeist. We

lave introduced the name of this author again in our heading list, because he,

md indeed all physiologists of the Schultz-Schultzenstein school, are much less

mown in England than they deserve. A collection of translations and abstracts

irould make an admirable volume for the new Sydenham Society.

jr.s. vol. xrv. ko. xii. -47

812 The Medical Uses of Wines. [December,

as in cases of mental depression, hypochondriasis without bodily
ailment, nervous exhaustion, over-anxiety, hysterical fainting,
vomiting, and the like, or when wine is wanted merely to
smoothe down the roughnesses of daily toil, we must remember
that the good result may be obtained without the evil ; and we
can obtain it with least chance of the evil by selecting liquors
richest in their peculiar scented constituents. Bordeaux, Cham-
pagne, Khine, and Moselle wines offered a variety of choice, the
first being the most perfect and suitable to the greatest number
of these cases ; whilst the others have certain inconveniences,
hereafter to be mentioned, which often forbid their use in the
special case to be prescribed for.

The beneficial effects on the nervous system are increased by
effervescence; thus, sparkling Champagne will sometimes have
a most magical effect in stopping vomiting in cases accompanied
with much nervous depression. And even in health, the greater
exhileration caused by genuine effervescing wines is notorious.
The physiological explanation of this result is not very clear.
It cannot be due to the carbonic acid alone, for the inhalation
of this gas tends to completely oppose consequences. Perhaps
the sudden physical change in the liquid during the extrication
of the fixed air developes ethers which in a nascent state are
more potent than at other times. Perhaps other gasses are
generatedj whose properties are in themselves exhilarating. In
the Champagne sent into Wurtemberg from Eheims, Baron
Liebig found that for every volume of carbonic acid there were
two volumes of protoxide of nitrogen* (laughing gas); and it
was assumed, without absolute proof, to have been artificially
introduced for the purpose of augmenting the joyous results ofl
the bottle. The subject demands chemical investigation on
purely scientific grounds; and it would moreover, be useful to
know if we could thus at will increase the required exhilaration,
while decreasing the quantity of alcohol or carbonic acid.

The gladdening effects of alcohol are augmented by its mix-
ture with other constituents of wine, but its intoxicating or
poisoning effects are diminished, and thus more may be taken,
with its advantages and without its evils. So that, for example,
if a man drinks a pint of Mr. Branded Marsala, he gets a some
what larger dose of spirit than there is in half a pint of gin,f
but it is unnecessary to say, without the same bad consequences
This is partly to be attributed to the presence of the ethers;}: and

* Medical Times, Nov. 1850.

| Marsala contains 2603 per cent, of absolute alcohol (Brande); Geneva, 49.4
per cent. (Jones).

\ The disinebriating influence of ether is shown by its being actually a remedy
for drunkenness. Twenty or thirty drops taken neat on a little oil will restore to
temporary sobriety. The knowledge of this fact has been popularized in France,,
by its forming a point in a wicked railway novel (Le Troup de l'Enfer), the author
of which perhaps owed it to M. Batilliat (Traite sur les Vins de la France, p. 1 90).

1858.] The Medical Uses of Wines. 813

sugar, but also in a great degree to the intimate combination
of the alcohol with extractive and albuminous matter, so that it
is not absorbed immediately by the membranes, but gradually
and during a process of digestion. It is obvious that its local
effect on the mucous surfaces and viscera must be thus much
modified, and a powerful argument is afforded in favor of the
use of wine instead of brandy for invalids.

Nutrition is an indirect effect of wine. There is shown by
chemical investigation to be very little substance in it capable of
building up the body. The phosphates and albumen are
more readily found elsewhere, as Franklin has imprinted on our
memories by his comparison of a penny roll and a gallon of beer.
But alcohol seems to render the alimentary canal more ready to
absorb nutriment. Farmers find this, and always try to put
some waste beer or fermenting grains in their pig troughs.
Physicians find it, too, and give their patients cod-liver oil in a
glass of sherry when they would have it fatten quickly. The
effect, however, is probably confined to oleaginous food and the
adipose tissue, for the digestion of albuminous matter by the
gastric juice is certainly impeded by alcohol. t

Hence we gain the following rules concerning the administra-
tion of wine as an aid to nutrition : 1st. That the alcoholic
contents are those of principal importance, and that the amount
of solid or nutritive matter in the wine makes little difference.
2udly. That we may hope help from it in increasing adipose
tissue, but not muscle. Brdly. That as its agreement with fatty
food is the prime object, we must avoid those wines which are
likely to make such food unassimilable, as, for example, by
making it rancid; and therefore, 4thly. That sound wines with
a small proportion of acid to their alcohol, and but little body
to cause re-fermentation, should be selected ; the types of perfec-
tion may be considered the dry Spanish wines, Amontillado and
Manzanilla. And, 5thly. They should be taken along with the
fatty food itself, or immediately after it.

The arrest of destructive metamorphosis, or what has been pic-
turesquely called "the moulting of the tissues," is unquestiona-
bly the most important of the medical uses of alcoholic liquors.
By them we are enabled to stay the progress of interstitial death
in low fevers, till the period of the zymotic poison's virulence
is passed, and it has either been evacuated or become inert. By
them we can check the exhaustion of the body through exces-
sive secretion, as in cases of chronic catarrh, ulcers, abscesses,
amputations, &c. By them we can diminish, in ordinary diete-
tics, the wearing out of the body by the over-worked mind,
which in this busy metropolis throws so many into the hands of
the physician. But in the wielding of this two-edged sword the

814 The Medical Uses of Wines. [December,

greatest judgment is requisite, lest we carry the effect too far-
The destruction of effete tissues is part of life, and necessarily
precedes constructive renewal ; if, then, we check it too far,
interstitial life is diminished, and the system is overloaded with
matter incapable of vitality.

It is better, therefore, to give alcohol in a diluted form, even
when we wish to produce its most decided action, as in typhus
fever, for example. And it is better to give it combined, as it
is in wine, with other substances of partially corresponding
action, than to administer it merely diffused in water, as is some-
times done for economy's sake. Sugar, we know from Dr.
Booker's experiments, has a special effect in limiting the destruc-
tion of tissues containing phosphates, tissues of no less impor-
tance than the bones and nerves. And it is likely that similar
investigations into the physiology of ethers may show some
special effects belonging to them. The acids, too, and the ex-
tractive in wines, seem to prevent better than water those injuri-
ous effects upon the mucous membranes which spirituous liquors
exhibit. There is, then, no extravagance in preferring wine to
brandy and water in the management of low fevers in hospital
and parish practice.

This is not the place to discuss details in the mode and period
of administering wine in acute complaints. But one remainder
may be deduced from the view taken of its physiological action
viz., to allow intervals to elapse, during which its effects may
subside, and the system recovered for a time its metamorphoses,
so that the effete tissues may have a due exit. The night is a
convenient time for this in general ; but if, from any cause,
that is considered inexpedient, some hours of corresponding
duration should be selected, during which the administration of
stimulants may be discontinued.

The wine chosen for fever cases is usually Port ; but the rarity
of really good Portugal wine, and the excessive badness of all
low-priced imitations now in the market, render it daily more
and more incumbent upon us to have substitutes at hand. The
best in the London market seem to be the red Spanish wines,
Beni Carlo, and Cadiz ; especially the former, which, indeed, is
often mixed with spoiled Portuguese wine, and sold as port. It
may be had in the wood at a low price, considering its strength,
and is highly to be commended for hospital use in a diluted
state.

Poor people, however, are not the only patients supplied
with Port wine unfitted for the sick room. The prepossession
in favor of antiquity causes many cellars in wealthy houses to
furnish nothing but a damaged article. To find fault with a
bottle that cost a great sum a great many years ago, is flat

1858.] The Medical Uses of Wines. 815

heresy ; and the better way is to give it up at once, and order
your patient a good full-bodied wine of a different nature, such
as Madeira, Burgundy, or Hermitage.

Inebriation is a terrible word to meet with in periodical
literature. It opens up a prospect of so many social and politi-
cal questions, that the reader is apt to close the page in despair.
He shall be let off here with a simple remark derived from way-
side observation viz, that in all countries where wine is plenti-
ful and cheap, drunkenness is almost unknown ; where it is most
expensive, that vice is at its maximum.

Degeneration of Tissue, as a consequence of drinking, appears
to be a chronic state of that arrest of metamorphosis which has
been already discussed as a remedy for disease. The effete tissue
remains as a useless burden mixed up with the healthy, and is
finally converted into the least vitalized of all the organic con-
stituents of the body, oil or fat. Careful and valuable observa-
tions have been made by Dr. Bocker, on the abnormally retained
blood-discs in the circulating fluids of habitual spirit-drinkers,
and the appearance of the degenerated hearts, livers, and kidneys
of these miserable suicides is familiar to us all.

Degeneration arises from the arrest of metamorphosis being
too long and continuously kept up. Hence there is little
danger of it in acute cases, where the large quantity of alcoholic
remedies we find it expedient to administer is necessarily
diminished as the disease recedes, and during convalescence is
reduced to the ordinary allowance of health!. But in chronic
cases it is often a matter for serious consideration whether we
shall employ an agent capable of doing along with the gocd we
intend, an evil greater than that originally to be combated. If
the dose of a stimulant be repeated before the arrest of metamor-
phosis has ceased and the reaction of the system has begun, a
second arrest indeed takes place as before ; but the postponed
reaction is augmented in force each time it is delayed, and when
it occurs at last, it is so painfully depressing that it becomes
more and more difficult to resist the instinct to put it off, and in
the end it is rarely dangerous to do so suddenly. This is the
short history of confirmed tippling; and often we fear it may
be traced in its origin to the carelessly worded advice of some
medical men. Science or practice has taught him that alcoholic
action will alleviate certain morbid phenomena, and he recom-
mends it without due warning. The patient knows no harm in
alcohol except drunkenness, and so long as he avoids that vice,
thinks he cannot keep up too steadily the agreeable relief he
experiences.

Alas ! much safer for him would be the occasional debauch
of a man he despises as a profligate, than his own continuous

816 The Medical Uses of Wines. [December,

steady course towards death. A drunken bout brings its own
cure, and is usually allowed to be followed by reaction after-
wards ; but the most alarming symptom in a tipler is that he
cannot get drunk. Day by day there is a little less and a little
less life in his system, till at last his degenerated body is fit for
burial.

Now, the result above described are, practically speaking, un-
known as the consequence of wine ; it is spirit drinking that
leads to them. There are several reasons for this, independent
of the chemical differences of the liquors. "Wine is rarely used
except at the principal meal, or as a sort of medicine in measur-
ed quantity at other hours, so that the effects have time to pass
away before another dose becomes due, and no craving for in-
creased quantity is experienced. In fact, men go on taking
daily for quarters of their life the same identical number of glass-
es, feeling daily the same comfort, and never finding it necessa-
ry to increase the quantity. But the spirit bottle is opened
when its owner "feels to want it," nay it is very often carried
about the person under the appropriate name, as regards its dead-
ly results, of a "pocket pistol".

We have been in the habit, in insurance practice, of omitting
the usual inquiries about "sobriety" and "temperance", &c,
which give offence and elicit no information, and substituting
for them the simple question "Do you ever take spirits between
meals"? This is something definite, not to be shirked, and if
answered in the affirmative should lead to rejection.

The subject of spirit drinking takes up more space in this
article than our promise of avoiding temperance common-places
perhaps led the reader to expect. But we have two excuses:
one is, that it occupies quite distinct ground from the question of
drunkenness, has much more to do with the production of disease
and is therefore much more the province of a medical reviewer.
The other excuse is (we blush to write it), that no class of per-
sons who have received a liberal education are so often addicted
to it as medical men. Londoners were shocked two or three
years ago at the suicide of a highly moral and intellectual sur-
geon, who left a paper attributing his despair to the habit of
secret tippling; but they would have been less astonished had
they known how many practitioners all over the country suffered
from the peculiar dyspepsia of alcoholism. The long robe and
her Majesty's uniforms are occasionally disgraced by inebriation,
clergymen may sit too long at the bottle, but spirit tippling seems
left to medical men and the classes below them. They have
many temptations: hard mental and corporeal toil, sudden calls
for exertion when tired, broken rest, irregular exposure to cold
and wet, weary waiting in lone farm-houses for lingering labours,

1858.] The Medical Uses of Wines. 817

the dull company of ill-educated persons, the wish to be sociable
and not seem proud, are a few of them. Into these temptations
they do fall, and that on a large scale, especially in rural districts.

To require of an unfortunate patient and brother practitioner
that he should give up at a blow that alcohol which instinct and
science agree in teaching him to be necessary, is too great a de-
mand. If he becomes a teetotaller, he would probably die all
the sooner. Hard common places about the virtue of temper-
ance and the evils of its opposite, produce no more effect than
schoolboy's themes. "What he wants is first, kind sympathy
with his misfortune, and second, a rational means of getting rid
of it. Now, nothing contributes more towards the latter than a
clear sketch of the chemistry and. physiology of the subject, and
a belief that the advantages of alcohol may be had without its
disadvantages. He should reflect how wine differs from the
spirits which are in it; and again, how it is not so much the
quantiey, but the frequency of the dose, which is hurrying him
to the grave and his children to poverty. The most complete
relief is the substitution of wine for spirits. The very economy
which was perhaps the first origin of the habit, will prevent ex-
cess in the dearer liquid. If that cannot be accomplished, let at
all events drams between meals be avoided as poison ; and let
the addition of sugar, and flavors in the shape of lemon, fruit, or
a few drops of nitric ether, make the drink approach a step
nearer to the juice of the grape, and be daily more and more
diluted.

Among the Derangements of Digestion arising from wine, it
will not be necessary to dwell long upon the immediate conse-
quences of a debauch. It is usual, in army medical returns, to
report it as " febris," as indeed there is, truly enough, an ephe-
meral fever, but, like other fevers, it works its own cure, and
civilians are not in the habit of applying to it the same euphe-
mistic nomenclature. But, without being taken in such quanti-
ty as to be considered an excess as regards alcohol, wines will
sometimes cause a disturbance of digestion, which prevents our
sanctioning their use in cases where otherwise we might be wil-
ling or anxious to do so. This is always accompanied by the
presence of a large quantity of acid in the alimentary canal.

In some instances this excessive production of acid follows
equally all sorts of wines, and even spirits. Then it is due to
the mucous membrane of the stomach being so morbidly sensi-
tive that it becomes irritable and temporarily inflamed, so that
it refuses to secrete its solvent juice, and to perform with suffi-
cient activity the peristaltic movements. Hence the alimentary
mass undergoes the acetous and lactic fermentations, instead of
being digested. These patients ought to abstain from all alco-
holic drinks whatsoever till cured of their morbid condition.

818 The Medical Uses of Wines. [December,

More commonly it follows only wines, and some sorts of wines
more than others. These cases deserve much thought, because
they are in danger of falling into the snares of spirit drinking,
and also because very often the patient's system especially re-
quires a stimulus which yet he cannot take without inconveni-
ence. When we reflect on the large quantity of free acid exist-
ing in wine, we cannot be surprised at its causing some trouble
in the stomach. If a man drinks hall a bottle of hock, he swal-
lows one hundred grains of acid, equal to five tablespoon fuls of
lemon-juice; in a pint of claret, eighty grains; in sparkling
champagne or Madeira, the same amount; in port, if he takes
even this comparatively large allowance, he does not get above
sixty grains ; but then in the three last there is nearly an ounce
of sugar, which, mixed up with the food, has a strong tendency
to ferment, and turn into a fresh portion of acid at a more advan-
ced period of digestion.

Here chemistry steps in with valuable aid. In the simple
instrument of a standard solution of caustic soda, we possess a
means of testing rapidly the whole acid contents of wines, and
rejecting any which are thus declared unfit for our patient.

But it makes some difference what sort of acid is contained
in the wine. Acetic is to many stomachs much less injurious
than tartaric, and it is found that the proportion of these to one
another varies very much in the products of fermentation.
Thus, in Madeira nearly one-third of the acid contained is acetic ;
in port, only one-fourth ; in claret, one-fifth ; in champagne,
one-seventh ; and in hock, not one-eighth, whilst the rest is the
least digestable, tartaric, or its ally, racemic* Besides these,
the tannic must be allowed for, small indeed in quantity, but
powerful in operation, as its use in medicine shows.

Of course, both the quantity of acid and the proportion of the
several acids vary within certain limits, in different specimens
even from the same vineyard, and still more in growths classed
under a common name in the market. So that to give an opin-
ion as to the fitness of a peculiar wine for drinking, we must
carry our investigation rather farther than merely the applica-
tion of the soda test.

The acetic acid may be estimated by distilling it off from the
wine slowly, at a moderate temperature, so as not to decompose

*See Mulder, p. 202. In 100 grammes of wine there were

Milligrammes of Milligrammes of

acetic acid tartaric, racemic, <fec.

Madeira 167 310

Rhine wine 66 480

Port 95 ..283

Bordeaux ordinaire 86 390

Champaigne 64 408

1858.] Paralysie Generate. 819

the extractive, and measuring it by the standard alkaline solu-
tion.

Sugar in wine which is to be taken by itself as a medicine, is
often beneficial by making the acid and alcohol less immediate-
ly irritating to the mucous membrane; but in that which is to
be mixed with food it is very apt to increase the generation of
acid in the stomach or caecum to an injurious extent, generally
two or three hours after meals. If an examiner of wine is dis-
posed to reckon the absolute quantity of sugar, he will have to go
to the expense of Soleil's saccharometer (which costs, with its ac-
cessories, not much under 20), and even then may have his
analysis doubted by a chemistf; but a fair comparative valua-
tion may be made by first neutralizing the acids with lime, and
estimating the sweetness which remains by the taste. This is
done by measuring the quantity of water which requires to be
added before all trace of it cease to be perceptible to the palate.

The injurious effect of ill prepared effervescing wines is easily
explained by the large quantity of undecomposed ferment they
contain. This is set in action by the warmth of the alimentary
canal, andean hardly be overcome even by the strongest diges-
tive powers. Flatus and acidity are its normal consequences.

The proverbial unwholesomeness of "mixed wines" is not
explained by chemistry. In most cases the evil may be traced
to the temptation to increased quantity, or to the taking of some
sorts which, even if adhered to throughout the meal, would be
equally hurtful. In fact, the precept of keeping to one wine
seems to rest on the same principle as keeping to one meat.
[Brit, and For. Medico- Chirurg. Review.

Paralysie Generate. By M. H. Eannev, M.D., Resident Physi-
cian of the New York City Lunatic Asylum.

This disease has been but recently discriminated from other
forms of paralysis. The attention of the medical profession was
first called to it by Esquiro], within the present century. It may
have been confounded, perhaps, with the results of apoplexy, ram-
ollissement, tumors, tubercles, &c, of the brain. It is a singular
fact, however, that its frequency has greatly increased during the
last sixteen years, as will be seen by reference to the various
annual reports of the Superintendents of American Hospitals for
the insane. In the report of the McLane, Asylum, for the year

\ The fallacy in Soleil's polarizing saccharometer as a quantitative test is, that
uncrystallizable sugar rotal y to the left, whilst glucose and cane sugar

rotate it to the right. So that a sample of sherry, for example, with its usual
allowance of the uncrystallizable, might be so adulterated with white lump,
molasses, caramel, or malt, as exactly to balance and appear to contain no sugar
at all.

K.8. VOL. XIV. NO. XII. 48

820 Paralysle Generate. [December,

1844, Dr. Bell remarks, " I have regarded it as a somewhat curi-
ous fact, that it is only within the last three years that this disease
has been admitted to this institution. As late as my visit to
Europe in 1840, it was unknown within our walls ; nor, after seeing
it so often manifested there, can I recall any case in our register
which would at all meet its characteristics, rendering it certain
that it was not overlooked. Since that period, however, wre have
abundant evidence that it is not a form of disease peculiar to
other countries."

The recent investigations by Calmeil, Foville, Rodrigues, Fal-
ret, and others have thrown much light on its nature and charac-
ter. The name adopted by Esquirol does not give a correct idea
of the disease. There is not usually complete paralysis, but the
power of volition is partially lost, so that muscular action is im-
perfect and unsteady.

The characteristics of this disease are found in the paralysis,
and in peculiar mental aberrations. Either the physical or the
mental affection may be antecedent in its manifestation.

The first paralytic symptom is an affection of the muscles of
the pharynx and larynx, which changes much the tone of voice
and produces a difficulty in articulation. There is a peculiar
" cracked" husky tone, and a hesitancy between syllables and
words like stammering. A slight excitement produces a spasmo-
dic action of the muscles of the face, particularly about the cor-
ner of the mouth and eyes. The tongue when protruded is
tremulous, and thrown forWard by successive efforts resembling
the spasmodic action observed in chorea. The face becomes
expressionless ; as the disease progresses all of these signs become
more marked, and a difficulty occurs in locomotion. The patient
totters in his gait, and if he attempt to change suddenly his direc-
tion, is likely to fall. In falling he makes no apparent effort to
recover himself, and his head stikes with equal force as other
parts of his body. Deglutition is gradually impeded, and even-
tually there is a loss of control over the sphincters. In most cases
epileptiform convulsions follow at intervals, varying from one
week to three months, each of which seem to lessen the vital
power of the system, and to increase, temporarily at least, the
extent and degree of the paralysis.

The mental changes are marked both in the susceptibility and
intellect. The patient is restless, constantly moving from place
to place, peevish, fretful, and impatient of contradiction. He is
ever discontented with his present condition, although the past
and future afford unalloyed happiness. Opposition to his
wishes is soon forgotten. Recent events are generally but feebly
retained, whilst the past affords to his mind images of unparalleled
success, and the future glows with day dreams of great achieve-
ments to be performed, or noble actions done. The disease may

1858.] Paralysie Generale. 821

assume the form of mania, monomania, or dementia. The most
prominent and usual characteristic is generally exaltation of the
imagination. The belief is permanent, that he excels in every-
thing, and possesses strength, wealth, influence, and intellectual
capacity far beyond that of any human being. They who were
previously endowed with a brilliant imagination, and had received
high mental culture, present visionary schemes of the most attrac-
tive character. Their language is well chosen, and their style
highly poetical. They project ships on an immense scale, and
palaces of pure gold, control kingdoms, and discover the secrets
of Providence. Great subjects alone occupy their attention.
The following extract, from the register of the New York City
Lunatic Asylum, illustrates this phase of the disease. The
imagery of the delusions is entirely that of the patient, and his
style and language is retained as far as practicable.

"H. H., born in Virginia, aged 32, admitted 1853. After re-
ceiving his degree at Yale, he was supplied with an abundance of
money, and unrestrained in the gratification of every desire. His
funds becoming exhausted, he endeavored to obtain a living by
his own exertions, but with indifferent success, on account of the
impairment of his mind and health through the influence of his
former habits. His system is very feeble, and a large ulcer upon
one of his limbs renders him almost helpless.

" The imagination of H. H., naturally active, is morbidly exal-
ted. He believes himself to be the 'Earl of Warwick, the
King-Maker,' and adds to the singularity of the delusion, by the
conception that he is fourteen feet high, and large in proportion.
He wishes to purchase the asylum and all its contents, proposes
to bestow the most magnificent presents and the most extensive
estates upon the physicians, and signs papers to that effect.
Nothing is beyond his reach by reason of its expensiveness ;
nothing too good for his friends. His clothes are of the finest cloth,
lined with the most costly satin, decked with intricate embroidery,
and ornamented with buttons of enormous diamonds. For him
magnificent pictures adorn the walls of mansions, which the
highest architectural skill has reared. The souls of Praxitiles
and Canova shine through the marble monuments of their art
which fill the corners of his libraries. Through the stained-glass
window, shaded by the heavy folds of Genoa velvet, the light
falls upon the most rare editions of the works of those men, whose
literature is eternai.

"Carpets, the delicacy of whose tints rival those of the summer
cloud at sunset, cover the floors of his apartments. Tables in-
laid with precious stones, which cause the envy of the brightest
stars of heaven, uphold wines sparkling upon the brim of golden
goblets, as if anxious to kiss the lips of the drinker, and viands
which have been prepared with the consummate skill of the high-

822 Paralysie Generate. [December,

est culniary art. Flowers of supernatural beauty, whose delicate
perfume angels might use on their spotless garments, fill his con-
servatories.

" Among the spreading branches of the trees of his pleasant
gardens birds of brilliant plumage and unrivalled song pour forth
their sweet voices in harmony with murmurs of fountains, whose
silver-edged bubbles ripple over pearls and garnets, and whose
banks are clothed with the herbage and verdure of the tropics".

Even they who previously possessed but little imaginative
power evince now the most lively conceptions. Matters of com-
mon occurrence may occupy the attention, but are so vividly and
fancifully described as to render it difficult to detect the real
nucleus of fact. The exhilaration produced on certain individu-
als from stimulating drinks bears some resemblance to the expan-
sive ideas in this form of paralysis. These delusions continue
until the disease has progressed to a low state of dementia.
There is an occasional exception to the general rule of exaltation.
In such cases the mind seems depressed and enfeebled from the
commencement of the attack, and the paralytic symptoms are
very strongly marked.

The presentation of symptoms and the diagnosis being the
principal object of this paper, I select a case from Esquirol, in
which the prominent characteristics are given. " M. L. I)., thirty
eight years of age, had participated in the last campaigns of the
empire, and was elevated to the rank of colonel after the restora-
tion ; uniting to every physical and intellectual quality all the
advantages of a lofty position in society, and a large fortune. He
was of the opinion that he had experienced injustice on the part
of the government. His self-love was deeply wounded, and after
many days of insomnia he gave himself several thrusts with a
knife in the region of the heart. He was promptly secured, and
his services were but for a brief period discontinued. From this
time he expressed with bitterness his dissatisfaction, but was in
no respect less exact in fulfilling his duties as a commanding officer.
Two years subsequently he has an attack of cerebral congestion,
for which he is largely bled. Two days later he has a second
attack, more severe than the first He remains excited, talks
much, is agitated, irritable, and exacting. He does not sleep, and
after a third attack a true mania is developed. The delirium is
generally attended with agitation and notions of grandeur and
fortune. He commits a thousand extravagances, remains almost
naked, talks incessantly, cries aloud, orders a thousand things at
once, is impatient, and commits strange and imprudent acts, which
compromise his life, though he entertains no idea of suicide.

"Several physicians are called in consultation, and the mania-
cal state of the patient cannot be denied. His age, however, and
the brief duration of the disease, offer to the counsellors expecta-

1858.] Pardlysie Generate. 823

tion of a cure. I affirm that the patient will never recover; 1st,
because three severe attacks of cerebral congestion had preceded
the maniacal state, and that, consequently, there was some degree
of cerebral lesion; 2d. because, notwithstanding his excessive
loquacity, certain words are imperfectly pronounced, and because
his gait, although lively and active, is uncertain. I added, that
active medication would hasten the progress of the disease ; that
the country, exercise, a severe regimen, and the repeated applica-
tion of leeches to prevent new congestions, appeared to me to be
the only proper course. One of the consulting physicians did not
concur with me in my unfavorable prognosis, and proposed certain
tentative measures.

"After a month spent in fruitless attempts, we were obliged to
renounce all hopes of cure. Paralysis had progressed and demen-
tia was confirmed the patient retaining incoherent notions of
grandeur, which persisted for more than two years. He regard-
ed himself as the possessor of several provinces and kingdoms;
distributed palaces, and gave away millions, and commanded also
an army of giants. His cavalry was mounted upon horses of
gigantic size; he possessed palaces of diamonds, and his stature
was 20, 30, and 40 cubits in height. He talked both night and
day ; now in a low tone, now loudly. He also uttered loud cries.
Beset by hallucinations of hearing, he listened to the voices of
imaginary beings, and replied to them, boasting of his person, dis-
puting with and even abusing them. He recognized the mem-
bers of his family, and addressed them with amiability and polite-
ness ; but after a brief interval, however, resumed his habits of
constant conversation. He was sent to the country".

Paralysie generate occurs more frequently among males than
females; in fact, among the latter it is of rare occurrence. No
good reason has been assigned for this the predisposing and ex-
citing causes to which the disease is referred being found in
operation in both sexes. At Charenton, of 619 insane {'SG6 men
and 253 women) there were 109 cases of general paralysis, (95
males and 14 females). Into the Asylum at Halle, in the Tyrol,
257 men and 181 women were admitted, among whom were 28
cases of general paralysis, (22 men, 6 women)-. In the New
York City Lunatic Asylum, of 5,092 (2,391 men, 2,701 women)
under treatment within the last eleven years, 85 deaths have oc-
curred (76 males, 9 females) from this disease. It is a disease of
adult life, rarely occurring before the age of twenty-five. Those
of a sanguine temperament are more liable to an attack, especial-
ly if of a full habit, with a tendency to apoplexy. It occurs to a
great extent in the class called good livers, who remain up late at
night, and indulge in suppers with a free use of wine, the mind at
the same time being actively engaged. Venereal excesses, a free
use of mercurials, syphilitic diseases, a hereditary taint of insani-

824 Paralysie Generate. [December,

ty, or scrofula in a word, everything that tends greatly to de-
teriorate the blood, impair the constitution, or lessen the vital
power of resistance, may act as a predisposing cause. The ex-
citing cause is generally some sudden mental shock a loss of
friends or property, great anxiety in business matters, or it may
be an indulgence in very great excesses.

There are various diseases with which it has been and may
be confounded. " Ramollissement du cerveau" has some symp-
toms in common with it; but the continued pain in the head,
occasionally vomiting, rigidity of the flexor muscles of the limbs,
and stupidity, instead of exaltation of intellect, seem sufficient to
distinguish it from general paralysis. In the last-named disease
there is also a softening of the brain, but it is the cortical portion
that is particularly affected, and this gives rise, usually, during its
progress from irritation to softening, to the peculiar mental symp-
toms that have already been described.

Cerebral haemorrhage is usually accompanied by paralysis of a
hemiplegic character, and its sudden invasion with the ordinary
apoplectic symptoms is a distinguishing feature in its diagnosis.

Inflammation of the brain or its membranes, as well as the
affections of the spinal cord, might lead to error from superficial
examination, but the rapid progress of the one and the paraplegic
character of the other, without any peculiar mental aberrations
would indicate the nature of the disease. Delirium, arising from
inflammation, differs essentially from delusions. There is gener-
ally a low condition of the system ; the mind is not occupied with
external objects, but seems to retire within itself, and in a half
comatose state is manifested by incoherent mutterings without,
ever exhibiting the reasoning power of insanity.

Paralysis caused by mercury, alcohol, or lead, may be distin-
guished by a careful study of the causes and symptoms, the mus-
cles of the extremities being in these cases at first affected either
with numbness, trembling, or a complete paralysis of the exten-
sors.

Morbid growths of the brain, such as tumors, (malignant and
non-malignant,) tubercles, &c, present many features in common
with general paralysis. The character of the morbid growth can
be inferred only from the particular diathesis, or by the external
manifestations, the paralytic and mental conditions involved in
them depending principally on compression and inflammation,
with its sequences. The change occurring in the mental facul-
ties is that of general enfeeblement, presenting eventually the
ordinary characteristics of dementia. The last stage of general
paralysis closely resembles this, and its discrimination requires a
knowledge of the previous history and a careful analysis of the
successive order of the paralytic symptoms.

The following is selected from the case book of the New York

1858.] Paralysie Generate. 825

City Asylum, as an illustration of this error in diagnosis. It had
been considered as the effect of a morbid growth in the brain,
previous to admission. "C. L S., aet. 36, by profession an actor,
was on the 10th of December, 1856, admitted into the Asylum.
When admitted, he was found to be completely demented, paraly-
zed, unable to walk or stand, and with difficulty to swallow. He
lingered nine days, when the disease terminated in death.

" The iollowing history of the case, communicated by his brother
together with the post-mortem appearances of the brain, indicate
the form of the disease of which the patient died to have been
paralysie generate. His brother states that he had always been a
temperate man. Some two years since, in consequence of domes-
tic and business troubles, he passed through a period of great
mental anxiety and excitement.

" A year ago last October, while in Philadelphia, he exhibited
strong symptoms of insanity of a maniacal character, succeeded
by a condition of prostration. Soon after recovery of physical
health, a change in his character was noticed ; he became irrita-
ble, impatient of contradiction ; at times despondent, and then
verv sanguine of success in his profession and business. His
time, following such recovery, up to April last, was spent inform-
ing business plans and studying the important characters of
Shakespearean the belief that he was to become a prominent actor,
although his friends knew him to be incompetent in this respect
from the great impairment his memory had lately suffered; When
slightly excited, twitching of the corners of his mouth and tremors
of the muscles of his face were noticed; his tongue was protru-
ded wTith difficulty, and his voice altered and 'cracked5 in its
tone. All of these symptoms increased in intensity about the
beginning of April last, when on the 8th of the month, he had a
convulsion of an epileptiform character, as described by his
brother, followed by prostration. From this he afterwards grad-
ually improved until August last, when he had another severe
convulsion, followed by loss of consiousness. For several hours
previous to this last convulsion, it was noticed that his left arm
had become paralyzed. He was then taken to a hospital, and for
a short time improved so as to be able to walk about the ward,
and regained considerable power in the use of his tongue and arm.

"During the four months he remained there, his brother states
that he had several convulsive attacks similar to those already
nentioned, followed each time by increasing helplessness and
greater loss of mental power, until he became reduced to the con-
dition in which he was brought to the Asylum. Autopsy four-
teen hours after death : skull a quarter of an inch thick, and of a
texture less dense than usual ; dura mater and arachnoid closely
adhered over summit of cerebrum : arachnoid thickened, and
presenting an opaline appearance, with serum between it and pia

826 Paralysie Generate. [December,

mater; general appearance of brain, atrophied; the cortical
structure somewhat softened and easily scraped with the knife or
finger-nail from the white medullary substance; this latter was
found to be hardened, of a firm texture, and glossy in appearance ;
the ventricles were largely distended, and contained liv. of clear
serum ; the floors of both lateral ones had a feeling of roughness
to the touch ; the foramen of Monro was large and patulous, easily
admitting the end of the little finger; the middle or soft commis-
sure was wasted to a thin ribbon of almost transparent membrane ;
the pons varolii and medulla oblongata were of less than usual
size, and the pituitary gland shrunken, and the upper portion of
its peduncle enlarged. The weight of the brain, drained of the
serum in its ventricles, was two and a half pounds, which is some
ten ounces less than the average given by Solly".

The most common pathological change in paralysie generate
is a softening of the vesicular neurine of the brain, especially in the
anterior portion of the parietal regions. Sometimes the tubular
neurine is also involved. Various other changes are occasionally
found, such as thickening of the membranes, effusion of serum,
induration of the cerebral substances, &c, but with no particular
uniformity ; and these, in fact, are found in many of the chronic
diseases of the brain. The length of time in which the disease
has progressed, must necessarily vary the cadaveric phenomena,
and if death occur very early, there may be no manifest softening ;
yet from this it does not follow that it has been in progress, that
there is no organic detritus. Either a subjective cause like over-
excitement of the mind, or an objective one like intemperance,
or moral and physical causes combined, may over-stimulate the
brain, and its continuance result in congestion, from which con-
dition serum may be effused into the primitive cellules, causing
irritation that may or may not end in softening. Why softening
follows in this form of paralysis, but not in ordinary congestion, is
not wrell settled. It may depend either upon some particular pre-
disposition on the part of the patient, or upon some unknown pe-
culiarity of the disease.

The prognosis is highly unfavorable. Rodrigues mentions a
few cases of recovery, but by most the disease is considered incu-
rable. Death follows, generally, in from one to three years after
the first symptoms appear, but life is occasionally prolonged be-
yond the last-named period. If it occur early in the disease, the
termination is usually by epileptiform convulsions ; if at a late
period, from general exhaustion, or disease of some important organ
other than the brain.

The object of this communication being merely to call the atten-
tion of the profession to the general characteristics of this form of
paralysis, I will not dwell upon the subject of treatment.

M. Roderigues recommends the adoption, at an early stage, of

1858.] Fevers their Identify and Treatment. 827

active measures, such as frequent venesection, &c. After the
disease is somewhat advanced, he advises the occasional abstrac-
tion of blood, in connection with tonics, aromatics, and cold baths,
while at a later period he recommends laxatives, and revulsives
to the skin. The treatment of M. Roderigues has not been found
successful when adopted by others, although he gives a very fa-
vorable account of its results.

The observance of general principles of treatment to meet the
indication of the symptoms has seemed to be attended with as
much benefit as the adoption of any other system. I have seen
more temporary good effects follow the use of a seton, or the free
application of Ung. Tart. Ant. to the back of the neck, than from
anvthing else in the way of treatment. If at a very early stage
the habitual excesses which had partially undermined the system
were corrected, and a careful hygienic course pursued, some
hopes might then be entertained of a gradual restoration.

[American Med. Monthly.

Fevers Their Identity and. Treatment. By W. L. Johnson, M.
D., of Charleston, Kv.

There is no class of disease in Xosonomy of such importance
to the physician as that of Fevers. (Febris, from fievre rel fer-
rore). The fevers prevalent in the different climates of the United
States, constitute a very large per centage of the disease with
which the physician has to combat. Moreover, they constitute
a class of disease frequently of great malignancy and fatality,
sparing neither age nor sex ; the inhabitants of the sunny South,
of the umbrageous West, of the frozen X orth, and of the East, are
alike often victims of their ravages. Of the mortality among the
people of the United States, a large per centage die of the great
scourge of the world, fever. How often does the scientific disci-
ple of /Esculapius find his skill unavailing, and feel his strong,
sinewy arm grow weak, as he beholds his patient in rigor mortis,
or struggling with the grim monster death. From these and other
considerations. I am induced to write an article on the subject of
fevers, hoping that it will merit a place in the columns of your
excellent journal, and throw out one glimmering ray of light
to the profession, or elicit something upon this important
subject from others of greater age and of riper intellects than the
writer. If I shall present ideas or views of the pathology, causa-
tion and treatment of fevers different from others, thev will be
conclusions or deductions arrived at from close observation and
study, and from an extensive practice of several years.

Medical literature abounds with accurate and faithful history
of all the phenomena, symptoms and complications of fevers, nev-

828 Fevers their Identity and Treatment. [December,

ertheless but a glimmering ray of light has been thrown out as
yet on its real causations and pathology.

In physiology as in chemistry every cause produces an infalli-
ble and uniform result, and like results or consequences must be
produced by identical causes.

The blood is now generally admitted by the most renowned
writers, as the seat of these phenomena, denominated fevers. The
idea is generally inculcated that they are occasioned by the intro-
duction into this fluid of some virus, malaria, miasm, effluvia, or
vapors, etc., so called by writers, which materially, chemically
or vitally change its character.

It would be absurd and illogical to arrive at the conclusion that
the multifarious substances affecting that fluid could produce the
same results; hence we are brought to the conclusion that all
similar febrile disturbances or diseases have the same or identical
causes or sources, caeteris paribus.

The analogy between fevers is striking to a casual observer,
considering the difference in the circumsUnces under which they
originate, which seem to indicate or estlish the probability of
the somewhat plausible hypothesis that they are produced by sim-
ilar or identical causes.

If we compare the miasmatic or autumnal fevers, we will find
as little difference between them as exists between cynanche
maligna and cynanche simplex, or the different species or fevers
of variola, scarlatina, etc., etc.

Now let us search out the localities, circumstances and seasons
favorable for the prevailing of intermittent fevers; the type of
those fevers which are admitted by all authors and physicians,
as being produced by some vegetable, and peradventure, in some
degree, by animal poison.

Intermittent fever is most prevalent in low, swampy lands, of
a wild, luxuriant growth, which has been for ages enriching the
soil by its decay, until its whole surface has become covered with
abundant vegetation, where the plough and pruning hook have
never been used by man, where the land is often inundated and
the soil is alluvial in character. It is there that we see the sallow
cheek, the yellow tinged conjunctiva, enlarged spleen, anasarca,
etc., among the poor and indolent inhabitants who have emigra-
ted there to subsist upon the game of the forest, and the fish of
the creeks and rivers. The intensity and frequency depends
greatly upon the overflowing of the rivers, creeks, etc., and
uniform heat or temperature of the season, thus producing great
and rapid decomposition of the vegetable matter, the prolific
source of the disease.

It prevails to a great extent in the counties of Hopkins, Chris-
tian and Caldwell, Kentucky, and in the vicinity of Charleston,
in midsummer and in the latter part of autumn and spring. This

1858.] Fevers their Identity and Treatment.

fever prevails in almost every river valley in the west, in the
savannahs of the south, and in the marshes and flats of the north-
eastern States. The disease becomes less prevalent as the lands
become cleared and cultivated by the agriculturist, which brings
to mind an old maxim, that when the cause shall be removed the
effect will cease to exist. A certain amount of virus or malaria
seems necessarv to produce intermittent fever, but a greater
amount produces fevers of a greater malignancy and of greater
duration, though similar in character.

The high lands contiguous to these regions or localities, where
intermittent fevers is so prevalent, are by no means secure or
exempt from this disease, though it prevails to a less extent and
is milder than in the low lands, and is often contracted in the low
lands, or the malaria is carried through the medium of the atmos-
phere.

Remittent fever arises under the same circumstances, and in
the same localities, seasons, etc., only requiring perhaps a greater
amount of malaria or heat.

The isthmus and yellow fevers are confined to low lands,
marshes and swamps, only in climates of higher temperature, and
are seldom found in the uplands or in the mountainous districts.

Typhoid, typhus, bilious fevers, etc., we think, from deductions
made from close observation, practice and study, are produced by
the same vegetable poisons in the same localities, though at differ-
ent seasons of the year, or in climates of a higher temperature.
They are the most prevalent when we have excessively hot sum-
mers, and when decomposition of vegetable matter has been very
great. When cold weather comes on and the decomposition of
vegetable matter is arrested by frosts, these fevers disappear, and
genuiue cases of typhoid, bilious, or typhus fever are but seldom
seen unless the disease has been contracted during the autumn.
They are very uncommon in high latitudes where the tempera-
ture is low, or in a dry, upland country. Therefore from the best
knowledge on the causation of these prevalent and important
diseases, we are bound to come to the conclusion that they have
identical can

Some other forms of fever remain unnoticed, but we will not
examine into the causation of any more in this article, but will
now show the great similarity of the initiatory or incipient symp-
toms of the general or prevalent fevers of the United States.

Taking intermittent and remittent fevers as the type of all the
miasmatic fevers, we will first give a meagre description of their
invasion, phenomena and course. These fevers are mostlv pre-
ceded by general lassitude, cephalalgia, soreness of the muscles,
vning, articular pains, etc., etc.. and frequently by some un-
pleasant enteric and hepatic symptoms, the tongue coated with a
whitish yellow fur. All of these are ushered in by a chill, followed

830 Fevers their Identity and Treatment. [December,

byTever, some cerebral disturbance or congestion. Now up to
this stage of these diseases, there is but little or no difference
between intermittent and remittent fevers ; this difference, should
it exist, is only in degree. Intermittent fever has three distinct
stages, its chill, fever, and the stage of perspiration ; these are suc-
ceeded by a marked intermission of duration proportionate to the
severity of the attack and the type, whether quotidian, tertian,
quartan, etc. But remittent fever does not present that perfect
intermission as in intermittent fever, but often presents remissions
of greater or less duration, according to the nature and malignan-
cy of the case, and often runs into typhoid fever, unless skilfully
treated, thus showing the identity between these diseases, or as
is sometimes the case, it runs into intermittent fever. The simi-
larity between intermittent and remittent fever is very striking,
nevertheless easily distinguished by the practitioner, and the indi-
cations of these two fevers are such as to require almostjbe same
treatment.

Bilious and yellow fevers have almost the same incipient symp-
toms as the two fevers just described, only differing in the
severity of their attack and character. These fevers are similar
and analogous, the latter only differing in its great malignancy,
and requiring a much higher temperature for its developement ;
both of which have great hepatic derangement, pathognomonic of
these affections, the viscus of the liver being more powerfully
affected than all others ; the whole secret of success in the treat-
ment of these diseases consist in addressing remedies to that organ,
and eliminating its poison or malaria in the system by the same
medical or therapeutical agents as in intermittent and remittent
fevers.

We now come to typhoid and typhus fevers, almost entirely
analogous or similar in character, incipiency, stages, duration, etc.,
and often a diagnosis is perplexing to the most scientific physician,
nor can it be made with great certainty until the disease has made
considerable progress. As in remittent fever there are often re-
missions, though imperfect. They are ushered in by a chill fre-
quently, headache, lassitude, pains in the back, diarrhoea, or con-
stipation, biliary derangements and delirium, though this last symp-
tom seldom presents itself until the second stage. So we find the
phenomena, the invasions, all the general symptoms of these two
fevers to be analogous or identical, doubtless produced by the same
cause but under somewhat dissimilar circumstances ; hence the
propriety of giving them different names in our text books.

From this hasty view and imperfect investigation of the causa-
tion of fevers, we arrive at a very correct or at best, plausible
conclusion, that the difference in malignancy, forms, duration etc.,
thereof, is caused by tbe different amount of malaria introduced
into the blood, the climate, idosyncrasy, previous organic derange-

1858.] Observations of Temperature in Patients. 831

merits, or pathological conditions, and circumstances undei which
they present themselves.

>w the inference or deduction is natural, philosophical and
plausible, that fevers have the same existing, identical cause, if it
be admitted that what we have stated is true relative to the locali-
ty, temperature, climate and circumstance under which they
originate. Moreover it seems equally plausible to admit the
identity of fevers, should there exist the great similarity in the
initiatory symptoms, exacerbations or paroxysms, and course, con-
comitant to the progress and termination of these diseases, des-
cribed in this article. We think that the contagiousness of yellow
and typhus fevers can be satisfactorily explained, upon the prin-
ciple of a vast amount of miasm or malaria in the vascular system,
to such a degree that it is given out, emitted or exhaled by the
lungs, or excretory ducts of the cutaneous system, etc., so that the
poison may be imbibed or received by the nurse or occupants of
the sick chamber from the victims of these malignant and alarm-
ingly fatal diseases, especially the former, yellow fever. In our
next article we will present the identity of the treatment of fevers.
Especial attention will be given to the treatment of typhoid fever,
the writer believing and knowing that it can be arrested and
greatly shortened in its course, having never lost a case of this
dangerous malady, or any other fever, though never having
treated a case of yellow fever. [Xashville Med. and Surg. Jour.

On the Observations of Temperature in Patients. By Prof. C. A,
Wuxderlich and Dr. L. Meyer.

Already during the last century several eminent physicians
endeavored to ascertain the temperature of the body in different
diseases. These efforts, however, were soon abandoned again,
and only quite recently the thermometric observations in pa-
tients have again received that attention which they so much
deserve. Prof. Wunderlich has, in this respect, a rich experi-
ence at his command ; accurate thermometric observations were
regularly made in his clinic in more than 5000 patients during
the whole course of their sickness, and also in private practice
he has conviuced himself of the practicability and usefulness of
this means of investigation. He considers himself justified,
therefore, to pronounce the view so generally taken, and recent-
ly advanced again by Lasegne, (Arch. Genrr., May, 1856.) that
thermometric investigations would never become very import-
ant to pathology, as perfectly erroneous. It is true, that for the
theory of diseases these observations of temperature have re-
mained as yet without direct use, and that they do not throw
much light at present upon the nature of fever, inflammation,

832 Observations of Temperature in Patients. [December,

etc., but also in reference to theory they have afforded facts
which are of great consequence for many important questions
in relation to pathological physiology. Of far greater import-
ance, however, are they in a practical point ; Prof. Wunderlich
considers them even of more value than most of the other means
of investigation, provided that also in local diseases the part
taken by the whole organism is considered of sufficient mo-
ment. As proof of his statement, the author gives the following
facts:

1. The observation of temperature offers the most reliable
means for deciding the importance of a disease of recent origin ;
with normal, or but little elevated temperature, the disturbances
of health are, with some exceptions, (cholera, apoplexy, pulmo-
nary hemorrhage, strangulated hernia, poisoning, etc.,) first of
all of no importance; an elevation of 2 E. or more, announces,
however, with certainty, the commencement of a serious disor-
der. This circumstance is a valuable guide, particularly in cases
of children, in which, as is well known, an insignificant disease
is frequently accompanied by violent symptoms, as also in re-
ference to the continuation of the patient's business, to his de-
parture, or transport, etc.

2. The observation of temperature points out frequently
important, though still latent disturbances ; an indisposition with
much elevated temperature deserves always particular attention ;
in the state of reconvalescence from serious diseases a relapse, or
a secondary disease, is frequently indicated first by an elevation
of temperature. This is particularly the case in typhus ; but
also in intermittent fever an elevation of temperature without
any other symptoms is frequently observed after an apparent
cure, and a relapse can then only be prevented by continuing
the use of quinine.

3. If the disease is developed the observation of temperature
offers the most reliable indications for the diagnosis. Diseases in
which the diagnosis of particular forms of the same or other of
pathological processes can be decided in this manner are, ac-
cording to Prof. Wunderlich, the following: typhus, (exanthe-
matic; enteric;) intermittent fever: pneumonia; meningitis, (at
the base; at the convexity ;) serous and purulent effusions in
the pleura or pericardium ; acute exanthemata ; internal suppu-
rations; peritonitis, (in lying-in women.)

4. The diagnosis being decided, thermometrical observations
are of the greatest use in reference to the prognosis. Intensity
and character of the disease, its stage the commencement of a
complication which is often not indicated by any symptom, the
usual aggravation and increase of the malady, as well as its de-
crease, can be recognized, as the author proves by many exam-

Observations of Temperature in Patients. 833

pies, the earliest and surest, sometimes even solely by the
behavior of the temperature of the body. A certain height of
temperature (about 34 R.) indicates, with certainty, a fatal
issue: perse veringly high temperature (over 32 '5) makes the
prognosis always more serious; a falling of temperature in a
proper manner, however, permits predicting a favorable turn of
the disease. In the state of convalescence changes of the tem-
perature of the body deserve no less consideration as a means
by which to recognize deviations from health, otherwise hardly
perceptible. Insufficient falling of temperature indicates, in
spite of apparent convalescence, an incomplete cure, and gives
reason for fearing the development of a chronic disorder; even
a small increase of temperature challenges precaution in regard
to diet and regimen of the convalescent.

5. Another great advantage derived from thermometric ob-
servations is the proof of a regular typic course of numerous febrile
diseases; it is true that physicians of a former period supposed
it to exist, but it cannot be demonstrated -with certainty but by
accurate observations of the changes of temperature of the body.
In the same way deviations from this regular typic course are
best recognized by the use of the thermometer, and we are thus
enabled to avert them by removing the causes, to neutralize
their consequences, or also, as many of such irregularities are of
a more favorable character than the normal course of the dis-
ease, to bring them on by therapeutical means.

6. From what has been said, the importance of thermometric
observations for therapeutics is evident enough; they indicate
where energetic interference is necessary, and when the disease
may be left to itself again. The thermometer gives us, however,
also reliable and accurate information in regard to the efficacy
of certain remedies and methods of treatment used ; for instance,
on the effect of general bleeding, of calomel, digitalis, camphor,
an emetic, and other energetic means in febrile diseases. The
observations of temperature have, as the author shows, so great
a value for therapeutics, particularly for the reason that the in-
dications for treatment have more frequently to be derived from
the general condition of the patient than from so-called local
disturbances which usually disappear spontaneously, and in
which direct interference is not of much benefit. [Arch.f. Phys.
Heilk., and North American Med. Chir. Rev.

Dr. Meyer considers observations of temperature in insane
patients of very great use, as they aid the physician in determin-
ing whether there exists a direct disease of the brain, or whether
the latter is affected merely by reflex action from another organ.
In the former case a corresponding change of temperature is ob-

834 Normal Course of Certain Typical Diseases. [December,

served ; if the delirium is accompanied by elevation of tempera-
ture without remission, a direct irritation of the brain exists.
In reflex alienations, however, this change of temperature does
not take place; if the temperature rises in these cases, it indi-
cates the occurrence of a complicating disease. These statements,
the importance of which for the prognosis and therapeutics of
mental diseases is very evident, the author proves by a con-
densed report of numerous cases, (mania, progressive paralysis.)
As the peculiar character of insane patients does not permit a
long continuance of the usual mode of observation viz., by
placing the thermometer in the axilla, he prefers to insert it into
the rectum. [Deutsche Klinih., 1858 ; Schmidt's Jahrbuch. 1858,
and Ibid.

On the Normal Course of Certain Typical Diseases. By C. A.

WUNDERLICH.

Professor Wunderlich considers the thermometer (applied to
the oral cavit}', the armpit, or rectum) as the best means of de-
termining the type of a disease, because its indications are but
little liable to be influenced by accidental circumstances; thus,
the character of the pulse, though presenting considerable uni-
formity in different morbid states, varies too much, and is too
dependent upon accidental circumstances, to allow of our using
it for the purpose of establishing the types of disease by its aid.
The author has not been able to determine any definite laws
regarding some acute diseases as acute articular rheumatism,
peritonitis, pleurisy, and pyaemia, nor for chronic diseases gen-
erally ; but he has found that febrile affections run a definite
typical course, which may be represented by the curves obtain-
ed by connecting the daily fluctuations of temperature; But
even in these typical forms of disease variations occur, which
depend upon the bearing of the individual, and upon influences
to which he is subjected. But there are certain influences which
are so uniform in their effect that this amounts to a law, and
thus a new type is established; this is the case with regard to
vaccination in its influence upon variola, venesection upon the
course of pneumonia, or calomel upon typhoid fever. This
knowledge of the typical course of a disease has a practical va-
lue, inasmuch as the diagnosis may be established by looking at
the curve ; the deviations from the normal condition are recog-
nized, and the exacerbations, as well as the commencement of
oure, are rendered visible. Moreover, when the typical course
of a disease has been demonstrated, a look at the curve will pro-
tect from all illusions regarding our therapeutic achievements,
while it affords a safe means of judging of really beneficial

1858.] Theory of the Production of Hernia. 835

effects produced by remedial agents; the unusual reductions or
diminutions of the course being shown irrefragably in the alter-
ed curve. Professor Wunderlich passes successively in review
his observations on the following diseases : Ephemeral fevers,
which he does well in restoring to nosology ; quotidian, tertian,
and quartan agues ; measles ; erysipelas ; scarlet fever ; variola ;
typhoid and typhus fever ; and several forms of pneumonia.
"Without reproducing the curves themselves, which give an
ocular demonstration of the rising and falling of the thermome-
ter in the various diseases mentioned, it would be futile to at-
tempt giving the details of Professor Wunderlich's elaborate and
valuable paper. The following general remarks will further
indicate the kind of results which he has arrived at by this me-
thod of investigating disease. In some forms, the mode in which
the disease commences is characteristic ; the increase of tempera-
ture may be very rapid or slow, the maximum being reached in
a definite period, or there may be a uniform rate of increase.
The period in which the fever arrives at its full development
affords numerous important points; the absolute elevation of
temperature is determined in part by the special form of disease ;
on the other hand, it indicates its degree. The duration of the
maximum point is even of more consequence than the absolute
maximum, and the larger or less variation between morning
and evening, and the number of days on which the tempera-
ture retains nearly the same elevation, are also points of import-
ance. The duration of maximum elevation varies somewhat,
but its duration must be regarded in the main as forming a
characteristic feature of the individual type. In some diseases
definite fluctuations occur during this period. The termination
of the process, and the return to the normal condition, which
the author terms defervescence, exhibit a very regular type,
which is characteristic for every form of disease ; the phenomena
of defervescence are even more precise than those of the com-
mencement and elevation of the morbid process, and serve still
better to mark the nature of the disease. [Archiv. fiir Physiolog.
Eeilkunde. and Brit, and For. Med. Chir. Rev.

On the Theory of the Production of Hernia. By Professor Eoser.

The views here advanced have already been published by Pro-
fessor Eoser, seventeen years since; but as they have not exci-
ted the attention he believes they deserve, he reproduces them
with the advantage of being able to add, that all subsequent in-
vestigation during so long a period of an active career, has only
confirmed his conviction of their truth.

Debating with a celebrated professor of surgery, he declared

n.s. VOL. XIV. NO. XII. 49

836 Theory of the Production of Hernia. [December,

that a sudden production of hernia was impossible, according
to the laws of mechanics. The professor maintained the possi-
bility inasmuch as he had examined persons who had shown no
signs of hernia, and yet, after violent exertion, its presence had
become manifest. This, Koser regards not as observation, but
as a post-hoc conclusion. It is well known how difficult (or
when small, impossible) it is to detect an empty hernia sac. We
only recognise it when the intestine has entered it, and we can
feel the impulse on coughing, &c ; but when such entrance is
prevented by various circumstances, the most we can say is, not
that no hernial sac, but that no hernia, is present. Why is it
not possible, as Scarpa and Cloquet have shown, to produce a
hernial sac on the dead body by the use of violent compressing
power, aided by apertures made in the tendinous walls of the
abdomen ? First, because the peritoneum is not sufficiently
elastic to bear the necessary extension ; and, secondly, because
compression of the soft and fluid contents of the abdomen acts
by hydrostatic law; and although the peritoneum may be
stretched, it is not thrust out as it is found to be in hernia, and
as it may be to some extent by the finger locally applied.

Professor Koser advances these two propositions, that femoral
hernia arises from the dragging out (Herauszerrung) of the peri-
toneum, and that external inguinal hernia, or more properly its
sac, is almost always congenital. First, with respect to femoral
hernia, the dragging out of the peritoneum is brought about by
nodules of fat, which, appertaining to the subserious tissue, are
firmly attached to the peritoneum. These nodules slide between
the fibres of the septum crurale, thrust them asunder, and lead to
their disappearance. The anterior part of a nodule passes out
under the plica, covered only by fascia superficial, and increases
in size. Its movements are favored by its pyriform shape, and
by the motions of the body, and the peritoneum following
it, a sack is gradually formed. In all the instances of commen-
cing hernia the author has had the opportunity of examining,
' he has found such fatty nodule at the apex of the sac. We can-
not expect to find this in old or large hernias, as it would disap-
pear under pressure. Professor Linhart, of Wiirzburg, the only
anatomist who has of late years investigated the subject of her-
nia, has confirmed these views, stating that he believes that trac-
tion exerted on the peritoneum exerts far more influence in the
formation of hernia than the pressure exerted by the contents
of the abdomen.

External Inguinal Hernia. The valvular character and oblique
course of the inguinal canal, should have formed a sufficient
reason for rejecting the ordinary theory of the formation of this
hernia. All subsequent investigation has convinced Professor

1858.] TTieory of the Production of Hernia.

Koser that his statement made long ago, that this hernia is
almost always congenital, is correct. He has found that the her-
nia vaginalis funiculi i. e., an open state of the upper part of
the vaginal process occurs much oftener than is supposed. It
has been found in almost all the children the subjects of inguinal
hernia, whom he has examined ; and he has frequently met in
adults hernial sacs so long and narrow, that they could only be
regarded as incompletely-developed vaginal processes of the
peritoneum, into which intestine had not passed. He has also
found the anatomical signs, detailed in his former treatise, ex-
hibiting the congenital nature of the affection. Other co-existing
anomalies of the peritoneal formation are often met with. Beside
the descent of the testis, there is a descent of the ccecum and
sigmoid flexure, and disturbances of these often occur at the
same time. As the author has feund in almost all the outer
inguinal hernias he has examined, such grounds for considering
them congenital, he has come to the conclusion that the bulk of
cases regarded as accidental do not merit the appellation, inas-
much as the sac has been in existence prior to birth. He refers
in confirmation of his views to Camper's statement, that of 63
full-timed children in whom the testis had descended, the vagi-
nal canal was obliterated only in 7, it being open on both sides
in 34, on the right side only in 14, and on the left side in 8. So
likewise Professor Engel, whose investigations are now publish-
ed in the ' Wien Wochenschrift,' states that in children at birth,
or during the first fourteen days afterwards the vaginal canal
is found oftener obliterated, or at least considerably shorter, on
the left than on the right side a fact agreeing with the prepon-
derance of hernia on the right side. He found the canal entire-
ly closed at birth in ten per cent. After fourteen days no trace
of it could be found on the left side in 30 per cent., while it re-
mained open on both sides at the end of fourteen days in 69 per
cent. In the adult the presence or the remains of the vaginal
canal was observed in 31 per cent, of the bodies examined, on
both sides in 37*5 of these, and on the right side alone in 62*5.

Outer Inguinal Hernia in the Female. The author long since
proposed the question to Professor Meyer of Zurich, whether
woman were not liable to a similar descent of the peritoneum
as men ; and that writer, in a paper in Muller's ' Archiv,' has
shown that in the female as well as the male foetus, a projection
of the peritoneum into the inguinal canal does not take place.
Its metamorphosis, however, occurs much earlier, as soon as the
fifth month ; and it is also less considerable, and therefore less
liable to disturbance than in the male sex.

Internal Inguinal Hernia. This, Professor Roser observes,
may, in some cases, have a fatty origin, like femoral hernia ;

838 Apparent Death during Intermittent Fever. [December,

but he believes that other cases arise from a local protrusion of
the peritoneum, in aged and relaxed subjects, in whom partial
atrophy of the fascia transversalis has taken place. This is a
very different thing, however, to the sudden production of her-
nia usually admitted. He believes with respect to internal in-
guinal hernia, that the fact that it occurs almost exclusively in
aged men is not generally known. It takes place indeed much
oftener than most authors admit ; and may be almost said to be
as frequent in old men as femoral hernia is in old women. The
much greater narrowness of the ring is the reason it does not
occur often in old women.

Umbilical Hernia. This is the only hernia which is produced
according to the old theory, viz., by a vis a tergo, and even here
the author suspects that in some cases it may arise from a con-
genital protrusion of the peritoneum, remaining from the foetal
state. As this hernia differs in the mechanism of its formation
from other kinds of hernia, so does it in the remarkable fact of
its being generally spontaneously curable, as may be seen from
the small number of cases met with in the adult, compared with
the large number occurring in infancy. In aged and fat indi-
viduals, accidental hernia of this form is, however, frequent.

Originally commencing his investigation with a purely scien-
tific object, Professor Eoser has since found that it has an appli-
cation to legal medicine, the question not unfrequently arising,
whether a hernia has been produced in consequence of acts of
violence in scuffles, assaults, &c, and the culprit risking to be dealt
with too harshly in consequence of the off-hand way in which the
affirmative is pronounced. [Arch. filr Physiol. Heilk.} and Ibid.

Case of Apparent Death during a Paroxysm of Intermittent Fever.
By Professor Fkanqois.

In the midst of an epidemic of intermittent fever which pre-
vailed at Mons in 1822, Professor Francois was sent for to a
lady, aged 40, who had a slight attack, which was soon relieved.
Two days after, he was suddenly informed she was in a dying
state. She had been seized with a new paroxysm, # and after a
little shivering and yawning, became almost immediately insen-
sible. He could find no pulse ; the pupils were insensible to the
action of bright light ; the whole surface was cold, pale and dry,
and respiration was suspended to such an extent that a mirror
placed before the mouth remained untarnished, and the flame
of a candle undisturbed, while the ear applied to the region of
the heart could not perceive the slightest sound, or impulse.
Every kind of stimulus was applied in vain, and she had so
completely the appearance of a corpse that her burial was alrea-

1858.] New mode of treating Purulent Ophthalmia. 839

dy spoken of. Although this state had continued nearly an
hour, M. Francois prohibited any such step being taken, believ-
ing it possible that he had to do with a case of pernicious inter-
mittent, in which the vital process might be merely suspended,
not extinguished. Stimuli, in the shape of frictions and glys-
ters, were therefore resorted to ; but it was not until about four
hours afterwards that a little moisture was observed on the fore-
head. Sinapisms and hot applications were again resorted to,
and shortly afterwards some slight pulsations of the heart and
respiratory movements were observed,, followed by a return of
the pulse and complete restoration. Quinine was administered
in abundant quantities as soon as possible. On the second day
after this another alarming paroxysm occurred, but this was the
last, and the cure remained assured. The lady lived for many
years afterwards. It is a curious fact that her husband, a fort-
night afterwards, suffered from an attack of pernicious fever of
the same nature, but less in degree. This case, in which the
pulsation of the heart could not be perceived during several
hours, forcibly shows the danger of the rule laid down by M.
Bouchut, that such complete suspension is a sign sufficiently
certain ta allow of interment being safely undertaken.

[Presse Medicate Beige, and Virginia Med. Jour.

A New Mode of Treating Purulent Ophthalmia. By M. De Coxde.

M. De Conde, a Belgian military surgeon, dissatisfied with the
present treatment of this disease, which seems to be very preva-
lent still in the Belgian army, lays down a new plan, based upon
the following considerations:

1. The greatest danger to the eye arises from the contact of
the upper lid, which, inflamed and swollen, floods its surface
with an acrid and corrosive pus. The excessive heat of the eye-
lid, the internal surface of which is rough and unequal, inter-
feres with the nutrition of the cornea, while the acridity of the
pus leads to its softening and destruction. 2. It is admitted
that it is of importance to prevent the contact of inflamed mu-
cous membranes by the interposition of an isolating body, such
as sharpie or wadding. This is seen in vaginitis, balanitis, and
fissure of the anus. 3. This body, which may alone produce
great amelioration, or even in some cases a removal of the dis-
ease, may exert a powerful effect if impregnated with an active
agent. In this way lint, soaked in a concentrated solution of
acetate of lead, and placed between the glans and the prepuce,
will cure gonorrheal balano-posthitis within forty-eight hours.
4. Cod liver oil exercises a powerful action in disease of the
mucous membrane, modifying and then suppressing their secre-

840 Successful Operation on Children Born Blind. [December,

tions. It strengthens the fibrous tissues of the eye and the
cornea, and tends to prevent ramollissement. It is especially in
ulceration and chronic ramollissement of this membrane that
this double action is perceived. 5. The red precipitate oint-
ment (four parts to fifteen of lard and fifteen of linseed oil) is an
excellent substitutive agent, sufficing alone to arrest the disease
when employed early. It is the best remedy for cutting short
the ophthalmia of new-born infants. 6. A solution of the chlo-
ride of lime (thirty parts to two hundred of water) is an ener-
getic modifier, neutralizing with certainty the virulence of the
secretions. 7. Lastly, perchloride of iron exerts an instantane-
ous haemostatic effect upon the hemorrhagic mucous membrane,
and an indubitable modifying influence upon the mucous secre-
tion.

As an isolating body, M. De Conde, after trying various sub-
stances, gives the preference to wadding, as forming at once an
inoffensive application, capable of imbibing and favoring the flow
of the secretions, and of being impregnated with medicinal
agents. A slip of the wadding somewhat longer than the trans-
verse diameter of the eyelids, is brought opposite the palpebral
aperture, and gently pushed up beneath the upper ^elid by
means of the little finger or a large probe. Some cases are rela-
ted as examples of the manner in which a disease often so
tedious in its progress, may, upon these principles, be rapidly
cured. [Annales d ] Oculistique, &nd Brit. & For. Med. Chir. Rev.

Six Cases of Successful Operation in one family, on Children Born
Blind. By Henry W. Williams, M. D., Boston.

In February, 1857, I visited a German family, residing near
the southern boundary of the city, of which five members, the
mother and four children, were affected with cataract in both
eyes, evidently of congenital origin.

The mother was not aware of any cases among her eight
brothers and sisters, or among her ancestors. In her, the lens
exhibited in each eye a disseminated, dotted opacity, the cloudy
spots being most numerous near the centre, while the margin of
the lens was comparatively clear. Consequently, in a bright
light she was almost entirely blind, but in a moderate light saw
sufficiently well to perform, in a slovenly manner, the house-
duties of a laborer's wife. The capsule of the lens, in her eyes,
and also in those of the children, was transparent. Her hair and
irides were dark ; the children had light hair and a grey or blue
iris. She has two other children, whose eyes as yet exhibit no
trace of cataract. The order of succession in the cases was as
follows : The oldest girl had cataract ; the second child, a girl,

1858.] Successful Operation on Children Born Blind. 841

was free from the disease ; the third and fourth children, a boy
and girl, were affected ; the fifth, a girl, was free ; the sixth a
boy, was affected.

The eyes of the children presented nearly similar appearances,
and one description may answer for the whole. Nearly the en-
tire field of the pupil was occupied by opacities, consisting of
dots of various sizes, and evidently occupying different planes
of the lens. In a bright light, reflections from crystals of chol-
esterine could be plainly seen. All the patients had sufficient
vision to enable them to find their way in a moderate light,
when the pupil was so far expended as to allow of vision through
the margin of the lens ; but in a bright sunlight they were nearly
blind, and their sight was at no time sufficient to enable them
to learn to read, or to gain a livelihood by ordinary pursuits.

Six operations were performed, on the afternoon of the 5th
of February, on the oldest girl, aged about 17, the boy about 12,
and girl about ten years. As I believed the entire lens might
be safely broken up in these cases, the same method was pursued
in operating on all the eyes, the lens and capsule being freely
divided by means of a needle introduced through the sclerotica.
Sparkling reflections from crystals of cholesterine were distinct-
ly seen in the posterior chamber, by several physicians who were
present. The eyes were covered with a dry compress and
bandage, and the pupils were kept well dilated by the use of a
solution of atropia. The oldest girl had very little pain or in-
jection of the eyes, and no nausea. The boy had considerable
pain in and around his left eye, and some nausea, continuing
for two days. His right eye gave him no pain whatever. The
youngest girl had considerable pain in the right eye, with in-
tolerance of light, continuing four days. Her left eye gave her
no pain at this time; but, the absorption of the lens going on
slowly, a second operation was performed some months after,
which caused some pain and nausea, but was followed by imme-
diate absorption of the residue of the lenticular substance.

As the size and density of the fragments diminished, the ab-
sorption of the lenses went on more and more rapidly ; but it
was several months before the pupil became perfectly clear in all
the six eyes. The children have now perfect vision, with the
aid of the ordinary cataract glasses, and they will be able to fol-
low any occupation they may prefer. The mother and the child
of two years have not yet been operated on, the mother being
timorous as regards her own eyes, even with the brilliant results
before her obtained by the operations on her children, and wish-
ing to have the little one left undisturbed till he is older. There
is nothing in either of their cases less favorable than those which
have already been relieved.

842 On the Absorption of Abscesses. [December,

I have seen another instance, in a family residing in this State,
of no less than seven cases. Other children in the same family
were free from the disease. Some of the eyes had been operated
on, but I think without much success, on account of portions of
the capsule which were left behind and had become tough.
These might, however, be readily removed by the small canula-
forceps. Mr. Streatfeild also reports an example, in the third
number of the "Ophthalmic Hospital Reports," of six cases- of
double cataract, five children and their mother. Three other
children exhibited no defect of vision. Two of this family had
been operated on, with partial success. The cases now reported
are interesting from the rare occurrence of such a group, and the
rare occurrence of such a group, and the still more rare perfor-
mance of so many operations at one time in a single family ; and
the results are particularly gratifying, as they have given almost
a new existence to those, who, but for the resources of our art,
must have been unfortunate and helpless during their whole
lives. [Boston Med. and Surg. Journal.

On the Absorption of Abscesses.

M. Chassaignac brought this subject recently under the notice
of the Paris Surgical Society, stating his belief that purulent
collections are never absorbed, at least the solid globular
portions, although the serum may sometimes be so removed.
Abscesses said to be so removed were in fact non-purulent col-
lections or lymph. M. Richard pointed out the error of suppos-
ing that pus-globules were not absorbable because they were
solid, inasmuch as tumours, effusions of blood, &c, are known
to undrgo such absorption. It is by no means rare to find small
axillary or peri-mammary abscesses becoming absorbed; ab-
scesses the size of a pigeon's egg, will in chronic farcy disappear
in twenty-four hours ; and congestive abscesses not unfrequent-
ly heal without any aperture having been made. M. Huguier
thinks every one must have seen examples of the spontane-
ous disappearance of abscesses, a by no means rare circum-
stance, in inguinal bubo. M. Yerneuil referred to a case that
came under his care, in which an undoubted abscess, as large as
the fist, situated in the middle of the thigh, entirely disappeared
after three weeks local application of iodine. In another case,
two abscesses in the axilla were opened, while two others, just
as manifestly fluctuating, being left to themselves, were sponta-
neously absorbed. In a case of hygroma, M. Morel-Lavellee
obtained a few drops of fluid by means of an exploratory punc-
ture. This was shown to be pus, and the rest of the fluid being
left in the collection, flying blisters were applied, and entire ab-

1858.] Carbonic Acid Gas in Diseases of the Womb. 843

sorption was induced. M. Chassaignac observed that this was
the only demonstrative fact advanced in the discussion, and he
must wait for others to be convinced. At present he does not
believe that properly-characterized abscesses are capable of ab-
sorption. Many cases are, it is true, mentioned by authors, but
with insufficient proofs. Fluctuation and other symptoms men-
tioned are not sufficiently rigorous ones. Thus, in a case of an-
gioleucitis, in which he opened two collections apparently alike,
one contained pus and the other plastic lymph ; and from some
inguiual bubos he has opened, he has only removed such lymph.
M. Broca, however, desired to know what M. Chassaignac de-
signates as " collections of plastic lymph ;" for if he means those
masses of yellowish concrete, semi-solid matter found in the
centre of commencing bubos, M. Broca can assure him that this
substance, which is susceptible of absorption, contains an enor-
mous quantity of pus globules. M. Collerier declares, that since
he has treated bubos by the method recommended by Dr. Sirus-
Pirondi viz., blistering, followed by tincture of iodine, he has
obtained a cure by absorption of the pus in nine-tenths of his
cases. Even when the blister does not succeed, it still exerts a
great influence upon the absorption of the globules ; and if the
bubo has afterwards to be opened, pus containing a large pro-
portion of serum is discharged. [Gaz. des Hojoitaux, and British
and Foreign Med. Chir. Rev.

On Injection of Carbonic Acid Gas in Treatment of Diseases of the
Womb, and their Influence upon the System. By Dr. Bereaed.

The application of carbonic acid gas in cases of painful uterine
disease, as recommended by Drs. Hardy and Simpson, has been
tried and found successful by the author in several instances.
He records eight cases, four of carcinoma uteri far advanced, and
four of a simple congestive but very painful character. In
almost all of them the carbonic acid gas had an anaesthetic in-
fluence, without producing any alarming symptoms, with the
exception of one case. The mode of application is very simple ;
a bottle, the cork of which is pierced by an elastic canula, is fill-
ed with twenty -five grammes of bi-carbonate of soda, and twen-
ty grammes of bi-sulphate of potash, with a sufficient quantity
of water. The development of the gas begins immediately,
which is brought up to the diseased portion by means of the
elastic tube.

The first case proves much in favor of these injections. The
patient suffered from carcinomatous ulcerations of the neck,
with a foetid discharge and violent pains. After application of
the gas, the pains not only disappeared entirely, but even the

844 Operation in Obstinate Vomiting. [December,

ulcers began to look better, and the patient improved considera-
bly in health, so that she was discharged as cured after two
months, because only two or three red excrescences could be
detected on the neck when she left the hospital.

The second case shows an old carcinoma, with violent hemor-
rhages and deep ulcerations of the neck, while the body of the
womb and the neighboring organs were not affected. In this
instance, the gas only showed its anaesthetic influence, having
no influence upon the disease itself.

In a third case of ulcerated carcinoma, the injections at first
stopped the discharge, and diminished the pain ; but afterwards
symptoms of intoxication were remarked, and when these injec-
tions were tried again after some time, they had a very bad in-
fluence upon the disease, so that their use had to be discontin-
ued.

The fourth case is one of far advanced carcinoma, with
violent pains in the lower part of the abdomen, which disappear-
ed very rapidly after the first injections. The disease itself was
not influenced in its course.

The fifth observation is one of inflammatory induration of
the neck, with violent pains. The gas had a local quieting in-
fluence, but produced such violent symptoms of intoxication,
that, its application had to be suspended.

In the sixth case, which was similar to the former one, the
pains disappeared very soon, and the swelling diminished, but
signs of intoxication were observed also.

In a seventh case, signs of absorption of the gas were observed,
but the pains disappeared, while the ulcerations remained un-
changed. The patient remained only a short time under treat-
ment.

Eighth case. Metritis, engorgement of the neck, violent pains,
against which a great number of remedies were applied, without
the least benefit. They disappeared after the first injections.

The anaesthetic influence of the gas only remains a short time,
therefore the injections have to be repeated several times in a
day. [Archiv. Generates, and New York Jour, of Medicine.

Report of a Case in which the Operation of Paracentesis Thoracis
was performed for the relief of Obstinate Vomiting.

The particulars of the case, communicated to the Society,
through the President, by Mr. Heslop, of Birmingham were as
follows : The patient was a girl aged 20, who had been for
two months affected with effusions into the left pleural cavity.
Extreme emaciation, night sweats, etc., were present, but in
addition to these, no food of any kind was retained by the

1858.] Menstruation in Austria. 845

stomach. No relief followed ordinary measures, and it being
evident that the patient was dying of inanition, Mr. Heslop
advised the performance of the operation. Two pints of fluid
were drawn off, and the relief which followed was immediate
and complete. The patient rapidly recovered. Mr. Heslop
added that, in advising the performance of the operation, he took
the same general line of argument as that pursued by the ac-
coucheur in inducing artificially premature labor, when the in-
terference with important functions, as that of low stomach, calls
for that proceeding [Proc. of Path. Soc. of London..

Menstruation in Austria. By Dr. Fred. Szukits.

Of 665 women born in Vienna, and menstruating there for
the first time, the mean age for its first appearance was fifteen
years and eight and a half months; in 210 cases, in the begin-
ning of the fifteenth year; in 87, in the eighteenth year: in 84,
in the sixteenth ; 6 women menstruated first at the age of eleven
years, 3 at twenty- two. The period during which menstruation
may primarily occur in Vienna comprises twelve years. In
Paris, in the same latitude, it occurs one year earlier.

Of 1610 women from the country, the age of first menstrua-
tion averaged about sixteen years and two and a half months.
418 menstruated during the fifteenth year, 251 in the sixteenth ;
then followed in order the seventeenth, eighteenth, and nine-
teenth. More than half, 888, menstruated after the fifteenth
year ; less than one-fifth 304 before it. Two menstruated at
ten, and the oldest two likewise first menstruated at twenty-
five. The period during which menstruation may primarily
occur, comprises therefore sixteen years in the country four
more than in the town of Vienna. Of these 1610 women, a. 603
were from Upper and Lower Austria Proper ; of them, the mean
age of first menstruation was sixteen years and three months ;
here also the greatest number, 142, menstruated in the fifteenth
year, 88 in the seventeenth, 81 in the sixteenth, and 72 in the
eighteenth year ; the youngest, 5, were eleven, and the oldest, 2,
twenty-five years old ; the period of primary menstruation com-
prising thus fifteen years, or three more than in Vienna, b. 430
were Bohemians, of whom the mean age of primary men-
struation was sixteen years and two months ; 148 menstruated
first at fifteen, 51 at seventeen, 49 at sixteen, and 46 at eigh-
teen ; the youngest was, ten, and the oldest twenty-four, at her
first menstruation ; the period of primary menstruation com-
prising fifteen years, c. 273 came from Moravia, the mean age
of primary menstruation being sixteen years and three and three-
quarter months ; 69 menstruated first at sixteen, 59 at fifteen,

846

Menstruation in Austria.

[December,

and 32 at seventeen ; the youngest, 8 in number, were twelve,
and the oldest, 8, twenty-two years old ; the period of primary
menstruation comprising thus only eleven years ; one year less
than in Vienna, and four less than in Behemia and the rural
districts of Austria Proper, d. 180 women came from Hungary ;
and of them the average age of primary menstruation was fifteen
years; 39 menstruated first at fifteen, 19 at fourteen, 16 at thir-
teen, 12 at seventeen ; the youngest was ten, the oldest twenty-
two ; the period of primary menstruation comprising twelve
years, e. 67 women came from Silesia ; the mean age of their
primary menstruation was sixteen years and one and a half
months; 21 menstruated first at sixteen, 14 at fifteen, 8 at sev-
enteen, 87 at 18 ; the youngest was twelve, the oldest twenty-
two years old ; the period of primary menstruation comprising
eleven years. /. 66 women came from Bavaria ; their average
age for primary menstruation was sixteen years and ten months ;
17 menstruated first at seventeen, 15 at 16, 9 at eighteen, and 8
at fifteen; the youngest was eleven, the oldest twenty-three;
the period of primary menstruation comprised thirteen years.

Brierre de Boismont fixed in Paris the age of primary men-
struation at fourteen years and ten months for the poor, fourteen
and five months for the middling classes, and thirteen years and
eight months for the rich ; and with this the observations of
Chomel, Andral, and Eecamier agree. Of our author's 2275
cases, 136 were of the middling classes in them the average
age of primary menstruation was fifteen years and two months;
730 handworkers medium age fifteen years and ten months at
their first menstruation ; 1207 female servants, of whom the
mean age of primary menstruation was sixteen years and two
months ; and 202 day labourers, whose mean age at their first
menstruation was sixteen years and one and a half month ; these
results agreeing with Boismont's observation, that menstruation
is earliest among the rich, and latest among the poor. Among
the 2275 women, the ages at which menstruation first occurred
are thus divided :

At 10 years 2 women menstruated.

n i

15

" 12 '

36

" 13 '

149

" 14 *

204

" 15 '

628

" 16 *

335

u 17 <

283

At 18 years 259 women menstruated.

19 "

147

20 "

95

21 "

34

22 "

30

23 "

4

24 "

2

25 "

2

The average age of primary menstruation in Austria being thus
fifteen years and seven and a half months. As influential agents
in hastening or retarding menstruation, Sz. enumerates geogra-
phical position, climate, populousness of a town, nationality,

1858.] Menstruation in Austria. 847

mode of life, occupation, food, clothing, dwelling, training, mor-
als, and bodily organization ; according to some authors, heredit-
ary tendency is also influential. Although in Austria menstrua-
tion most commonly occurs between the fifteenth and seventeenth
years, many cases have been recorded of its much earlier occur-
rence. Wilson observed a case in which it occurred in the fifth
year; the breasts being as large as those of a marriageable fe-
male. Scanzoni records one case at eight years; D'Outreport,
one at nine months ; she had protuberant breasts, and menstrua-
ted every four weeks till her death in her twelfth year. Bois-
mont records two cases in one menstruation commenced in the
third month, in the other in third year. Similar observations
are recorded by Mad. Boivin, Dieffenbach, and Martin Wall.
In France, early menstruation is more common than in Austria ;
as Boismont, in 1200 cases, found fourteen who had menstrua-
ted before their tenth year. According to Szukits' observation,
in scarce one-third was primary menstruation painful ; while in
France, according to Boismont, this was the case in more than
two-thirds. In one case of dysmenorrhcea our author observed
trifling acne rosacea on the chin and sides of the nose the
woman was twenty-seven years old. In three cases, each men-
strual period was attended by an eruption of uricaria over the
entire body ; and in two girls, one fifteen, the other seventeen,
the molimina of primary menstruation were attended by inflam-
mation of the cellular membrane, which again disappeared on
its cessation in three to five days after. Strong, healthy women
generally menstruate more sparingly than feeble, anasmic, or tu-
berculotic females; the latter, if not labouring under amenor-
rhea have profuse watery menstruation, lasting from ten to
fourteen days. Of 1013 women, 240 menstruated sparingly,
560 moderately, and 187 profusely ; of the latter, 26 passed clots
without there being any uterine lesion present. Of 1013 women
Sz. found that only 642 menstruated regularly every twenty-
eight to thirty days, 371 menstruated irregularly, 269 menstrua-
ted from every eight days to every three weeks, 128 only every
five or six weeks. The duration of menstruation is influenced
by the same causes which influence its early appearrnce its
medium duration is 3f days. Three times, Sz. saw menstrua-
tion occur for a shorter or longer period during pregnancy ; also
during lactation it was frequently seen. Trustworthy cases are
recorded in which menstruation only occurred during pregnan-
cy or after delivery. During fourteen years, and in 8000 cases,
14 occurred of total absence of menstruation ; four of these had
borne children repeatedly, the others never ; most of them had
from time to time, every three or four weeks, molimina menstrua-
tionis ; in none was there any vicarious menstruation ; in two

848 Pepsine in Obstinate Vomiting of Pregnancy. [December,

cases, imperfect development of the uterus was discovered. Of
263 women, menstruation ceased in 99, between forty-six and
fifty years; in 77, between forty-one and forty-five; in 42, be-
tween fifty-one and fifty-five ; in 26, between thirty-six and forty ;
in 15, between thirty and thirty five ; and in 6 cases, between
fifty -six and sixty years. The youngest woman who had ceased
to menstruate was thirty-two, the oldest sixty -one, at the period
of cessation. This may occur suddenly, without interruption
to the general health, or it may take several years for its comple-
tion. Boismont reckons the average of this at two years. Sz.
found the mean duration of uterine power to be thirty years.
125 women menstruated from twenty-one to thirty years ; 106,
from thirty-one to forty years. The shortest peried of menstrua-
tion was twelve years, and happened in two cases ; the longest,
forty-five years, likewise occurred twice. Boismont found one
case with a duration of only five years, and another with a du-
ration of fortj^-eight. Of 863 women, 64 were never pregnant;
124 conceived once; 73, five times; 63, six times; 74, seven
times; 38, eight times; 32, nine times; 27, ten times; 11, eleven
times ; 15 twelve times ; 13, thirteen times ; 5, fourteen times ;
2, fifteen times; 7, sixteen times; 2, seventeen times; 3, eigh--.
teen times; 1, twenty times; 2, twenty-two times; 4, twenty-
four times 863 women, of whom 61 aborted ; each woman
averaging about five conceptions. The most usual period of
conception in Europe is between the fourteenth and fiftieth year ;
but cases of child-birth in the sixteenth year ; are recorded by
Meissner, Bernstein, Osiander, Mende, and Busch. Haller saw
one case of childbirth at sixty-three, and another at seventy ; as
also Labatt in Dublin, and Capuron, in Paris.

\_Zeitschrift d. Wien Aerzte, and Ed. Med. Jour.

Beneficial Effects of Pepsine in the Obstinate Vomiting of Pregnan-
cy. By L. Gros, M. D.

In the great majority of cases the vomiting of pregnancy may
safely be left to the influence of time ; but there are some cases
in which females are scarcely able to retain in their digestive
system a sufficient amount of nourishment to support their ex-
istence, and are therefore reduced to the last degree of emacia-
tion. In some, also, the shocks occasioned by this obstinate and
repeated vomiting become the source of abortions, which might
have been prevented by moderating the activity of the morbid
phenomenon. A very remarkable case was related in 1856, by
M. Teissier, Professor of Clinical Medicine at Lyons, showing
the immediately beneficial effect of a dose of pepsine in a case of
vomiting during pregnancy. In this case the symptoms resist-

1858.] Animal Charcoal an Antidote for Cantharides. 849

ed all the ordinary methods which were employed, and
the patient was unable to retain in her stomach any substance
whatever. Under these circumstances, the patient was brought
to M. Teissier, who found her in the following condition : The
vomiting had continued for two months, and she was at
the end of the fourth month of her pregnancy ; she presented
the appearance of a skeleton, having the aspect and the cough
of a phthisical subject; the pulse .was 140, and M. Teissier
thought at first that the case was one of pulmonary tubercle.
Finding that all treatment had been hitherto inefficacious, and
that the lady was actually dying of inanition, he was seriously
meditating upon the propriety of inducing abortion as a means
of saving her life: but as a last resource before operating, he
determined to employ pepsine. He accordingly prescribed one
gramme, to be divided into two doses, and take every day in a
spoonful of broth. At the very first dose the broth was retained,
and from that moment the vomiting never returned. On the third
day the lady ate some chicken, and then some beef-s'eak. The
treatment was continued in the same manner for three weeks,
and at the end of that time the cure was complete : the emacia-
tion was replaced by embonpoint, the fever and the cough ceased
with the vomiting, and at the end of the ninth month the lady
was safely delivered.

Dr. Gros then relates six other cases in which the pepsine was
employed with the samesuceess, and he thinks himself warrant-
ed in concluding that pepsine undoubtedly produces good effects
in the vomiting which attends pregnancy. He explains the re-
sults by supposing that, although in the first instance the vomit-
ing is due only to the sympathy existing between the uterus
and the stomach, yet subsequently the stomach itself becomes
affected, as is proved by the fact that in the beginning of preg-
nancy the vomiting occurs only in the morning or the evening ;
but in aggravated cases it supervenes after every meal, and all
alimentary matters are rejected. In such cases, therefore, when
the stomach has taken on a morbid habit, and exhibits an alter-
ation of secretion, the pepsine appears to be really iudicated ;
although in a merely sympathetic .action between the uterus and
stomach it would be difficult to explain the efficacy of its action.
Brit, and For. Med. Chirurg. Itev., from Bull. Gen. dc Therapeut.

Animal Charcoal an Antidote for Cantharides. By M. Thouery.

It is generally known that charcoal possesses proprieties which
are most interesting ; that it removes most of the metallic salts
from water; combines with oil to such an extent that it cannot
be separated by ether, and fixes certain of the vegetable princi-

850 Inversion of the Body for Renal Calculus. [December,

pies. M. Thouery, in 1851 and 1852, made a series of experi-
ments, from which he concluded that animal charcoal possesses
real efficacy in combatting poisoning by cantharides. These ex-
periments were 54 in number, and were performed on dogs.
Lately M. Thouery has published the details of an experiment
made on men.

During the night of the 12th-13th of December, 1856, An-
toine B. experienced very acute suffering after having taken an
infusion of centaurea from a vessel which contained powdered
cantharides. Being called to see him, M. Thouery recognized
it immediately as a case of poisoning by an irritant corrossive
poison, but none of the liquid remaining for examination, he
could not determine the nature of the poison ingested. He con-
fined himself to the administration of general remedies, uniting,
however, calcined magnesia and animal charcoal, and giving them
in large doses. The condition of the patient did not seem to
improve at first, but, after two days of intolerable suffering, re-
lief was obtained and health was restored.

Thouery afterwards found that the poisoning had been pro-
duced by cantharides. He does not doubt, then, that animal
charcoal largely contributed to the cure ; and he regards this
observation as confirmative, in a certain measure, of the results
of his previous experiments. The only objection which we can
adduce against this theory of Thouery is, that it does not neces-
sarily follow from the fact reported*. [American Med. Monthly.

Inversion of the Body for the Relief of the Symptoms produced by the
Passage of a Renal Calculus along the Ureter.

Professor Simpson exhibited to the Edinburgh Medico-Chir-
urgical Society (May 5, 1858) a small oblong renal calculus,
from a patient who had passed them at different times, and
always suffered terribly during their transit from the kidney to
the bladder. This patient had been now twice relieved of the
agonizing symptoms accompanying the passage of the calculus
by inversion of the body. Prof. S. had subjected her to this
treatment in consequence of his belief that the passing calculus,
falling down into, and becoming impacted in the ureter, acted
at its point of arrestment as a pea- valve, and by its accumula-
ting the urine above, or in the pelvis of the kidney and higher
portion of the ureter, led to the accompanying distress by the
morbid distension of these portions of the urinary ducts. When

* We have translated this notice from the French, not because we consider the
claims of charcoal as an antidote for cantharides to be established as a certainty,
but with the view of calling attention to it, and obtaining from our own country-
men some additional facts bearing upon the subject of cantharides as a poison.

1858.] Treatment of Diabetes. 851

the body was inverted, and the affected side manipulated, the
calculus probably fell backward, and consequently upwards, by
its own gravity. At all events, whatever be the explanation,
the practice in this and in one other case had immediately re-
lieved the patient. He had seen partial relief from changed
position in one case also of gallstones. Position was a more
important therapeutical agent than was generally supposed, not
only in medicine, but also in surgery and therapeutics. Several
years ago and shortly after the famous case of Mr. Brunei
Dr. S. saw, with Dr. Patterson and Dr. James Duncan, a case
in which a shilling passed into the windpipe, and where upon
inversion of the patient the shilling fell back into his mouth,
thus saving the patient from the operation of tracheotomy. Dr.
Duncan has published a full account of the case. In prolapsus
of the umbilical cord in labour, the mere gravity of the cord in
the usual supine position of the patient was no doubt one great
cause of the difficulty of retaining it in utero, above the head or
presenting part of the child, when once returned. But some
late cases and observations proved that the return and retention
of the cord could be effected with comparative facility, if the aid
of position was called in, and the patient was placed upon her
face, or upon her hands and knees, till the presenting part filled
the brim of the pelvis ; for in this prone position the cord gravi-
tated toward the fundus uteri, instead of towards the os.

[Edinburgh Med. Jour., and Amer. Jour, of Med. Science.

Rationale of the Saccharine Treatment of Diabetes.

Dr. John Sloane, in a paper read before the Leicester Medical
Society (April 20, 1858), gives the following rationale of the sac-
charine treatment of diabetes :

"Glucose, the variety of sugar found in the urine of diabetes,
is generated in the livers of animals throughout the animal king-
dom, almost wholly irrespective of the nature of their food. The
glucose secreted by the hepatic cells passes into the hepatic veins,
thence into the inferior vena cava, and through the right side of
the heart to the lungs, where, being exposed to the atmosphere,
it sometimes completely disappears. M. Bernard has found sugar
in the livers of mammals, of birds, of reptiles, of fishes, of molluscs,
and of articulated animals. He has found it in omnivorous, her-
bivorous, and carnivorous animals. That the secretion of sugar
is independent of the nature of the food, he proves by many ex-
periments, of which I shall mention the following. He fed dogs
exclusively on flesh for six or eight months ; and when they were
killed, at the expiration of that period, he found as much sugar
in their livers as in those of dogs fed upon a mixed diet. Owlets

n. s. vol. xrv. NO. XII. 50

852 Treatment of Diabetes. [December,

taken in their nests were fed exclusively on raw bullock's liver
for three months, and were then killed; their livers always con-
tained the normal quantity of sugar. Two dogs were fed solely
on flesh, three on both flesh and bread, and two on amylaceous
or saccharine food ; they were all killed at as nearly as possible
the same period of digestion, and the results of the chemical ex-
amination of their livers showed that the quantity of sugar secret-
ed did not depend on the nature of their diet.

" Rollo recommended the use of fat for diabetes. M. Thenard
and Dupuytren made them eat lard. We have fed dogs with
lard and axunge ; and we have found this very curious fact, that,
under the influence of this alimentation, the sugar diminished in
the liver absolutely in the same manner as if the animal had been
kept fasting. In dogs to which M. Bernard has given nothing
but pure water, he has fouud the secretion of sugar kept diminish-
ing, and it ceased to appear about three or four days before their
death. For the first thirty-six hours, the quantity continues con-
siderable, but during the following days it diminishes very rapidly.

" A dog, having fasted thirty-six hours, had a copious repast of
boiled sheep's head, and three hours afterwards, was killed. The,
blood in the portal vein, previous to its entrance into the liver,
contained no trace of sugar ; whereas, in the blood from the he-
patic veins, there was a considerable quantity. This experiment,
writes Bernard, would alone suffice to cause one to admit, as a
natural and necessary conclusion, that the sugar is produced in
the liver; yet we have accumulated proofs of every kind about
this proposition ; and wTe have shown that the hepatic tissue con-
stantly contained sugar, and that it was the only tissue of the
body which offered this character.

"In an animal fasting, the blood which arrives at the liver pre-
sents no trace of sugar ; that which leaves it contains a considera-
ble quantity. Inversely, the blood which arrives in the lung
contains sugar ; and that which leaves it presents no trace of
this substance. The sugar in this physiological state remains
hidden between the liver and the lung, and does not show itself
at the exterior. This statement is true only in an animal fasting.
When the digestion commences, the quantity of sugar gradually
augments ; yet during the two or three hours following the inges-
tion of aliment, notwithstanding the increase of the saccharine
secretion, all the sugar can be destroyed before it arrives at the
arterial system; and it is only after the lapse of time that the
production of sugar surpassing the limits of destruction becomes
temporarily excessive in the organism. At this period of diges-
tion, one finds sugar in all the vessels of the body, arterial and
venous, and even in the renal arteries; but the proportion is too
slight for any of the sugar to pass in the urine. Yet we shall see,
that under certain physiological circumstances, the quantity of

1858.] Treatment of Diabetes 853

sugar can be increased to the point that it passes off in the urine
without the animal being diabetic. Under the ordinary circum-
stances of digestion, this species of saccharine overflowing is
manifested equally with animal or amylaceous diet, and it lasts
about three or four hours. It is not less than six or seven hours
after a meal that the excess of sugar in the blood commences to
disappear, and that the equilibrium between its production and
its destruction tends to re-establish itself as before digestion. This
species of oscillation, which the glycogenic function presents, it
is very important to know ; for in the pathological state (diabetes)
we find exactly the same phases, with the exaggerations we should
expect in this malady. Different observers Raver in France,
and Traube in Germany have remarked that there are diabetics
who do not pass sugar in their urine, except at the time of their
digestion ; and that, in the interval, their urine does not contain
sugar. This phenomenon can be reconciled very naturally with
the physiological fact which has been pointed out to you. There
is nothing essentially different between the normal state and the
pathological symptom, save the intensity of the phenomenon
caused by a deviation of vital activity.

" The sugar is formed from the albuminous substance ; and
this sugar is the result of the physiological action of the liver upon
those principles, which are divided so that their oxygen, hydrogen,
and carbon, are grouped so as to form sugar, while their azote
enters into other combinations, and probably into the azotized
principles of the bile. One does not know, indeed, any other
origin for the saccharine matter, which cannot be produced in
the intestine by digestion. Experiment has shown us that,
during alimentation, by means of albuminous substances, the in-
testine and the blood of the portal vein never contain saccharine
matter of any kind. Neither gelatine nor flesh produce sacchar-
ine matter in the intestinal tube by the known digestive pro-
cesses. The amylaceous matters taken as food enter as sugar
into the portal vein, and, arriving at the liver in this state, are
then destroyed by this organ, and changed into another matter,
which has every appearance of a fatty substance converted into
an emulsion par une mature proteque speciale. We have said
that the sugar introduced into the intestinal tube does not augment
the quantity of this matter contained in the liver, but that it is
there destroyed, and causes the appearance of an emulsive sub-
stance. That the sugar introduced into the intestinal canal does
not augment the quantity of this matter contained in the liver,
M. Bernard shows by the following experiments. He takes two
rabbits, whose urine he first finds, by testing, to be free from sugar.
Into the stomach of one he injects a quantity of sugar in solution,
with some ferrocyanide of potassium. Beneath the cellular tissue
of the other he injects half the quantity of an exactly similar solu-

854 Treatment of Diabetes. [December,

tion. He examines their urine an hour afterwards, and he finds
in that of the first not the least trace of sugar, while the urine of
the second presents it in considerable quantities. But you may
say that this difference may be accounted for by the intestinal
absorption being less rapid than the subcutaneous; but in both
the ferrocyanide of potassium was readily detected in the urine.
This will prove that the absorption is equally effectual in the in-
testine as under the skin, but that, in the first case, the solution
has abandoned one of its constituents, the sugar, in traversing the
liver; whereas this has not taken place in the second instance.
He arrives at similar results in the following experiments.
Through a small opening in the abdomen of a rabbit, he injects
a quantity of the same solution into one of the branches of the
portal vein; and into the jugular vein of another rabbit he injects
the same quantity of the same solution. It is clear that, in this
mode of operating, we cannot have any difference in the absorp-
tion, as in both cases we introduce the substances directly into
the blood. Nevertheless, we obtain exactly the same result ; that
is to say, that in the rabbit, in which we injected by the jugular,
the sugar has passed into the urine with the ferrocyanide of potas-
sium, and with very great rapidity ; whilst in the rabbit injected
by the portal vein, the ferrocyanide of potassium alone will have
passed into the urine, where one cannot find the least trace of
sugar. These experiments are very conclusive. Bernard proves
by experiment that starch, taken as food in the intestine by the
influence of the pancreatic juice, becomes converted into sugar;
and this passes into the portal vein. That sugar is destroyed by
the liver, receives further confirmation, he states, by the facts
known in the fattening of cattle. You all know that animals fat-
ten most by the use of food in which starch predominates; that
the geese and the ducks, in which the fat livers are artificially
produced, are gorged with a pate of maize or other
amylaceous food ; that the fat formed by an animal is not in pro-
portion with the adipose matter which it takes ; that, on the con-
trary, the animals which only eat fat, far from becoming fat, get
lean rapidly. Hereafter it is not only the biliary secretion which
we shall have to look upon in the liver ; it has two other func-
tions of capital importance one the production of sugar, which
is dependent upon the aliment containing albuminous matters ; the
other, the production of fat, which is dependent upon the
amylaceous and saccharine matters in the food.

" Cane-sugar is never destroyed; it is constantly eliminated
by the urine when it is injected directly into the blood ; but this
sugar, when in the intestine, is in part, at least, transformed into
glucose. The latter, on the contrary, injected into the blood, can
be destroyed in certain proportions.

" When we prick the mesial line of the floor of the fourth ven-

1858.] Treatment of Diabetes. 855

tricle, in the exact centre of the space between the origins of the
auditory and pneumogastric nerves, we produce an exaggeration
of the hepatic (saccharine) function, and of the renal secretion ;
if the puncture be effected a little higher, we very often only pro-
duce an augmentation in the quantity of the urine, which then
frequently becomes charged with albuminous matters ; while, if
the puncture be below the indicated point, the discharge of sugar
alone is observed, and the urine remains turbid and scanty.
Hence it appears that we may distinguish two points of which
the inferior corresponds to the secretion of the liver, and the supe-
rior to that of the kidneys. As, however, these two points are
very near to one another, it often happens that, if the instrument
enters obliquely, they are simultaneously wounded ; and the
animal's urine not onlv becomes superabundant, but at the same
time saccharine. The urine becomes saccharine in from one to
two hours after the operetion, but seldom continues for more than
a day.

" The secretion of sugar is not under the direct influence of the
pneumogastric nerve ; for if it be divided before irritating the floor
of the fourth ventricle, sugar still appears in the urine. Bernard
believes that the influence is transmitted by reflex action through
the ganglia of the sympathetic.

" There is a phenomenon which is manifested, for example,
when, after fasting a certain time, a great quantity of sugar is
taken. The intestinal absorption then proceeds with extreme
rapidity. A great quantity of sugar arrives in mass in the liver ;
the mechanical circulation much prevails over the chemical ; the
sugar is poured into the general circulation in proportion much
greater than occurs in the normal state; and it passes then into
the urine, where its short-lived presence can be found for a certain
time.

' M. Bernard, after a great many experiments in reference to
the subject, has proved that there is a species of election in the
excretion of matters which pass out of the organism. Sugar is
eliminated in two ways only by the kidneys, and by the mucous
membrane of the stomach. When sugar is injected into the
blood of an animal to saturation, and puts it for a time into a
state of diabetes, we do not find sugar in the saliva, in the tears,
pancreatic juice, bile, nor perspiration ; whilst the urine and _
trie juice contain it in proportions more or less notable. These
results entirely resemble those obtained in diabetic patients.
Lehmann states, however, that he has obtained sugar from the
saliva of a diabetic. The presence of sugar has been pointed out
in the expectoration of diabetes. Bernard admits that sugar can
be had in notable quantity in the expectoration. But, he writes,
we must not confound the bronchial mucus which these patients,
almost always phthisical, in the last stage of the disease expel in

856 Treatment of Diabetes. [December,

abundance, with the salivary secretion properly so called ; it is the
mucosities formed in the lung which contain the saccharine mat-
ter. Nevertheless, this fact is not constant ; for M. Rayer has
reported to the Society of Biology a case in which the expectora-
tion of a phthisical patient examined by M. Wurtz did not contain
sugar. Bernard proves by the following experiments the state-
ments regarding the election in excretion of matters which pass
out of the organism.

" He takes a dog with a parotidean opening, into which he in-
serts a tube. Nothing flows by this tube, which proves that the
secretion is not continuous. By putting in the mouth some vine-
gar he excites the flow of saliva, which passes out of the tube
rapidly in large drops. He next injects into the jungular vein of
the animal a solution containing sugar, prussiate of potash, and
iodide of potassium. Immediately after this injection the saliva-
ry secretion is again excited in the same way. The saliva is
received into three glasses. One is examined for sugar, and none
is found. The sugar therefore does not pass in the saliva. The
second is examined for prussiate of potash, and it is not present.
The third is found to contain iodide of potassium. This substance
then passes immediately into the saliva, whilst the prussiate of
potash and the glucose, equally soluble, cannot be found. In the
saliva extracted before the injection, none of the substances exist.
In the urine of the same animal after the injection the prussiate
of potash is found in considerable quantity, and the iodide of
potassium in small proportion. As regards the sugar, there is
none yet, but we shall find it presently. It requires an hour or
more for the sugar to appear in the urine.

"The urine then eliminates all these substances in a manner
more or less rapid. The prussiate of potash appears first and the
glucose last.

" There is another secretion in which the presence of sugar
can be found ; this is the gastric. The passage of the sugar into
the stomach has surprised most of the observers who have seen
long since that when diabetics vomited, although they had eaten
nothing but flesh, the vomited matters were saccharine. When
it was believed that diabetes proceeded from a perversion
of the digestive functions, it was considered that the flesh was
changed into sugar in the stomach. But one need not now be
mistaken; the flesh is not saccharine. Bernard himself has ob-
served that, in diabetics who vomit fasting, in the vomited matters
the presence of sugar could be found. But this has only occurred
when the disease is at its greatest intensity ; and in all those
cases, even in the animals which have been rendered artificially
diabetic, it is much more difficult to obtain the passage of glucose
into the gastric juice than into the urine.

" The sugar is formed, as we have seen, at the expense of the

1858.] Treatment of Diabetes. 857

albuminous substances. In the healthy man it is clear that a part
only of these matters is consumed for this purpose. The diabetic
who forms much sugar expends a very large quantity of azotized
material ; the blood is impoverished ; and, although the patient
eats enormously, he gets thin like a man badly nourished. The
liver takes in a manner the ration of the other organs, which un-
dergo a considerable attenuation, because the albuminous elements
are transformed into sugar.

" M. Bouchardat has proscribed the use of amylaceous and
saccharine matters in the food of dibetics. The facts which Ber-
nard has himself witnessed in the practice of M. Raver proves
clearly the utility of azotized aliment. In the regimen of these
patients, writes Bernard, vegetable aliments ought to be forbid-
den, as it is evident that they augment the functional activity of
the liver. You know, also, that they are excitants of the kidnevs ;
that they are much more diuretic than animal matters. Thus
all the herbivora pass much more urine than carnivorous animals.
In the azotized regimen diabetics have the advantage of food
which is nut diuretic.

" I have at great length reminded you of M. Bernard's views
regarding the formation of sugar in the animal economv. As
some of them are of so novel a character, and so little in accord-
ance with the notions formerly held, I have thought it advisable
to mention the experiments upon which he founds his opinions.
That they will, upon further investigation, be more or less modi-
fied, is not improbable ; but they have been very generally receiv-
ed by the most distinguished physiologists and pathologists.

" From M. Bernard's investigations, we learn the following
facts of importance in reference to the saccharine plan of treating
diabetes :

" 1. Sugar may be rationally administered to diabetic patients,
inasmuch as the sugar found in the general circulation is almost
always secreted by the liver, and as sugar introduced into the
intestinal tube in its passage through the liver is there altered and
converted into an emulsive substance, which serves to fatten these
patients, and thus to counteract their tendency to emaciate.

iim2. Substances which contain glucose such as honey and
fruits, should be given to diabetics in preference to those contain-
ing cane-sugar, because the latter is not destroyed when injected
into the blood, but is constantly eliminated by the kidneys;
whereas glucose can be destroyed in certain proportions.

"3. Cane-sugar would be beneficial to a certain extent ; as when
taken into the intestine it is in part at least transformed into
glucose ; but if given in too large proportions to be thus com-
pletely transformed, the disease would be probably aggravated
by the presence in the blood, and subsequent excretion by the
kidneys, of the former variety of sugar.

858 Editorial. [December,

<;4. The glucose should be given in moderate quantities at a
time, and frequently, rather than in large quantities at long inter-
vals; because, when much sugar is taken fasting, it is absorbed
too quickly to admit of its complete destruction in the liver, and
it passes into the general circulation, whence it is eliminated in
urine." British Med. Jour., and American Jour, of Med. Sciences.

EDITORIAL AND MISCELLANEOUS.

End of the Fourteenth Volume. The present number closes the
Fourteenth Volume of the Southern Medical and Surgical Journal.
While carefully reviewing the accumulated results of our labors during
the past year, as we have been obliged to do in the preparation of the
final Index, we can but feel encouraged by the high style, practical char-
acter and great value of many of the original papers kindly furnished by
contributors. The true intent and purpose, of a medical journal, as we
conceive them, are never so fully carried into effect as when its original
communications present a clear, full and reliable exposition of the Pa-
thology and Therapeutics peculiar to the region in which it is published.
There is perhaps no circumstance which strikes the mind more forcibly,
when opportunity for observation is allowed, as the difference impressed
upon the type and progress of disease, and no less on the treatment re-
quired, by the change of locality. The fevers of the Northern climates
would, we opine, but illy bear the active medication found necessary at
the South, while our endemics would fare badly, if the temporizing pre-
cepts of our northern brethren were not mended to meet the dangerous,
and often fatal tendencies, impressed upon them by our peculiar climatic
and thermotic influences. Medical journals, then, must record these
differences, if they would attain their full degree of usefulness in their
own region, or supply to other and more distant regions a faithful report
of the history of disease in their immediate vicinity.

But a restricted record of local medical facts and precepts would not
fully answer all the demands of even, a local journal ; the neglect to
embody in its pages a portion of the vast amount of valuable information
accumulating in other portions of the world, would deprive its readers
of much which justly belongs to them. The Eclectic department there-
fore, becomes no less important than the Original, and when this is
carefully and judiciously conducted, a monthly medical journal can be
made to supply a greater variety of practical and useful information

1858.] Editorial and Miscellaneous. 859

than can be made available by the practitioner, who is actively engaged,
even from the largest and best selected library.

To such a purpose, we have earnestly endeavored to devote the
pages of the Southern Medical and Surgical Journal, and to the same
end, we shall endeavor to labor during our connection with it in the
forthcoming fifteenth volume. "With this view, we ask the assistance of
the Profession, not only in extending the encouragement of prompt pay-
ments to our faithful and liberal Publisher, but also, we, as Editors, invite
contributions, which shall enhance its scientific value, and keep it, as it
has heretofore been, a store-house, full of valuable practical information
for readers, not only at home, in the South, but in the North, the East,
and the West wherever its pages may be perused.

Ocr present number has been detained somewhat beyond its usual
time in the preparation of the Index to the volume. For the delay, the
Editors are alone responsible ; the work of the publisher was fully
ready at the usual time of issue. Book notices, and much other Editorial
matter, are necessarily delayed for our next number.

Chloroform in Dentistry. There is an impression abroad amongst
dentists that every man is his own keeper, and that his life is in his own
hands. Lamartine says that it is strongly characteristic of the weakness
and imperfection of humanity, and typical of our earthly nature, that
man comes into the world impotent to save himself, or to add one day
to his life when beneath the edge of the mortal shears, destitute and
helpless, but armed with the power of annihilation and self-destruction.
This privilege the dentists of some sort are disposed to grant freely to
their dupes. Chloroform is undoubtedly a mortal agent, an agent which
may become inimical to life. Its risks have but too frequently and too
fatally been shown by many recent accidents, and especially by the un-
happy death at Epsom on the 27th ult, of a person, to whom it was ad-
ministered by a druggist. There is a moral as well as an intellectual
side to our art, and to the art of the true dentist. It is time that the
ethics of chloroformization were established. The extraction of a tooth
is not an operation which in any way bears upon life; it is not in itself
attended with any risk. The deaths which chloroform has occasioned,
when administered to facilitate this process, are unbalanced by any cor-
responding gain of equal import. The moral duty of the dentist is there-
fore clear. He has not the right to risk the patient's life for the extrac-
tion of teeth. The timidity of the patient or her pressing entreaties are
not more germane to this consideration of duty than her rank or her
wealth would be. In the cause of life everything is permissible. It is
justifiable to refute the arguments of her ladyship ; it is right to give a
flat denial to her grace. However crooked those cruel fangs, they are
less pitiless than the fangs of death ; and though the patient turns rebel-
lious from the door, it is better than that she should have found there

860 Miscellaneous.

" that bourne whence no traveller returns." It is chiefly our fashionable
ladies who demand chloroform. This time it was a servant girl who was
sacrificed ; the next time it may be a duchess. If a patient should press
urgently for any dangerous poison it would not be administered to her,
notwithstanding her own personal responsibility. Nor should chloroform,
although only probably dangerous to life. Henceforward we think that
this must be looked upon as a matter of conscience amongst operators.
To our thinking they are bound to withhold Chloroform for the extrac-
tion of teeth by every consideration of right and moral responsibility.

[London Lancet.

Castration for Malignant Disease. The diseases which may lead to
the necessity for castration, as given in Mr. Curling's work on " The Testis,"
are the different forms of carcinoma, incurable struma, abscesses, and
tedious sinuses consequent on inflammation, and cystic disease. We
have given clinical records of most of these from time to time ; but the
most common form which demands this operation is carcinoma, and not
unfrequently the medullary form. We saw the right testicle removed
on the 10th ult., at Guy's Hospital, by Mi*. Cock, from a man twenty -five
years of age, who was married and the father of a family. His general
health was good; but eight months ago he first noticed an enlargement,
and this gradually increased, until latterly it has become rapidly much
larger. There was no history of having received a blow, and there was
no pain ; there was a degree of fluctuation about it which indicated a
surface of fluid. A needle was introduced a few days before, which gave
exit only to a little blood. Mr. Cock suspected it to be malignant ; for
besides the suspicious character of the nature of the swelling, the cord
was enlarged. An incision was made over it, and then a section into the
body, when the gland was found to be completely disorganized from soft
cancer. It was, therefore, removed, the vessels of the cord being tied
before the tumour was detached. The cord consisted principally of a
mass of tortuous veins in a varicose condition, but was not otherwise
affected, and therefore held out a favorable prospect of cure from the
operation.

In Mr. Coulson's case, the testicle was extensively diseased, as a result
of inflammation, and removal was equally imperative, as in the foregoing
instance. [Ibid.

Traumatic Diabetes. Dr. Plagge relates the case of a young man who
received a blow upon the occiput, and the following night complained of
strangury. Three days after he suffered from excessive hunger and thirst,
and passed large quantities of urine, of the sp. gr. of 1*043, containing
much sugar. His condition remained stationary in spite of the employ-
ment of opium, tannin, and an annualized diet. A drachm of the bicar-
bonate of soda (the urine being slightly acid) was then given to him
daily, and he considerably improved. Nevertheless, the quantity of urine
continued in excess during two months. \Gaz. des Hop., and Virginia
Med. Journal.

INDEX TO VOLUME XIV.

PAGE.

Abdominal Typhus in children. . . .
Absorption of Medicines by large

intestine , 762

Abscesses, absorption of 842

Aconitum Xapellus aconite 706

Acclimation of Xegroes 452

After treatment of Surg, operations, 488

Albumen, discrimination of 506

Amaurosis of Laziness 645

American Med. Association 417, 283

American Med. Monthly, notice of. . 2S7

American Medical Gazette? 287

American Dentists in Europ'e 792

Ampelopsis quinquifolia or Virgin-
ia creeper 358

Anaesthesis by Projection 216

Anaesthetic, a new 433

Animal Heat, influence of Surgical

affections on 760

Anderach bark, a new febrifuge. . . 357
Antony, Dr. E. L. Method of remo-
val of fish-hook 214

Analysis of human excrements. ... 766
Antagonism of opium and quinine . . 77^
Animal Charcoal antidote for Can-

tharides 849

Appropriate Treatment of Dysente-
ry. Robert Campbell, M.D. .107, 147
Aphonia, treated with electricity. . 564

Apoplexy, intellect in 326

Appointment of Prof. Jos. Jones 282

Apparent death during paroxysms

of fever 838

Armor, Prof. S. G 57 3

Arthritis, clinical lecture on 555

Artificial rupture of amniotic sac

in labor 35

Artesian Wells in Sahara 218

Asthma, influence of atmosphere on 486
Atlanta Medical College, resigna-
tions, <fcc 69

Augusta, Ga., healthiest city in the

Union 650

Augusta, health of 718

Autopsy 30 years after removal of
uterus ..." 690

Baker, P. De L., M.D. Sources and
qualities of Honey 802

Barclay's Manual of Diagnosis, no-
tice of 212

Battey, Robert, M D. Subcarbon-
ate of Bismuth 11

PAGE,

Beneficial effects of Pepsine for

vomiting of pregnancy 848

Bibron's antidote for rattlesnake

poison 485

Binding of 14th volume 70

Bismuth, subcarbonate, Robt. Bat-
tey, M.D 11

Books rec'd for review, notice of 69, 497
Books, journals <fc pamphlets rec'd . 432
Burns, treatment of cicatrices after ii74

Calcarious Salts in treat, of rickets, 352

Campbell, H.F., M.D. Classification
of Febrile diseases by their rela-
tion to the nervous system 13

Campbell, H.F., M.D. Diphtheritis,
quinine and alum in 784

Campbell, EL F, MD. Technicali-
ties before juries, physicians and
lawyers 142

Campbell, H. F., M D. Meckel's
Ganglion 133

Campbell, Robert, M.D. Appropri-
ate Treatment of Dysentery, 107, 147

Campbell, Robert, M*D. Letter on
Treatment of Typhoid fever. . . . 487

Cannabis Indica Haschisch Indian
hemp 707

Cancer, manganate of potash a caus-
tic in 217

Cancer, escharotic treatment of. . . 262

Cancer in a woman 80 yrs. of age, 358

Carbonic acid gas in diseases of
womb 843

Carnochan, J. M., M. D. Exsection
of 5th Nerve 126

Case of Transfusion 280

" " False Conception 563

Castration in malignant disease 860

Cathartics In Dysentery 42

Caustic Sulphuric acid" and sulph.
zinc 48O

Caustic, painless 578

Cauterization of Strictures in nasal
canal..

Chamomile, new property of. . . 017

Chase, D.S., M.D., D.D.S/ Electri-
city in extracting teeth 433

Chloroform liniment in burns 73

" an antidote for strychnia, 290

in paralysis * 48 1

" in Dentistry 859

Chlorate of potash, uses of 202

862

INDEX.

PAGE.

Chlorate of Potash in ulcers 358

Cincinnati Lancet and Observer. . . 287
Clinical Lecture upon some of the
effects of Intemperance, by L. A.

Dugas, M. D 3

Clinical Lecture on Treatment of

Dysentery, by R. Campbell, M.D 75
Clinical Lecture on Appropriate
Treatment of Dj^sentery, by R.

Campbell, M.D 107, 147

Clinical Lecture on Influenza 232

Clinical Lecture on Chorea & mye-
litis of chord 411

Clinical Lecture ou Dyspepsia. . . . 543
Clinical Lecture on Pulmonary Hae-
morrhage 550

Clinical Lecture on Arthritis 555

Clinical Lecture on Conical Cornea, 623
Cod-liver oil solidified with gelatine, 63
Coffee and lemon-juice in ague. . . . 432

Colica Pictonum 71

Compliment to Doctors 290

Commendable to the Profession. . . 718

Convulsions, pathology of 210

" puerperal 505

" of children 793

Correspondence, professional. .... 489
Corrosive sublimate and collodion

an escharotic 361

Croup, indications and treatment of 345

Daguerreian Art in Med. <fe Surgery 74

Death of R. Q. Dickinson, M.D 434

" Robert Hare, M.D 506

" " For'gn eminent Med. men, 722

Dentistry, chloroform in 859

Diabetes Mellitus, a case of, treated

by Jos. Jones, A.M., M.D 291

Diabetes Traumaticus 351

Diabetes, saccharine treatment of

rationale 851

Diabetes, traumatic 860

Diagnosis between Cancer and Con-
dylomata 488

Different methods of treating Inter-
mittent Fever 245

Diphtheria 750

" Epidemic , 753

Diphtheritic Affections 747

" or malig. Sore Throat, 274
335

Diphtheritis, alum and quinine in,

by H. F. Campbell, M.D 784

Diphtheritic Aug. epidemic at Lima, 748
Diseases of Mucous Memhrane, by

T. Douglas, M.D 744

Diseases of Cervix Uteri, Notes to

Report on, by J. A. Eve, M.D. . . 92
Diseases of Respiratory Organs,

treatment 472

PAGE.

Dissecting Wounds, treatment of . . 72

Doughty, W. H., M.D, Report of
Cases in City Hospital 602

Dr. P. F. Eve's Address, American
Medical Association 498

Dugas, L. A., M.D., Lecture on Some
of the Effects of Intemperance . . 3

Dugas, L. A.,M.D., Lecture on He-
morrhoidal Affections 219

Dugas, L. A., M.D., new principle
of diagnosis in dislocations of the
Shoulder-joint 315

Dugas, L. A., M.D., the Indigenous
Races of the Earth Review... 18

Dunglison's Med. Dict'ry, 15th ed. . 68

Duration of Cancer 217

Dysentery, treatment of, R. Camp-
bell, M.D 75

Dysentery, appropriate treatment
"of, R. Campbell, M.D tt>7, 147

Dysmenorrhea, valuable remedy in 642

Ear, Human, Physiology of, 47

Eczema of Face in children, local

applications in 432

Editorial 350

Edinburg celebrities Dr. Simpson, 362
Effects of poisoning upon the Foetus, 629
Electricity in extracting Teeth, D.

S. Chase, M.D, D.D.S 433

Elimination, doctine of. 482

Empyema, injections of water into

pleural cavity in 175

" treated by injections. . . 261

Emulsions, Robert Battey, M.D. . . 538

End of Fourteenth volume 858

Epidemic Fever and Pharyngitis. . 252
Epithelial Cancer of Anus & Rectum 681

Epilepsy Lactate of zinc in 478

" Ligation of common Car-
otid in 346

Epidemics & Topography of Geor-
gia, J. F. Posey, M.D 106, 191

Epidemics investigated by experi-
ment 705

Ergot in Menorrhagia 479

Errors in relation to Hysteria 461

Erysipelas, new local application in 578

" tobacco in 713

" perchloride of Iron in. . . 483
Escharotic treatment of Cancer. . . 262
" collodian and corrosive

sublimate as an 361

Eve, J. A., M.D., Notes on Cervix

Uteri 92

Eve, Dr. Paul F., President's Ad-
dress Amer. Med. Asso., at "Wash-
ington, D. C 498

Excision of the Hip-jtoint 69

Exsection of 2d branch of 5th nerve, 526

INDEX.

863

PAGE.

Facial Neuralgia, cautery to helix, 798

Farell, W., M.D., Formula', remarks
on. . . '. 8<)6

Fatal disease of Appendix Vermi-
form is 467

Fatty degeneration of the heart
death from the inhalation of the
Tinct. Chloroform 691

Felder, W. I*, M.D., remarks on the
chlorate of potash 227

Fenner, E. D., M.D., new remedies
in yellow fever 772

Fenner, E. D., M.D., acclimation of
negroes 452

Fenner, E. D., M.D., valuable rem-
edy in dysmenorrhea 642

Fevers, their identity and treatment 827

Fever, Malarial, observations on,
by Jos. Jones, A.M., M.D.,. .363, 435
507, 579, 651, 723

Fistula in ano <t pulmonary disease, 287

Flint's Report on PracticeMedicine 243

Foreign body twenty years in nasal
passage .-. 474

Forensic medicine, Cadaveric sound, 287

Foul ulcers of the legs 361

Fourteenth volume of South. Med.
and Surg. Journal 64

Fractures, ununited, treatment of. 277

Gaseous injections into Cellular

Tissue 782

Gelatinized Chloroform 361

General paralysis of the Insane. . . 342
Glycerine as a solvent and vehicle

for Iodine, (fee 7 4

" in Corns 215

" in Phthisis 290

" with alum and white

precipitate 578

Green, W. A., M.D., Malformation, 451

Haemostatic, a new 721

Haematuria, sulph. of quinine in. . 558
Haemorrhoids, sulphur and nux vo-
mica in 650

Headache 612

Head symptoms relieved by quinine 464

Hemorrhage 794

" liquor ferri sesquichlo-

rati in 349

Hemiplegia, intellectual faculties in 026

Hernia of the ovary 695

Hernia, theory of its production, . . 835

Hippocrates, discovery of tomb of. 290

Holmes, O. W., M.D., fine simile. . . 218

" " " on controvorsy, 362

Honey, question of poisonous 715

" catches inoref flies than vin-
egar 719

PAGE.

Honey, qualitio* and sources of . . . . 802
" alleged deleterious effects of

by V. La Taste 680

Honors conferred on American phy-
sicians 145

Hooping cough, vaccination in. .. . 717

How to keep rooms cool in summer, 434

Hydrocele, electricity in 578

Hypertrophy of the tongue 359

Incontinence of urine 216

Increase of insanity in England. . . 506
Indications and treatment of croup, 345

Infants found dead in bed 578

Inflammation, acute, internal treat-
ment of 269

Influence of atmosphere on asthma, 486
" pregnancy on tubercles, 487

" of surgical affections on

animal heat 760

Injection of urea and other substan-
ces into blood 703

Intermittent Fever, treatment of. . 348

" " urethral 562

Inversion of bod}' to relieve renal
calculus 850

Jackson, Dr. Charles T., of Boston, 146
Jones, Prof. Jos., appointment of. . 282
Jones, Jos., A.M., M.D., case of dia-
betes mellitus 291

Jones, Jos., A.M., M.D., Observa-
tions on Malarial Fever, 363, 435

507, 579, 651, 723
Journal de Physiologie de l'homme
et des Animaux 575

Kinloch, R. A., M.D., Excision of
Hip-joint 69

Labor in a girl 13 years old 721

Laceration of Perinaeum 721

Lactate of Zinc in Epilepsy 478

Lead Colic 352

Lecture, clinical, on effects of Intem-
perance, by L. A. Dugas, M. D . . 3
Lecture, clinical, treatment of 1)\

entery, by Robt. Campbell, M.D. 107
Lecture, clinical, appropriate treat-
ment of Dysentery, by Robert

Compbell, M.D../ 147

Lecture, clinical, on Influenza 232

Lecture, clinical, on Chorea <fe mye-
litis of chord 411

Lecture, clinical, on Dyspepsia 543

Lecture, clinical, on Pulmonary Hae-
morrhage 550

Lecture, clinical, on Arthritis 555

" on Conical Cornea, 623

" " on Scarlatina 26

364

INDEX.

PAGE.

Lecture, clinical, on catamenial gon-
orrhoea and Syphilis 63

Lecture, clinical, on Hemorrhoidal
Affections, by L. A. Dugas, M.D. 219

Lectures, Watson's, on Practice of
Physic, notice of 790

Legal Doctrines concern'g Insanity, 137

Letter on treatment of T}rphoid Fe-
ver, by Robert Campbell, M.D. . 487

Liability of Negroes to Epidemics
of the South 253

Lichen and Cod-liver oil 73

Ligation of common carotid in Epi-
lepsy 346

Liquor Ferri Sesquichlorati in hem-
orrhage 349

Local Influence in Spasmodic Asth-
ma 759

Maine Med. and Surgical Reporter,

notice of 576

Malarial Fever, observations on, by
Jos. Jones, A.M., M.D.,. 363, 435,

507,579, 651, 723
Malformation, case of, "W. A. Green,

M.D 451

Mammary Abscess, treatment of. . 794
Manganate of Potash, a caustic in

cancer 217

Meckel's Ganglion, Dr. Carnochan's

operation, H. F. Campbell 138

Medical. College of Georgia, annual

commencement 284

Medical and Surgical Reporter. . . . 289
" College of State of So. Ca.,

resignations and app'ts.. 496
" Jour, of N. Car., notice of, 791
" and Physiological Commen-
taries, Dr. Payne's 788

" and Medico-legal notes on

extra uterine Pregnancy, 676
" Journals of the U. States. . 217

Memphis Medical Recorder 288

Menstruation during Pregnancy. . 704

" in Austria 845

" Phvsiology of, by E.

Hillyer, M.D 795

Miller's Principles of Obstetrics,

notice of 565

Minutes of annual meeting of Med.

Society of State of Geoi-gia 353

McClellan, Prof. J. H. B 572

McDaniel, R., M. D., Tapping in

Ovarian Dropsy 450

Musgrove, W. C, M.D., Phytolacca
Radix 230

Nashville Jour. Med. <fe Surgery, . . 287
" Monthly Record of Med.

and Phys. Sciences 791

PAGE.

Nashville Medical Society. 574

Navy and Army appointments... 720

Negro, liability to epidemics 253

New Antiperiodie 361

New Febrifuge Anderach Bark. . 357

New Hsemoslatic 721

New local application in Erysipelas 578

New method of amputation 577

New mode of treatment for Puru-
lent Ophthalmia 839

New Orleans School of Medicine. . 573

Med. News & H. Gaz. 288

" Med. & Surg. Journal, 288
New Principle of diagnosis in dis-
locations of Shoulder-joint, L. A.

Dugas, M.D 315

New Remedies in Yellow fever. . 772

Non-Mercurial treatment Syphilis. 209

N. Am. Med. Chir. Review 287

Notes to Report on diseases Cervix

Uteri, by J. A Eve, M.D 92

Novel method for foreign bodies in

CEsophagus 214

Observations on Malarial Fever, by
Jos. Jones, AM, M.D., 363, 435,

507, 579, 651, 723
Observations on Diabetes Mellitus, 479
" " the poison of Upas

Antiar 697

Observations on Pepsine in vomit-
ing of pregnancy 710

Observations on the temperature of

patients 831

Obstinate vomiting, iodine in .... 481

" " pepsine in 710

Obscure forms of nervous affections, 756
Obstructions from disease of caecum, 687

Obituary 434

Oglethorpe Med. and Surg. Journal, 496
Ohio Med. & Surg. Jour'l, notice of 574

Oil of Tanzy 70

Oil of Cedar 71

On the use of Iron 398

Ophthalmia, irritating applications

in 345

Our exchanges, changes, fusions, <fcc. 286

Pacific Med. & Surg. Jour., notice, 212

Pain, the uses of 763

Paine's Insti'tes. of Med., notice of, 570

" Med & Phys. Commentaries, 788

" Vitality & action of remedies 788

Painless Caustic 578

Paralysis of Facial Nerve 794

Paralysis, Intellect in > 326

Paralysie generale 819

Pathology of Convulsions 210

Pennsylvania Medical College 650

Penin. & Ind. Med. Jour., notice. . 288

IXDEX.

865

PAGE.

Perehloride of Iron in Erysipelas. . 483

Pertussal Glucosuria

Phagedenic Clcen treated by irri-
gation

Phytolacca Radix, W. C. Musffrove,

M.D .....800

Physicians and Lawyers, technical-
ities before juries, H. F. C 142

Phosphates in Tuberculosis

Platinized Charcoal 505

Pleuropneumonia, treatment of. . . 475
Pneumonia after Laryngotomy. . . 414

Polypus, uterine, ecraseurin

Poison census 362

Practice per capita 646

Pregnancy, influence of tubercles

siting of, pepsine in. . 710

" signs of 216

" watery discharge of Ute-
rus in 770

Pressurein Phlegmasia Dolenus. . . .434
Prevention of ill consequences of

Surgical operations

Professional candor, excision of the

Tongue 213

Professional changes, <fcc 572

dignity 721

Prolapsus Ani 794

Puerperal Convulsions 06

Puerperal Fever 698

Pulmonary Epithelium 7ii

Quack, an insect 362

Quinine and alum in Diphtheritis.
H F. Campbell, M.D 784

Rattlesnake poison, Bibron's anti-
dote for 485

Remarks on Chlorate of Potash, by
W. L, Felder, M.D 227

Remarks on Hypophosphite-

Remarks on Rheumatism 561

Remarks on the sources and quali-
ties of Honey, by Paul De Lacy
Baker, M.D 802

Remarks on Formula, by "W. Far-
ell, M.D ... 806

Remitting fever of children 243

Remittent fever, treatment of . 247

Report of cases in City Hospital, by
W. H. Doughty, M.D 602

Reproduction of joints

Rev. Sidney Smith on Hay fever. . 216

Rheumatism of the epithelial and
non-epithelial tissues 48, 114

Rheumatism, chronic, principles of
treatment in 470

Saccharine Urine, various tests for. 465
Savannah Journal of Medicine 284

Scarlatina, treatment of

" yeast in

Shelby Medical College

: Pregnancy

Sir Philip Crampton's coffin

Sir Benjamin Brodie

Six cases of Cataract in one family,
operatioas successful

Slitting up the lachrymal canal . . .

Smith,' Dr. R.K.Bloekley hospital,

Sound common sense and quackery.

Southern Journal of Med. and Phy-
sical B

Specific for Scabies

Statistics of coiling of the funis. . . .

Stricture, introduction of catheter
in

Strychnia in Sciatica

Substitute for human milk

Sulphuric acid and sulphate of zinc,
caustic

Sulphur and nux vomica in haemor-
rhoids

Supra-renal capsules, congenital ab-
sence

Supra-renal capsules and bronzed
skin

Surgery in San Francisco

1 Suture of tendons of fingers

Symmetrical morbid action

Sympathetic inflammation, eye-ball,

Syphilis, primary rules of treatm't.

Syphilis, non-mercurial treat, in . . .

Syphilis, primary, treat, with Iron,

Syphilis, primary, treatment of. . .

Syrup of Super-phosphate of Iron,

Tapping in O^tk&n Dropsy, by R.

McDaniel, MT> 450

Temperature of patients, observa-
tions on 831

Temperature of body in Intermit-
tent Fever * 215

for saccharine Urine 465

Test for Quinine and Morphine 70

Tetanus 794

Tetanus, Traumatic, relieved by

amputation 341

Tetanus, treatment of. 74

Traumatic 339

The Indigenous Races of the Earth,

L, A. Dugas, M.D 18

The Divine unconscious in Medicine

nonsense 361

The "' Sands of life played out"

The Uses of Pain * 763

Thyroid Body, functions of. 348

Tobacco in Erysipelas 713

Tongue, hypertropy and amputa-
tion of . * ". 359

AGE.

248
361
574
216
650
7-1

360

675

721

57S
350

711
713
254
a
480

650

290

320
215
783
576

10
486
209

65
360
263

366

INDEX.

PAGE.

To Readers and Correspondents. .. 113
Treatment of Diseases without Al-
cohol 639

Transfusion of Blood 343

" successful case, 73

Tracheotomy, statistics of 768

Trismus and Tetanus, treatment. . 709
Tubercles, influence pregnancy on, 487
Tuberculosis, proximate cause and

specific remedy 208

Tuberculosis, Bronchial 281

" Phosphates in 207

Typhoid Fever, letter on treatment

of, by Robert Campbell, M.D. . . 487
Typhoid Fever, Thoracic form, its
treatment. Translation, by J. J.

West, M.D 178

Typhoid Fever, ulcerated larynx in 359
Typical Diseases, normal course of, 834

University of Louisville 573

University of Louisiana, professori-
al change 497

Upas Antiar, poison of 697

Urea and other substances injected

into the blood 703

Urethral Intermittent Fever 562

Urine, saccharine, various tests for, 465
Uses of Chlorate of Potash 202

Vaccination in Hooping Cough... 717
Value of a young lady's teeth. . . . 290

PAGE.

Valuable remedy in Dysmenorrhea, 642
Varicose subcutaneous operation. . 780

Venereal Badge 359

Virginia Creeper, Ampelopsis Qnin-

quefolia 358

Vomiting of pregnancy, pepsine in,

710, 848
" Puerperal cured by indu-
cing labor 45

" Paracentesis Thoracis in. 844

"Watery discharge from the "Womb

in Pregnancy 770

Water drinking, its influence upon

the metamorphosis of the system, 714
West, J. J., M.D., Thoracic Form of

Typhoid Fever 178

West's Lectures on Diseases of Wo-
men, notice of 68

Westmoreland's Syllabus 285

Wilson's Anatomy, notice of 790

Wind of a shot 650

Wines, the medical uses of 809

Womb, Carbonic acid gas in dis-
eases of 843

Woorara. properties of 71

Wright, Prof. Daniel F 572

Yeast in Scarlet fever 367

Yellow Fever, new remedies in. . . 772
treatment of 261

1399
Pi

Southern Medical Mnd Surgical Journal

. Vol. U, 1858

_